2. If it is done to safeguard a wife with a narrow pelvis it is a means, evil in itself, used directly to effect a good end; and a good end, or any end or effect, never justifies a direct evil means or cause. There is in reality no such thing as a good effect from an evil means or cause; the evil means or cause essentially and substantially vitiates the effect. There is no question here of a double effect, one good and one evil, wherein the good effect is intended and the evil permitted, both coming with equal directness from the single causal act. On the contrary, from the vasectomy here there is the single direct effect that the man is sterilized, and then directly from this sterility comes the desired effect, the protection of the wife. For exactly the same reason, vasectomy done to prevent the transmission of a hereditary disease is illicit; it is an evil means used directly to effect an end intended. In artificial abortion when the fetus is inviable the act done is to empty the uterus, and this act itself kills the fetus, which is not an unjust aggressor, and is murder. This murder may save the mother's life, but the end does not justify the means. The vasectomy to protect the mother's life or to avert an evil heredity is a parallel case.[245] [245] See the chapter on General Principles concerning Mutilation for an explanation of the act with a double effect. The fourth case supposes that the vasectomy was done to cure the man of some malady. If there were a malady that endangered the patient's life, or destroyed the health of the body and it could be cured by vasectomy, the operation would of course be licit for the reasons given in the chapter on General Principles concerning Mutilation. Dr. Carrington tells us[246] that he did vasectomy on an epileptic convict and cured him. Such a cure is doubtful as to permanence. He describes two dangerous insane negro homicides who were rendered harmless by vasectomy. In cases like those of the homicides any one responsible for them would probably be justified in having the operation done, although these two cases are the only direct ones on record. Epileptics sometimes show a homicidal tendency, but it is doubtful that vasectomy would help them. The operation of vasectomy as a cure for bodily ill has a very limited field. There are very many conditions in women where it is necessary to remove the ovaries or the tubes to save life, or to cure chronic invalidism of an unbearable nature. These conditions are discussed in the chapter on Gonorrhea. There is no objection to the removal of a tube or an ovary when such removal is absolutely necessary, but the necessity must be clearly evident. There is a tendency in some surgeons to mutilate women in this manner without sufficient reason or to follow out a therapeutic theory. [246] _Virginia Medical Semi-monthly_, vols, xiv, xv.