What Shall We Make of Ectopic Pregnancy?

In 2004, the Vatican designated Gianna Beretta Molla the Patron Saint of Mothers and the Family for her willingness to sacrifice her life for that of her unborn child. When the doctors found a large uterine tumor pressing against the unborn baby, they recommended abortion, but she insisted upon the option that would imperil her life—tumor removal. She explained, “If you must choose between me and the baby, no hesitation; choose—and I demand it—the baby, save him!” adding “The doctor should not meddle. The right of the child to live is equal to the right of the mother’s life. The doctor cannot decide; it is a sin to kill in the womb.” Consequently, her daughter Gianna Emanuela was born in April of 1962, one week before an abdominal infection took Gianna Beretta’s life.

Many would declare this mother’s decision an act of supererogation—going above and beyond the call of duty—and question her judgment that the child’s life takes precedence. But at least there was a chance that both would make it. And she deserves our commendation for the heroic love she showed to her unborn daughter.

I think back to a Fourth of July parade in Evanston, Illinois, where I was a church planter in the early 2000s. For our float, we brought in a WWII veteran from Oregon, a vibrant Christian who’d received the Congressional Medal of Honor for throwing himself on a grenade in France to save his buddies. Providentially, he was able to grab a blanket to absorb some of the blast, and, though terribly wounded, he survived through months of hospital care. Gianna Beretta in sense threw herself on a grenade, and, it was conceivable that both she and the baby would survive. She certainly deserved a medal.

But there is another sort of childbearing crisis that short circuits this sort of heroism—the ectopic pregnancy. If this had been Gianna Beretta’s situation, her refusal to undergo an abortion would have most likely meant the death of both mother and child. For when a fertilized egg implants in the fallopian tube or elsewhere outside the viability of the uterus, disaster awaits both parties if the ovum is allowed to grow. It eventually ruptures the tube, with lethal bleeding to follow. The “brave soldier” mom dies, as does her “buddy in the foxhole” child. It’s a darned-if-you-do/darned-if-you-don’t predicament, a lose/lose dilemma.

From Runaway Trolleys to a Raft of Resolutions

In 1967, British philosopher Phillipa Foot presented us with the “runaway trolley problem,” which puts us at a fateful railway switch. Do nothing, and a bunch of people die on track one; pull the lever, and only one guy dies on track two. Again, darned if you do, darned if you don’t. (Of course, there are variations and proposed workarounds, but you get the point.) In such situations, we speak of the principle of “double-effect,” whereby unavoidable bad things can eventuate when we’re focusing on doing a good thing.

Now back to the ectopic quandary. In this connection, I think most would urge that we save the mother, particularly when she has other kids in her care, as did Mrs. Molla. Indeed, I see no moral culpability today in ending an ectopic pregnancy. In this, I stand with pro-lifers who carve out an exception for saving the life of the mother, even as we back away from rape and incest exceptions, where no one needs to die.

This was where we stood when I chaired the Southern Baptist Convention (SBC) Resolutions Committee in 1989.[1] We simply reiterated what the Convention had said about an exception for “cases where the mother’s life is immediately threatened,” deployed in 1980, 1982, 1984, and 1988, anticipating what the committee would go on to say in 1991, 1993, and 1996. Of course, the pro-life 1980 resolution signaled a huge change in the SBC’s denominational stance, an outworking of the conservative resurgence which began with the election of Adrian Rogers as president in 1979. Before that time, in 1971 and 1974, the Christian Life Commission (now the ERLC) urged the Resolutions Committee to say we should “work for legislation that will allow the possibility of abortion under such conditions as rape, incest, clear evidence of severe fetal deformity, and carefully ascertained evidence of the likelihood of damage to the emotional, mental, and physical health of the mother.” (Hard to believe the SBC was so squirrely on this issue back then.)

1. For those unfamiliar with SBC polity, every year thousands of members of Southern Baptist churches gather for a “convention,” hence the denomination’s name. One of the purposes of this meeting is to pass resolutions, which are public statements showing what that year’s attendees (called messengers) believe about certain issues. Resolutions are submitted to the Resolutions Committee, which wordsmiths a selection of resolutions to be added to those resolutions that they themselves initiate and refine. Then the Committee brings them to the floor for a majority vote, and if successful, the resolution goes forth as a public declaration of what the body thought that year (subject to change in future years, as was the case with abortion). These resolutions are not binding on the churches, but they are valuable in marking and reporting the sense of the current body.

But what shall we make of the more recent 2021 resolution on abolishing abortion, which resolved “that we humbly confess and lament any complicity in recognizing exceptions that legitimize or regulate abortion”? Well, I’ve had over a year to think about it, and, for the reason I’ve sketched out above, I still can’t bring myself to “humbly confess and lament” wrongdoing in 1989. Nevertheless, I was gratified to see the Convention, in its closing hours, push back against the exclusive policy of incremental ingratiation that the ERLC has embraced to sell the pro-life program.

It’s worth noting that some say there’s no conflict anyway since ectopic abortion is not actually abortion at all, for the aim is not to kill the baby (as with elective abortion), but rather to save the mother when the unviable baby is lost anyway. But, again, at the moment of eliminating the problem, you’re still targeting the conceptus with death.

Of course, abortion enthusiasts cherish the ectopic exception as a way to let the camel’s nose into the tent—a little now, more and more later. (“See, you can’t be absolutists, if you allow for this! Now, let’s talk about other humane considerations.”) But I would suggest that even some pro-lifers appreciate this exception as a way to keep the zealots on their own team at bay—a trump card in their hand. So let me venture to suggest a path that deserves more attention, one that puts a range of parties on the spot.

A Better Way

What if the SBC, or any other ecclesial body, passed a resolution urging the development and refinement of medical procedures to transplant the ectopic baby onto the uterus, thus averting disaster? A quick survey of evangelical literature on the subject underscores the contingency of this exception

• In Ethics for a Brave New World, John Feinberg of Trinity Evangelical Divinity School says, “So, at the current state of technology, the only genuine optionswith an ectopic pregnancy are either to lose one life (the baby’s) or both the mother and child.”[2]
• In Christian Ethics: An Introduction to Biblical Moral Reasoning, Wayne Grudem of Phoenix Seminary inserts a qualifier to the currently bleak set of options—“If the medical technology exists to save the child’s life in such cases, then of course the child’s life should also be saved.”[3]
• In 50 Ethical Questions: Biblical Wisdom for Confusing Times, Midwestern Baptist Theological Seminary professor J. Alan Branch quotes both physician William Cutrer, late of Southern Baptist Theological Seminary ( “At this moment, we have no way to achieve such movement” [of the fertilized egg to the uterus]” and The American Association of Pro-Life Obstetricians and Gynecologists (“There are currently no possible re-implantation techniques for ectopic embryos”).[4]

From this quick survey of those in the know, the current state of medical affairs is not set in stone. The same goes for ‘viability,’ which was designated a standard in Roe v. Wade but is now up for review. As a Bloomberg piece published in the Washington Post acknowledged, “In the 1992 Planned Parenthood v. Casey case, the Supreme Court said viability tended to be around 23 to 24 weeks but could shift toward an earlier date as medical technology improved.”[5]

My generation has seen glorious advances in medicine, including the Salk vaccine in the 1950s, transplantation of human hearts in the 1960s, and invention of the MRI in the 1970s. Research and Development has never stood still, nor will it. Witness this piece from The Medical Futurist, “The Technological Future of Surgery,” which sketches emerging possibilities for such resources as surgical robotics, augmented reality, and the iKnife.[6] Or we might glance backwards to 1917, where an article entitled “Transplantations of Ectopic Pregnancy from Fallopian Tube to Cavity of Uterus” appeared in Surgery, Gynecology, and Obstetrics.”[7] Of course, this is an outlier, but there is no reason to believe that the performing surgeon, Dr. C. J. Wallace, was a liar.

But why go to so much trouble to address this situation, especially since it’s a relative rare event? To answer that, I turn, for sake of analogy, to the 2018 Tham Luang cave rescue in northern Thailand. The crisis arose when an assistant soccer coach took his youth team of twelve two and a half miles back into a cave, where they were trapped by rising flood waters. They weren’t discovered for a week, but then an enormous international effort, involving 10,000 people and the loss of two divers’ lives, freed the boys and their coach from their perch on a rock prominence. The passageways were as narrow as “15 x 28,” and the complex solution involved rendering them unconscious with ketamine and passing them from one volunteer to another, the whole journey taking three hours.[8]

8. “Tham Luang Cave Rescue,” Wikipedia. Accessed December 11, 2023.

Again, why go to so much trouble? The answer is simple: Young, innocent human beings were in peril for their lives. So too is a “fecundated ovum” (to use Dr. Wallace’s terminology), a human being trapped in a fallopian tube, destined to perish unless delivered by adults determined to perfect and effect a rescue scheme. Yes, there is an important difference: The boys were narrowly savable, given current technological resources; in contrast, the misplanted conceptus is currently a lost cause. But the rationale and the goal are the same, and we mustn’t forget that.

For this reason, BE IT RESOLVED that we press for a medical breakthrough that enables the transplantation of the ectopic baby to the mother’s womb. And whatever the law may say eventually about success stories, BE IT FURTHER RESOLVED that Christians will be at the forefront in providing such life-saving care to mothers and children afflicted with this perilous condition.