To save one person’s life can you kill another? According to Catholic moral teaching, the answer is a clear and consistent no. But it is not always a painless decision.
A case in point is the national furor last month over the announcement of Bishop Thomas J. Olmsted of Phoenix that a nun who worked as an executive at a local Catholic hospital had excommunicated herself by counseling a woman to abort her 11-week-old unborn child.
The pregnant woman had been diagnosed with pulmonary hypertension, a condition that doctors said would mean almost certain death if she continued the pregnancy. So to save the mother’s life, Mercy Sister Margaret McBride, a hospital vice president on call that day late last year, as a member of the ethics committee at St. Joseph’s Hospital and Medical Center, made the rapid decision to OK the killing of the unborn child, according to a report in the Arizona Republic. The woman reportedly survived.
Since making her decision, Sister McBride has been demoted and transferred to another department in hospital administration, the Republic said.
According to the Diocese of Phoenix, Sister Margaret automatically excommunicated herself from the Church because she “gave her consent that the abortion was a morally good and allowable act according to Church teaching. Furthermore, she admitted this directly to Bishop Olmsted.”
Bishop Olmsted said Sister McBride and anyone else who directly participated in the decision to abort the baby — presumably the other members of the ethics board, doctors who performed the abortion and the patient — had been automatically excommunicated according to canon law (see sidebar).
“The Catholic Church will continue to defend life and proclaim the evil of abortion without compromise, and must act to correct even her own members if they fail in this duty,” he said.
According to canon law, those who have been excommunicated can have the ban lifted during confession and after consultation with the bishop to repair the damage that the sin caused through scandal.
The hospital defended its actions by identifying what it perceived to be a qualifying exception in the current Ethical and Religious Directives (ERDs) for Catholic Health Care Services promulgated by the U.S. bishops.
“As the preamble to the Directives notes, ‘While providing standards and guidance, the Directives do not cover in detail all the complex issues that confront Catholic health care today,’” said St. Joseph’s Vice President Suzanne Pfister. “In those instances where the Directives do not explicitly address a clinical situation — such as when a pregnancy threatens a woman’s life — an Ethics Committee is convened to help our caregivers and their patients make the most life-affirming decision. In this tragic case, the treatment necessary to save the mother’s life required the termination of an 11-week pregnancy.”
Citing the same guidelines, though, Bishop Olmsted stated that there is no ambiguity about the prohibitions against abortion in the ERDs.
“Abortion — that is, the directly intended termination of pregnancy before viability or the directly intended destruction of a viable fetus — is never permitted,” said the bishop, quoting the ERDs. “Every procedure whose sole immediate effect is the termination of pregnancy before viability is an abortion.”
Phoenix ob-gyn William Chavira, a member of the diocesan medical ethics board, told Our Sunday Visitor he was unfamiliar with the specifics of the case, which are protected by patient privacy laws, but was surprised the woman’s doctors felt compelled to take such a drastic measure so early in the pregnancy.
“Normally you don’t have huge increases in blood volume and cardiac output and major decreases in blood pressure at that gestational age,” he said. “What effect an 11-week-old baby is placing on the mother that early that would cause her to decompensate so rapidly is really — to be forthright about it — not a common situation or case.”
Pulmonary hypertension is a congenital heart condition that causes high blood pressure due to a disruption of normal blood flow from the heart to the lung. It can be fatal when blood reverses back to the heart, causing heart failure, Chavira said.
If the hospital was faced with that dire situation, Chavira wonders why the staff didn’t attempt to induce early labor with the goal of expelling the placenta, which produces a hormone that affects blood flow and may have been a significant factor in the woman’s condition.
But this procedure also likely means the baby’s death because the child is too premature to survive outside the womb. How is this an acceptable medical option in Catholic teaching?
“The difference there is that we induce labor prior to viability with the idea of emptying the uterus or treating the pathology at that point,” Chavira said. “The baby will probably not survive given where science is in this day and age in preserving premature babies, but my intention is to treat the mother’s disease, not to kill the baby.”
In Catholic moral teaching, this is known as the principle of double effect. It is permissible to do an action that will have both a good and a bad effect if the action is good in itself and directly produces the good effect, and the reason for the action is proportional to the seriousness of the indirect bad effect.
While pulmonary hypertension is a serious health risk for pregnant women, Chavira said abortion is the antithesis of treating this or any other condition.
“Are there cases unfortunately where women may die? Yes,” he said. “But because we have the technology, I would hope we would exhaust every avenue and every means to treat her. I don’t think it’s still ever justified to directly do a procedure that would destroy the life within a pregnant woman because that life is just as valuable as the mother’s life.”
Joseph O’Brien writes from Wisconsin.
Some offenses are considered so disruptive of Church life that they may be met with excommunication imposed automatically (called latae sententiae ) rather than after a Church trial. In the 1917 Code of Canon law there were 30 such offenses identified; the revised 1983 code has just seven: apostasy, heresy or schism; violation of the Eucharist; physical violence to the pope; absolution of an accomplice; consecrating bishops without Vatican authorization; violation of the seal of confession; and procuring an abortion.
Excommunication is considered a “medicinal” penalty intended to bring about the reform of the offender. It generally can be lifted only by a higher Church authority, but in the case of procured abortion, many bishops in the United States have delegated the authority to lift it to their priests in the confessional.