Department of unintended consequences: The excommunication of Sister Margaret McBride has apparently drawn the attention of the ACLU. CNS reports: "In a July 1 letter to the acting administrator of the Centers for Medicare and Medicaid Services, the ACLU said the Phoenix case and others cited in an October 2008 article in the American Journal of Public Health show that 'religiously affiliated hospitals across the country inappropriately and unlawfully deny pregnant women emergency medical care.'" The ACLU's letter charges that Catholic hospitals have violated both the Emergency Medical Treatment and Active Labor Act, "which requires hospitals that participate in Medicare and Medicaid to treat patients in emergencies and active labor, and the Conditions of Participation for hospitals receiving Medicare and Medicaid funds, which require that patients be informed of their rights prior to furnishing or discontinuing care."
Womansenews reports that the controversy aroused by McBride's censure "is an opportunity to identify and rectify a troubling and dangerous violation of federal law potentially taking place in Catholic hospitals across the country." The allegation is apparently that pregnant women cannot expect comprehensive care at Catholic institutions because of the church's objection to the use of abortion as an optional response to prenatal crisis of some sort. Womansenews reports: "The law rightly requires hospitals to provide life-saving medical care to their patients," said Vania Leveille, ACLU legislative counsel. "The government must ensure that the well-being of the patient does not take a back seat to religious beliefs."
The CNS report includes a response from Catholic Health Association President and CEO Sister Carol Keehan that "a couple of stories that the ACLU has dredged up doesn't hold a candle to the competent care and respect for both mothers and their infants that have been a daily part of life in the maternity units and neonatal units of Catholic hospitals for decades." Keehan said that in contrast to the "unsubstantiated" examples cited by the ACLU stands a history of "hundreds of thousands of women and their infants who have been cared for wonderfully well" in Catholic hospitals.
That's certainly a fair assessment, but it's not likely to provide much protection to Catholic institutions targeted by an HHS probe. The possibility of a broad investigation of procedures at Catholic hospitals or, in a worst-case scenario, the loss of Medicare/Medicaid funding can't be good news for Catholic institutions. This latest flashpoint between church and secular beliefs is not far off from the recent contretemps over foster care and adoption by gay parents which led to the withdrawal of Catholic social agencies from longstanding child welfare services in Washington. If the ACLU and similar critics are able to provoke a federal investigation it could have the ultimate net effect of driving Catholic entities out of health services, which have been a long-standing part of its active engagement in U.S. civic life. To a minority view which rejects any government-funded social service role for religious institutions this would be a social good. The folks living in economically downsized communities where Catholic health centers may be among the last civic institutions standing, public or private, might have a different perspective.
The Pharisees tried to trick Jesus with the same argument.
A husband and children now have a living, healthy mother.
The cold hard facts do not back up the assertion that Catholic hospitals will survive. They won't.
You say that there are "all kinds of exceptions to killing" but you are only right in a strict and limited sense, and this is where we get down to why removal of a fallopian tube is permissible, and direct abortion is not permissible.
One may never, in Catholic ethics, directly intend the death of another person. Most ethicists would say that the bombing of Dresden, or any predominantly civilian target is never justifiable. This is of course besides the point...where are civilian or collateral casualties justified in "Just War" and Catholic ethics? Let's take the example of a perpetrator in your house; when you shoot him, your action is morally good if your intention is to stop him from harming you (given it is reasonable force in the circumstances). If he dies, that is an unintended, secondary evil. If your intention is to kill him, for daring to break into your house, that is a moral evil, because it is your primary intention and the primary effect of shooting him in the head.
Chesterton once said "Only Calvinists can say the road to hell is paved with good intentions" and he is right, our primary intention is very important. But so is the primary effect. For any action to be justifiable, the intention and primary (first, principal) effect must both be good. In the case of an eptopic pregnancy, saving the mother's life is always a good intention. Check! But the two actions (using a tube to suck out the fetus versus removing the fallopian tube) are different. In the first, the action of removing the fetus directly results in the termination of that life (although it would have died anyway), in the second, removing a defective piece of the fallopian tube is the primary effect, and the loss of the fetus is a secondary unintented effect. For more information, look up "principal of double-effect" which explains this better.
You would have to do more research on why Catholic ethicists would say one could not remove the uterus, I am not familiar with that case.
Also, there is the following, from the USCCB's Ethical and Religious Directives for Catholic Health Care Services, Fourth Edition:
In compliance with federal law, a Catholic health care institution will make available to patients information about their rights, under the laws of their state, to make an advance directive for their medical treatment. The institution, however, will not honor an advance directive that is contrary to Catholic teaching. If the advance directive conflicts with Catholic teaching, an explanation should be provided as to why the directive cannot be honored.
It seems to me it is the right of Catholic hospitals to do anything they please, as long as patients know well in advance what the Catholic hospitals will and will not do, and as long as patients have an alternative to choose a non-Catholic hospital. But neither of these conditions is being met at the moment, especially when it comes to emergency care.
Let's hope something can be worked out, because while it would be a shame to withdraw government funding from Catholic hospitals (most of which would not survive without it), it is also not right for people to be denied lifesaving, legal care just because the hospital the ambulance took them to happened to be a Catholic hospital.
One further thought. In my opinion, the jury is still out on whether the Phoenix abortion was direct and illicit, or indirect and licit. Bishop Olmsted may have the authority to decree it one or the other in his diocese, but the reasoning of the hospital ethics team in Phoenix has not been thoroughly examined and debated by moral theologians or medical ethicists. When that happens, we'll have a good answer to the question, one way or the other. The statement by the USCCB Committee on Doctrine has been interpreted by many to support Bishop Olmsted, but it contains no discussion of the details Sister McBride's ethics committee decision and does not explicitly declare Bishop Omsted correct in his judgment that the abortion was direct. It would be extremely ironic if Bishop Olmsted's decision is the trigger for some kind of action detrimental to Catholic hospitals and eventually the consensus of Catholic moral theologians and medical ethicists turns out to be that the ethics committee was right and the bishop wrong.
I propose a different solution. My question to my fellow physicians and to those more versed in ethics is this: If removal of a fallopian tube in an ectopic pregnancy is allowed because the fallopian tube (with the fetus) will rupture and kill the mother then , why can't the uterus (with the fetus) be removed because the uterus and umbilical cord, feeding the fetus, worsens her pulmonary hypertension and will kill her. Why not removal of the uterus and fetus as is allowed for removal of the fallopian tube and fetus?
Let me tell you, all Hell can break loose on Catholic hospitals, leading to their demise, if this isn't resolved soon. And the loss of Catholic hospitals WILL BE CATASTROPHIC, to patients and to the Church as was the sex abuse scandal.
People know that Catholic hospitals adhere to Catholic moral principles and if the federal government (i.e. the Leviathan) wants to start a fight with a major independent provider of healthcare and social services...then so be it.
This is all about power and homogenization against independent civil/religious associations (and it is no suprise that some liberal/progressive catholics on here welcome the suit and this continued aggression in the name of "equality and tolerance"...)
'If removal of a fallopian tube in an ectopic pregnancy is allowed because the fallopian tube (with the fetus) will rupture and kill the mother then , why can't the uterus (with the fetus) be removed because the uterus and umbilical cord, feeding the fetus, worsens her pulmonary hypertension and will kill her.' I add.. Is uterus tissue more sacred than fallopian tissue?
Lets not hear any more anti-governmant, anti-ACLU , anti-progressive Catholic, rants until we can hear someone who knows what he is talking about answer the doctor. Lets hear from the bishops, theologians, someone who thinks he/she can refute the doctor. OR Are we going to to let the Catholic health care system be shut down to please ranters like we did the adoption agencies?
In any case, the attacks on Catholic social outreach (hospitals, services etc.) is due to the intolerance of the tolerance czars - the radical liberal influences and willful relativism within the government - it is not due to actions by the Catholic community.
Any pretext will do for the ACLU and homosexual activists (as shown in DC or in the recent firing of a Catholic professor for articulating the faith (of course no coverage in America on that: http://www.sj-r.com/breaking/x41627418/U-of-I-instructor-fired-over-Catholic-beliefs)
According to their desire to promote "tolerance" (read destruction of any association independent of the government that limits individual freedom) they seek to level any and all meaningful civic/religious associations. Competition/subsideraity (esp. in health care during their bid for centralization) is bad for business for both the federal government and the progressive ideologues...
There are all kind of exceptions to killing, during war it is sometimes to bomb the enemy inorder to persue a greater goal, an example would be bombing Dresden with fire bombs, killing innocent men, women, children and pregnant women and fetuses. Another exception should be my uterus example when we are faced with losing one life or losing two. Losing two lives versus one life is the greater evil.
We have two Catholic hospitals in my area and both have struggled to compete with several larger medical centers. They have succeded and are surviving, in some cases are exceeding the level of care provided by the larger, non Catholic hospitals. Furthermore, by being a respected and powerful force in society by competinw with larger, faceless medical centers, they either interrupt or reduce the number of abortions on demand. They also cause many to reconsider having an abortion.
However,
MAKE NO MISTAKE. This issue has the potential to DESTROY Catholic hospitals. It's not enough to say, well, they're Catholic and we know what they do and don't allow, so we will pick and choose. Doesn't work that way. It is a highly COMPETITIVE market and a decrease in percentage points of income can drive them out of business. Many if not most hospitals also employ physicians by contract. They provide the hospital with patients for surgery and medical testing. If they see their patients drop because of bad PR they will not renew their contracts and will contract with the larger hospitals and transfer their patients there. Without that lifeblood the Catholic hospital is toast.
Add to this debacle, just the rumor of losing HCFA (medicare) or medicaid reimbursements will drive patients away if they think they have to pay for expensive hospital care out of pocket. This can destroy the hospital.
We can engage in ivory tower arguments and opposing views all night. By not allowing any exceptions then the Catholic hospitals will cease to be a force in our society. We are losing our schools, next hospitals, next will be our Church and the ability to save souls. Furthermore, without Catholic hospitals abortion on demand will increase. Do we want that? I don't believe that we should lose everything to ''cut off our nose to spite our face'' over this issue which was a medical necessityto save the live of the mother and not an abortion on demand.
If the government pushes for exceptions to the rule then we should go along, if we get reimbursements from Caesar then we should render to Caesar what is Caesar's and to God what is Gods.
Exactly wrong. By ALLOWING exceptions and abortiosn to be preformed at Catholic hospitals, then and only then, will we cease to be a force in society. (also, less than 1% of births even need to consider such drastic measures)
By conforming to evil (as required by Caesar or Obama) is no way to preserve the truth and uniqueness of the Catholic mission in the world - in fact, it will destroy it.
In the fallopian case, although the fallopian tube is removed, it is the growing fetus that is the etiology of the problem. Removing the fallopian tube with the fetus solves the problem but the fallopian tube is really the secondary etiology, the primary etiology, the actual cause, is the fetus in an ectopic pregnancy in the fallopian tube.
Also I think we agree that the example of a perpetrator in your house; when you shoot him, your action is morally good if your intention is to stop him from harming you (given it is reasonable force in the circumstances). If he dies, that is an unintended, secondary evil.
The termination of the pregnancy is the uterine case would fall under this example. The fetus is killing the mother, and the intention is to stop him/her from harming the mother? Of course the death of the fetus is an evil but the mother and those helping her are without blame and innocent in the fact she was protecting herself. This is not an abortion on demand, but an act to save herself.
Thank you for your discussion without hyperbole and polemics as is so often the case on these blog sites!
In the case of removing the uterus (this is only my guess) the uterus is not what is causing the hypertension and death of the mother, it is the baby/fetus. In this case removing the uterus would not be justifiable because you are really intending to remove the cause of the hypertension, which is the baby/fetus. In the case of the fallopian tube, it is the pregnancy that is causing the eptopic pregnancy, BUT it is generally the fallopian tube (at least that section) that is likely scarred or wrinkled in such a way, that it is reasonable to conclude it is the fallopian tube not the embryo which has caused the eptopic pregnancy (and hence that fallopian tube, or section is likely to result in this again).
That is only a guess on your question, doctor, and I know all of this sounds like minute splitting of hairs, but Catholic ethicists have agonized for decades over how to help people in difficult medical situations, without leading them into doing something that is morally unjustifiable. You all now may rant about how it doesn't make sense, but remember that "the ends don't justify the means" and it is up to more philosophically and ethically trained people than us to work these things out and determine the "means", and we should not glibly tell them they are wrong because it doesn't mesh with our common sense, because "common sense" often tells us things that are wrong...like that "the ends justify the means."
-
This is the part that scares me. I had a simple test at a (Sisters of Mercy) hospital a few weeks ago as an out-patient, but the admissions procedure was the same as if I were to be an in-patient. The woman asked me if I had advance directives, but she did not inform me that they would not be honored, if the hospital chose to ignore them.
If a person's advance directives include NO feeding tube, but the hospital follows the Church's (new?) requirements for feeding tubes, etc., then what? What are the Church's (new?) teachings about pacemakers? The NYT article on the difficulties of turning them off was terrifying:
http://www.nytimes.com/2010/06/20/magazine/20pacemaker-t.html?scp=1&sq=turn%20off%20pacemaker&st=cse
And where is Sr. McBride? Has America investigated to find out if she's okay? Has she been expelled from her community? Did any other sisters leave with her? Did she lose her pension, if she had one, from the hospital? Etc.
Yes, it is nice to have rhetoric free discussion, well said!
Sorry, it looks like I was writing while you posted that. I only have a second before I have to run. In the case you outlined, I do not believe that we can put the perpetrator on par with the fetus: here's why:
The death of the fetus really the PRIMARY EFFECT given that this is what you are looking to remove the hypertension...whereas shooting the perp is not certain to result in his death (therefore the PRIMARY EFFECT can remain stopping him, whereas his death may be secondary unintended effect)
One would have to say that the primary effect of removing the uterus is saving the mother's life to make it justifiable, but one cannot say this because saving the mother's life is a remote consequence of removing the fetus (it is removal of the fetus that saves (one argues) the mother's life)...again the intentional ending of a human life to save another is an "ends justify the means argument."
Sorry that is really quick response, great discussion and questions! These are hard issues that we should never take glibly, as people are in terrible and difficult situations surrounding these things.
Also, we have to look at scripture carefully and see what Christ taught. The woman caught in adultary, as an example, and sentenced to death. Despite her sin and her death sentence, all proper according to the religious authorities, acceptable to the teaching magisterium and ethicists of the time and Christ stopped the ''execution'' for all have sinned. Interestingly, she didn't ask for forgiveness but Christ gave it anyhow.
If we look at this as an example of how to proceed. Sometimes in real life we are faced with sin, and have to choose the lesser of the two but Christ understands, as he did the adulteress, and forgave freely even when she didn't ask for it DESPITE the fact that her execution was indeed morally correct.
It't good that we have forgiveness even when we don't ask for it.
Here is a key paragraph form an article in America about the reasoning of the hospital ethics committee:
Federal laws limit what can be divulged in regard to deliberations concerning patient care, but in a report later made to the bishop of Phoenix, the hospital’s ethics committee identified the pathological organ as the placenta. The placenta produces the hormones necessary to increase the blood volume in pregnant women; in this case, the additional volume put an intolerable strain on the woman’s already weak heart. Since the placenta is located in the uterus, perhaps it would have been more accurate for the ethics committee to designate that organ as pathological and thus compel its removal. The committee might have also investigated more closely the work of the moral theologian Germain Grisez, who has argued that the principle of double effect applies to cases in which both mother and child would die if the infant is not delivered prematurely.
http://www.americamagazine.org/content/article.cfm?article_id=12348
It seems to me (and I have argued this at length elsewhere) that the rationale of targeting the placenta (and thereby performing an indirect abortion) in the case of a pregnant woman dying of pulmonary hypertension is at least as defensible as the rationale of targeting the fallopian tube in the case of an ectopic pregnancy. While I would not want to argue any Catholic out of approving of a salpingectomy in the case of ectopic pregnancy, it seems to me that there are a number of good arguments against the credibility of claiming the salpingectomy is about the tube rather than the embryo. The salpingectomy is generally performed well before there is any danger to the mother, and something like half of all ectopic pregnancies would resolve themselves through miscarriage if left untreated. Also, if methotrexate is used to stop the development of the embryo (and eventually kill it), the tube does not require surgical intervention to repair it. So it makes it a little difficult to claim that a salpingectomy is necessary to treat the tube. What is the danger to the mother is that the embryo keeps growing. It seems to me that a more plausible reason for the salpingectomy than that the fallopian tube needs attention.
So I think the decision of the Phoenix ethics committee is defensible within the framework of Catholic thought. But I also have the gut feeling that so many Catholics and non-Catholics have about the situation that took place in Phoenix. If a mother is going to die if her pregnancy continues, and her unborn child is going to die as well, it is difficult to accept that the most moral choice is to let both die. This case acts as kind of a reductio ad absurdum argument against Catholic thought in this area. If the conclusion is that the right thing to do is to let both mother and unborn child die rather than save the life of the mother, then there must be something wrong somewhere in the premises or the arguments based on them.
Mercy and love do not require killing, as Dale suggests, either in Dresden or in abortion. This is not rhetoric, it is truth.
I am not going to say my Church hierarchy right or wrong on this issue. The Church is all of us - and if the USCCB is too out of step with common sense and justice, they will be ignored by our hospitals and the people. The authority of the bishops is no longer as weighty as it once was - they need to realize this or find themselves stewing in their own juices with no one noticing. The same goes for Rome as well.
And before you accuse me of persecuting the Church, get over yourselves. Richard Doerflinger & Co. at USCCB are no more (or less) infallible than I am. As long as he treats life as a fetish, he will risk being ignored.
The question ''What would Jesus do'' is an interesting one here, since Jesus was a Jew, and in Judaism, abortion is permitted (some might even argue it is required) if necessary to save the life of the mother. There are very ancient Christian documents condemning abortion, and there are Jewish documents condemning abortion that are considerably more ancient. But Jews, to the best of my knowledge, always permitted whatever was necessary to save a pregnant woman's life. Exactly where and why Christianity and Judaism diverged on this question would be interesting to look into.
Speaking of anger, I have attempted to explain the position of Bishop Olmsted (which I personally disagree with) to people who get so angry that they won't let me continue. There is certainly something to be said for the principle of never doing evil that good may come of it. But the case of a woman with a life-threatening pregnancy is so emotional, it is difficult to argue about it directly, and it is so unique, it is impossible to come up with analogies.
Although I would prefer to believe it is not true, it certainly seems that many people who condemn Sister McBride harshly are indifferent to the plight of women with life-threatening pregnancies. To hear some people talk, it seems like they believe women in that situation have a stark choice between heroic martyrdom or eternal damnation. I find it difficult to believe that God puts anyone in such an extreme situation.
Paul Baumann, After Tiller: Envisioning ACompromise, NPR.org, June 19, 2009 · http://www.npr.org/templates/story/story.php?storyId=105413931