St. Gianna Molla and the Principle of Double Effect

Since her canonization by Pope St. John Paul II on May 16, 2004, St. Gianna Beretta Molla has become the Patroness of the Unborn Child.  Faced with serious complications during the pregnancy of her fourth child, St. Gianna bravely put the needs of her child ahead of her own.  Pro-lifers often point to her heroic witness as a model to be followed.  They are right in doing so, but maybe not for the reason they often cite.  Most portray her situation as an all or nothing—they say she was faced with having life-saving treatment and an abortion or no treatment at all.  The problem is that this is not actually what happens.  The details of St. Gianna’s dilemma matter greatly in the retelling of her story, especially because it helps illustrate a moral solution for mothers who are faced with serious medical problems during pregnancy.

St. Gianna’s Story

While pregnant with her fourth child, St. Gianna developed a large fibroid; a benign tumor of the uterus.  In the normal course of events when these tumors are found during pregnancy they are unobtrusive enough that they may be left be.  In St. Gianna’s case, the tumor was large enough that it was likely to cause serious complications during the pregnancy that ultimately could threaten the development of the child and put her in considerable pain and risk for a serious infection.  There are additional medical details of her situation (detailed here) but for the sake of our discussion this should suffice.

When St. Gianna learned of the fibroid tumor, she was, according to her husband, presented with three options by her doctors.

  1. Terminate the pregnancy via direct abortion and remove the fibroid
  2. Have a hysterectomy that removed her uterus. This would also result in the death of the 2 month old preborn child.  For her personally this was a low-risk approach and was also the standard of care at the time given the lack of medical technologies (such as ultrasound machines) that we have today.
  3. Remove the fibroid and continue her pregnancy. This option could result in the spontaneous miscarriage of the child because of the irritation to the uterus.  It also carried with it serious risks for herself.  The blood loss from a pregnant uterus can be excessive and difficult to control.  It might also be that the wound could re-open during any point in the pregnancy.

Notice that not receiving any treatment was not one of the options as the story is often portrayed.  This was not a real option as to not do anything would have placed the child at great risk.

Examining the Moral Principles

Before examining her decision, it is helpful to make some distinctions and define some moral principles.  This is what makes knowing the details of her case very instructive.  It is a real-life, concrete example of what someone did and it contradicts the abortion or nothing approach that many people often assume.

The first point to look at is why (1) is morally problematic and (2) is morally permissible.  Looked at superficially, the two acts look to be the same—in both scenarios the child ends up dead and the mother lives.  But how we end up there matters, even if we end up in the same place.  Despite Machiavellian protestations to the contrary, one may never do evil so that good may come about.  The end does not justify the means.  Abortion, that is the direct killing of an innocent human being is always wrong regardless of whether the mother’s life is in jeopardy or not.

In scenario (2), the death of the child, although foreseen, is not directly willed even if it is permitted.  What is willed is the preservation of St. Gianna’s life.  Notice too that the preservation of her life does not come about as a result of the child’s death, but as a result of the removal of the uterus.  That same removal of the uterus also has the “side-effect” of killing the baby, even though it was not chosen for that reason.  Finally, there is a certain proportionality involved in the moral calculation in that both mother and child’s life are of equal value and by not acting you are placing one or both of their lives in jeopardy.

Option (2) demonstrates an important moral principle called The Principle of Double Effect.  This principle recognizes that none of our acts occur in a moral vacuum.  Each of our actions are complex with a mixture of goods and evil attached to them.  Thus, even if the will chooses some good, there can often be an evil associated with it.  This is why when we make our moral calculation, we must look not just to the external act but to the underlying choice of the will.  With this in mind, there has classically been the need for the distinction between two types of will—the direct will and the permitting will.  We may never, morally speaking, directly will an evil.  However, we may permit it.

The Principle of Double Effect

The Principle of Double Effect says that it is morally allowable to perform an act that has at least two effects provided all four of the following conditions are met.

  1. the object to be done must be good in itself
  2. the intent of the agent must be to achieve the good effect and to avoid the evil effect as much as possible. The evil effect must not be directly willed but only permitted.  This is the case even if the evil effect is foreseen.
  3. the good effect is proportional to the bad effect and there is no other way to achieve the effect.
  4. the good effect must follow directly from the action and not as a result of the harmful effect.

St. Gianna would have been morally justified in choosing option (2), but instead she chose option (3).  Although under no moral obligation to do so, this decision flowed from her desire to put the life of her child first.  She was a mother and a holy one at that, so this decision came somewhat second nature.  It is not the reason she is saint, but she made this decision because she was on her way to sainthood.

Most of us know that she eventually lost her life after delivering a healthy baby.  But there is not direct evidence that she died because of her decision.  The cause of her death was an infection in her abdomen that was brought about as a result of the Caesarian section that was performed.  Why this detail matters again speaks to how we present her as a witness.  She knew that her health was in jeopardy by choosing (3) but there was no reason for her (she was a doctor) to think it may end up leading to her death.  She made a courageous decision, but also one based on prudence.  It is her courage and prudence that made her a saint and makes her a great Pro-life witness.  It wasn’t her unwillingness to do something evil, but her willingness to love her children at great personal cost.  Saints are praised not because they didn’t choose evil, but because of their witness of heroic virtue.  Knowing the details enables us to let her witness speak clearly to a very confused age.

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