The case of an abortion at a Catholic hospital in Phoenix prompted an angry bishop to rebuke the Sister of Mercy who allowed the surgery to save the mother’s life.
But you don’t have to be a pregnant woman with a rare heart condition to be affected by the questions raised at St. Joseph’s Hospital and Medical Center.
You don’t even have to be Catholic.
If you are in a Catholic facility (where one-sixth of U.S. hospital beds are located), the Phoenix case could make you question who has final say in life-and-death decisions: You, or the local bishop?
This seems to me a difficult one. If you look at the resources on the diocesan website, especially the [url=http://www.catholicsun.org/2010/phxdio-stjoes/Q-AND-A-ST-JOSEPH-HOSPITAL-FINAL.pdf]questions and answers[/url], the implication is that a D&C is precluded even for an ectopic pregnancy. In that situation, a physician [i]can[/i] be “100% sure” that the baby will not survive and that without a D&C the mother will not.
We don’t appear to be talking about the “rape, incest or health” rationales here, we do seem be talking about life (the Diocese of Phoenix doesn’t suggest that the physicians were seeking to mislead). That being the case, I would have thought the principle of double effect would permit a D&C unless the mother herself demanded that she be allowed to go to term (again, there’s no suggestion that the hospital went against her wishes).
Any of our subscribing medical experts have an opinion? I am genuinely curious.
[url=http://catholicandreformed.blogspot.com]Catholic and Reformed[/url]
I believe that the bishop is in error. The principle of double effect should lead one to save the mother’s life because the mother’s life is salvageable. The child’s life cannot be saved. Even in war, one saves those who can be saved, and leaves to God those who cannot.
Unfortunately, bishops do err and not all are as grounded in moral theology as one might wish. And few are grounded in basic medical principles. Indeed, it is a sad fact that a number of Catholic boomer bishops are disappointing in their general level of intelligence and may have trouble understanding complex subjects. It is a fact that thanks to the Catholic priest shortage, any US high school graduate with a pulse, an interest in religion, no criminal record, a low sex drive, and a 2.5 GPA can get a free ticket to a seminary education and a life time job. Once in seminary, the focus is on personal holiness rather than analytical thinking. It is tougher to get into the military than into the Catholic priesthood, and tougher still to stay in the military for the 20 years needed for a pension than to stay in the Catholic priesthood. Thus, the folks who display what would be ordinary competance if we were talking medicine, law, or accounting, are quick picks for bishop (though relatively few wish the job, as most priests find parish work much more emotionally rewarding). This leaves a relatively small field to choose from for bishop (though I have known some very bright bishops).
I am a Tiber-crossing Catholic…However there are times that one seriously misses the thoughtful intelligence of the Anglican church. Some TEC folks may be heretics but at least they’re not stupid…
The double-effect principle can sometimes be difficult to apply correctly, but in the case of the pregnant woman with pulmonary hypertension I don’t think it was applicable. If the patient were receiving treatment for her pulmonary hypertension which incidently induced an abortion then the double-effect principle would be applicable. The procedure, itself, can’t be an abortion, which it was in this case in order for double-effect to be applicable. Abortion is not a treatment for pulmonary hypertension.
Interestingly, our understanding of intention is critical in applying the double-effect principle and it has also been widely misunderstood in Anglican discussions about the morality of same-sex acts. Too commonly, we tend to use the term intention in a very subjective way. For example, the doctor’s rationale in the instant case was that his/her intention was to save the life of the mother, which takes precedence over his intent to perform an abortion. However, both the intent of the act and the more subjective intent of the actor must be moral.
Phil (#3),
Could there be [i]any[/i] conditions that required a D&C?
I take your point about the condition, but none of us have actually seen the patient’s case notes.
#4, my understanding is that no, it is never permissable. Double effect does not apply to a D&C since the object of the act is the child and the intent is to abort (kill) her. In the case of the ectopic pregnancy, the object of the act is the fallopian tube and the intent is to remove the tube.
As for this particular situation, I know of at least one thoughtful orthodox Catholic who has argued that the Bishop’s actions were unwise http://www.firstthings.com/onthesquare/2010/05/excommunicating-intentions and http://mliccione.blogspot.com/2010/06/getting-it-right-while-getting-me-wrong.html
Jeremy, it’s my understanding that the double-effect principle in these cases relies upon a distinction between direct and indirect abortions. In the cases of an ectopic pregnancy or a cancerous uterus, the treatment might be removal of the fallopian tube or the uterus. The fetus dies as a result of the treatment, but the direct object of the treatment was not an abortion. In the instant case, abortion is not a treatment for pulmonary hypertension. If for instance there were drugs that treated her hypertension, but had the unintended consequence of inducing an abortion then double-effect would be applicable. Again, intentionally killing one person in order to save the life of another person is not what we call medical treatment.
Removal of the placenta is a treatment for pulmonary hypertension. The woman was already on medications to try to control the pulmonary hypertension. Unfortunately, removing the placenta willl result in killing the child.
If a pregnant woman develops preeclampsia in which her blood pressure goes sky high and it can’t be gotten down within a few hours, she will die unless the baby is delivered shortly. In these cases the baby is delivered by c-section and, depening on age, may not survive. I had two friends who had babies delivered very prematurely as a result of this. Both survived, but one was very damaged. Not sure if that was the case here but pregnancy is very significantly related to uncontrolled blood pressure.
#8. Exactly. The young woman in question had an 11 week pregnancy. Only Jesus Christ can save an 11 week gestation. The earliest live birth recorded is 21 weeks, and that by itself was a miracle. The American Association of Pediatrics states that babies born at less than 23 weeks of age and 400g in weight are not considered viable.
The bishop should remember that the job of a physician is to save the living, not to resurect the dead. The latter is somebody else’s job.
http://www.usatoday.com/news/religion/2010-05-18-nun-abortion_N.htm?csp=obinsite
Leaving aside the difficult bioethical issues that this sad case illustrates, I was struck by two things in this article. First, the fact that one out of every 6 hospital beds in America is in a Catholic hospital. Wow, I didn’t realize it was that high a percentage.
Second, I’m disturbed by the way [b]USA Today[/b] framed the issue: who do you want making life or death decisions involving your care, you or the local RC bishop? Yikes. Sounds like a rhetorical set up to me.
David Handy+
Look, Phoenix has many good hospitals. The issue of maternal pulmonary hypertension is when the pregnancy is carried to term. This is NOT an emergency where the mother was only 11 weeks pregnant. It did NOT have to be done at this hospital. The nun knew the rules. I smell ulterior motivations just like in the “peace loving flotilla members.”
Of course, a female with pulmonary hypertension will be told in no uncertain terms that pregnancy carried to term is fatal. The women should have had a tubal ligation. Tubal ligation is not an excommunicable offense.
BTW, since 1945 Catholic physicians CAN treat tubal pregnancies even though this results in the death of the fetus. (Note: I do not use the term fetus because that is the medical term. The usage does not imply that the life is not infinitely valuable.)
For the issue of saving the maternal life and abortion, see
http://www.newadvent.org/cathen/01046b.htm
Please note the discussion in paragraphs 6-10, especially.
The Church says she can NOT get a tubal ligation although admittedly this is a “lesser offense.” If there is 100% certainty that this pregnancy carried to term will be fatal to the mother than it will almost certainly also be fatal to the unborn child. Thus the nun was considering two options “an 11 week old fetus will die and the mother will live (and her children will have a mother)” vs “a highly developed fetus will die and the mother will die and a number of children will be left orphans.” Since the evil part of each decision is the SAME (the unborn child will die) then it is clear what the answer should be. This is not a “mother’s life vs child’s life.” This is “mother and fetuses death vs fetuses death.”
I have been thinking about this some more. What we are saying is that “it is better that the child die than that both mother and child perish”. This makes good sense in human and medical terms but it is the sin of Caiphas. “You know nothing at all nor do you understand that it is better for you that one man should die for the people, not that the whole nation should perish.†{John 18}.
Scripture does permits Christian to lay down their lives for others (as Christ did for us) and on three other ocasions has permitted the taking of life, but I do not believe it has permitted the taking of innocent life in order to prevent the people from perishing.
There are four conditions in which Scripture permits the taking of life (never innocent): 1. Judgement must be issued by the leader of Israel (no private vendettas) 2. The person selected for death is named, and is already guilty of an offense (not an innocent victim) 3. Those surrendering the person are innocent 4. People face inevitable destruction if they refuse to surrender the person.
These conditions are met by Sheba 2 Samuel 20; Johoiakim 2Kings 24; Laban 1 Nephi 4.
The only time that God ordered the taking of innocent life was with the sacrifice of Isaac, who was not, however sacrified, and who was, in any event, a forerunner of Christ.
I’m still not sure what the “right answer” is, and my medical insticts scream “save the mother’s life”. However I’m sure that Caiphas’ political instict was screaming, “keep the Romans from destroying Jerusalem”. Since Scripture tells us that Caiphas was a “bad guy” even though as a politician what he said “made good sense”, we do need to be a little careful before allying ourselves on his side.
I am grateful to not be an obstetrician.
I have been asking around, and mulling through it some more. It is not clear to me that the mother’s life was in imminent danger. The majority of the danger in pulmonary hypertension (and most maternal crises such as eclampsia etc) is in the third trimester. I understand that an unborn child at 11 weeks gestation puts only a negligible load on the heart of a mother, even one with severe pulmonary hypertension. The load becomes severe after the 24th week or so, however at that point the baby would be viable and could be delivered when the mother’s life actually _was_ in imminent danger. Such a child would be premature, and might well have the various expenses and disabilities that come with prematurity, however chances are the child would live. The reason to perform abortion early would be because it is much easier to do a D&C at 11 weeks, then a delivery at 25 weeks, and of course, if one does, then one does not need to deal with the issues of caring for a child with learning disorders. (Having had two such children, now mercifully both normal, I do understand what that might involve).
But, I think one needs to take one’s eye off of the mild bulging of the woman’s abdomen, and to close one’s eyes and see the shining soul of the child, sitting next to the shining soul of the mother, equal in dignity, both counting on you. In a war, if an enemy demanded that such a child be killed or delivered up to them to destroy, on pain of “destroying the whole house” we would refuse. Many families sheltered Jewish children during WWII. I hope that if it came to that, I woud do the same. But it is easier to understand our duty when we can see the face of the proposed sacrifice. There are somethings we know are are worth dying for. Not being a murderer is one of them.
I think maybe, I owe Bishop Olmsted an apology. Mea culpa.