I am not understanding why you think it is the tube that is the problem. In some cases the reason for the ectopic pregnancy is that the tube is damaged, or it becomes damaged when it ruptures, but often that is not the case.
If it is caught in time, the tube can be perfectly healthy. It is possible medically, under those circumstances, to remove the embryo without the tube being compromised at all.
In order to understand why the tube is the problem, we must first step back and look at the overall context of the disease, and then we must identify the
part of that context in which the problem lies, and therefore requires treatment.
The overall context of the disease in this case is basically this: A fallopian tube is functioning as an embryonic implantation site. If the embryo implanted in that tube is allowed to continue to gestate therein, this will in all likelihood cause the tube to rupture. This, in turn, will in all likelihood result in the deaths of both the mother and the child.
Now, in which
part of that context does the problem lie? Is it in the embryo? Surely not. The embryo by itself is not a parasite--it's a child, quite naturally growing and developing inside its mother. If it could be moved to the uterus and then re-implanted, so that it could continue to grow and develop there, then surely this would be the preferred course of treatment, but unfortunately, modern medicine is not able to do this.
The reason why the problem is in the tube and not in the child is because the child's implantation and gestation in the tube is
caused by the tube's
functioning as an implantation site. A fallopian tube is not
supposed to function as an implantation site. The tube is therefore
malfunctioning. It is therefore in the tube, rather than in the child, where the problem lies. What is required for treatment, therefore, is to cause the tube to
stop mal-functioning as an implantation site.
The reason why removing the child would save the mother's life is because it would be one method whereby the tube's malfunctioning as an implantation site might be arrested, but it would be a misidentification of the problem--for, as I've shown, the child by itself is
not the problem. Instead of getting rid of the child as some sort of parasite, treatment
should proceed by seeking to arrest the tube's malfunctioning as an implantation site, as this is the
root cause of the disease. Unfortunately, medicine is not yet able to do this and prevent the child's death from resulting of it, but medicine
is able to direct its course of treatment toward correcting the root cause of the disease, which is
not located in the child.
And depending on where it implants, if it is outside the tube, direct removal of the embryo might be the only option - it is not in anything to remove.
Whatever tissue is malfunctioning as an implantation site would be the locus of the problem, and the course of treatment would seek to arrest that malfunction. If you want details, then you'll need to present a specific case for me to consider.
But under the Catholic teaching, this is not allowed, because it would be considered a direct attack on the embryo. The best they allow is to say that the tube is diseased and can therefor be removed, and the removal of the embryo along with it is unintended, and therefor falls under double effect.
That is, they can only apply double effect by defining the problem as the tube, not the embryo that is going to rupture the tube. They are redefining the problem so they can use this principle, but the redefinition is not really all that accurate. How can you say the tube is the problem when in fact there is nothing wrong with it.
But there
is something wrong with the tube. As I've shown, the tube's malfunctioning as an implantation site
is the problem. Removing the child would save the mother
because that would effectively arrest the tube's malfunctioning.
That the child is not the problem can be seen in the fact that if it were possible to re-implant the child in the uterus, then by so doing, the disease would be successfully treated.
That is why they only allow tube removal, not other medical options like opening the tube or using a drug that will cause the embryo to flush from the tube.
Whatever course of treatment would arrest the tube's (or other tissue's) malfunctioning, while not
directly causing the death of the child and causing as little harm to the mother as possible, would be the preferred course.
(In fact the more strict Catholic theologians will say you have to wait for the tube to rupture before double effect can apply.)
I know, and I disagree with them. Malfunctioning as an implantation site to the effect of compromising the lives of both mother and child will suffice for allowing a double-effect course of treatment, even if the tube is not yet ruptured.
All of this seems to be a way to avoid a situation where there seems to be no really good way to proceed - where acting and not acting both have morally questionable results, which tends to be the case in many of the more difficult moral issues we face.
But for some reason Catholicism seems very uncomfortable with the idea that in some instances, the least immoral course of action open to us may have real objectively immoral elements.
In cases such as these, there really is no
good way to proceed. We just have to do the best we can with the circumstances we're presented with. As long as we do that, then we're pursuing the moral course.
