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I disagree, but appreciate your respectful dialogue. Intentionality is important both philosophically, legally, and morally. Additionally, the direct or indirect action is important philosophically, legally, and morally.

In the US, my current state’s definition of first degree murder is the following: “the killing of a human being with intentionality and premeditation.” Foreseeing the indirect result (death of an embryo) after the direct action (removal of the Fallopian tube) is not premeditation. Or to enter the moral discussion about determination, God’s omnipotence is not predetermination…the fact that he knows what will happen does not mean that he removes our freedom and predestines our salvation or damnation. So knowing what will happen in the future is not willing it to happen and is not forcing it to happen either.

The distinction between direct and indirect action is important at the very least because researchers are developing artificial wombs with the hope of aiding preterm babies in exact situations like this. For example, in 200 years, a salpingectomy or ooforectomy could be completed while at the same time saving the life of the baby. This is not the case with clinical abortion.

While currently, a salpingectomy results in the direct removal of the Fallopian tube with the natural tragic, presumed, eventual death of anything living inside it, this isn’t a certainty with the advent of better medical technology. Nor is a human responsible for the tragedy of that human death if they do everything that can be done to save the child’s life after indirectly placing it in that situation.

The same is not true for direct and intentional abortions. Saline injections directly and intentionally burn the child to death in utero, abortifacient pills strangle the baby directly, and partial birth directly removes body parts after the baby’s living skull is crushed and separated from its body.

Legally this concept of direct vs indirect is important as well. If someone directly shoots 20 people with intentionality and premeditation, that is first degree murder. If an architect designs a bridge that collapses and results in the deaths of 20 people a few years later, that action is not first degree murder, even though the results are identical. The directness of an action has moral, legal, and philosophical consequences.

Comparing the two situations (clinical abortions versus salpingectomies) is intellectually dishonest. Simply because a medical organization such as ACOG has a definition for abortion does not mean that it should not be critically evaluated. As a medical student, I can tell you that doctors are not trained in philosophy, and had I not received my undergraduate degree in philosophy, I would not understand the distinctions made in your post, or why the ACOG has an inadequate definition of abortion. The ACOG’s definition fails to account for the legal (practical philosophy) ramifications of intentionality and direct action.

With clinical abortions, the death is direct and intentional, correctly classifying it as an abortion. With salpingectomies, the death is neither direct, nor intentional, meaning that they are not classified as abortions in hospitals and should not be…even if they fall into the broad definition of the ACOG. This is an important oversight in your analysis of salpingectomies.
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Good article. I agree with your main thesis - pro-life advocates should not argue that abortion is never medically necessary to save a woman's life, and we should be upfront about supporting a life of the mother exception. "Never" is a very risky statement - it takes only one counterexample from a pro-choice person to disprove the claim. Think of it like the inverse of the sovereign zone argument - if the government can never, ever tell a woman what to do with her pregnancy because her body is a sovereign zone, then pregnant women have the right to take thalidomide and abort at any stage for any reason (obviously an untenable position to anyone with a functioning conscience). But I have a few comments:

  • It's not stated in the article, but a major reason many pro-life advocates take the "never medically necessary" approach instead of simply supporting a life of the mother exception is because the Catholic Church teaches that direct, intentional abortion is never permissible. It's not merely an emotional aversion to the word "abortion". Hence Catholic ethicists and theologians debate what does and doesn't count as a direct, intentional abortion (most notably the question of which ectopic pregnancy treatments are acceptable, and the Margaret McBride saga). To my knowledge, the Church has never infallibly declared what can and can't be done in life-threatening situations. A Catholic perspective would've been helpful.

  • It is not just pro-life activists that distinguish ectopic pregnancy intervention from abortion. Under many of the laws that went into effect after Dobbs, abortion is defined in such a way that treating ectopic pregnancy is not legally considered an abortion thus doesn't fall under the law. Such exclusions should be present in all pro-life laws, alongside a life of the mother exception. Additionally, Planned Parenthood's website said that "Treating an ectopic pregnancy isn’t the same thing as getting an abortion". They scrubbed it after pro-life people noticed. Even Dr. Jen 'fetal pole cardiac activity' Gunter, who shamelessly tells lies to advance the pro-abortion cause, tweeted on multiple occasions (as recently as March 2022) that ectopic pregnancy treatment is not an abortion. This makes sense given ACOG's definition - the interventions are not done in order to prevent a live birth, nor do they accomplish that (as live birth wouldn't have taken place if they weren't done).


  • The "smarmy Democrat" in the video is none other than Rep. Eric Swalwell, who used to sleep with the Chinese spy Fang Fang. This is critical context that must be included in any article mentioning him. Given that, the fact that he ran circles around the head of one of the most influential and effective pro-life organizations in the United States was incredibly humiliating and damaging to the pro-life cause. We need to do better.

  • Pro-life people need to understand that this is not a matter of people misunderstanding the law. The laws are very clear that treating ectopic pregnancy and miscarriages are allowed. This is a deliberate disinformation campaign designed to put women in harm's way for the sake of undermining the law. Abortion advocates know that if Savita Halappanavar had been given the care she was legally entitled to rather than the "Catholic country" speech, abortion would still be illegal in Ireland and its pro-choice movement would be little more than a couple of trolls on Broadsheet.ie. They need a corpse to rally abortion grays against the law. To get one, they need a woman to forego care (because she's afraid of criminal prosecution) or be denied care by a pro-choice doctor. Pro-life advocates must forcefully call out these doctors and hospitals. To remove the last trace of plausible deniability, attorneys general in pro-life states must issue legal opinions stating that women with life-threatening conditions can be treated immediately if reasonable medical judgement indicates it is necessary. This article is helpful:


Doctors that have harmed women by denying them care should be sued for malpractice, and pro-life advocates should help patients and families seek legal aid. These medical professionals are a clear danger to the public, and their licences must be shredded. Meanwhile, it's critical that all pregnant women (especially those in pro-life states) find a doctor that won't kill their babies or let them die for the greater good (securing the right to kill an unborn child). This is a good place to start: