As I was reading Laura Turner’s Buzzfeed essay about Christian health sharing ministries this past week, I was startled to discover that Samaritan Ministries, the insurance alternative my husband uses, does not cover expenses related to ectopic pregnancies.
In Section VIII of the Samaritan Ministries Guidelines, “Needs Shared by Members,” Ectopic Pregnancies is listed as the ninth item under “Miscellaneous Items Not Shared.” The guidelines state:
“Expenses related to the termination of the life of an unborn child are not publishable. The removal of a living unborn child from the mother which results in the death of the child is a ‘termination of the life of the child’ unless the removal was one for the primary purpose of saving the life of the child, or improving the health of the child. This means that the removal from the mother of an unborn child due to an ectopic pregnancy (outside the normal location in the uterus) is not publishable unless the member states they believed the child was not alive before the procedure. Considerations of the health or life of the mother does not change that the removal of a living unborn child from the mother may be a termination of life.”
Ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most commonly in one of the fallopian tubes. The condition can be highly dangerous to the mother, who is at risk of internal rupturing and blood loss. While there are different classifications of ectopic pregnancies and a few different methods of treatment, Turner approximates the cost of surgery to save the life of the mother to be around $15,000.
The cost of such a surgery would not be covered by Samaritan because the treatment would be “related to the termination of the life of an unborn child.” However, the consensus of Christian bioethics is that, at the very least, treatment of ectopic pregnancy by the removal of the fallopian tube is a permissible application of the doctrine of double effect. The surgeon would remove the affected fallopian tube with the intent to save the life of the mother, and foresee but not intend the death of the child.
Or, as Catholic bioethicist Fr. Tadeusz Pacholczyk explains,
When an ectopic pregnancy does not resolve by itself, a morally acceptable approach would involve removal of the whole section of the tube on the side of the woman’s body where the unborn child is lodged. Although this results in reduced fertility for the woman, the section of tube around the growing child has clearly become pathological, and constitutes a mounting threat with time. This threat is addressed by removal of the tube, with the secondary, and unintended, effect that the child within will then die.
In this situation, the intention of the surgeon is directed towards the good effect (removing the damaged tissue to save the mother’s life) while only tolerating the bad effect (death of the ectopic child). Importantly, the surgeon is choosing to act on the tube (a part of the mother’s body) rather than directly on the child. Additionally, the child’s death is not the means via which the cure occurs. If a large tumor, instead of a baby, were present in the tube, the same curative procedure would be employed. It is tubal removal, not the subsequent death of the baby, that is curative for the mother’s condition.
Samaritan’s stated reasoning behind its policy on ectopic pregnancies falls outside of the general consensus of Christian bioethics on this topic. While there are treatment options for ectopic pregnancies that many Christians would consider unethical, the policy would benefit from added specificity that allowed for at least the most widely accepted treatment to be publishable.