The Deacon's Bench

The Deacon's Bench


Nun approved abortion at Catholic hospital

posted by jmcgee

The circumstances were extraordinary — and the decision, I’m sure, was not easy to make. But the result has sparked a growing controversy in Arizona, where even the bishop has now intervened.

From the Arizona Republic:

A Catholic nun and longtime administrator of St. Joseph’s Hospital and Medical Center in Phoenix was reassigned in the wake of a decision to allow a pregnancy to be ended in order to save the life of a critically ill patient.

The decision also drew a sharp rebuke from Bishop Thomas J. Olmsted, head of the Phoenix Diocese, who indicated the woman was “automatically excommunicated” because of the action.

Neither the hospital nor the bishop’s office would address whether the bishop had a direct role in her demotion. He does not have control of the hospital as a business but is the voice of moral authority over any Catholic institution operating in the diocese.

The actions involving the administrator, mostly taken within the past couple of weeks, followed a last-minute, life-or-death drama in late 2009. The patient had a rare and often fatal condition in which a pregnancy can cause the death of the mother.

Sister Margaret McBride, who had been vice president of mission integration at the hospital, was on call as a member of the hospital’s ethics committee when the surgery took place, hospital officials said. She was part of a group of people, including the patient and doctors, who decided upon the course of action.

The patient was not identified, and details of her case cannot be revealed under federal privacy laws.

The Catholic Church forbids abortion in all circumstances and allows the termination of a pregnancy only as a secondary effect of other treatments, such as radiation of a cancerous uterus…

<snip>

…According to the medical directives that the hospital follows, abortion is defined as the directly intended termination of pregnancy, and it is not permitted under any circumstances – even to save the life of the mother.

On the other hand, a second directive says that “operations, treatments and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman are permitted . . . even if they will result in the death of the unborn child.”

A letter sent Monday from Catholic Healthcare West, signed by Sister Judith Carle, board chairwoman, and President and CEO Lloyd Dean, asks Olmsted to provide further clarification about the directives. Agreeing that in a healthy mother, pregnancy is “not a pathology,” it says this case was different. The pregnancy, the letter says, carried a nearly certain risk of death for the mother.

“If there had been a way to save the pregnancy and still prevent the death of the mother, we would have done it,” the letter says. “We are convinced there was not.”

Visit the link for more, including some opinions from medical ethicists.

UPDATE: The complete statements by the hospital and the Diocese of Phoenix can be read right here.



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Fiergenholt

posted May 15, 2010 at 6:28 am


A few years back, our local deacon preached on the life-choices of St. Gianna. After that mass, I listened-in on a conversation between him and one of our local religious sisters. She wasn’t all that comfortable about the growing veneration of St. Gianna. Then, after reading this post, I am beginning to wonder if there isn’t a gender difference here? And, if there is, why is that? Do men and women — especially religious women and ordained male clergy — have a different set of values when it comes to defining evil?



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Mary

posted May 15, 2010 at 7:23 am


I don’t think it’s a gender thing at all. People are different and each person will come at this and other difficult questions in their own way. I am staunchly anti-abortion, I used to be incredibly judgemental toward women who had abortions. As a social worker hearing more and more of their stories, I changed my views on the people who choose to have an abortion – but not on abortion itself. I was working at a Catholic Social Service agency where people don’t come prior to the abortion but seek counseling for many issues, in particular Post Traumatic Stress. So, there were many on my caseload with this as an issue or contributing one. In particular, I had one case in which I know I would have seriously considered an abortion myself if I were in that persons shoes. Would I have – I don’t know I thankfully never had to be in that position or make a choice. I thought her choice was agonizing and she was still agonized over having to make it.
In the case Deacon Greg has shared, the decision is about your own life. I think it is the case that few of us would want to make the choice to die. Should we? Yes? But would we? I worked at a Cancer Center – people fight for life. The above decision is wrong but I won’t throw the first stone and, I don’t think women make different choices about sacraficing their lives than men do. Few of us want to sacrafice and few of us have enough faith to know that the sacrafice is worth it. Instead we are terribly frail and human. And that’s why St. Gianna is a saint. And, perhaps the meaning and reward of the sacrifice made should be emphasized in the discussions as opposed to the evilness of it. It is evil but how often do we read about the graces of one’s sacrifice of life?



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Margaret Lawrence

posted May 15, 2010 at 10:45 am


This is nothing new. Pregnant, I was admitted to a Catholic hospital back in the ’60′s and the nuns were wheeling me in to surgery for an abortion when a doctor stopped them and asked them if they had checked for a heartbeat. They told him with the amount of bleeding the baby was obviously dead. He stopped them, examined me, stopped the bleeding and my daughter is now 42 years old.



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hlvanburen

posted May 15, 2010 at 10:49 am


Also from the story:
“Catholic teaching, he said, is that a pregnancy cannot be terminated as a means to an end of saving the life of a mother who is suffering from a different condition.
Asked if the church position prefers the mother and child to die, rather than sparing the life of one of them, Walters said the hope is that both would survive.”
Read more: http://www.azcentral.com/arizonarepublic/news/articles/2010/05/15/20100515phoenix-catholic-nun-abortion.html#ixzz0o0f8qvq9



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Gerard Nadal

posted May 15, 2010 at 11:58 am


Deacon Greg,
This past March I attended the bioethics conference hosted by the Bioethics Institute at Franciscan University in Steubenville, Ohio. At table for dinner one night were several physicians and the director of the Institute, Dr. Patrick Lee.
As we were talking, I mentioned that I had plans to write an article about the principle of double-effect and abortion, and the cases that may fall outside of double-effect that still threaten the life of the mother. I asked straightforwardly if these physicians knew of any such medical conditions. To a person they all said that there were none, given that we can take babies at 25 weeks through C-section which gives them a fighting chance at life.
That’s more than can be said if they are aborted.
I pressed the physicians further and said that I needed to know if there were ANY conditions at all that would warrant abortion to save the mother prior to 25 weeks of gestation, NOT covered by double-effect. One of the physicians said,
“There are none, Gerry. Write the article.”
The others all nodded their agreement. I haven’t written the article yet, but you have the scoop. Thanks for a good post.



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LHJ

posted May 15, 2010 at 12:31 pm


This is a bit off-topic for the article, but related to the ethical question involving abortion to save life. Twin-to-twin transfusion syndrome is something I’d never heard of until I became pregnant with twins who developed this unusual condition in which identical twins share a blood supply unequally. Each case is unique, but there are situations in which the imbalance of the blood supply is so unequal that the life of one twin is placed at risk, and the death of one twin in utero would cause an immediate risk to the life of the other because their blood supplies are connected.
There are prenatal laser surgery techniques available, but they dance into the realm of abortion ethics and law, especially as the pregnancy progresses, because severing connecting blood vessels to save one baby could jeopardize the other, but doing nothing could mean the loss of both.
As a mother who desperately wanted both of her babies, and who could not begin to imagine carrying both while only one was still living, it was truly overwhelming to factor in the legalities on top of the medical and ethical issues. While we were able to buy time and were blessed with two little boys, very early, but very much alive, I feel great compassion for those confronted with a different outcome.



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pagansister

posted May 15, 2010 at 2:42 pm


The nun was doing what she thought was right, given the circumstances. Now she is paying (paid) the price by being a woman who saved the life of another woman,(at least for awhile) by having the RCC “excommunicate” her. Good thing there are other religions she can belong to…more forgiving ones. I admire what the Sister did…used her best judgement call, along with the others who were involved with the decision. Abortions are sometimes necessary…but from what I understand, the fetus is more important than the mother in cases where one has to die to save the other!
In a perfect world, there would never be a need to make a decision like she had to make, but I have a feeling that those decisions are made everyday, somewhere.



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romancrusader

posted May 15, 2010 at 6:09 pm


Paganister,
the catechism disagrees with you.
2272 Formal cooperation in an abortion constitutes a grave offense. The Church attaches the canonical penalty of excommunication to this crime against human life. “A person who procures a completed abortion incurs excommunication latae sententiae,”77 “by the very commission of the offense,”78 and subject to the conditions provided by Canon Law.79 The Church does not thereby intend to restrict the scope of mercy. Rather, she makes clear the gravity of the crime committed, the irreparable harm done to the innocent who is put to death, as well as to the parents and the whole of society.



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Klaire

posted May 15, 2010 at 6:25 pm


This is truly about as hard as it gets, at least IMO. I am staunchly pro life, and have written many times that abortions necessary for “the life of the mother” are almost non existent. This may well have been that 0.001 percent exception.
Pulmonary Hypertension is very serious and life threating, and even worse, this women was only 11 weeks pregnant. That means she had at least 4 months to go before a C-section would have been an option. She truly would have needed a team of experts (MD specialists) if there was any chance of either of them living (short of Divine Intervention).
I have to wonder if insurance was a factor. Since no info is given, we have to wonder if she was a rich women from Scottsdale or a poor imigrant sans insurance.
My guess this was a case more about cost than about being able to provide the medical care. Regardless, its never ok to “save the mother only”, although as mentioned, the church does allow “treatment to save the mother” which may have the consequence of death to the baby. An ectopic pregnancy would be such an example.
For what it’s worth, my neighbor just had a similar situation, except she was in her 9th month. She did have the baby, but had a heart attack after delivery, a very common thing to occur with this condition in pregnancy. She was in intensive care for a week, but now is fine (to the extent she has some minor heart damage).
These decisions are anything but easy. Even though many may know what the church teaches, it doesn’t guarantee that all will have the grace to follow it. On the other hand, I could write about countless situations where women of deep faith, in similar situations,put their trust in God and all ended well and beautiful.
As for the nun, objectively she was certainly against church teachings, even without knowing all of the facts about the mother.
Regardless, it’s a very sad situation for all involved.



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SMcG

posted May 15, 2010 at 7:19 pm


It doesn’t do to guess or assume in any situation. The only people who know for sure what the particulars were are the people directly involved. The only entity whose judgement counts as far as anyone involved in this situation is concerned is God.
Otherwise, it’s just not a bunch of strangers’ business. Frankly, I think it’s sinful to assume or guess anything about a private situation you have absolutely zero personal knowledge of.
Period.



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Eka

posted May 15, 2010 at 7:39 pm


Way too little information here about all of the circumstances for any of us to judge decisions made by mothers, doctors, ethicists and bishops…pray for them all.



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Klaire

posted May 15, 2010 at 8:39 pm


Eka and SMG:
We don’t need to know the details to know what the church “objectively” teaches. As Catholics, that’s “objective truth”, regardless of the situation(s).
It’s motives and hearts we aren’t to judge, certainly not objective truth.



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ds0490

posted May 15, 2010 at 10:19 pm


“Way too little information here about all of the circumstances for any of us to judge decisions made by mothers, doctors, ethicists and bishops…pray for them all.”
But Gerard “Dr. Remote Control” Nadal has assured us that there are NEVER any instances where the mother’s life is threatened by a pregnancy before the 25th week of gestation. So we can be absolutely certain that the mother in this case was wrong, as were the attending doctors, ethicists, and the administration of the hospital who were looking at the medical records of the woman in question. After all, in Catholic medical circles, looking at patients and studying medical evidence is not needed. All the attending physicians need to do is to check Catholic teachings in the Catechism and act accordingly.
After all, if the woman and the baby both die, it’s clearly God’s will, and who should interfere with God’s will? Certainly not a Catholic doctor.



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SMcG

posted May 15, 2010 at 10:41 pm


Klaire, you were assuming and speculating all sorts of things about the woman’s financial status, the cost of any other medical options, and the motivations of the woman’s healthcare providers (and the nun in question) based on those purely fictional and assumed factors.
The Church teaches what the Church teaches.
Only God knows the full truth about anything. Only God knows the hearts and minds of his children.
That’s all that needs to be said.
Gossiping about this woman and this nun and the medical personnel involved is just that: gossip.



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Gerard Nadal

posted May 16, 2010 at 1:38 am


Deacon Greg,
I really don’t mind the fact that ds0490 is so blinded by hatred of the Church, that he/she can’t grasp the nuances in my post, but the commentary about child abusers seems to place us right back to the sort of Church-bashing, incendiary invective that you have banned after a two-week cool-down.
If that’s allowed to stand, count me out. Rod Dreher promotes that sort of thing, so it’s not like ds0490 is bereft of a home for hatred.
[You're right, Gerard. I just deleted it. Dcn. G.]



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Klaire

posted May 16, 2010 at 7:04 am


SM I’m not assuming anything, clearly noting that we don’t have all of the facts regarding the situation of the mother. Regardless, as you well said, “The church teaches what the church teaches”, and I will add, “For good reason.” Consequently, it is NEVER ok to directly kill a baby, for ANY reason.
I question if you know the difference between “news and gossip.” Did it ever occur to you that some or many reading this tragic story will offer both prayers of reparation and healing for all involved, in addition of course for God’s mercy on the aborted baby?



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SMcG

posted May 16, 2010 at 10:38 am


I do know the difference between news and gossip. Reported facts are news. Speculation on the whys and wherefores behind the very personal decisions of people we do not know is gossip.
Adding a disclaimer that we don’t know all the facts…BUT…and then going on to speculate and assume is like saying I don’t mean to offend…BUT…and then following it up with something clearly offensive.
We don’t know the facts. At best, all we can really discern from this story is that regardless of what the Church teaches on paper and how things actually play out in real people’s lives are two very different things. Teachings on paper are black and white. Real life contains myriad shades of grey.
Asking someone to essentially commit suicide in order to supposedly protect the life of a non-viable fetus (who, at the stage of the pregnancy in question, would not survive if the mother dies) is as morally reprehensible as electing to have an abortion for much more cavalier reasons.



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Steve D

posted May 16, 2010 at 3:18 pm


One of the inconsistencies that I have found is that Pro-Lifers are pro-life when it comes to the embryo/fetus/unborn child. Not when it comes to the life of the mother. I agree with SMcG, the unborn child had no chance of survival, whereas, the mother did have a chance without the child.



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pagansister

posted May 16, 2010 at 3:56 pm


romancrusader: “the catechism disagrees with you”.
Of course it does. I figured it did when I wrote my opinion. However, the Sister knew what she was doing. I give her credit and admiration for following what SHE believed was right at the time, as I mentioned above. I would expect she didn’t make the decision lightly. If one truely believes in a compassionate God, then she/he would understand. However she “broke the rules” so she got booted. No compassion exhibited there, huh?



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Laura

posted May 16, 2010 at 5:26 pm


I certainly hope that the embryo was baptized so that it is rid of Original Sin and can spend all of eternity in the Loving Arms of our Lord, JEsus Christ. Limbo is not a nice place.



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SMcG

posted May 16, 2010 at 5:36 pm


Laura, “limbo” isn’t any place at all — there is no limbo, no doctrine or dogma about limbo, nada, nothing, because this never was, has been, or will be Catholic teaching. That the Church has to continue to come out and reiterate the fact there is no limbo time after time, even in this day and age, only speaks to the tragic amount of misinformed, superstitious people out there who really and truly believe this is Church teaching.



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romancrusader

posted May 16, 2010 at 5:57 pm


“Of course it does. I figured it did when I wrote my opinion. However, the Sister knew what she was doing. I give her credit and admiration for following what SHE believed was right at the time, as I mentioned above. I would expect she didn’t make the decision lightly. If one truely believes in a compassionate God, then she/he would understand. However she ‘broke the rules’ so she got booted. No compassion exhibited there, huh?”
Perhaps that’s because you don’t view abortion as a violation of human rights.



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Steve D

posted May 16, 2010 at 6:10 pm


@romancrusader
“Perhaps that’s because you don’t view abortion as a violation of human rights.”
And the mother’s rights? Did she give them up when she got pregnant?



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SMcG

posted May 16, 2010 at 6:18 pm


Given what little we do know, it would seem the two choices would be a)abort the baby and save the mother or b) refuse to abort the baby and both mother and baby die.
How is ‘a’ then not the only moral choice?
Also, the only thing that matters is God. An institution can excommunicate members based on their limited and flawed understanding of a situation, but no human being or institution can excommunicate another individual from God Himself.
I never worry about these excommunication things because it’s all so silly and sort of pathetic — all these men running around deciding who is and who isn’t worthy of God. As if their opinion matters one whit in God’s eyes. Although



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SMcG

posted May 16, 2010 at 6:22 pm


*Although the excommunication proclamation might cause undue stress on an already emotionally and physically traumatized woman.



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BobRN

posted May 16, 2010 at 7:36 pm


Given what little we do know, it seems as imprudent to speculate that the choices involved were limited to only two as it is to speculate that there were dozens of choices from which to choose.
But we do know these facts: Sister was working at a Catholic hospital, and she knew it. She also knew of the Church’s opposition to direct abortion, even in cases where the mother’s life is in danger. Given that, she shouldn’t be surprised by the bishop’s actions, or the actions of the hospital to “rebuke” her for her actions. In my reading of the article, I failed to note where Sister protested the bishop’s statement or the hospital’s decision regarding her status. Perhaps this is because she wasn’t surprised by them. But we don’t know that.
We also know that the hospital’s claim is that the choice was one of life or death. We know that the article says that the remedy for the mother’s life-threatening condition was the killing of the unborn child. We know that there is debate among ethicists and within the medical community about whether or not the circumstances exist where the only option for saving the life of a pregnant mother is to kill her fetus. Is there a medical/moral difference between saying that and saying that the pregnancy is the cause of the mother’s life-threatening condition? It seems not, which opens up another whole can of worms, if we’re willing to use that language as justification for direct abortion.
What we don’t know is: Why was the mother at this particular hospital? What was her condition? How emergent was the situation?
Given what we don’t know, we can hardly condemn that actions of the bishop or the hospital in rebuking Sister. The Church’s teaching is clear. Sister knew that.
The line of demarcation in this case, as in pretty much every case re: abortion is the identity of the one in the womb. If the one in the womb is not a human life, abortion is a usually minor medical procedure with little moral implications. If the one in the womb is a human life, direct abortion is the direct killing of an innocent human life, and the circumstances do not exist that justify it.
SMcG, your contention that the only relationship that matters is the one between God and the individual is perfectly reasonable — for a non-Catholic believer. However, we’re talking about a Catholic bishop, a Catholic sister, and a Catholic hospital. So, it’s not clear to me how your comments are helpful.



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SMcG

posted May 16, 2010 at 7:56 pm


Well, I’m sure they’re not helpful to you, but what does that matter?
The patient was involved in this decision as well, according to the story. This was not an unexpected or unwanted pregnancy, otherwise she would most likely have gone to an abortion clinic and aborted the fetus. She most likely wanted this child very much and would have welcomed an alternative that would have allowed the pregancy to continue.
I can only accept the claim this was indeed a life and death situation and that this patient was indeed in critical danger of losing her life should the pregnancy continue.
Under those circumstances, and you can call them hypothetical if you wish, there is little difference here than the decision to remove an ectopic pregancy (allowable according to Church teaching) in order to save the mother’s life.
The most important relationship, IMO, anyone can have is their relationship with God. If a person places their relationship with the flawed, imperfect humans who run the Church here on earth before their relationship with God, they are engaging in idolatry, IMO.
God is clear on that issue. Nothing comes before God.
It would be dishonest of me to blindly follow what someone else tells me I must think in order to remain in _their_ good graces rather than to bring my doubts and concerns to God Himself and then follow my conscience. I can’t do that. If I go to hell because I cannot lie to God, then so be it. I take these matters seriously and I will not allow myself to be bullied into pretending to believe something I don’t or cowed into being dominated by other humans.



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Steve D

posted May 16, 2010 at 8:40 pm


@ BobRN
“What was her condition? How emergent was the situation?”
What has been published by the AP via different websites is that the condition was pulmonary hypertension. Now I am a lay person when it comes to medical issues, however a quick look up of pulmonary hypertension in Wikipedia finds the following quote:
“Levels of mortality are very high in pregnant women with severe pulmonary hypertension”
This line was footnoted as follows:
“Kelley’s essentials of internal medicine. Hagerstwon, MD: Lippincott Williams & Wilkins. 2001. pp. 84. ISBN 0-7817-1937-2.”
Based on the diagnosis that is reported by the AP, the Sister and the ethics committee may very well have seen the situation as urgent, if not emergent.
The treatment for pulmonary hypertension includes drug therapy and surgery. Some of the drugs mentioned could have potential hazards for the unborn child.
While I understand your concern for the unborn child, I feel that there can be another view that has not been discussed. If the woman was going to be treated for her presenting problem, the cure might have also done damage to the child and/or put the mother at further risk.
The real ethical issue is not how the mother came to be at that hospital. The ethical issue is did she and her child get THE BEST CARE POSSIBLE. This happens to be a case (as presented) where there are no good choices. Tragically, at 11 weeks, this child could not have survived without a mother and a womb. Therefore, if the mother was allowed to die, the child would have died as well. Contrary to what I have read in some posts here and elsewhere, the choices presented were not black and white.
If you are a medical professional, then I’m sure that you understand that this type of moral dilemma is somewhat common to the medical profession. In many ways, it is a textbook classic medical ethics issue that happened for real.
In many ways I have gained much respect for the Sister. She made a tough decision and has not complained publicly about the consequences.



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panthera

posted May 17, 2010 at 2:18 pm


A sane person would want that sort of person IN the Church, not kick them out.
That was a poor decision and lacking in both judgment as well as charity.



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pagansister

posted May 17, 2010 at 4:54 pm


romancrusader:
Your response was to be expected. I’m not going to get into the famous debate of “when does life begin” etc. I’m also not going to debate as to when a fetus is viable outside the womb. With modern medicine, fetus’s that would have died now survive…many with lots of problems. IMO, if a termination is done, the woman should make up her mind before the end of the 3rd month. In the case of a medical problem..save the fetus or the woman….each case is different and has to be decided on a case to case basis, like the Sister did. The “we hope to save both” is a crock.
Basicly, it is ultimately the woman’s decision, her human right to do as she feels necessary with her own body. Not hard at all.



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Conservative

posted May 17, 2010 at 5:25 pm


I thought the Bishop’s statement made it quite clear. A direct abortion is never permitted no matter what the circumstances. The child’s life is just as valuable as the mother’s.
I think Sister has a lot of praying to do.



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SMcG

posted May 17, 2010 at 5:32 pm


The mother’s life is just as valuable as the child’s, and since both her’s and the child’s were at stake and there was no possible way to save the child’s, then the only moral thing to do was to save hers.
Anything else is cold-blooded, calculated murder on the part of the Catholic Church.



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ALT

posted May 17, 2010 at 5:34 pm


The issue is pretty clear. As tragic as this situation was for all of those involved, the Church’s teaching regarding this issue is clear. The direct and intentional taking of an innocent human life from the moment of conception until natural death is always, everywhere and in every case a grave moral evil. This sister, as a Catholic ethicist, knew this very well and so cooperated in something that we believe is always forbidden. Her entire responsibility is to help the Hospital retain Catholic values and ethical principles. She violated the very reason she is there in the first place. So, whether the commentators on this page are in favor of the Church’s teaching regarding this matter or not is of little consequence. Catholic institutions have a right and a responsibility to live our values as they serve the community. To do otherwise is no longer to be a Catholic institution.
Regarding the poster who said this is no different from ectopic pregnancy: You are mistaken the moral content of acts and confusing it with the outcome of acts. While Tubal Ligation and direct abortion both result in the child’s life ending, they are of a completely different moral content. In one case, it is the direct and intentional killing of a child. In the other case, it is the unintended consequence of a medical procedure. Morality and ethics are not merely concerned with outcomes.



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Conservative

posted May 17, 2010 at 6:10 pm


SMcG unless you have an STD in Moral Theology from some Pontifical University, I would suggest you refrain from making moral proclamations. I think your comment on the Catholic Church was the kind of comment that got comments suspended here.
In your spare time maybe you could read up on the Catholic Catechism or maybe just the story of Saint Gianna Molla.



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SMcG

posted May 17, 2010 at 6:23 pm


Conservative — would you die to save another human being, even if that human being is an 11 week old fetus that will never live to see the light of day as soon as you die?
Would you do that?
Oh, sure, you’ll SAY yes, because you’ll never, ever be in that position.
That’s why your opinion and the opinion of men who cannot suffer the same consequences they would force others into don’t mean a thing to me.



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BobRN

posted May 17, 2010 at 9:46 pm


The reason why the mother came to be at that hospital is a relevant question is because that hospital is an institution willfully associated with and claiming fidelity to the moral teachings of a faith tradition that condemns the direct destruction of innocent human life. That hospital is being placed in a position of whether or not to participate in the direct destruction of an innocent human life. Is it moral to demand that this institution, and those who work there, displace their moral convictions under these circumstances?
Obviously, individuals who are not willfully associated with or claiming fidelity to that tradition are not going to be concerned with the hospital remaining true to that tradition. For them, the decision of the hospital to go forward with the direct abort under the circumstances given is a no-brainer. However, regardless of how obvious it is to them, their simply stating (and re-stating) what is obvious to them is not helpful in answering a very difficult dilemma for Sister, the bishop, or the hospital in terms of a moral tradition they represent and are committed to living faithfully.



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David J.

posted May 17, 2010 at 9:51 pm


‘”Perhaps that’s because you don’t view abortion as a violation of human rights.”
And the mother’s rights? Did she give them up when she got pregnant?’
Apparently so. As I understand from what I’m reading here, the mother is expected to risk her life and if necessary sacrifice it for the fetus. In effect, the position is not that the fetus’ life is as valuable as the mother’s but that it is more valuable and hence a woman must take any risk to try to carry it successfully to term no matter the potential danger to her life and health, and if she dies or is invalided it will be in a good cause, so to speak. Many families living here on Planet Earth might not see it that way, though.



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BobRN

posted May 18, 2010 at 12:19 am


“Many families living here on Planet Earth might not see it that way, though.”
Happily, neither does the Church.
A strategy often employed by those who favor “abortion rights” is to set the mother and fetus against each other, usually in a fashion that portrays the fetus as an aggressor or threat to the mother. The obvious thing to do is to remove the threat, for the sake of the mother.
The Church rejects this thinking because innocents, by definition, cannot be destroyed under the justification that they pose a threat to another. To accept the idea that an innocent can be destroyed under such circumstances is to argue that persons have no higher purpose other than the utilitarian function they provide to those who have power over them, and no dignity independent of that provided them by those who have power over them. You continue to exist because I allow you to. You are now a threat to me, so I will destroy you, even though you have no moral responsibility for being in such a position.
There are two arguments that are traditionally offered by “abortion rights” advocates as an attempt out of this utilitarian definition of human purpose and totalitarian definition of human dignity. The first is the old analogy between the fetus threatening the mother’s life and a kidnapper or burglar who has invaded and taken over another’s life and is now threatening to kill them. No one would argue that you can’t kill the kidnapper who is threatening to kill you. The fetus is in a similar position. The fetus has invaded the mother’s body and is now a threat to her life, physical, psychological, economic, etc, …. So, you can kill the fetus. This is absurd, of course, since the fetus is in no way, shape or form morally responsible for his or her existence, and cannot be constructed as a moral actor threatening another. The fetus is innocent.
The second argument is that the fetus is not a human at all, so there is no moral obligation to respect his or her life. A variant of this is that the fetus, if human in any way, is certainly not as human as the mother, so if one must be sacrificed, most people on Planet Earth would choose the fetus. So, again, it largely comes down to the identify of the one in the womb.
The Church has long taught that a legitimate moral option during a pregnancy where the mother’s life is in danger, and that danger is directly linked to the existence of the pregnancy, is to put all therapeutic efforts toward saving the life of the mother, including those that place the fetus at risk (ie: medications to control pulmonary hypertension that may be harmful to the fetus, the removal of a cancerous uterus, or a fallopian tube about to burst, etc,…), even if the unfortunate and undesired indirect consequence is the death of the fetus. Direct abortion, even in these circumstances, cannot be justified because the proximate end sought is the death of the fetus as a means to saving the life of the mother. Killing an innocent, even to save another, cannot be justified, for that would be insisting that one innocent’s life is of more intrinsic dignity than another’s. Where would that end? There are all sorts of people with power over others who are quick to argue that their innocent lives are of more intrinsic dignity than another’s.
Think triage. Sometimes, when medical resources are thin, it may be necessary to deny resources to those who have little or no chance of ultimate survival in order to spare those resources for those who do. However, this wouldn’t justify actively killing those with little or no chance of survival.
I suppose in this age of sound bites, I should apologize for my lengthy post.



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cathyf

posted May 18, 2010 at 1:30 am


I think, in fact, the subtlety is that the direct action criteria is dangerously close to the notion that actions can be sinful but inactions not. Of course our notion of sin includes both actions and inactions in every other context. (“…what I have done and what I have failed to do…”)
The subtlety is that the doctors apparently had two choices: to allow the baby to die (and to allow the mother to die) or to cause the baby to die (and to perhaps allow the mother to live). I understand the distinction between “allow” and “cause” being made, but this is an extraordinarily fine hair being split here. Given the abilities that the medical professionals have, isn’t this distinction between “allow” and “cause” pretty much artificial? If it was a year later, and the 15-month-old baby was brought into the ER after being seriously cut, and then bled to death in the waiting room for some utterly trivial reason, like the doctors and nurses were too busy eating donuts in the break room to stop the bleeding, then I think that there would be no one saying that the doctors and nurses had merely “allowed” the baby to bleed to death as opposed to “causing” the baby to bleed to death. In a case like that we would expect the bishop to excommunicate all of the donut-eaters for killing the child — why does the distinction between “allow” and “cause” not get them out of moral culpability in that case?
I think that you can make a really good argument that this case is much more analogous to a case where the unborn child has died of natural causes, and then failed to be expelled from the womb. In this case doctors have a clear obligation to removed the corpse from the body of his/her mother, and the obligation is to do so with the minimum risk to the only live person — the mother — even if this requires some desecration of the corpse of the deceased child. Technically the child was still alive, but technically a person who is brain dead and who is being kept “alive” on a respirator while their organs are being harvested for transplant is “alive” and then “killed” by the removal of the organs. We managed to slice that same hair on the other side in that case…



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David J.

posted May 18, 2010 at 2:11 am


“Direct abortion, even in these circumstances, cannot be justified because the proximate end sought is the death of the fetus as a means to saving the life of the mother. Killing an innocent, even to save another, cannot be justified, for that would be insisting that one innocent’s life is of more intrinsic dignity than another’s. Where would that end?”
It would end in the hospital between a woman and her doctor. By forcing a woman to carry a pregnancy to term at the risk of her life and health, you are by default privileging the fetus over the mother. I think a woman’s life and health come first and I think most husbands and families would agree.



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panthera

posted May 18, 2010 at 2:48 am


Cathyf,
That is very well written.
Gerard picked up on the problem at once, as have one or two others – ectopic pregnancy, the one grand exception discussed here.
This is 2010. Even in Arizona, medical diagnostics (if not necessarily medical practice) is enormously advanced over where it was in 2000 or 1990.
In the fairly recent past, there weren’t too many situations capable of black and white diagnosis as was ectopic pregnancy. That required that one do something, and do it fast because the child may not live and the mother needs must die, horribly.
I find it reasonable, nor have I read otherwise, to assume that the medical personnel were versed in modern art and acceptable to a Catholic hospital.
I think it certain that the attending medical experts and ethics commission at a Catholic hospital have at least a glancing familiarity with Church teachings on this matter.
I find it highly likely that these experts presented the matter to the “on call” decision maker from the ethics commission as a situation which, based on diagnostic technology of these days indicated two outcomes: Either the baby died or the woman and the baby both had to die.
Nobody has suggested (nor have I read anywhere otherwise) that this was a matter which breached delay. The Sister had to decide, there, on statements by medical experts (in a Catholic hospital), immediately, whether the pregnancy could continue or not.
Had she said, let the pregnancy continue, both would have died.
That is what was presented to her.
If the Church can allow for ectopic pregnancy, then obviously, she is open to situations in which no outcome is going to ‘feel’ right. As I understand it, the Church is not interested in ‘feeling’ right, rather in ‘being’ right.
This case should not have been decided so rapidly. A church which can take decades to decide whether to remove a pedophile priest from working with children certainly could have and should have taken the time to analyze this matter.
Conservative, romancrusader, there are quite a few people seeing nuances here, striving to be notional here who are otherwise black and white in their views on Church teachings.
That a Gerard Nadal or a Klaire see a need to take look at this very carefully while you pronounce august judgment should be grounds to stop and actually reflect.



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buudien

posted May 18, 2010 at 10:34 am


I hope not to draw too much controversy but rather I want to just state some things I’ve come across. Firstly, the article is appropriate in length but cannot provide enough details. Secondly, I am troubled at the circumstances and what I am reading. That said, I think we shouldn’t rush to judgement yet on the situation, we are not provided all the details.
What I can gather about pulmonary hypertension and pregnancy is that it is somewhat manageable but typically occurs in a situation called Eisenmenger’s syndrome, an extremely rare condition where the mother’s heart has a defect which was not repaired before her getting pregnant. The mortality is as high as 50% in some retrospective studies (Kahn, ML. Eisenmenger’s syndrome in pregnancy. N Engl J Med 1993; 329:887) and weakens the mother’s circulatory system to the point of near collapse even during the preterm period. However, some experts recommend that this can be treated with heparin although the majority of experts recommend against it (heparin therapy may not be good as it can lead to other bad problems of prgenancy). Considering that this occurred in an 11 wk pregnancy, perhaps the mother’s health was dramatically declining, who knows.
I just don’t know the details but thought I would submit my speculation. Not knowing the full extent of the details we can’t make judgement calls but I thought I’d bring this up for consideration.



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cathyf

posted May 18, 2010 at 12:11 pm


By forcing a woman to carry a pregnancy to term at the risk of her life and health…

This little mindless repetition of pro-abortion propaganda is utterly beside the point. We are not talking about term, we are not even talking about viability, we are talking about 2-1/2 months short of any hope at all of the baby surviving.



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David J.

posted May 18, 2010 at 2:17 pm


‘”By forcing a woman to carry a pregnancy to term at the risk of her life and health…”
This little mindless repetition of pro-abortion propaganda is utterly beside the point. We are not talking about term, we are not even talking about viability, we are talking about 2-1/2 months short of any hope at all of the baby surviving.’
It’s not beside the point. It’s the heart of the matter. (I’m overlooking the cheap shot about propaganda.)
Thank you for your post, buudien. It was most helpful.



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BobRN

posted May 19, 2010 at 10:38 am


A traditional criticism of the principle of double effect is that the distinction between allowing and causing the end are trivial or artificial because the end is the same.
There are many people who are in life threatening circumstances that could stand to benefit from the deaths of others. Many medical professionals want the authority to harvest organs from trauma patients who are expected to die, but are not yet dead. Medical ethicists, already concerned about the too rapid diagnosing of patients as brain dead, raise genuine concerns about the subtle or not so subtle influence harvesting organs from patients who are not yet dead will have on the diagnostic process. A former president of Paraguay suffered from a blood disorder requiring frequent transfusions, and homeless men started showing up dead of blood loss on the streets of Anuncion. In China, those sentenced to death are expeditiously executed so their organs can be made available on the international market. Is anyone surprised that it doesn’t take much to be sentenced to death in China? In the triage case I presented above, does anyone here want to argue that it is a legitimate moral act to directly kill those who will not be receiving the limited medical resources? This is why the distinction is not trivial.
How we treat people, especially those most vulnerable, speaks to what we believe about people. Do we believe that people have an intrinsic dignity, given them by God, which all are bound to respect? Or do we believe that people have a conditional dignity, given them by the state or social contract, which we are bound to respect as long as their deaths serve no use to us? The Catholic faith and moral tradition holds to the former, which is why the distinction is not artificial.
Respectfully, the Arizona case is not analogous in any way to the case of a fetus who has died of natural causes. In such a case, the fetus is not a human life, and there is no moral dilemma in removing the remains of the deceased fetus. I’m not aware of any authority inside or outside the Church that regards the removal of the remains of a deceased fetus as desecration of a corpse.
The essential question is this: Is it ever moral to directly kill one innocent as a means of saving the life of another? Many posting here say yes. Perhaps in the Arizona case, it seems obvious that that is what must be done. But the prospects of that sort of moral reasoning are grim and dangerous.
Finally, just to be clear, those who have been diagnosed as brain dead are not being kept “alive” in order to harvest their organs. They are dead. The heart and lungs are being maintained mechanically in order to ensure that the organs are adequately perfused with blood and, hence, oxygen. Organs that are not adequately perfused are quickly of no use to anyone. Those who have recovered from brain death were prematurely diagnosed as such. This happens too often because there are no universally adopted diagnostic criteria for determining brain death. Some institutions use a dozen criteria, others use only a couple.



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SMcG

posted May 19, 2010 at 1:28 pm


Then it is equally morally wrong to remove an ectopic pregnancy — the pregnancy, which involves a human life that is every bit a human life as the other, is terminated by removal of the pregnancy from the mother’s body.
In this case, the pregnancy is lethal to the mother in the same way an ectopic pregancy is lethal to the mother. Medical science and Catholic ethicists agree that the pregancy has nowhere to go moving forward, and the mother will die should that happen. In this case, the pregnancy has nowhere to go moving forward, and the mother will die should the pregnancy continue. The termination of the pregnancy — because it is _the pregnancy_ which is threatening the life of the mother, not the fetus — is the same as the termination of the pregnancy — also the issue in an ectopic situation rather than the fetus itself — is done in order to save the life of the mother, the death of the fetus is secondary.
The intent is not to kill the fetus. The intent is to save the mother. The knowledge everyone is operating under is that the pregnancy will be terminated and the fetus will die along with the mother should the pregnancy continue.
Therefore it is completely evil and immoral to essentially murder the woman to stick to some dogmatic point that has no bearing on the reality of the situation.
Frankly, if the mother has to die, then I say go out and shoot the father too — fair is fair — if she has to die because of this pregnancy, then so should he because it’s his pregancy, too, in a way.
To me, killing him is just as logical as killing her.



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BobRN

posted May 19, 2010 at 4:55 pm


“Then it is equally morally wrong to remove an ectopic pregnancy…”
No. In the case of an ectopic pregnancy, there is no medical intervention that will save the life of both the mother and the fetus (or, more properly at this stage, the embryo). As well, the embryo is doomed, since a fallopian tube is incapable of supporting a pregnancy. Most moral theologians would apply the principle of double effect and allow the removal of the fallopian tube, thus saving the mother. The consequence, of course, is the death of the embryo, but that death is not caused directly, but as a consequence of removing the fallopian tube. So the life of the mother is not spared by the direct killing of the child, but by the removal of the fallopian tube. Again, think triage: the life of those who have the potential to survive is not spared by the direct killing of those who do not, but by the directing of resources toward their survival. The consequence of such, sadly, is the likely death of the others, who are understood to be doomed.
The dogmatic point to which one is sticking in this case is the intrinsic dignity of the human person, and the obligation all have to respect that dignity. Is it morally permissible to directly kill one innocent person in order to save the life of another? If it is not, and the Catholic moral tradition would certainly say it is not, then the next question is: Does that dignity apply to those in the womb? So, here we are again back to addressing the question of the identity of the one in the womb. The Catholic faith and moral tradition has, from the earliest centuries, condemned attacks on the life of those in the womb. Obviously, those who are not committed to that tradition are not going to be moved by arguments provided in the light of that tradition. But, since we’re talking about Catholics acting in a Catholic institution, it still isn’t clear to me how those who insist that the Church apply to her institutions arguments from traditions that are diametrically opposed to her own are contributing to a helpful answer to this dilemma, because that isn’t going to happen.
Also, in reference to an earlier post, the options are not between saving the mother by directly killing the child on the one hand and doing nothing on the other. It is morally permissible to direct all medical resources (procedures, medications, etc…) toward saving the life of the mother, even if the consequence of such is the indirect and undesired death of the fetus.
In the Arizona case, then, one wonders why the decision was not made to remove the mother’s uterus. If it was the pregnancy that was the cause of her life-threatening emergency, and if she is going to be put at similar risk with all future pregnancies, as is the case with pulmonary hypertension (those known to have this condition are counseled to avoid pregnancy), why not remove the uterus, allowing the mother to live with the indirect and undesired consequence being the death of the fetus? Instead, they elected to perform a direct abortion on the fetus. I wonder why?



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BobRN

posted May 19, 2010 at 5:12 pm


SMcG,
In reading through your post of 1:28pm again, it occurs to me that we’re finding common ground. The same moral principles that would allow for the removal of the fallopian tube in the case of an ectopic pregnancy would, indeed, allow for the removal of the uterus in the Arizona case. In both cases, the termination of the pregnancy by the removal of the involved organ is a legitimate moral option, it seems to me (though, again, I don’t have all of the facts in the Arizona case).
The question remains: Why did the doctors, and Sister, decide for a direct abortion rather than a hysterectomy?



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cathyf

posted May 19, 2010 at 6:21 pm


The question remains: Why did the doctors, and Sister, decide for a direct abortion rather than a hysterectomy?

Perhaps they were working very very hard to save both mother and baby with various and sundry treatments, and by the time they realized that they could not save the baby the mom’s condition had deteriorated to the point that she would not have survived the surgery?



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cathyf

posted May 19, 2010 at 6:44 pm


The problem I have with the direct action principal is what happens when the probabilities are not 100%.
For example, take a 22-week pregnancy, mom has a uterine infection which is causing labor which can’t be stopped. The correct medical course of action is to perform a c-section. The baby has the best chance of survival — about 20% — that way. But if you do the c-section, then you are “directly causing” the baby to be born, and 80% of the time you will be causing the baby’s death. If you allow the labor to continue and then the baby dies, then you didn’t “directly cause” the baby’s death because you simply “allowed” the baby to be born early. In this case, choosing the “direct cause” also significantly increases the baby’s chances of survival.
Aggressive medical interventions often significantly increase probabilities of survival (that’s why we do them!) The “direct action” principal seems to set up a strong prejudice against intervention, by somehow preserving the fiction that if you didn’t do anything then it’s not your fault.



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SMcG

posted May 19, 2010 at 6:48 pm


Or perhaps she was a young woman who would have preferred to save her uterus so she might have children in the future.
The very notion that a hysterectomy in her case would be morally licit even knowing that it was killing the baby, but an abortion would not be even though it’s killing the baby is mind-boggling.
It also speaks to the sense women’s lives and their wellbeing are just not all that important.
Better to butcher her unnecessarily — punishment for a) having failed to breed successfully and b) forcing the men to have to dirty their hands with complicated grey-area moral questions involving icky girl bits — than to perfom the least invasive, safest procedure, eh?
The hard fact is the baby is killed either way — knowingly, premeditatedly killed. To remove a uterus containing a live fetus is the same thing as removing the fetus and leaving the uterus. Everyone knows what they’re doing, and all the fasttalk and legalese isn’t going to change anything. It is what it is.
Anything less than doing the one thing that will save the woman from a certain death — a certain death that includes the equally certain death of her child — is murder. It is not more moral to kill them both.



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BobRN

posted May 19, 2010 at 8:20 pm


cathyf,
Regarding your comment of 6:21PM: Perhaps.
Regarding your comment of 6:44PM: The principle of double-effect, from which I’ve been arguing (not “direct action principle,” of which I’ve never heard; perhaps you have, but I’ve not, so I wouldn’t be able to speak to that), claims that it may be morally permissible to do a good act, even if bad consequences are the indirect and undesired result of that act, so long as the good achieved is proportional to the bad consequences. It is, however, never moral to do an bad act, even if the intended result is a good end. Ends do not justify means. It is never morally permissible to directly kill one innocent as a means of saving another.
The principle of double-effect would not apply to the example you offer, as far as I can see. In your example, the doctors would be morally obliged to birth the baby via c-section, thereby increasing the baby’s chances of survival from zero to 20%. It’s tragic, to be sure, but it’s the best that can be done. To allow the labor to continue would be a dereliction of duty, a sin of omission, if you will. I know of no moralist or moral tradition from which one could argue that allowing the labor to continue is a moral option.
SMcG,
Regarding your comment of 6:48PM: As was said before, and the literature on pulmonary hypertension (which another poster informed us was the mother’s condition) confirms, women who are known to have pulmonary hypertension are counseled not to get pregnant because pregnancy presents such a high risk to the life and health of the woman. It would seem remarkable, given the life-threatening circumstances surrounding this pregnancy, that the mother would risk another.
You obviously have little interest in or respect for the Catholic faith and moral tradition, and your anger at men permeates your comments to the point of incoherence. Your only solution for the moral dilemma faced by the Catholic sister, the Catholic hospital and the Catholic bishop is to abandon their Catholic moral tradition in favor of one diametrically opposed to that tradition; that is, in effect, to stop being Catholic, and go ahead with the direct abortion. You must be pleased to learn that that is exactly what Sister and the hospital chose to do. Sister is now facing some of the consequences of that decision. Perhaps there are consequences that the hospital and staff will also face. Hopefully, this case will bring together the hospital staff, including Sister, and the bishop into dialogue to consider what might be done in the future to avoid such consequences. We’ll see what comes of it.



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Gerard Nadal

posted May 19, 2010 at 10:51 pm


The issue here is not medical, but administrative.
The Catholic Church has clear guidelines in moral theology and bioethics about what is, and is not permissible. A Catholic hospital’s administration is responsible for communicating those boundaries to the attending physicians, who are then responsible for respecting those limits, and communicating them to their patients.
This woman didn’t go from totally healthy to needing an abortion overnight. In going for her prenatal care, the physician no doubt was treating her for the hypertension, and should have communicated that the pregnancy could exacerbate the condition, presenting the dilemma of abortion v. danger of maternal mortality prior to viability at 25 weeks. Further, the physician should have communicated to the parents that if the condition did deteriorate, presenting at St. Joseph’s would preclude abortion as a therapeutic option.
In the time it took to go to St. Joseph’s and wait for a round of medical/ethical consults, the couple could have gone to another hospital in a city of 1.5 million, with a metro area of 4.5 million.
It isn’t hard to see that there was a breakdown in the communication of clear limits regarding abortion. Someone needed to be held to account for that breakdown. Sister McBride’s decision could not be left standing as a precedent for the future in a Roman Catholic Hospital.
There are plenty of other hospitals where this is an acceptable procedure. The clear communication of these limits by the administration and OB/GYN’s on staff would direct patient management in cases like this toward facilities offering the abortion option, if that is an option that the couple wishes to hold in reserve.
That said, this was a case tailor made for more Bishop bashing by abortion’s apologists who would love nothing more than to see Catholic hospitals forced through law, or bad administrative precedent, into performing abortions. Bishop Olmsted is to be commended for his moral clarity.



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BobRN

posted May 20, 2010 at 3:10 pm


Gerard Nadal,
Excellent points. I’m not familiar enough with pulmonary hypertension to speak to how quickly it can develop, or whether or not the mother had the condition prior to her pregnancy. I’ve suspected that other options were available to the mother than going to a Catholic hospital, but I didn’t know that. I’m glad your more familiar with the case and can bring some clarification to these matters. Clearly, there were other options for the mother than going to a Catholic hospital. I suspect, too, there were other options for the doctors at the Catholic hospital than direct abortion. This may come down, sadly, to medical personnel creating a crisis in order to force an agenda on the Church.



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cathyf

posted May 20, 2010 at 11:13 pm


I’m not saying that this is what happened here — it’s more of a hypothetical. But it seems that one treatment for the hypertension is large doses of heparin. But the large doses of heparin would mean that the mother would almost certainly bleed to death in a hysterectomy.
So imagine that you have a mother who desperately wants her baby. So she goes to the Catholic hospital precisely because they will value her baby’s life highly. They try all sorts of treatments, which don’t work, or work for awhile and stop working. So they are at the end of the line. The mother is going to die, and her baby will of course die a few minutes later. They have 2 choices: 1) do a hysterectomy right now, which, for the reasons that BobRN has already described, is allowed under the principal of double-effect; 2) start large doses of heparin, in the hope that they can beat the disease back for another 10-11 weeks to give the baby a chance to survive, but the problem is that if it doesn’t work the hysterectomy will now kill the mother and the only way to save the mother’s life is through a “direct” abortion.
Ok, so this is a hypothetical, but it looks like a situation where option 1) avoids the “direct abortion” by giving you the double-effect “out” but option 2) gives the baby one more small last-ditch chance at surviving. In other words, if you choose option 1) you give up sooner and kill the baby sooner and the only reason you do it is to maintain your double-effect fig leaf.
Unless you can construct a double-effect argument that once the mom & baby have been given the heparin (which of course has the virtuous intention of being a last-ditch effort to keep the baby alive) then the procedure normally considered a “direct abortion” is simply the first stage of the hysterectomy, which gets done as soon as the heparin clears the mother’s system. The heparin which can’t be turned off until the baby is gone.
Except, of course, that once the baby is gone, and the mother is not pregnant, then the hypertension recedes. Which means that the only purpose of the hysterectomy is contraception, which is immoral.
But, anyway, the bottom line seems to be that your “pro life” principles have maneuvered you into a corner where you are giving up and killing a baby before trying everything that might save it.



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BobRN

posted May 21, 2010 at 9:39 am


cathyf,
Except that we are not bound to initiate every treatment that represents “one more small last ditch chance.” We are only bound to attempt every treatment that, under the circumstances, offers a reasonable chance of success. Otherwise, we would be bound to provide every treatment to every patient, even if it offered only the slightest chance of benefit, which clearly we are not bound to do.
I suppose any number of hypothetical scenarios could be envisioned. The fact is, none of us were there, so we really don’t know the circumstances of the mother’s medical condition, or what treatment options were in her best interest. The doctors claim it was a life and death situation, the only options being direct abortion or maternal and fetal death.
The fact, however, that time was available to consult the patient, family and the Ethics Committee suggests it was not the “last minute” emergency the Arizona Republic said it was. Again, the hospital statement says it was the pregnancy itself that put the mother at risk. The likelihood of the mother attempting another pregnancy given the risks being pretty slim, why not proceed with the hysterectomy? I don’t know why they didn’t, of course, because I don’t know all of the circumstances of the mother’s medical condition. But I think it’s a question worth asking, and an option worth considering should a similar case come up in the future.
One thing is clear: the hospital was known to be a Catholic institution with a policy of no direct abortions. If direct abortion , then, was on the list of options the mother was wiling to consider under the “right” circumstances, she should have made the decision to receive her care at a non-Catholic hospital long before any problems surfaced.



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MarkC

posted May 21, 2010 at 10:36 am


BobRN,
You’ve made some excellent points; I appreciate your thoughfulness. There is a lamentable dearth of perspective on this case in the Catholic blogosphere (Deacon Greg is to be commended for posting on this!). It seems the career Catholic bloggers are hiding under their desks while the Bishop and Catholic Hospitals in general are being pilloried by the commentariat …
I was following your argument that the child’s life is of equal dignity to the mother’s and Catholic ethics require that all efforts be expended to promote the health of BOTH. However, there is one point you did not address which is relevant to this case. It seems that, given the mother’s condition, BOTH the mother and the child were going to die; so, isn’t it better to save ONE life. I know that abortion is the direct taking of a life, and an immoral means etc. BUT … answer the question …
If your answer is that an hysterectomy could have been done under the principal of double effect – it seems to me slightly cynical … after all, there was nothing wrong with the women’s uterus … no cancer or whatever. I do not believe it is ethical to remove it, if it was perfectly healthy and not really a direct therapy for the hypertension.
I also think it is slightly cynical to suggest, we at a Catholic hospital don’t need to worry about tough cases where an abortion might be sought to save the mother’s life … because there is an abortuary right up the street!! I don’t think that is an argument faithful Catholics should make.
What do you think?



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MarkC

posted May 21, 2010 at 10:58 am


Another question which is being posed on many outlets where this “tough case” is being exploited by the enemies of the Church … and it requires a response – not just, “if she wanted an abortion, she should have gone to the abortuary up the street” – is this: should Catholic hospitals receive federal funding when their charter restricts the range of medical options which many consider standard care?
I don’t think it is terribly difficult to make a case for Catholic health care, where the destruction of life (abortion) or healthy organs (tubal ligation) are prohibited – “do no harm”. However, currently NO ONE IS MAKING THIS CASE IN THE CATHOLIC BLOGOSHPERE!



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Panthera

posted May 22, 2010 at 6:42 pm


Goodness.
The anger and venom flowing here is pretty much symptomatic for the culture wars which have polarized us to the point at which communication has become impossible.
Given the way the Catholic church treats gays, I find it very hard to believe that BobRN actually believes what he is writing about dignity towards all, born or unborn. Were this to be true, then the hatred and passion with which we are oppressed on the secular level by the Church intervening in our lives would not be.
I also find the attacks (no other word will do) on SMcG inexcusable.
My understanding is sufficient to grasp the principles being discussed here.
And yet, the thought of killing the mother that the fetus might die indirectly is absurd – and that is the conclusion, should one follow the logic. Hateful. Purely hateful.
As to removing the uterus. It is 2010. This is a very young woman. What are the odds that medical science will find a solution to permit her to carry a pregnancy to term within the next 20-25 years? Pretty good.
This aspect of the culture war has nothing to do with being Christian and everything to do with men telling women to go back to being brood mares, barefoot in the kitchen.



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BobRN

posted May 22, 2010 at 7:51 pm


MarkC,
Thanks for your comments and questions.
I attempted to respond to your posts this morning, but for some reason it didn’t go through. Not sure why.
I work night weekends, so please be patient with me. I hope to get back to you Monday morning.
God’s peace.



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MarkC

posted May 24, 2010 at 9:02 am


In case anyone is interested, there is an in-depth discussion of this story here:
http://www.whatswrongwiththeworld.net/2010/05/excommunicating_intentions.html#comments



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BobRN

posted May 24, 2010 at 9:26 am


MarkC,
I appreciate your comments and your patience in waiting for me to get back to you. I’ve just gotten off work and am in our hospital library. For some reason, I’ve not been able to access Deacon’s Bench from my home computer. Each time I try, I get “Bad Request.” So, this will probably be my last contribution to this discussion. I plan to take a summer break from reading blogs, anyway.
So, here goes…
A moral dilemma is a conflict between two or more goods or duties. In the Arizona case, there is the good/duty of saving the mother’s life, the good/duty of saving the fetus’ life, and the good/duty of respecting the intrinsic dignity of human life in general. This last is the good/duty we owe to humanity, since the choices made in this case, if they disrespect or weaken our attachment to the intrinsic dignity of the human person, can be used to justify atrocities in other scenarios. For instance, consider that there are many who have posted here who do not recognize this case as a moral dilemma at all, because they don’t recognize the humanity of the one in the womb: the result of two generations or more of living in a culture that acts as if life in the womb is second class, at best, or even expendable.
From a Catholic perspective, we may not commit an evil act to achieve a good end. Ends don’t justify the means. It’s never a moral option, then, to directly kill one innocent as a means of saving another. To say that it is, or to act in a way that it is, is to give free reign to those who may benefit from the deaths of others over whom they have the power of life or death. I gave some examples in an earlier post, but consider another: There are five people in need of organ transplants. Is it moral to kill one innocent person in order to make his organs available to the five? Many would say, “Yes!” Five for one is a great bargain, after all. Again, where would it end? We already have a president who says it’s okay to kill an American citizen accused of terrorist acts, even before he is seized and tried for these crimes. But, what if he’s innocent? Isn’t that why we have trials? Who cares, the president seems to think. Maybe his death will save others, or at least give terrorists second thoughts.
Or consider that pulmonary hypertension, the mother’s condition in the AZ case, can be cured by a lung and heart transplant. Is anyone who has posted here in favor of directly killing by abortion the fetus in her womb willing to volunteer their lungs and heart so the mother can live and carry her baby to term? You see, it’s so easy to say it’s okay to kill this one to save that one when the one being killed isn’t me or mine. But, the fetus is going to die anyway, you say. So are we all…
Is it better to save one life than that both die? Of course, but only in such a way that achieves or respects all of the goods/duties at stake. Otherwise, in saving the one life, we will have laid the foundation for justifying the deaths of millions. Isn’t that what Roe v. Wade and Doe v. Bolton did?
So, what can be done in the AZ case? According to the principle of double effect, all efforts (therapies, procedures, medication, etc…) can be dedicated to saving the life of the mother, even if the indirect and undesired consequence is the death of the fetus. This achieves the good/duty of saving the mother’s life. It doesn’t achieve the good/duty of saving the fetus’ life, but it does achieve the good/duty of respecting the dignity of the fetus’ life by acting in such a way that makes clear the fetus’ life is not expendable. The fetus’ life is not reduced to a utilitarian means of saving the mother. The fetus is not reduced to one who exists for the sake of the mother, or at the behest of the mother, so that, when the fetus becomes a “burden” or “threat” to the mother, he or she can be dispatched expeditiously, as if he or she were a wart on the mother’s thigh. Such would be an attack on the dignity of the fetus’ life and, as such, an attack on all our lives, especially those vulnerable ones in this world. Again, think triage: those who are saved are not saved by the killing of those who cannot be saved. They are saved by the dedicating of the available resources toward the good of saving their lives. The indirect and undesired consequence is that not all will be saved.
It is just as legitimate, should the mother choose, to put all efforts toward saving the life of the fetus, even if the indirect and undesired consequence is the death, or the risk of death, to the mother. Some mothers have chosen to do this, sacrificing their own lives for the sake of their children.
I proposed that a hysterectomy could be justified in the AZ case under the principle of double effect, in the same way that a fallopian tube can be removed in the event of an ectopic pregnancy. You point out, however, that that would be a cynical choice based on the fact that there really is nothing wrong with the uterus. That’s true, and perhaps I’m wrong on that one. I’m not sure how the bishop or a Catholic ethicist would see it. What needs to be done, and what should have been done, is for those involved to get together well before complications arise to decide what options are available in the event of complications. The mortality rate of pulmonary hypertension in pregnant women being so high, I would be amazed if that didn’t happen. When did a direct abortion get put on the list of legitimate options for the staff of a Catholic hospital?
The more I read about pulmonary hypertension, the more I wonder about the circumstances surrounding this case and if it was really a life and death, last minute emergency. Obviously, I can’t judge the decisions of the doctors, or question their expertise, though others in the profession have. I can, however, wonder about the process and their motives. How did it get to the point where a woman with known pulmonary hypertension who decides to get pregnant get to the point where a direct abortion at a Catholic hospital became the only legitimate option in the minds of her medical team? I do believe the case merits an investigation. I know well that doctors can manipulate the facts if they are determined to go in a particular direction, giving patients few options, or none, if they are set on a particular course of therapy. At the very least, the hospital staff needs to sit down with the bishop and professional ethicists and devise a plan for how to deal with these sort of situations in the future.
After reading your post, I agree that the idea of Catholic hospitals relying on the fact that other institutions exist that are willing to do the dirty deed is cynical and an unworthy argument for a faithful Catholic. The Catholic hospital should have encouraged the woman to get her care there, providing her with all of the information regarding risks and options, and making it clear that direct abortion would never be considered. The woman could then make the decision to stay or go, without the benefit of a referral from the Catholic hospital. I suppose that’s the best that can be done. The fact that it obviously wasn’t made clear that a direct abortion was not an option at a Catholic hospital is another reason the case merits an investigation.
I see no conflict with Catholic hospitals receiving federal funds. Many private, religious institutions receive federal support with the understanding that the parameters of their mission is determined by the principles of their faith tradition. That question has been answered several times by the Supreme Court as it relates to federal funds going to religious schools. If the federal government wants to insist that Catholic hospitals perform abortions, then the government needs to be prepared to absorb the care of those patients into their already overwhelmed medical system. The city government of Washington, DC is facing a similar situation now. When they created laws limiting the distribution of city funds to organizations that recognize same-sex “marriage,” the Washington archdiocese simply said that they would no longer contract with the city to perform the city’s services to the poor. So, the archdioces will continue their ministries to the poor, as they always have, and the city government will find someone else to carry out the city’s services to the poor.
That’s it for me. God bless us, every one!



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MarkC

posted May 24, 2010 at 4:39 pm


Thanks BobRN! You’ve made a complex set of circumstances nearly intelligible. It is sad that the Church haters have used this “hard case” as an opportunity for faith bashing. Amazing how quickly they can turn any story or issue pertaining to the Church into one of gender politics or somehow related the “abuse scandal”. Sheer demagogery!
Incidentally, a commentor on another blog (who goes by the name of “The Masked Chicken”) I think summarized this case nicely in terms of our limits in acting on issues where we are tempted to “play God”. I hope he doesn’t mind my repeating quoting him here:
“God created both mother and child. He has sovereign rights over both. He may give life or take away life. That is his to do.
He has placed certain restrictions on man so that man may not think of himself as equal to God. One of those restrictions is: though shalt not murder. If a man does, he puts himself not in God’s position, but above God’s position, because when God ordains a man to die, it is just and rational. When a man takes another man’s life, without God’s permission, he commits an act of injustice towards the man he kills as well as towards God, whose role he usurps. Injustice is always irrational. Thus, for a man to murder, especially the innocent, he commits an act that is both unjust and irrational. It is a violation of both the Seventh and First Commandments.
If the baby dies in the mother womb, God is the actor and it is his sovereign right to allow this to happen. If a man removes the baby and let’s it dies, he is murdering the baby. He is not only playing God, he is playing a super-God, since even God, himself, would not remove the baby just to let it die. If the baby and mother are to die because we, as man, acknowledge God’s laws, then what of it? That is a matter for God.
In the second temptation of Christ in the desert, Satan told Christ to throw himself off of the parapet of the Temple because surely God would save him. He refused because it would have put God to the test. It would be an attempt to make God act in a way this was inconsistent with his nature as the Sovereign. God is in charge. He is not at the beck and call of any old man who wants to presume on his mercy.
Likewise, the devil suggested that the doctors to throw the baby out from the womb of the mother so the mother could be rescued, presuming that God really didn’t say, “Thou shalt not kill’” but rather, “If you think there is no other way, then, I didn’t really mean it. Go ahead and kill.”
The doctors are not God; they are not cooperating with God by killing the baby. If the baby dies, what is that to you. That is in God’s hands. If the mother dies (ASSUMING – BIG IF) because we refused to kill her baby, what is that to you? That is in God’s hands. If you think an injustice is being done, then your disagreement isn’t with Bishop Olmsted, it is with God.

I say, again, you simply do not know all of the facts. You see as man sees, not as God sees. No one can see as God sees, but we can do what he has said to do and let him take care of the rest.”



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