Catholic moral teaching is “usually followed” when a pregnant woman is in need of lifesaving treatment that can harm her unborn baby, according to national health ethics committee chairman Pierre Mallia.
Maltese law usually respects Catholic moral teaching as the normative value
Abortion is strictly forbidden in Malta and there is no statutory legal provision to allow for the wilful termination of a pregnancy, even to save a pregnant woman’s life.
In a recent homily, Gozo Bishop Mario Grech said medical treatment that could harm the unborn child of a seriously ill pregnant woman was ethically permissible, as long as all options to protect the mother and the child were explored.
“The direct killing of children to save the mother is never acceptable,” Mgr Grech said.
Asked via e-mail to explain what guidelines medics followed in such situations, Prof. Mallia said: “Maltese law usually respects Catholic moral teaching as the normative value. This allows for harm to be caused, including death (to the unborn child) when it is foreseen, indirect and unintended. The emphasis is on ‘indirect’.”
Prof. Mallia, an associate professor in family medicine, patients’ rights and bioethics at the University, said medical treatment in such situations had to follow the ethical principle of double effect.
This principle stipulates that it is ethically permissible to do something morally good that has a morally bad side-effect, providing the bad side-effect was not the intention of the action, even if it was foreseen.
“The act itself must be intrinsically good,” Prof. Mallia said.
Prof. Mallia said this meant it would be permissible for medical personnel in Malta to remove a fallopian tube when treating an ectopic pregnancy (where the embryo is growing outside the womb) “as this would be indirect killing (of the unborn child)”.
The same happens if a mother needed surgery or chemotherapy that would harm the baby.
“But if to save the mother one needs to directly kill the baby – such as the extreme case of a baby caught in the passage during delivery – then this does not follow double effect as a direct killing and dissecting of the baby is needed,” Prof. Mallia said.
Prof. Mallia explained that in such cases doctors would have to “take a greater risk and operate on the mother, even if perhaps she is in distress.” Such cases were rare, he noted.
Several follow up e-mails and calls to Prof. Mallia’s University office requesting clarification on whether medical personnel were issued with specific guidelines on how to apply the principle of double effect in such cases went unanswered.
Questions on this issue were sent to the Medical Council on March 20 but a spokesman said this week that members had yet to discuss their response.
In its submission to the UN in March, the International Commission of Jurists recommended that Malta decriminalised abortion and ensured women had access to safe and legal abortions in situations where their life or health may be at risk or where they were at risk of “torture or cruel, inhuman or degrading treatment or punishment”.
Malta is the only EU country with a blanket legal ban on abortion under all circumstances, although abortion law in Ireland is also murky.
Ireland’s Supreme Court ruled in 1992 that abortion was permissible on Irish territory when a woman’s life was endangered by her pregnancy.
However, Savita Halappanavar died of septicaemia in an Irish hospital last October after being denied an emergency abortion, despite suffering severe complications with her pregnancy, as doctors could still detect a foetal heartbeat.
Ireland is in the process of passing legislation that would set a statutory basis in law for a woman to undergo an abortion when there is a real and substantial risk to her life, including suicide.
pcooke@timesofmalta.com