The Holy Office, May 4, 1898, again decreed: "Necessitate cogente, licitam esse laparotomiam ad extrahendos e sinu matris ectopicos conceptus, dummodo et foetus et matris vitae, quantum fieri potest, serio et opportune provideatur."[104] This decision was not clearly understood, and on March 5, 1902, the same congregation reported the following question: "Is it ever licit to remove from the maternal pelvis an ectopic fetus which is still immature; that is, which has not yet completed the sixth month after conception?" The answer was, "No; according to the decree of May 4, 1898, which prescribes that the life of the fetus and the mother must as far as possible be carefully safeguarded. As to the time, according to the same decree, the questioner will remember that no premature delivery is permissible unless it is effected at such a time and by those methods which in ordinary circumstances safeguard the life of the mother and fetus."[105] [104] "In a case of necessity, it is licit to do a laparotomy for the removal of an ectopic gestation sac from the maternal pelvis, provided the life of both fetus and mother be carefully safeguarded." [105] "Negative, juxta decretum 4 Maii, 1898, vi cujus, foetus et matris vitae, quantum fieri potest serio et opportune providendum est: quod vero tempus, juxta idem decretum, orator meminerit, nullam partus accelerationem licitam esse, nisi perficiatur tempore et modis, quibus ex ordinarie contingentibus, matris ac foetus vitae consulatur." If the fetus is removed and so killed to avert a threatened danger to the maternal life, but not an actually operative destruction of her life, this removal or homicide is an evil means used to avert the danger. There is no question of a double effect, that is, of two effects, one good and the other evil, coming with equal directness from the cause, which is the removal or killing of the fetus; but of a good effect, the averting of the danger to the mother, issuing from an evil cause, the removal and death of the fetus. A good effect does not justify the use of evil means; it is not permitted morally _directly_ to kill the fetus, as in this case, to save the mother from a _threatened_ grave danger. The case is not like that of the woman who has an operable cervical cancer while she is bearing an inviable fetus. If the cancerous uterus is not removed the woman will surely die; if it is removed she has a reasonable chance of cure; but if the inviable ectopic fetus is not removed it is by no means certain that the woman will die. In the cancer the uterus is directly removed, the fetus is indirectly killed; in the ectopic case the fetus is directly killed, and the danger to the woman's life is removed as a direct effect of the killing.