A Missouri Republican lawmaker says he plans to amend a bill he recently introduced concerning ectopic pregnancies to allay concerns that it would prevent women from receiving treatment for the potentially deadly medical condition.
House Bill 2810, proposed by State Rep. Brian Seitz, was criticized last week as appearing to outlaw medical treatment for ectopic pregnancy, which occurs when an embryo implants outside the uterus, usually in the fallopian tube.
Once implanted, the embryo’s growth is likely to rupture the fallopian tube, which can cause the death of both mother and child. While there are treatments for ectopic pregnancies that do not constitute direct abortion, the embryo is highly unlikely to survive, whether treatment is done or not.
Though relatively rare, the most recent data available from the CDC shows the rate of ectopic pregnancies increasing to about 1.4% as of 2013.
Seitz says he introduced the bill in response to the FDA’s Dec. 2021 decision allowing doctors to prescribe abortion-inducing drugs online and mail the pills, allowing women to perform early abortions — up to 10 weeks of gestation — without leaving their homes.
Seitz described his bill as an attempt to curtail the illegal use of abortion-inducing drugs in Missouri, such as in instances where captors may want to induce an abortion in a human trafficking victim.
The bill’s language currently stipulates that a person will have committed a class A felony — which in Missouri carries with it a jail sentence of 10 to 30 years — if an abortion “was performed or induced or was attempted to be performed or induced on a woman who has an ectopic pregnancy” in violation of any state or federal law.
Attempting to address “confusion” surrounding the section of the bill addressing ectopic pregnancies, Seitz stated during a public hearing of the House of Representatives’ Special Committee on Government Oversight March 9 that women “absolutely” can get treatment for an ectopic pregnancy under the bill, while also admitting he did not know what those treatments involve. The bill needs to be voted out of committee before it can come before the full House.
Seitz said his bill is an attempt to outlaw the use of drugs to treat ectopic pregnancy “outside a hospital, outside of a doctor’s care.” He said he plans to introduce an amendment to the bill stating: “Nothing in this section shall be construed to limit a licensed physician or healthcare provider from performing a lawful medical procedure on a patient to treat an ectopic pregnancy.”
There are three common medical procedures to address ectopic pregnancies, two surgical and one involving a drug.
Dr. Mary Jo O’Sullivan, a high-risk obstetrician and professor emeritus of obstetrics and gynecology at the University of Miami, explained the three procedures to CNA in 2019.
Expectant management — that is, not taking any action, and waiting to see if the embryo will naturally dislodge itself — is an option, O’Sullivan said, but this option demands thorough conversation between the patient and physician, and both must be perfectly willing to accept the risk that while they are waiting the tube could rupture, causing an acute emergency.
Instead, the patient may be offered methotrexate, which is an anti-cancer drug that stops the embryo’s cells from dividing. Another surgical option is to open the fallopian tube so the embryo can be removed, a procedure called a salpingostomy. Alternatively, salpingectomy can be preformed to transect the segment of the tube on each side and remove it completely.
In all of the procedures, the embryo dies. O’Sullivan said in her view, the methotrexate treatment and the salpingostomy both constitute abortions, because they are “direct attacks on the baby itself.”
A salpingectomy, in contrast, is an act to remove the damaged portion of the fallopian tube. This procedure is generally considered moral under the principle of double effect. The objective of the surgery is the removal of the affected tube, and the embryo dies as an undesired, although foreseen, side effect.
From a Catholic perspective, direct abortion — the intentional killing of an unborn baby — is never permitted, but a procedure to save a woman's life that has the unintended effect of an unborn baby's death can be morally permissible.
The Ethical and Religious Directives for Catholic Healthcare Services, a publication of the U.S. Catholic bishops, reads: “Operations, treatments, and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman are permitted when they cannot be safely postponed until the unborn child is viable, even if they will result in the death of the unborn child.”
Crucially, in a salpingectomy, the death of the child is not the means by which the mother’s life is saved; it is instead an unintended consequence. Since there are no alternative procedures that can save the life of the embryo, salpingectomy is considered morally acceptable, O’Sullivan said.
Still, some Catholic bioethicists defend salpingostomy as also being an acceptable procedure, O’Sullivan said, adding that she knows pro-life doctors who have performed salpingostomies. It is a less mutilating procedure than a salpingectomy, and could potentially preserve future fertility, the main reasons doctors may choose it, she said.