DIFFICULT MORAL QUESTIONS

Question 71: May a pathologist examine tissue from immoral procedures?

I am a pathologist practicing as a member of a private group of pathologists in a community hospital. Several moral questions connected with my work concern me.

Medically, we distinguish between spontaneous abortions (miscarriages) and induced abortions (terminating pregnancy on purpose). Induced abortion is the destruction of an unborn human being, and I see no reason to consider it any less wrong than killing anyone else. Of course, as a pathologist, I am not asked to perform abortions, since I do not perform any operations at all. However, is it improper to examine the tissue, which includes the remains of the fetus, from an induced abortion? I think it is wrong, because the main purpose of the examination is to verify the abortion’s success, that is, make sure the entire fetus and all the accessory tissues have been removed. But what if my partners felt they could examine the tissue? Would I be obliged to quit the group or would it be enough if I avoided doing those examinations and left them to my partners?

Other questions concerning proximity to abortion: Is it permissible to provide other lab work—such as blood and urine testing—for clinics that do nothing but abortions? I think it is not. But is it also improper to provide these services for gynecologists who do some abortions while also providing various sorts of appropriate health care to women—caring for pregnant women and delivering babies, doing regular checkups, and so forth?

Following the teaching of the Church, I consider sterilizations—tubal ligations on women and vasectomies on men—morally wrong. As with abortions, I’m not asked to do them. However, on a daily basis I do verify the ligations by tissue studies. Is this cooperating too closely in sterilizations?

I discussed the abortion and sterilization questions with the hospital chaplain. Having conferred with some other priests and theologians, he said they felt I was not morally obliged to avoid doing this lab work. I assume they have their reasons, but in good conscience I still do not want to examine tissue from abortions. Also, I do not want to provide any other laboratory services to abortion clinics.

At this time, most of our work comes from the hospital, and, so far as I know, no induced abortions are done in it. Fortunately, my present partners respect my position on abortion, and have agreed not to solicit any outside work related to induced abortions. But there is a possibility that the rules at the hospital are going to change. Suppose that happens and the tissue from abortions is sent to us. Would I be required to quit the staff? Or could I leave it to my partners to examine the abortion tissue?

With regard to sterilizations, I’ve been following the chaplain’s advice. The procedures are so ubiquitous that it would be next to impossible to practice pathology and avoid them. I realize that this fact by itself does not make doing the examinations right, but I think I’m not in morally questionable territory, since sterilization does not involve killing someone as abortion does.

Analysis:

The questions presented here concern cooperation with wrongdoing. The questioner cooperates only materially and is not likely to be tempted to cooperate formally. Still, judged by the usual criteria, the material cooperation with sterilization is morally questionable; since the tissue study can lead to a second attempt, doing it impedes witness. Still, I think the questioner may tolerate his or her partners doing that work, and, if the alternative is giving up his or her profession, may even continue to do it personally. As for the partners’ examining tissue from abortions, even tolerating that would be morally questionable. If employment were available in a situation free of abortions, the questioner would, in my judgment, be obliged to accept it.

The reply could be along the following lines:

Your questions manifest conscientiousness in doing your professional work. Like you, and in accord with the constant and most firm teaching of the Catholic Church, I believe that both induced abortion and sterilization are always wrong. So, in replying to your questions, I shall presuppose the truth of the moral norms absolutely excluding operations of both kinds. Examining the questions you raise from various points of view, I shall apply several distinct ethical criteria. Just as you might identify pathology in a sample of tissue by only one of several studies you make, so my analysis will show that in one respect, though not in others, the lab work you describe is morally unsound.

Your proper role as a pathologist is to examine tissues in order to answer specific factual questions about them, and then to report your findings accurately to those who sent the tissues to you. Plainly, the actions you must do to fulfill that role are not in themselves wrong, are conducive to knowledge of the truth, and ordinarily serve health as well. However, while your work ordinarily contributes to other physicians’ efforts to save lives and promote health, examining tissues from abortions and sterilizations contributes to other physicians’ killing babies and destroying people’s reproductive capacity. Thus, your questions require examination of your intentions and of various side effects. I shall consider both and, as will become clear, find some difficulties with the latter.

Though pathologists do not arrange operations or direct those who perform them, some pathologists perhaps desire that induced abortions and sterilizations be done so that they will derive income from work consequent upon these procedures. Plainly, you do not share that wrongful desire. Moreover, you do not do tissue studies to verify the success of induced abortions, although you do perform such studies to verify sterilizations. But even a pathologist doing studies in both kinds of cases need not intend the operations themselves, for, after others have undertaken them, someone might seek to verify their success with upright intentions of two sorts. First, as you of course know, an abortion in which parts of the fetus or accessory tissues are left behind can be life threatening to the woman, and so the pathology studies needed to verify the completeness of abortions can be chosen to preserve women’s lives. Second, carrying on the practice of pathology to make a living and serve patients in other sorts of cases might require that a practitioner verify the success of various procedures that should not have been done. (Apparently, your reasons for verifying sterilizations are of this second sort.) Of course, if your tissue study does not verify the success of a sterilization, your report is likely to lead to a second attempt. However, while foreseeing that result, you need not intend it. Consequently, it seems to me that the hospital chaplain’s advice—you need not avoid doing this lab work—is sound in the respect that such work need not involve a wrong intention.

Not personally doing anything inherently wrong and not sharing the objectively wrongful intentions of those who choose to do induced abortions and sterilizations, you contribute at most only incidentally to what they are doing. Your main questions thus reduce to the moral acceptability of the side effects of what you are doing (verifying sterilizations) or might do in the future (continue to participate in a group practice whose other members examine tissue from induced abortions).

Your involvement would be an occasion of sin for you if it were likely to tempt you to share the wrongful intentions of those doing induced abortions and sterilizations. That seems unlikely, and so this possible side effect can be set aside. Your involvement would constitute scandal—that is, it would wrongly risk leading others into sin—if it were likely to lead others to choose to perform or undergo induced abortions or sterilizations, or to cooperate wrongly in them. That also seems unlikely, not only because your work as a pathologist begins only after these operations are undertaken but also because it is carried on behind the scenes, hardly noticed by anyone except other professionals, who very likely already have taken their own stands on these matters.

Though the preceding tests have revealed no moral pathology, the examination is not yet complete.

You say it would be “virtually impossible” to practice pathology and avoid verifying sterilizations. But since doing so leads to a second attempt when the first is unsuccessful, it does contribute to bringing about the procedure’s illegitimate goal. Moreover, insofar as possible, everyone should bear witness to moral truth in word and deed. Even incidental involvement in what you believe wrong impedes your witness before your partners and other professionals. Therefore, it seems to me you should try to desist from this work. However, tolerating your partners’ doing it would distance you from it and so, I think, would be compatible with your own witness against sterilization. But if your partners will not cooperate in freeing you from verifying sterilizations, I do not think you must give up your profession so as to avoid doing so.

The requirement of witness to moral truth about induced abortion also argues against even remote, incidental involvement in it. Also, and perhaps even more cogently, against such involvement is its contribution, however minimal and indirect, to the killing of unborn children. One must apply the Golden Rule and ask: If one’s own life or that of someone near and dear were at stake, would one regard a similar degree of involvement by others as excusable, or would one want them to refuse to be involved? On this basis, it seems to me, you are rightly unwilling to examine tissue from abortions or to do other laboratory services for abortion clinics. If the hospital’s rules change and your partners decide to examine tissue from abortions, tolerating their doing such work would be harder to justify than tolerating their verifying sterilizations. If you could find employment in a situation that excluded examining tissue from abortions, it seems to me you would be obliged to take it, in order to bear witness to the truth about the sanctity of human life.

As for doing lab work, such as blood and urine testing, for gynecologists who do some abortions but also provide various sorts of appropriate health care for women involving the very same kinds of tests, the incidental involvement in abortion seems to me so slight and remote that you need not be morally concerned about it.