Columbus, Ohio, Dec 12, 2019 / 00:48 am
Controversy continues over a bill in Ohio that would require doctors to attempt to "reimplant" embryos removed during procedures to treat ectopic pregnancy, with both pro-life and pro-choice advocates noting that doing so is not yet medically possible.
"I understand the theoretical ideal of being able to do something like that," Dr. Mary Jo O'Sullivan, a high-risk obstetrician and Professor Emeritus of Obstetrics and Gynecology at the University of Miami, told CNA in an interview.
"But it's an ideal, and it's theoretical, and I don't know that a lot of patients would go for it...you just have to have proper evidence that this is really a viable option."
HB413 in the Ohio Legislature includes a provision that doctors must attempt to "reimplant" ectopic pregnancies in a woman's uterus "if applicable." The bill, which has garnered attention around the world, is currently in committee.
"[Reimplantation] is so theoretical at this point, that I can't imagine how anybody would vote to approve this," O'Sullivan commented.
"It's food for thought, no question about that. Maybe it will stimulate some kind of research to see whether this can actually be done, at least in animals."
An ectopic pregnancy occurs when an embryo implants outside the uterus, usually in the fallopian tube. Once implanted, the embryo's growth is likely to rupture the fallopian tube, which can cause the death of both mother and child.
With modern ultrasound, it is possible to make a diagnosis of an ectopic pregnancy fairly early on, as long as you have an early first trimester ultrasound, O'Sullivan said.
There are three common medical procedures to address ectopic pregnancies, she noted, only one of which is widely considered to be moral from a Catholic perspective.
The patient may be offered methotrexate, which is an anti-cancer drug that stops the embryo's cells from dividing; or the fallopian tube can be opened and the embryo "scooped" out, a salpingostomy; or the segment of the tube can be transected on each side and removed completely, a salpingectomy.
In all of the procedures, the embryo dies. However, in the first two, the procedure itself is an act to end the life of the embryo. A salpingectomy, in contrast, is an act to remove the damaged portion of the fallopian tube.
For this reason, salpingectomies are 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. Since there are no alternative procedures that can save the life of the embryo, this process is considered morally acceptable.
Dr. O'Sullivan said in her view, the methotrexate treatment and the salpingostomy are both abortions.
"What you're doing this time [in a salpingectomy] is you're taking out damaged section of tube, and since it's removed it's cut off from its blood supply, and ultimately the little baby, the little fetus, will die," O'Sullivan explained.
"In the other two cases, the baby is going to die, too. But both of them are direct attacks on the baby itself. In this latter one, you primary intent is to remove the diseased section of the tube, and you know that the outcome of that will be the loss of the pregnancy."
Kevin Miller, a Catholic moral theologian at Franciscan University of Steubenville, agreed.
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"I think it is somewhere between extremely hard and impossible to conceptualize [methotrexate] administration for ectopic pregnancy as anything other than direct killing of the embryo," he said.
"The embryo's death is the chosen means to the end of resolving the ectopic pregnancy and saving the mother from possible hemorrhage – it is not a 'side effect.'"
"Wait and see"- i.e. not taking any action, and waiting to see if the embryo will naturally dislodge itself- is an option, O'Sullivan said, but this option demands thorough conversation between the patient and physician, and both must be perfectly willing to accept the risk that while they are waiting, the tube could rupture, causing an acute emergency.
"It takes a great deal of counseling, and understanding, and cooperation on the part of both the patient and physician," she said.
Dr. O'Sullivan said in her experience, in the hospitals she has worked in, patients facing an ectopic pregnancy are offered each of the three treatment options and given the chance to choose for themselves.
"In this world of patient autonomy, often the patient is presented with what the options are, and sometimes they make the decision as to which procedure they would prefer," she explained.
The National Catholic Bioethics Center (NCBC) reports that incidences of ectopic pregnancy have increased by 600% in the United States in the last two decades.
"Epidemiologists from the Centers for Disease Control and Prevention attribute the rise to chlamydia and other sexually transmitted diseases that can scar the fallopian tubes, as well as failed tubal sterilizations and the increased use of drugs and surgery to induce ovulation. Other conditions, such as endometriosis, can also contribute to this pathology," the bioethics center says.
Some Catholic bioethicists defend salpingostomy as also being an acceptable procedure. It is a less mutilating procedure than a salpingectomy, and could potentially preserve future fertility, the main reasons doctors may choose it. O'Sullivan said she knows pro-life doctors who have performed salpingostomies.
O'Sullivan said she could find evidence of only two reported cases of a successful replantation of an ectopic pregnancy, one of which allegedly happened in 1917, with the doctor's case report the only evidence that it occurred.
"You have no way of proving that happened. You have to accept what the guy wrote," she commented.
She said the pregnancy would likely be at 5-6 weeks at the earliest before the doctor sees it, and trying to remove the embryo without damaging the amniotic sac, and trying to put it back into the uterine cavity through the cervix, is in her words "pie in the sky."
It also would be difficult to get a procedure like this through an institutional review board, O'Sullivan said, because it would be extremely dangerous to test on humans.
"There's absolutely no animal evidence that this would work, that I could find," O'Sullivan said.
"[The procedure] should be done in animals before you even attempt to do it in humans...I'd be reluctant to talk to a patient about that, and I'd be reluctant to do it without animal evidence of safety."
