CASE
A 27 y/o patient, 7 months pregnant, developed stage III endometrial carcinoma without metastasis. The attending physician recommended total hysterectomy, explaining that without the operation, she risked death.
QUESTION
The mother argues that a total hysterectomy amounts to killing her baby. Is the hysterectomy ethically acceptable?
POSSIBLE SOLUTION
Here, a certain action (hysterectomy) produces at least two effects: a good one (cure of the mother) and a bad or evil one (death of the fetus). The principle of double effect analyses similar cases by dissecting the different components of the action, as follows.
1. Considered in itself, the action contemplated (hysterectomy) holds no evil. In fact, it remains a routine procedure.
2. What one intends remains the good effect (cure of the mother), and not the evil effect (death of the fetus) which the team tries to avoid. If the fetus reached around 28 weeks or older, the medical team would try to save the baby as much as possible (but, sadly, in this case it proves impossible).
3. The bad effect never causes the good effect. That is, what causes the mother’s cure is not death of the fetus, but the removal of the cancerous tissues. (To see this more clearly: if she were not pregnant, she would still be cured through hysterectomy; if on the other hand the baby were directly killed and no hysterectomy were done, she would not be cured.)
4. No available means achieve the good effect without having the bad effect; otherwise, such means should be employed.
5. The good effect should start simultaneously or immediately after the bad effect. (This is a further safeguard for nos. 3 and 4 above.) In our case, the mother starts to heal immediately after the uterus (and along with it, the fetus) is taken out.
Given that the above conditions are met, hysterectomy is considered ethically acceptable.
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Copyright (C) 2025 by Author: Fr. Gregory Ramon D. GASTON, SThD, DComm. ALL RIGHTS RESERVED. No reproduction, transmission, or distribution of this content may be made without the explicit written permission of the author.