In all of the procedures, the embryo dies. O’Sullivan said in her view, the methotrexate treatment and the salpingostomy both constitute abortions, because they are “direct attacks on the baby itself.”
A salpingectomy, in contrast, is an act to remove the damaged portion of the fallopian tube. This procedure is generally considered moral under the principle of double effect. The objective of the surgery is the removal of the affected tube, and the embryo dies as an undesired, although foreseen, side effect.
From a Catholic perspective, direct abortion — the intentional killing of an unborn baby — is never permitted, but a procedure to save a woman's life that has the unintended effect of an unborn baby's death can be morally permissible.
The Ethical and Religious Directives for Catholic Healthcare Services, a publication of the U.S. Catholic bishops, reads: “Operations, treatments, and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman are permitted when they cannot be safely postponed until the unborn child is viable, even if they will result in the death of the unborn child.”
Crucially, in a salpingectomy, the death of the child is not the means by which the mother’s life is saved; it is instead an unintended consequence. Since there are no alternative procedures that can save the life of the embryo, salpingectomy is considered morally acceptable, O’Sullivan said.
Still, some Catholic bioethicists defend salpingostomy as also being an acceptable procedure, O’Sullivan said, adding that she knows pro-life doctors who have performed salpingostomies. It is a less mutilating procedure than a salpingectomy, and could potentially preserve future fertility, the main reasons doctors may choose it, she said.
Jonah McKeown is a staff writer and podcast producer for Catholic News Agency. He holds a Master’s Degree from the University of Missouri School of Journalism and has worked as a writer, as a producer for public radio, and as a videographer. He is based in St. Louis.