Some time ago I posted on the principle of double effect, and mentioned cases of conflict that are not evidently resolvable by the principle of double effect, at least not in its usual sense. There is also a problem applying the principle of double effect to resolve an issue or dispute, if the very point in question is whether a given effect can or should be considered as an effect, that is, as a circumstance of the action, or whether it must be considered as a defining aspect of the object.
For example, when a live baby is delivered by the induction of labor or C-section before it is mature enough to live for long outside the womb, is the death of the child an effect of the action, so that it could fall under the principle of double effect, or does the action morally need to be described as the direct killing of an innocent child?
A discussion arose recently about the case in Phoenix, where a nun at a Catholic hospital approved an abortion that was considered medically necessary to save the mother's life, and when there was (apparently) not considered to be any reasonable hope of her carrying the child until viability. The bishop of the diocese of Phoenix declared the nun who approved the abortion to have been automatically excommunicated by her action.
The diocesan's Q and A on the situation (PDF) says, "If a necessary treatment brings about the death of the child indirectly it may be allowable. A Dilation and Curettage (D&C) or Dilation and Extraction (D&E), however, would never be such a treatment since it is the direct killing of the unborn child and is, morally speaking, an abortion." This suggest that such a procedure may have been done at the hospital. I have been unable to verify the facts on this question. But suppose that the abortion was carried out by C-section, delivered a live baby, who died hours or days later because it was as yet too immature to live outside the mother's womb. Would that change the situation?
The doctrinal commission of the USCCB's statement on this case, as well as the USCCB's Ethical and Religious Directives for Catholic Health Care Services (5th edition, 2009, PDF), seem to imply that it would not alter the situation morally. The ethical and religious directives say "Abortion (that is, the directly intended termination of pregnancy before viability or the directly intended destruction of a viable fetus) is never permitted. Every procedure whose sole immediate effect is the termination of pregnancy before viability is an abortion." The doctrinal comission's comment on this is: "Direct abortion is never morally permissible. One may never directly kill an innocent human being, no matter what the reason." In other words, it considers any "directly intended termination of pregnancy before viability" to be, morally speaking, the "direct killing of an innocent human being," even when physically it is indirect, as when a live baby is delivered before viability.
The same thing seems to be taught by a statement of the Holy Office:
Dr. Titius, when called to a pregnant woman, who was very ill, observed repeatedly that the only cause of her deadly disease was her pregnancy, i. e., the presence of a fetus in her womb. Hence there was but one way open to him to save the patient from certain and imminent death, namely, to cause abortion. On this course he usually decided in similar cases, taking care, however, to avail himself of such remedies and operations which would not of themselves, or not immediately kill the fetus in the womb, but, on the contrary, would, if possible, deliver the child alive, although, not being able to live, it would die soon afterward. But after reading a rescript from the Holy See to the Archbishop of Cambrai, dated August 19, 1888, that it was unsafe to teach the lawfulness of any operation which might directly kill the fetus, even though such were necessary to save the mother, Dr. Titius began to doubt the lawfulness of the surgical operation by which he had not unfrequently caused abortion to save pregnant women who were very ill.
Therefore, in order to set his conscience at rest, Dr. T. humbly asks whether, on recurrence of the like circumstances, he may resort to the aforesaid operations.
To this urgent request the Cardinals of the Holy Roman Congregation of the General Inquisition, after advising with the theological consultors, have decided to answer: No; according to other decrees, namely, those of May 28, 1884, and of August 19, 1888…. (Response of the Holy Office to the Archbishop of Cambrai, July 24, 1895; AAS 28, 383ff., Denzinger, n. 3298)
More related statements of the Catholic Church on Abortion
In response to the argument that the death of the child that is consequent upon delivery of the child is an effect of the delivery, and thus the delivery of a child through induction of labor or C-section before viability may fall under the principle of double effect, when without such an operation both mother and child will die, the position taken by the Holy Office at that time (the CDF has been curiously silent on the question in the past forty years in its various statement on procured abortion, respect for life, etc.) and by the USCCB seems to amount to: one may not consider the principle of double effect applicable; one must consider the death of the child as an essential, determining aspect of the act of delivering the child.
I must admit, I am quite at a loss as to the logic that could be behind the position of the Holy Office and the USCCB (Dear readers, HELP!), and wish that the CDF would make a statement on the issue, either to say that this earlier decision of the Holy Office (assuming I'm rightly interpreting it) is correct, or that it is incorrect or misunderstood or not applicable, or that the question is an open one: the silence I find distressing, particular in view of the wide gap that seems to be present between the views of Catholic doctors and the views of many bishops.