On cooperation on procured abortion

Cooperation to induced abortion can occur in several ways:

Intentional or formal cooperation may occur, whereby the cooperator does so with the intention of bringing about the expected death by means of abortion. This subject cooperation is always a morally wrong act, even if it does not result in the death of the foetus or embryo, for whatever reason.

The other possibility of cooperation is unintentional or material. In this case, although actions are taken that enable or assist in the performance of the abortion, the actor does not intend to perform the abortion, which would not occur if it were up to him alone.

Within this material cooperation, two different situations can be considered:

Immediate or direct cooperation. This is provided by those who help the gynaecologist to perform the abortion: an anaesthetist and his nurse, the instrumentalist and other nurses of operating room, the doctor who financial aid the gynaecologist, etc. This subject cooperation is always gravely illicit, and there is no compelling reason why such cooperation should be lawful.

Mediate or indirect cooperation. This is provided by those who facilitate material circumstances or medicines that allow the abortion to be carried out, without their action being directly involved in the performance of the abortion. This is the case of laundry services, cleaning, sterilisation of instruments, pharmacy, etc.

Indirect material cooperation, if it is exclusive, i.e. if it is a financial aid that is provided solely for the purpose of performing abortions, is morally wrongful. This is the case of a person who works in auxiliary duties in a clinic that only performs abortions, or the supply by the hospital's pharmacy service of drugs that are only used for internship abortion (mifepristone or RU-486, for example).

Indirect material cooperation, if not exclusive, may be morally acceptable in certain circumstances which are detailed below. This is the case of the cleaning service, sterilisation service, etc., of a large hospital, in whose gynaecology and obstetrics department abortions are sporadically performed. This case also includes the hospital's pharmacy service, which supplies prostaglandins or oxytocin to the gynaecology service, provided that the following circumstances are taken into account:

a) if the pharmacy service knows that the specific destination of this medicine or material is the internship of an abortion, it has a grave moral duty not to provide it.

b) if the pharmacy service does not know the intended use of a medicinal product that may be used for abortions, in addition to other licit applications, it may supply it under certain conditions:

1) if the issue number of abortions performed in that hospital is tiny or anecdotal compared to the issue number of patients needing that same medicine or surgical material, it is not ethically obligatory to ask about the use of the medicine every time it is given, and providing that medicine would not be a morally wrong action. This is very rarely the case.

2) If it is known, or even only suspected, that the issue number of abortions performed in this gynaecology department is more than a rarity compared to the rest of the patients who need this medicine or material, the manager of the pharmacy department is morally obliged to ask what the product is going to be used for. If it is to be used for an abortion, he/she should refuse to provide it, and if it is to be used for any other lawful purpose, he/she can provide it, observing a series of prudent measures:

- In each case, only the dose to be administered to the patient should be provided, so that for each new dose to be administered, the patient must go to the pharmacy service to collect it. This avoids having a stock of the product on the ward, which could then be used in a way that is contrary to medical ethics.

- This medicine must be kept under lock and key, and it is the responsibility of the head of service to keep it under lock and key staff or by another trustworthy person.

- Sources of information other than the gynaecologist who ordered the product should be sought to avoid deception. Failure to do so would be naïve and not without fault.

Antonio Pardo.