What about when it’s required to save the mother’s life?

First of all, abortions required to save a mother’s life constitute a fraction of a percent of the abortions performed yearly in the U.S. Prior to Roe v. Wade, medical interventions that resulted in the death of a fetus were allowed in these cases, and, if Roe v. Wade were overturned, they would almost certainly still be allowed.

From an ethical standpoint, actions that deliberately target an innocent human being for destruction are intrinsically wrong. Something that is intrinsically wrong cannot be justified by good intentions. Nearly all elective abortions (and anything that involves deliberately ripping or burning a fetus to death) fall into this category. By contrast, some actions can reasonably be foreseen to result in a person’s death without necessarily being wrong. They do not directly target a person for destruction and can be justified, but only in rare circumstances where the goodness of the end achieved is proportionate to the harm foreseen to result indirectly from the action. When speaking of medical interventions which indirectly kill a fetus, saving the mother from imminent death is such an end. Most other reasons, including improving the mother’s health, would not qualify as proportionate ends.

What does this mean in specific circumstances? In cases where the life of both the mother and the baby are in danger if the pregnancy continues, attempts should first of all be made to save both. For example, in a toxemia¹ pregnancy, the induction of premature delivery may be necessary, but it should be done at a point that balances the survival chances of both mother and baby, and in no case would it be acceptable to kill the child before delivery, even if the child’s chances of surviving outside the womb at such a premature age are low.

In cases where the unborn child is way too young to survive outside the womb and both mother and child will definitely die before fetal viability, saving one person’s life is the best that one can do, even if the death of the second person is hastened slightly as a foreseen but unintended consequence of that action. Two such cases are fast-spreading uterine cancer that coincides with pregnancy and ectopic pregnancies in which the embryo implants in the fallopian tube. The doctor may ethically remove the cancerous uterus or the damaged fallopian tube, respectively, in order to save the life of the mother, even though he has reason to believe that this action will slightly hasten the death of the unborn child.

Initially, this strikes many as an example of a good end justifying an intrinsically evil means, but this is not the case. Deliberately targeting an innocent human being for destruction is intrinsically evil. Most abortions do exactly that. The death of the offspring is not a foreseeable but unintended consequence of the procedure—rather, it is the whole point of the procedure. We know this because, in virtually every case, an abortion would be considered a failure by both the mother and the doctor if the child survived. By contrast, the surgical procedures discussed above do not deliberately target an innocent human being for destruction. Indeed, if a pregnant woman’s cancerous uterus is removed and the unborn baby defies expectations and clings to life, it would be considered an unexpected success.

To summarize, actions that will possibly or even probably result in the death of another person may be prima facie wrong and thus only justified in rare circumstances. But they are not intrinsically wrong. Extreme situations clearly exist in which it is morally obligatory to engage in an activity even though one foresees that that activity poses a risk of death to another person. If an innocent death does occur, there is a moral distinction between having engaged in the activity and having deliberately targeted that person for destruction, which no good end can justify. Thus, because they do not deliberately target an innocent person for destruction, surgical procedures necessary to save a woman’s life can be morally—and thus legally—acceptable even if the death of a preborn infant is a foreseeable consequence.