Missouri lawmaker says controversial bill won’t ban treatment for ectopic pregnancy

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A Republican lawmaker in Missouri has said he plans to amend a bill he recently introduced regarding 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 Representative Brian Seitz, was critical last week as appearing to ban medical treatment for ectopic pregnancy, which occurs when an embryo implants outside the uterus, usually in the fallopian tube.

Once implanted, the growing embryo is likely to rupture the fallopian tube, which can lead to the death of both mother and child. Although there are treatments for ectopic pregnancies that do not constitute direct abortion, it is highly unlikely that the embryo will survive whether or not the treatment is performed.

Although relatively rare, the most recent data available from the CDC shows that the rate of ectopic pregnancies increased to about 1.4% in 2013.

Seitz says he introduced the bill in response to the FDA’s December 2021 decision allowing doctors to prescribe abortion drugs online and mail the pills, allowing women to perform early abortions — until 10 weeks gestation – without leaving home.

Seitz described his bill as an attempt to reduce the illegal use of abortion-inducing drugs in Missouri, such as in cases where kidnappers might want to induce an abortion in a victim of human trafficking.

The wording of the bill currently states that a person will have committed a Class A felony – which in Missouri carries a prison term of 10 to 30 years – if an abortion “was performed or induced or attempted to ‘be performed or induced on a woman who has an ectopic pregnancy’ in violation of any state or federal law.

Trying to clear up the “confusion” surrounding the section of the bill dealing with ectopic pregnancies, Seitz told a public hearing of the House Select Committee on Government Oversight on March 9 that women can “absolutely” get treatment for an ectopic pregnancy under the bill. , while admitting that he did not know what these treatments consisted of. The bill must be rejected by committee before it can be presented to the full House.

Seitz said his bill is an attempt to ban the use of drugs to treat ectopic pregnancy “outside of a hospital, outside of a doctor’s care.” He said he planned to introduce an amendment to the bill stating: “Nothing in this section shall be construed to prevent a physician or licensed health care provider from performing any lawful medical procedure on a patient to treat an ectopic pregnancy.”

There are three common medical procedures for treating ectopic pregnancies, two surgical and one involving medication.

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, taking no action and waiting to see if the embryo will dislodge naturally — is an option, O’Sullivan said, but that option requires a thorough conversation between the patient and the doctor, and both must be perfectly arranged. accept the risk that, while they wait, the tube will rupture, causing an acute emergency.

Instead, the patient may be offered methotrexate, which is an anticancer drug that stops cells in the embryo from dividing. Another surgical option is to open the fallopian tube so the embryo can be removed, a procedure called salpingostomy. Alternatively, a salpingectomy can be preformed to sever the tube segment on each side and remove it completely.

In all procedures, the embryo dies. O’Sullivan said that in his opinion, methotrexate treatment and salpingostomy both constitute abortions because they are “direct attacks on the baby itself.”

A salpingectomy, on the other hand, is an act to remove the damaged part of the fallopian tube. This procedure is generally considered moral under the principle of double effect. The goal of surgery is the removal of the affected tube, and the embryo dies as an undesirable, though expected, side effect.

From a Catholic point of view, direct abortion – the intentional killing of an unborn baby – is never permitted, but a procedure to save a woman’s life which has the unintended effect of the death of a unborn baby may be morally acceptable.

The Ethical and Religious Guidelines for Catholic Health Services, a publication of the U.S. Catholic Bishops, reads: “Operations, treatments, and medications which have as their direct objective the cure of a proportionately serious medical condition of a pregnant woman are permitted when they cannot be safely postponed until the unborn child is viable, even if they result in the death of the unborn child.

Fundamentally, in a salpingectomy, the death of the child is not the means by which the mother’s life is saved; rather, it is 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 advocate salpingostomy as an acceptable procedure as well, 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.

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