New Sherwood

Lorraine Allard: England’s “Gianna Molla”

In contrast to the depressing post below, today we have this beautiful yet heart-wrenching story from England. It seems to me that we may have a case here of something beyond ordinary virtue – a case of what the Church calls “heroic virtue”, the kind of virtue also displayed by Saint Gianna Molla.

Just look at that photo: there is serenity and joy in those eyes, the peace of a pure conscience. May God grant Mrs. Allard eternal rest in the arms of her Savior, bless her newborn child, and console her dear family.

(Note to readers: This entry has been edited due to ambiguities in the article and discussion in the comment boxes.)

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January 26, 2008 - Posted by | Uncategorized

50 Comments »

  1. Almighty and merciful God, grant Thy noble servant Lorraine, peace and rest in the life to come and send comfort unto her family left behind, this we beseech Thee in the name of Thine only begotten Son, Jesus Christ. Amen.

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    Comment by KJC402 | January 26, 2008 | Reply

  2. Lorraine Allard could have legitimately and morally undergone chemotherapy in this case, even if the treatment had unintentionally resulted in the death of her unborn child.

    Unintentionally? I doubt it. That’s why she refused the treatment.

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    Comment by William Luse | January 26, 2008 | Reply

  3. KJC402: A lovely prayer. Thanks for posting.

    Bill: So far as I know the Church allows for something called “double effect”, where the object and intent of an act (chemotherapy for the purpose of curing cancer) is moral and permissible, although the secondary effect (death of an uborn child) is an evil. I think the principle is similar to that of a just war: if, in the prosecution of a just war, nations were forbidden to do anything which would knowingly harm innocents, then the practical result would be total pacifism. The evil of bringing harm to innocents is the secondary result, or the “double effect”, of an action that is morally good in object and intent.

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    Comment by Jeff Culbreath | January 26, 2008 | Reply

  4. When I get a little ahead, I wish to commission an icon of Saint Gianna.

    Beautiful story, thank you for sharing this.

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    Comment by ASimpleSinner | January 27, 2008 | Reply

  5. Jeff, you’re correct about “double effect.” In fact, in the case of St. Gianna Beretta Molla, since the tumor was in her womb, she could have chosen to have the womb removed even though the child also inside it would have died. Instead, she chose to have a different, riskier surgery that sought to remove the tumor alone. She also specifically told her doctors that if they had to choose who to save, they were to choose the child. If I remember correctly, what ultimately took St. Gianna’s life was not the tumor but an infection following childbirth.

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    Comment by Mia Storm | January 28, 2008 | Reply

  6. the Church allows for something called “double effect”

    Yes, people are always using it to get where they want to go.

    where the object and intent of an act (chemotherapy for the purpose of curing cancer) is moral and permissible, although the secondary effect (death of an uborn child) is an evil

    It’s not a secondary effect if you know for a certainty that it will result. It becomes the object of your act: to kill another to save yourself. If certainty is not in play, then it becomes a matter of prudence, of weighing the risk to the child. But the fact that a judgement is prudential does not automatically make it the right thing to do. Double-effect doesn’t even apply until we are first certain that the means to the end are in themselves permissible.

    A whole other story lies beneath the choice the doctors offered her: we can’t give you chemo because you’re pregnant; but if you let us abort, we can.

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    Comment by William Luse | January 28, 2008 | Reply

  7. There is definitely a “rush to double-effect” tendency in present-day Catholic discourse which simply ignores the problemmatic of the object. In part this may be because medievals like Aquinas simply took it for granted. What the medievals took for granted and therefore neglected to make excruciatingly specific, positivist moderns ignore as nonexistent.

    I don’t know where this particular case comes out; but I am skeptical of the supreme confidence which pronounces the alternative to what she chose licit under double-effect.

    On the other hand, I don’t think the fact that all of a martyr’s options other than accepting death are evil in any way denigrates the heroism of martyrdom. I was having a recent discussion on my blog with a commenter who thought that we should not be grateful when given our due. That reminds me of the notion that it isn’t heroic to just do the right thing. The ‘separation’ or ‘truncation’ of heroism implied in the idea that just doing the right thing is not heroic is something I find bothersome. Sometimes all options are evil except the heroic one; that doesn’t make the heroic one any less heroic.

    God bless this woman and her family.

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    Comment by Zippy | January 29, 2008 | Reply

  8. “I am skeptical of the supreme confidence which pronounces the alternative to what she chose licit under double-effect.”

    Did I pronounce with too much confidence on the point? Perhaps. But I accede to the Church’s teaching on double-effect, and would not dare to accuse a wife and mother of three in Mrs. Allard’s situation of “rushing to double effect” in order to “get where she wants to go” if she chose a non-abortive treatment of some kind.

    At the same time, I do have a hard time imagining any mother consenting to medical treatment that she knows would seriously endanger the life of her child. But sometimes we are given impossible choices in life. Mrs. Allard appears to have taken the heroic path, with the least moral complications, and indeed it may have been the only path her conscience would allow.

    That’s why I’m not too hard on pacifists. I appreciate their dilemma: just because I so easily accept that innocents may be knowingly killed in wartime in pursuit of a just war doesn’t mean I am not glad there are people with more sensitive consciences on the point. If I’m not mistaken, the medieval Church, while at the same time exhorting the Crusaders to make war, would not admit them to the altar for three years after they returned because they inevitably spilt innocent blood. King David, also, whose wars were just, was not permitted to build the first temple because he was a man of war. Does morality admit of degrees? It would seem so …

    Fr. Frank Pavone of Priests For Life expresses the orthodox teaching as it pertains to an ectopic pregnancy:

    “There is more than one medical way of handling an ectopic pregnancy. The relevant moral question is whether the method or action is in fact a killing of the child. If so, that is a direct abortion, which is never permissible for any reason. ‘Direct’ means that the destruction of the child is willed as the end or the means to another end. Sometimes ectopic pregnancies are handled this way, killing the child but leaving the tube intact. Such an action is morally wrong.

    However, if what is done is that the damaged portion of the tube is removed because of the threat it poses to the mother, that is not a direct abortion, even if the child dies. What is done is the same thing that would be done if the tube were damaged from some other cause. The mother is not saved by the death of the child but by the removal of the tube. Because the death of the child in this case is a side effect which is not intended, and because the saving of the mother’s life is not brought about by the death of the child, such a removal of the damaged portion of the tube is morally permissible. The ethical rule that applies here is called the Principle of the Double Effect.”

    Msgr. William B. Smith writes in Homiletic and Pastoral Review:

    “All Catholic authors agree that salpingectomy is a licit application of the principle of double effect. That is, full salpingectomy — the entire fallopian tube (together with the ectopic pregnancy) is surgically removed; or, partial salpingectomy — only the damaged segment of the tube enveloping the ectopic pregnancy is removed, and then the severed ends of the tube are brought together and sutured.

    Clearly, the surgery here is on the tube, a portion of which is pathological and poses a significant threat to the health and life of the mother. The death of the unborn is foreseen but not directly intended. The improvement in mother’s health and life is not precisely caused by the death of the unborn but comes through (caused by) the removal of pathological tissue. Thus, an indirect abortion and a legitimate application of double effect.”

    Bill wrote: “It’s not a secondary effect if you know for a certainty that it will result. It becomes the object of your act: to kill another to save yourself.”

    The theologians above, however, say that “forseen” is not the same as “intended”. To forsee that an evil will result from my action does not necessarily mean that the action has an evil object, or that I am “doing evil so that good may result”.

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    Comment by Jeff Culbreath | January 29, 2008 | Reply

  9. But I accede to the Church’s teaching on double-effect, …

    As do I, and Bill.

    …and would not dare to accuse a wife and mother of three in Mrs. Allard’s situation of “rushing to double effect” in order to “get where she wants to go” …

    That strikes me as a very tendentious way of putting it. At issue is what is objectively morally right and wrong, not who would dare accuse whom of what. When I stand before the Judge on the last day I plan – I hope – not to accuse anyone of anything. That doesn’t mean there is no such thing as objective right and wrong.

    …if she chose a non-abortive treatment of some kind.

    Precisely what is at issue though is what behaviors are intrinsically abortive and what behaviors are not. And my point is that when people discuss ‘hard cases’ they typically skip over that issue and simply assume that double effect applies. But of course double-effect only applies when the specific chosen behavior is not intrinsically evil: when the object of the act is at worst morally neutral.

    That “foreseen” and “intended” are different is also not in dispute. If I foresee that Bob will kill Fred unless I run Bob over with my car, and I don’t run Bob over with my car, it doesn’t follow that I necessarily intend to kill Fred. Examples can be multiplied. I also agree that some behaviors treating ectopic pregnancy are morally licit and some aren’t. So we all agree that forseen effects are different from intended effects, and we all agree that the principle of double-effect applies to some cases. None of that is at issue.

    My observation, again, is that a great many people simply skip the step of carefully evaluating whether double-effect even applies to a particular dilemma; and it is far from manifestly obvious that it applies to this case, though I suspect that it does.

    And again, that a particular act (or refraining from a particular act) may be the only morally good option does not in the slightest diminish the heroism of choosing it, in my view. (The notion that it would is an insult to the heroism of the martyrs).

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    Comment by Zippy | January 29, 2008 | Reply

  10. “My observation, again, is that a great many people simply skip the step of carefully evaluating whether double-effect even applies to a particular dilemma …”

    Undoubtedly. Bill apparently thinks I have done so in this instance, and perhaps you do also.

    “… and it is far from manifestly obvious that it applies to this case, though I suspect that it does.”

    Well, from what I read in the news story, it seemed manifestly obvious to me.

    I’ll grant what I think is your point: I was too strident in my statement about the morality of alternative treatment in the original post. It isn’t possible to know all of the essential details from a newspaper article, I could have misinterpreted what I read, I could have been mistaken in my understanding of double-effect to begin with, and besides, as you point out, a lack of moral options would not detract from Mrs. Allard’s heroism.

    But if I didn’t make a few dogmatic and all-knowing judgments about newspaper stories from time-to-time I wouldn’t be much of a blogger, now would I?

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    Comment by Jeff Culbreath | January 29, 2008 | Reply

  11. I have to say that in this particular case, the whole point seems pretty much moot: She went into labor _two weeks_ after the diagnosis. She already had cancer on her liver, and the most the doctors hoped for was _maybe_ to give her a couple more years. I mean, liver cancer is pretty much a death warrant. It’s highly unlikely that starting chemo two weeks earlier would have made the difference between life and death, and they knew she was incurable and was going to die in a couple of years at the most anyway.

    The doctors absolutely would not do chemo while she’s pregnant. It doesn’t say how bad the chemo would have been for the baby probably partly for that reason. As for what I think about the hypothetical question, if it wouldn’t be a serious risk of serious harm to the child, then it seems to me it might be morally justified. But if it’s likely to kill the child, then it’s not. My take, FWIW.

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    Comment by Lydia | January 29, 2008 | Reply

  12. Well, from what I read in the news story, it seemed manifestly obvious to me.

    I guess part of what I am saying is that moral license to do these kinds of things under double effect often seems manifestly obvious to the majority of people (that is, the majority who actually know or care what the PDE is in the first place) when it is usually not obvious that double-effect even applies. I took Bill’s point to be that many Catholics are great at invoking the PDE and explaining things under its rubric, but few seem to even have a notion that there are certain specific kinds of behavior to which it simply doesn’t apply, no matter what intentions (other than the kind of “intention” in choosing the behavior) or circumstances obtain.

    I suppose this point has become a bit of a hobby horse of mine. But in my defense, in a desert, water isn’t an irrational or inappropriate hobby horse to ride.

    But if I didn’t make a few dogmatic and all-knowing judgments about newspaper stories from time-to-time I wouldn’t be much of a blogger, now would I?

    Ah, a point of unanimity :-)

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    Comment by Zippy | January 29, 2008 | Reply

  13. Lydia:

    Thanks for the added info about liver cancer, of which I was completely ignorant. That does change the dynamics of the situation, but perhaps not that much. The principle of double-effect (I’ll use Zippy’s PDE from now on) does hinge on proportionality, but the difference between saving one’s life for twenty years and saving one’s life for two years may not seem so great when death is imminent.

    And I had missed the line that reads, “The doctors said they couldn’t do anything because she was pregnant.” Couldn’t, or wouldn’t? – I wonder.

    Nice to see you commenting here. Stony Creek Digest must be moving up in the world. :-)

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    Comment by Jeff Culbreath | January 29, 2008 | Reply

  14. Zippy, leaving the article aside for the moment, I’d like to better understand your thinking on PDE. Suppose we know the following facts about a similar case:

    1. A wife and mother of three is pregnant with child number four.
    2. Four months into her pregnancy she is diagnosed with cancer.
    3. There is better than a 50-50 chance that non-abortive treatment for this cancer will save her life or extend it for several years.
    4. There is certainty (or near certainty) that this same treatment would result in the death of her unborn child.

    Would accepting treatment be a legitimate exercise of PDE in this case? I’d like to know Bill’s answer as well. Thanks.

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    Comment by Jeff Culbreath | January 29, 2008 | Reply

  15. Note to readers: Some of my commenters have convinced me that I should edit the original blog entry. Due to ambiguities in the article I’m going to remove the following statement:

    “Lorraine Allard could have legitimately and morally undergone chemotherapy in this case, even if the treatment had unintentionally resulted in the death of her unborn child. As a wife and mother of three she certainly would have had compelling reasons for doing so.”

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    Comment by Jeff Culbreath | January 29, 2008 | Reply

  16. Jeff, this is the key point on which the question turns:

    There is better than a 50-50 chance that non-abortive treatment for this cancer will save her life or extend it for several years.

    Given that it is definitely a non-abortive treatment, the PDE would definitely apply. Precisely what is at issue though is what is it that makes a treatment non-abortive. Most people seem to think that “you aren’t intending to kill the child” or some such formulation works. But the word “intent” is one slippery fellow in these discussions: that is why, in my opinion, the encyclical Veritatis Splendour never once uses the term “intent” with reference to the object of the act, and instead repeatedly refers to the object of the act as the “chosen behavior” or “chosen action”.

    So a slightly better way to say it is that a treatment is non-abortive when you aren’t choosing to kill the child. (Everything which is chosen is intended in the morally relevant sense, even if one wishes that one did not have to choose it in order to achieve one’s goal). A still better way to say it is to say that killing the child is not built into the behavior which is being chosen, independent of what motivates that behavior, if the behavior is non-abortive.

    None of these “ways of saying it” are immune to distortion though.

    People often fall back on accounts of causality when discussing the PDE in these kinds of cases: that is, they will claim that if the death of the child does not cause the end of the cancer, the death of the child is not intended. And that is a perfectly valid claim, if the PDE applies in the first place. But again, the PDE only applies when the object of the act (the chosen behavior) is not evil in itself independent of what one is trying to accomplish in choosing that behavior.

    Another contemporary example which may help is condoms and AIDS (assuming a married couple where one has HIV, say from a blood transfusion, and setting aside prudential concerns, negligence, etc. for the sake of argument).

    The claim goes something like this: the reason the use of the condom is chosen is not to prevent fertility, but to prevent the transmission of the HIV virus. The prevention-of-fertility does not cause the prevention-of-virus-transmission, so the prevention-of-fertility is not (on this account) intended. In my understanding though that particular kind of intent is irrelevant unless and until it has been determined that the PDE applies in the first place. If the chosen behavior (note that a different sort of “intent” is present in choosing a particular behavior, e.g. choosing an act of condomistic sex) is immoral in itself, then it doesn’t matter why one is choosing that behavior; it only matters that one is (knowingly — the morality of the act does depend on the perspective of the acting subject) choosing that kind of behavior.

    Is that helpful?

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    Comment by Zippy | January 29, 2008 | Reply

  17. Jeff:

    I left a comment here earlier this morning answering your question. I could re-post it, but before I do, do you know what happened to it?

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    Comment by Zippy | January 30, 2008 | Reply

  18. Ah, and there it is. For some reason it wasn’t showing, despite refreshing the page, etc. Nevermind.

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    Comment by Zippy | January 30, 2008 | Reply

  19. Thank you, Zippy. Comments are moderated here and I just released yours. I don’t have time to respond fully this morning, but I promise to get to it. Earlier you wrote:

    That “foreseen” and “intended” are different is also not in dispute … So we all agree that forseen effects are different from intended effects, and we all agree that the principle of double-effect applies to some cases. None of that is at issue.

    A question, then: what kind of treatment in the scenario I outlined would be “non-abortive” if the death of the unborn child was forseen with moral certainty?

    Your last comment seems (to me) to make “intent” irrelevant, or at least unintelligible, in the sense used by Fr. Pavone and Msgr. Smith in the articles I quoted. Hmmm. Looks like we may be headed right back to the sterilization debate…

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    Comment by Jeff Culbreath | January 30, 2008 | Reply

  20. I thought the comment thing was odd, because it appeared immediately but then disappeared a few hours later.

    …what kind of treatment in the scenario I outlined would be “non-abortive” if the death of the unborn child was forseen with moral certainty?

    I can’t even discuss that intelligently, let alone render my own conclusion, without having a detailed medical knowledge about those kinds of cases which I don’t have (of the sort which underlies the salpingectomy/otomy distinction in cases of ectopic pregnancy, for example). The kinds of things which might be considerations include (for example) whether the treatment does or does not directly inject lethal poison into the child’s body.

    Also, it is worth noting that “[a]ll Catholic authors agree that salpingectomy is a licit application of the principle of double effect” overstates the case, though it is probably true that a majority of Catholic theologians who have examined the issue closely hold this, and I also think it is probably correct. For example in Kaczor’s book (IIRC) he discusses the issue without rendering a personal judgement, and goes on to say that it is probably a moot point since (unspecified) more modern and more obviously licit techniques are now available.

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    Comment by Zippy | January 30, 2008 | Reply

  21. Briefly (I hope!), another consideration in play here which is not in play in the case of salpingectomy is that it is at least arguable that we can do no better than the salpingectomy as far as the child is concerned. In cases like this one we are morally certain that the child is not in the process of dying, whereas an ectopic child is at least arguably in the process of dying: the child in our case here will presumptively live if the cancer is not treated and the mom dies from the cancer after delivery. (Indeed, that is precisely what actually occurred in this case). So whatever one thinks of the salpingectomy/otomy distinction (I know for example that Lydia is a skeptic), this kind of case is significantly more problemmatic.

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    Comment by Zippy | January 30, 2008 | Reply

  22. Sorry, but I need to address this too:
    Your last comment seems (to me) to make “intent” irrelevant, or at least unintelligible, in the sense used by Fr. Pavone and Msgr. Smith in the articles I quoted.

    But this is exactly the point: in the case of intrinsically immoral acts (such as killing the innocent or committing adultery or whatever), that kind of intent – the kind which answers the question “what are you trying to accomplish” as opposed to the kind of intent which answers the question “what behavior are you choosing” – IS irrelevant.

    The kind of “intent” which answers the question “what are you trying to accomplish?” becomes relevant only when the PDE applies, that is, when we have already determined that the behavior being chosen is not immoral in itself. To use that kind of “intent” in order to make that determination – the determination of whether or not the PDE applies – is fundamentally question-begging. Note that in describing the difference between -ectomy and -otomy as behaviors that kind of intent is not invoked: Pavone and Smith notably (and correctly) don’t say that -otomy is OK if what we are trying to accomplish is to save the mother, not to kill the child, because that kind of intent is irrelevant until we’ve gotten to evaluating the act under the PDE.

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    Comment by Zippy | January 30, 2008 | Reply

  23. Zippy makes a good point to the effect that the child can be expected to live if chemotherapy is delayed. I gather cases of this kind (cancer treatment) aren’t all that rare. That makes this a pretty much straightforward “life of the mother” issue–if the treatment causes the death of the child, and the child would otherwise have lived a normal lifespan though the mother would have died of cancer sooner than otherwise, we really are just pretty much choosing the chance at lengthening of the mother’s life over the child’s life. Or so it seems to me.

    Jeff, I gather the language “couldn’t do anything” means a kind of combined legal-moral “couldn’t.” That probably wd. obtain in the U.S., too, though here the fear of lawsuits would be a bigger factor. I assume from the wording that the NHS wouldn’t allow it in England, where medicine is state controlled. Yes, yes, it’s strange that they’d consider the abortion ethical but not the chemo on a pregnant woman. I’m in fact meditating a post on precisely this question–why do doctors think this way? I don’t really know, but my guess is that doctors have oddly tidy minds. They consider it unprofessional to do something destructive accidentally, but it doesn’t bother them nearly so much to do it on purpose!

    Bill Luse told me to take a look at this post. :-)

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    Comment by Lydia | January 30, 2008 | Reply

  24. I shd. add that I’ve done some additional googling on liver cancer, and apparently there are some stages that are more treatable than others. However, number of tumors is listed as a factor–more being worse, of course. The article on this lady refers to tumors in the plural, and the husband expressly says something like, “The were going to try to shrink the tumors and thought they might be able to give her two more years.” This doesn’t sound hopeful. Also, she began treatment apparently less than three weeks after diagnosis and was still dead within less than three months, which makes it pretty clear that she was in bad shape by the time the diagnosis was made.

    I just wanted to be as accurate as possible.

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    Comment by Lydia | January 31, 2008 | Reply

  25. I’d like to know Bill’s answer as well.

    I haven’t been purposely ignoring this thread. On the day of my last comment, I fell ill and have been essentially unconscious ever since. I’m still running on vapors, but can see the print through the fog.

    I may be differing with Zippy here slightly. He says the “key point on which the question turns” is that There is better than a 50-50 chance that non-abortive treatment for this cancer will save her life or extend it for several years. “Given that it is definitely a non-abortive treatment, the PDE would definitely apply.”

    On the face of it, yes, since the reception of chemo, unlike abortion, is not intrinsically evil. But this requirement of your scenario interferes with my leaving it at that: There is certainty (or near certainty) that this same treatment would result in the death of her unborn child. There is a huge gap between the parenthetical “near certainty” and its predecessor. If there is certainty, then I would think the chemo becomes the means of delivering death to the child and health to her. It is her chosen behavior to sacrifice the child for her own life’s sake. Even though the child is not the cause of her distress, and she does not consider it her intended target, it’s difficult to see how she can claim to be attacking the cancer and not the child. She has to go through the latter to get to the former. Under traditional PDE, the child’s death would be held a foreseen, but unintended, evil effect, which may be permitted with proportionately grave reason, i.e., the good effect outweighs the evil. Two things get tricky for me here. I don’t see how the child’s death can in any wise be considered an “accident”; secondly, we may indeed weigh good against evil effects, but one thing we may never do is weigh the value of one life against another. Hence my emphasis upon “certainty,” and which leads me to believe that in this case (under Jeff’s scenario) an ordinarily good thing – reception of chemo for curative purposes – is rendered evil by the circumstances applying to its administration; as, in the same way, other moral means of achieving a good end can be corrupted by the circumstances in which they occur – viz., the execution of a murderer tainted by cruelty, or intercourse between husband and wife rendered sinful by perverse practices.

    If the medical judgement is “less than certain,” then I would say that PDE most definitely applies, as it then falls to the mother to make a possibly agonizing prudential judgement concerning the level of risk to which she is willing to subject the child, though I would caution here against minimizing the gravity of that judgement and simply granting her carte blanche.

    I did not intend in any way to minimize this woman’s heroism. It would not surprise me to discover, if it were knowable, that she would have refused the treatment even if it had posed something far less than the threat of death for her child.

    I’m also unsure of the wisdom of editing your original post, unless you think readers will be clear as to what provoked the discussion.

    The fog is regaining the upper hand, so I must close.

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    Comment by William Luse | January 31, 2008 | Reply

  26. I may be differing with Zippy here slightly.

    Part of the problem is that the first premise in the scenario assumes the desired conclusion by stipulating “non-abortive treatment”. If it is a non-abortive treatment then simply by definition it falls under prudential evaluation; but that isn’t particularly helpful in terms of guiding concrete action, and it may well conflict with other parts of the scenario.

    Hope you feel better. Whiskey sometimes helps (I’m just sayin’).

    Like

    Comment by Zippy | February 1, 2008 | Reply

  27. I’m still swamped with work and can’t respond at length, but just so’s I understand:

    Is it your position (Bill and/or Zippy) that cancer treatment cannot be “non-abortive”, by definition, if the death of the child – as a *result* of the treatment – is forseen with certainty?

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    Comment by Jeff Culbreath | February 1, 2008 | Reply

  28. Isn’t there a danger here of just fiddling with the word ‘abortive’? For example, suppose a guy who knows that a woman he hates is pregnant shoots her in the head, on purpose, and kills her instantly, on purpose. I _guess_ we could say that that is “non-abortive.” I mean, it isn’t what one would normally consider an abortion, because an abortion is normally directed at the child rather than the mother. It would be an odd use of the term to say that the shot to the mother’s head is “abortive.” Okay, so suppose for the sake of using ordinary language in an ordinary way we say it’s “non-abortive.” But I would still for sure say that he murdered both the mother and the child.

    Similarly, even if we called the chemo-therapy “non-abortive” on ordinary language grounds, it doesn’t follow that it isn’t an act of deliberately killing the child, if you know for sure that it is going to kill the child. And in that case it doesn’t by definition fall under prudential judgement. In other words, do we want to say that any act that deliberately kills an unborn child is an act of abortion? It might seem that that’s a sensible thing to say, but when you get to cases like this–or even my woman-killer example–that’s not so clear.

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    Comment by Lydia | February 1, 2008 | Reply

  29. Is it your position (Bill and/or Zippy) that cancer treatment cannot be “non-abortive”, by definition, if the death of the child – as a *result* of the treatment – is forseen with certainty?

    I haven’t taken a definite position on either that or its contrary. Part of the problem is that “treatment” can mean almost anything. As I mentioned above, I’d have to look at a particular treatment in detail as the incarnate act of a person in order to make a judgement.

    But I’ll do a little thinking out loud for the sake of discussion.

    In the case of salpingotomy, I think the procedure is probably licit once the child is in fact dying or dead – that is, post- or imminent- rupture – and probably not before. I expect that salpingotomy at the first sign/diagnosis of an early stage ectopic pregnancy is really just killing the child as a moral matter; not “saving the mother and allowing the child to die naturally”.

    In a cancer case like this where the child is not dying, but something can be done to the mother’s body to treat the mother for an unrelated illness not bound up with the health of the child but which (the treatment) kills the child, who would otherwise live if nature took its course, I’m inclined to say that that is always morally wrong. There might be odd cases that appear to fit that general description where it isn’t the case though, and I’m really just spitballing without a better understanding of what is actually going on with the incarnate bodies of the human beings involved. Again, the reason -ectomy/-otomy is a paradigmatic case is precisely because it is (1) commonplace; (2) controversial (despite the categorical statement made by Smith above); (4) well understood as a physical matter; (5) relatively simple to explain to nonspecialists; and (6) specific enough as an incarnate embodied act upon persons to make it a good subject matter for discussion of these kinds of medical situations.

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    Comment by Zippy | February 1, 2008 | Reply

  30. Good comments by Zippy and Lydia, in which I concur.

    Is it your position (Bill and/or Zippy) that cancer treatment cannot be “non-abortive”, by definition, if the death of the child – as a *result* of the treatment – is forseen with certainty?

    No. Abortion is a very specific kind of procedure. Substitute “non-murderous” for “non-abortive” and it would convey my meaning. There’s more than one way to kill a baby. All offered, of course, with Zippy’s caveat in mind, that we know “what is actually going on with the incarnate bodies of the human beings involved.” Since the doctors would not offer her chemo while she was pregnant, I suspect we do.

    Whiskey sometimes helps (I’m just sayin’).

    I’m ready to try it.

    Like

    Comment by William Luse | February 1, 2008 | Reply

  31. Substitute “non-murderous” for “non-abortive” and it would convey my meaning.

    Note that in the discussion above I was presuming “non-abortive” to simple mean “non-murderous with respect to the child”. I interpreted the question as “if the treatment isn’t murdering the child, is the treatment murdering the child?” — the answer to which is a trivial no, by definition. So I think any differences between Bill and I on this in the above discussion have been purely semantic, not substantive. Precisely what is at issue is what specific behaviors constitute murdering the child. I expect that chemically poisoning the child to death concurrent to attempting to at least partially poison the tumors to death almost certainly constitutes murdering the child: all assuming Jeff’s premise that the child will definitely and knowingly be poisoned to death by the proposed treatment.

    Like

    Comment by Zippy | February 1, 2008 | Reply

  32. FYI.

    Like

    Comment by Zippy | February 1, 2008 | Reply

  33. Good distinction, Zippy, point taken.

    Like

    Comment by William Luse | February 2, 2008 | Reply

  34. To be fair, I’m not sure that the refusal of the doctors to give her the chemo while pregnant means that the child would have died. In fact, it’s part of that strange medical mental tidiness that they would likely have refused even if it had been likely to cause any health problems for the child at all. Again, though, they would have been willing to abort the child. I think the most the doctors’ refusal tells us for sure is that there was a significant probability of _something_ bad happening to the child, but actual death–I’m not sure. The lungs (and brain?) may present the greatest question; since chemo targets rapidly dividing cells, then whatever parts of the child’s body would be developing fastest in the third trimester might well be the part most likely to be harmed.

    But I could be quite wrong, and maybe indeed they would expect it to be fatal. I’m just pointing out that doctors are odd birds and might well have refused even if they did not expect the child to die as a result.

    Like

    Comment by Lydia | February 2, 2008 | Reply

  35. I think that Lydia’s last comment hits in on the head – I have dealt with pregnant women with various conditions (including breast cancer!) and I am always amazed at docs who won’t take the risk to the baby of using an effective treatment for the mom but are all too ready to recommend abortion. To me, it is a moral divide that is incomprehensible. It’s OK to kill a baby, but not to risk that the baby might have a birth defect or be a little slow? It is part of the real issue which is the culture of perfection.
    Right now I am labor sitting with a young woman who had surgery earlier in her pregnancy for an ovarian tumor, which thankfully was not cancerous. But even if it had been, we would have moved heaven and earth to find this woman treatment that would have helped both her and her baby…..
    Modern medicine seeks to create what is essentially a false dichotomy that separates the interests of the mother and child, placing them in conflict with each other. This is one of the most poisinous legacies of the masculine feminist movement (as opposed to the Mulieris dignitatum type of feminism).

    Like

    Comment by alicia | February 2, 2008 | Reply

  36. Thanks for the comments, everyone. I really appreciate the effort that has been put into this discussion, especially on Zippy’s part. I’m just going to chew on all of this for awhile.

    I wish I could say the discussion has clarified things … maybe it has for some of you. The arguments presented by Zippy and Bill really seem to make PDE a pure abstraction. Perhaps that’s as it should be, I don’t know. Assuming the truth of their arguments, I can’t imagine a situation in which PDE would be helpful to anyone on the ground, as a guide to moral decision-making.

    Part of the problem seems to be language. Zippy confessed:

    “Note that in the discussion above I was presuming ‘non-abortive’ to simply mean ‘non-murderous with respect to the child’. I interpreted the question as ‘if the treatment isn’t murdering the child, is the treatment murdering the child?’ — the answer to which is a trivial no, by definition.”

    Why this presumption? Abortion and murder are clearly two different things. Non-abortive does not mean non-murderous: it means non-abortive. Direct abortion is always murder, but murder is not always direct abortion. Furthermore, not every abortion is a direct abortion, and indirect abortion (so far as I understand) can sometimes be licit. That is, it is not intrinsically immoral and therefore requires other criteria to evaluate the morality of the act.

    More importantly, an act can be lethal without being murderous. It might be argued that a lethal act is also abortive, by definition, as applied to an unborn child. I can live with that, but it really misses the point. The point is to make a distinction between a direct abortion (which is always murderous) and a treatment that is lethal to the child but is not murderous.

    The object, circumstances, and yes the intent of an act determine whether a lethal act is in fact murderous. That an act is forseen to be lethal does not, in seems to me, automatically make killing the object of the same. As for eliminating intention (whether by fiat or by a thousand nuances) as a relevant consideration in determining the true object of an act, I still think such an approach requires that we dismiss more traditional Catholic thinking than authentic “development” really allows.

    Like

    Comment by Jeff Culbreath | February 3, 2008 | Reply

  37. “In a cancer case like this where the child is not dying, but something can be done to the mother’s body to treat the mother for an unrelated illness not bound up with the health of the child but which (the treatment) kills the child, who would otherwise live if nature took its course, I’m inclined to say that that is always morally wrong.”

    I apologize for forcing you into speculating on this, but I don’t believe that whether or not a human being is dying has any bearing on the morality of taking that person’s life. Perhaps you are thinking of certain end-of-life scenarios where ordinary care becomes extraordinary and may be withdrawn when death is imminent?

    But it seems to me that an act which procures the death of a human being is either murder, or it isn’t, without regard to whether that person is already dying.

    Like

    Comment by Jeff Culbreath | February 3, 2008 | Reply

  38. Why this presumption?

    Because abortion just is the murder of an unborn child, as far as moral evaluation is concerned. In addition, the semantic distinction is moot: if we know that an act is either murder or (more specifically) abortion it makes no difference with respect to permissibility, and precisely what is at issue is whether the act is permissible under the PDE: not what we label the act, but whether or not it is morally permissible.

    I don’t believe that whether or not a human being is dying has any bearing on the morality of taking that person’s life.

    Exactly. The argument for salpingotomy is that we aren’t taking the life of the innocent child, because if we were that would be murder: and murder is intrinsically immoral, that is, cannot be justified under the PDE. The child is dying of natural causes anyway, and cannot be saved.

    This does not apply in the case of a healthy child whose mother has cancer.

    The arguments presented by Zippy and Bill really seem to make PDE a pure abstraction.

    Definitely not, because I can (parroting Anscombe) point to real cases where the PDE applies. For example, even if we are morally certain that millions will die if we do not nuke the enemy’s civilian city, we are not morally responsible – because under the PDE the killing of those millions by the enemy is not indented by us – when we choose not to nuke the city.

    Now there are a great many different concrete scenarios out there where the PDE probably doesn’t apply even though licentious technologically-driven moderns think that it does; but it cannot be said that the PDE is a pure abstraction, because it very definitely applies to very definitely real situations.

    I expect that Lydia probably has the practical reality fairly well nailed. It isn’t that known treatments will definitely kill the child, it is that they are likely to cause nasty birth defects, and from the standpoint of modern medicine and legal practice it is “better” (which is to say more tidy) for the child to be dead and gone than for the child to have birth defects caused by the treatment. This is perhaps related to what I wrote about some time ago when I speculated about why people choose abortion over adoption. We moderns like things to be “clean”: to finish the job, dust off our hands of all responsibility, and move on to the next job. Death is better than lingering responsibility.

    Like

    Comment by Zippy | February 3, 2008 | Reply

  39. Typo: indented should be intended, which is to say I didn’t intend to indent.

    Like

    Comment by Zippy | February 3, 2008 | Reply

  40. “Because abortion just is the murder of an unborn child, as far as moral evaluation is concerned.”

    There are other ways of murdering an unborn child besides direct abortion. The whole crux of this discussion centers on whether chemotherapy, among other treatments, might be one of them in the scenario that I outlined.

    But what I am sensing is that you reject any distinction between abortion and other acts which might bring about the death of the baby. If a deliberate act results in the death of the baby, and the baby’s death is forseen with certainty, then it is by definition abortive in Zippy’s book – am I close?

    “The argument for salpingotomy is that we aren’t taking the life of the innocent child …”

    But Fr. Pavone states that the death of an innocent child is a “side effect” of salpingectomy. Msgr. Smith calls it an “indirect abortion” and “a legitimate application of double effect”. Do you also reject the distinction between direct and indirect abortion?

    “For example, even if we are morally certain that millions will die if we do not nuke the enemy’s civilian city, we are not morally responsible – because under the PDE the killing of those millions by the enemy is not indented by us – when we choose not to nuke the city.”

    Interesting application, where the “effect” applies to inaction rather than action. The “act” of not nuking the city is morally good, one of the forseen effects is evil, and so PDE applies. I get that. But does it not also apply in reverse? Let’s take a positive act of killing that is not murder, such as the killing of an aggressor – an aggressor who happens to be in the close proximity of innocents, and who cannot be stopped without harm to those innocents. If PDE doesn’t apply here (with all due regard to proportionality), then war is never justified and we are effectively pacifists, Catholic just war principles notwithstanding.

    Like

    Comment by Jeff Culbreath | February 3, 2008 | Reply

  41. “For example, even if we are morally certain that millions will die if we do not nuke the enemy’s civilian city, we are not morally responsible – because under the PDE the killing of those millions by the enemy is not indented by us – when we choose not to nuke the city.”

    Also – I don’t think this makes PDE any less abstract. The decision not to nuke a city is, in fact, the only moral choice. Applying PDE to this scenario is purely an intellectual exercise: nuking a city is intrinsically immoral, period. In actual practice, PDE is only helpful with respect to acts that are not intrinsically immoral, in which other criteria are needed to determine the morality of an act.

    Like

    Comment by Jeff Culbreath | February 3, 2008 | Reply

  42. This is an honest question: Is the term “principle of double effect” applied only when the undesired secondary effect is definitely expected? Or can it apply when there is merely a possibility, a concern, etc? If the latter, then there are of course _tons_ of cases to which it applies. In fact, it applies to nearly every accident that ever happens when one is trying to do something morally legitimate in itself. I drive my car, I get into an accident, someone gets killed. But I wasn’t trying to kill anyone, even though I knew there was some real but not high probability that a car accident would happen. Like that.

    Like

    Comment by Lydia | February 3, 2008 | Reply

  43. Do you also reject the distinction between direct and indirect abortion?

    I think that that language tends to be confusing. There isn’t anything that makes it necessary to interpret that language in a way which is inconsistent with Catholic moral theology, but some people certainly do interpret it in such a way. If “direct abortion” refers to every chosen behavior (object of the act) which directly kills the child then the distinction is consistent with the moral theology of VS, and is a valid distinction. If not, not. Double effect does not license one to choose to kill the child and then claim not to be responsible for directly killing the child.

    …such as the killing of an aggressor – an aggressor who happens to be in the close proximity of innocents, and who cannot be stopped without harm to those innocents. If PDE doesn’t apply here (with all due regard to proportionality), …

    If you had to (for example) saw off the head of an innocent person in order to get at the bad guy who was holding a detonator, then no, it would not be morally permissable to do that. People tend to think they have moral license to directly kill innocents as long as they are also trying to get the bad guy in the process. They don’t.

    This doesn’t render just war impossible, it seems to me, because all kinds of acts take place in a just war which do not involve directly killing specific innocent people. It is one thing to know that innocents – whom you cannot identify ahead of time – will accidentally die as collateral damage, and another thing entirely to, in one’s own act, directly kill an innocent.

    I don’t think this makes PDE any less abstract.

    By “abstract” I took you to mean not applying to any obvious concrete choices. A single counterexample of an actual concrete choice to which it applies is sufficient to put to rest the accusation of being abstract.

    As Anscomb points out, the PDE is necessary in order to preserve the very possibility of absolute moral norms. If the certain consequences of every choice are “intended” then the million deaths which result from refraining to nuke the city are intended. (A great many people argue precisely this with respect to the Hiroshima and Nagasaki bombings). If there is no PDE then when life faces us with choices in which all expected consequences of our choice are evil, we are literally incapable of refraining from doing evil, and God’s promises mean nothing.

    To turn this around in order to license directly killing the innocent is bad moral theology, whomever it may be who is promulgating it. I am willing to interpret (e.g.) Fr. Pavone’s words in a way consistent with Catholic moral theology, but it is certainly possible to interpret them in a way which is inconsistent with Catholic moral theology. Just about any sound bite or brief quotation can be interpreted multivocally; if you insist on an interpretation of Fr. Pavone’s sound bite that is inconsistent with the moral theology of VS then I definitely reject that interpretation. I might even disagree with him personally if we had a discussion about it; who knows?

    But if you think pacifism or abstraction of the just war doctrine to irrelevance is implied by the position I have rather carefully articulated (as far as I can tell merely parroting the authoritative Magisterium as best I can in the process), then all I can say at this point is that you don’t understand it. I’m not sure there is anything else useful I can say at this point.

    Like

    Comment by Zippy | February 3, 2008 | Reply

  44. “If there is no PDE then when life faces us with choices in which all expected consequences of our choice are evil, we are literally incapable of refraining from doing evil, and God’s promises mean nothing.”

    Yes, there are no real moral dilemmas. Literally, none.

    I can think of a couple of types of cases to which it seems to me some cousin (at least) of the PDE applies. I guess it’s just a matter of terminology whether you think of these as “real” PDE cases.

    Type 1: You undertake a risky attempt to save A’s life, without which you are justifiably sure that A will die. But your attempt kills him. Fill in the details as you like–aneurism surgery would probably be a good example. Now, here, you are marginally increasing or maybe even substantially increasing the probability that _that very person_ will live by doing what you do. And you have some hope of success, though it’s risky. His death is therefore not your fault. You were trying to help _him_. That makes a huge difference; it’s not “hey, A died as a result of my attempt to rescue B,” which can be a lot more morally questionable. There can’t be any question of your instrumentalizing A if the act that killed him was an attempt to save his own life.

    Type 2: Bad guys kill innocents–maybe even you–because you keep on doing some good thing that the bad guys have threatened you to try to get you to stop doing. E.g. Saintly nun runs the only clinic in dirt-poor country for miles around. Bad guys tell her, “Leave, or we’ll get you.” She stays to keep helping people; they kill her. There’s no question of her committing suicide by continuing to treat the sick. The act that killed her was entirely in the hands of a different, free person.

    Beyond that, it seems to me that I would be most likely to apply some version of the PDE when I really did not expect the bad thing to happen at all, when it was in the strictest and most ordinary sense an accidental side effect of some other innocent activity, as in the case of a car accident and a million others. But again, I’m not sure if you would want to call these PDE cases or not.

    Like

    Comment by Lydia | February 4, 2008 | Reply

  45. “This is an honest question: Is the term ‘principle of double effect’ applied only when the undesired secondary effect is definitely expected?”

    I would say so, Lydia. As I understand it, in order for PDE to go beyond abstraction or irrelevancy it needs to be an aid to moral decision-making. Moral decisions are made, in part, based upon forseen and expected effects. If the forseen effect of an act is evil, then the question arises of whether evil becomes the object of the act itself, or is simply a secondary effect. The answer to this question helps to determine the morality of the act.

    Like

    Comment by Jeff Culbreath | February 5, 2008 | Reply

  46. If the forseen effect of an act is evil, then the question arises of whether evil becomes the object of the act itself, or is simply a secondary effect.

    That doesn’t seem quite right as stated. An evil effect doesn’t “becomes” the object of the act in virtue of being intended. An evil effect can make an act with a morally neutral object evil if the evil effect is intended, either as an end or a means. But being intended doesn’t turn an evil effect into the “object” (chosen behavior) of the act. If I deliberately publish a website with volatile content on it which incites Muslims to kill a bunch of Christians, the Muslims killing the Christians – an effect I foresee from my act – doesn’t become the object of my act. My act is not intrinsically evil (it isn’t per se evil as a behavior to publish a website with volatile content or whatever): it is evil because I intend one of its evil effects as an end or a means. Object, intentions, and circumstances are different parts or modes of a human act, not things that “become” each other.

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    Comment by Zippy | February 5, 2008 | Reply

  47. “An evil effect can make an act with a morally neutral object evil if the evil effect is intended, either as an end or a means. But being intended doesn’t turn an evil effect into the ‘object’ (chosen behavior) of the act.”

    I’m with you, but it seems that you disagree with Bill, who wrote: “It’s not a secondary effect if you know for a certainty that it will result. It becomes the object of your act: to kill another to save yourself.” Clearly I’m losing track of who holds which argument on your side of this conversation …

    Like

    Comment by Jeff Culbreath | February 5, 2008 | Reply

  48. “By ‘abstract’ I took you to mean not applying to any obvious concrete choices.”

    That’s right, that’s exactly what I meant.

    “A single counterexample of an actual concrete choice to which it applies is sufficient to put to rest the accusation of being abstract.”

    But your counter-example was not an example of an actual concrete choice. Why? Because the choice should be made on other grounds having nothing to do with PDE. You don’t nuke entire cities, not because PDE persuades you, but because nuking a city is intrinsically immoral, period. PDE doesn’t give anyone license to do what is intrinsically immoral. PDE is irrelevant to the question of whether to nuke a city.

    PDE seems to be useful – to apply to actual concrete choices – only where the act itself is moral, or at least neutral, but is susceptible to mitigation by secondary effects. These secondary effects can loom so large as to seem to cancel the goodness of the act itself. Therefore I would surmise that proportionality is important here – the secondary effect, if evil, must not be greater than the good accomplished by the act itself, whose object must not be contrary to divine or natural law.

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    Comment by Jeff Culbreath | February 5, 2008 | Reply

  49. But your counter-example was not an example of an actual concrete choice. Why? Because the choice should be made on other grounds …

    Maybe you mean that it can be justified on other grounds.

    I’ll give a different example if you don’t like that one. Say the act is “order your platoon to march up that hill”. One may do this under the PDE even knowing with moral certainty that some members of your platoon will be killed: you aren’t (necessarily: see David/Uriah) murdering the members of your platoon, even though their deaths are a directly foreseen effect of your act.

    Clearly the PDE applies to many real, concrete acts. It just doesn’t apply to all the acts that people want it to apply to. The fact that it doesn’t apply to all the acts people want it to apply to doesn’t render it “abstract”.

    Therefore I would surmise that proportionality is important here – the secondary effect, if evil, must not be greater than the good accomplished by the act itself, whose object must not be contrary to divine or natural law.

    Be careful here: what Aquinas means by “proportionality” is that the act is proportioned to its end, not that good effects outweigh bad effects under some “ten lives are more valuable than five” kind of evaluation. E.g., if you can easily and certainly stop the terrorist by shooting him in the leg then it would be immoral to blast him to Kingdom Come with a bazooka.

    Both “kinds” of proportionality do enter into prudential moral evaluations, but it is important to distinguish between them.

    Like

    Comment by Zippy | February 5, 2008 | Reply

  50. depending on the chemo and because it is mentioned in the article that she would not have started chemo until after a few weeks of healing a c-section (which she did not have so she was able to start right away) is the possibility that the chemo would have caused severe harm to the pregnancy and then also jeapordizing the mother as well and then you have no justification at all to start that particular course. What I mean is that if she had to undergo surgery while under treatment you risk her life proportianally more than living out the last stages of cancer. So it may be that the doctors saw this choice of abortion as the only one which in the end really was a non choice.

    But I learned alot in this discourse of yours!

    Her heroisim is obvious in her eyes!

    Thanks for this beauty of life
    a first time reader (found you off Amy’s)
    JennE

    Like

    Comment by jennifer | February 23, 2008 | Reply


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