The moral analysis rejected by Bishop Olmsted.
Last summer, Bishop Olmsted of Phoenix asked Catholic Healthcare West to provide a moral analysis of the case that started this controversy. So CHW secured the services of the moral theologian M. Therese Lysaught. Her analysis, sent to the bishop in October, was rejected by Olmsted last month. We have obtained Lysaught’s cover letter to CHW along with her analysis.
In her cover letter, Lysaught summarizes her conclusion: “The procedure performed at St. Joseph’s Hospital and Medical Center on November 5, 2009, cannot properly be described as an abortion. The act, per its moral object, must accurately be described as saving the life of the mother. The death of the fetus was, at maximum, nondirect and praeter intentionem. More likely, the fetus was already dying due to the pathological situation prior to the intervention; as such, it is inaccurate to understand the death of the fetus as an accessory consequence to the intervention.”
Lysaught’s analysis includes a detailed summary of the medical condition of the mother. In October 2009, the mother’s doctor counseled her to terminate the pregnancy because the symptoms of her pulmonary hypertension were worsening. He estimated that, given the advanced state of her disease, she would have a 50-50 chance of surviving the pregnancy. The mother, a Catholic with four children, decided against ending the pregnancy. Less than a month later, she was admitted to St. Joseph’s with more severe symptoms.
A cardiac catheterization revealed that the woman now had “very severe pulmonary arterial hypertension with profoundly reduced cardiac output”; in another part of the record, a different physician confirmed “severe, life-threatening pulmonary hypertension,” “right heart failure,” and “cardiogenic shock.” The chart noted that she had been informed that her risk of mortality “approaches 100%,” is “near 100%,” and is “close to 100%” if she were to continue the pregnancy. The chart also noted that “surgery is absolutely contraindicated.”
As Lysaught makes clear, the pregnancy itself exacerbated her symptoms. Owing to physiological changes accompanying pregnancy, the mother’s heart could no longer supply enough oxygenated blood to sustain her organs–or the fetus. “In short,” Lysaught writes,
in spite of the best efforts of the mother and of her medical staff, the fetus had become terminal, not because of a pathology of its own but because of a pathology in its maternal environment. There was no longer any chance that the life of this child could be saved. This is crucial to note insofar as it establishes that at the point of decision, it was not a case of saving the mother or the child. It was not a matter of choosing one life or the other. The child’s life, because of natural causes, was in the process of ending.
There’s much, much more in the rest of the document–including Lysaught’s analysis of the intervention based on the work of Fr. Martin Rhonheimer and Germain Grisez, along with her response to the National Catholic Bioethics Center’s analysis and an application of the USCCB statement [PDF] responding to the controversy. The whole document is worth your time.
You can read Lysaught’s cover letter to Lloyd Dean, president of CHW, here [PDF]. And Lysaught’s twenty-four-page analysis is available here [PDF].
NCR‘s story on Olmsted’s decision to revoke CHW’s Catholic status is here (be sure to follow their helpful links).
Tags: Olmsted
This becomes worse than what was apparent before the report. The report states the fetus was already dead or at least irrecoverable. This begins to impugn the bishops motives and integrity. As far as what is reported he gave no real explanation for his action except to say the action was against Catholic doctrine which he gives no verifiable data to support his position. It is like he was looking for a cause to make a name for himself and he would seek the limelight without regard to accuracy and truth. If one studies his actions it is clear that he goes against the orthodox position of the church. The bishop comes out opposed to the orthodox and unorthodox. Looks sleazy at his point.
Now we see the consequences of appointing bishops who cannot muster the intellectual prowess to deal seriously with moral issues. The current emphasis on the bishop as ultimate teacher is challenged by inability of some bishops like Olmsted to handle serious theological arguments. The crisis of clergy education has come home to roost. Poorly educated seminarians have now become bishops. God help us all.
“God help us all.”
Let’s remember this sad situation is part of the legacy of JPII.
In this case, Olmsted epitomizes the pharisees of our day.
Status seeking hirelings become bishops and theological reflection and pastoral leadership for the People of God is not part of the package for such men. Their gig is all compensation all the time. “Look at me, I’m a bishop.” God help us all!
http://www.arizonacatholic.org/wp-content/uploads/2010/12/DIOCESE-OF-PHOENIX-DECREE-122110.pdf
I am really upset at the way these things are done. I realize I don’t know much about canon law but wouldn’t it make sense to have a hearing within the Catholic community about these things? Is there an appeal process? I know the Church is not a democracy but it should not be a tyranny.
I am also concerned that the bishop has not told us what other medical steps should have been taken to save the woman’s life. It seems to me that he owes the hospital and the faithful at least that.
Peace in Christ,
Carolyn Hyppolite
carolynhyppolite.blogspot.com
It’s good to see in this post a new focus on the substantive argument of the abortion (although that dead horse rather reeks by now), rather than the erroneous opposition to the RIGHT of the Bishop to remove the name “Catholic” from the hospital. As the America blog has cited, the validity of Bp. Olmstead’s authority in the matter is perfectly clear:
Canon 216: “Since they participate in the mission of the Church, all the Christian faithful have the right to promote or sustain apostolic action even by their own undertakings, according to their own state and condition. Nevertheless, no undertaking is to claim the name Catholic without the consent of competent ecclesiastical authority.”
Bp. Olmstead has withdrawn his consent. You might disagree with the basis for his doing so, but he has the authority to do so, like it or not. You might disagree with his pastoral approach, but that does not change the fact that he has the authority to deny this hospital the right to call themselves a Catholic hospital.
More on Canon 216, from canon lawyer Ed Peters:
http://canonlawblog.blogspot.com/2010/12/bp-olmsted-canon-216-and-st-josephs.html
By the way, anyone who wants to continue moral analysis of the recent abortion should stop beating that dead horse and try to rationalize the fact that Bp. Olmstead first initiated discussions with CHW problems SEVEN YEARS AGO. This is not a matter of a single instance of arguable morality, double effect yadda yadda. It is a lengthy and wide-ranging pattern of policies which betray the teaching of the Catholic faith in their hospital’s operations.
http://www.all.org/article.php?id=13111
“Bp. Olmsted first initiated discussions with CHW problems SEVEN YEARS AGO.”
Which lends a certain irony to the title of the previous post discussing Bp. Olmsted’s revocation of “Catholic” from the hospital: “Fast Acting”.
There goes the credibility of this bishop. When, one future day, he has something worthy to say, few will listen. Worse, he is damaging the church by his actions. He is torpedoing the authority of his office by misusing it. Isn’t that scandalous? The sisters have tried to talk with him, but he won’t listen. Can we excommunicate him now?
Olmsted made clear in his Nov 22 letter to CHW that his primary concern was his authority; he emphasized it about a dozen times in the one letter. His concern is understandable since he had apparently tried for seven years to impose himself on CHW without success. The summary information now available here about the medical situation suggests that the bishop’s dealing with the alleged abortion was closer to attempted fraud than incompetence. If there is any future benefit out of this, in addition to the mother’s life, it may be that the bishop has taught us far more than he might have wished to about himself.
“You might disagree with his pastoral approach, but that does not change the fact that he has the authority to deny this hospital the right to call themselves a Catholic hospital.”
And I have the right to inform the bishop he just committed a very serious sin. He has abused his authority and violated the First Commandment.
I call upon this sinner to repent.
What is the practical downside, if any, of the hospital losing its official “Catholic” designation? Does it impact its funding stream? Would it lose a meaningful number of clients? For me, I would actually be more confident with a hospital that had a “Sisters of Mercy” designation than one that was officially “Catholic”. But what’s the real impact?
Irene,
A lot depends on what kinds of agreements are in place between the hospital and various parties. Funding is not an issue. The Church gives no funds to Catholic hospitals, which are subject to the usual difficulties of all hospitals — that is, being a provider of last or even first resort for people who can’t pay (which is why hospitals tend to view health care reform through the opposite side of the lens from physicians).
CHW is a conglomerate — a very large provider of health care services that, I imagine, long ago ceased depending on its derivative status through the USCC, if it ever did so. More likely, the impact will be felt on the religious order and the personnel placed in the hospital through the order, or, if they exist in Arizona (doubtful), Catholic universities or medical schools that cooperate with the university.
The more I think about this the more I think Cathy Kaveny’s original take on the situation is correct — that a prophet embraces hard cases to validate his principles and authority. I have the awful, unshakeable feeling that the bishop actually looks forward to a repeat of the circumstances of this situation, so that can command the death of a woman to prove his own authority.
It is precisely this kind of situation that is pushing people out of the churches in droves. The vast majority of human beings – Catholics as well as Protestants, Jews, Muslims, Buddhists and nonbelievers — being presented with the unfortunant, painful facts of this case would arrive at exactly the same sad conclusion and response as the hospital. But the Bishop comes to the opposite conclusion and not for sound theological reasons but instead to uphold and exert authority. That the mother, despite warnings from doctors, tried to keep this problematic pregnancy going is a wonderful example of bravery and faithfulness. The truth of this is not lost on Catholics. It is not lost on women and mothers. Fathers (and I don’t mean priests!) or brothers. So when Catholics see autocratic bishops ignoring “truth” in favor of authority — how can they not walk away?
Why would Catholics listen to leaders like Bishop Olmstead? Why would Catholics in the face of evidence and compassion, blindly follow a bishop they know has made a bad, self interested decision? If Catholics know anything by now it is this: those in the greatest positions of power in the church have far more self interest and interest in preserving the power of the church as an institution than in ministering to and leading the faithful.
This is in the end what wlll kill off the vitality of the church. Sorry, we are not called to follow poor leadership. Most Catholics can’t – and won’t – be fooled.
Suzanne is right!
The comments are analogoius to what carolyn Disco noted at the end of the thread on Cathy’s article below.
But the Defenders of the Faith will staunchly back the Bishop, cite canon law, etc, -all of which is more offputting.
I think that any bishop can command the death of a woman all that he wants, but that physicians, surgeons and nurses are not going to fall in line to obey such commands. I’d call this an impasse and I side with the physicians, surgeons, nurses, etc.
Molly, I agree that the bishop’s lack of empathy seems extreme — that it’s one thing to make doctrinal pronouncements but it’s quite another to stand around and refrain from doing exactly what one was trained to do and bring about the avoidable death of a mother of four young children. I wonder what it does to the mental health of people being put in that situation.
Suzanne,
I don’t think the bishop is acting out of selfish interest for power. I think he’s wrong. I think there’s a problem with the way these things are done. But I think he means well and has genuine concerns about the hospital.
This press conference is worth watching:
http://www.azcentral.com/video/719142915001
peace in Christ,
CKH
carolynhyppolite.blogspot.com
How exactly does the bishop gain by this? It’s lousy PR, as many note. It’s not as though Phoenix is likely to become an archepiscopal see, much less a cardinalate.
What’s his alleged cashout?
“Bp. Olmsted first initiated discussions with CHW problems SEVEN YEARS AGO.”
That is probably a very broad use of the word “discussion.”
“Authority has simply been abused too long in the Catholic Church, and for many people it just becomes utterly stupid and intolerable to have to put up with the kind of jackassing around that is imposed in God’s name. It is an insult to God himself and in the end it can only discredit all idea of authority and obedience. There comes a point where they simply forfeit the right to be listened to.”
Thomas Merton in a letter to W. H. Ferry dated 1-19-67, as quoted in a letter to the Editor in 10/2/98 NCR.
“Authoritarianism is authority that has ceased to struggle to become leadership.” Richard A. McCormick,SJ, Notre Dame ethicist, America, 7/20/96.
” That the mother, despite warnings from doctors, tried to keep this problematic pregnancy going is a wonderful example of bravery and faithfulness. ”
Suzanne –
Indeed. She deserves our greatest respect. Not only did she have to go through the trauma of facing her own death, but she had to accept the death of her unborn child, and had to make the excruciating choice to permit it. When I think of her I keep thinking of Mary at the foot of the Cross. I can’t imagine a worse choice to make. Add to that the final insult of having her privacy invaded. I say she is a saint, and the Mercy nun is another one to whom we owe enormous gratitude for her integrity, compassion and strength.
Bp. Olmsted is a threat beyond the case at hand. Suzanne S. asks “Why would Catholics listen …?” Whatever the reason, some do and will. Before doing so, consider.
The bishop asserts in his Dec 21 prepared public statement “In this case, the baby was healthy and there were no problems with the pregnancy; rather, the mother had a disease that needed to be treated.” This justification for his allegation of abortion is patently false about the baby and the pregnancy as shown by year-old information to which he has had access. Whether the falsehood is due to ignorance, malice, or agenda is irrelevant. Its publication by him shows Olmsted’s approach to a profoundly serious pro-life problem, and there is no reason to expect him to become wiser in the future.
If it were my wife on the table, I would be deeply concerned if the responsible professionals were listening to the likes of Olmsted.
http://www.arizonacatholic.org/wp-content/uploads/2010/12/DIOCESE-OF-PHOENIX-STATEMENT-122110.pdf
Carolyn H. –
Thank you for your post. It reminds us that we really don’t know the individual bishops well at all, and we shouldn’t judge the individuals *intentions* unless we know the individual bishops well. There’s that word again — it more than anything is, I think, what makes us human. But it’s a plain fact that the bishops are so far removed from their flocks that there is no possible way we can really know them. All of there decisions seems to be made in utter secrecy and their justifications for their actions are often really just fiats. There is no arguing with these people. So how can we possibly know them, and if we don’t know them how can we respect them?
But we do have to have some way to think of them as parts of this whole system we call “Church”, and as I see it few of them *show* the compassion we need to see in our leaders if we are to take them seriously. The compassion might be there, but where is its manifestation? Then there is the justice of the acts of individual hierarchs. There is no way to challenge it in the Church. Oh, sure, I can respect the office of bishops and I do easily enough, but respect for the exercise of that office has to be earned, bishop by bishop.
I wonder if, in light of this kind of decision, we’ll begin to see more and more hospitals describe themselves as being “in the Catholic” tradition, as is the case with some colleges and universities.
Here’s the institutional problem: most bishops would not have chosen a hard and heartbreaking case like this to draw a line in the sand. The bishop’s extreme position on what counts as “abortion,” coupled with a clear and imminent threat to the mother’s life, put the hospital in the spot of choosing whether to follow the expectations of this bishop or to risk exactly the kind of public mess that has ensued, by saving the mother’s life.
But another bishop would have made no such move. So, it would seem that the designation of one’s hospital as “Catholic” under canon law, (NB: not civil law, as the example of all those colleges “in the Catholic tradition” demonstrates,) depends on the particular opinions of the current bishop. Each change of bishop could mean a change in the hospital’s designation of “Catholic,” with all the questions that arise about accreditation and physician licensure, not to mention the consciences of all involved.
I bet a number of Catholic hospital boards will be having hard conversations in the coming weeks and months, at least those in dioceses where the present bishop interprets the ERD in the very physicalist way the Olmsted does.
Although it is true that there is no cure for pulmonary hypertension, it can be controlled through adequate treatment. Unless I missed it, it appears the clinical history submitted by Therese Lysaught does not contain information as to what treatment was used to try to control the patient’s pulmonary hypertension.
That being said, this report http://www.lifesitenews.com/news/report-sheds-light-on-abortion-contraception-in-catholic-hospital-network/ sheds light on the moral analysis that was used to determine that Catholic Hospital West, through The Mercy Care Plan, is not committed to following the teaching of the Catholic Church and thus the Bishop’s response was due to the fact that the faithful have a right to know whether this institution or any institution that professes to be Catholic is Catholic in practice and not in name only.
“Although it is true that there is no cure for pulmonary hypertension, it can be controlled through adequate treatment. ”
Nancy,
When the hypertension is caused by the abnormal demands made on a woman by her poor dying child, the only adequate way to control the hypertension is removal of the poor child. This is a horrible truth. Life is sometimes horrible.
Bp Olmstead: call Dr. Phil.
http://www.drphil.com/shows/show/1529
(H/t Joe J)
It’s worth noting that, in addition to Lysaught’s moral analysis of the case, which to my reading follows pretty closely along the path that Cathleen Kaveny illuminated here in dotCom a few months ago, the Lysaught paper brings a couple of things to light:
* She seems to have access to the patient’s medical chart, and provides some details attesting to the gravity of the medical situation
* If I understand correctly, we learn that the specific procedure used to treat the patient was a D&C (dilation and curettage). Wikipedia (the most technical medical journal I can follow) describes the procedure as “the dilation (widening/opening) of the cervix and surgical removal of part of the lining of the uterus and/or contents of the uterus by scraping and scooping (curettage). It is a therapeutic gynecological procedure as well as a rarely used method of first trimester abortion.”
My assumption is that the choice of this procedure lies at the heart of what the bishop (and presumably his ethics advisers) found repugnant about what happened at the hospital that day.
Lysaught goes to great lengths in her paper to demonstrate that one can’t simply look at the nature of the D&C procedure and conclude that a directly willed abortion took place; the circumstances (the baby would certainly die no matter what) and the intentions of the principals (saving the life of the mother) are crucial in determining the morality of the action.
I watched the press conference linked above. Oh, the banality of evil. The bishop is convinced that he made the right decision. He’s now unable to decide differently b/c he needs to believe he’s correct. “The baby was healthy.” How does he come to that conclusion when all the medical evidence points to a dire outcome for both fetus and mother? This is both sad and disgusting. This mild-mannered looking man apparently is well acquainted with obedience, but is lacking in intellect, imagination and common sense.
By definition, if a woman who is 11 weeks pregnant is dying, the fetus is dying too. Neither can be deemed “healthy” under the circumstances. I find the refusal to see the interrelatedness of woman and fetus in a healthy or unhealthy pregnancy to be downright frightening. It’s a rejection of reality.
So, it looks like it will be the bishops against the nuns. What a disaster! Please, pray for our Church.
http://ncronline.org/news/catholic-health-association-backs-phoenix-hospital
Peace in Christ,
Carolyn Hyppolire
Nancy and Ann:
From my reading, too, Dr. Lysaught’s written review of the medical case specifies neither the type of pulmonary hypertension the patient had nor the treatments attempted before and during her pregnancy. As someone how knows Dr. Lysaught and her work, I’m confident she did a thorough review of all records available to her, sought highly-qualified medical opinion, and included necessary data in her report (to the degree HIPAA regulations permitted, if the patient is otherwise identifiable). Absence of specifics about treatment ought not be overinterpreted.
A 2007 review of the treatment of pulmonary hypertension in pregnancy (Huang and DeSantis, Am J Health Syst Pharm. 2007 Sep 15;64(18):1922-6.) lists the usual therapies: inhaled NO, calcium channel blockers, and sildenifil (aka Viagra or Revatio), as well as some newer targeted pulmonary vasodilators. Standard guidelines, including Up To Date, a readily available online point of care medical reference, make clear that the pregnancy, or rather the placenta, significantly worsens underlying pulmonary hypertension through its hormonal effects on blood volume and flow. Early identification and treatment are necessary for medical treatment, rather than removal of the placenta, to have any chance of saving mother or child, and mortality rates increase sharply with severity of disease. (Dr Lysaught’s review indicates the patient’s disease was severe to extreme.)
I am a pediatrician and not an OB, so I yield to any OBs, pulmonologists or perinatologists who wish to comment. I was, however, able to locate the cited review with a few quick clicks on PubMed, a standard medical literature search engine. Since the patient was followed by a pulmonologist and an OB/GYN, and the case was reviewed by the hospital ethics committee, it’s highly improbable that these therapies were unknown to these professionals, given the gravity of the situation. It seems, therefore, reasonable to assume that all therapies short of the procedure at the heart of the controversy were at least seriously considered if not attempted. If you have information to the contrary, I hope you will share it with us.
I offer this only as supplementary information, with the assumption that all concerned in this sad human drama, including commenters on this thread, are acting in what they understand to be good faith.
Brian, I know nothing about the details in the medical records. That being said, Catholic Healthcare West has not responded to these charges:
http://www.all.org/pdf/CHW_ALL_Report_20101220.pdf
In good faith, Catholic Healthcare West should respond to these charges unless they believe that Bishop Olmstead has made the right decision.
Dr. Volk –
Thank you for the expert information concerning possible treatments.
I am a bit mystified why you address me with Nancy. I don’t share her view. Since no evidence whatsoever has been offered to make us doubt the competence of the medical professionals involved, I think we are morally bound to accept their judgement about the severity of the woman’s condition. I think the ethics committee of St. Joseph’s made the correct, though excruciating decision.
Given the case as described by apparently competent medical professionals, I find it simply astonishing that the bishop should pronounce the fetus “healthy”. As if his doctorate in canon law makes him competent to criticize the medical judgments of the medical doctors!
Meanwhile, in the Washington Post, Mar Muñoz-Visoso, the assistant director of media relations for the U.S. Conference of Catholic Bishops, said Wednesday that “the specific case of the Phoenix hospital is a local issue within the realm of the authority of the local bishop.”
There is nothing “Local” about this case. What if every Catholic hospital in the country must deal with patients (especially those with life-threatening pregnancies), as the local ordinary directs the hospital?
Little Bear –
You might be right, but it looks to me like the NCCB is distancing itself from Bishop Olmsted. I hope so.
Nancy:
I appreciate the concerns you raise about Catholic Healthcare West and hope someone will respond to them soon. As far as I know, Dr. Lysaught was not asked to address these matters, only the case in question. I offered the information above only to help others understand how readily treatment information, such as it is in this extremely difficult condition, can be obtained and evaluated. Then again, as Wendell Berry rightly says, “…medicine is an exact science until applied; application involves intuition, a sense of probability, “gut feeling, ” guesswork, and error.”
Ann:
Forgive me for not being clear. I understand you don’t share Nancy’s view. I included you in my comment only because you had addressed Nancy regarding treatment of pulmonary hypertension, and I hoped I might clarify things a bit. Unless I’m missing something, it is difficult to tell from Bishop Olmstead’s decree yesterday what expert medical advice he sought in making his decision. For the benefit of all involved, I hope he will soon clarify the reasoning behind his assertions on the medical issues.
My assumption is that the choice of this procedure lies at the heart of what the bishop (and presumably his ethics advisers) found repugnant about what happened at the hospital that day
That is the crucial distinction here. A distinction that Lysaught ignores, but goes to great lengths to twist and distort and obfuscate.
(1) This was not a mere “termination of pregnancy.” Birth is a termination of pregnancy. Induced premature delivery is a termination of pregnancy.
This was an intentional killing of an unborn child. It was the doing of an act with the certain knowledge that such act would result in the death of the child.
There was no attempt to save the life of the child. There was no attempt to utilize methods that would try to save the life of both the mother and the child — which is the distinction to be made in this case. Instead, there was merely the choice to utilize a method that involved the mutilation and dismemberment of the child, which would necessarily kill her or him.
(2) The child was NOT terminal or otherwise dying, any more than a person in a burning building is already dead. Now, to be sure, there are a lot of medical “ethicists” who will insist that people like Terri Schiavo are, because of their condition, in a process of dying, such that to starve and dehydrate them is not to cause their death. But in those cases, and in this, that is only outcome determinative argument to justify the unjustifiable, and to try to say that what is evil is good, and what is good is evil.
Had there been some recourse or attempt to utilize a method that might possibly save the life of both patients, e.g. an induced premature delivery or c-section, rather than utilizing a method that involved the affirmative killing of one of them, then even if the attempt failed to save the life of the child, then that would have been the moral thing to do.
When you have one too many people in the lifeboat, it is not a moral choice to shoot one of them in the head. Nor is it intellectually honest to then say that you did not intend to kill that person, you only intended to save the others. An intentional act done with the knowledge that it will absolutely cause the death of a person is an intentional killing.
But instead of thinking through the issue, let’s simply reflexively bash the bishop and the Church once again.
What’s really odd about the sanctions that Bp. Olmstead imposed on the hospital, namely no reservation of the Blessed Sacrament, no Mass, no use of the name Catholic, is that he seems to think that somehow he can make God’s saving power and grace less accessible to the patients and staff of the hospital. Why would he think such a thing?
Dr. Volk –
Thank you so much for your input. Expert perspective is always appreciated here. (Well, sometimes, anyway :-)
Dr. Volck’s contribution is invaluable in pointing out a few necessary considerations if one is going to begin to evaluate the Phoenix case. A brief supplement on the subject of pulmonary hypertension offers other considerations on how to think about it at
http://www.merckmanuals.com/professional/sec05/ch058/ch058a.html#CIHJGDCI
Bender
The proposal of “induced premature delivery or c-section” to save the life of an 11-week fetus is absurd for the human race in 2010, even if the mother had been in perfect shape. The people who suffer through these sorts of events deserve better consideration.
I suspect that “induced premature delivery or c-section” would be high risk procedures for the mother, who could not be moved to another hospital because of her condition.
Nancy referred to a report that accuses CHW of ignoring Church teaching. As far as I can tell, the report primarily accuses CHW of active involvement in community health care. Because they have granted money to organizations like the city-sponsored San Francisco Health Plan, they are presumed to endorse everything SFHP does. IOW, they want Catholic Health organizations to do nothing to support community health initiatives for fear they might promote contraception. (of course, the authors also opposed the federal government’s efforts to improve community health centers because of similar far-fetched entanglements, so there may just be animosity toward efforts to promote health)
The report also claims “CHW helped create” a health program because CHW’s CEO was chairman of the committee that produced the program. If we are going to hold to that standard, then we need to cut off all ties with the Catholic Church because the Pope headed a diocese that allowed sexual predators to work as priests. These are similar nebulous connections that might seem reasonable to people; I am just suggesting that consistency demands the rules be applied as rigidly to the Church as they are being applied to CHW.
There are other accusations, but I suspect they are as flimsy as these. I can understand why these complaints have been ignored.
Is it possible that the only fully moral thing to do in this sad case was to monitor the fetus (who at best would not long survive the death of the mother) in hopes that it might die naturally while there is a small window of opportunity to save the mother? The risk is that the mother dies first, of course. Is it possible that the only fully moral option is to attend that risk. I don’t say ethical here, because it’s clear that medical ethics–and most everyone’s common sense–says to do what you can, what you must, to save one life if the only other choice is that two individuals will die.
I think even the most ardent defenders of Bishop Olmsted have to recognize that viability was too many weeks away to hold out much hope that the mother would survive the pregnancy. Or am I wrong? Is the implicit argument that the hospital was too eager to terminate the pregnancy (through abortion) when it might have done so through a live birth two or three months later? Or is it that the only action consistent with Catholic moral teaching was to refrain from the medical procedure that was at once life saving for the mother and life destroying for the fetus?
Was the hospital at fault in doctrinal terms for intervening too quickly, rather than allow nature to take its course? Or is the argument
Is anyone here prepared to say that in MORAL terms two deaths in this case were preferable to one (if it came to that), so long as no human hand was a direct cause for the death of the fetus? and that if the situation were to present itself again that outcome would be the correct choice?
I suspect there are some who might say, “I understand that the mother would (definitely/most likely) have died absent the D&C, but that is a death a faithful Catholic must accept as an act of God human beings are not permitted to prevent under the circumstance.” Is anyone able to claim this position and defend it?
Apologies for poor editing. I hit reply too soon.
Regarding the induction of pre-term birth: I was told that inducing delivery before the cervix is ready is actually pretty difficult. Most planned/urgent premature deliveries are by c-section for this among other reasons. Further, if you are absolutely required to bring about induced labor, you might need to use agents that are toxic to the fetus. It also takes a lot of time. Even when you induce when you are ready, it can take hours for active labor to kick in. Of course by that point this woman would most likely have been dead — and all of this prolonging of process at great peril to the mother would not actually have had any effect on the outcome for the fetus.
Bender, your objections would seem to run counter to the recommendations of the USCCB’s health care directives, which offer the analogous example of doctors removing the uterus of a pregnant woman with uterine cancer. The fetus dies, and that is foreseeable but that is not the intended effect. But it is a morally licit action. the bishops say:
http://www.usccb.org/doctrine/direct-abortion-statement2010-06-23.pdf
BTW, Cathy Kaveny (I believe) also raised the issue in previous threads of the legal exposure of a Catholic hospital if it followed the directives of a bishop in a case like this. In other words, if they had gone ahead and did not take action on the placenta to address the hypertension and the mother (and baby) died, then the hospital would be sued. Following Olmsted’s path would seem to make it practically speaking impossible to have a Catholic health care institution. No?
“The report also claims “CHW helped create” a health program because CHW’s CEO was chairman of the committee that produced the program. If we are going to hold to that standard, then we need to cut off all ties with the Catholic Church because the Pope headed a diocese that allowed sexual predators to work as priests.”
Excellent point, Jim McK. Another example of the official Church proclaiming a general moral principle as inviolable in one case — yet breaking it in specific other cases. So you tell me — what is the teaching of the official Church about not contributing to an evil act == is it what the Church *says* or what the Church *does*??
By the way, lest any visitors to the blog think that it is just Catholics who are obsessed with cases like this one, there is a very active sub-field in ethics these days devoted to “the trolley problem” or “trolleyology”. It is named after a mind experiment of philosopher Phillipa Foot’s. It goes like this:
‘A trolley is running out of control down a track. In its path are five people who have been tied to the track by a mad philosopher. Fortunately, you could flip a switch, which will lead the trolley down a different track to safety. Unfortunately, there is a single person tied to that track. Should you flip the switch or do nothing?’
http://en.wikipedia.org/wiki/Trolley_problem
There are many, many variants of the story.
There has also been a lot of work done by psychologists researching how people react to such moral dilemmas. Typically, it seems, we react with both strong feelings and with strong arguments, and our thinking and feelings typically conflict.
How does the Church feel about “innocent aggressors”? Are we permitted to protect ourselves- save our own lives- in those situations? (I know that kind of language sounds really cold when talking about a mother and child; I’m just trying to work through this in my own head). I completely feel the woman has a right to save her own life and there would be something terribly wrong about forcing a woman to go through with a pregnancy that was, for her, a death sentence. Parsing out whether the procedure is an abortion or not doesn’t answer the real question, whether a woman has a moral right to save her own life in those circumstances.
Also, is this one of the objectives of the pro-life movement? To ban abortions even when they’re necessary to save the mother’s life?
It seems to me that in these cases it is important to begin with a clear and defensible account of the meaning of the prohibition against killing. It is not simply a prohibition against causing death, which could be done by lightning, but a causing of death through a deliberate human act that violates justice. This is when one person chooses to take the life of another, either as an end in itself (you simply want the other dead), or–more likely–as a means to some end (for revenge, to facilitate a robbery, to prevent the inconvenience of an unplanned pregnancy, etc) as per Evangelium Vitae no.57.
Whether a given case is an extreme “vital conflict” in which the doctor bears no moral responsibility–(in my opinion but this is not settled in official Catholic teaching)–for causing the death of an unsavable child (whose continued existence will take the mother’s life) will then turn on the clinical details. Unfortunately, the full clinical details in this case are not readily available, which suggests the need for caution drawing conclusions.
Irene, without all the details of the medical records, one cannot know what procedures were used to save the mother’s life. That being said, even though there are those on this site who would dismiss the numerous charges that have been made against CHW, CHW has not denied these charges and in fact they are aware that they are not following the teaching of The Catholic Church. There is enough evidence in this report to determine that CHW, through The Mercy Care Plan, is not Catholic in practice.
David Gibson: the issue would be the nature of the informed consent obtained in instances where an institution deviates from a professional standard of care for religious reasons. For instance, if I seek treatment from a Christian Science facility, I would be hard pressed to sue because it didn’t offer surgery. It should be obvious to me that this is the case, moreover, it is unlikely to be licensed to provide surgery.
The special difficulty here is that St. Joseph’s is equipped to provide all of the care that this woman received — and does provide it in many instances, but might withhold the provision of such care in specific cases based on its own ethical imperatives. While the Church places great emphasis on “inaction” or the indirectness of action as being the separator between moral and immoral undertakings with respect to the fetus, that is probably not going to be much of a defense for the hospital.
It is not a simple matter to obtain informed consent in such a case, as the information provided will likely be too general to address the specific circumstances of individual patients. I reviewed the website for the MFM Department at St. Joseph’s and it provides no indication that some types of care might be withheld for ethical reasons. I have long felt that Catholic hospitals insufficiently address this issue for emergency care services and also in instances where the hospital reserves the right to ignore end of life directives.
I suspect Commonweal readers need to decide whether or not they choose to be obedient to their local Ordinary, or to follow their own consciences, or both.
Those of us who live in Phoenix, and have delivered our own children at St. Joseph’s, and observed what has gone on at CHW and their affiliates recognize that its time to consider other hospitals.
Paul L Scamperle
Tempe, Arizona
-Whether obeying an ordinary or folowing conscience is not just a choice for Commonweal readers, but all Catholics, and, perhaps, with increasing frequency.
-Fr.Martin over at All Things in the America blog, notes the discussion here and also (with its poor wording) the NYT editorial today.
It did make me think of Prof. Kaveny’s question though on accreditation , which has hardly been dealt with here.
-IMO we continue down a path to try to shore up authority/compliance at the expense of service and credibility.
I think the posture of USCCB finds itself impotent to critique openly one of its own, and even if “distancing”, undermines further its own credibility.
In the absence of an OB on this thread, I’ll add just a little more on some of the medical issues. I echo Nancy’s cautionary advice here: “without all the details of the medical records, one cannot know what procedures were used to save the mother’s life.” It may well be that neither Bishop Olmstead nor Dr. Lysaught had all records available; outpatient encounters and therapies before admission may not have been recorded – or recorded adequately – in the hospital record. And even the best-kept charts, which are, after all, written by humans, can miss or misstate important information.
Some have suggested that heroic methods to “save the baby” were required, such as inducing delivery or c- section. Inducing delivery in the presence of an unripe cervix, severe pulmonary hypertension and cardiogenic shock is pretty much out of the question. I have never been in labor myself, but I’ve seen it enough to know that, even in the best of circumstances, it’s exhausting. If the diagnosis of cardiogenic shock was correct, it would most likely have been lethal. And, even if it weren’t, the result would be uniformly lethal for the 11 week baby. To induce delivery at this gestational age is analogous to a mifepristone (RU-486) induced abortion. The likelihood outcome of pursuing a time-intensive, high-risk approach in this case would have been 200% mortality (mother and baby). Similarly, a C-section at this gestation would be a form of hysterotomy abortion, would likely require general anesthesia and, given the mother’s condition as reported, would once again have likely resulted in double mortality.
If the records we have outline the story, the medical providers were in a terrible situation with limited options. Cardiogenic shock is a scary state even in the nonpregnant patient. The compromised heart no longer delivers adequate blood and oxygen to peripheral tissues, and those tissues sicken and die if not treated immediately — and even then, mortality can be high. In pregnancy, one of those “peripheral tissues” not getting blood and oxygen is the baby. This is where Bishop Olmstead’s assertions of the baby’s health require clarification, ideally from the Bishop or his medical advisers.
To quote from Dr. Lysaught’s analysis:
“As Pius XII noted, the Catholic tradition holds that certain medical interventions aimed at healing a mother or saving her life that simultaneously cause fetal death (at the level of physical causality) may be justified and in fact are not categorized as “abortions.” Justified via the principle of double effect (PDE), the three primary types of such interventions include:
a. Surgical removal of a fallopian tube containing a fetus;
b. Surgical removal of a cancerous uterus containing a fetus; and
c. Administration of chemotherapy or other pharmaceuticals required to treat
maternal diseases or conditions which may result in fetal death.”
In each instance noted, the fetus can be called “healthy,” for the time being at least, but Catholic tradition does not designate the treatments as direct abortion. Is a healthy 11 weeker in a healthy uterus still healthy if the placenta between baby and uterus is propelling mother and baby toward death? Can anyone help me here?
In the absence of all relevant information, we’re at a loss, I suspect, rather like those in the “trolley problem” described above. Such hypotheticals are necessarily abstracted from reality, without a story, without a body, without a person. Yet the Phoenix case was real, with stories, bodies and persons demanding quick and difficult decisions. I, for one, am thankful I wasn’t there, but I would appreciate hearing from someone who was.
I hope Bishop Olmstead will address these matters soon, just as I hope CHW will soon address the concerns Nancy raises.
Again I ask, is anyone prepared to state that it would have been the better thing, the right thing, to let the pregnant women’s condition progress further, even if her risk of death approached ever closer to 100% rather than take the measure of a D&C? Is anyone here prepared to say that the death of two persons is preferable in this case?
Why I ask: there are some who take an “I support the local ordinary” position but do not spell out in what way their moral position on abortion intersects with medical ethics in this case. Is it correct to infer that for some there are situations in which being a witness to the sanctity of life means standing witness even unto a preventable death? and that a truly Catholic hospital would make that moral choice even at the risk of legal action and loss of accreditation?
I guess I’m looking for someone to say, “Here’s where the hospital, including Sr. McBride, was wrong, here’s where the bishop was right, and here’s what should have happened in a Catholic hospital.” Any takers?
Barbara,
Informed consent is a fascinating issue here, because pro-life advocates (such as Matt Bowman of the Alliance Defense Fund, whom I frequently encounter at Vox Nova and Mirror of Justice) insist on the right of pro-life health-care providers not even to mention abortion. In the Phoenix case, I think the Catholic pro-life position as advocated by “hard-liners” would have been that it was improper even to mention to the pregnant woman that terminating her pregnancy could save her life. To inform her that abortion was one of her options, and to suggest that she transfer to another hospital if she wished to have an abortion, would have been impermissible. Also, pro-lifers insist on the right not to make referrals. Had the woman in the Phoenix case been well enough to be moved to another hospital for an abortion, no one in St. Joseph’s Hospital could have participated in her transferral. I don’t think the staff of St. Joseph’s could have actively interfered with her leaving, but it seems to me that they would have had to wash their hands of the matter and let someone acting on the patient’s behalf arrange for another hospital to send someone to come in and physically remove while the staff of St. Joseph’s stood by passively.
You can’t give informed consent if you aren’t informed, and it seems to me pro-life activists want — in the name of conscience protection — the right not to inform patients that abortion is an option, even when the patient’s life is at stake.
This would seem to me to be worrisome to everyone — pro-choice and pro-life alike — because we have in the Phoenix case an instance where experts disagree on whether what occurred in this case was a “direct abortion.” So it is not merely a matter of knowing in advance that if you go to a Catholic hospital you can’t have an abortion. It is a matter of knowing which Catholic hospitals consider which procedures to be abortions.
William, I suspect that Jim Pauwel’s comment up thread about the use of D&C is substantially correct. If there were a “clean” way to remove a placenta without using D&C (like there is a uterus or fallopian tube), I suspect that the bishop would have been able to “fit it” into that paradigm, as described by Brian in his immediately preceding comment.
One must ask, as I have done over and over again, is the technical nicety of the operation truly the fulcrum that drives the right moral response to one side of the see-saw or the other? This seems incredible to me, when the effect of each procedure is to terminate the pregnant state and thereby bring about the death of the fetus. In a less fraught context, it’s like sending someone to jail for three months for selling 1 gram of cocaine and 30 years for selling 2 grams. Sure, even obvious bright lines can often seem to bring about asymmetric results, but the asymmetry here is literally the difference between heroic efforts to save a life, and allowing death to come as a matter of course, and that difference, it seems to me, requires those asserting that this doctrine is mandatory and fundamental, to rely on moral principles that are manifest and obvious, rather than relying on subtle differentiation and biological determinism.
Barbara writes: “Regarding the induction of pre-term birth: I was told that inducing delivery before the cervix is ready is actually pretty difficult. Most planned/urgent premature deliveries are by c-section for this among other reasons. Further, if you are absolutely required to bring about induced labor, you might need to use agents that are toxic to the fetus. It also takes a lot of time.”
This is true. About 12 years ago, I was six months pregnant with a baby girl when she died in utero. I had to be induced to deliver her. It took an entire day at the hospital with various medications, (petosin won’t even work in these situations – they bring out the harder stuff) to get my body to go into labor. The body will not give up a baby easily when it is not the right time. It was a very long process.
A final thought — something from Thomas Merton — :
“[This] is one of the things that we are struggling with, ourselves, in a rather naive way:.. the kind of dualism that arises in a strictly dogmatized religion. Where you continue to declare this is true and this is false,… very soon you build up a very uncomfortable body of statements that are reputed to be false but which contain truths that can’t be ignored and that have to come out in some other way… There comes a point when the things that you reject are going to come back home to roost.”
What is happening now in the church is that these “things” are coming back home to roost —
I disagree with the Bishop, but that in itself isn’t very important, what is important is that his reponse is one more nail in the coffin of the church. I fear that the majority of Catholics will reject his reasoning (like my devout 79-year-old mother).No mother will accept the idea that her adult’s daughter’s life is being thrown away in hopes of saving a baby who is unlikely to make it anyway (mom would need to stay alive for at least three more months for the baby to have any chance to live outside the womb). No father will accept it either or husband or sister. The nun who was there agreed with the decision. Why should we doubt her?
This family tried to keep a pregnancy going despite the advice of medical personnel. They deserve nothing but sympathy and prayers.
By the way, I should add that I am pro life down the line.
If there were a “clean” way to remove a placenta without using D&C (like there is a uterus or fallopian tube), I suspect that the bishop would have been able to “fit it” into that paradigm . . .
It does seem to me, based on my admittedly limited knowledge, that a D&C is at least theoretically a “clean” way to remove the placenta. I am basing that statement on a description from here, which contains the sentence: “The doctor will begin to press the tip of the curette along the surface of your uterus to dislodge the placenta and the sac that contains the baby.” It seems to me that if this is the intended first step in a D&C (even if in actual practice something else might happen), then dislodging the placenta is equivalent to removing a uterus with the unborn child inside it. I presume this is the reason why a D&C was the procedure chosen.
I recommend this interesting comment from Arturo Vasquez on Vox Nova. A snippet:
How does one pastor an errant bishop? Is this not the real crisis in this situation?
David, D&C is minimally invasive and requires no anesthesia, though I think local is usually given. You can’t remove a uterus in the same way, in the same timeframe, and without anesthesia. I don’t really care whether there is a clean way to remove a placenta because I think that simply bypasses the larger issue — whether that point should be morally determinative.
If David’s first paragraph at 11:40 am is correct, and I guess it is, it is incumbent upon a pregnant woman to think long and hard about her beliefs before allowing herself to be admitted to a Catholic Hospital. This would include women who are not catholic.
If you are not going to be told about the medical alternatives because of religious dogma, then you could be at risk.
Probably this link was provided on dotCom some time ago – I’m sure I’ve seen it before, but it’s more interesting reading in light of Dr. Lysaught’s paper – here is a statement from last May by the Phoenix diocese’s medical ethicist.
http://www.catholicsun.org/2010/phxdio-stjoes/Medical-Ethics-Director-Statement-05172010.pdf
The statement, while not footnoted nor as detailed as what Dr. Lysaught prepared for CHW, is nonetheless a clear exposition of the principles by which the diocese – the bishop – evaluated what transpired at the hospital.
I would think that Bishop Olmsted, in reading Dr. Lysaught’s paper, would have these principles in mind in determining whether or not it is persuasive.
The diocesan statement seems to confirm what we’ve been surmising: that it is specifically the nature of the D&C (or D&E) procedure that is objectionable. It notes that both mother and baby are considered patients, and so the only procedures that may be considered are those that will help both. Pretty clearly, a D&C helps one by harming the other.
When I have some time, I’m going to re-read Dr. Lysaught’s paper in order to better understand how she attempts to meet the objections that are implicit in the diocesan statement.
Catholics in Phoenix — especially at this time — should watch the replay of Dr. Phil’s program with Dr. Zimbardo, professor emeritus of psychology at Stanford and, without doubt, recognized as a notable member of his profession.
In addition, I suggest they review the idea of “cognitive dissonance” because I definitely see it (as well as Zimbardo’s work) in evidence on this blogsite as well as NCROnline’s.
Should we obey authority simply because it is authority?
How do we reconcile conflicting views that touch deeply on our sincerely held beliefs?
As distasteful as I find abortion (especially the kind that involves cutting up baby before extracting it from mother’s belly), I think the doctors did the morally right thing. More and more, I am coming to see such sad scenarios as instances of self-defense against an aggressor. The matter of “innocence” is not germane to the moral analysis.
“The diocesan statement seems to confirm what we’ve been surmising: that it is specifically the nature of the D&C (or D&E) procedure that is objectionable. It notes that both mother and baby are considered patients, and so the only procedures that may be considered are those that will help both. Pretty clearly, a D&C helps one by harming the other.”
Jim, all due respect, this conclusion is simply not consistent with what has been considered morally permissible under Directive 47, as quoted above by Brian, and restated for convenience:
a. Surgical removal of a fallopian tube containing a fetus;
b. Surgical removal of a cancerous uterus containing a fetus; and
c. Administration of chemotherapy or other pharmaceuticals required to treat
maternal diseases or conditions which may result in fetal death.”
None of these permissible actions HELPS the fetus, and indeed, the first two inevitably destroy the fetus, healthy or otherwise, and the third places fetal health in great jeopardy. It takes an act of willful denial to see a & b as being materially different from a D&C in a case such as this one, elevating the technical details of medical procedures to a pivotal status in moral reasoning that they don’t deserve.
Jim Pauwels wrote;
“The diocesan statement seems to confirm what we’ve been surmising: that it is specifically the nature of the D&C (or D&E) procedure that is objectionable. It notes that both mother and baby are considered patients, and so the only procedures that may be considered are those that will help both. Pretty clearly, a D&C helps one by harming the other.”
So game over then? If “do no harm” to any living being is the absolute standard, is it not the case that both patients are doomed in certain scenarios to either live together or die together. Hard truth, but maybe one we have to accept.
However, I can’t see (m)any medical professionals signing on to this clear and consistent ethic of life.
Jim,
From the statement to which you provided a link: “Second, when speaking of a woman who is pregnant, we are always referring to two people: mother and child. Therefore, any medical intervention must seek the good of both mother and child.”
This is utterly false and not Catholic teaching. In all the classic cases to which the Phoenix case is being compared (cancer of the uterus, ectopic pregnancy, radiation or chemotherapy during pregnancy), the treatments are not for the good of both the mother and unborn child. How in the world is removing a cancerous uterus with a previable infant in it good for the infant? I am just amazed how distorted people’s perceptions and comments are regarding this case.
I see we have all jumped on Jim, but it really is not his fault. It is the fault of Fr. John Ehrich, STL Medical Ethics Director, Diocese of Phoenix. He is the one who is clearly an unequivocally misrepresenting Catholic teaching. If Bishop Olmsted is relying on this guy, no wonder there is a problem.
Barbara says: “One must ask, as I have done over and over again, is the technical nicety of the operation truly the fulcrum that drives the right moral response to one side of the see-saw or the other? This seems incredible to me, when the effect of each procedure is to terminate the pregnant state and thereby bring about the death of the fetus.”
Could someone answer that question please?
I feel like this conversation ducks the issue. People who believe that abortion should never be allowed under any circumstances are evading the question of how to justify letting a woman die even though her baby can’t be saved; they’re saying those facts don’t apply here, or we don’t know if they do. Well how about when these facts do apply? What then? Do you save the woman or not? And people who think the decision was justified seem to be saying “well it really isn’t an abortion, call it something else or focus on the technique used, so we don’t have to say outright that abortion is sometimes morally justified. ”
I think it was an abortion and I think it was justified, but I wish people who are knowledgeable in this area could be more direct in how they discuss it. It would be helpful to people like me looking for guidance.
I second Irene. I, too, think the procedural act in question was an abortion and that it was the only ethical choice facing the medical team. To allow the woman to die would have been a heinously irresponsible thing.
There are times, however few, when abortion is morally justified. That’s why I keep asking if there is anyone whose pro-life position is so thorough as to claim that even in this case abortion can never be an option.
Agree with Irene and William.
(Lots of problems. One will be, that with the increased incidences of early puberty, there will be more little girls impregnated, but unable to carry a pregnancy to term. What will happen?)
I was reading an article on equine pregnancy the other day. Forgot the link, but very detailed, lots of verrrry graphic pictures of all the things that can go wrong. “Red bag”, et al.
No one would stand by and let a cow or a mare or a sow or a ewe or a pet die, if there was some way to intervene and save the animal, even if meant losing the calf, the foal, the piglet, the lamb, the pup. (Olmsted grew up on a farm in Kansas. He must be aware of this.)
Didn’t Jesus say it was okay to break the Sabbath if your ass (or jenny) falls in a hole?
“That’s why I keep asking if there is anyone whose pro-life position is so thorough as to claim that even in this case abortion can never be an option.”
Yes. Bishop Olmsted, P Flanagan and Nancy Danielson, just to name three.
It’s very unfortunate that this woman has lost a child and has been excommunciated as well. Insult to injury.
The Orthodox Jewish view on these tragic cases which, as I understand it, has been explicit at least with Maimonides and probably earlier:
“As a general rule, abortion in Judaism is permitted only if there is a direct threat to the life of the mother by carrying the fetus to term or through the act of childbirth. In such a circumstance, the baby is considered tantamount to a rodef, a pursuer after the mother with the intent to kill her. Nevertheless, as explained in the Mishna, if it would be possible to save the mother by maiming the fetus, such as by amputating a limb, abortion would be forbidden. Despite the classification of the fetus as a pursuer, once the baby’s head or most of its body has been delivered, the baby’s life is considered equal to the mother’s, and we may not choose one life over another, because it is considered as though they are both pursuing each other.”
http://www.aish.com/ci/sam/48954946.html
” — has been excommunciated as well.”
I suspect that God isn’t paying too much attention to this travesty on the part of Olmstead.
And any priest with any sense of Christianity as well as common decency will ignore the excommunication and treat her as he does anyone else who presents herself for communion, counseling or whatever. If he fails to do just that then he is the same whited sepulchre as is this faux bishop.
“There are times, however few, when abortion is morally justified.”
That is not the position of the Catholic Church.
CCC 2271 Since the first century the Church has affirmed the moral evil of every procured abortion. This teaching has not changed and remains unchangeable. Direct abortion, that is to say, abortion willed either as an end or a means, is gravely contrary to the moral law.
And, for those who would horrifyingly compare a human unborn child to a calf or piglet:
CCC 2274 Since it must be treated from conception as a person, the embryo must be defended in its integrity, cared for, and healed, as far as possible, like any other human being.
I wrote: “[the statement by the Phoenix diocese's medical ethicist] notes that both mother and baby are considered patients, and so the only procedures that may be considered are those that will help both. Pretty clearly, a D&C helps one by harming the other.”
Barbara replied: “Jim, all due respect, this conclusion is simply not consistent with what has been considered morally permissible under Directive 47, as quoted above by Brian, and restated for convenience:
a. Surgical removal of a fallopian tube containing a fetus;
b. Surgical removal of a cancerous uterus containing a fetus; and
c. Administration of chemotherapy or other pharmaceuticals required to treat
maternal diseases or conditions which may result in fetal death.”
None of these permissible actions HELPS the fetus, and indeed, the first two inevitably destroy the fetus, healthy or otherwise, and the third places fetal health in great jeopardy. ”
Barbara, you’re quite right to call me on careless wording on my part. I’ll reproduce here the relevant snippet of the actual statement, although, reading your entire comment, I suspect you may see it as a distinction without a difference:
From the diocesan statement:
“Second, when speaking of a woman who is pregnant, we are always referring to two people: mother and child. Therefore, any medical intervention must seek the good of both mother and child. In short, we are dealing with two patients, not just one. So, we never would speak of how the mother’s life is at risk without reference to her unborn child. Her child has as much dignity and value as she does. Morally speaking we can never prefer one life over the other.
“Third, the unborn child can never be thought of as a pathology or an illness. That is, the child is not that which threatens the life of the mother, rather it is the pathology or illness (cancer, premature rupture of membranes, hypertension, preeclampsia, etc.) which threatens the mother’s life. While it is often possible that the pregnancy will aggravate an existing condition, we should never accuse the child of being a threat to the mother.”
So I was careless in stating that a treatment must “help” the child; what the Phoenix statement says is that treatment must “seek the good of both mother and child”. We may ask, in what way does removing the fallopian tube (in the event of an ectopic pregnancy) seek the good of the child. Possibly an answer would be that such a procedure preserves the child’s bodily integrity, and bodily integrity is a good thing.
I agree with you (I assume everyone is in agreement) that the tubal ligation example will certainly result in the death of the child. The distinction between what is *intended* and what is *foreseeable* seems pertinent. In the tubal-ligation example:
* we foresee the death of the child
* We don’t intend the death of the child
* We act in such a way (removing a part of the mother’s organ) that doesn’t directly kill the child.
Compare that to what apparently happened in the St. Joseph’s ER:
* We foresee the death of the child
* We intend (reluctantly and regretfully) the death of the child
* We act in such a way (D&C or D&E) that directly kills the child
I suppose my penultimate bullet directly above may be controversial. Fr. Ehrlich, the author of the Phoenix statement, is pretty direct: “A Dilation and Curettage (D&C) or Dilation and Extraction (D&E) procedure in this context is the same thing as an abortion since it is the direct killing of an unborn child.” In other words, it’s difficult or impossible to reconcile the choice of those procedures with a sincere intention to not harm the child. The choice of procedure seems to reveal the intention of the decision makers.
I don’t like commenting in this manner. I’d rather pray for everyone involved.
“That’s why I keep asking if there is anyone whose pro-life position is so thorough as to claim that even in this case abortion can never be an option.”
Theodicy. How can an all loving God permit evil in this world? Worked through in sincerity for an issue such as this, where there appears to be no “good” answer, we reach a brick wall beyond which our reason cannot go, as in a Zen koan. The only conclusion to the question of theodicy is that our Almighty Father is teaching us that we are not living for this world…we are only pilgrims in this world, our home is in heaven. That perfect justice is found not in this world, but in the next. And we must act in this world from the perspective of the next. That precious knowledge, that understanding, that faith, is the greater good that God can derive from this evil.
This is the basis for martyrdom. Martyrdom is the fullest expression of faith; thanks be to God most of us are not called to it. But martyrdom is still the ultimate truth. That is why the church teaches that a martyr goes directly to heaven, because she has given her life itself for the love of God. Not many will have the perseverance and faith to decide for love of God as did Saint Gianna Beretta Molla but that IS what God calls us to strive toward.
100 years from now, we’ll all be dead. Hopefully, we will all be in heaven. Whether we died tonight or 60 years from now, from that perspective of eternity, is mere trivia.
“So game over then? If “do no harm” to any living being is the absolute standard, is it not the case that both patients are doomed in certain scenarios to either live together or die together. Hard truth, but maybe one we have to accept.”
I’m not certain that it’s “game over”. At the very least, it means that the procedure that apparently was used in that case should have been precluded. The Phoenix statement suggests that, when possible, treatments that directly treat the underlying malady (in this case, hypertension) are permissible. Also permissible, apparently, are treatments that would not *directly* harm the child.
“However, I can’t see (m)any medical professionals signing on to this clear and consistent ethic of life.”
Probably true. It’s worth considering that this situation occurred months before it came to the bishop’s attention. How did the bishop ever learn of it? I’m not sure that we know the answer, but it’s not out of the realm of possibility that a medical person – a nurse? – was bothered enough to go to the bishop, or to someone who took it to the bishop.
If I may, I’d like to just interject this as a factor to consider: we Catholics reverence life as a gift from God, and deplore the unjust attacks on human life in the present age. Yet for us, life is not the ultimate good, to be valued and preserved above and at the expense of all else. We are called to prepare ourselves for eternal life. That doesn’t mean we should be cavalier about sacrificing human life. But our life on earth is not the end for which we are preparing ourselves.
Someone above said something to the effect that God doesn’t care that Sr. McBride is excommunicated. I would reply that scripture teaches us that what bishops bind on earth is bound in heaven, and what they loose on earth is loosed in heaven. If we acknowledge that scripture is genuine revelation, then this is something we must account for.
None of this is to say that the bishop is right and that McBride, Lysaught and CHW are wrong. Lysaught’s paper, to my amateur reading, seems cogent (and, as I say, I’m going to read it again when time permits). If Lysaught is right, then what happened at St. Joseph’s wasn’t a directly willed killing of the baby, and the commenters above who believe that it was a justified abortion may have supported more than is necessary to support.
I am suggesting that we don’t preserve human life at all costs. Preserving human life by committing a serious sin really is a grave risk on the part of the sinner.
Thank you Jim Pauwels and P Flanagan for clear articulation of the moral point on which this case rests. It does seem that, at least for some, the only moral choice in this difficult case was supportive care of both patients even unto their natural death, whatever the calculus involved, i.e., saving at least one of two lives when one could be saved (by hastening the other’s death) and the other cannot. In a case such as this, by rigorous Catholic reasoning, they both have to die.
Jim Pauwels wrote:”The choice of procedure seems to reveal the intention of the decision makers.”
So what other “shake one’s head in sorrow” conditions of troubled pregnancy are a virtual death sentence for mother and fetus in Catholic moral terms?
It’s hard to believe that it all comes down to a choice of a procedure, when the outcome is certain death for the fetus by whatever means it is separated from its mother. But perhaps it is that simple. If only the mother had had some other life threatening set of conditions that allowed for a different procedure (albeit one resulting in certain death for the fetus), the medical intervention would have not been gravely evil.
I wanted to point out that the USCCB Health Care Directives define ANY termination of a pregnancy before viability as a “direct abortion” and thus would disallow even an induction or cesarean at this stage of pregnancy.
“It’s hard to believe that it all comes down to a choice of a procedure, when the outcome is certain death for the fetus by whatever means it is separated from its mother. But perhaps it is that simple. If only the mother had had some other life threatening set of conditions that allowed for a different procedure (albeit one resulting in certain death for the fetus), the medical intervention would have not been gravely evil.”
Hi, William F., it really is true that the act (in this case, the medical procedure) is an important component in assessing the morality of a situation.
Whether the procedure used was the only possible procedure is something that folks with more medical expertise than me can weigh in on.
Regarding the gravity of the evil: we can give thanks that such evil, if not reparable on this earth, is at least absolvable. *If* it is true that great evil was committed, then there are remedies available – graced moments of forgiveness and healing.
“I wanted to point out that the USCCB Health Care Directives define ANY termination of a pregnancy before viability as a “direct abortion” and thus would disallow even an induction or cesarean at this stage of pregnancy.”
Hi, Becky, can you please provide cites/details on that? Wouldn’t there be instances of termination of a pregnancy before viability that wouldn’t be a direct abortion? E.g., if the mom has (let us suppose) malignant breast cancer, it seems plausible that the treatment of the cancer could terminate the pregnancy as a foreseen but unintended side effect?
The purpose in inducing labor or performing a C section usually is to foster the health of the baby and mother. While everyone agrees that the baby was not viable outside the womb, it seems that neither was the baby viable inside the womb, so it doesn’t seem to be morally worse to deliver the baby.
Of course, it’s been pointed out above by knowledgeable people that these procedures may well kill the mother, so on that basis, they wouldn’t be eligible for consideration?
As a lurker (up to this point) it seems to me that the more minutely and finely one dissects and parses the official moral calculus in this case, the more inhuman that calculus seems.
Anyhow, while human justice provides trial by jury and the right of appeal, there is no such recourse in this case.
So, Jim Pauwels, if inducing labor or performing a C section are not really options in a case of extremis such as the one in question, and a D&C is of its nature a gravely evil act, then palliative care until the natural death of fetus and/or mother is perhaps the only course of treatment consistent with Catholic moral teaching? That is what you are saying, yes?
Sure, there may be some line to let out in terms of ‘wait and see’, but at some point, should it come to an either/or decision–we terminate this pregnancy or else the mother dies–well, no one ever said following Christ is easy.
The ERD defines abortion in two different ways in no. 45: “Abortion (that is, the directly intended termination of pregnancy before viability or the directly intended destruction of a viable fetus) is never permitted.”
Much confusion here results from “Abortion” being used in two different senses:
1> the termination of a pregnancy
2> “abortion… is the deliberate killing of an innocent human being.”
As Fr Ehrich, says it in the diocesan statement: “There is a significant difference, morally speaking, between directly killing versus allowing a child to die as an unintended side effect of life saving treatment. A similar, although not completely analogous, distinction is made between murder and self-defense.”
For some reason, Fr Ehrich classifies this procedure as an abortion, rather than as a life-saving treatment. I do not see why he does this, but it clearly is the point of difference between Olmstead and those who disagree. It does not help to say it is both an abortion and a lifesaving treatment, though that is the obvious difficulty. Abortion, by definition, is done to kill the child, not to save a life, just as murder is done to kill someone, not to defend someone.
The question here is “what is the object of the act?” JP2 went into this issue in Veritatis Splendor:
By the object of a given moral act, then, one cannot mean a process or an event of the merely physical order, to be assessed on the basis of its ability to bring about a given state of affairs in the outside world. Rather, that object is the proximate end of a deliberate decision which determines the act of willing on the part of the acting person.
So Barbara is correct that the physical procedure is not what determines the morality of the action. There are several proximate results to this action, ie the death of the child and alleviating the cardiogenic shock of the mother. Obviously, by consulting the ethics committee, delaying treatment until it was dire, etc, the choice here was not “kill the child”, but “alleviate the life threatening condition of the mother”. Olmstead and Ehrich see it differently, but again, I do not see why. This was not done to kill the child, but to save the life of the mother; it was not murder by defense of life.
This is my completely untutored reading of JP2. I welcome correction by anyone that would show why this action should be assessed as a deliberate choice to kill the child, rather than as a deliberate attempt to alleviate the mother’s life threatening condition. I am mystified.
Some have wondered about how the bishop came to know about this case. Several possibilities have been offered, but there is another that I have not seen considered: Perhaps the woman in question asked the bishop. Maybe not directly, but through her pastor, or by contacting the diocesan ethics board, or some other person because of her ambivalence about the procedure that killed her child yet saved herself.
Obviously, she put off any treatment until she was in extremis, as the diocese and others have proposed. Sr McBride was decreed excommunicate, but not the mother or father. So perhaps the bishop is trying to defend this woman whom he feels was betrayed by the staff at St Joseph’s.
I am not saying this is the case. But if we cannot sort through these issues, how much harder must it be for the family of the deceased who are trying to deal with survivor’s guilt.
The notion that, since the baby would die anyway, a medical procedure to save the life of the mother that would directly kill the baby is justified seems to be widely shared.
In an emergency, then is it also the case that a doctor can be justified in hastening the death of someone who is virtually certain to die soon (say 12 hours from now) in order to harvest organs which can be used immediately to save the lives of five others in the next hospital room?
“It seems too sweeping to say that it is all right to do a certain harm to someone if that harm is going to happen to them anyway. This would mean you could steal anything which was about to be stolen, and rape anyone you saw about to be raped.”
Anthony Kenny on Double Effect
Anthony Manetti: “it seems to me that the more minutely and finely one dissects and parses the official moral calculus in this case, the more inhuman that calculus seems.”
Amen and Amen! Such pluperfect distinctions lose their agency fairly quickly.
My answer is to make sure as much as possible that I never cross the doors of a Catholic hospital again.
Jim McK, thanks for your lucid comment of 12/23 9:57. I’m not sure if you’ve had an opportunity to read through Dr. Lysaught’s analysis, but she follows essentially the same reasoning you desribe, in fact citing the same passage of Veritatis Splendor (with some very helpful analysis of the passage). An entire section on the moral object begins on p.7 of her study.
It seems to me that the difficulty is reconciling that passage with a passage from Evangelium Vitae, cited I believe by both Lysaught and Ehrich: “I declare that *direct* abortion, that is, abortion willed as an end or as a means, always constitutes a grave moral disorder, since it is the *deliberate* killing of an innocent human being.”
A couple of things to note about this passage:
* The “I declare …” formula in the encyclical suggests that the Holy Father here is invoking his teaching office and promulgating a principle intended to guide the faithful. It would seem that those who are responsible for advising in these difficult situations are bound by this principle.
* “abortion willed … as a means … is the *deliberate* killing of an innocent human being” – that sounds like an accurate description of what happened that day.
My reading of Ehrich is that this is the diocese’s central contention: that we’re all supposed to follow this teaching, and it wasn’t followed that day.
Personally, I’m still working through how to harmonize this passage from EV with the passage from VS that you cited.
Patrick Malloy – the same thought re: organ harvesting had occurred to me. For that reason, I’m not sure I’m convinced by Rhonheimer’s account as explained by Lysaught.
A mother is alive today thanks to the wise prudential judgment of the medical professionals who made the best of a difficult situation. Hurrah.
Dr. Lysaught, concludes in her analysis that the removal of the placenta is parallel to the removal of a cancerous uterus, that the hospital was only removing a diseased organ, and that the death of the fetus was an undesired effect, thus the abortion was moral.
I beg to disagree.
The placenta is not a “shared organ” as Dr. Lysaught described it. It is, rather, an organ of the offspring. The placenta develops from the outer cells of the blastocyst, has the same DNA as the offspring, carries only the blood of the offspring, and has as its purpose the nourishment and survival of the fetus. While the placenta secretes hormones that affect the mother, the hormones have as their purpose the survival of the fetus. The placenta’s function after birth is completed and it is thus expelled, being no longer necessary for the survival of the fetus.
One cannot intend to remove a critical, life essential organ of the fetus and claim that one is not intending the death of the fetus. Such a procedure is a direct and intended abortion. One can no more remove a placenta of a fetus than one can remove a heart of a fetus. Both are direct attacks upon the life of the fetus.
The removal of the placenta of a fetus is drastically different from the removal of a cancerous uterus. The cancer is not an organ of the fetus and attacking the cancer is not attacking the fetus. This is the so-called double effect. Attacking the placenta is an attack on the fetus since the placenta is an organ of the fetus necessary for its survival and so this procedure did not qualify as a double effect.
The Bishop is correct in his conclusion that this procedure was an abortion, proscribed by Church teaching. One may never directly and intentionally kill an innocent human being even if to save the life of another.
I don’t think a woman terminating a pregnancy to save her own life is in any way analogous to organ harvesting. The woman is acting in self-defense by preventing the baby from unintentionally killing her.
Also, I know it’s not the point of this thread, but when there is a foreseeable risk of injury and death through pregnancy, considering the Church’s hard line on abortion, where does it come down on artificial contraception/ voluntary sterilization in those narrow circumstance? Is it acceptable for a woman who knows that pregnancy can harm her to use otherwise prohibited forms of contraception to avoid a scenario which might destroy a human life?
Bishop Olmsted claims the procedure performed upon that mother of 4 was a “direct abortion” Let’s look at how the American Bishops define a “direct abortion” in their Ethical & Religious Directives to Catholic health care providers such as myself.
45.Abortion (that is, the directly intended termination of pregnancy before viability or the directly intended destruction of a viable fetus) is never permitted. Every procedure whose sole immediate effect is the termination of pregnancy before viability is an abortion, which, in its moral context, includes the interval between conception and implantation of the embryo. Catholic health care institutions are not to provide abortion services, even based upon the principle of material cooperation. In this context, Catholic health care institutions need to be concerned about the danger of scandal in any association with abortion providers.
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Please pay special attention to lines 3 and 4: “Every procedure whose sole immediate effect is the termination of pregnancy before viability is an abortion,” Now zero in on the word “sole”. Now imagine that the word “sole” was left out. If it was left out, then ALL procedures that immediately terminate a pregnancy would be illicit. But the bishops who studied the issues, as recently as the latest revision in 2001, placed the word “sole” in there. By definition, that implies that THERE ARE SITUATIONS WHEN ABORTION IS LICIT as long as there is a another primary immediate effect. By the definition of “direct abortion” laid out by the American bishops in their own ERDs, which were and are the guideposts which St. Josephs Hospital used in reaching their painful, but entirely licit decision, the procedure in this unfortunate and sad situation was indeed licit. The primary intended immediate effect was to relieve the mother’s soon to be fatal congestive heart failure secondary to her pregnancy which was exascerbating her idiopathic primary hypertension. The unintended secondary immediate effect was the death of the fetus. The American bishops then went on to describe such circumstances in ERD 47.
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47. Operations, treatments, and medications that have as their “direct purpose” the cure of a “proportionately serious pathological condition” of a pregnant woman are permitted when they “cannot be safely postponed until the unborn child is viable, even if they will result in the death of the unborn child”. (The quotation marks are added by me for emphasis.)
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The DIRECT PURPOSE of the therapeutic abortion was to save the mother’s life by alleviating the source of her soon to be fatal congestive heart failure (A PROPORTIONATELY SERIOUS PATHOLOGICAL CONDITION) that could not BE SAFELY POSTPONED UNTIL THE UNBORN CHILD WAS VIABLE, EVEN WHEN IT RESULTED IN THE DEATH OF THE UNBORN CHILD.
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Now am I dense or is it Bishop Olmsted? What part of the plain English of these 2 ERDs does he not understand? Here’s what I think. Back in the mid 90′s I believe, JP the Lesser stated (some claim ex-cathedrally) that ALL abortion is illicit. I have not seen the exact text, so I do not know if he qualified it as “direct abortion”. There appears to be a growing coterie of US bishops who take the statement “ALL abortion is illicit” as the gospel truth, even if it results in the death of the mother. This attitude is a de facto INDIVIDUAL revision of the ERDs as printed and explained above. What we have here are bishops like Olmsted and Vasa that are going rogue.
Now there’s one more area of women’s health that was properly dealt with in the ERDs where my own Bishop Vasa in Oregon is threatening the lives of women. This has to do with when sterilization is and is not licit. ERD 53 deals with this issue directly.
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53.Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health care institution. Procedures that induce sterility are permitted when their direct effect is the cure or alleviation of a present and serious pathology and a simpler treatment is not available.34
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I was not in the room when this ERD was drafted, but any reasonable person would infer that this meant two things. 1) Removal of tubes and/or ovaries and/or the uterus, or the testes/vas deferens/prostate as part of a standard cancer or other operation (endometriosis, fibroids, spermatocele, etc.) involving one or more of the organs (and hopefully in this day and age in women who have the BRCA-1 or BRCA-2 gene that predisposes them to breast and gynecological cancers). And 2) Women with a serious health problem that would be exascerbated by pregnancy to the point of killing them or the serious potential for a serious health problem brought on by pregnancy that could kill them. A few examples are: Pre-existing heart conditions such as moderate to severe mitral valve insufficiency, aortic stenosis, and previous myocardial infarction as well as 3 or more previous c-sections leading to placenta previa,or a previous history of breast cancer to name a few of the situations where pregnancy could result in a markedly increaed risk of death of the mother.
At my hospital, Bishop Vasa has bullied our Ethics Committee and the Administration into not allowing sterilization after the the 3rd c-section as recommended by the American College of Obstetricians and Gynecologists (ACOG). By the way, every trial lawyer in this country considers the ACOG recommendation as the standard of care for malpractice purposes throughout the entire US. The reason for sterilization is that very well researched studies (science once again being the nemesis of the bishops) have proven beyond a shadow of a doubt that starting with the 3rd c-section the risk of placenta previa, a potentially fatal placement of the placenta over the cervix, increases from the random number of 0.5% in any pregnancy to 4% after the 3rd c-section and tops out at about 10% after the 5th c-section. http://en.wikipedia.org/wiki/Placenta_previa
You might ask, “Why not have a vaginal delivery?” After a c-section, the risk of rupture of the uterus after c-section is about 1 in 5,000. Those are long odds, and for a while, vaginal deliveries after c-section were back in vogue with proper informed consent. But 5 years ago, my rural hospital lost a $13 million lawsuit because the jury ignored the informed consent and paid out in favor of the child sitting on the front row with cerebral palsy. Over night, every hospital in Oregon quit doing vaginal deliveries after c-sections, and now we have women at 3 or more c-sections that should be getting tubal ligations during their 3rd c-section to avoid the risk of bleeding out and dying in 15 minutes in a future pregnancy from placenta previa. Doing a tubal ligation as an outpatient elsewhere after the c-section has these problems: 1) Scar tissue from the c-sections causes adhesions that can lead to bleeding and/or bowel puncture during laparoscopy. 2) Sterilization as an independent procedure is not carried by some insurance, has a separate deductible, drives up the cost of health care for the rest of us, and is inaccesible to poor patients without insurance, and 3) Duplicating the procedure doubles the risk of infection, anesthesia complications, and every other risk having to do with any surgical procedure.
Bishop Vasa’s solution: Abstinence (we’re talking about a married couple here) or Natural Family Planning (playing Vatican roullette with the woman’s life). Birth control pills? Not from our hospital, but if she’s over 30 and/or smokes, the risk of pulmonary embolus (fatal blood clot to the lungs) skyrockets. Condoms? They break. IUD? Believe it or not there are devout Catholics who distinguish between a tubal ligation and a method that prevents the implantation of an embryo.
But wait, isn’t the scar at the base of the uterus from those 3+ c-sections a serious pathology that is causing the problem for which a simpler treatment is not available and therefore amenable to sterilization under Section 53 as quoted above? Not in Bishop Vasa’s world. According to him, the uterine scar is NOT in and of its self the pathology. The pathology according to him does not exist until she’s pregnant! For him, there is no pathology until the woman is pregnant, but if she is pregnant, then Olmsted’s Law kicks in and there can be no abortion. A classic Canonical nonsensible Catch-22! So my hospital’s Ethics Committee Kow-Tows to Bishop Vasa and women needing tubal ligation after their 3rd c-section are routinely turned away and sent 35 miles down the road to a Lutheran Hospital.
I pray to God that the cannon shot fired by CHW today will be the Cannon Shot Heard Around the Catholic Healthcare World, be it the US, Europe, or anywhere else where ethically sound Catholic hospitals are being bullied by bishops hell bent on imposing Sharia Law upon women, and mothers in particular. Hopefully, some day we can all stand together after the orthotoxic bishops cut us loose and cry out “Free at last! Free at last! Thank God almighty, we are free at last!”
As to the remarks of P Flanagan above, it is my understanding that St. Joes will maintain the word “Catholic” in its corporate charter until hell freezes over. Bishop Olmsted has NO authority to strike the word “Catholic” from its corporate charter than he or any other bishop has the power to strike the word Catholic from USCatholic.org or the National Catholic Reporter, to name just a few examples.
No morally healthy, emotionally mature person would agree to withhold life-saving medical treatment from his or her beloved for a principle, if the outcome in upholding that principle is two deaths rather than one.
I thus reject the invocation of theodicy as an transcendent explanation of what we must be prepared to accept in faith. In truth, I think this kind of reasoning is a form of madness, the stuff of Greek tragedy. Now if someone wants to choose the martyr’s path for herself, so be it.
“Bishop Olmsted has NO authority to strike the word “Catholic” from its corporate charter”
Search this thread for “Canon 216″ to find out why you are wrong on this point of fact.
“I thus reject the invocation of theodicy as an transcendent explanation of what we must be prepared to accept in faith. In truth, I think this kind of reasoning is a form of madness, the stuff of Greek tragedy. Now if someone wants to choose the martyr’s path for herself, so be it.”
Your rejection fulfills the words of Our Lord, “Father, forgive them, for they know not what they do”.
You are absolutely right, though, that someone must choose the martyr’s path for herself. Yet that is what we are called to do, although for most of us, the spirit is willing, but the flesh is weak. Always remember that the Apostles, filled with the fullest spirit of Jesus, willingly submitted to martyrdom for the sake of the Name. That is the highest calling, whether that martyrdom is of blood or of bearing our crosses in love.
But to shun that entire concept and embrace a worldly determination of good based on earthly survival at all costs? That has something barbarous to that, a spirit of the flesh, brutish animal survival instinct, without conception of the transcendent.
In one of our parish school Masses, Father asked the kids what they had to do to get to heaven. A first grader replied “We have to die”. This elicited great mirth from the parents, but that is one of the wisest statements I have ever heard during Mass.
Thank you for this Dr Catholic Physician.
I am left with two thoughts:
How can the average woman not think she is treated as a lessor life form by the church.
And anyone who does not buy into this weird Bishopthink should avoid Catholic hospitals like the plague, because it is quite probable that what you, as a woman, think is irrelevant. You are not in charge of your own body or your own health.
The reality of God’s creation intrudes at last, thanks to Catholic Physician and Brian Volck earlier. Nouns are easy to qualify and distinguish in abstract debates. Not so the complexities of a pregnant woman.
Bishop Olmsted declared in his Dec 21 prepared public statement “In this case, the baby was healthy and there were no problems with the pregnancy; rather, the mother had a disease that needed to be treated.” His concept of the human body appears to be a pile of adjacent pieces, like Lego blocks. If he is unaware of the numerous vital interactions and interdependences among the many parts and systems of the body, which include the fetus in a pregnant woman, he might well be confident speaking – as he did – of the fetus in isolation, the pregnancy as if it were another separate piece, and the mother as if she were elsewhere. sasurfman above describes the fetus as if it were all alone, recognizing implicitly by the words “the nourishment” that there is a complex system beyond the placenta essentially interacting. Those on the scene in Phoenix lacked the luxury of neatly partitioning the challenge in the way Bishop Olmsted did.
The focus by Catholic Physician on the word “sole” in ERD 45 is critical for two reasons. It straightforwardly determines the sense of the two sentences defining abortion, fundamentally different from the sense without that word. (The pertinent USCCB statement of June 23, 2010, includes the full statement in defining abortion, as in Catholic Physician’s quote of ERD 45 above.) The word is also conspicuous for the frequency with which it is ignored by those who prefer another rule which the ERD authors did not write; see an example above. Those enduring life-and-death situations in Phoenix, and probably elsewhere today, deserve respect in theoretical assessments of their obligations, options, and performance.
Jim P, I guess I was not as lucid as I would have liked. I think the problem is with the term “abortion”, which means an action whose object is the death of the fetus. So when JPS refers to “direct abortion” he is referring to an action whose object is the death of the fetus. This does not include the procedure we are discussing, because the object of that procedure is alleviating the life threatening condition of the mother. It is not an abortion, just as shooting someone accidentally is not murder. It is not a good thing, but it is not an abortion as defined by JP2.
sasurfman wrote:
One cannot intend to remove a critical, life essential organ of the fetus and claim that one is not intending the death of the fetus. Such a procedure is a direct and intended abortion.
I already clarified above that this is not an abortion as prohibited by JP2. Your remarks point to another issue I cannot claim to understand, which is the relationship of object and intention, tow different parts of a moral action. Assuming your remark is true, what is the relationship of that intention to the object of the action? Aren’t you blurring object and intent? I am sincerely asking because
I have real problems with your statement above that keep me from responding cogently. Why can’t one “remove a… organ of the fetus” and not intend the death of the fetus? I do not see the connection between these two. Anytime a child is born, the placenta is removed. More perplexing to me, what do you mean by “remove”? From the mother? From the fetus? Because I cannot sort this stuff out, I cannot figure out how your comments might affect my own thinking.
P Flanagan,
Either you are very young or very calloused, or both. You are concerned about THEORY only! That a real live woman was involved here—who is a wife, a mother, a daughter, a sister, a friend—-a real human being—just is over the top of your head. She’s not your wife, your mother, your sister, or your friend.
It seem that you think that she’s just an pawn, an element to be used as an example in the abstract concepts that make up this section of Canon Law—laws that were written by men, for men, —- diminishing and disregarding the imput, concern and care of/for women.
In the early church, during the persecutions—Christians chose the Martyr’s path. They recognized that Jesus’ love for us—had won our salvation. So many of them had a personal, spiritual relationship with Jesus. Rejecting their Christianity would be to reject their BEST FRIEND. So they chose death.
But in this case—there is no element of a rejection of faith. Nothing would be gained by both mother and fetus dying. Nobody has to die for some bishops’ obscure understanding of Canon Law.
Jesus stated that he came to bring us LIFE in abundance, not DEATH. Living one’s life following the footprints of Christ, ACTING like Christ, is also a life-long martyrdom—and it leads to Heaven as well as a martyr’s choice.
“But to shun that entire concept and embrace a worldly determination of good based on earthly survival at all costs? That has something barbarous to that, a spirit of the flesh, brutish animal survival instinct, without conception of the transcendent.”
At all costs? You need to be able to say, “Yes, the fetus was going to die as soon as it’s mother died, if not slightly earlier. Yes, there would be two deaths, one preventable at the hastening of the other in a manner unique to pregnancy. Still, this is God’s will because of the particular nature of the life-threatening complications in this pregnancy.”
It is not generous to assume that anyone who thinks that one life can be saved in a case like this adopts a “brutish animal survival instinct, without conception of the transcendent.” You get to be right in the embrace of principle, but here is a case where those who think otherwise are not without merit, without love, without a functioning moral compass.
You get to be right in the embrace of principle, but here is a case where those who think otherwise are not without merit, without love, without a functioning moral compass.
…or without principle.
“Jim P, I guess I was not as lucid as I would have liked. I think the problem is with the term “abortion”, which means an action whose object is the death of the fetus. So when JPS refers to “direct abortion” he is referring to an action whose object is the death of the fetus. This does not include the procedure we are discussing, because the object of that procedure is alleviating the life threatening condition of the mother.”
Jim McK – I’ll preface what I write by noting that I’m still working through these issues and don’t claim to have the puzzle put together.
I do note that directive 45 as quoted by Catholic Physician does include a definition of abortion: “the directly intended termination of pregnancy before viability or the directly intended destruction of a viable fetus” Clearly,the fetus was not viable, so for purposes of this case, we can ignore everything after the word “or”.
The part before the “or”, though, may apply: “the directly intended termination of pregnancy”.
I believe the diocese is arguing that the action that was intended that day was, indeed, the directly intended termination of the pregnancy. The *indirect* intention was to save the life of the mom. The abortion was the means to the end of saving the mom’s life.
I’m following the dots connected by Lysaught on this (I think): both the exterior act (the D&C) and the interior act of will (abort the baby to save the mom) combine to determine the object.
“Please pay special attention to lines 3 and 4: “Every procedure whose sole immediate effect is the termination of pregnancy before viability is an abortion,” Now zero in on the word “sole”. Now imagine that the word “sole” was left out. If it was left out, then ALL procedures that immediately terminate a pregnancy would be illicit. But the bishops who studied the issues, as recently as the latest revision in 2001, placed the word “sole” in there. By definition, that implies that THERE ARE SITUATIONS WHEN ABORTION IS LICIT as long as there is a another primary immediate effect. By the definition of “direct abortion” laid out by the American bishops in their own ERDs, which were and are the guideposts which St. Josephs Hospital used in reaching their painful, but entirely licit decision, the procedure in this unfortunate and sad situation was indeed licit. The primary intended immediate effect was to relieve the mother’s soon to be fatal congestive heart failure secondary to her pregnancy which was exascerbating her idiopathic primary hypertension. The unintended secondary immediate effect was the death of the fetus. The American bishops then went on to describe such circumstances in ERD 47.”
Catholic Physician: with much respect, I believe you’re reversing your primary and secondary effects.
If (for example) the procedure attempted that day had been to operate on the mom’s heart to relieve the stress that the pregnancy was putting on it, and an unintended consequence of that operation had been the death of the baby, then I would agree with your analysis.
It seems that the purpose of the procedure in question, and the intent of those who approved and performed that procedure, was to abort the baby. With great reluctance, filled with revulsion at what they were doing, hating every second of it, cursing the God who put them in that morally impossible position, they aborted the baby. The primary effect of an abortion is to kill the baby. The effect on the mother’s health is the secondary effect. The former was the means to the latter end. One can’t get to the end except by going through the means. They are not simultaneous and independent effects; the one begets the other.
“Jesus stated that he came to bring us LIFE in abundance, not DEATH.”
And Jesus taught us not to ever deliberately take the life of another person, as this unborn child under discussion, before God’s time. THAT is life in abundance, to recognize that we act on this earth in the light of our future eternal life. To prematurely end the life of anyone, as was done at this hospital, is the very definition of callous.
“Yes, the fetus was going to die as soon as it’s mother died, if not slightly earlier. Yes, there would be two deaths, one preventable at the hastening of the other in a manner unique to pregnancy. Still, this is God’s will because of the particular nature of the life-threatening complications in this pregnancy.”
Almighty God either permits or ordains everything that happens in this world. We need to not shirk from the consequences of that primary truth. To conform ourselves with the will of our Father in heaven, we try to understand how to choose such that we help bring His greater good out of whatever local evil we encounter, such as this difficult situation. To do less is to fail to do the will of God…killing one of His children cannot possibly be the will of God, and those who argue for it reveal a certain blindness to the will of God.
“. . . cursing the God who put them in that morally impossible position, . . .
———–
¿
Disagree that the health professionals felt what you claim/wish they felt when they saved the woman’s life.
Jim, I agree with you, that’s how I read it too. “Immediate sole effect” refers to the immediate effect and intention of the action, not the ultimate intention to save a life. A D&C or induction of labor has as its sole *immediate* effect the termination of the pregnancy. The life is saved *because* of the termination of pregnancy, but the action taken was explicitly intended to terminate the pregnancy. According to the Catholic health care directives, this is not acceptable, ever. This is in contrast to removing a cancerous uterus, which would need to be done in any case, and whose immediate effect is two-fold: removal of a cancerous organ and terminating the pregnancy.
How this reasoning can be applied to a tubal pregnancy, when the tube is only “diseased” because of the pregnancy, and for which removing the tube is only a fix because it also terminates the pregnancy, I don’t know.
I should say I think the solution would be to accept self-defense reasoning even in the case of abortion, but that’s currently not permitted.
I now go to the non-Catholic hospital.
“I now go to the non-Catholic hospital.”
Well, then, you can go to St Joseph’s in Phoenix.
There are times when I am nearly persuaded to accept the transcendent arguments offered here, as when I think about torture and the death penalty and find myself an absolutist on the sanctity of life and the principle of dignity in body and mind to be free of coercion.
Perhaps if I sensed that abortion was not a special case for ardent commitment and that the principle that life was sacred was applied in every instance, even to the most heinous of moral actors, I could embrace the ‘whole enchilada’ and agree that even here it were better for both to die than to be a contributing agent to the death of a fetus who was going to die anyway.
Bottom line for me: The hospital medical/surgical staff performed an abortion (ordinary and popular meaning of the word) to save a human life.
P Flanagan, you state, “And Jesus taught us not to ever deliberately take the life of another person, as this unborn child under discussion, before God’s time.”
Please clarify your reference to “before God’s time”.
What do you mean?
The primary effect of an abortion is to kill the baby. The effect on the mother’s health is the secondary effect. The former was the means to the latter end. One can’t get to the end except by going through the means. They are not simultaneous and independent effects; the one begets the other.
Jim,
I am baffled as to why people see it this way. As I have noted before, the argument was that the placenta was presenting difficulties. The placenta is not the unborn baby. As was noted, a unborn baby can die, but the placenta can go on living for months. The same procedure would have been performed had the baby been dead or alive. Therefore, I can’t understand why anyone would say that the intention was to perform an abortion or to kill the baby. I fail to understand why this isn’t a close parallel to the removal of a cancerous uterus. The hysterectomy would be the same operation were there no baby, a dead baby, or a living baby. The uterus would be removed. The baby would not be the direct target. Similarly, if this baby had died and the placenta kept functioning, the D&C performed would have been exactly the same as it was in the Phoenix case.
The point of the D&C was not to kill the unborn baby. It was to detach and remove the placenta, which is an organ in it’s own right. That the death of the baby was foreseen and completely predictable is no more relevant here than in the case of the cancerous uterus. One can’t remove the cancerous uterus without killing the baby, but the intention of removing the cancerous uterus is not the killing of the baby or the termination of the pregnancy.
Almighty God
This may be picky, but saying “Almighty God,” and somewhat similarly saying “John Paul II the Great,” doesn’t render invoking their names any more persuasive than saying “God” or “John Paul II.”
David, according to the directives an action intending to terminate the pregnancy is an abortion. I would accept your line of argument, but according to the bishops’ definition, since you are intending to terminate the pregnancy by removing the placenta, then you are intending to perform an abortion. The placenta itself was healthy, it was the effects it was having on the rest of the body, the very burden of the pregnancy itself, that was the problem.
“This may be picky, but saying “Almighty God,”…doesn’t render invoking their names any more persuasive…”
I carefully chose that familiar term for God to accentuate his inscrutable omnipotence in the context of that line:
“Almighty God either permits or ordains everything that happens in this world.”
“Please clarify your reference to “before God’s time”.
Someone who died in accordance with the ordained or permitted will of God has died in God’s time. Someone who died outside of the will of God, as does anyone who is murdered – including all victims of abortion, has died before God’s time.
God permitted a stern test in Phoenix, and Sr. McBride failed that test. Abraham, when his faith was similarly tested, passed and it was credited to him as righteousness. That is why we pray in the Our Father that we may not be put to the test…because it is the most difficult thing we will ever do in this life.
“It was to detach and remove the placenta, which is an organ in it’s own right. That the death of the baby was foreseen and completely predictable is no more relevant here than in the case of the cancerous uterus.”
David, I see your logic. But is there not a distinction in that the cancerous uterus would be despite the baby, whereas the issue with the placenta was ONLY because it was supporting the life of the baby? In other words, the only reason this was a life and death issue was precisely and solely because of the pregnancy. In the cancerous uterus scenario, the pregnancy is not relevant to the condition. This somehow seems quite germane to a moral understanding of the procedure that was undertaken.
“Someone who died outside of the will of God, as does anyone who is murdered – including all victims of abortion, has died before God’s time.”
By the way, this is also the best moral argument against capital punishment (at least where the guilty person has been rendered unable to do further harm to society). To execute them before they have had a full opportunity to evolve into repentance, thus possibly condemning them to eternal damnation…that most certainly would not be a death “in God’s time”.
P Flanagan, thank you.
You write, “Someone who died in accordance with the ordained or permitted will of God has died in God’s time.” You go on to state that murder victims and criminals executed by the state (when incarceration is a viable option) have died “outside the will of God.”
If you found yourself on the battlefield and saw an enemy charging toward you with gun and fixed bayonette, would you be prepared to kill this enemy?
I do also note similarities between the questions raised here and the arguments about polio vaccine. Does vaccinating one’s kids against a killer virus, (which was created by God,) thwart God’s will for the child and the virus? Isn’t it keeping kids alive whom God would have wanted dead? (This is a case for choosing physicalist natural law or Aristotelian natural law. The Aristotelians say that we have brains in order to figure things out, like human flourishing.)
Now let’s step back and ask a meta-question: if Olmsted was reading the current tradition correctly, i.e., that the magisterium prefers the deaths of two to one, especially where the “extra” death is that of a woman, while in no other case in human experience is self-defense denied, regardless of the intention of the assailant, is this a case in which the teaching needs revision?
The ectopic pregnancy exception is a moral fiction, designed to obscure an essential fact–the intention is to remove (and therefore to allow to die,) a pre-viability embryo. To speak of the fallopian tube as diseased is untrue. It is dilated, yes, but because of the embryo. The problem is the embryo, not the tube. Since less harmful ways exist at present to remove embryos from fallopian tubes than salpingectomy, then removing the tube is mutilating the woman in order to maintain a moral fiction.
It seems to me that either:
1. Those who support Olmsted’s position would want to deny the ectopic pregnancy exception, thus altering received tradition.
2. Those who reject Olmsted’s position want to recognize that the life of the mother in cases where both cannot be saved is a relevant circumstance, and so allow (again, only IF this stringent reading of the tradition is accepted,) the removal of the fetus, therefore allowing it to die. If Olmsted is right, this also is a change in the tradition.
Which revisionist position shall we adopt, and why?
Does anyone else see a problem with the invocation of Abraham, who was about to kill his own son, as passing the test in question that Sr McBride supposedly failed? Geez. Here Abraham was willing to sacrifice his own son, though there are different ways to read that story.
Now we count as the most evil of acts any such sacrifice. Now the test is whether we are willing to allow a loved one to die for a principle that life is too sacred to save a life at the expense of a life all but certain to die anyway.
I will say again: I cannot fault anyone who acted to save this woman from certain death whatever the arguments offered against that outcome. I would take my chances on judgment day.
David, I see your logic. But is there not a distinction in that the cancerous uterus would be despite the baby, whereas the issue with the placenta was ONLY because it was supporting the life of the baby?
P Flanagan,
But the report itself points out:
Had the surgical team carefully killed the baby (as is done in “selective reduction” of a pregnancy where there are, say, triplets and the mother wants only a single child), that would not have solved the problems presented by the placenta, which could have continued functioning for weeks or months. The intention was to stop the placenta from doing what it was doing, not to stop the baby from doing what it was doing. Had the baby been dead at this point, the exact same procedure would have been performed to save the life of the mother. It seems to me very closely analogous to the removal of a cancerous uterus. You do it to save the mother whether the life of an unborn infant is at stake or not. So with the placenta. St. Joseph’s Hospital would have done the same thing whether a (living) baby was present or not. If the baby had been dead, you could not argue that the intent was to kill the baby. So if the baby in this case was alive, and the same procedure was performed, I don’t see how you can say the intent was to kill the baby.
So it seems clear to me that you cannot say they targeted the placenta only because it was supporting the life of the baby. They targeted the placenta in spite of the fact that it was supporting the life of the baby.
Two random thoughts:
If this kind of intense, detailed analysis were applied to killing in war or killing by the police, armies and police forces could not do their jobs.
I think a lot of the defenses of Olmsted and his approach to this incident implicitly assume that the life of an unborn infant is not equal in value, but higher in value, than the life of the pregnant woman. Of course, I suppose some of Olmsted’s critics implicitly or even explicitly assume the life of the mother is of higher value than the life of the unborn infant. But neither is the Catholic teaching, which is of course that both the life of the mother and unborn child are of equal moral value.
@Joseph Jaglowicz “If you found yourself on the battlefield and saw an enemy charging toward you with gun and fixed bayonette, would you be prepared to kill this enemy?”
Of course. That’s clearly justified self-defense, check the CCC on military service, too.
@Lisa Fullam “that the magisterium prefers the deaths of two to one, especially where the “extra” death is that of a woman”
Are you seriously expecting reasoned argument in response to such a tendentious, baseless statement? “Prefers”!? “ESPECIALLY…death…of a woman”!? C’mon, calm down, I have seen serious arguments from you here.
@David Nickol “The intention was to stop the placenta from doing what it was doing, not to stop the baby from doing what it was doing.”
Still seems to me the placenta is only a danger to the mother BECAUSE of the pregnancy, i.e., BECAUSE of the existence of the baby.
I dunno about this “how many angels can dance on the head of a placenta” argumentation, I just wanted to try to address your thoughtful post in good faith. To me, the transcendent argument is always preeminent in difficult matters. Turn to God for answers to the most difficult questions, right? Not doctors.
But I am certain that in future difficult abortion decisions, once a precedent such as this has been established – however well reasoned – the inertia will be such that “therapeutic” abortions such as this will be done more and more often with less and less analysis and hand-wringing until we inevitably reach a point where they will become grotesquely routine. Call that a slippery slope argument if you wish, but it has turned out that way over and over in such matters.
“If this kind of intense, detailed analysis were applied to killing in war or killing by the police, armies and police forces could not do their jobs.”
It IS applied and has cost the lives of many of our servicemen in Iraq and Afghanistan. Do you recall that at the very beginning in Afghanistan, we had Mullah Omar in the crosshairs, but “intense, detailed analysis” and a lengthy chain of command kept the trigger from being pulled?
http://www.historycommons.org/context.jsp?item=a100701nomullahkill
Legalistic rules of engagement have put our soldiers at grave risk in those wars. I’m not necessarily condemning us fighting wars with high moral standards, just stating a fact.
@David Nickol “The intention was to stop the placenta from doing what it was doing, not to stop the baby from doing what it was doing.”
Still seems to me the placenta is only a danger to the mother BECAUSE of the pregnancy, i.e., BECAUSE of the existence of the baby.
P Flanagan,
You seem to be ignoring the fact that while the placenta is there because of the pregnancy, it is an organ separate from the unborn infant, and it can act on its own for months even if the baby dies. Surely you would not argue that the D&C could not have licitly been performed to remove the placenta, even if the baby had died, on the grounds that the placenta was there because of the pregnancy. It does not matter why the placenta is there. It matters why they remove it. And they remove it not to kill the baby but to save the mother.
I dunno about this “how many angels can dance on the head of a placenta” argumentation, I just wanted to try to address your thoughtful post in good faith.
The problem is that this is a very technical argument involving moral theology. If you want to simplify it by saying nothing may ever be done that results in the death of an unborn baby, that will make things a lot easier, but it will also misrepresent Catholic moral theology. Many of the problems, it seems to me, arise from the meaning of the word direct. Some people seem to object that Lysaught’s analysis changes the meaning of direct. But what we are dealing with is a philosophical and ethical argument in which you can’t assume terms have their everyday meanings.
Legalistic rules of engagement have put our soldiers at grave risk in those wars. I’m not necessarily condemning us fighting wars with high moral standards, just stating a fact.
P Flanagan,
Nothing even remotely resembling this analysis we are engaging in here takes place in the fighting of a war. There is no ethics committee that meets to decide, in each individual case, whether a soldier can fire his weapon. Something reasonably close happens when the United States wants to assassinate one of its own citizens, but aside from that, rules of engagement are extremely broad.
“Of course. [Killing enemy soldier is] clearly justified self-defense, check the CCC on military service, too.”
And the mother authorizing removal/killing of baby (who poses threat to her life) is not self-defense?
Please explain.
Catholic Physician, To answer the question as to whether the sole immediate effect is the termination of the pregnancy prior to viability one has to answer the question: What diseased organ was removed or treated by the operation? In this case NO diseased organ was removed or treated. The planceta, the putative organ sought to be removed, was not diseased, it was functioning normally and it was deemed that this normality was the threat to the mother’s life. Since there was no diseased organ to be removed or treated, it must be concluded that the sole immediate effect was the termination of the pregnancy prior to viability. There is no Double Effect argument possible here because there was no diseased organ removed or treated. Abortion in itself, cannot morally be a treatment for disease.
Jim McK, the object of the procedure must be more than a mere intention to save the mother’s life. The object must be something physical other than the fetus, which is the target of the procedure. If one had bone cancer and one underwent chemo that targeted the bone cancer, but had the side effect of killing the fetus, this treatment would qualify as acceptable in spite of the double effect. In other words, an abortion cannot be the means of the treatment, but only a side effect of the treatment.
In this case the abortion was the means of the “treatment.” The fetus itself (or the placenta, which is the same thing), was considered to be the cause of the threat to the mother’s life and the so fetus was directly attacked. One may never kill another innocent person so that one may live.
Consider the example where two men are trapped underwater and only one excape device is available. Can one man morally kill the other in order to use the excape device for himself? No, he cannot. Murder is never justified by self-survival. This is quite different than being attacked by another and killing the other in self-defense. Could the man grab the excape device and make for the surface himself leaving the other behind to die? Perhaps. This could be viewed as saving one’s own life knowing that another would die in the process. It would not be murder.
“One may never kill another innocent person so that one may live.”
Yes, one can. It was done in this sad case. Fetus was destroyed, mother lives. A better outcome than fetus was not destroyed, mother died; and so did fetus. You can rail to the high heavens about the evil of that outcome or the evil that was done to produce that outcome. Any doctor worth her salt would make that choice again and let God be the judge. Tsk, tsk all you wish. Rail against the immorality and brutishness, the situation ethics, the poor state of cathechesis.
I so want to accede to the correctness of the position that in this case both mother and child had to die, and then I draw back to the messy, ugliness of it all and take comfort that in this case man’s ways trump God’s way.
What diseased organ was removed or treated by the operation? In this case NO diseased organ was removed or treated.
It is my layman’s understanding that the termination of an ectopic pregancy (ie. any pregnancy in which the fertilized egg does not implant in the uterine cavity) is considered morally licit. In that case, it is not the organ that is defective but a condition that is being alleviated.
I can’t get past the casuistic niceties that regard ectopic pregnancies as allowable abortions but death-inducing cases of pulmonary hypertension as test cases for how well we really value the truth of the gospel, a truth so many have failed, to here some tell it. Ectopic pregnancy? You get to live. A normal pregnancy that will kill you before you can deliver a child to term? Your death is the hard truth that affirms the gospel of life.
When we are reduced to diseased organ arguments to preserve the principle but obtain the desired result, sin free, I get cynical about the moral high ground that consigns a woman to a preventable death and excommunicates everyone involved. It’s the legerdemain of annulment (rather than divorce) all over again.
Jim P, and others,
I do not see how the comments here can be reconciled with JP2′s discussion of the object of a moral act in Veritatis Splendor: By the object of a given moral act, then, one cannot mean a process or an event of the merely physical order, to be assessed on the basis of its ability to bring about a given state of affairs in the outside world. Rather, that object is the proximate end of a deliberate decision which determines the act of willing on the part of the acting person.
The deliberate decision was not “Let’s kill the child so the mother may live.” Rather it was “Let us ameliorate the shock that is killing the woman.” In the course of ameliorating the strain on the mother, the child died. The immediate effect was an easing of the strain on the mother, and the secondary effect was the death of the child. The chosen effect, which is the moral object of the act, was the easing of the strain on the mother.
If the doctors chose to kill the child, and did not have the life of the mother as their direct object, it was an abortion as Olmstead claims. But the thought of that is just too horrifying to actually consider. Why would doctors, confronted with a woman in dire straits, shift their attention to the child and choose to kill him? Context says their concern was the mother’s survival, not choosing the death of the child.
This can be interpreted in different ways, as David does when he cites the placenta as the focus of medical concern. Maybe he is right. The physical characteristics do not determine the morality of the act; that is determined by the choice made. It makes no sense to say the choice was to kill the child, rather than to save the mother. The child’s death is secondary to the procedures taken to allow the woman to live.
If Olmstead is saying that the doctors chose to murder the child, and only secondarily were concerned with the life of the mother, he should be sued for slander.
Directly treating the diseased organ is not the most common way that medicine operates. A person who has Type I diabetes has a diseased immune system which destroys the insulin-producing cells in his pancreas. Injecting insulin certainly does not treat the immune system, and once the cells are destroyed, “fixing” the immune system (via immunosuppression) does no good, the damage is done. A person who has blocked arteries from high cholesterol has a defective liver (which produces too much cholesterol.) Cardiac bypass, stents, etc. have nothing to do with the liver. A woman with pre-eclampsia has kidneys which drastically cut back the production of urine — the treatment is to deliver the baby, if viable, and if delay is necessary, to lower the blood pressure by dialating the blood vessels, not to do anything to her kidneys. Hashimotos thyroiditis and Graves disease are both autoimmune diseases where the body attacks the thyroid. The treatment for the first is thyroid supplementation, for the other, destroying the thyroid. Treatment for a broken leg is to immobilize the joints on either side of the break, and wait for the break to heal itself.
The distinction between “directly treating the diseased organ” and some other way of solving the problem is vacuous — sometimes that is possible, usually it’s not. Either way is the effective practice of medicine.
“One may never kill another innocent person so that one may live.”
“Yes, one can. It was done in this sad case. Fetus was destroyed, mother lives. A better outcome than fetus was not destroyed, mother died; and so did fetus. You can rail to the high heavens about the evil of that outcome or the evil that was done to produce that outcome. Any doctor worth her salt would make that choice again and let God be the judge. Tsk, tsk all you wish. Rail against the immorality and brutishness, the situation ethics, the poor state of cathechesis.
“I so want to accede to the correctness of the position that in this case both mother and child had to die, and then I draw back to the messy, ugliness of it all and take comfort that in this case man’s ways trump God’s way.”
God will be the Judge. It is His commandment, “Thou shall not kill.” The Church, The Pope, and Her Bishops in communion with the Pope, teach what is and what is not in accord with God’s commandment. God gave Her the authority to teach in His Name. Each of us can choose to abide by God’s commandment as taught by His designated authority or not.
The difference between killing a person and allowing a person to die as a result of a disease, is the difference between murder and natural death. We are not held accountable for the natural death of a person, we are held accountable for the murder of a person. The Church’s primary concern is our salvation, not our earthly survival. Whether one or both patient’s die as a result of the disease is not our call. Our call is to treat both patients the best we can, not to kill one in favor of the other.
Noticeable missing from the anaylsis of this case is any mention of the use of drugs such as Prostacyclin analogues, Endothelin receptor antagonists, Phosphodiesterase-5 inhibitors, High-dose calcium channel blockers, Anticoagulants, Diuretics, Antiproliferative agents, and Oxygen treatment (source Mayo Clinic) to control or treat the disease. These are the actions that should have been taken to treat the patient and to attempt to save both the child and the mother. Had the patients died while applying these treatments, the outcome would have been moral.
“It is my layman’s understanding that the termination of an ectopic pregancy (ie. any pregnancy in which the fertilized egg does not implant in the uterine cavity) is considered morally licit. In that case, it is not the organ that is defective but a condition that is being alleviated.
I find this case the hardest to understand. My understanding of the Church teaching is that the Fallopian tube must be excised rather than evacuated and repaired. The first is moral, the second not. The first is an indirect removal of a diseased organ, the second is an attack on the embryo, a direct abortion. The outcome of both is the same, but the action of the doctor is different.
Jim McK says: “If the doctors chose to kill the child, and did not have the life of the mother as their direct object, it was an abortion as Olmstead claims. But the thought of that is just too horrifying to actually consider. Why would doctors, confronted with a woman in dire straits, shift their attention to the child and choose to kill him? Context says their concern was the mother’s survival, not choosing the death of the child.”
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This is an ends justifying the means argument. One may not take an immoral action to obtain a moral outcome. God may bring good out of evil, but we cannot do evil to bring about good.
I find this case the hardest to understand. My understanding of the Church teaching is that the Fallopian tube must be excised rather than evacuated and repaired.
As I mentioned, according to my layman’s understanding an ectopic pregnancy includes *any* extra-uterine pregnancy. From https://health.google.com/health/ref/Ectopic+pregnancy
“An ectopic pregnancy occurs when the baby starts to develop outside the womb (uterus). The most common site for an ectopic pregnancy is within one of the tubes through which the egg passes from the ovary to the uterus (fallopian tube). However, in rare cases, ectopic pregnancies can occur in the ovary, stomach area, or cervix.”
sasurfman: It is incorrect to say the Church teaches “Thou shalt not kill” and stop there. What the Church et al. teach is that thou shall not kill except in certain circumstances under specific conditions. Details are available in the Catholic Catechism, the USCCB June 23 paper on abortion and medicsl procedures, and many other sources.
Your list of drugs raises several obvious questions. Who from the May Clinic examined the patient in Phoenix? What disease is to be controlled or treated — pulmonary hypertension? right-side cardiac failure? diiffuse cardiogenic shock? all? What are the time delays associated with each drug before achieving significant improvement? Your answers would make it clear why you say these should have been used in order to save the fetus as well as the mother.
Antonio Manetti says: “As I mentioned, according to my layman’s understanding an ectopic pregnancy includes *any* extra-uterine pregnancy. From https://health.google.com/health/ref/Ectopic+pregnancy
“An ectopic pregnancy occurs when the baby starts to develop outside the womb (uterus). The most common site for an ectopic pregnancy is within one of the tubes through which the egg passes from the ovary to the uterus (fallopian tube). However, in rare cases, ectopic pregnancies can occur in the ovary, stomach area, or cervix.”
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The implication being that removal of the embryo is an abortion? Like I said, this is a hard case. I would explain it this way. The organ that the placenta attached to is not designed to fulfill, nor can it fulfill for long, the function it is now being called upon to fulfill. It is in effect diseased. An operation to fix the diseased area will entail removal (and repair) of the diseased area and along with it the placenta and fetus. The demise of the fetus would fall under the forseen but unintended double effect.
This is different from the case at hand because no organ was being repaired by the abortion. The pregnancy was stressing her body and the hospital chose to end the pregnancy. This is a direct and intended abortion. The reason for the abortion (to eliminate the stress and save her life) does not change the fact that it was the abortion per se that was seen as the “medical treatment.”
David N. ==
Thank your for your careful reading of the case. I think it points out once again that the Aristotelian theory of substance is just too simple to handle complex medical problems like this.
Given our current biological knowledge, new philosophical questions have to be asked. For instance, what IS the placenta: part of the child, part of the mother, or something else which is neither? OR, in philosophical language, what is the ontological status of the placenta? It seems to me that the placenta is a being other than either mother or child is clearly the answer
But this doesn’t fit in the simple Aristotelian theory of biological substance. In his theory each organism has a sort of absolute independence of each other. However, we now know from things like symbiotic relationships and from colonies or corals that some individuals are absolutely dependent on some sort of physical union with others organisms. Also, in Aristotle’s theory there is a fixity of species — he held that like produced like, but we know now that evolution happens. Like sometimes produces what is unlike — as is the case, apparently, with placentas.
These and other sorts of anomalous biological occurrences simply can’t be explained by Aritototle’s simple view. Not that he is entirely wrong — it is just that not all substances have exactly the properties that he predicts. The whole place of DNA in establishing ‘identity” in metaphysics, and by implcation, medical ethichs, needs to be thought out.
And a Merry Christmas to all, and to all a good night :-)
Jack Barry says: “It is incorrect to say the Church teaches “Thou shalt not kill” and stop there. What the Church et al. teach is that thou shall not kill except in certain circumstances under specific conditions. Details are available in the Catholic Catechism, the USCCB June 23 paper on abortion and medicsl procedures, and many other sources.”
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I quoted the Fifth Commandment as cited in the CCC. It means that one shall not murder; murder being the unjust killing of an innocent human being. There is such a thing as justified homicide, but abortion does not qualify.
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Jack Barry says: “Your list of drugs raises several obvious questions. Who from the May[o] Clinic examined the patient in Phoenix? What disease is to be controlled or treated — pulmonary hypertension? right-side cardiac failure? diiffuse cardiogenic shock? all? What are the time delays associated with each drug before achieving significant improvement? Your answers would make it clear why you say these should have been used in order to save the fetus as well as the mother.”
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Read section ‘I. The Clinical History and Events’ of Dr. Lysaught’s analysis (http://www.commonwealmagazine.org/blog/wp-content/uploads/2010/12/St.-Josephs-Hospital-Analysis.pdf) and you will find your answers there as to the disease except for the treatments attempted. No where does she say what drugs were used and what their outcome was or whether oxygen treatment was used and what its effect was. She says surgery was contraindicated, but does not explain why. These are serious ommisions from the analysis. We don’t know from her analysis if these had been tried and failed, or whether they had not been tried. The analysis also speculates about the demise of the fetus due to lack of oxygen, but offers no empirical test that show the fetus was actually dying of oxygen starvation. There are lots of questions without answers regarding her analysis.
Ann, I agree with your comments, and continue to believe that the Church’s approach to issues involving maternal/fetal conflict is ill-fitted to actual circumstances, and that it leads to unfathomable, highly suspect moral decision making. That it is presented in a package of certainty makes it galling. If a reasonable person can’t quite understand the difference between the ectopic pregnancy situation and this one, how in the world can we defend erring on the side of greater mortality?
I was taught that the placenta “belongs” to the fetus, and that’s also been stated above. However, a student challenged me on this recently, and I responded: “get me sources.” He cited Gray’s anatomy, viz: http://education.yahoo.com/reference/gray/subjects/subject/12., that describes the anatomy as a shared organ, with maternal and fetal parts. I also found a 1991 human microscopic anatomy book defining the placenta as consisting of both maternal and fetal portions. So, ontologically–it’s a close interweaving (but not connection) of maternal and fetal bloodstreams, but the maternal as well as the fetal portions seem to compose the placenta as it’s finally shed. The extra-embryonic membranes, though, belong to the fetus.
As to clinical steps short of the D&C that may have been taken: this was a woman who’d been diagnosed previously with pulmonary hypertension, and chose to try to continue the pregnancy. It is inconceivable that other treatments, before and concurrent with the crisis, would not have been taken. If they weren’t, it would have constituted malpractice. Again, it seems clear that none of the principals here was eager to end this pregnancy.
No where does she say what drugs were used and what their outcome was or whether oxygen treatment was used and what its effect was.
sasurfman,
What we are trying to deal with here is a question of moral theology. In a case where a pregnant woman’s life is in peril because of pulmonary hypertension, does it constitute a “direct” abortion to dislodge the placenta from the uterus?
What is your motive in trying to complicate the issue further by questioning the medical competence of the doctors and nurses of St. Joseph’s Hospital or the completeness of the report by M. Therese Lysaught? It goes without saying that if the medical team did not do their absolute best to save the mother without recourse to taking an action that terminated the pregnancy, they are morally culpable. It also goes without saying that if M. Therese Lysaught deliberately glossed over medically relevant information in her analysis, we don’t have sufficient information to make a judgment about the rightness or wrongness of the actions taken by the medical team or the decision made by the ethics committee.
It is as if you were intent on sitting in judgment of the doctors and nurses in the hospital, the ethics committee, and M. Therese Lysaught instead of assuming they acted in good faith. It is as if you not only want to come to a conclusion about the point of moral theology, but also to “prove” that all those involved were guilty of incompetence and/or willful defiance of Church teaching based on reasoning they knew to be false. Or perhaps it is as if you were hedging your bets so you can argue that even if the D&C could have been justified as a last resort, the medical team did not exhaust all other options and so were still wrong.
Certainly most of us arguing this case have an emotional investment in our own position and to some degree want to be right independent of rationally believing we are right. That is only human. But it seems to me you are letting your emotional investment influence you to the point where it’s not just that want your reasoning to be write and the reasoning of those at St. Joseph’s to be wrong. You don’t just want to question their judgment on the moral issue, but also to question their competence, their honesty, and their sincerity.
“My understanding of the Church teaching is that the Fallopian tube must be excised rather than evacuated and repaired. The first is moral, the second not. The first is an indirect removal of a diseased organ, the second is an attack on the embryo, a direct abortion. The outcome of both is the same, but the action of the doctor is different.”
And the original intention in either case was ????
Apparently this is the last official word from the Vatican on the topic of ectopic pregnancy:
While the last thing I would want to do is contribute to the reversal of the majority opinion in Catholic ethical circles on the handling of ectopic pregnancies, I would note that there have been cases of ectopic pregnancies in which the infants have developed to the point of viability and the lives of the mothers were not endangered. Also, surgery is almost always performed immediately upon discovering an ectopic pregnancy, often well before there is an actual threat to the life of the mother. (I believe in the Latin American countries that completely prohibit abortions, surgery is not performed until the mother is in crisis.)
I would have to say that I find the moral argument (based on Catholic principles) for removal of the placenta in the Phoenix case to be more compelling than the reigning moral approach within Catholicism to ectopic pregnancy.
I was taught that the placenta “belongs” to the fetus, and that’s also been stated above . . .
Lisa,
I find the most compelling arguments about the nature of the placenta to be based on the fact that it can live on for weeks or months after the fetus dies. It is difficult to say the placenta is an organ of the fetus if it continues to live and function after the fetus dies. The placenta, in fact, can live on after a miscarriage, and the woman may still believe herself to be pregnant because the placenta continues to produce pregnancy hormones. Some of our organs can, of course, be kept alive artificially after our death. But it seems to me a clear sign that the placenta is not an organ of the fetus if the fetus can die and the placenta can go on living.
Jimmy Mac,
Another thought experiment: A valuable but hungry lion has escaped from a circus, and has entered a home where there is a tiny infant upstairs. The police are called, and their special forces goes out, complete with stun gun and firearms. First they shoot the lion with the stun gun, but to no avail. It continues its search for food. In order to remove the threat, the police then shoot it with live ammo and kill it.
Was it their intention to kill a lion or was it their intention to remove a threat to the child? I say it could easily be the latter AND NOT the former. The latter is only tolerated and regretted.
With the St. Joseph case, some people cannot see that a mental intention is quite another thing from the intent of an objective act (the removal of the fetus), and that the objective act of killing actually has *two* effects, one intended, one not, e.g., the intent to remove the lion is the intended threat.
Analogously, the removal of the fetus is one effect and the killing of the fetus which results is another effect even thought those effects (removal an death) might be simultaneous. But those performing the removal do not intend the secondary effect.
Is this cutting our reasoning very thin? In one sense it it — it requires us to look extremely carefully at what is happening and what is being done about it. It is all very complex. But complexity doesn’t imply that the conclusion reached, the judgment must be false.
“With the St. Joseph case, some people cannot see that a mental intention is quite another thing from the intent of an objective act (the removal of the fetus), and that the objective act of killing actually has *two* effects, one intended, one not, e.g., the intent to remove the lion is the intended threat.”
Oops -sorry, that is a terrible sentence. Should be:
As to the St. Joseph case, some people cannot see that a mental intention is quite another thing from the intent(s) of an objective act, and that an objective act of killing can actually have *two* effects, one mentally intended and one not mentally intended. In the case of the lion, the only mentally intended effect is the removal of the threat to the infant. In the St. Joseph case the only intended effect is the removal of the threatening fetus.
One more try. JP2, in Veritatis Splendor wrote:
the object of a given moral act… is the proximate end of a deliberate decision which determines the act of willing on the part of the acting person.
There were multiple proximate ends of the procedure in Phoenix, but not all of them determines the act of willing on the part of the acting person. Relieving the strain on the woman’s cardiovascular system was the end that determined the choice made in this situation. The doctors et al. did not see a woman near death in the emergency room, assess her situation, and then let their treatment be determined by their desire to kill the child. Killing the fetus did not determine their act of willing; saving the life of the mother did.
This is not not “the ends justify the means” but The primary and decisive element for moral judgment is the object of the human act, which establishes whether it is capable of being ordered to the good and to the ultimate end, which is God. Misreading this medical procedure as an abortion is similar to misreading killing someone defensively as a murder. The death of the attacker is not the object of a defensive act; stopping the attack is the object. The death of the fetus is the object of an abortion, but it was not the object of the procedure we are discussing.
Should I add the boilerplate here about “The Church, The Pope, and Her Bishops in communion with the Pope, teach what is and what is not in accord with God’s commandment.”? All of us are trying to understand what has been taught.
Well put, Jim McK.
“The primary and decisive element for moral judgment is the object of the human act, which establishes whether it is capable of being ordered to the good and to the ultimate end, which is God.”
Jimmy Mac —
I think this principle needs a lot more consideration. As I see it, the St. Jos. case exemplified a situation in which not to act was worse than to act. There are sins of commission and of omission, and in this case not removing the child would have resulted in the child’s and mother’s deaths and the siblings being left without a mother, which cumulatively was a dreadful set of consequences.
At least on the surface, that whole picture to me indicates that something was dreadfully wrong with the bishop’s thinking. It violates even the first thing we learn in arithmetic, which is the only totally science. How can demands of one person over=ride the equal demands of another? (YEs, the Sophie’s choice problem.) And in the St. Jos. case the whole consequence of not acting would be two deaths (including the fetus) and 4 semi=orphans.
Lisa (2:22PM) – Every single cell and molecule of the fetus and placenta are material provided by the mother’s functioning body (less the residue of one small spermatozoon.) All development and functioning of the fetus and placenta is dependent on the continuous provision by the mother’s body of an assortment of chemicals and reception of chemicals from the placenta. It is misleading to suggest no “connection” based on arbitrary boundary lines drawn on paper or vague adjectives (e.g., “shared”) and to try to assign “ownership” to one or another of the entities without considering function and origin.
Ann O (1:36AM!) mentions the crux of the problem that ends up hidden under the moral theological questions — a postulate of “a sort of absolute independence” among the entities under discussion. Since the times of Aristotle, Augustine, and Acquinas, and even 1902, major advances have occurred in knowledge and understanding of human beings as they live on earth. Interdependence of the entities composing a human is usual; independence is a rarity. (Knowing this, a doctor assessing your heart is likely to check your ankles, 4 feet away.) Misrepresenting the reality as Bishop Olmsted’s statement did with “the baby (sic) was healthy”, “no problems with the pregnancy”, and “the mother had a disease” can only lead to irrelevant conclusions. As Ann O and others point out, fundamental, sharp rethinking is required if authoritative declarations are to retain any credibility at all.
So let me see if I get this straight according to various medical and theological perspectives that have been advanced. If this woman had been somewhat (say 1 month) further along, yet still several weeks from fetal viability; and it would have been possible to induce labor in order to deliver a live birth of a very small child whose death was all but certain, the method of delivering a child to a morally certain death in order to save the mother’s life = good. However, the method of D&C to accomplish the same intention (to save a mother’s life) with the same foreknowledge (at the expense of certain death to her fetus) = evil. The method of medical intervention resulting in certain death of the fetus to the likely saving of the mother’s life is, for some, the crucial matter here.
Yet wouldn’t a delivery through vaginal birth (or C-section) of a non-viable fetus be the moral equivalent to abortion just as much as the method in question here? Wouldn’t the sin against life be the separation of mother and child prior to viability?
David Nickol says: “What is your motive in trying to complicate the issue further by questioning the medical competence of the doctors and nurses of St. Joseph’s Hospital or the completeness of the report by M. Therese Lysaught? It goes without saying that if the medical team did not do their absolute best to save the mother without recourse to taking an action that terminated the pregnancy, they are morally culpable”
The burden is upon them to demonstrate that they did do their best. If the analysis is to justify their actions it must be complete — and it is not. My motive is to get all the facts, not just some of them. I would think that the women would have been hospitialized, placed on oxygen, given the necessary drugs and monitored for her health and the childs health. The hypertension could have been controled in this manner and oxygen levels maintained. If not, at least the fetus could have been monitored for vital signs and if the fetus did die, then it would have been appropriate to do a D&C to evacuate the uterus. Evacuate AFTER the fetus died a natural death. Doctors do take the easiest course of action and oftentimes that is abortion. There is no reason for this information to be missing from this analysis.
Lisa Fullam,
I have no disagreement with gray’s description of the placenta. What I am saying is that the placenta functions to support the life of the fetus. While the uterine wall prepares for the implantation of the embryo, it is the embryonic tissue that invades the uterine wall for the purpose of nurishing the fetus. The organ belongs to the fetus in that it functions to sustain the life of the fetus. The placenta performs no such function for the mother and is totally unnecessary for the mother. In this sense, it can be rightfully called an organ of the fetus not the mother.
Jimmy Mac,
“And the original intention in either case was ????”
Not relevant. A lie is still a lie even if telling it had a good intention. An abortion is still an abortion, even if it was done to save the life of the mother.
I think that the term “intent” is being used differently by us. Those arguing for the procedure seem to use the term to mean the ultimate goal of the procedure, while those arguing against the procedure seem to use the term to mean the immediate goal or the object of the procedure.
I beleive that the Church uses the term to mean the immediate intent or the object of the procedure. If the immediate intent is to remove a diseased organ, that is an acceptable procedure whereas if the immediate intent is to terminant the pregnancy, that is unacceptable. The ultimate intent in both cases is the saving of the women’s life, but it is not the ultimate intent that determines the morality of the act. This is the basis of the mantra: one can never do evil that good may come of it.
In this case the immediate intent was to terminant the pregnancy. There was no diseased organ being removed. That is what makes this an illicit procedure.
There is no reason for this information to be missing from this analysis.
sasurfman,
M. Therese Lysaught is a moral theologian, not a medical doctor. She was called upon to do a moral analysis of the events at St. Joseph’s Hospital. She was not asked, nor would she be qualified to judge, whether the doctors provided optimal treatment for pulmonary hypertension. If Bishop Olmsted had been concerned about the quality of the medical care, he would have demanded a medical investigation, not a moral one.
Doctors do take the easiest course of action and oftentimes that is abortion.
In other words, you consider the doctors in this case guilty until proven innocent, even though Bishop Olmsted himself did not raise the question of what treatment the patient received prior to the termination of the pregnancy, and you consider yourself competent to make a judgment of both the medical and moral aspects of the case.
“In this case the immediate intent was to terminant the pregnancy. There was no diseased organ being removed. That is what makes this an illicit procedure.”
I, for one, am happy this woman is alive. Thanks be to God.
Just popping in to wish everyone a most blessed Christmas. If I have time to continue conversing over the next few days, I will do so.
If I can make a general observation:
I’ve made some comments here that seem supportive of the reasoning of the Phoenix diocese. Let me just say that I find the outcome of that reasoning – the death of the mother – extremely troublesome.
It is attractive to approach moral problems like well-constructed systems, with input (pregnant mom with hypertension), a system of moral reasoning, and exquisitely reasoned output (“ergo the mom dies” / “ergo the mom lives”). This seems to be a situation that defies such neat processes.
Along those lines: I sense that this is also where Rhonheimer and Grisez are on this issue: it doesn’t seem right that the mom should die when there are means at hand to prevent her death, and when the baby will die regardless. But … if they have constructed a rigorous and coherent moral explanation that also respects church teaching regarding the sanctity and dignity of life, and the preferential option to the most defenseless, then that explanation hasn’t really been presented in any of the documents we’ve been perusing here.
Intuition seeking understanding, I guess.
@Jack,
Not exactly–the key of the Church’s argument that the fetus counts like an independent person is its genetic independence since conception.
It’s being argued that if the placenta is genetically an “organ” of the mother, it could be removed on grounds that any organ that it posing a threat to its host’s survival may be. This is the core of the ectopic pregnancy exception. If an embryo implants in a fallopian tube, the tube may be declared “diseased,” and removed, even though the embryo will certainly die. (Indeed, astronomically rare exceptions excluded, tubal pregnancies do not come to term.)
If the placenta is genetically part of the fetus, it functions like, say, the fetus’ lungs, in providing transmission of oxygen (and everything else) to the fetus. If it is the fetus’, genetically, then removing it is like removing someone’s lungs. It is reasonably foreseen that detaching a placenta pre-viability will result in fetal death. It’s a different kind of act than removing a “diseased” organ from a mother.
Here again–I want to return to questions of self-defense for pregnant women. In fact, sometimes being pregnant poses a real and imminent threat to the mother’s life. Women, like men. get to defend themselves from real and imminent threats, EVEN IF THE ATTACKER IS MORALLY INNOCENT. (E.g., if the attacker is crazy and doesn’t personally intend harm. An Alzheimer’s patient, e.g., might strike at a caretaker, perceiving a threat that isn’t real. The caretaker gets to defend him/herself.)
Parsing what “counts” as an abortion takes us down too many rabbit holes, like the anatomy and physiology of placentas, to be adequate for most real situations. Our tradition cannot deny self-defense to women without a clear justification for doing so. The present magisterial “argument” against seeing the embryo as a materially unjust attacker (not morally responsible for causing harm, but causing harm anyway, like a crazy person attacking someone,) is a rhetorical question. That’s it. Just a rhetorical question.
Jim McK says: “One more try. JP2, in Veritatis Splendor wrote:
the object of a given moral act… is the proximate end of a deliberate decision which determines the act of willing on the part of the acting person.
“There were multiple proximate ends of the procedure in Phoenix, but not all of them determines the act of willing on the part of the acting person. Relieving the strain on the woman’s cardiovascular system was the end that determined the choice made in this situation. The doctors et al. did not see a woman near death in the emergency room, assess her situation, and then let their treatment be determined by their desire to kill the child. Killing the fetus did not determine their act of willing; saving the life of the mother did.”
==============
“proximate” end means immediately preceding or following an act rather than ultimate goals. Relieving the strain on the woman’s cardiovascular was an ultimate goal not the proximate end. The proximate end of the moral act was the termination of the pregnancy. That is why this act is immoral.
Lisa,
If the fetus is an aggressor, what is the act of aggression? Its mere existence? You are headed down the road of pro-choicers who say that the fetus is a parasite.
There is a kind of “terrible beauty” in the argument that a double death is preferable (because conforming to the will of God) over a ‘life-saving’ abortion. Its awesomeness and transcendence is seductive. There’s something about the way P. Flanagan opines, above, that Sr. McBride failed the test, while Abraham–apparently ready to sacrifice his own son (= murder?)–passed his that I find unnerving. I remain deeply suspicious as I follow this thread that the morally correct choice may be its own lure for those susceptible to the vice of purity.
A blessed Christmas to my fellow followers of Christ!
“M. Therese Lysaught is a moral theologian, not a medical doctor. She was called upon to do a moral analysis of the events at St. Joseph’s Hospital. She was not asked, nor would she be qualified to judge, whether the doctors provided optimal treatment for pulmonary hypertension. If Bishop Olmsted had been concerned about the quality of the medical care, he would have demanded a medical investigation, not a moral one.”
David,
Dr. Lysaught was asked to evaluate the morality of the medical acts of the doctors. That evaluation must include all the acts of treatment. If the doctors did all these things than your argument is stronger, if not weaker. It could go either way. The absence of addressing these issues makes for a weak analysis of the case.
sasurfman: “Doctors do take the easiest course of action and oftentimes that is abortion.”
David: “In other words, you consider the doctors in this case guilty until proven innocent, even though Bishop Olmsted himself did not raise the question of what treatment the patient received prior to the termination of the pregnancy, and you consider yourself competent to make a judgment of both the medical and moral aspects of the case.”
No, I don’t consider the doctors guilty until proven innocent. I consider the questions open and unanswered.
As to whether Bishop Olmsted raised the questions I don’t know. I don’t have access to all the communications between the Bishop and the hospital. Do you?
“There is a kind of “terrible beauty” in the argument that a double death is preferable (because conforming to the will of God) over a ‘life-saving’ abortion. Its awesomeness and transcendence is seductive. There’s something about the way P. Flanagan opines, above, that Sr. McBride failed the test, while Abraham–apparently ready to sacrifice his own son (= murder?)–passed his that I find unnerving. I remain deeply suspicious as I follow this thread that the morally correct choice may be its own lure for those susceptible to the vice of purity.
William,
It is not the case that a double death is preferable. It is the case that two natural deaths are preferable to one murder.
Since when is purity a vice?
‘ “There is a kind of “terrible beauty” in the argument that a double death is preferable (because conforming to the will of God) over a ‘life-saving’ abortion. ‘
Terrible, yes. Beauty? Oh, I don’t think so!
“Since when is purity a vice?”
Since Jesus tousled with Pharisees over dietary laws and keeping of the sabbath.
“Since Jesus tousled with Pharisees over dietary laws and keeping of the sabbath.”
That wasn’t about purity, that was about hypocrisy
There is something unbelievably chilling in the stance of Olmstead and his supporters.
A woman becomes an object of theological, theoretical speculation, not even consulted about the circumstances or choices in her life. Indeed she has no choice other than submit to the tender mercies of a bishop perhaps more concerned with his own doctrinaire standings than anything or anyone else.
I shudder at the implications, and give a nod to my departed mother who insisted on not going to a Catholic hospital when I was born in 1940. Way ahead of her time, she knew better than to trust her life to any Catholic bishop.
The Pharisees are alive, well, and in charge in too many places today. Their narrow certainty is scary.
Thank you, William FitzGerald for this response: “Since when is purity a vice?”
Since Jesus tousled with Pharisees over dietary laws and keeping of the sabbath.
Jim Pauwels wrote:
“Catholic Physician: with much respect, I believe you’re reversing your primary and secondary effects.”
and
“It seems that the purpose of the procedure in question, and the intent of those who approved and performed that procedure, was to abort the baby. With great reluctance, filled with revulsion at what they were doing, hating every second of it, cursing the God who put them in that morally impossible position, they aborted the baby. The primary effect of an abortion is to kill the baby. The effect on the mother’s health is the secondary effect. The former was the means to the latter end. One can’t get to the end except by going through the means. They are not simultaneous and independent effects; the one begets the other.”
My reply: The primary INTENDED purpose of the procedure was to remove the the placenta which was the instigator of her acute heart failure. The unintended, but predictable effect, was the death of the fetus. The primary intention was not to kill the fetus, but that was the unavoidable consequence of the primary intention. ERD 47 specifically allows this action. You use the adjectives “simultaneous” and independent” ERD 45 uses neither word. Again, ERD 45 states, “Abortion (that is, the directly intended termination of pregnancy before viability or the directly intended destruction of a viable fetus) is never permitted. Every procedure whose sole immediate effect is the termination of pregnancy before viability is an abortion, which, in its moral context, includes the interval between conception and implantation of the embryo.” That sentence defines what “abortion” is in the eyes of the Church. In addition to the termination of the pregnancy in this case, the immediate effect also was the relief of the source of her acute heart failure. There were dual immediate effects, one intended and the other unintended, but not unexpected, which fell into ERD 47. Luckily for her, the heart has not dilated out beyond its ability to recover and she was soon off of the ventillator and home in a week to her 4 surviving children and husband. I could not help but notice that when you were quoting ERD 45 to Jim McK at 12:30 pm on 12/24, you intentionally left out the key qualifying sentence I quoted just now that followed the one you quoted [I do note that directive 45 as quoted by Catholic Physician does include a definition of abortion: “the directly intended termination of pregnancy before viability or the directly intended destruction of a viable fetus”] Why, pray tell is that 2nd qualifying clause in there and why did they insert the word “sole” if they were intending to exclude procedures that would save the mother’s life while destroying the fetus? And I believe Jim McK pretty well nailed down the importance of intent in this situation as to deciding what is licit or illicit.
sasurfman wrote: “Catholic Physician, To answer the question as to whether the sole immediate effect is the termination of the pregnancy prior to viability one has to answer the question: What diseased organ was removed or treated by the operation? In this case NO diseased organ was removed or treated. The planceta, the putative organ sought to be removed, was not diseased, it was functioning normally and it was deemed that this normality was the threat to the mother’s life. Since there was no diseased organ to be removed or treated, it must be concluded that the sole immediate effect was the termination of the pregnancy prior to viability. There is no Double Effect argument possible here because there was no diseased organ removed or treated. Abortion in itself, cannot morally be a treatment for disease.”
My reply: Go back and read ERDs 45 & 47 and show me that removal of a diseased organ is a requirement. The ERDs were last revised in 2001 with the understanding of modern medicine and its capabilities. The double effect, “gotta take an organ out”, rule was developed as the result of a Vatican ruling around 1910, as I recall, that sought to forbid the removal of tubal pregnancies and the uproar that followed. The ERDs as drafted by the American bishops and disseminated by the bishops to every Catholic hospital and clinic in America are what are at issue here. St. Joe’s can not be held accountable in this case involving this mortally ill mother except for what the ERDs plainly said. If the ERDs are out of line with Canon Law, that is not St. Joe’s fault. If the ERDs are revised to make what happened in Phoenix illicit, every Catholic hospital in the nation will have to disassociate itself from the bishops or face violations of EMTALA http://en.wikipedia.org/wiki/EMTALA as well as massive lawsuits from the families of dead mothers as well as a certain class action suit from the ACLU. Regarding the list of drugs you cited: I can assure you that any reasonable physician would have thrown those at her. She may well have even been on some of those when she got pregnant. I know this disease, pulmonary hypertension, very well. As a 2nd year pathology resident 25 years ago I gave a hospital wide Grand Rounds on that topic to about 150 or so attending physicians and house staff at Rush-Presbyterian-St. Lukes Medical Center in Chicago and later published a paper detailing the pathophysiology and histology of PH as it relates to long term survivors of sickle cell anemia and children born with a ventricular septal defect. None of those drugs have been found effective in a woman already in heart failure and on a ventillator at 11 weeks of pregnancy. The ever enlarging placenta is too much for the paltry drugs that we have at our disposal to overcome. When this case went public back in June, I did a literature search and could not find as much as a single case report where medical therapy alone could save a mother who was critically ill in the 1st trimester. They all had to undergo a termination of their pregnancy in order to live.
Finally, I do also believe there is a self defense issue. Yes, the fetus is an innocent aggressor. But so is a crazy man, innocent in the eyes of God, charging into my office with a knife. I have the right to draw a gun and kill him and so would anyone else in the room who chose to protect me.
Catholic Physican,
You present a lucid argument. In the end, it is the Bishop who must determine what is meant by the language of ERD’s 45 and 47. If the audience for whom the ERD’s are written have a different understanding of them, once that understanding is corrected by the Bishop, then the audience must comport their behavior to that teaching. Bishop Olmsted is teaching that the action of the hospital violated ERD 45 and did not qualify under ERD 47. Rather than accept that teaching, the hospital attempts to tell the Bishop that it is he who is being taught by them about the meaning of the ERD’s.
Not everything that can be done should be done. There are moral lines that must be drawn and the Bishop, The Church, are the ones to draw those lines. The Bishop is saying that the removal the placenta falls under ERD 45 not 47. He is saying that the removal of the placenta is a direct and intended abortion regardless of the ultimate intention of saving the mother’s life or reducing the stress on her heart.
The Bishop no more desires the death of a mother than any else, but his greatest concern must be the salvation of souls. It is for the Church to guide man to moral behavior according to God’s design. If the hospital dissents from the teaching of the Bishop (and the Bishop is in communion with the Church, the Pope), then it is only right that the hospital not be identified as in communion with the Church.
I think we should ‘reverse engineer’ the theology so that women who would otherwise die in failing to give birth (along with their non-viable fetal children) are provided a chance to live. Everything must be done to save two lives. However, if the survival of a fetus nears mathematical impossibility, to a degree of moral certainty, it is time to change the paradigm of medical intervention: something must be done to separate mother and fetus to give at least one of two otherwise doomed individuals a fighting chance for survival.
I do not think holding this position or acting on it makes one a merchant of death, unwittingly or not.
With all due respect, sasurfman, we have to get beyond the trend of the ‘creeping infallibility’ that has been infesting the church for the last 30 years or so. Just because a bishop is in communion with the Pope—does not make that bishop “infallible.” And his decisions are not beyond serious questioning.
And this particular bishop, is no more capable of determining what is medically correct—than the proverbial ‘man in the moon.’ His position does not grant him supernatural powers—and if he ever gets off of his Rodney Dangerfield stance—he might intelligently recognize that.
We also have to get past the point where the analysis, presentation, and practice of well-trained laity is disgrgarded by a bishop who doesn’t have the background to make an intelligent decision. We are no longer in the days of Pope Pius IX—who declared himself to be in opposition to the modern world.
The hospital should be judged on its adhearance to Gospel values—to heal as Jesus did—to preserve and save as many lives as possible. It should not be determined by the whims of a hyper-conservative bishop—whose biography mirrors the biographies of the Pharasees who conspired and condemned Jesus to death. Bishop Olmsted doesn’t know how to be pastoral—doesn’t perform pastoral services for his people—doesn’t even like people. He should have entered a contemplative religious monastery.
Little Bear,
If the question is on the Bishop’s ability to decide correctly, then there is appeal process available in Canon Law. Put the question to Rome, if you think the Bishop wrong. But stop the ad hominem attacks and the character attacks. You show a lack of christian charity and a lack of ability to recognize that reasonable men can disagree. The National Catholic Bioethics Center doesn’t share your opinion (http://www.ncbcenter.org/NetCommunity/Document.Doc?id=171) nor does the Catholic Medical Association (http://www.cathmed.org/issues_resources/publications/press_releases/statement_on_bishop_olmsteds_action_regarding_st_josephs_hospital/). The Bishop did not approach this issue without consultation and it is unjust to malign him so.
“You show a lack of christian charity and a lack of ability to recognize that reasonable men can disagree.”
This has truly become an irony-free zone.
In reading sasurfman’s link to the Catholic Medical Association, it seems to me that group simply stated in its press release that its defers to the bishop in deciding this issue. It’s not really helpful in figuring out if the bishop made the correct decision.
Thank you Catholic Physician and others for your very helpful insights.
This thread could be instructive to anyone still wondering why people leave the Church.
sasurfman
First, I endorse what Little Bear has to say about the creeping infallibility that some bishops are imposing upon the laity. Second, Bishop Olmsted has no authority on his own to re-write the ERDs to his liking by trying to deny that there was a concurrent immediate effect (relieving the source of exascerbation of the pulmonary hypertension) that served as the primary INTENT of the physicians and the hospital. If the bishop told me that the Sun revolves around the Earth, am I supposed to quash my own conscience and kow tow to the bishop? Wait, the Church has already been through that matter when pig headed bishops and cardinals would not accept what the science was telling them because they have at times been constitutionally unable to carve out square holes into which to insert newly developed square pegs, in lieu of the previously present round holes. The theologians are at best split on this matter and I guarantee you the Sensus Fidelium is at least 90% behind the decision of the hospital and the mother.
The National Catholic Bioethics Committee is a tool of the USCCB to trot out and say to the press or a hospital what a bishop wants them to say. In this matter, it would be a kangaroo court worthy of Kafka. The CHA is an organization that I, and most ethical Catholic physicians, have refused to join because there is absolutely no room for meaningful discussion of medical ethics in that organization.
I can assure you that discussions are being held right now at the highest levels of Catholic Health Initiatives (based out of Denver) as well as all of the constituent hospitals of the CHA over this matter. I would hope and pray that these organizations will en mass notify the local bishops in the dioceses where they have hospitals that an attempt to impose “Olmsted’s Law” upon their hospital(s) will end in the same stalemate as in Phoenix. It may not then be long before the ERDs will not be worth the paper they are written upon because there will be no more institutions upon which to impose them.
Dear Bishop Olmstead,
We lay people have been told for years, by priests and bishops, that when our prayers are not answered, it is for a reason. In your press conference you admitted that you have been praying for years for St. Joseph’s to see it your way. And you also admit that your prayers have not been answered.
It appears, that, as a surrogate “physican,” now is the moment to “Heal Thyself.” God is not hearing your prayers apparently for a reason. Whether it’s your style of communicating, your difficulty accepting the immutable medical facts, or something in your intention or disposition known only to you and God, you might want to change that intention of yours to be one of greater surrender to God’s will instead of your own. Because apparently in this case God wanted the one survivable life to be rescued, as opposed to the certain death of two lives lost and several existing young children becoming motherless.
Hmmm……
Just a suggestion……
My bad, in my next to the last paragraph above, I used the initials CHA when I meant CMA. To my knowledge, their membership accounts for about 1/10th of 1% of all Catholic physicians.
“An abortion is still an abortion, even if it was done to save the life of the mother.”
So much for the principle of double effect.
ssurfman, I hope that you are not in charge of medical ethics in any hospital in which I find myself.
Bishop Olmstead must have recently read “The Cardinal” where his attitude was portrayed therein. It ended in disaster then and even so today, only today fiction has become reality.
Gerelyn,
I find myself wondering why those here are in the Church (assuming that they are). For myself, I am Catholic because I believe that the Church is truly Jesus’ Church, guided by the Holy Spirit to lead us to salvation, and that includes teaching the moral law. If I didn’t believe that, I wouldn’t be Catholic.
So I put the question to each of you. Why are you Catholic, if you are? Why have you not left, if you don’t believe the Church?
One can believe in the Church without believing in Bishop Olmsted.
What will the bishops have to say about this? Will they allow physicians, patients, and hospitals to take advantage of this?
http://www.nytimes.com/2010/12/26/us/politics/26death.html?_r=1&scp=1&sq=death%20panels&st=cse
“Under the new policy, outlined in a Medicare regulation, the government will pay doctors who advise patients on options for end-of-life care, which may include advance directives to forgo aggressive life-sustaining treatment.”
And, also from the NYT article:
“‘Using unwanted procedures in terminal illness is a form of assault,’ Dr. Berwick has said.”
(I agree.)
Let’s imagine that I have a problem pregnancy, and go into a coma. My family takes me to a Catholic hospital, believing that my wishes to follow Catholic ethics will be respected. Will they be?
So I put the question to each of you. Why are you Catholic, if you are? Why have you not left, if you don’t believe the Church?
sasurfman,
Are you inviting people to leave the Church? If you are convinced “the Church is truly Jesus’ Church, guided by the Holy Spirit,” why in the world would you want to shoo people away, even if they don’t believe to the extent you do? If you believe the Catholic Church has the truth, why would you want people to leave it and go elsewhere even if they think it only has part of the truth?
Let’s imagine that I have a problem pregnancy, and go into a coma. My family takes me to a Catholic hospital, believing that my wishes to follow Catholic ethics will be respected. Will they be?
Kathy,
I see the whole Phoenix case as being about a disagreement among Catholic doctors, ethicists, and bishops about exactly what Catholic ethics require. If there were a definitive interpretation of exactly what Catholic ethics required in every case, we wouldn’t be having this discussion. In the Phoenix case, the pregnant woman herself made the decision to go ahead with the D&C. If you are in a coma and you are abandoned by your family in the hospital, then the hospital would have no choice but to follow Catholic ethics as they understood them. However, if you had made your understanding of Catholic ethics clear to your family, then I can only imagine they would make the decisions on your behalf according to your wishes, and the hospital would follow what your family said.
I find it strange and rather appalling that so many people seem to see this case an instance of a rogue ethicist making up an obviously false justification for a direct abortion. Germain Grisez is not a crackpot, and as I understand his theories, just about anything they could have done to end this pregnancy would have been licit. I think M. Therese Lysaught made a more “conservative” case than she needed to for those who accept Grisez’s approach.
I see this as truly a case where experts disagree on a matter of moral theology, not a case of Catholic ethics versus non-Catholic ethics.
Besides this scenario on which there is much disagreement, to put it mildly, can anyone offer a scenario of a troubled pregnancy in which a woman’s life could not be saved by termination of a pregnancy under Catholic ethics but could be under non-Catholic ethics?
“I think M. Therese Lysaught made a more “conservative” case than she needed to for those who accept Grisez’s approach.”
I agree with you. But I disagree with Grisez and agree with Bishop Olmsted on the right course of action. If I were the patient, and if my family agreed to go along with the ethics practiced by the hospital, I would want to be in a hospital subject to Bishop Olmsted rather than to ethicists who follow Grisez on this question.
I certainly disagree with Lysaught’s construal of the placenta, if I understand correctly, as an organ of the mother’s. Rather it seems to me that the placenta is the means of basic life support of the child.
Many are framing the incident in terms of the woman’s safety. My question is whether there is a hospital where nothing will be done against my religion, even if I am unable to weigh the decisions personally. I’d really like for bishops to make that possible.
“So I put the question to each of you. Why are you Catholic, if you are? Why have you not left, if you don’t believe the Church?”
sasurfman: let’s play “ask a pope:”
“When Pius X died, the conclave of 1914 elected Benedict XV, who immediately issued an encyclical (Ad Beatissimi Apostolorum – http://en.wikipedia.org/wiki/Ad_Beatissimi_Apostolorum) calling on Catholics ‘to appease dissension and strife” so that “no one should consider himself entitled to affix on those who merely do not agree with his ideas the stigma of disloyalty to faith.’
‘There is no need of adding any qualifying terms to the profession of Catholicism,’ he concluded. ‘It is quite enough for each one to proclaim ‘Christian is my name and Catholic my surname’ “
David Gibson, “Who Is a Real Catholic?” The Washington Post, Sunday, May 17, 2009
http://www.washingtonpost.com/wp-dyn/content/article/2009/05/15/AR2009051501390.html?sid=ST2009051503626
“Are you inviting people to leave the Church? If you are convinced “the Church is truly Jesus’ Church, guided by the Holy Spirit,” why in the world would you want to shoo people away, even if they don’t believe to the extent you do? If you believe the Catholic Church has the truth, why would you want people to leave it and go elsewhere even if they think it only has part of the truth?”
David,
I am inviting people to be honest. If they reject any part of Catholic teaching on faith and morals, they have rejected the Catholic faith. Why pretend to be Catholic? “From the first moment of his existence, a human being must be recognized as having the rights of a person — amoung which is the inviolable right of every innocent being to life.”
(CCC 2270.) “You shall not kill the embryo by abortion and shall not cause the newborn to perish.” (CCC 2271)
“…Bishop Olmsted has no authority on his own to re-write the ERDs to his liking by trying to deny that there was a concurrent immediate effect (relieving the source of exascerbation of the pulmonary hypertension) that served as the primary INTENT of the physicians and the hospital.”
I have addessed this concept of INTENT already. I’ll repeat it.
=============
I think that the term “intent” is being used differently by us. Those arguing for the procedure seem to use the term to mean the ultimate goal of the procedure, while those arguing against the procedure seem to use the term to mean the immediate goal or the object of the procedure.
I beleive that the Church uses the term to mean the immediate intent or the object of the procedure. If the immediate intent is to remove a diseased organ, that is an acceptable procedure whereas if the immediate intent is to terminant the pregnancy, that is unacceptable. The ultimate intent in both cases is the saving of the women’s life, but it is not the ultimate intent that determines the morality of the act. This is the basis of the mantra: one can never do evil that good may come of it.
In this case the immediate intent was to terminant the pregnancy. There was no diseased organ being removed. That is what makes this an illicit procedure.
=============
“proximate” end means immediately preceding or following an act rather than ultimate goals. Relieving the strain on the woman’s cardiovascular was an ultimate goal not the proximate end. The proximate end of the moral act was the termination of the pregnancy. That is why this act is immoral.
========
I know I am not alone in seeing a parallel between the legalistic thinking Jesus specifically attacked in the Judaism of his day and the doctrinaire and legalistic approaches against abortion that would acquiesce to an extra death rather than bloody one’s hands in a tragic intervention. No one here has been arguing about elective abortion. There’s something here that strikes this lay person as perverse in its purity and reminds me, perhaps unfairly, of the Levite in the story of the ‘good’ Samaritan.
It seems to me, again perhaps unfairly, that there is something in the moral code in which abortion is the epitome of evil that logically demands the possibility that a pregnant woman die along with her fetus as the ultimate validation of an ideology. There is something here that goes beyond the intertwined demands to advance both justice and mercy as imperfectly as we may act in their pursuit. Honest to God, I am frightened by the transcendence of earthly understanding represented by cases as these.
William,
Don’t forget that Jesus attacked legalism that allowed people to escape their responsibilities, especially family responsibilities. Quoting Moses on divorce was not enough for Jesus; that law had been written only in response to stubbornness. In the beginning it was not like that. Declaring property “corban” was not enough for Jesus. The fourth commandment had to be followed as well.
Because I am a Catholic I care about what the Church teaches. When a bishop takes a controversial position, it is appropriate to examine that position and see how it aligns with Catholic teaching. Sometimes that includes IF it aligns with Catholic teaching.
I cannot see how Olmstead’s position on abortion can be aligned with Catholic teaching. It certainly is not pro-life, since it calls on us to allow people to die when we might prevent their death. It does not seem to fit with the moral theology JP2 laid out in VS and EV. I hope that his position can be clarified so that he can be understood as being in harmony with Catholic tradition, so I question, seeking understanding.
I appreciate the efforts you have made to clarify, but they have really not helped. You seem consumed with details that are largely irrelevant to the morality of the action, eg is there an organ that is being treated, does the fetus die before or after the strain on the mother’s system is alleviated, etc. If Olmstead made these arguments, I would simply ignore him as not representing Catholic teaching.
There are some issues you raise that certainly would lead me to question whether I should continue being a Catholic. For instance, It is the case that two natural deaths are preferable to one murder. seems so fundamentally anti-life that I would question whether Catholicism is appropriate for me.
So why do you remain a Catholic despite this rejection of life, your dismissal of JP2′s moral reasoning, etc?
My question is whether there is a hospital where nothing will be done against my religion, even if I am unable to weigh the decisions personally. I’d really like for bishops to make that possible.
My layman’s guess is that the standard of treatment is a matter of civil law and no Catholic institution is going to jeapordize its standing with the civil licensing authorities or put its malpractice insurance costs at risk. Of course, there’s always the possibility that this issue would be aired in a civil court of law as a freedom or religion issue. I suspect one result is that such institutions will simply jettison their sectarian association.
Perhaps someone with legal credentials could comment.
assurfman, since you have repeated some comments you made to me I will address them.
“Relieving the strain on the woman’s cardiovascular system” is as immediate as the death of the child, so the argument that what is sooner is more proximate is irrelevant. Both consequences accompany the procedure, but it is the impact on the mother that is the proximate end that determines the choice of the procedure, so it constitutes the object of the action. The drs did not do this so that they could kill the child and by that action save the mother; they did it as teh only option that would reasonably alleviate the strain that was killing her.
This has to do with the OBJECT of the act, not with INTENT. Most of us use ‘object’ and ‘intent’ differently from how JP2 uses the terms, so it is important to understand how intentionality determines an action. Only when we understand that can we really begin to understand what JP2′s prohibition on abortion means, that it is “thou shalt not murder”, NOT “thou shalt not kill.”
“I cannot see how Olmstead’s position on abortion can be aligned with Catholic teaching. ”
Jim McK ==
I think this is the basic issue of this thread: what IS the teaching of the Catholic Church on cases such as the St. Joseph one? Some people think that there has been only one teaching, other that there are several. Some people simply cannot tolerate the historical fact that the Church ever changes its teachings, and so they won’t admit that there have been more than one teaching about this kind of case.
But the fundamental problem, the problem below the St. Jos. case, is not abortion. The problem is that some people are incapable of changing their own judgment about what the RCC is about. They kling to childish things, to what Sr. Mary Margaret taught them in the 4th grade even though she really didn’t know very much.
Some of us see the Church as holding fast to the truths revealed by God — those are truths written down in the Bible and embodied in tradition, but those truths need interpretation and we can sometimes be wrong about just what they mean. Others hold that the RCC can never be wrong, AND that they cannot ever be wrong about just what the Church is. That too is a childish thing that needs to be put away.
Yes, we are left sometimes in very uncomfortable uncertainty. But that seems to be the will of God. Jesus never promised He would answer all our questions or that we would ever be left uncertain.
My question is whether there is a hospital where nothing will be done against my religion, even if I am unable to weigh the decisions personally. I’d really like for bishops to make that possible.
Kathy, the Catholic way is for individuals and groups to apply teaching to the best of their ability, and for the rest of us to forgive lapses and offer help to achieve adherence to religious teaching. It is impossible to guarantee that every decision will be made in conformity with Catholic teaching, only that people will try. I would think that most Catholic hospitals will try to implement Catholicism, and that is the best you can ask for imo.
Bishops certainly can exercise their authority to assure that their understanding of Catholic teaching is implemented, but I am sure you have met plenty of bishops whose understanding differs from yours. Forgiveness is the basis for living with those discrepancies, and a fundamental part of faith as the foundation of religion.
Again, there is no guarantee that mistakes will not be made by doctors, bishops, or patients. You might be left alive as the result of someone’s mistake, and have to live without your child. Or you might die and move past all these issues. Only God knows which of those results from Catholic faith, and which is the mistake.
Recalling 1400 years or so of often bloody history directly involving popes and bishops, usually in pursuit of the salvation of souls, it seems premature to assume present bishops have all abruptly changed to being literally, totally pro-life with no more incoherent exceptions and specifications. The institution they lead changes continually but slowly.
Simplistic misrepresentation of what is well known about the human body and its medical care for the sake of moral argument seems to me to represent a conflict in significant values. Real patients and doctors deserve better care.
Hippocrates was establishing ethics long before any bishops (or Jesus) appeared. His wisdom, adapted to the times, seems to me to be powerfully reflected in the Dec 21 statement from the President of St. Joseph’s, which could structure a fruitful discussion:
“Consistent with our values of dignity and justice, if we are presented with a situation in which a pregnancy threatens a woman’s life, our first priority is to save both patients. If that is not possible we will always save the life we can save,….”
(Catholic Physician – You may be too optimistic on the astronomy. The Bishop of Sacramento was inspired this fall by how our earth revolves around the sun, creating the natural cycle of night and day. Slow learner or wrong planet.)
http://faithcatholicdigital.com/publication/?i=44608
No hospital, in my view, could adopt the course recommended by Olmsted and retain its licensure– at least for an emergency room.
“My question is whether there is a hospital where nothing will be done against my religion, even if I am unable to weigh the decisions personally. ”
Jim McK ==
It seems there are two kinds of problems about doing our bidding. In the St. Jos. case the woman asked that something be actually done against the bishop’s rules. In another kind of case, a much more common kind, the patient’s instructions say that nothing more should be done, e.g., no more tubal feeding, no more extraordinary means.
But “extraordinary means” is ambiguous for some people, for instance, doctors. My mother had told her doctor (an extraordinarily conservative man) she wanted no tubes and such if there was no hope of improvement, but he was ready to order all that paraphernalia she had said herself that she didn’t want. He kept insisting. It was very upsetting. Finally we consulted the Monsignor who taught medical ethics at the seminary, and he assured us that we were right, that there was no necessity to prolong my mother’s life. The doctor had to give in and was later highly insulting to me, asking over and over, “You believe in euthanasia? You believe in euthanasia?” I was particularly angry because we had known each other since college, and he knew damn well I didn’t. But anything to impose his own conscience. Later my family got another doctor.
I strongly recommend you all check out both your doctors and their hospitals. And put your instructions in writing and discuss them with your MD while you are well..
“There are some issues you raise that certainly would lead me to question whether I should continue being a Catholic. For instance, It is the case that two natural deaths are preferable to one murder. seems so fundamentally anti-life that I would question whether Catholicism is appropriate for me.”
The direct taking of an innocent life brings about spiritual death of the murder. This is a far greater evil than the natural death of two people. It is the greatest tragedy that can befall man. As Christians we understand that we are but pilgrims in this earthly life and that our true home is Heaven. We won’t get there if we kill innocent people, regardless of the reason we kill them. It is our eternal life that the Bishop is concerned about most. He is not at anti-life.
“The direct taking of an innocent life brings about spiritual death of the murder. This is a far greater evil than the natural death of two people. It is the greatest tragedy that can befall man. As Christians we understand that we are but pilgrims in this earthly life and that our true home is Heaven.”
Sasaurian ==
I agree with your general statement. But the St. Joseph case is not a case of murder. You think it is, but the best evidence is that you are wrong. You also disagree about that. So be it. You disagree.
Oops — excuse me, sasurfman.
“I agree with your general statement. But the St. Joseph case is not a case of murder. You think it is, but the best evidence is that you are wrong. You also disagree about that. So be it. You disagree.”
Ann,
So who is to decide what is or is not murder? We ourselves or the Church? Bishop Olmsted is the voice of the Church in his diocease. If he is out of step with the Pope there are ways to examine this. Put the case to Rome and let Rome rule.
sasurfman,
You are still stuck on the “diseased organ”. I’m stuck on the ERDs, as written. You can keep raising the “diseased organ” strawman until Hades freezes over, but I will continue to raise the issue of dual immediate intended effect that is covered as I explained above in ERDs 45 & 47. As a physician and the Chief of Staff in a Catholic Hospital, I am bound by the plain English, as written by the USCCB. If you want to argue the “diseased organ” theory, take it up with the USCCB. As for the proximate end, the stress on the mother’s heart was immediately relieved when the placenta was ripped free of the mother’s blood supply. That’s immediate enough for me. If you want to call purple, orange and orange, purple, you are free to do so, but it will not change the facts in this case.
As to why I am Catholic? 1st of all, I’d point out that I am baptised a Catholic, which put a Catholic mark on my soul forever. 2nd, I was confirmed as a Catholic, and during that confirmation, Bishop Tschoepe of the Dallas Diocese rapped my cheek to remind me I might some day have to defend my faith. 2 years later in 1972 , that same bishop placed a known pedophile priest into my parish where I was a 15 year old altar boy. I only learned the truth a few years ago at the bishopaccountability.org web site. It was then, and with my recent dealings with Bishop Vasa, that I learned that the enemies of the Catholic faith all too often include priests and, yes, bishops. I was brought up in a devoutly Catholic home where I was instructed that our faith is one of reason and fidelity to Christ and His teachings and that I should never judge or abandon the faith because of a priest or a bishop. Or for that matter, a pope. I will stay and fight on for a Church that accepts the advances of science where it can bring healing, health, food, and shelter to more and more of God’s people. I will stand up to and fight the scribes in our church who are hellbent on enforcing inflexible Canon Laws that were created by celibate men, for men and women, married or single. Especially when they rule on female body parts with nary a woman in the room, save for a housekeeper refilling their water pitchers.
As for the consequences of putting the the non-viable fetus’ life before the viable Mom, here’s what the ACLU has in store:
http://www.washingtonpost.com/wp-dyn/content/article/2010/12/22/AR2010122206219.html
They already have documented cases where women in Catholic facilities were denied timely evacuation of their uteruses in cases where non-viable fetuses were infected and spontaneously aborting. The reason for the delay was because a fetal heart beat was still detected. As the mothers lay waiting for the heartbeat to stop, the infection spread to their own bloodstream (blood poisoning in layman’s terms) and some of of these women nearly died. Sooner or later they will find a dead Mom, and all hell will break loose. There will be no religious exemption here, anymore than if the Jehovah’s Witnesses tried to run an ER and hospital without a blood bank. There have also been cases where ERD 45 & 47 have been ignored and methotrexate has been forbidden to be used in some Catholic facilities to remove an ectopic tubal pregnancy without surgery. The sasurfman “diseased organ” non requirement seems to be required in these institutions. Now imagine that! In order to remove the gestational sac that will soon threaten the mother’s life, you have to sacrifice 1/2 of her potential fertility. Baloney! The use of methotrexate is interpreted as a “Chemical abortion”, intention be damned.
As for a “Catholic” nursing home honoring your end of life wishes for no feeding tube and/or hydration:
http://www.msnbc.msn.com/id/35550235/ns/health-health_care/
You should have your intentions written down, signed, dated, and witnessed, hopefully by someone likely to survive you as well as your immediate next of kin. Then they should be prepared to see that you are admitted to a facility willing to honor them.
“It was then, and with my recent dealings with Bishop Vasa, that I learned that the enemies of the Catholic faith all too often include priests and, yes, bishops”
What? You never heard of Judas?
“So who is to decide what is or is not murder?”
sasaurian ==
Gpd. Jesus said, “Judge not, that ye be not judged”. That includes you and me. Remeber, the Church teaches that murder is matter of both action and intent. No intent, no murder. And only Gpd knows other people’s intents.
Catholic Physician,
I submit that you have failed to understand ERDs. That you are understanding them the way you want to as opposed to the way the authors intended. I submit that Bishop Olmsted has authority to explain how the ERDs are to be understood. I further submit that the ERDs cannot be divorced from the subject they apply to which is the act of man in question, and that means discussion of whether the organ was diseased is relevant.
“If you say, for instance, that “all men are equal,” I may take you to mean that all men are equally endowed at birth with intelligence, strength, and other abilities. In the light of the facts as I know them, I disagree with you. I think you are wrong. But suppose I have misunderstood you. Suppose you meant by these words that all men should have equal political rights. Because I misapprehended your meaning, my disagreement was irrelevant. Now suppose the mistake corrected. Two alternatives still remain. I can agree or disagree, but now if I disagree, there is a real issue between us. I understand your political position but hold a contrary one.”(“A Meeting of Minds,” Mortimer J Adler Phd (http://radicalacademy.com/adlermeetingminds.htm))
‘Jesus said, “Judge not, that ye be not judged”. That includes you and me. Remeber, the Church teaches that murder is matter of both action and intent. No intent, no murder. And only Gpd knows other people’s intents’
Ann,
You misuse that verse. Subjective judgement is God’s alone, but objective judgement of the act must be made otherwise we would never be able to determine right from wrong. Such determination requires a judgement of the morality of the act. We must judge was acts are murder and what acts are not. If we can’t do that, we can’t know how to act.
Who here would support the outlawing of all abortions in the U.S. except for abortion ‘necessary’ to save the mother’s life?
sasurfman,
You said earlier that reasonable people can disagree, but you seem to be very upset that reasonable people here are not agreeing with your position. We don’t all agree that we need to accept Bishop Olmsted’s position without question. This is a hugely important moral issue with human lives at stake. I think we have a right to try to think this through and decide for ourselves whether the bishop chose the correct action.
Some pretty cogent arguments have been made here supporting the woman and her care providers’ decision. Your response to this thoughtful discussion is to, first, question why those of us who disagree with you (or disagree with the bishop) bother to remain Catholic. Then, in your last post, you very insultingly imply that we’re really all pro-abortion anyway. I think these sort of attacks are very unfair and they deflect from the discussion.
“Who here would support the outlawing of all abortions in the U.S. except for abortion ‘necessary’ to save the mother’s life?”
Depends on the criminal statutes, their thoroughness and severity. I would want laws with teeth and serious incarceration for all responsible parties consistent with the American jury system.
Irene,
I am not upset and I am not saying that everything a bishop says is correct. What I am saying is that the Church teaches us what the moral norms are. Lambasting the Bishop serves no useful purpose. Put the question to Rome and let Rome speak to the issue. Ask Rome if removing the placenta to save a women’s life qualifies as double effect regarding the abortion. Put the question to the USCCB Committee on the Doctrine, they wrote the ERDs, but keep in mind they are not the ordinary of Phoenix.
What is unfair in this discussion is the attribution of reasons other than good will to the Bishop’s position and action. Because his conclusion is different than the conclusion of those here, they accuse him of all sorts of nefarious motives. THAT is unfair and unjust.
By the way, the USCCB has issued a statement on this. Have you read it? http://usccb.org/doctrine/direct-abortion-statement2010-06-23.pdf
Thank you, sasurfman.
Jim,
There is forgiveness, for everything: abortion, misjudgment–everything. What is needed first is some indication of regret and amendment. I think that’s what’s missing in this situation.
Kathy, doesn’t it depend on the nature of the regret? If the “regret” is, “I would have done it differently if I had it to do over again,” which is clearly what Olmsted envisions, then I agree that there is likely no regret. If there is regret in the sense of, “I am truly sorry that my actions resulted in the death of another human, however justifed, and I pray for God’s understanding and mercy,” then I am pretty sure the parties involved have met the standard, or that at the very least, it is a matter of private conscience between them and God or their confessor.
I would also point out that sasurfman gives nothing of his background to indicate why he or she is better placed to interpret the ERDs than catholic physician, who has told us more than he probably should about his professional status, which fairly obviously involves much effort to understand and apply the ERDs in real life situations on a day to day basis.
It’s worth repeating that, although it was a long time ago, it wasn’t always the case that Church officials assumed greater knowledge in the face of the superior education and talents of lay contemporaries.
The secular law defines murder too.There is a strong possibility that criminal charge could have been brought against the hospital – and even the bishop himself – if the woman had died. I had my research assistant look into this this past summer.
“It’s worth repeating that, although it was a long time ago, it wasn’t always the case that Church officials assumed greater knowledge in the face of the superior education and talents of lay contemporaries.”
Barbara, do you have a particular era in mind? I’m not sure what you are referring to here.
I am referring to before the fall of the Roman Empire, when people gained influence at least partly by being very well educated. The fall clearly shifted the center of learning in just about every discipline to the Church for a very long time. All present Church power structures and prerogatives are based on the implicit or explicit notion that somewhere there is someone with a clerical identity within the Church who has superior discernment on any matter that touches Church doctrines — whether it is marriage or medicine. For those of us who see this attitude as increasingly arrogant and out of touch, it’s worth understanding that it arose in a time and place when it really might have been the case. It isn’t the case any longer, and for my money, Olmsted’s unselfconscious certainty is Exhibit A.
Interesting. My understanding of that era is just the opposite. For me, the time before the Fall of the Roman Empire was the time of the great teaching bishops: the Cyrils, the Cappadocians, Ambrose and Augustine, Hilary, Irenaeus, Chrysostom and Chrysologus. They all spoke with authority, I think.
Wow -when I shut down yesterday, 190 posts -today 230+ and continuing to grow.
I think Gerelyn’s comment of 12/26 is spot on but the argument will continue.
It will continue between those who are committed to CCC and the Code of Canon Law as final words as their idea of being Catholic and those who beleive we have much to learn and figure out as we employ the Gospel pronciples and no tmaximal magisterialism.
All of this (as Gerelyn is right about) is critical to drift and godbye problems.
We are about to push new evengelization – i just saw my Bishop on TV telling people this is the time to come back.
And here we have folks saying essentially that we should follow Olmstead or get out.
This is a truly sad picture of the weird world of Catholicism today, being driven even into worse depths by the “smaller purer ” Church advocates.
Last night I saw the Blair Hitchens debare on CSPAN and I thought it touched on the faith and Modernity book review in the NYt yesterday.
Fundamentalism is driving many away from religion and the lack of humility in the certitudes of the fundamentalists is the sharp edge pushing them away.
“The secular law defines murder too.There is a strong possibility that criminal charge could have been brought against the hospital – and even the bishop himself – if the woman had died. I had my research assistant look into this this past summer.”
The possibility of being convicted in a secular court of law for negligent homicide in such cases should be of no practical concern to a committed Catholic doctor, cleric or ethicist; neither should the fear of civil lawsuits. It would be the equivalent faith testimony to a conscientious objector.
The possibility of being convicted in a secular court of law for negligent homicide in such cases should be of no practical concern to a committed Catholic doctor, cleric or ethicist; neither should the fear of civil lawsuits. It would be the equivalent faith testimony to a conscientious objector.
William,
Why would it be of no practical concern to a doctor to take a job with a hospital where he would be forced to open himself to malpractice suits or forced to commit negligent homicide? Don’t doctors have a right to a career? First, a “committed Catholic doctor, cleric or ethicist” may not be in agreement with Bishop Olmsted, and so would be bound by conscience not to defer to is interpretations. Second, a Catholic doctor who did agree with Olmsted would be far better off in a non-Catholic hospital where, if he did agree with Olmsted, he could exercise a right to conscience and let some other doctor handle the case.
Presumably there are doctors, nurses and administrators well trained in their craft and well-formed in their consciences who would risk their careers by serving on the ‘front lines’ of a Catholic hospital and, should it come to pass, would sacrifice themselves rather than kill the innocent or walk away knowing someone else would do it? If not, then Catholic hospitals cannot be in this obstetrics field.
William,
You seem to be implying that this is not an area where experts disagree, but an area where those who agree with Bishop Olmsted are correct and everyone else is wrong.
To the best of my knowledge, the following has never been withdrawn by the “Holy Office,” now the CDF:
To be straight, I realize full well that experts disagree. To a certain extent was ventriloquizing what an Olmsted line would, or should, be if it was as serious as a heart attack where their own talents and treasure on the line for the absolutist position they have espoused.
But I was dead earnest about this point: if the absolutist position that insist that two patients must die rather than perform the procedures questioned in this case, Catholics will have to choose between practicing medicine or their faith. I also think good sense will reign and that Olmsted and his defenders will become ever more marginalized, though in that process the Church’s moral authority will be further damaged.
With apologies, I should have said: “If the absolutist position that insists that two patients must die rather than perform the procedures questioned in this case is to become the ethical standard, Catholics will have to choose between practicing medicine and their faith.”
William, it is highly doubtful to me that a hospital could get much traction by running a maternal fetal medicine department that truly adhered to Catholic norms. This sort of extreme case is only part of the reason — the kind of prenatal screening and genetic counseling that are the mainstay of such services all present significant challenges under Catholic norms. On the other hand, if the department significantly departs from what other comparable departments do, then the whole enterprise might founder, in terms of things like referrals from community obstetricians, or the hiring of specialists, and so on. It’s not like a single person can simply go out there and start dictating what’s going to happen when a case like this arises — the person has to have some reason to consult you in the first instance. And in the case of St. Joe’s or Catholic hospitals generally, the more bishops push their authority for resolving the extreme situations, the less likely it is that Catholic hospitals will be able to staff and run sustainable maternal fetal medicine departments that are utilized by the entire community, and not simply for those like Kathy who want to know in advance that these difficult situations will be resolved in a specifically Catholic way.
It’s like these cases where pharmacists refuse to fill certain prescriptions — and then refuse to make a referral, or in some cases, confiscate the prescription so it can never be filled. They do this on an ad hoc basis because the situation has landed in their lap. If it were advertised that this is what would happen, women would avoid that pharmacy and the conflict would never arise.
if Kathy were in this situation, could she insist that nothing be done, at a secular hospital? Theoretically, yes. But practically, the stranger the decision seems to the docs, the more likely they are to press their lawyers to find a way to have a patient declared temporarily incompetent. Moreover, – if she’s unconscious and her family wants to save her, the hospital is probably going to save her, absent a very strong and clear patient directive. And family members may well think that it’s better to ask forgiveness than permission. So she might want to have a moral theologian who suits her named to make the call. What Kathy can’t insist on is that everyone else in the secular hospital be treated in accordance with her favorite moral theologian’s norms.
Cathy,
Not in a secular hospital, no. But in a Catholic hospital, I should receive treatment according to the mind of the Church. Much in the same way as I should receive teaching according to the mind of the Church in a Catholic school.
Just to be clear, I’m not only talking about whether moral norms might be violated at a Catholic hospital. I’m also talking about whether my daughter or son might be directly targeted and killed.
A bracelet.
http://www.zales.com/product/index.jsp?productId=2709122&camp=SEM_GOO_none_none
You can have three lines of 14 characters each engraved on it.
I’m Catholic.
In emergency,
call a bishop.
Kathy, if the “mind of the Church” deviates more and more in material respects from the “mind of secular medicine” it will be harder and harder for Catholic hospitals to even survive. This is a real dilemma for Catholic institutions, and the real risk of such public inflexibility on the part of bishops. How many Christian Science hospitals do you know of?
We’re not that weird, Barbara. There are a few bright lines we won’t (and shouldn’t) cross, and I’m glad the bishops are saying so. We can be state of the art, but careful about these few things–which are wrong anyway.
My guess is that bishops like ethicists are divided.
Suppose a different bishop decided the case differently, Kathy – and followed the Grizez analysis. If you were the ethicist making the call, would you disobey this bishop, and let the woman die, because you see it as a direct abortion? Is it obedience to the local ordinary that matters to you, or the right underlying analysis?
I think Barbara’s right- I think the ERDs won’t matter much practically in a decade- the systems will voluntarily disaffiliate and become secular, or hospitals in the Catholic tradition. And the Olmsteds of the world won’t be able to start a brand new hospital system as easily as a brand new college.
I would really love to see a Gallup poll of Olmsted’s diocese on this.
“But I was dead earnest about this point: if the absolutist position that insist that two patients must die rather than perform the procedures questioned in this case, Catholics will have to choose between practicing medicine or their faith. I also think good sense will reign and that Olmsted and his defenders will become ever more marginalized, though in that process the Church’s moral authority will be further damaged.”
A man has the liberty to offer the services to others that he deems moral. Those who seek services have the liberty to seek them from like minded people regarding moral ethics. When one enters a Catholic hospital, one should understand that the word Catholic means something. It means there are moral principles in place that guide the care the providers offer. There is no reason Catholics should be required to choose between practicing medicine and practicing faith unless they are persecuted for their faith by others, such as the government.
[A] Catholic doctor who did agree with Olmsted would be far better off in a non-Catholic hospital where, if he did agree with Olmsted, he could exercise a right to conscience and let some other doctor handle the case.
I should imagine that may be easier said than done. For example, in an emergency case, where the original attending physician had detailed knowledge of the patient’s medical history.
In any event, since reality has a way of confounding religious doctrine and confusing the laity, perhaps bishops need to provide 24×7 doctrinal coverage in all Catholic hospitals to handle emergency cases.
The Statement the USCCB issued concerning the situation at St. Joseph’s Hospital present two scenarios. The first scenario applies to facts as involved with St. Joseph’s Hospital.
“The first scenario describes a direct abortion. The surgery directly targets the life of the
unborn child. It is the surgical instrument in the hands of the doctor that causes the child’s death. The surgery does not directly address the health problem of the woman, for example, by repairing the organ that is malfunctioning. The surgery is likely to improve the functioning of the organ or organs, but only in an indirect way, i.e., by lessening the overall demands placed upon the organ or organs, since the burden posed by the pregnancy will be removed. The abortion is the means by which a reduced strain upon the organ or organs is achieved. As the Church has said many times, direct abortion is never permissible because a good end cannot justify an evil means.” (USCCB)
At St. Joseph’s Hospital the woman had diseased heart. The procedure performed was not on her heart, but was on the fetus. The abortion was the means by which strain was reduced on her heart.
The USCCB goes on to say: ‘There is nothing intrinsically wrong with surgery to remove a malfunctioning organ. It is morally justified when the continued presence of the organ causes problems for the rest of the body. Surgery to terminate the life of an innocent person, however, is intrinsically wrong. There are no situations in which it can be justified. Pope Pius XII summed up Catholic teaching when he stated: “As long as a man is not guilty, his life is untouchable, and therefore any act directly tending to destroy it is illicit, whether such destruction is intended as an end in itself or only as a means to an end, whether it is a question of life in the embryonic stage or in a stage of full
development or already in its final stages. . . . Pope John Paul II acknowledged that women considering abortion often face very difficult situations.
It is true that the decision to have an abortion is often tragic and painful for the
mother, insofar as the decision to rid herself of the fruit of conception is not made for
purely selfish reasons or out of convenience, but out of a desire to protect certain
important values such as her own health or a decent standard of living for the other
members of the family. Sometimes it is feared that the child to be born would live in
such conditions that it would be better if the birth did not take place. Nevertheless,
these reasons and others like them, however serious and tragic, can never justify the
deliberate killing of an innocent human being.
Nothing, therefore, can justify a direct abortion. “No circumstance, no purpose, no law
whatsoever can ever make licit an act which is intrinsically illicit, since it is contrary to the Law of God which is written in every human heart, knowable by reason itself, and proclaimed by the Church.”‘
It would seem that Bishop Olmsted’s position is supported by the USCCB, by Pope Pius XII, and Pope John Paul II.
Antonio,
Kathy says, above, “There are a few bright lines we won’t (and shouldn’t) cross, and I’m glad the bishops are saying so.” The problem as I see it is that there isn’t a bright line here. As I keep repeating, ethicists disagree on whether this was a direct abortion. Cathy Kaveny guesses (and it’s my guess, too) that bishops are divided. Perhaps for the sake of clarity, the guideline should be changed to the following: “No medical care provided for a pregnant woman is permissible if it will result in the death of her unborn child.” This of course rules out the classic “double effect” cases as well, but it’s crystal clear. I personally don’t even find convincing the reasoning that allows salpingectomy in the case of ectopic pregnancy anyway.
David,
There is a bright line. The procedure must be performed directly on the diseased organ, not indirectly on the fetus.
Now that that’s all settled…
Yes. The hospital doesn’t think it was a direct abortion. That’s the point. And, judging that it is an indirect abortion, the hospital, in my view, had no choice but to proceed as it did– even if it is stripped of official designation as Catholic.
Because the placenta is an organ of the mother, or for some other reason?
Pius XII wrote: “As long as a man is not guilty, his life is untouchable, and therefore any act directly tending to destroy it is illicit, whether such destruction is intended as an end in itself or only as a means to an end, whether it is a question of life in the embryonic stage or in a stage of full development or already in its final stages.
I would have thought that ?man? in the first sentence was generic, and included women. But it seems that a mother’s life is not untouchable, but subject to death by negligence in order to avoid
oops. Accidentally submitted the above. But I guess it is clear enough as is.
That is not the Grisez analysis, as I am sure you know since you said you disagreed with it.
“Yes. The hospital doesn’t think it was a direct abortion. That’s the point. And, judging that it is an indirect abortion, the hospital, in my view, had no choice but to proceed as it did– even if it is stripped of official designation as Catholic.”
This then, is the reason the Bishop stripped the hospital of its Catholic status. It doesn’t hold to the Catholic moral teaching. The hospital has every right to reject Catholic teaching. It has every right (in fact its duty) to follow its conscience regarding the issue. It just doesn’t have the right to falsely identifiy itself as Catholic.
No, it’s the Lysaught analysis, though. Unless I misunderstand.
What harm, exactly, was done to the 11 week old fetus in having its life snuffed out by the surgeon’s scalpel instead of death by suffocation a very short while later? I know, I will be considered an amoral monster by even asking this impertinent question because there is a principle of the sanctity of life that’s being violated. But would it not also be impermissible by the logic being used to challenge the hospital’s actions to sacrifice one’s own life in order that someone else might live in a case where our own death was a foregone conclusion but by dying earlier we allowed another to live?
“You should have your intentions written down, signed, dated, and witnessed, hopefully by someone likely to survive you as well as your immediate next of kin. Then they should be prepared to see that you are admitted to a facility willing to honor them.”
— and they should be prepared to sue the snot out of any organization that does not honor your duly stated, executed and witnessed end-of-life wishes, no matter what affiliation that organization espouses.
Would jump in and support some of Prof. Kaveny’s comments. Appreciate the “catholic physician” point of view – it obviously captures real life experience in a catholic hospital or with catholic patients.
Not sure that the question about whether the placenta is the mother’s or the child’s is the key issue.
Don’t have the link right now but last month Charles Curran gave a talk at Southern Methodist University on the political process and abortion within the church’s viewpoint. His starting point was to accept completely the church’s stance on abortion. But, he then outlined 10 points about how that stance must be acted on in real life; in US politics, and suggestions in terms of the current US hierarchy and their positions.
His main point was that reason (scientific facts e.g. hospital, medical knowledge) can not demonstrate when “personhood” begins. It can inform on when the various aspects of human life are present but is not able at this time to say when that life has personhood. Given that, Curran developed a number of points that basically stated that faith/reason together has no 100% certitude about personhood and thus, given this lack of certitude, it weakens the church’s stance to state that some decisions/actions/etc. are intrinsically evil. Rather, until medical science can speak with certainty; then we will continue live in a gray area and need to use caution when speaking about moral decisions.
Was thinking about this in terms of this very long blog – if anything, the hospital carefully worked within the ERBs; the CHA guidelines; etc. and made a decision in a situation that has no certainty. Olmsted reacted to this situation – he has reached a different conclusion using his certainty – but neither reason, medical science, nor faith has the certainty that he has.
Curran was trying to say that, when no one has certitude, the church needs to be careful about imposing absolutes – using terms such as intrinsic evil; declaring that someone’s moral anguish leaves them excommunicated; etc.
Wise words.
There is a bright line. The procedure must be performed directly on the diseased organ, not indirectly on the fetus.
sasurfman,
Suppose (as can happen) a baby dies, but the placenta continues to cause problems in the way the placenta caused problems in the Phoenix case. May surgeons remove it? Of course. Because it is threatening the life of the mother. What is their intention? It is not to kill the baby, since the baby is dead. So why, when the baby is alive, is the intention of removing the placenta to kill the baby? Answer: It isn’t.
If the doctors would do the exact same thing with the placenta whether the infant is alive or dead, how can you say their intent is to kill it?
You keep insisting that anything done to the mother to save her life must involve a “diseased organ,” but the USCCB document you are using is presenting two scenarios, and in one scenario, the surgery is on a diseased organ. Just because one scenario involves a diseased organ doesn’t mean every case where a mother’s life is save the doctors must only operate on a diseased organ.
Here is what I consider to be the important statement about the scenario: “The surgery does not directly target the life of the unborn child. The child will not be able to live long after the uterus [or placenta] is removed from the woman’s body, but the death of the child is an unintended and unavoidable side effect and not the aim of the surgery.”
David,
These are the words of the USCCB:
“The surgery does not directly address the health problem of the woman, for example, by
repairing the organ that is malfunctioning. The surgery is likely to improve the functioning of the organ or organs, but only in an indirect way, i.e., by lessening the overall demands placed upon the organ or organs, since the burden posed by the pregnancy will be removed”
The placenta is not the organ that is malfunctioning, the heart is malfunctioning. Removing the placenta (directly causing the abortion) improves the heart fuction indirectly by lessening the overall demands on it. The second scenario is not the scenario present here.
sasurfman,
You didn’t answer the question I asked. The question is this: If the doctors of St. Joseph’s Hospital would have performed the same surgery they did no matter whether the baby was dead or alive, how can you say their intention was to kill the baby? You yourself suggested they might have waited for the fetus to die and then performed the D&C. So how can the intention of the D&C have been to kill the baby? The question is, was it their intention to kill the baby. The answer seems to me clearly to be no. Directly killing the baby, as with an injection into its heart, would not have saved the mother. So why would they intend the baby’s death if it would not have saved the mother’s life?
Could someone please explain to me why an analogy to self-defense in this context is incorrect? Why doesn’t a woman have a right to defend her own life against the certain death this other person, through pregnancy, is causing her? Clearly, the fetus is not morally culpable for the mortal threat its existence is posing to its mother, but is he or she not in fact killing her? Has she no recourse but to allow it? (Not a snarky question.)
The most dubious of bright lines it now seems to me is that between the ectopic pregnancy and the systemic nature of heart-lung maladies. The “diseased organ” exception strikes me as a fine bit of Jesuitical thinking in that provides for an enabling fiction built on a direct-indirect binary. Let me say thank God for the lives this exception has saved, but it still seems to be to be akin to a mental reservation. Why am I wrong?
William, it is not incorrect, not IMHO. Moreover, if the Catholic teaching is to insist that the fetus must be treated as being biologically separate and distinct for purposes of moral reasoning, one might conclude that the church is imposing a higher ethical duty on pregnant women than it imposes on other people — for instance, potential organ donors. There is no cogent reason given for this distinction.
“You misuse that verse. Subjective judgement is God’s alone, but objective judgement of the act must be made otherwise we would never be able to determine right from wrong.”
sasurfman –
Quite true. But the issue of this thread is whether or not the removal of the fetus *was* murder. Most think that it is your judgment that is objectively wrong, that in fact your judgment does not conform to Church teaching. Most important, if your judgment had been implemented, an innocent woman would die unnecessarily, leaving four children orphaned.
Time for you to be self-critical, sasurfman, and stop telling the rest of us we ought to be honest as if you can be certain that we’re not). You can’t.
http://ncronline.org/news/politics/curran-how-bishops-challenge-abortion-laws-flawed
Ann – this link goes to Curran’s November points and explicitly outlines his distinction between abortion as an evil and calling abortion “murder”.
Highlghts: “Curran said that uncertainty about when life begins, which has been consistently acknowledged in church teaching from ancient to modern times, as well as the bishops’ acceptance of legislative compromise on other issues and “the weakness of the intrinsic evil argument” undermines the bishops’ position that abortion should take precedence over every other issue in the public realm.
“In my judgment, the U.S. bishops claim too great a certitude for their position on abortion law and fail to recognize that their own position logically entails prudential judgment so that they cannot logically distinguish it from most of the other issues such as the death penalty, health care, nuclear deterrence, housing,” Curran said.
“Pope John Paul II’s 1995 encyclical Evangelium Vitae “also recognized the speculative doubt. However, from the standpoint of moral obligation, the mere probability that a human person is involved would suffice to justify an absolutely clear prohibition of an attack aimed at killing the embryo,” said Curran.
So the contention by bishops today that “from the moment of conception, each member of the human species must be given the full respect due to a human person,” said Curran, “is accurate but not totally forthcoming.
“The most accurate way to state the Catholic moral teaching is that direct abortion even of a fertilized ovum is always wrong, but you cannot say it is murder. There is doubt about the reality of the early embryo,” said Curran.
Consequently, the teaching on the morality of abortion “is not as certain” as the church’s teaching on such other issues as murder, torture or adultery, he said. “In making the moral case against abortion, there is need for a further argument based on the principle that in doubt one must give the benefit of the doubt to the existence of a truly human being,” said Curran.
Intrinsic Evil Argument (gets at Prof. Kaveny’s point about catholic hospitals and legal requirements/accreditation/licensure/etc. vs. the bishop’s moral terms): “Finally, argued Curran, the use of the term intrinsic moral evil as a rationale for giving abortion preeminence among all other political issues is a faulty argument.
“The primary problem is that intrinsic evil is a moral term and not a legal term. The fact that something is an intrinsic moral evil has nothing to do with law or legality. Aquinas himself following Augustine, was willing to accept no law against prostitution, which according to Catholic teaching is a morally intrinsic evil.”
Today, he said, many U.S. states do not have criminal laws against adultery, even though “Catholic teaching insists that adultery is an intrinsic moral evil.”
No Catholic bishops, he said, have campaigned for anti-adultery laws. Because something is intrinsically evil according to Catholic teaching “does not mean there should always be a law against it,” he said.
The weakness of the argument based on intrinsic evil, said Curran, “once again undermines the position of the bishops wanting to see the public policy position on abortion as differing from public policies on most other issues.”
William -
The most useful words today are “the systemic nature of heart-lung maladies”. Add on the systemic nature of cardiogenic shock and pregnancy. cathyf 12/24 10:28P gave some simple examples illustrating consequences of recognizing this aspect of the nature of the human body. Attempts to mentally encapsulate selected pieces in isolation for the sake of argument are word games. The fetal and placental cells are genetically distinguished from the mother’s cells as pointed out by Lisa Fullam 12/25 10:47P. Nevertheless, every single molecule and cell in the fetus and placenta after the original fertilized ovum consists of material from the mother’s body. Rationalizing processes and treatment as if they depended on “a diseased organ”, with “diseased” in quotation marks when the fallacy gets too obvious, cannot address situations like the pregnant mother in Phoenix. Focussing on the system as the medical people must do should allow some clarity on the moral problems.
Perhaps I’ve missed something in the recent official pronouncements on this matter, but nowhere do I find an explicit textual admission that both mother and child will die if the letter of official doctrine is observed and that, furthermore, the possibility of such consequences must be accepted by faithful Catholics.
I believe these unpleasant realities were not mentioned in any recent official ecclesial text not because they’re obvious but because such explicit mention would cast the bishops and the rest of the hierarchy in a less than humane and heroic light.
Bill deH –
I agree with Curran that Church teaching from antiquity has not decided when the person is definitely present. This is why I think it it urgent that that combination of metaphysical and biological evidence be reviewed yet again. As far as I can see there is definitely no person at least within the first few days. Recognition of this fact would eliminate the stem cells issue, I think. But there might be evidence that there is no person until the third month.
That is an extremely important point because as Curran says unless we are certain there is no person present, ordinary abortions are not permissible in the first three months. That would cover the St. Jos. case. and many, many others.
Having read all 280 odd posts, it seems to me there are twi main issues::
First, can one physical act (scraping a womb with a fetus attached) have more than one effect? Note, I’m not asking whether it can have more than one *moral* effect. (That would be begging the question.)
I think it can. The one physical action effects both the death of the child and the removal of the child. If the former is not intended, then it seems to me that the principle of two-fold effect applies.
Second, there has been a lot of talk about “directly” killing the child. As I understand the prohibition of directly doing evil, it is a consequence of the principle that evil may not be done to accomplish a good. However, that principle is not the same as the principle of double effect (which admits that one action can have two different effects, one of which is good and one of which is evil.
Perhaps the question becomes: is it morally possible to directly intend a good end when the action carrying out that good intention also directly causes an evil physical effect (the death of the child)? It seems to me that if the principle of two-fold effect takes precidence, than the answer is Yes, it may be done. While if the principle “do no evil directly” takes precedence then the answer is not so clear.
Maybe the problem is that the two sides are really divided about which of the two general principles ought to apply — both or only one of them.
The surgical team enabled the mother’s self-defense against the unborn child — just as a combat team enabled the homefront’s self-defense on the battlefield — just as a police officer enabled visitor/patient/staff defense against a mentally deranged aggressor in a hospital.
Self-defense.
Enabled by others trained to render such help.
Ann,
To follow double effect, the directly intended act must be good or at least neutral. It can’t be bad. An unintended, though foreseen effect, may be evil, and the evil cannot outweigh the good.
There are four standards for double effect. Sometimes two of these are amalgamated, but they all have to be in play, whatever the expression:
1. the action in itself from its very object must be good or at least indifferent;
2.only the good effect can be directly intended;
3.the good effect must be at least as immediately caused by the action as the bad effect
4. there must be a grave reason to permit the cause of the bad effect
Condition #3 may be why the placenta was brought into the argument, I suppose. #2 (and #1 by extension) can be met by the Grisez standard, according to his inadequate (as I see it) framing of “intention.”
No one is questioning #4. It’s a grave reason, it’s grave enough that anyone would want to help.
In the more usual questions of end-of-life care, the key question is “extraordinary means”, and in the question of whether a device, procedure, etc. is “extraordinary” it is quite proper to consider whether the procedure is futile. So a person who has a stroke which has caused a certain amount of damage can be put on a ventilator with the complete expectation that he will soon be off of it as the brain heals itself. Another person can have such massive brain damage in a stroke that the ventilator would serve only to keep him in a state of a “breathing corpse” whose organs will shut down over days/weeks/months until even the machine cannot simulate life signs anymore.
In that latter case, it is the Catholic Church that has pioneered the theories of “extraordinary” and said that the proper and humane decision is to disconnect the person from the machine and allow the inevitable death to proceed. So somehow we now have the principle that leaving someone plugged into a ventilator to delay an inevitable death by a few weeks is extraordinary and NOT required, but KILLING a person (the mother) in order to delay an inevitable death (her child’s) by a few hours is not extraordinary and IS required?
The Confiteor makes no distinction between what we do and what we fail to do, so the principle that we cannot commit evil to accomplish a good, no matter how great, applies just as much to committing evils of omission as commission. We can state this by saying that we are not allowed to commit the evil of failing to save the life of the mother, even for a great good, and I would submit that delaying the inevitable death of the baby by a few hours doesn’t even qualify as a GREAT good.
Normally, Catholic medical ethics are informed by a certain fearlessness in the face of the harsh realities of just what we can and cannot do. We operate both hospices and pro-life offices, because we know that human dignity needs to be protected from those who would take life, but also needs to be protected from those who would use extraordinary means to deny the reality of death.
Patrick Molloy 12/23/2010 – 11:53 posted the following: (it is unclear whether this is his rhetorical or the words of Anthony Kenny )
“In an emergency, then is it also the case that a doctor can be justified in hastening the death of someone who is virtually certain to die soon (say 12 hours from now) in order to harvest organs which can be used immediately to save the lives of five others in the next hospital room?”
If you strip away the overly dramatic language, that’s not a particularly inaccurate description of the current practice of organ transplants. A healthy person has some massive fatal brain injury. Machines are used to keep the vital organs functioning, the person in a state that most previous generations would have defined as “alive” (heart beating, lungs inflating and deflating) but we define as “brain dead”. Then the dead-alive-depending-on-your-definition person’s body is wheeled into an operating room, where his living heart, kidneys, liver, etc. are carved out and taken and transplanted into other people. If you define the person as already dead (brain dead) then carving his corpse up and causing still-living tissues to die is perhaps distasteful — but lots of moral and virtuous medicine is yucky in practice. If you define the person as still alive, then that looks a whole lot like murder. As Catholics, we have concluded that “brain dead” is DEAD, and organ transplantation is good. But not because it’s OBVIOUSLY true with no thought required, but because we have carefully split hairs and reasoned our way to that conclusion.
“3.the good effect must be at least as immediately caused by the action as the bad effect”
Thanks, Kathy. Yes, I think this is where the the two sides differ most basically. It seems to me that because both the good effect (the removal of the child) and the bad effect (the death of the child) are caused by one and the same action (scraping of the womb), the good effect is as immediately caused as the bad one. One action is as good as two simultaneous ones in meeting this criterion.
I really don’t see the relevance of the placenta to the case, except that its removal is part of the intended object of the physical action. As I understand the case, both the placenta and child are intended to be removed.
I’d also like to add that I think that the argument concerning an unjust aggressor has a lot of merit relative to this case. But that whole principle needs to be re=examined, I think.
Midst the multitude of minute, dizzying considerations of one sort or another on this issue, I pull back to another perspective. What characterizes or leads to the absolutist approach, versus different realities? I’m talking about the opposing stances or lenses that shape the arguments. And it may well be, I fall into my own confusions, but something resonates, and I pass it on.
This goes back to depth psychology and how to integrate various modes of being into our lives. I am indebted as always to Ann Ulanov, professor psychiatry and religion at Union Theological, for posing these issues around the feminine and the masculine, as elements in our approaches to theology.
“The feminine mode of being, just like the masculine, belongs to all of us. It is a style of thinking and doing, experiencing and acting, that is characterized by going down into what happens, into the matter of things and what matters. It is to live with the opposites, their division and their mingling.
Its style of perception issues upwards from body instinct and impulse, unconscious affect and spontaneous image: it issues in hunch, in dream image, in the amazing linking of heretofore separate things. We need this style of perceiving and connecting in this our new century, with its many divisions in communities across the world…this brooding pondering of the heart that issues in living (the Trinity) in the flesh…It means…that the Holy comes into us through the feminine mode of being in each of us, moving us to live this love into the world.
In previous centuries the masculine mode of being gave access to these mysteries (images for God in the Trinity). We abstracted upwards from the tumult of instinctive life and found refuge in the Trinity as the unchanging eternal, or the ever rational, the pure, removed from the mess of human instincts and conflicts.
But in the last decades of theology, where the direction has been to bring God down into human realities of race, politics, and gender, what opens us to receive this divine offering is the feminine mode of being. Nothing is in the abstract; all is in the flesh, symbolized by Jesus being born from Mary’s womb.”
I wonder if the feminine approach is more manifest in the saving of the mother’s life in Phoenix, while the masculine dominates in the loss of two lives?
Again, both modes of being operate in all of us, men and women, but I find something cold, abstract, and deeply frightening in holding that two deaths somehow represent God’s will — making Him almost a celestial sadist in posing such dilemmas.
Isn’t integration of feminine and masculine called for, more than just literalism and certainties based on pluperfect, mind-numbing abstractions?
Thank you immeasurably to Catholic physician for his/her contributions. Also, I take to heart the need to make certain that my end-of-life directives will be honored, and set punishing legal consequences for violations.
I think Prof. Kaveny is prescient in seeing that hospitals will disaffiliate in droves if Omsted is the new rule in Catholic hospital management.
Third from last paragraph above, I should add “mind-numbing distinctions.”
Sorry for the late response, William Fitzgerald, to this question (rhetorical?) of yours:
“Is anyone here prepared to say that in MORAL terms two deaths in this case were preferable to one (if it came to that), so long as no human hand was a direct cause for the death of the fetus? and that if the situation were to present itself again that outcome would be the correct choice?”
I don’t know about “anyone here.” But every ‘rad-trad’ Catholic is “prepared to say that,” as is — obviously — Bishop Olmstead. He answered explicitly in his press conference (and since you yourself brought up the distinction) that medical ethics is not Catholic ethics. In which case, no one who considers himself or herself bound by medical ethics first or ultimately, should allow his or her own assignment to a Catholic hospital. The entire premise of ultra-modern-fundamentalist Catholic policies regarding these and similar pregnancy situations is that passive suicide is what is indicated when such scenarios present. It seems to me that there is a fine line between this and Christian Scientism, which similarly allows “God’s will” to intervene or not intervene, and accept the consequences.
And has several people here, and in the ncronline comments have noted, that whole above masochistic/sadistic line of reasoning is anti-classical Catholic moral theology.
Ann,
Regarding #3, “the removal of the child” would not be considered a good effect, and could not be included in a double effect argument.
As I understand it, a positive resolution of the mother’s pulmonary crisis was the intended good effect; however, this was relatively remote. It was not as directly affected by the action as the life of the child was. It was affected, but the directness is not really comparable.
Kathy,
Do you personally find a salpingectomy justifiable in the case of ectopic pregnancy, even very early in pregnancy when there is no immediate threat to the life of the mother?
David,
Yes. I think salpingectomy is justifiable.
cathyf @ 12/27/2010 11:50 pm
The words were mine, not a quote from Kenny. However, the example was Kenny’s (and ultimately Philippa Foot’s). His concern was that the justification “It was going to happen anyway” was too sweeping since it would justify what was totally wrong (in Kenny’s words), i.e., “for a doctor to kill one person to provide spare parts for grafting onto five others who needed them,” even if the one person was about to die anyway. Thus the example was meant to show that the “it was going to happen anyway” justification would recklessly permit rights violations in situations where the patient was alive by any definition but likely to soon die. The justification Kenny opposes is much broader and would not be limited to an ordinary organ transplant situation in a Catholic hospital.
Other notable Kenny quotes from the same article:
“so many philosophers are attracted by one or other form of consequentialism that if told that their theories are incompatible with the principle of double effect their reaction will be not to give up their theories, but to say ‘so much the worse for the principle of double effect.’” But, he continues, “A common morality… consists of values and rules. Rules may be absolute, but values are not in the same sense absolute. No value is absolute in the sense that its pursuit justifies the violation of every rule. Some rules are absolute in the sense that their violation is never justified, no matter what the value pursued by their violation. This is simply to say that there are no ends which justify every means, and there are some means which no end will justify.”
Not every rule is absolute, of course, but some definitely are, which is obviously what much of the controversy is about. Kenny also adds this, however, “those who wish to justify abortion do so most effectively when they deny that the unborn are members of the same moral community as adult mothers and surgeons…it is the question of membership of the moral community, rather than the principle of double effect, which is the crucial issue when we seek to make a judgment about the morality of abortion.”
FWIW, Kenny has explicitly rejected the Catholic faith, though he is sympathetic to important elements of Thomism (and Aristotelianism).
One other observation, this time mine — The double effect principles are often stated so as to include this condition: “No evil is intended.” I think a fuller and more accurate statement would be “No evil is intended, either as a means or as an end.” The second version would make obvious what is wrong with the examples cited by Philippa Foot: “A merchant who sold food he knew to be poisonous in order to make money would be morally no better than an unemployed gravedigger who deliberately killed to get trade.” The first version would be invoked by someone who claims that his only relevant intention is to make money, something that is not intrinsically evil. Likewise, the ultimate intention in the Phoenix case, to save the life of the mother, is granted by all to be worthwhile. The crucial argument is about the morality of the means, the importance of which is stressed by the second version.
As to the double effect argument here: The act is “removing placenta (and fetus) from the mother.” Good effect: relief of the mother’s respiratory distress, saving her life. The bad effect: the inevitable death of the fetus. Two effects at equal causal distance from the act.
Again, as with most DE arguments, a lot hangs on naming the act. Wasn’t it moralist Peter Knauer, many years ago, who pointed out this characteristic of DE, arguing that, in real life, it generally comes down to the question of proportionality?
As to the materially-unjust aggressor argument, to my knowledge, it’s been dismissed with a rhetorical question. Sorry no citation, but the line goes something like “How can an embryo be considered an aggressor?” As far as I know, that’s the sum of the magisterial case against self-defense on the part of women endangered by pregnancy.
Two things (i.a.,) I like about the self-defense approach: 1. it avoids the endless wrangling about intentions and placentas that we see here, when the issue is defining abortion. 2. IMO, it reflects better a truly pro-life stance in keeping with the Church’s tradition.
Consider: if abortion is defined in part by an intention to harm the fetus, then very few women who terminate pregnancies commit abortion. Instead, the vast majority see themselves as, for whatever reason, not able to be pregnant. Those reasons range from financial to professional to relational, to health and life-related. Invoking self-defense, OTOH, says that if one is threatened, one may defend oneself with the minimum harm necessary to remove the threat. If continuing the pregnancy is medically possible, that would be expected. This approach accepts the personal value of the embryo/fetus, and values the mother’s life equally to that of the embryo.
In real life, the question of whether double effect applies usually comes down to degrees of directness.
Are they really equal causal distance from the act? If the placenta is considered as an integral organ of the fetus, then removing the placenta is equivalent to removing the fetus. The placenta’s genesis is the embryo. The villi penetrate the decidua to form the organ. While the organ has both maternal and fetal tissue, it should rightly be considered a fetal organ. It is vital to the functioning and life of the fetus, not of the mother.
This has been compared to defending oneself from an attack of a crazed man. There is a difference, however. A crazed man attacking oneself has the intent of doing harm to oneself. He may not be culpable, but he does will harm toward his victim. The fetus, on the other hand, wills no harm to the mother. The fetus merely exists in its natural state and its natural environment, carrying on the natural process of living. This process may stress the mother, but it is not an aggression against the mother. The justification of self-defense cannot rightfully be applied toward the fetus.
In other words: I don’t want to destroy my baby, but I will so I don’t have to be pregnant. Is that any different from saying: I don’t want to kill you, but I will so I can take your money? No, this line of reasoning is flawed. It confuses the motivation of the act with the intention of the act.
As an aside, let us not forget that if a women does not want to be pregnant, she only has to wait nine months.
Could we say that the rescue of the mother from an all but certain death from the excision of the placenta points to a high degree of directness in an empirical relation of cause to effect? Whereas killing the fetus in utero but leaving the placenta in place would have likely not prevented the death of the mother?
Let me say that there is a lot of room for mischief on both sides of a direct vs indirect binary (that is really an ideologically-laden spectrum).
Put me down on the pro self-defense side of the ledger. It seems the most instinctively correct frame for the moral perplexities here, though I don’t expect any ‘diehards’ will be persuaded.
“As an aside, let us not forget that if a women does not want to be pregnant, she only has to wait nine months.”
So sasurfman writes above–the single most insensitive and repugnant thing I have read in all these posts to date, given the case at hand. By their fruits shall ye know them.
“A crazed man attacking oneself has the intent of doing harm to oneself. He may not be culpable, but he does will harm toward his victim.”
Oh no, not true… quite often they have the mental abilities of …what’s that word? There it is…an infant! They have no mental capacity to “will.”
“As an aside, let us not forget that if a women does not want to be pregnant, she only has to wait nine months.”
Unless you’re this woman. Then you only had to wait a matter of days. After that you can rest peacefully knowing you widowed your husdband and left your young children motherless.
I would appreciate it if you would not take things out of context. This statement applied to the quote above it which did not concern the medical case at hand.
On a different thread a month or so ago, it was suggested that we avoid using the term ‘innocent’ in such scenarios. I agree. After all, what constitutes “innocent” and who determines the governing definition?
Likewise, I think we should avoid using the word ‘unjust’ as in “unjust aggressor”. An aggressor is an aggressor, regardless, when one finds oneself on the receiving end of a bayonette! Or the aggressive behaviors of a deranged person! Or, yes, the aggressive presence of an unborn child.
I regard the life-saving efforts of the surgical team in this case as I would the life-saving efforts of any other team or individual trained to respond on our behalf — whether battlefield, mental ward, or operating room.
Baby is innocent. So what? Deranged person is innocent. So what? Enemy is innocent. So what?
I can just imagine a future situation where a “JPII bishop” renders the very same orthotoxic pronouncement as that given us by the good bishop of Phoenix: “Oh, my God, this idiot is doing another ‘Olmsted’!!!”
sasurfman,
With apologies for any misconstrual of your words and your intent on my part, I say that the sentence still rankles in its lack of empathy in this context.
Sorry no citation, but the line goes something like “How can an embryo be considered an aggressor?”
John Paul II does it in Evangelium Vitae 58:
“The one eliminated is a human being at the very beginning of life. No one more absolutely innocent could be imagined. In no way could this human being ever be considered an aggressor, much less an unjust aggressor! He or she is weak, defenceless, even to the point of lacking that minimal form of defence consisting in the poignant power of a newborn baby’s cries and tears.”
Phoenix’s Medical Ethics Director echoed this in a statement cited earlier:
“Third, the unborn child can never be thought of as a pathology or an illness. That is, the child is not that which threatens the life of the mother, rather it is the pathology or illness (cancer, premature rupture of membranes, hypertension, preeclampsia, etc.) which threatens the mother’s life. While it is often possible that the pregnancy will aggravate an existing condition, we should never accuse the child of being a threat to the mother.”
Fr. John Ehrich, STL. Medical Ethics Director, Diocese of Phoenix. 5/17/2010
The encyclical poses some interesting problems, since earlier it says “”legitimate defence can be not only a right but a grave duty for someone responsible for another’s life, the common good of the family or of the State”.(Catechism of the Catholic Church, No. 2265) Unfortunately it happens that the need to render the aggressor incapable of causing harm sometimes involves taking his life. In this case, the fatal outcome is attributable to the aggressor whose action brought it about, even though he may not be morally responsible because of a lack of the use of reason.” EV 55
Unfortunately, I see no effort in the encyclical to reconcile these two principles, or even recognize that they might conflict. What is God’s role in placing the child in the care of a mother who is unable to physically nurture it? A most interesting form of theodicy, I think.
sasurfman wrote “While the organ has both maternal and fetal tissue, it should rightly be considered a fetal organ.”
Would it be acceptable to you if the blood supply of the mother to the placenta were cut off by something analogous to a tourniquet? This presumably would directly address the disease state of the mother, presumably having the effect of relieving her respiratory distress.
I have a hard time seeing the moral difference between that and a D&C, though the medical difference is enormous. But I do not know how you see it. Perhaps you think the mother has an obligation to continue nourishing her child even to the point of her own death?
How does any of this discussion affect Triage? Life and death decisions are made that condemn some to die because resources could be better used elsewhere. When can one make a decision that patient A cannot be helped, and attention should be placed on patient B? Do those principles apply when patient A is a fetus, and patient B is the mother?
Is this the longest thread ever on dotC?
I am grateful for the education, with 305 comments so far.
If the placenta is considered as an integral organ of the fetus, then removing the placenta is equivalent to removing the fetus. The placenta’s genesis is the embryo. The villi penetrate the decidua to form the organ. While the organ has both maternal and fetal tissue, it should rightly be considered a fetal organ. It is vital to the functioning and life of the fetus, not of the mother.
sasurfman,
It seems to me your analysis of exactly what the placenta is may be influenced by your position on whether or not this was an abortion, and not vice versa. I would say the placenta is not an organ of the fetus. It can go on living (without scientific intervention) if the unborn infant dies. In fact, there does not even have to be an unborn infant involved at all:
Also, the placenta is discarded at birth. Off the top of my head, I can’t think of any human organs that are used for a certain time and then thrown away altogether. There are baby teeth, but they are replaced.
John Paul II does it in Evangelium Vitae 58:
“The one eliminated is a human being at the very beginning of life. No one more absolutely innocent could be imagined. In no way could this human being ever be considered an aggressor, much less an unjust aggressor! He or she is weak, defenceless, even to the point of lacking that minimal form of defence consisting in the poignant power of a newborn baby’s cries and tears.”
This strikes me as one of those kinds of statements that makes the life of the unborn more worthy of reverence than the life of the “post-born.” The unborn infant (besides being tainted by original sin) is “innocent” not because it is good or virtuous, but because it has not had a chance to make any moral choices. It strikes me that if this is truly innocence, it is innocence of the most trivial kind. The mother pregnant with this “innocent” child could be one of the greatest saints to walk the earth, and her life would be worth less than the baby’s because “no one more absolutely innocent could be imagined.”
One problem is that the bishop is legally insulated from the consequences of such a decision — in particular when obedience to the bishop’s dictates on the part of the caregiver results in the mother’s death.
Thus this issue might get resolved differently if the hierarchy is seen to have exposure to punitive legal consequences.
There is an aesthetics to the pro-life movement (as opposed to well-formed moral disposition regarding the sacredness of life) that is far from sanguinary, in my opinion. You are seeing it in the rhetorical excesses of Pope John Paul !!.
Does anyone have any details about the last occasion(s) on which a Catholic hospital did the ‘right thing’ in the Olmsted reading of the situation, that is, a case in which a pregnant woman did die along with her non-viable fetus because no licit remedy of her condition could be found?
I’m not speaking of cases where Catholic hospitals ‘outsourced’ the killing of the fetus to a non-Catholic hospital–a medical version of extraordinary rendition in some ways. But then again, this would be useful to know. How often does a Catholic hospital send its acute moral dilemmas elsewhere so that we do not learn of these painful cases? Does anyone have any credible data?
“As I understand it, a positive resolution of the mother’s pulmonary crisis was the intended good effect; however, ; ; ; ”
But, Kathy, the removal of the child *S the resolution of the mother’s crisis. No child, no crisis.
Oops — should bee “the removal of the child IS the resolution of the mother’s crisis”
“Thus this issue might get resolved differently if the hierarchy is seen to have exposure to punitive legal consequences.”
Antonio –
The issue might also get resolved differently if all bishops were required to be married men.
Ann,
The lungs are considerably farther from the placenta than the scraping tool was from the baby. The pulmonary crisis was due to multiple factors, only one of which was the pregnancy, whereas the death of the baby was caused by this one action.
Thus the bad effect was (much, much) more direct than the good.
Kathy –
There was a causal sequence, and the presence of the child initiated it. The other events were subsequent to the initial cause, the poor child.
The fact that the placenta can go on living only comes about because it has a supply of nutrients and oxygen available from the close interface with the maternal tissue. These really does not support the argument that the placenta should not be viewed as a fetal organ.
The placenta is so integrated with the fetus that the fetal heart has two shunts (1. Connection between the right and left atria via the foramen ovale 2. Connection between the truncus pulmonalis and the aorta via the ductus arteriosus) and a parallel blood flow path. These shunts close after birth allowing full blood flow to the lungs of newborn. The placenta substitutes for those fetal organs that cannot yet function because they are not developed and they are not in the environment for which they are designed. The placenta is designed for one environment, the lungs for another. Both are fetal organs.
Ann,
The mother had a preexisting condition, actually, but that’s hardly relevant to the moral issue. The causal sequence you mention does not have any bearing on the applicability of double effect.
Or have you changed your argument from the double effect argument? I’m having a little trouble following your steps.
I think we can also say that an organ supports the organism. Is a mother supported by a placenta?
“The lungs are considerably farther from the placenta than the scraping tool was from the baby. The pulmonary crisis was due to multiple factors, only one of which was the pregnancy, whereas the death of the baby was caused by this one action.
Thus the bad effect was (much, much) more direct than the good.”
Kathy –
Your analysis of “the problem” does not take its complexity into consideration. The child’s effect on the mother is the problem. The removal of the child removes that problem and all the consequences that follow from that problem.
Your argument is similar to saying “I didn’t shoot my husband, the bullet and the trigger of the gun did”.
Ann,
I’m not analyzing “the problem.” I’m analyzing the act.
The fetus (placenta and all) is unwillingly, unwittingly killing its own mother. I am dumbfounded to learn, ad nauseum, that she has no recourse but to die. It doesn’t make any sense. It doesn’t.
Time to re-read Kafka. And Antigone.
William,
She can have any and all medical treatment possible, as long as the direct killing of an innocent is not involved.
Imagine if I were dying because of an inoperable heart condition. I’m a candidate for a heart transplant but no hearts are available. In the next bed in the ICU is a car accident victim in a coma, who happens to be a very close match for me. Somehow the protocol is arranged that in the event of her death, I will receive her heart. My life is rapidly ebbing away; her vital signs are currently holding, but the doctors believe she will probably die soon.
What is the right act? Why?
Antigone did the right thing even when it was the costly thing.
Serious question: what is “an innocent”? analyze that rhetoric for me.
But you in the other bed are not materially contributing to my immanent death, draining my life away. And your own death is not materially conditioned on my death. Your analogy has little salience to the symbiotic scenario of gestation.
William,
I agree with your second objection, but not the first. In strictly consequentialist terms, if the other patient lives long enough, I will almost certainly die. The other patient will almost certainly die as well. It’s a choice between 2 and 1.
“I’m not analyzing “the problem.” I’m analyzing the act.”
Kathy –
But the question is which activity is the bad reality which is causing the woman to die? In other words, what is the root problem that is killing the mother? It is the activity of the child as it affects the mother that is this root cause, the cause of the mother’s impending death.
Ann,
I don’t know about “root cause,” since there was a pre-existing condition. But yes, it seems that the mother had a much better survival rate if the child were not there.
But, the child was there. That is the reality in all its complexity. And now it is time for a human act to take place in freedom. What will it be?
If these two unique human beings were not entwined in a tragic, deathly embrace, but were physically separated (as in the simpler scenarios to which pregnancy is being reductively compared), I would entirely agree that ends do not justify means. I am a virtual absolutist on the death penalty, so I would not kill even the guilty. Yet I support the homicide of a doomed fetus to end a vicious cycle. You save whomever you can.
“I don’t know about “root cause,” since there was a pre-existing condition. But yes, it seems that the mother had a much better survival rate if the child were not there.
But, the child was there. That is the reality in all its complexity. And now it is time for a human act to take place in freedom. What will it be?”
Kathy –
The case I’m discussing is that of a woman whose life is threatened by the child in her womb. Without the child in the womb, the pre=existing condition would not have killed the mother.
This is a horrible biological fact, but innocent children sometimes kill their mothers. In this case, the child indirectly was causing *its own death* by causing the mother to die. This is a horrifying thought but there is the evidence. Without the child, the mother’s life was not threatened. It was child which was causing its own mother’s death and its own death.
Thank you, Ann O:
“The case I’m discussing is that of a woman whose life is threatened by the child in her womb. Without the child in the womb, the pre-existing condition would not have killed the mother.”
and William F:
“I am dumbfounded to learn, ad nauseum, that she has no recourse but to die. It doesn’t make any sense. It doesn’t.”
Just curious – are there any mothers here who agree with Olmsted?
“I am dumbfounded to learn, ad nauseum, that she has no recourse but to die. It doesn’t make any sense. It doesn’t.”
‘The chart noted that she had been informed that her risk of mortality “approaches 100%,” is “near 100%,” and is “close to 100%” if she were to continue the pregnancy. The chart also noted that “surgery is absolutely contraindicated.”’
Approaches, near and close to do not equal 100% Everyone here is talking as if death was certain. It was not certain. There was still a chance that she would live.
So which is it? Was it approaching 100% or was it a certainty. The above quote seems to be a conclusion of Dr. Lysaught as she doesn’t source it from the charts or attending physicans. Death was not a certainty, but abortion does make death a certainty for the unborn.
Are there any records anywhere of survival in light of these or similar conditions? I seriously doubt it.
“The unborn infant (besides being tainted by original sin) is “innocent” not because it is good or virtuous, but because it has not had a chance to make any moral choices. It strikes me that if this is truly innocence, it is innocence of the most trivial kind. The mother pregnant with this “innocent” child could be one of the greatest saints to walk the earth, and her life would be worth less than the baby’s because “no one more absolutely innocent could be imagined.”
Thank you! I have understood for a very long time that it is not the medical professionals who “play God” by saving the single life worth saving in the rush to double-extinction, but the Catholic hierarchy which makes statements such as cited by David Nickol. Doctors and nurses save every life they can, including criminal suspects and convicted criminals and those whose crimes have been freshly witnessed. There are no moral judgments in the ER. But in its arrogance, and despite its medical ignorance, Catholic clergy feel entitled to play God when faced witth the unknowable and unpredictable. It seems to me that medical staff have more respect for God, and for the possibility of life and hope, than do male clergy who find the mother worthless apart from being a baby-making machine. And when she does make babies, those babies are more important than her. Never mind that she might already be a saint, or on the way; never mind that an 11-week old fetus within her may even eventually develop into an evil person — the next Wall Street Swindler, or a menace to society because of congenital, untreatable mental illness.
In a moment in time, “innocence” is a philosophical concept which has yet no moral context until behavior and free will become activated, which necessitates the ability to make decisions and not just respond biologically. In fact, in the 1940′s and ’50′s, infants were virtually raced to baptisms because of the prominence of the theology of original sin in Catholic consciousness.
An 11-week-old fetus is neither evil nor good as an individual. His/her existence/life is good from an absolute philosophical standpoint — noy more so nor less so than the life of the mother to whom is attached the same philosophical goodness. In addtion, though, she has concrete value as the source of goodness for other innocent, dependent lives waiting at home. Preserving her life, then, is at least as important as preserving what can be preserved of any life in utero — which in this case could not.
There’s so much hypocrisy in a Church which holds up the Mary as the ideal of motherhood but has contempt for every other mother relative to any life they carry UNTIL, the birth. There’s a real sickness here, I’m sad to say.
CORRECTION: I didn’t mean “the single life “WORTH” saving (above). I meant the single life “ABLE” to be saved.
Ann,
Quick question: are you still promoting a double effect argument, or can we set that aside for now?
“So which is it? Was it approaching 100% or was it a certainty. The above quote seems to be a conclusion of Dr. Lysaught as she doesn’t source it from the charts or attending physicans. Death was not a certainty, but abortion does make death a certainty for the unborn.”
Be serious, please. This coy gambit is beneath everyone.
“Be serious, please. This coy gambit is beneath everyone.”
cardiogenic shock has an 80 – 90% mortality rate and recent studies have shown a 50 -75% mortality rate — nih. The present case say that she was approaching 100%. That means there was a chance that she and her child would not die. What was that chance 10%? 20%? 1%? It was not a certainty that she would die. If there is any chance that she would live that calls into question the deliberate killing of the unborn. The death of the unborn becomes a certainty in an abortion and a 100% chance of death is greater than a 99% chance of death. The argument is that the hospital saved the one they could. What the did was traded odds. They decreased the unborn’s survival chance to zero, and increased the mothers chance of survival to what? They don’t say. Even after the abortion the mothers chance of survival does not go to 100% bt to something far less.This is no coy gambit. Is it moral to impose certain death upon one when the two have a 1% or greater chance of survival?
The hypothetical entity some would invent for the sake of discussion does not exist in the hospital. The pregnant mother, including fetus/placenta, is simultaneously stressed by the _combined_ effects of at least four major phenomena – pulmonary hypertension, cardiac failure, cardiogenic shock, and pregnancy. The body-wide effects of each are aggravated, not diluted, by the active presence of the others. All are dynamic processes, meaning conditions change continually, for the worse in this case. The challenge is to find a way to break the lethal network in order to save life or lives if humanly possible. This situation is a good illustration of the limits of aiming for “a diseased organ” or one primary cause. (Note that other vital organs involved haven’t even be mentioned here, e.g., kidneys, hypoxic brain.)
sasurfman -
Nature does not grant informed professionals on the scene the luxury of 100.00% certitude in some of the most demanding medical situations, like the one in question. If ever three doctors tell you something vital “approaches 100%,” is near 100%,” and is “close to 100%”, you should bet on it, whether it’s your life or salvation at stake.
“This is no coy gambit. Is it moral to impose certain death upon one when the two have a 1% or greater chance of survival?”
Prudential judgment recognizes degrees of moral certainty as a basis for action. It is basis for medical intervention, especially in emergency situations. It is meretricious to suggest that the problem was that the hospital did not wait long enough, when it is clear from your commitment to a principle that there is never a time when the steps they took would reside within your moral compass.
So, yes, it is moral to impose “certain death” upon one when the only other foreseeable outcome is certain death for both. Otherwise, we would be discussing elective abortion, not life-saving intervention. You are intransigently opposed to allowing such a distinction.
“It is meretricious to suggest that the problem was that the hospital did not wait long enough, when it is clear from your commitment to a principle that there is never a time when the steps they took would reside within your moral compass. ‘
I could level the same charge against you. You clearly have a commitment to justify the action of the hospital and that commitment prevents you from considering any possible moral error in the judgment of the hospital to abort the child.
“So, yes, it is moral to impose “certain death” upon one when the only other foreseeable outcome is certain death for both.”
Begs the question. My assertion is that there was no certainty of death, only a high probability. Physicians are not omniscient. They cannot know what the outcome would have been had they treated or continued to treat the patients (yes there were two patients here, or have you forgotten that?) to the best of their ability.
If 100 or 1000 doctors told me that something vital ‘approaches 100%’, ‘is near 100%’, and ‘is close to 100%’, it still would not be 100%. should I not leave it to God to decide what is going to happen rather than take another’s life to improve my odds?
sasurfman, the practice of life-affirming medicine is based on if-then premises, which in turn are based on medical experience (case histories). The difference between the 21st century, and the early 20th & before that, is that doctor saws the signs of inevitability but were much more often powerless to stop the approach of death — even for just a single, non-pregnant patient.
Yes, you’ve made clear what your stand is, and what the fundamentalist Catholic stand is: passivity. Do nothing when faced with crisis, “just in case” God may intervene. In a medical setting, that’s not life-affirming; it’s death-enabling. And it’s disrespect for our intelligent humanity. One of the foundations of classic Catholic theology, derived from scripture, is that we are made in the image and likeness of God. Our intellects are derived from God himself; he expects us to use them as an aspect of grateful relating to Him. Calling inaction a virtue is cultist and sado-masochistic; calling it virtuous does not make it so.
Finally, all classic moral theology is applied theology, based on the full facts at hand. Bishop Olmstead does not have the medical training required to make moral judgments on what happened in a medically complicated critical pregnancy, such as this. That’s why hospitals have ethics boards.
Georgina,
Between “do nothing” and “do anything” there is the middle ground of “do all that is morally acceptable.” Having the ability to do something does not mean that what we can do is moral. Everything that can be morally done should be done to save the lives of both patients. One crosses a moral line when one decides to kill one for the sake of the other. It is at this moral line that we must surrender to God. God expects us to use our intellects to know Him and His Will and He has commanded us not to kill.
Satan deceived Eve into eating the forbidden fruit by enticing her with the “goodness” of the act of eating the fruit. We too can be deceived by the perceived “goodness” of our actions.
It is for the Church to guide us in this moral decision making process. That is the mission Jesus gave to the Church. Bishop Olmsted, as a successor of the apostles, has the authority and responsibility to guide St. Joseph’s Hospital in what is in accord with God’s Will and what is not. He is providing that guidance. The hospital must now choose whether they are truly Catholic.
I think Olmstead does have the training to make moral decisions in this matter. He can get medical advice that he needs. I am not sure he should be second-guessing the decisions made in difficult circumstances, but he thinks he has an obligation to do that.
What Olmstead apparently lacks is an ethical system that reaches a proper conclusion in this case. Imo this is exemplified by the two quotes from JP2 that I posted yesterday that say:
1> “the fatal outcome is attributable to the aggressor whose action brought it about, even though he may not be morally responsible because of a lack of the use of reason.” EV 55
2> “No one more absolutely innocent could be imagined. In no way could this human being [in the womb] ever be considered an aggressor, much less an unjust aggressor! ” EV 58
Much of this discussion comes down to choosing one of these two principles to the detriment of the other. No one has offered, as far as I remember, a reason why the child should not be thought an aggressor. JP2, and Phoenix’s medical ethics director simply assert the fact.
One problem is in applying “threat” generically. This child, behaving as a child, is a threat to his mother because of her preexisting condition, which differs from most pregnancies. That pre-existing condition, even if it is the fault of the mother, still makes the child’s action a threat. (not to trivialize, but as a diabetic I can consider chocolate cake a threat, though it is not a threat to every person who might eat it. that is poorly analogous, but I hope some understand the point I raise.)
sasurfman,
your argument re percentages applies equally to abortion. There is a NEAR certainty that abortion will end in the death of the child, but there is a chance that the child will miraculously survive. And there is a chance the mother would have survived until the child died. If the doctors determined it was “near 100%” that both would die, they had reached the same certainty as there is with an abortion.
In any event, not treating the mother would have been murder by negligence, possibly prosecutable and certainly would justify malpractice suits in my completely uninformed opinion. Doing nothing is not a morally neutral act.
Georgina –
It seems to me that sometimes there is reason to favor saving the life of the child (though in this case there was no real possibility of that). A woman has already had a chance to live a life, enough years even to conceive a child. The child in the womb has had no such chance. All things being equal (which they rarely are), I would favor the child’s life..
Kathy –
I’m not eliminating any sort of argument.
If 100 or 1000 doctors told me that something vital ‘approaches 100%’, ‘is near 100%’, and ‘is close to 100%’, it still would not be 100%. should I not leave it to God to decide what is going to happen rather than take another’s life to improve my odds?
sasurfman,
Why wouldn’t this apply in the case of ectopic pregnancy, cancer of the uterus, and all the other hard cases where “indirect” abortion is permitted? There have been cases of ectopic pregnancy where the baby survived. And doctors can’t be 100% certain about the course of any cancer. Sometimes (very rarely) cancer spontaneously goes away.
Also, why doesn’t this apply in the case of self-defense? How can you be 100% certain someone is actually trying to kill you?
Also, as I understand your argument, you would not have found an abortion permissible if the doctors had known with absolute certainty that the woman would die without it.
I don’t think there is any question that the situation was grave. We could argue about the gravity ad nauseum–and in fact I think Lysaught equivocates–but no doubt it was serious. It threatened both the mother and the baby. The mother has four other children who would be seriously affected. It was a wrenching situation.
However, the gravity of the situation cannot be the only factor determining the validity of the act.
If it did, terrible, terrible things would be justifiable by the same reasoning. If I can kill a baby who unwittingly “threatens” my life, I can certainly torture a terrorist who refuses to reveal the location of the bomb. I can kill potential organ donors who refuse to die in a timely way. In fact, since one organ donor can save several lives, why not customarily sacrifice a life whose chance of survival is low, so that the many can live? I can bomb Hiroshima because the Japanese warrior code does not admit of surrender.
All of these acts are justifiable, if gravity is the standard. But gravity is not the standard.
Good human acts are the standard.
1> “the fatal outcome is attributable to the aggressor whose action brought it about, even though he may not be morally responsible because of a lack of the use of reason.” EV 55
Like most moral issues, the problem is linguistic — “aggressor whose action” connotes a conscious agent whose behavior is a willed act. The issue is what defensive action is licit when the threatening agent has neither consciousness nor will.
However, the gravity of the situation cannot be the only factor determining the validity of the act.
No one has said otherwise. That’s a strawman argument.
Kathy ==
You seem to think that the Church itself does not admit exceptions to the no-evil-to-cause-good principle. It does regularly. Killing a soldier in the state of grace is killing an innocent person. So that is an exception to the no-evil rule. Oh, sure, the Church probably re=defines “innocent” to try to cover-up its inconsistency, but inconsistency it is.
The moral problem as I see it is to find a principle which tells us which exceptions to the no-evil rule are tolerable.
Antonio, it seems like the concept of fetus as person is applied selectively in this respect. If the fetus is to be treated as a fully separate person then it must be accorded all of, but not more than, the privileges that the rest of us humans get. To exempt the fetus from “agressor status” is to limit its definition as a person in important ways. Any person can become an aggressor, that is, an active threat to another person, if the right conditions are present. We can come up with outlandish examples: let’s say a very young child finds a grenade and begins playing with it in a crowd of other children — that child is most definitely an aggressor notwithstanding complete innocence as to what he is doing or its potential consequences for others.
“The moral problem as I see it is to find a principle which tells us which exceptions to the no-evil rule are tolerable.”
There is such a principle: the principle of double effect.
It has 4 elements, of which one is gravity.
The element of directness (see my #3 above) has not been seriously considered by anyone on the pro-CHW side of the argument, to my knowledge. I wish it would be.
To exempt the fetus from “agressor status” is to limit its definition as a person in important ways.
I agree. I was referring to the word’s connotive sense, which is how JP II used it. The best alternative I can come up with is ‘agent’ — although even that doesn’t have the degree of moral neutrality I’m searching for.
Kathy -
Your counter-illustrations don’t fit very well with the case under discussion. Suppose the terrorist reveals the location of the bomb to be under his shirt. What options do you allow? As for bombing Hiroshima, I’ve never heard the Japanese code offered as a primary reason. Enormous numbers of lives were to be lost under any options the US had available to help end WWII. How would you choose among them? All the options were undesirable by most standards.
Kathy –
The principle of double effect does not permit intending an evil. It only permits tolerating a simultaneous evil. IF a proportionate good is achieved. The problem is that metaphysically the same physical effect (the death of the child, the removal of the child) is both good and evil. This seems a paradox, but there it is.
It seems to me that the problem lies in the fact that one act can be simultaneously related to two different ends, and that’s where the duality becomes possible. Then the problem becomes: which end, if any, should have priority. In the St. Jos. case since the child had no reasonable chance at all of surviving without the mother, the only permissible solution is to save the mother.
Ann Olivier writes:
“You seem to think that the Church itself does not admit exceptions to the no-evil-to-cause-good principle. It does regularly. Killing a soldier in the state of grace is killing an innocent person. So that is an exception to the no-evil rule. Oh, sure, the Church probably re=defines “innocent” to try to cover-up its inconsistency, but inconsistency it is. ”
Game. Set. Match!
Suzanne,
Combatants are considered aggressors, whether they’ve been to confession recently or not.
Ann,
Your naming of “the removal of the child” as a good effect is beyond tenuous. “Removal of an 11-week old fetus,” simpliciter, would never fit any criterion as a good effect. In any case that is an act, not an effect. Let’s be real.
The good effect sought is “relieving the additional pulmonary and systemic distress the mother is enduring due to her pregnancy.”
1. The good effect sought is “relieving the additional pulmonary and systemic distress the mother is enduring due to her pregnancy.”
2. The bad effect is the death of the child.
3. The act is the scraping out of the uterus, under these conditions.
“Your naming of “the removal of the child” as a good effect is beyond tenuous. “Removal of an 11-week old fetus,” simpliciter, would never fit any criterion as a good effect. In any case that is an act, not an effect. Let’s be real.”
Kathy –
Obviously, some of us disagree with you that it is beyond tenuous.
You seem to think that I’m saying that the removal of the child is not an evil. I’ve said before that, yes, it IS an evil. But it is only one of the effects of the removal of the child, and it is only tolerated, not intended. My quarrel with Church moral theology is that, while it sees the moral relevance of not intending that evil consequence, it also denies that the death of the child is an evil caused by choosing its good aspect.
The Church wants to have it’s cake and eat it — retain the no-evil-for-good principle absolutely, yet also retain the double-effect principle. I don’t think you can accept both and have a consistent ethic. You seem to see that there is an inconsistency there, and you’re right. Where we differ is that I think that there are some exceptions to the cause-no-evil rule, but efforts to formulate a principle describing those exceptions have not been successful.
I think that it’s the aesthetic revulsion most of us discover as a proper reaction to the act of “the scraping out of the uterus” that is at the core of the objection many have in this case.
“My quarrel with Church moral theology is that, while it sees the moral relevance of not intending that evil consequence, it also denies that the death of the child is an evil caused by choosing its good aspect.”
Well, I really messed that one up, didn’t I. I should have said “My quarrel with SOME OF the Church’s moral theologians is that while they see the moral relevance of not intending an evil consequence, they do not see that the act of removal of the child simultaneously causes an evil effect, THUS violating the principle of cause-no-evil.
I think that it’s the aesthetic revulsion most of us discover as a proper reaction to the act of “the scraping out of the uterus” that is at the core of the objection many have in this case.
But the choice of words was designed to elicit aesthetic revulsion. To me, witnessing the trauma associated with a normal birth, a ceasarian or a breech birth produces the same effect. What then?
They [some of the Church's moral theologians] do not see that the act of removal of the child simultaneously causes an evil effect, THUS violating the principle of cause-no-evil.
Is allowing the death of the mother not considered an evil? Aren’t there situations in which evil is unavoidable?
“You seem to think that I’m saying that the removal of the child is not an evil. I’ve said before that, yes, it IS an evil. But it is only one of the effects of the removal of the child, and it is only tolerated, not intended.”
Ann, this is a long thread, and long threads are easily tangled, if you will excuse the pun. But here you mention “the removal of the child” as both the bad effect AND the act. And at some point above, if I understood you correctly, you were suggesting that the good effect intended was the removal of the child.
I’m not sure “removal of the child” is a precise enough description for any of these. Certainly it does not suffice for all three.
The bad effect is a death.
The good effect is a decrease in the mother’s health crisis.
The scraping out of the uterus, under these conditions, is the act.
(Perhaps there is an equally non-euphemistic way of saying “scraping” that isn’t as graphic, and that would be fine with me. Yet keep in mind, the physicality of the act is part and parcel with a moral act.)
“Why wouldn’t this apply in the case of ectopic pregnancy, cancer of the uterus, and all the other hard cases where “indirect” abortion is permitted? There have been cases of ectopic pregnancy where the baby survived. And doctors can’t be 100% certain about the course of any cancer. Sometimes (very rarely) cancer spontaneously goes away. ”
David,
It might apply. In cases where the baby survived the ectopic pregnancy, the pregnancy was in a location that did not immediately threaten the mother’s life. She was able to carry the pregnancy to the point the child was viable before surgical removal.
Likewise cancers have different pathologies and it may be possible to carry a child to viability before intervention.
Either way the Church teaches us the difference between what is unintended but foreseen effects and intended effects.
“Also, why doesn’t this apply in the case of self-defense? How can you be 100% certain someone is actually trying to kill you?”
You can’t be 100% certain that someone is trying to kill you unless they announce their intent to you. I think that is one reason the Church teaches than one must use the minimum force necessary to successfully defend oneself from an attacker.
“Also, as I understand your argument, you would not have found an abortion permissible if the doctors had known with absolute certainty that the woman would die without it.”
It is an interesting and difficult question. If I knew for certain that two people were going to die, and there was a possibility that I could save one person by killing the other, and both persons were innocent persons, should I kill the one person? What are the moral consequences for me by my action or inaction? I have to think more on that.
Perhaps there is an equally non-euphemistic way of saying “scraping” that isn’t as graphic, and that would be fine with me. Yet keep in mind, the physicality of the act is part and parcel with a moral act.)
To the layperson, it might evoke a reflexive emotional response as if the surgeon had taken a rusty paint scraper and had at it. My point is that to the layman all surgical procedures are gross apart from whether or not they are licit and apart from the language one uses to characterize them.
Anyhow, if we are going to start describing events in the starkest language, I suggest we also start describing in excruciating detail what might happen if the medical team stood by and did nothing. I suspect that’s pretty revolting as well.
It was a desparate situation, that is true. That’s one of the reasons why these things have to be discussed when the pressure is not on. Momentous actions must be based on good reasons and clear thought processes.
Kathy,
What I find troubling here is that the Holy Office in 1902 gave an emphatic no to the question “whether it is at any time permitted to extract from the womb of the mother ectopic fetuses still immature, when the sixth month after conception has not passed.” It was not until 1933 that T. Lincoln Bouscaren came up with the currently accepted rationale permitting salpingectomy. Women were dying until Bouscaren came along and invented what amounts to a “work-around.”
If you had talked to anybody but Catholics deeply influenced by the teachings of the Church and arcane moral reasoning, they knew before Bouscaren proposed his “solution” that it was wrong to let ectopic pregnancies continue when they were a serious threat to women’s lives that could easily be taken care of. This is why Bouscaren and those who went before him kept working on a “solution.” You don’t try to justify something you know is wrong. And similarly, nobody but Catholics deeply influenced by the teachings of the Church and arcane moral reasoning think it is right to let a woman and her unborn child die when the woman can be saved.
So the question really is how many women have to die before (a) the arguments of Grisez, Rhonheimer, Lysaught, etc. become accepted, or (b) how clever does someone have to get to become the Bouscaren of pulmonary hypertension?
I am reading an interesting paper by James F. Keenan titled The function of the principle of double effectthat argues that removing the cancerous uterus and performing a salpingectomy are not analogous (something Bouscaren himself expressed doubts about):
The solution is pretty much what people arrive at intuitively. Terminating a life-threatening pregnancy is equivalent to self-defense on the part of the mother. Nobody should have to come up with an intricate and arcane argument based on double effect in either the case of ectopic pregnancy or pulmonary hypertension. If the pregnancy is killing the mother, she should be allowed to save her own life.
The element of directness (see my #3 above) has not been seriously considered by anyone on the pro-CHW side of the argument, to my knowledge. I wish it would be.
Kathy,
If I understand you correctly, I tried to address this with my discussion of the “object” of the act. The object was alleviating the systemic stress on the mother, and the death of the child was an indirect consequence of the only feasible treatment. IOW, the mother’s cardiovascular system was as close to the placenta as the fetus; that system, not the child, was the object of the procedure.
Ann addressed this even more directly when she pointed to causality as a better standard for directness rather than the distance you had proposed as a standard. In that case, you simply reasserted distance as the standard for directness, without any explanation that I can see.
David N has speculated on placentas without living fetuses, I presume to offer a different view of whether the procedure was directly concerned with the fetus.
If those do not address “direct” adequately, what considerations would you like addressed? Is physical distance the primary consideration?
he gravity of the situation cannot be the only factor determining the validity of the act.
I think sasurfman is the only person who tried to say the gravity of the situation should determine the morality of the act, in the sense that the mother’s illness was not grave enough to justify the procedure used.
The gravity is important in determining the proportionality of the act. The bad effect is the death of the child, but the gravity of the situation calls for us to say the bad effect is the death of the child an hour early. The good effect is a decrease in the mother’s health crisis for another year+. The time periods are not what makes the act good or bad, but they allow for a proportionate comparison of their relative value.
Physical distance is not the only consideration, but it usually enters into the question of directness, especially in taking the life of an innocent human being. In the case of ectopic pregnancy, for example, one cannot simply (directly) remove the embryo from the fallopian tube. The tube itself must be taken; the embryo is removed indirectly.
In terms of causality the two effects are completely incomparable. The death of the child –the bad effect–was causally concurrent with the act of the D $ C. To scrape the womb of a pregnant woman is to kill the child in the very act of the surgery. It is causally immediate. There is no long string of causal connections. Whereas the positive effect on the mother’s health–the good effect of the same act–was one of many factors influencing her health, did not involve the uterus directly, could only alleviate the condition somewhat rather than curing it, and was the result of a long string of medical causes and effects. As an effect caused by the same act, it is much much more remote.
(Sorry, I meant to address the above to Jim)
“The solution is pretty much what people arrive at intuitively. Terminating a life-threatening pregnancy is equivalent to self-defense on the part of the mother. Nobody should have to come up with an intricate and arcane argument based on double effect in either the case of ectopic pregnancy or pulmonary hypertension. If the pregnancy is killing the mother, she should be allowed to save her own life.”
It just seems so reasonable, without undermining a genuine commitment to the sacredness of life. As I said before, just ‘reverse engineer’ all the Thomistic gears and pulleys.
(Also I meant D & C. Sorry)
I appreciate greatly David Nickols’ knowledgeable response above; worth repeating:
“If you had talked to anybody but Catholics deeply influenced by the teachings of the Church and arcane moral reasoning, they knew before Bouscaren proposed his “solution” that it was wrong to let ectopic pregnancies continue when they were a serious threat to women’s lives that could easily be taken care of.
This is why Bouscaren and those who went before him kept working on a “solution.” You don’t try to justify something you know is wrong. And similarly, nobody but Catholics deeply influenced by the teachings of the Church and arcane moral reasoning think it is right to let a woman and her unborn child die when the woman can be saved.
So the question really is how many women have to die before (a) the arguments of Grisez, Rhonheimer, Lysaught, etc. become accepted, or (b) how clever does someone have to get to become the Bouscaren of pulmonary hypertension?”
…The solution is pretty much what people arrive at intuitively.” Intuition being a feminine mode of being I alluded to above.
Nickols reiterates what is the bottom line for many of us. We may not yet have the hyper-distinctions and academic intricacies neatly arranged, but a compelling moral approach presents itself.
The Olmsted view holds a visceral repugnance I cannot overcome. All the ultra fine reasoning seems an intellectual, surreal exercise — almost a medieval debate removed from fostering whatever life in the flesh is genuinely versus theoretically possible. Instead of human presence of some kind, there is nothing left but nothingness.
Again, I ask. When was the last occasion when a Catholic hospital delivered patient care the Olmsted way to pregnant woman and fetus until their mutual and natural death? How unique is this situation we have devoted hundreds of posts to discussing. Does anyone know?
“All the ultra fine reasoning seems an intellectual, surreal exercise — almost a medieval debate removed from fostering whatever life in the flesh is genuinely versus theoretically possible. Instead of human presence of some kind, there is nothing left but nothingness.”
Does thought have nothing to do with conscience? Is conscience a matter of feeling and desires and what is “obvious,” or does it have anything to do with the human capacity for thinking?
The line of reasoning that claims the D&C is somehow more “direct” than is saving the mother’s life would also disallow just war. The killing of a soldier (whose innocence as a person is unknown, who might actually be soldiering under duress or in ignorance of the injustice of the cause, and who is defined as “guilty” only because s/he is part of an attacking force,) is immediate, while the good of defending the attacked state is uncertain, though it must be probable, and that good is distant from the soldier’s gory death.
Much of what’s here is roughly analogous to just-war questions in similar ways. Pacifism is a venerable option for Christians, and possesses a moral clarity that just war, with all its messiness, uncertainty, and toleration of death, destruction and killing do not. Just war should always be a reluctant option, but IMO, it remains an option when innocents are attacked. True pacifists must be willing to say they will never sully their hands with the death of another, even if countless innocents die because of their inaction.
@Kathy. I addressed the double-effect question you raise at 1:00, 12/28. Long thread, hard to follow all the twists and turns.
Lisa,
Actually I saw your comment there and responded immediately. I disagreed with you. It seems to me that the question of directness–not of proportionality–is the most commonly unmet criterion for double effect.
In this case the gravity question, I believe, was a met criterion.
The war analogy is interesting but ultimately I suppose it fails, the problem of individuality in a combat force having been taken into consideration in the formation of just war theory in the first place. The blanket assumptions one must make about one’s enemy, and the remoteness and tenuousness of the good effect sought, are part of the evil of war, and this evil severely restricts the conditions under which wars can be justifiably fought.
Wil this thread hit 400?
IMO Carolyn is on point with “incredibly chiling”!
The test of thinking by conscience resides in real life experience, not apologetics for a point of view.
Kathy, it’s not that thought has nothing to do with conscience, but it doesn’t take much thought to recognize that saving this woman’s life would be a good thing. This isn’t well, on the one hand, on the other — her death is a truly bad thing in relative or absolute terms. In such a case, I think we should be able to start with the presumption that a course of action that lets her live is appropriate except where there is a compelling justification for not acting, that goes well beyond one plausible interpretation of the rule. In a case like this, if there is a plausible interpretation of the rule that lets her live, that’s the interpretation that we should be glad to accept even if logic doesn’t compel us to. Indeed, I don’t see any other basis for accepting the logic of the salpingectomy exception.
How many scholastics does it take to change a light bulb?
is what I keep thinking.
Prudential wisdom works like this in face of moral dilemmas:
Doctor A: It would be wrong to perform X in order to save this woman’s life. In doing so, we would injure, nay, even kill her fetus, our other patient. And yet, I can’t think of any other course of action left to us.
Doctor B: But isn’t this child going to die even if we do nothing?
Doctor A: Yes. But it would be a terrible thing to have the death of this child on our hands, rather than God’s hands.
Doctor B: Except that God can use our hands to save this woman. It’s a damnable paradox, but there it is.
Doctor A: (to God) Please God, forgive me for what I am about to do. (to Doctor B): Let’s get this done.
In the end, it’s what needed to be done. Lord, hear our prayer.
Does thought have nothing to do with conscience? Is conscience a matter of feeling and desires and what is “obvious,” or does it have anything to do with the human capacity for thinking?
But isn’t it always being said that Natural Law is “written on our hearts”? Thus, isn’t our reasoning supposed to have its foundations in our intuitions about human flourishing?
Barbara,
I’ve said, several times, that the reasons are grave.
Just by the way, I am surprised to find anti-intellectualism among commentators on this blog, particularly regarding a conscience matter.
Kathy, sometimes the superifical (most obvious) explanation is the correct one — and not losing sight of the obvious is not the same thing as being anti-intellectual. Emotional reasoning is a component of — not a parallel path to — intellectual analysis. If the result “seems” or “feels” wrong it is often a very good clue that the logic being used to arrive at that result is also flawed.
For instance, I find nothing compelling or even all that logical in your assertion to the effect that “spatial” proximity of organs to each other has some bearing on whether a procedure can be viewed as causing a “direct” result. We are talking about a human being in which all the organs combined are likely less than 18 inches away from each other. Where exactly is the cut off line for that criteria? My face isn’t all that close to my lungs either by your measure but if I am suffocating, removing the plastic bag or the pillow case that is impeding my breathing will have a direct and immediate effect on the situation. I simply can’t imagine using that kind of artificial “benchmarking” to deny someone life saving treatment.
One of the strangest aspects to this whole sad affair is the remark I have heard in the news, more than a few times, that the patient’s condition (as in close to death) was too far along for her to be transported to another [non-Catholic] hospital. Why is that? Why would the patient be moved? I get a sense that there’s a good number of cases in which a medically necessary abortion is performed where a decision had been made to transport a patient to facilitate exactly what happened at St. Joseph’s. I have asked if anyone knows more about how common this practice is.
I reason that there’s not a doctor in scrubs (or precious few at any rate) who has reasoned himself or herself into the position that the bishop and those who think like him are correct.
Barbara,
Systemically, the lungs are far apart from the uterus. It’s a different system of the body, with many other factors affecting it besides the pregnancy. It’s not just physical distance but causal distance. Whereas the effect on the baby occurred in the very act of the doctor. It was physically, temporally, and causally the same, differing as “act” and “effect” only by analysis.
In other words, this is my version of an emotional analysis:
Doctor #1: OMG, what the hell are you doing?
Doctor #2: I’m saving this woman’s life!
Doctor #1: But look at what you’re doing! Look at what you’re doing with the curette in your hand!
Doctor #2: OMG! I just killed a baby!
Of COURSE there is a huge tragedy in letting a woman and her unborn child die. But the question here is, is there a GOOD act that will save them? The principle of double effect allows certain bad effects, even death, to happen, as a result of good acts. It often comes into play in obstetrics cases specifically.
In this case, if I’m not mistaken, any treatments that would have directly addressed the systemic stressors and the pulmonary condition could have been employed, even if a foreseen but unintended consequence was likely to be a miscarriage. Very strong drugs could have been given, for example. A miscarriage could not be directly intended by the treatment, but if miscarriage were foreseen and not intended, such treatment would have been licit.
But that was not the decision. The decision was made to directly kill the child to end that stress on the mother, and by extension, the child. So this is the best spin that can be put on this action, according to the Catholic moral tradition.
Q: What are you doing with the curette in your hand?
A: I’m killing a baby.
Q: You can’t do that. It’s always wrong to directly kill an innocent human being.
A: I know. But I felt I had to. Otherwise the mother was probably going to die, and the baby as well. It was the only thing I could do.
Q: It’s wrong anyway.
A: I felt I had to do it.
Those who have stayed with the thread so far are invited to read the section Ectopic Pregnancy in “Contemporary Catholic Healthcare Ethics” by David F. Kelley (browsable for free on Amazon). The section gives a history of Bouscaren’s analyses and the evolution of the current USCCB directives, including Dr. Kelly’s involvement in their shaping. The perception of settled doctrine seems to fall short of the tangled reality, as the controversy among ethicists and doctors continues along with the potential for conflicts with civil law.
For example, regarding the ectopic pregnancy treaments of salpingectomy (fallopian tube removal) versus salpingostomy (a method for removal of the fetus which leaves the fallopian tube intact), Dr Kelly writes:
“Bishops surely will be slow to reiterate their earlier condemnation of salpingostomies now that physicians doing salpingectomies instead (where the less intrusive salpingostomy is possible) might run the risk of having their license taken away. What we have here is another example of the absurdity of using the PDE [principle of double effect] in this physicalist kind of way. As Peter Knauer once put it, “Who can understand this?” (Knauer 1979, 149).”
“You can’t be 100% certain that someone is trying to kill you unless they announce their intent to you.”
Future “street” scenario: sasurfman is walking down the street at night with his or her kid in tow, and sasurfman sees two men approaching with knives in hand.
SA: “Excuse me, sirs, do you intend to kill me and/or my child?”
Man 1: “That all depends.”
Man 2: “What’dya mean ‘That all depends’??? We don’t want any witnesses talking to the cops! Let’s get this over with.”
SA: “Please announce your intent, as I have my child in tow.”
Future “combat” scenario: same circumstances with rifle and fixed bayonette aimed at sasurfman.
Future “ward” scenario: same circumstances with deranged patient approaching with hypodermic needle or other dangerous object in hand.
I mean, really…………..
In this case, if I’m not mistaken, any treatments that would have directly addressed the systemic stressors and the pulmonary condition could have been employed, even if a foreseen but unintended consequence was likely to be a miscarriage. Very strong drugs could have been given, for example.
Not according to the doctors who have addressed this issue on this thread. Quoting Catholic Physician at 12/26, 1:16 am:
“Regarding the list of drugs…cited: I can assure you that any reasonable physician would have thrown those at her. She may well have even been on some of those when she got pregnant. I know this disease, pulmonary hypertension, very well. As a 2nd year pathology resident 25 years ago I gave a hospital wide Grand Rounds on that topic to about 150 or so attending physicians and house staff at Rush-Presbyterian-St. Lukes Medical Center in Chicago and later published a paper detailing the pathophysiology and histology of PH as it relates to long term survivors of sickle cell anemia and children born with a ventricular septal defect. None of those drugs have been found effective in a woman already in heart failure and on a ventillator at 11 weeks of pregnancy. The ever enlarging placenta is too much for the paltry drugs that we have at our disposal to overcome. When this case went public back in June, I did a literature search and could not find as much as a single case report where medical therapy alone could save a mother who was critically ill in the 1st trimester. They all had to undergo a termination of their pregnancy in order to live.”
Just by the way, I am surprised to find anti-intellectualism among commentators on this blog, particularly regarding a conscience matter.
Kathy,
I don’t see anti-intellectualism. I see objection to over-intellectualization. As I have noted before, I am struck that women died because of the Vatican ruling on ectopic pregnancy, and it took thirty years of trying to come up with an intellectual work-around to allow them to be saved.
What are we to make of a system of morality in which a physician treating a woman with an ectopic pregnancy in 1902 has to wait thirty years for the correct reason to perform life-saving surgery? It seems to me the women who died during that thirty-year period were human sacrifices on the altar of men over-intellectualizing the female role in human reproduction.
It is difficult to know what the function of a conscience is if one is faced with a moral dilemma that can’t be decided until far in the future when droves of intellectuals have published erudite papers and some kind of majority opinion emerges.
The principle of double effect is not a mathematical formula that, once you fill in all the variables, yields a moral conclusion. This is not to say that we don’t need philosophers and ethicists debating difficult ethical problems. But it is to say that making moral decisions is a human judgment, not a mathematical calculation.
As I said before, the people who came up with a justification for salpingectomy in the case of ectopic pregnancy clearly were going on the intuition (or gut feeling) that it had to be wrong to let women experience the high risk of ectopic pregnancy without intervening to prevent potentially deadly results.
As purely a personal opinion, it seems to me that it is in this area of sexual and reproductive issues that the reasoning of the Church becomes so abstruse that good and decent Catholics don’t fine it convincing (if they understand it at all) and either don’t follow what the Church says or follow it without being convinced. I think the Church has over-intellectualized the whole area to the point where individual humans are told they don’t get to rely on their own consciences, but must have a “well-formed conscience” and obey what they don’t understand.
David,
I know you won’t mind my asking, considering your earlier question to me about ectopic pregnancies. Do you believe that torture is justifiable, under a ticking-clock scenario? If not, why not?
Carolyn –
About feeling and conscience. I’m afraid (there’s another feeling) that I put less trust in feelings than in thinking. Too often our final judgments turn on what we want, both consciously and unconsciously, especially when we want something dreadfully. Coming from the South I have since 1930 heard all sorts of rationalizations for segregation and other indignities against black people put forth by otherwise kindly folks. So their appeals such as, “I just feel very strongly that it’s right” don’t hold much water with me. And, I’m sure that you have heard many appeals to pity for the cover-ups in the sex scandal. (Pity the poor pedophiles who need forgiveness and help, pity the old ladies in the pews who will be scandalized, pity the children and their families for making it known. . . )
What I”m saying is appeals to pity and to our feelings of horror at the prospect of the deaths of both, while very relevant, are not enough. I agree that feelings are quite relevant, that they sometimes (only sometimes) point us in the right direction. But the terrible problem is: how do we tell the difference between our altruistic feelings and our selfish ones, our feelings based on irrational hope and those based on facts? There is one criterion, I think — when our feelings for another person go against our own interests, that is usually, I think, a good indication that at least we’re not being selfish. But is not being selfish itself a good guide? I’d say not necessarily.
This is another of those topics I think needs a lot of airing.
I’ve read some of the Ulanov’s work, and as I read it it is so indefinite in its references, so uncheckable, so totally subjective that I can’t accept them as guides. Yes, we should adopt an open-minded attitude to new-thinking, especially new criticisms of the old principles. But open-minds do not always lead to truth either. But I”m willing to learn more about their method, if you can call it one.
It is also my experience that people hate to do complex thinking. American schools don’t prepare us very well for it. Or whatever the cause, thinking is not held in high enough esteem. And that is no excuse for not doing it. The Middle Eastern problem is extraordinarily complex, but no one would say we should just opt for a simple answer. To often that leads to bombing.
“MO Carolyn is on point with “incredibly chiling”!?
Bob N. –
This is a judgment about *your own feelings*, not a judgment about objective facts. Why is it relevant? (That’s my big problem: how can a subjective feaction (feeling) reveal what is objective (moral facts)? I don’t say none can. But how do you tell the difference between objective and subjective feelings?
“But isn’t it always being said that Natural Law is “written on our hearts”? Thus, isn’t our reasoning supposed to have its foundations in our intuitions about human flourishing?”
Antonio –
LEave it to you to get down to the absolute essentials :-) The question is, I think: why is flourishing the absolute value? The answer to that determines why murder is the worst wrong. But then we get into the paradoxes. How can the value of one life be weighted against that of another? How can there even be a problem like that in the first place? (Now we’re in theology. Sigh.)
Maybe someday we’ll have all our answers. In the meantime we struggle.
I know you won’t mind my asking, considering your earlier question to me about ectopic pregnancies. Do you believe that torture is justifiable, under a ticking-clock scenario? If not, why not?
Kathy,
I am tempted to ask you first — considering that a lie is an intrinsic evil — if the Nazis come to the door and say, “Are you hiding Anne Frank here, and if so, where is she”? you are obliged to say, “Yes, she’s here. You’ll find her in the attic”?
On the ticking time-bomb scenario, I would say if you know the bomb is about to go off in, say, Manhattan, and you know you have a terrorist in custody who has the information about where the bomb is and how to disarm it, and you know the only way to get the information from the terrorist is to torture him, then I would say torture him. Now I suppose you will say I am a consequentialist. But even if I am, that does not mean my argument that people are over-intellectualizing on the issue of a life-threatening pregnancy are in fact not over-intellectualizing.
David,
You are a consequentialist :)
At least you’re consistent.
About feeling and conscience. I’m afraid (there’s another feeling) that I put less trust in feelings than in thinking. Too often our final judgments turn on what we want, both consciously and unconsciously, especially when we want something dreadfully.
Ann,
Which side — pro-Olmsted or anti-Olmsted — in this debate is not relying on feelings? Also, what were Bouscaren and others relying on when they persisted in their efforts to come up with a rationale for surgical intervention in ectopic pregnancy? The question was already answered quite definitively by the Holy Office. It seems to me their feelings that women should not die in this situation motivated their efforts to come up with a “solution.” Since self-defense had been ruled out — and more by authority than by lack of reasoned arguments — they had to come up with a double-effect argument.
For “orthodox” Catholics, there is a lot at stake here to motivate them to side with Olmsted. Let’s not pretend that the people who are aghast that a pregnant mother and her unborn must die when one of them could be saved are the only ones being influenced by feelings.
Kathy –
I see now that I have indeed been using “removal of the child” ambiguously. Analysis of the two (or more meanings) would take a good deal of thought, and probably more knowledge of the fine points of scholastic ethics than I have. I really have to get into these questions more carefully, which means more study. But it seems to me that the outlines of the proper argument are quite clear: a D&C, one action, has a good effect and a bad one. The effects are proportionate, therefore it is proper to allow the death of the child to save at least one life. YOu say that the death of the child is the ‘immediate” effect. I say it is *an* immediate effect, the other one being the severing of the connection between child and mother.
You appeal to distinctions between spatially close and far removed effects/ acts and immediate v. proximate, and direct v. indirect effects. Like Barbara, I find no value at all in the spatial distance criterion. The reason gets into metaphysics and chemistry. Question have been raised about sequences of ends and means, and sequences of causes and effects that probably need some winnowing out. I mean some of the objections are not really relevant to the problem as I see it.
So now I have to go look for some competent literature about fundamental ethics of an Aristotelian/Thomistic stripe. I don’t mean contemporary “virtue ethics”. It only goes so far. And Anscombe too is limited. Any body know any good books that include both the grounding of ethics? (MacIntosh’s “After Virtue” is fine, but it only goes so far, and same is true of Rommen’s Natural Law.) But I’m interested in all those great distinctions that help us analyse complex problems, and I’m especially interested in how we establish ethical priorities when there are conflicts. Anybody have any suggestions? (I never had a graduate course in ethics, so I’m looking for basics but not popularizations.)
Kathy,
This consequentialist is waiting to hear your response to the question of whether it is permissible to tell a lie (an intrinsic evil) to the Nazis asking if you are hiding Ann Frank.
Did the apostles make a rational decision to follow Jesus, or did they go by emotion and intuition?
T’is true that emotion and gut-level reasoning are not unique to one side or the other. I would say that intellectual analysis (that takes a clear objective eye to matters) is itself always a rhetorical strategy to wield against opposing viewpoints. The ideal judgment integrates emotional and intellectual perspectives in ways that affirm our deepest values.
David,
We’d gone 400 comments defying Godwin’s Law. Why don’t we make it 500.
Kathy ==
I keep trying to find out what this “consequentialism” is that some of the scholastics reject. If EVER there was an ethical system that is determined by considerations of consequenses it is the Aristotelian sort. Consequences are *ENDS* and ends are the end all of Catholic moral systems. Anscombe is against it, she means by it, but she doesn’t make much sense to me about it, given her particular theory of intentionality.
“But it seems to me that the outlines of the proper argument are quite clear: a D&C, one action, has a good effect and a bad one. The effects are proportionate, therefore it is proper to allow the death of the child to save at least one life. YOu say that the death of the child is the ‘immediate” effect. I say it is *an* immediate effect, the other one being the severing of the connection between child and mother.”
This is the most cogent articulation in philosophical terms of what those who believe the action taken was morally licit, even ethically required. I’m glad I wasn’t in that OR.
David N. –
Feelings can be very useful to ethics for making us criticize our prior thinking. But you tell me how a subjective action (a feeling) reveals an objective fact? How can my subjective inclination be a description of an objective reality? “It is evil” is quite different from “I dislike/hate it”.
Just to put it on the record, I think there;s boith too much over intellectualizing and too big a split between (purported) intellectual activity and emotional recation.
And, please)!) not to 500.
William FitzGerald: The ideal judgment integrates emotional and intellectual perspectives in ways that affirm our deepest values.
Amen.
Ann Ulanov might characterize these under masculine and feminine modes of being, understanding both rightly belong to each man and woman. It is the integration of these that matters, in ways “that affirm our deepest values.” Jesus is to me the perfectly integrated human being who did not just follow the literalism of the law, but made space for the spirit’s role.
Yes, Ann O, so much of Ulanov’s writing focuses on the intersection of psyche and soul, which of their nature do not lend themselves to exact definitions and categories. That is part of the challenge of being human: somehow bringing intellect and emotion, conscious and unconscious, seen and unseen, time and eternity into life-giving harmony — hopefully with more inspiration than awkwardness.
Some of this is above my intellectual grade, but it makes sense in ways I honor, even if I cannot explain objectively. Going forward in fear and trembling while praying for guidance seem the best we can do.
We’d gone 400 comments defying Godwin’s Law. Why don’t we make it 500.
Kathy,
The choice of Anne Frank and the Nazis is purely incidental to the example and does not, in my opinion, count as as an instance of Godwin’s law. But I withdraw the question and offer this:
Do you agree with Augustine that the naked truth must be told whatever the consequences may be? If you are hiding someone from a murderer, and the murderer comes to the door and asks if his would-be victim is in the house, must you say yes? I acknowledge there are ways you may throw the murderer off track, as by saying, “Why in the world would I be hiding so-and-so?” But let’s assume the murderer is a lawyer and knows when someone is evading the question . . . . as you did by bringing up Godwin’s law! :-)
Feelings can be very useful to ethics for making us criticize our prior thinking. But you tell me how a subjective action (a feeling) reveals an objective fact?
Ann,
Wouldn’t you call compassion a feeling? Is mercy the result of rationality or feelings.
“A madman is not the man who has lost his reason. The madman is the man who has lost everything except his reason.” — G. K. Chesterton
On 12/29, Ann Olivier wrote:
“Georgina –
“It seems to me that sometimes there is reason to favor saving the life of the child (though in this case there was no real possibility of that). A woman has already had a chance to live a life, enough years even to conceive a child. The child in the womb has had no such chance. All things being equal (which they rarely are), I would favor the child’s life..”
And in so doing, you are playing God. True medical professionals, and I would argue true Christians, do NOT pretend to do that. Everybody’s life is deemed to have value. That criminal that is being saved in the ER may, out of gratitude, transform into a saint. You have no way of knowing that. Nor do you have any way of knowing whether the mother in this case, since saved, may bear a moral world leader in the near future, whereas the life that was extinguished may have been geneticaly predisposed to become the next Green River killer, or may have chosen another lifelong sinful path, without bad genes.
David, it’s a fair question, but I don’t have an answer for you. I haven’t read or heard much about the demands of Catholic moral theology re: truth-telling, and I haven’t run across the question personally very often. Sorry.
Where does the quote from St. Augustine come from?
Btw, there’s a related story about St. Thomas Aquinas. His students were goofing off and they pointed out the window and said, “Look, Brother Thomas! There’s a flying cow!” Thomas responded by going to the window and saying, “Where?” The brothers cracked up and said, “You believe in flying cows, do you?” And Thomas said, “I would rather believe that cows can fly than that a Dominican would tell even the smallest lie.”
David N. –
Yes, in one sense, the predominant one, compassion is a feeling, but not *only* a feeling. It is a feeling which helps us understand the feelings of others and sympathize with their pain. But that is not the whole story. Compassion also includes understanding of pain and other people’s helplessness. But those feelings alone do not result in compassion. What we understand about the other’s predicament determines our compassionate action.
For instance, it is not compassionate, in the fullest sense of the term, to simply feel sorrow for a child who hates taking its medicine. A truly compassionate parent insists that it take the medicine, or have its bone set, or whatever. Further, to just feel sorry for someone but do nothing about it is not compassion at all, not in the morally admirable sense. I can feel sorry for the Haitians, but if I don’t send help I’m not compassionate.
I’ve never said feelings weren’t important == but as means of understanding objective problems and helping us to criticize our own assumptions and ways of thinking. But in themselves they aren’t reliable.
But if you know of a way to distinguish the objective ones from the usual ones, I’d genuinely like to hear how. I’ve even said that I think there *are* some feelings that tell us something about the objective situation. For instance, the natural revulsion against torture seems to somehow reveal that torture is worng. But would I think it is rational to torture someone to stop WW III? Yes. Would I do it? Probably not. But maybe that’s just my moral weakness — including a lack of compassion for the millions who would probably die if there were no torture. I really don’t see any moral solution for such cases, if they actually ever happen.
Georgina –
If choosing the child is playing God, then choosing the mother is also playing God. The question is: who loses more if the child is not chosen — the mother or child.
Sure, the child might be Damon incarnate. But it’s mother might also turn out to be Lucretia Borgia. Those are “mights”, not “probablys”.
By the way, if anybody is interested in discovering just how complex the human psyche is as it makes moral decisions, let me recommend a classic little book about meditation. It is Lawrence LeShan’s “How to Meditate”. It will teach you all sorts of methods including some which I think are not what they’re cracked up to be. But it also included some great ones, including a Budhhist one that helps one to understand ones motives and feelings. (All the great religions encourage us to know ourselves.)
The method is called “the thousand petalled lotus”. It’s great for examinations of conscience, and, if you do it regularly will help you discover some of your hidden, double and triple motives for your choices and non-choices. Happily, sometimes you discover not just bad stuff, but occasionally some good stuff as well.
Complexity, complexity.
Thank you to everyone for these many, many thoughtful comments.
E pur si muove!
Whereas the positive effect on the mother’s health–the good effect of the same act–was one of many factors influencing her health, did not involve the uterus directly, could only alleviate the condition somewhat rather than curing it, and was the result of a long string of medical causes and effects. As an effect caused by the same act, it is much much more remote.
Kathy,
I am not a medical person, and I do not even think these medical considerations are that important to the morality of the action, but as I understand it, shock is a systemic condition that reflects a> a decreased volume of blood in circulation; or b> an enlarged circulation with an insufficient increase in blood volume. (more complicated than that but for the moment…) As a systemic problem, it is as present in the uterus as the fetus. In pregnancy, circulation encompasses the placenta, a significant enlargement that was a factor in the patient’s system-wide shock. The procedure that killed the child just as immediately reversed that enlargement of the circulation, with subsequent effects throughout the system. That it has effects outside the uterus is no reason for saying the procedure is less direct than killing the child.
This description oversimplifies the process; the medical language is tricky. That in itself points to the importance of remembering that there are systemic features that are difficult to sort through. This is two individuals, each of whom is a complex system of interacting components, bound together into a single system. Honoring that complexity makes it difficult to talk about directness.
As I said, I do not think this has much to do with how direct the procedure is. The object of the procedure is the health of the mother, and the death of the child is an indirect effect that accompanies that choice. That is a different way of seeing directness, but I think it is more pertinent to evaluating the morality of the action.
Jim,
Part of the complexity of the situation is the body-soul unity of the actor. The doctor is doing something with his physical person. What is he doing? That action obviously has many components, including the intention of the mind. But what is the intention he expresses physically? He is not a disembodied mind, watching the action. He is scraping away a fetus. He is doing this on purpose–for a reason he obviously feels is overriding.
That action is his direct action. The immediate effect of his action, causally, temporally, locally, is the death of the person the doctor is destroying. He separates the unity of the two individuals, by directly killing one.
I’m not trying to be flippant by bringing this up. There’s an exchange in the movie Speed in which Keanu Reeves tells Jeff Daniels that the way out of a hostage situation is to shoot the hostage. That takes the hostage out of the equation. Later on in the movie Reeves shoots Daniels. The whole thing is played for a kind of macabre laugh between tough guy cops.
The problem with the Phoenix situation is that among all the many good acts allowed to the hospital personnel, none of these good acts would simplify the equation. Double effect did not apply. Just war theory did not apply. And time was running act.
Given the dire and tragic nature of the situation, the hospital chose a bad act.
Kathy,
Are you able to state what the good act was in this situation? Presumably to medicate and monitor until close to death became arrived at death. (No flippancy here intended).
The one thing that could save her life was an impermissible bad act, so the good act was to refrain from doing that act. Is that right? Or was there some other good act that you imagine, only the hospital didn’t choose that either?
I’m just seeking clarity on what you think the choices were that they made the wrong choice to do a bad act.
Do you think the hospital was cowardly, arrogant, negligent? confused? overwrought by the dilemma? seduced by a simplistic moral calculus?
Kathy,
Are you opposed to the death penalty?
Kathy —
Why do you think a direct action is more relevant than an indirect one? If I use a tool (e.g., a gun) to intentionally destroy an innocent person’s life that is not a direct action, but it is nonetheless murder.
By the way, I think this whole discussion has ignored the distinction between a physical evil and a moral evil. Natural death is a physical evil. Murder is a moral evil. I think that part of our problem is that Kathy sees the death of the child as a moral evil, while most of the rest of us see it as a simply physical evil, a tragic one, of course, but nevertheless as a simple physical evil.
Ann, I think you are right about the disconnect.
I see the death of the mother (and inevitably the child) as a physical evil, a natural death. Whereas I think others here see a moral dimension to that, such as negligence.
I see the direct killing of the child as a morally wrong act.
I’m not certain if failing to perform a potentially life-saving/absolutely life-destroying abortion is a matter of negligence. That’s how the current state of medical ethics and the civil law would see it, however. I cannot see how to reconcile current Catholic thinking with medical ethics, unfortunately.
William,
I agree with your description of the situation, but I am at a lossd to understand it. Pre-born life has become so undervalued as to make this decision a no-brainer for many, but how can this be?
How can it be negligent to do the following: Upon being presented with two patients, a medical team works diligently to save both. Both die.
I see the direct killing of the child as a morally wrong act.
Kathy,
I think it would be more correct to say that in this thread, those who agree with the doctors and ethics committee at St. Joseph’s Hospital do not see this as the direct killing of a child, and you do. Everyone agrees that direct killing of an innocent child is morally wrong. But those who believe in the PDE argument (the placenta was the target), the Grisez theory of human action (the killing was not direct because it was not willed), and the self-defense argument do not believe the act was morally wrong because they do not believe it was a direct killing of an innocent person.
Pre-born life has become so undervalued as to make this decision a no-brainer for many, but how can this be?
Kathy,
I think many of us would say something quite the opposite. In certain Catholic circles, “pre-born life” for at least a century has been considered so sacrosanct that the life of pregnant woman scarcely counts at all in a high-risk pregnancy. For a thirty-year period ending when Bouscaren proposed his argument, Catholic women with ectopic pregnancies had to risk death when there were reasonable arguments for them not to, and now women with pulmonary hypertension are in the same boat.
“How can it be negligent to do the following: Upon being presented with two patients, a medical team works diligently to save both. Both die.”
Because medical ethics has a utilitarian dimension that values saving lives over protecting life. As soon as one life becomes ‘unsavable’ to a degree of moral certainty, all attention goes elsewhere. It is a brutal calculus, I concede.
Ann Olivier said:
“If choosing the child is playing God, then choosing the mother is also playing God. The question is: who loses more if the child is not chosen — the mother or child.
Sure, the child might be Damon incarnate. But it’s mother might also turn out to be Lucretia Borgia. Those are “mights”, not “probablys”.
——————————————————————–
No, choosing the mother was choosing the only life realistically possible to be saved in this particular instance. That’s all it was. Medical personnel, when they’re acting professionally, do not insert their own feelings about patients when addressing needs and urgencies. The Phoenix personnel did not act to save the mother “because” of any arrogant moral belief that the mother was “better” than the child, but neither should a non-medical institution who has not been given Power of Attorney for Health Care, be allowed to veto one life over another because of that institution’s beliefs as to hierarchies of innocence.
To say that two lives should be ended because an adult is “probably less innocent” than an 11-week old fetus may turn out to be eventually, is really the height of arrogance.
By the way, just as a reminder for everybody, a sin of omission is a category of sin, not a degree of sinfulness. Grave sins of omission occurred during the Nazi regime in the ’30′s and ’40′s. People stood by and did nothing, resulting in murder. I’m not comparing this to the Phoenix situation: I’m reminding those who side with the hierarchy in this case, that to do nothing to save LIFE, when one is in a position to save that life, contradicts Catholic moral theology and scripture itself.
Those of us who were raised on Catholic philosophy and theology really do see enormous contradictions in the unfolding of this case.
As far as I can reason it through, the ectopic ‘exception’ to abortion is not supportable if the pulmonary hypertension exception is not also morally licit. I cannot reconcile the distinction. It as if the left hand doesn’t know what the left hand is doing.
This is why I keep saying there’s something aesthetic in all of this.
William,
I’m not sure it is always the case that “As soon as one life becomes ‘unsavable’ to a degree of moral certainty, all attention goes elsewhere.”
A long way up the thread, I proposed a ticking-clock transplant situation in which the donor patient, though dying, does not die soon enough to save another patient. No hospital could ethically kill the donor patient. That patient receives enough attention to be considered a human person; that patient’s life is sacrosanct.
I do not that that failing to save the mother in this case is a sin of omission or that there is a moral obligation to perform an act that at once kills as it saves. If the hospital had acted as the bishop had wished, I would not say that the act of not intervening was evil.
However, it would have been a profound breach of medical ethics as they currently exist. And I don’t see medical ethics coming round to the Catholic view of the matter anytime soon. It would likely require a constitutional amendment that guarantees personhood to human beings in utero.
We agree on the point, Kathy. The medical team sees the death of the fetus as an unfortunate co-occurrence of the removal of the placenta because they weren’t trying to kill the fetus. If I pull the plug on a dying patient to obtain vital organs for another dying patient, I am most definitely trying to kill that patient whatever the larger motive. What else am I doing?
I do see the fact that pregnant patient and fetal patient are connected, one inside the other as being substantially different from the analogous case you offer to donor and recipient. You could still be on solid moral ground without that analogy.
Suppose this woman had chosen on the advice of her doctor to abort at 5 or 6 weeks because there was a substantial risk she would not survive this pregnancy herself or bring her baby to term: would we say that an abortion was ‘beyond the pale’ in this case?
I would.
Me: “It seems that the purpose of the procedure in question, and the intent of those who approved and performed that procedure, was to abort the baby. … The primary effect of an abortion is to kill the baby. The effect on the mother’s health is the secondary effect. The former was the means to the latter end. One can’t get to the end except by going through the means. They are not simultaneous and independent effects; the one begets the other.”
Catholic Physician: “My reply: The primary INTENDED purpose of the procedure was to remove the the placenta which was the instigator of her acute heart failure.”
Please reread the directives you quoted. The phrase “intended purpose” doesn’t appear in either 45 or 47. Intention and purpose are not the same thing, and it’s unhelpful to adjoin them. They must be kept distinct in order to analyze this case.
“The unintended, but predictable effect, was the death of the fetus. The primary intention was not to kill the fetus, but that was the unavoidable consequence of the primary intention.”
The road to hell is paved with good intentions. That is why, in the passage from me quoted at the top of this comment, I alluded, not to intention, but to purpose and effect. As I wrote several days ago, the good intentions of the actors isn’t in question. But intention, by itself, isn’t sufficient to justify the procedure. Many horribly evil acts have been committed by persons who had good intentions. The purpose of the procedure also comes into play. This is where Lysaught’s object analysis is also deficient.
” ERD 47 specifically allows this action.”
ERD 47 doesn’t seem relevant at all, as you’ve set it up. ERD 47 states (I’m pasting your paste of it from far up in the thread), “Operations, treatments, and medications that have as their “direct purpose” the cure of a “proportionately serious pathological condition” of a pregnant woman are permitted when they “cannot be safely postponed until the unborn child is viable, even if they will result in the death of the unborn child”. (The quotation marks are added by me for emphasis.)
Does a D&C have, as its *direct purpose*, the cure of the woman’s pathological condition? That seems simple enough to test: Would this procedure be performed to treat this condition if the woman wasn’t pregnant? I’ll defer to your medical expertise, but I assume that a D&C would never be performed on a non-pregnant woman to treat an acute heart ailment, because *that is not the purpose of a D&C*. If I’m correct in that assertion, then istm that it becomes problematic, to say the least, to claim that the *direct purpose* of the procedure is to treat the woman’s heart.
It seems clear that the *direct purpose* of the procedure is to abort the baby.
“You use the adjectives “simultaneous” and independent” ERD 45 uses neither word. Again, ERD 45 states, “Abortion (that is, the directly intended termination of pregnancy before viability or the directly intended destruction of a viable fetus) is never permitted. Every procedure whose sole immediate effect is the termination of pregnancy before viability is an abortion, which, in its moral context, includes the interval between conception and implantation of the embryo.” … In addition to the termination of the pregnancy in this case, the immediate effect also was the relief of the source of her acute heart failure. There were dual immediate effects, one intended and the other unintended, but not unexpected, which fell into ERD 47. ”
Doctor, your reference here to “dual immediate effects” means, in essence, that you are arguing that this is a case of Principle of Double Effect. This is why I was pointing out that the two effects – destruction of baby and relief of strain on mother’s heart, aren’t, in fact, “dual immediate effects”. One (destruction of baby) is immediate; the other (relief for the mother) isn’t immediate; it is contingent on the baby’s destruction. As I correctly stated, the two effects are not independent of one another. The effect on the mother is the *end*; the effect on the baby is the *means*. You can’t get to the end any other way.
It seems clear that this situation falls afoul of Catholic teaching. The passage from EV cited by Fr. Ehrich states that one can’t abort, neither as an end *nor a means*. You seem to be claiming that 45 and 47 state that abortion can’t be the intended end; on that, we are all in agreement. But you also must concede that neither can an abortion be a *means* to some other good end; and a procedure whose purpose is to accomplish that illicit means cannot be permitted.
Rather than continue to debate the moral calculus, I’d like to know more about the actual process that occurs when a decision is made to ‘let nature take its course.’ If the eclampsia cannot be relieved by removing the placenta, thus killing the child, what must the mother and child endure? What treatments, if any, are licit to alleviate suffering? Since this is official Catholic doctrine, should not such licit procedures already be part of the training for Catholic physicians and other Catholic caregivers?
Antonio,
This is a good question. I have been asking a similar question in terms of precedent at Catholic hospitals.
Are there cases where doctors watched and waited as both patients worsened, ready to act as soon as the fetal patient was certifiably dead? Does the pregnant patient always die first?
The attempted distinction between baby and placenta in this case, as in, ‘the intent of the D&C wasn’t to harm the baby, but to remove the placenta’, is invalid. Removing the placenta would be morally the same as treating the mother’s heart condition by removing her heart. Surely such a procedure would violate the canons of medical ethics. It couldn’t reasonably be claimed that the mother’s heart could be removed with no intention of killing her. One can’t justify the removal of a vital organ by claiming that it was done with no intention of killing the patient.
How common are these situations? That both Rhonheimer and Grisez seem to have written about them suggests that they are not unknown.
Is this statement true:
If pregnancy is itself what is killing you (perhaps because of some other complicating systemic factors), you have no licit moral recourse… because termination of a pregnancy can never be a means to an end.
Is it as simple (and as hard) as that?
Kathy wrote:
Part of the complexity of the situation is the body-soul unity of the actor. The doctor is doing something with his physical person. What is he doing? That action obviously has many components, including the intention of the mind. But what is the intention he expresses physically? He is not a disembodied mind, watching the action. He is scraping away a fetus. He is doing this on purpose–for a reason he obviously feels is overriding.
Kathy,
I do not know how to answer this. Perhaps it is because of what you left out, ie “from the womb” in your description of the action. Maybe it is because I do not think he expresses any intention physically. (see my earlier quote from VS) I do feel he is doing this for an overriding purpose — to save the life of the mother — but I am guessing you think he has a different purpose.
Those differences mean that I draw different conclusions about the doctor’s action. A direct immediate effect is an empty uterus. The death of the child is not imo a direct effect of the object of the act, as object is defined by JP2 in VS. But that is what we have already said. What new information or insight are you providing?
The incident from Speed seems to me like it supports my position, not yours. If Daniels had died, would Reeves’ act be murder? I think not, and the same applies to “the scraping away of the fetus” — it is not an abortion unless the object was to kill the individual. Killing is different from murder.
Then your conclusion simply reasserts “Double effect does not apply” without addressing the issue beyond your reassertion of your position earlier in your note. I honestly do not see the point of such reassertion.
Jim P,
I addressed your concerns last night at 9:29.
I do not fully understand the processes in shock, but let me give a simplified version. Imagine two balloons on either end of a straw, each filled with air so they are equally full. If you were to let out air from one balloon, the pressure in both would fall. Instead add a third balloon, but no more air. The pressure inside the other balloons fall until all 3 are at equal, but lower pressure. If you try to keep balloon A inflated to certain pressure, you have to keep pushing the air out of the other balloon or balloons. The lower the pressure, the faster you have to push to keep the pressure up in Balloon A.
Shock is the lower pressure state, with blood unable to penetrate the lungs and other organs (Balloon A). One response to this is to constrict the blood vessels, ie make the straw thinner, but the resulting hypertension does not really help with the lower pressure in the organs. The heart pumps faster to keep the pressure up until it fails.
Adding the third balloon is like a pregnancy. Blood pressure falls and blood volume increases usually. In Phoenix, the heart was not able to keep up with the demands to the point that the mother’s organs and her child were not getting enough blood circulating. The obvious way to restore the mother to help is to remove “the third balloon” restoring it to the original system of two balloons on a straw, but the third balloon in this case was a child, and moral complexity.
This could be a complete misinterpretation of the medical facts, but it serves to show that an effect can be local and systemic, and is not aimed at healing the heart, but at restoring an equilibrium that is needed for the organs to survive. The most direct way of saving the mother’s life is not treatment of the heart, or of the other organs, but removal of the additional shock-inducing diversion of blood to the fetus.
Just because a pregnancy will kill you doesn’t mean in every case you can end it. And never ‘directly’. To believe otherwise is not Catholic. Yes?
“Pre-eclampsia: Etiology and Clinical Practice”, available for browsing on Amazon, seems to be reasonably accessible to the layperson (although it’s rather pricey). The section on the rates of eclampsia and pre-eclampsia occurrence in the US, based on a Lexus-Nexus search, along with some instances of litigation is particularly interesting. There appear to be no cases in which failure to act was accepted by the Courts as a reason for avoiding liability.
I suppose all that remains is for the bishop in charge of the diocese to have tort exposure when a hospital acts in accordance with his doctrinal edicts. My guess is that the bishops will either look the other way (as I suspect most do now) or hospitals will take the path of least resistance by shedding their Catholic identity as quietly as possible.
Recalling the parable of the blind men and the elephant, I wonder how Christians of other religions view such issues doctrinally. (Recognizing, of course, that some blind persons do not perceive their own blindness.)
It disturbs me to think that the threat of tort exposure would be the impetus toward revising medical policy at Catholic hospitals. If the moral position is correct, no risk of lawsuits or criminal prosecution for negligence to hospitals or hierarchy should be germane. Or is this too idealistic?
William F -
Catholic hospitals and doctors are simultaneously bound by the law of God, the law of the land, and, in a particularly immediate fashion, the laws of nature. A committed Catholic doctor who ignores the law of the land can be a committed Catholic as long as she wants but not likely a committed doctor. See your states physicians licensing board for details.
Removing the placenta would be morally the same as treating the mother’s heart condition by removing her heart.
Jim P,
I can’t make any sense of this. Are you saying the placenta is a vital organ of the baby? As I have noted several times, it strikes me as incorrect to consider the placenta a part of the baby. First, a placenta can live on after the baby is dead, continuing to produce the hormones of pregnancy, and the woman will think she is pregnant. How many vital organs of a person continue to live and function (without some kind of medical or scientific intervention) after a person dies. (It is untrue, by the way, that even hairy or nails continue to grow after death.) Second, a placenta and pregnancy sac can form after “conception” with no baby developing (look up “blighted ovum”). Third, after viability, the placenta is not necessary for the baby to survive, and at birth it is thrown away. What other “vital organ” can this be said of?
Jack Barry,
Let’s suppose that in this case the ethics board of St. Joseph ruled out a D&C and not so long after the pregnant patient died. If that was the correct moral decision (and I am not saying it was), the loss of one’s career as a medical professional should not influence the course of treatment, including a failure to do the one thing that might possibly save a pregnant patient’s life if that one thing is against the laws of God and nature.
I don’t know. Perhaps Catholic hospitals will have to stop providing care to pregnant patients.
Pregnancy seems to confound the theories and theologies of moral action that are brought into play.
Does anyone else think some major paradigm shifts are in order to make sense of these moral questions? Or do most think the intellectual tools are adequate in properly trained hands?
“Everyone agrees that direct killing of an innocent child is morally wrong. ”
David N,–
Sadly, I don’t agree. I think it must be argued that the killing of the child is no more wrong than killing a madman in self-defense. None of the arguments so far have been entirely satisfactory, I think. And the main reason is the do-no-evil-for-good principle. In fact the Church does admit exceptions to that principle (though it also denies that it does, sigh), and I think that the St. Jos. case is an conspicuous though tragic exception to that rule. It makes no sense for two to die when one can be saved. (I keep coming back to the overwhelming arithmetic of the case.) It makes what would otherwise be an evil act (killing the child) into a permissible one. Yes, there are problems with that position too.
Which brings me back to my general complaint of many, many years: Catholic moral theology’s basic principles need further consideration. As they stand they lead to too many contradictions not to mention confused faithful, as well as confused moral theologians, and, yes, bishops.
Sadly, I don’t agree. I think it must be argued that the killing of the child is no more wrong than killing a madman in self-defense.
Ann,
As I understand it, killing a madman in self-defense is not the killing of an innocent person. The madman is a “materially unjust aggressor.” The madman may be innocent in that he is not morally culpable for his actions, but he is not innocent in the sense that he is an unjust aggressor (materially).
The road to hell is paved with good intentions. That is why, in the passage from me quoted at the top of this comment, I alluded, not to intention, but to purpose and effect. As I wrote several days ago, the good intentions of the actors isn’t in question. But intention, by itself, isn’t sufficient to justify the procedure. Many horribly evil acts have been committed by persons who had good intentions. The purpose of the procedure also comes into play. This is where Lysaught’s object analysis is also deficient.
Jim P,
But intention can be all that makes the difference between a licit and indirect ending of a pregnancy and an illicit and direct. As I have written before, it used to be fairly common for a pregnant woman who did not want the baby and wanted to be sterilized to simply have a hysterectomy. That would be two illicit procedures in one — an abortion and a sterilization. Also, I can’t see how this would have been anything other than a direct abortion. In the case of cancer of the uterus, the operation would be identical, and yet it would not be a direct abortion and it would not be illicit sterilization.
Suppose a pregnant woman discovers she has cancer of the uterus and has available a number of potentially effective ways of dealing with the cancer, hysterectomy being just one among them. Suppose she chooses hysterectomy primarily because she does not want the baby but she does not reveal the reason for her choice to the surgeon. In this case, the surgeon performing the hysterectomy is not performing an abortion, but the woman is nevertheless having an abortion. It is only their intentions that make the procedure the surgeon is performing licit for him, but the procedure the woman is having illicit for her.
In every case where double-effect reasoning makes an action permissible, if the actor intends and wills what is described as the “unintended” effect, there is no double-effect justification, since the “foreseen but unintended” effect is actually intended.
If a doctor has a dying patient in great pain and gives the patient a massive does of painkiller approved by the ethics committee as having the possibly unintended side effect of hastening the patient’s death, if the doctor administering the painkiller says to himself, “I hope this finishes the guy off,” he is doing something wrong, and it depends entirely on his intention.
Good Lord — 456 comments at this posting.
Is that some kind of a dotCommonweal record???
“Pre-born life has become so undervalued as to make this decision a no-brainer for many, but how can this be?”
Because it is pre-born, not yet alive and living on its own. If one must choose (note I said “must”) between the unknown pre-born and a known, living, breathing born, I suspect most of us – if we are being honest – will choose the born.
I would, but I don’t have to face that emotional and moral challenge, either.
David, I realize you’re playing “devil’s advocate” with Ann, but I’m with her in her view that “killing [a] child is no more wrong than killing a mad-man in self-defense.” I’m not familiar with the philosophical or theological underpinnings, if any, of the concepts of ‘innocence’ and ‘materially unjust aggression’. If a kid is walking toward me with hand grenade and will not stop at my request/command/warning, that poor kid may be “innocent” but he represents a very real danger to my life. And I will stop him if necessary — even to the point of killing him!
I agree with the suggestion that the Phoenix case should be seen as a case of bona fide self-defense. All the parsing on double-effect is, for me, just mind-boggling.
To repeat what a few others have suggested: Time for the lawyers and theologians to return to their drawing boards and figure out how a bunch of us mere mortals were able to arrive at a commonsense and (what we believe to be a) morally acceptable solution in the Phoenix case.
Sometimes, I suspect, casuistry gets in the way of clear thinking.
“Pre-born life has become so undervalued as to make this decision a no-brainer for many, but how can this be?”
It needs must be said that the situation at issue is not a case of undervaluing life in the womb. Everyone involved wanted the fetus to become a baby, wanted it to live. This is not a case of callous disregard for life.
But doesn’t the value of pre-born life consist of its potential, potential to be born alive. I dare say it: an eleven week old fetus whose natural end is to be at best a twelve week old fetus has questionable value, hardly negligible value. But the value of living a little longer in the womb but never seeing the light of day must be weighed against the value of its life and the woman who carries it. That said, I’m not sure how one negotiates valuing individual lives vs. the sanctity of life in principle.
And each and every one of them is going into poor Grant’s inbox.
David N: I think this is exactly what Ann is arguing, that the fetus is a materially unjust aggressor. As with the attacking madman, (or the enemy soldier, for that case,) the attacker’s own state of mind or soul isn’t the key to the right of self-defense. The attack itself is unjustified. One gets to defend oneself from unjust attack, even if the attacker thinks s/he is doing God’s will. The fetus in this case means no harm because it is, as this point in development, incapable of the kind of thought that is required to intend anything. Yet the attack on the mother’s life is unjust.
@Jim P: D&C isn’t part of care for pulmonary hypertension in non-pregnant women, for the simple reason that non-pregnant women nearly never have placentas in their uteri. If, somehow, a woman managed to have a freak placenta (the type of case sited here of an placenta is very rare: it represents the aberrant growth of a doomed ovum or zygote,) without an organized fetus, and suffered from PH, of course it would be removed. Such cases would be vanishingly rare.
ISTM that pregnancy is a morally unique (but very common) situation in human experience. Hostage analogies fail because of the intrinsic connection of the embryo to the woman. If the magisterium wants to deny self-defense to pregnant women, (making their lives de facto less important than the lives of their fetuses throughout pregnancy,) we need stronger grounds than the mere assertion of EV. What would those grounds be?
Re: William F. (“major paradigm shifts”) and Anne O (“principles need further consideration”)
Separation in time was suggested as a factor of possible weight in judgments on the pregnancy issues. If applied to appeals to authority, it indicates that the recalled thinking of the Holy Office of 1902 is closer in time to the Spanish Inquisition and its views on life and death than to the present century. Some “truths du jour” are less than eternal. Holy Office authoritative thinking and decrees on the “auto-da-fe” are one example of change with time which acted directly to decrease the number of avoidable deaths. There is every reason to hope, if not believe, that openly, honestly rethinking the relevant principles and paradigms in light of present views on life and death and present knowledge of human biology would lead to helpful results. It should start with agreeing on the definitions of basic terms involved.
Perhaps we need to consider an evangelical perspective for all of this. If we are trying to win people over to Christ and his Church, what “good news” story do we tell about what happened in Phoenix or what should have happened in Phoenix?
Rather than being fine print in the Catholic contract, what if this was a bold headline. Extra! Extra! What would the headline be?
David N: I think this is exactly what Ann is arguing, that the fetus is a materially unjust aggressor.
Lisa,
If so, then Ann is making an argument well within Catholic thought, although the argument has generally not been accepted. That doesn’t necessarily make it wrong. Also, if it can’t be successfully argued that fetus in the case of, say, and ectopic pregnancy is a materially unjust aggressor, it seems to me that doesn’t preclude another argument along similar lines. The case of ectopic pregnancy and the case of danger to the mother in the case of pulmonary hypertension or new and unique cases. I don’t see why they must necessarily be shoehorned into some form that will create a direct parallel to old principles. From what I have read, Aquinas formulated the principe of double effect. Does that mean that there were insoluble ethical problems prior to the 13th century that had no solution? Did people just have to throw up their hands and wait for Aquinas to come along, or did they act on their best judgment? I don’t know when the concept of materially unjust aggressor came along, but certainly people being attacked by madmen before that time didn’t forego self-defense.
It seems to me saving the mother’s life in such situations is the obviously correct thing to do. Certain this is the case in Jewish though, which has no less reverence for life than Christian thought (although people have tried to argue with me when I have said that before). The problem seems to me that the Catholic Church has an overly rigid set of “rules,” that make it difficult to handle a truly new situation that arises. And this situation is much more difficult than others because statements like those of John Paul II quoted in Jim McK’s message of 12/28/2010 – 4:05 pm above set up unborn life as more worthy of protection than “post-born” life.
“As I understand it, killing a madman in self-defense is not the killing of an innocent person. The madman is a “materially unjust aggressor.” The madman may be innocent in that he is not morally culpable for his actions, but he is not innocent in the sense that he is an unjust aggressor (materially).”
David N. ==
I think that “materially unjust aggressor” is just some fancy linguistic footwork for “physical evil”. As I see the scholastics (and I consider myself one of them) too often we invent a new word or phraseand call it a solution to a problem, when what we should be doing is examining our most general principles to see where they can be improved.
It disturbs me to think that the threat of tort exposure would be the impetus toward revising medical policy at Catholic hospitals. If the moral position is correct, no risk of lawsuits or criminal prosecution for negligence to hospitals or hierarchy should be germane. Or is this too idealistic?
In my ideal world, the bishop would have to decide the matter a-priori (rather than after-the-fact) and bear tangible responsibility for the consequences of adherance to that decision (rather than have the opportunity to posture for the sake of appearances) — just as the commander of a naval ship is held accountable in the event of a collision.
” But what is the intention he expresses physically? ”
Kathy –
What the doctor is literally doing is separating the child from its mother. This action has a double effect — the death of the child and the removal of a threat to the mother’s life. The child is not being separated in order to kill it. It is being separated in order to remove the threat (itself) to the mother. There are two effects, not just one, and they are commensurate. So it is lawful to allow the death in order to preserve at least one life.
“Aquinas formulated the principe of double effect. Does that mean that there were insoluble ethical problems prior to the 13th century that had no solution? Did people just have to throw up their hands and wait for Aquinas to come along, or did they act on their best judgment?
. . .
” The problem seems to me that the Catholic Church has an overly rigid set of “rules,” that make it difficult to handle a truly new situation that arises.”
David N. –
Yes, Aquinas’ double-effect principle no doubt helped a lot. As to what he said about unsolvable problems, I’ve been told he offered this decision procedure for making very difficult moral judgments (judgments of conscience), though I’ve not found it explicitly in his works:
1. When in doubt about what to do or not do, consult what the Church teaches.
2. If Church teaching is not clearly right to you, then consult the theologians.
3. If the theologians disagree, consult someone/others who has/have had the same moral problem, e.g., a life-threatening pregnancy.
4. If those persons answers still give no clear answer, then do what you are inclined to do subjectively. (I think he was probably relying here on feelings — what he called “connatural knowledge”, and that’s another whole problem in Aquinas.)
Aquinas wasn’t a totally hard-hearted authoritarian who did not appreciate that moral problems can be terribly difficult to solve. He even says that the further away we get from general principles and the more we get into actual situations, the more unsure our moral judgements become. On the other hand, he was in some ways a total absolutist. Sigh.
Just remember what Benedict XVIII says: above all, do what you think is right.
About who should make the decision of what to do or not do, it seems to me the conflict, being between a medical judgment and a moral judgment, that the moral authority (theoretically the bishop ?) ought to take precedence. But I suspect that, unless the Catholic hospitals advertise themselves clearly as under the ultimate moral authority of the bishops, that they will indeed be subject to the consequences of civil law. And maybe if they so advertise, they will still be held legally accountable for malpractice.
Should it be this way? That involves the other great problem for Catholics — freedom of religion under the Constitution.
But that’s a whole other thread. OR sequence of threads. Maybe we could talk about is, say, along about July? (My brain aches.)
The following comment on the concept of an “unjust aggressor” is from a 1970 article by William J. Kenealy, S. J., published by the Natural Law Institute. The article is entitled “Abortion: A Human Problem”·
Like the sorcerer (or the apprentice), one seeks the magic words needed to bring about the desired result.
“And aggression must consist at least in the exercise of some volitional or active force directed by the aggressor against the life to be defended. But the unborn child directs no volitional or active force against the life of the pregnant woman. The unborn child simply exists and grows, passively and without volition, in the womb of its mother. To say that it is an aggressor. by reason of its physical existence and natural growth in the place intended for its existence and growth. is to do violence to meaningful language.”
Antonio ==
Notice that Kenealy give no reason *why* the aggressor must be exercising a “volitional or active force”. Dogs are aggressive but they have no volition. Perhaps he supports this claim somewhere else, but the text you supply doesn’t do it.
Further, the child *does* exercise an active force on the mother’s body, by its exchanges with her through the placenta it stresses out her vital functions. Further, to call such child’s growth a “natural” one is hardly accurate — is is in an unnatural, overly-dependent association with its mother which is no more natural than the presence of a fetus in a fallopian tube. A pregnancy that kills both mother and child is by no conceivable definition “a natural” one.
Keneally’s argument is the kind that make women really mad — he overlooks the most obvious facts — mother and child are dying, for God’s sake.
These inaccuracies get Kneally nowhere logically speaking..
Notice that Kenealy give no reason *why* the aggressor must be exercising a “volitional or active force”. Dogs are aggressive but they have no volition. Perhaps he supports this claim somewhere else, but the text you supply doesn’t do it.
I agree. I cited the article as an example of the meaning supporters of Catholic doctrine usually attach to the term.
FYI: The author’s background and the publication history of the article were given as follows:
“Director. National Office of The Jesuit Social Apostolate; A.B .• M.A., Ph.D .•
S.T.L.. LL.B. This article represents a slightly revised version of.a paper delivered by the
author before the Thirteenth Annual Natural Law Institute on April 9, 1970 at Loyola
University. New Orleans, Louisiana.”
To say that it is an aggressor. by reason of its physical existence and natural growth in the place intended for its existence and growth. is to do violence to meaningful language.
We do not like violence in the world, yet God’s world is full of volcanos and tornados and other natural violence. And just as those forces violently collide with human structures, contact with God does violence with the structures of language.
It would be nice if mother and child coexisted peacefully, but that does not always happen. Sometimes they are in competition for scarce resources, for nourishing blood in this instance or for for change in the case of birth. That this competition is rooted in our most basic instincts, and not willed, chosen, active etc. does not make it any less threatening in some instances. It is natural, and sometimes manifests the violence of nature.
Situations like this do violence to our language, to our ethics, our rationality, as these 400+ notes have shown. We should not deny that violence, and try to pretend there is some happy “good” solution. There is no perfect solution when God imposes an unbearable burden on someone who is too weak.
There are a variety of options for facing this tragedy. We can choose to avoid all evil acts. Some would choose in favor of life, of preserving what ever life can be preserved. Whatever choice is made, we remember it is in the face of the whirlwind, the unimaginable force of an unmanageable God. We are here to live with that whirlwind, not to preserve our ideas about the innocence of children or the harmony between mother and fetus.
You make a major point, Jim McK. Maybe ethicists should pay more attention to the violence in nature itself. Scary.
“To say that it is an aggressor. by reason of its physical existence and natural growth in the place intended for its existence and growth. is to do violence to meaningful language”
I accept a principle of self-defense, but I agree that the language of aggressor is not a helpful characterization of natural growth processes.
Kenealey’s statement raises more questions than it answers. Why doesn’t a non-innocent human being have the same right of defense as an innocent human being? Is this early punishment for past sins? Who is to judge the innocence, when, and by what criteria in practice? If experts afterwards, for what purpose?
The unborn child certainly lacks volition but it hardly “exists and grows, passively”, either metabolically or, as mothers will attest, kinetically. If the oxygen it consumes, combined with the mother’s consumption, creates a total demand which the mother’s system is incapable of meeting, it is contributing to the death of itself or both, hardly a passive role.
“By reason of its physical existence and natural growth in the place intended for its existence and growth”, meaningful language may call it a parasite. May a lethal parasite be removed to protect life?
Jim McK spoke words of wisdom. They help explain why notable humility in the face of ignorance is often one of the marks of good experienced surgeons.
Those who have persevered thus far may feel that the discussion is just beginning. There’s more fuel for both sides in this instructive and short (12 minute) discussion covering some of the same points mentioned above: greater good, double effect, thought experiments re abortion and torture. The site also links to Robert George’s short essay on reasoning vs feelings and emotion in moral action.
http://bloggingheads.tv/diavlogs/29451
Go to the segment labelled “Bob tries to convince Robby to kill a child for the greater good.” It begins at 40:26 and goes to 52:55.
Although a lot of the George-Wright discussion involves sorites arguments against utilitarianism. Towards the end though (around the 57 minute mark), Professor George gives the example of shooting down an aircraft headed towards the Twin Towers. He concludes that the death of the passengers is an unwanted and unavoidable side effect, therefore the act is licit.
Here, the goal is not to depict objective reality (although the disputants usually claim otherwise) but to persuade others. Thus, the way one chooses to describe what’s going on is literally decisive.
(BTW: One thing that troubled me in the converstation was the focus on actions rather than choices . I believe it’s a hairsplitting but useful distinction when weighing moral issues.)
Jim McK:
“We do not like violence in the world, yet God’s world is full of volcanos and tornados and other natural violence. And just as those forces violently collide with human structures, contact with God does violence with the structures of language…
Whatever choice is made, we remember it is in the face of the whirlwind, the unimaginable force of an unmanageable God. We are here to live with that whirlwind, not to preserve our ideas about the innocence of children or the harmony between mother and fetus.” (see if my effort at italics works)
Yes, yes, yes; cogent, wise words! Much food for long thought and pondering…like Mary pondering in her heart in today’s Gospel. I see no neat, perfectly reasoned objective solutions anywhere.
Perhaps there are no choices that do not do violence in some way to the usual theological, ethical, philosophical — you name it — frameworks. We must learn how to live creatively with such contradictions/ambiguity, no?
There’s an irony, I think, in that every discussion I’ve been in with pro-lifers over criminalizing abortion eventually gets to the question of what the pro-lifers would propose as the criminal penalty for women who procure abortions. The pro-lifers accuse those who raise this question of engaging in “scare tactics,” and say they do not want to punish women who have abortions. They claim that women are the victims of abortion, and that generally women are pressured into having abortions by people like parents or boyfriends, or that women are pressured by circumstances to have abortions for fear of having to drop out of school, interrupt their careers, and so on.
On the matter of life-threatening pregnancies, thought, there has been little or no excuse making on the part of pro-lifers for the pregnant women involved, who are obliged (they claim) to choose death. It almost seems like pro-lifers are more sympathetic to women who have elective abortions than those who have life-saving therapeutic abortions.
Carolyn – agree with both of you. The problem with Kenealy’s work if that it starts with an “outdated” definition of natural law – one that no longer reflects current scientific or even philosophical agreement. His research is consistent with that older natural law definition but it limps badly in terms of today’s realities.
As many moral theologians have consistently said since VII, the church’s understanding of natural law needs to be updated. Then, a better natural law understanding can be used to reconsider today’s challenges.
There is no certainity in this area; as many wise church leaders have said, in that situation, the moral decisions need to be between the faithful and their pastor. Trying to write a new moral code that anticipates every likely moral situation merely returns us to the “old” manualist period of moral theology. Do we really want to go there?
Bill deH. –
Rather than giving the phrase “natural law” a new definition, how about just inventing a new phrase for your new theory so the rest of us won’t be confused. “Natural law” goes all the way back to the pre-Socratics and is weighted down with so many, many variant meanings that it’s already very confusing. In fact, in my opinion, that is one of the reasons that it stopped being a force in ethics — people were never really sure which theory was being propounded.
“On the matter of life-threatening pregnancies, thought, there has been little or no excuse making on the part of pro-lifers for the pregnant women involved, who are obliged (they claim) to choose death. It almost seems like pro-lifers are more sympathetic to women who have elective abortions than those who have life-saving therapeutic abortions.”
Martyr or murderer–hardly a happy choice.
Plus, so many harmful readings of the Natural Law had been understood to be intrinsic to the method. We’d forgotten that Natural Law is a process of reason, not a set of “objective” observations, as though such were deemed possible in this post-modern age. So Natural Law upheld the “natural” inferiority of women, for example. More recent ethics has shifted to language of “human person” to scour off the accumulated rust of years of misuse or obsolete use of “human nature.” So Louis Janssens speaks of “the human person adequately considered” to be the referent for moral reasoning.
But some feminists (e.g. Lisa Cahill of Boston College,) have reclaimed natural law thinking as an ally. And of course Jean Porter’s recent work helps update the notion. Natural law thinking aims not at eternal unchangeable truths but rests on claims about human nature that may themselves be argued. So we’re back to the basic “human reason reflecting on human nature to glean moral insight.”
David,
I think you’re discussing apples and oranges. The question at hand is what is to be done in the case of a life-threatening pregnancy. That is entirely different from the question of whether a woman who is post-abortion should be prosecuted. In all of our thought experiments we have been looking forward, not backward. No one (to my recollection) has suggested that the woman involved should be punished.
To echo David, I think the strategic yoking (in some contexts) and separation (in others) of the respective agency of pregnant patient and her physician is very much germane to the discussion.
If a person could defend herself from a mortal threat without expert, highly technical assistance from others, the debate would have a substantially different character.
Does a woman’s agency extend to her doctors? Are ‘their hands’ effectively her hands in this case?
The question at hand is what is to be done in the case of a life-threatening pregnancy.
Kathy,
This thread has not been limited to a hypothetical problem in moral theology. Much of it has dealt with an actual case involving real people, any of whom (including the mother herself) may very well be reading what we write. You never know who’s reading dotCommonweal. I made an unkind remark about a well known author here once and was taken aback to find an objection from him in my private e-mail.
In my opinion, commenters on dotCommonweal are among the most sensitive and thoughtful, so what I am saying applies much more to other discussions I have read than to this amazingly extended one here. For example, someone over on Vox-Nova said, “Allowing oneself to die rather than raising oneself above the common good may be a difficult choice, but it is not heroic. It is simply the demand of justice.” Fr. John Ehrich, STL Medical Ethics Director, Diocese of Phoenix, issued a statement that said in part:
It does seem to me that the pro-life movement justifies and forgives women who have elective abortions, and it is more than willing to do so in advance. As a general rule, the more militantly anti-abortion, the more insistent that women who have abortions are victims. To propose anti-abortion laws that in no way penalize women who have abortions on the grounds that they will, in the future, make their decisions under pressure and deserve compassion not punishment is, to me, difficult to harmonize with making statements that the mother in Phoenix acted against “the simple demand of justice” and will “have to live the rest of her existence knowing she had her child killed.”
Lisa –
Interesting — you see natural law theory as a method. Insofar as it is a theory of using “practical reason”, I think you’re right. But I don’t think that’s all it is. I’m with the ancients and oldies who try to ground ethics in a (limited and revisable) body of knowledge of *what people are and what we automatically tend to for fulfillment”. Of course, they disagreed wildly in WHAT we are — they included everyone from Hobbes who thought people are born horrible to Jefferson who was inordinately optimistic.
These theories see ethics as grounded in facts — except the ancients *also* sometimes talk as if ethics is even more basically grounded in desires. Some contemporary Catholic natural law theorists (e.g., Finnis) don’t ground ethics in facts at all. How anybody can call them Thomists I’ll never know.
I guess we need a number of new names for these various new systems.
I”ve decided that my New Year’s resolution is to learn more natural law theories. But I’m starting with the generally acknowledged master, Aquinas.
Happy New Year all!
On the matter of life-threatening pregnancies…there has been little or no excuse making on the part of pro-lifers for the pregnant women involved, who are obliged (they claim) to choose death. It almost seems like pro-lifers are more sympathetic to women who have elective abortions than those who have life-saving therapeutic abortions.
This assessment seems to veer pretty far in the direction of the political. Anyhow, it was my impression that pro-lifers are not in lock-step over this issue. Although perhaps that merely reflects expedience.
In any event, according to Time magazine, even Ireland with its stringent anti-abortion laws allows termination of the pregnancy “in cases of cervical cancer, pre-eclampsia and ectopic pregnancy”.
See: http://www.time.com/time/world/article/0,8599,2037804,00.html#ixzz19pXvIezm
I cringe to see a statement like this:
“It is not better for a woman to have to live the rest of her existence knowing that she had her child killed because her pregnancy was high risk.”
As if we are talking about some callous computation where the Phoenix mother did not by every measure in fact face certain death (spare me the ultra-hairsplitting 100% accuracy argument in this case)…
As if there were any choice that did not mean death for the fetus…
As if her decision were based on selfishness…
This is just plain cruel, and maybe the mother is indeed reading this thread. May she not be burdened by the moral calculus of Fr. John Ehrich, STL Medical Ethics Director, Diocese of Phoenix, but find strength in God’s compassion and love, raising her four children in good health, and at peace with both herself and God.
I wonder if the same emotional burden was visited on women with ectopic pregnancy from 1902 to 1933.
To propose anti-abortion laws that in no way penalize women who have abortions on the grounds that they will, in the future, make their decisions under pressure and deserve compassion not punishment is, to me, difficult to harmonize with making statements that the mother in Phoenix acted against “the simple demand of justice” and will “have to live the rest of her existence knowing she had her child killed.”
Such a decision may be inconsistent but it is a politically shrewd one. Either juries would undermine the law by not convicting mothers charged with such crimes or there would be a major public outcry if women get convicted and punished. Either way, it’s political poison.
Carolyn D -
Earning the nine degrees held by Fathers Kenealy and Ehrich cannot teach what sleeping every night for nine months beside a pregnant woman can teach then and in the years that follow about life and God’s creation. There’s no grain to be harvested from barren fields as the their quotes above show.
Carolyn Disco said: “As if we are talking about some callous computation where the Phoenix mother did not by every measure in fact face certain death (spare me the ultra-hairsplitting 100% accuracy argument in this case)…”
Thank you. Medical science is only as scientific as it can be, and must involve decisions based on likelihoods and on tested, verified case history. Medicine is not in the business of playing the lottery, as such would be malpractice. We are required by God’s law to operate to the maximum within finite knowledge and within the confines of time and space, without the advantage of foresight, let alone of vision into the various souls of hospital patients. The people opposing the Phoenix decision prefer paralysis to decision-making, but medicine is all about decision-making — a moment at a time, in real time, a day at a time, etc. (What do I know now? and what have I known about these scenarios in the past, that lead me to make the following judgments?)
Not to decide is to decide, and to deny that is to deceive oneself.
Carolyn also said: “As if her decision were based on selfishness…….This is just plain cruel, and maybe the mother is indeed reading this thread. May she not be burdened by the moral calculus of Fr. John Ehrich, STL Medical Ethics Director, Diocese of Phoenix, but find strength in God’s compassion and love, raising her four children in good health, and at peace with both herself and God.”
I find enormous hypocrisy in the so-called ‘pro-life’ movement. It is, as familiar as I am with it, spiked with cruelty, especially in the not-so-subtle hopeful predictions that so-and-so mother will be ‘bound by guilt her entire life,’ ‘never set free,’ ‘be permanently not at peace.’ Etc. (They wish!) This kind of emotional manipulation has nothing of Christian charity in it, and is probably the main reason why I will never join their ranks.
To maximize the agency of medical personnel and minimize that of pregnant women is definitely a political strategy. People (juries, voters) would be more willing to penalize and even prosecute a provider of an abortion than a procurer. It’s a losing strategy for pro-life activists to speak of jail for the patient. It does contribute to cognitive dissonance when someone is at once identified as a victim and as an exemplar of selfishness. The pro-life activists will need to get their rhetorical ducks in a row.
A woman who dies rather than consent to an abortion would be a perfect martyr for the pro-life cause. What better testimony? So I can imagine some level of resentment, however subtly expressed, when someone who might have occupied that role chooses not to embrace it.
William and David,
Perhaps people worry too much about “cognitive dissonance.” It’s not a rhetorical device, you know. Everyone deserves compassion and care.
William – The martyr exists.
In May 2004, John Paul II canonized Saint Gianna Beretta Molla, an Italian pediatrician and mother of three young children. In 1962, she refused recommended abortion and hysterectomy while in a troubled pregnancy with her 4th child. Gianna died from the after-effects of Caesarean section, and the infant survived. In 1973, Pope Paul Vi praised her “conscious immolation.”
See Gianna Beretta Molla (1922–1962) at Vatican web site and Wikipedia.
http://www.vatican.va/news_services/liturgy/saints/ns_lit_doc_20040516_beretta-molla_en.html
“A woman who dies rather than consent to an abortion would be a perfect martyr for the pro-life cause. What better testimony? So I can imagine some level of resentment, however subtly expressed, when someone who might have occupied that role chooses not to embrace it.”
I was going to mention Gianna Beretta Molla except that Jack Barry beat me to it. And William, it is not subtly expressed by “pro-lifers” (big quotes) –the resentment that all women do not choose that route. It is directly expressed. The only problem is that the Church has said that women are NOT obligated to make Gianna’s choice — that she went to a level of heroism that is not a moral requirement. Yet the rad-trads continually misrepresent the Church’s stand on this, and instead condemn all women who do not choose passive suicide, or as the pope put it, “conscious immolation.”
It is ‘subtly’ expressed when the attention is placed on the doctor’s physical action and not the intension of the mother (to save her own life) who authorizes that doctor. But you will here few defenders of the bishop say outright that a dying patient has the moral obligation to refuse a D&C in these circumstances. Or that a doctor has a moral obligation to over-ride the (talking) patient’s directives. Instead focus on the knife.
Everyone deserves compassion and care.
Kathy,
What worries me is that Bishop Olmsted is taking it upon himself to define “care.” If I understand the rules under which many like Bishop Olmsted want Catholic hospitals to operate, doctors and ethics committees who know how to save the life of a patient such as the one we have been discussing would not even be permitted to tell her what her options were. They would not even be allowed to arrange for such a patient to transfer to another hospital were there time. The bishop wants to take it upon himself to make life-and-death decisions without the patients being allowed to give informed consent.
It seems clear to me that everyone involved in the Phoenix case believed (and still believes) they were doing something licit to save a life. What about their rights of conscience?
There is an old cliché about hard cases making bad law. The bishop chose to wage a very public battle over a very hard case and declare his word law. I think it is quite possible that even if the consensus of ethicists and moral theologians doesn’t back St. Joseph’s, the question will remain open indefinitely. I think it was an error to make this case the deciding factor as to whether a hospital could be Catholic or not.
“If I understand the rules under which many like Bishop Olmsted want Catholic hospitals to operate, doctors and ethics committees who know how to save the life of a patient such as the one we have been discussing would not even be permitted to tell her what her options were.”
David is spot on here and this is the essence of the problem in the clash between morality (hammer) and ethics (anvil). No hospital can operate under Olmsted’s paradigm. The hammer must lose. This is a hard truth some refuse to see to the weakening of the Church’s credibility and moral authority. This was a bad horse to bet so much upon.
David,
The bishop did not define “care.” I would think that doctors routinely care for patients in ways that would completely escape a (medical) layman.
What the bishop did was this: he defined an immoral act.
The doctors could and should have done every good act possible to save the woman, and thus her child with her. Everything good should have been done. But nothing bad. Certainly nothing this bad.
“The doctors could and should have done every good act possible to save the woman, and thus her child with her. Everything good should have been done. But nothing bad. Certainly nothing this bad.”
Then she should have been let to die, a willing or reluctant martyr.
“What the bishop did was this: he defined an immoral act.”
Can we stipulate that this very bad immoral act was impermissible and against God’s will even if–taking medical personnel out of the equation–the woman were able to perform it upon herself? That it doesn’t matter which human person was performing the act because the act itself is unconscionable?
This seems an important matter to be clear about.
Of course it would still have been a direct killing if the mother herself did the same act.
Medical science doesn’t have to work miracles. People die from illnesses. Doctors must do everything, diligently, to save a patient. But they do not have to do evil acts. They do not have to speed up the dying processes of potential organ donors, for example, even if this would save lives.
“Of course it would still have been a direct killing if the mother herself did the same act.”
But would it have been morally permissible or impermissible for a woman to directly kill her own fetus if doing so would save her own life (because the pregnancy itself was the immediate threat to her own life) and there were no conceivable remedies beyond performing this act if she wish to remain alive? Must she choose between grave sin and the grave?
Must she refrain from doing something in her power against an immediate moral threat?
If you think the answer is “yes, she must refrain from doing so, ” then please say so.
William,
Of course she cannot kill the child.
Thanks for the clarity, Kathy.
The bishop convicted himself with his prepared statement of Dec 21 declaring “the baby was healthy and there were no problems with the pregnancy; the mother had a disease that needed to be treated.” Culpable ignorance plays a role somewhere in moral calculations, as I recall. That statement justifying his conclusion is an excellent example of culpable ignorance. A fetus whose sole, entire life support is collapsing can hardly be considered healthy. A declaration of no problems with that pregnancy is inexplicable. (No one has questioned that the mother had a disease.)
http://ncrnews.org/documents/olmsted_statement_dec21_2010.pdf
Saint Gianna chose a path on which she was willing to abandon her 3 living children, ages 3 to 6, for the possibility, not guaranteed, of saving a fourth. As a trained medical doctor who had been pregnant six times in six years, she can hardly be viewed as inadequately informed. Notwithstanding the praise of multiple popes, one might question how she fit respect for life into her scale of values. Evidently, existing lives, to which she had a fundamental, God-given, maternal obligation by most views, were relatively unimportant. Simplifying the theoretical arguments post-facto doesn’t simplify the reality of multiple, simultaneous, conflicting factors acting in that case as in Phoenix. Selectively ignoring inconvenient ones might be viewed as professional negligence, at least in ethical medicine.
Jack Barry, thank you for your last post. I happen to agree with the rhetorical question you posted. As the mother of two (and who lost a 3rd to spontaneous abortion), my current motherhood has always been my controlling, instinctive orientation. Consciously risking my existence and place in my daughters’ lives is something that I would find unimaginably cruel & cavalier. There have been occasions when I was concerned about some medical outcomes of my own, and my terror was always for their lives (my disappearance). Were I pregnant with still another, which threatened my existence, I would consider it my primary sacred duty to preserve my own, for my existing born children.
But there’s a broader issue that your rhetorical suggestions, my own reaction to motherhood, and William Fitzgerald’s recent hypotheticals raise: that is of sheer physical instinct. (Bringing the issue back to the “awful” forces of nature alluded to earlier.) There have been a few times in my life when I thought I was near death (struggling to stay alive). One is desperate. One is not thinking like a celibate male theologian — intellectualizing the bloody hell out of an emergency. One has, or at least most people have, a primary reflex to Stay Alive. The survival instinct is paramount, and guess Who put it there? The same person who created life, is the author of life. The idea that some cold, disembodied godhead is remotely judging & expecting the humanity He created to suspend its humanity for some invisible celestial purpose is just a savage & primitive concept of divinity, one rooted not in love but in terrified subservience. God created humanity but hates our human instincts and condemns us for them? Think about it.
The contradictions highlighted by this case just pile on and on. Catholic philosophy declares God to be One. He is not some sick schizophrenic who is not sure if he loves or hates humanity — asking us to employ the force of will at the one moment when we are least likely to be able to (when the adrenaline He created rushes in to order our choices when our existence is most threatened).
I have no doubt that Gianna is in heaven, and probaby bypassed purgatory. Why? Not “because” she engaged in ‘conscious immolation,’ but because she was convinced that she was making a sacrificial choice, regardless of whether I or anyone else would have made that same choice, should be required to make that choice, etc. For her this was a loving act, oriented to what she believed God wanted. Undoubtedly he blessed her for that and embraced her in His bosom. Our faith is just that: faith. No matter how ‘convinced’ we are, we are acting with limited understanding.
What the bishop did was this: he defined an immoral act.
Kathy,
I disagree. The analysis of the events at St. Joseph hospital by M. Therese Lysaught made many complex points, and all Bishop Olmsted did was say he disagreed with her conclusions and in the Archdiocese of Phoenix, he’s the “decider.”
He has clarified the issues raised by the St. Joseph’s doctors and ethicists not at all, he has said next to nothing about the analysis of M. Therese Lysaught, and he is insisting that those involve agree with him based not on any arguments about moral theology, but based on the fact that he is the bishop. Were St. Joseph’s Hospital to encounter a similar medical emergency in the future, he wants them to follow not their own consciences, but his dictates. The very least he owes them (and everyone following this controversy) is a detailed analysis of all the issues involved and an explanation of why he believes himself to be right and St. Joseph’s Hospital wrong.
David,
By “defined,” I mean that he said definitively that this was an abortion, an immoral act. In the end, yes, he is the decider. Yet note that the letter mentions months of dialogue. Presumably the moral questions have been discussed again and again. The bishop still judges that an abortion took place. The CHW continues to advance dissenting arguments on the subject.
The bishop’s letter suggests that CHW thinks that there is no decider and no final decision. Under such a conception, the debate could continue with no resolution and no need for conversion. The bishop disagrees with this, invoking apostolic authority.
So there are two points that the bishop is making: 1) an abortion took place, and 2) he has the authority to exercise apostolic judgment in matters of faith and morals in his diocese.
“So there are two points that the bishop is making: 1) an abortion took place, and 2) he has the authority to exercise apostolic judgment in matters of faith and morals in his diocese.”
Kathy –
Where is it anywhere written that a bishop exercises “apostolic judgment” when he decides on the particularities and which moral principles are relevant in an actual case?
The way I learned it, it is for the bishops to teach general principles, not to claim infallibility in applying them in actual circumstances. .
” Doctors must do everything, diligently, to save a patient. But they do not have to do evil acts.”
Kathy –
You over-simplify. Doctors do indeed do *physically* evil acts all the time — they cut off legs, they cause pain, etc. But not all physical evils are *moral* evils. The issue in this case is whether or not a morally evil act occurred. You still seem to think that if an act involves a physical evil (at least in the case of abortion) that it is necessarily a *moral* evil.
Really, you must maintain the distinction between the two kinds of evil if the discussion is ever to make progress.
Ann,
I don’t think of an amputation as evil. If you would like to introduce (or perhaps re-introduce, if this was done before) the category of “physically evil” that is fine, but I’m not sure I would use it for any therepeutic act.
In the case at hand, the death of the woman and of the child due to illness would be “physical evils,” I think. But they would not be moral evils. Direct killing of the innocent child was both a physical and moral evil.
So to rephrase the statement you’ve quoted: “Doctors must do everything, diligently, to prevent physical evils, but they do not and should not do evil acts.”
‘ Doctors must do everything, diligently, to save a patient. But they do not have to do evil acts”
Kathy –
OK, they don’t have to do *morally* acts. So the question is: was this killing of the child (directly or indirectly) a morally evil act?
You say it was because it was a “direct” killing. (lDirect killing of the innocent child was both a physical and moral evil.”) The questions now are: 1) what do you mean by “direct” killing? and 2) why is a direct killing as opposed to an indirect killing morally evil?
(Ultimately the question is going to be: can we ever do evil for the sake of a good — even if the evil is one which in other circumstances is morally wrong.) But that can wait. Sigh.)
So there are two points that the bishop is making: 1) an abortion took place, and 2) he has the authority to exercise apostolic judgment in matters of faith and morals in his diocese.
Kathy,
So if a hospital located in another diocese does the exact same thing, and the bishop of that diocese accepts the reasoning of Martin Rhonheimer, Germain Grisez, and M. Therese Lysaught, in this other diocese an abortion did not take place, and the hospital has every right to continue with their interpretation of Catholic medical directives, because their bishop is the “decider” for them. Is that correct? Since there is no high-level, authoritative document that defines direct, what is a direct abortion in one diocese may be a “non-direct” abortion in another. Certainly it is not only on this issue that two bishops in communion with Rome may have different opinions.
The direct vs. indirect distinction is not illuminative. It would be as if a newborn killed with a butcher knife indoors (direct) were a different moral act from wrapping that baby in a blanket and setting outside in the cold to die. To me this distinction is analogous to a D&C vs a salpingectomy (a baby ‘wrapped’ in a fallopian tube). In both cases, a pregnancy is terminated, and a baby is aborted, in both cases a medical abnormality places the mother at grave risk and that risk is directly and substantially lessened by the surgical procedure.
It is merely a clever moral nicety to claim that a salpingectomy escapes the absolute prohibition on the taking of a life in utero that Kathy has continually asserted. It defies any standards of common sense to maintain that if a fetus finds its way into a fallopian tube a pregnant woman can hope to live whereas a ‘normal’ but no less life destroying pregnancy consigns her to death. What am I failing to understand??
This argument, I dare say, is an intellectual and moral embarrassment. It wins no converts to Christ because though it be a hard teaching it takes a courageous stand on the sanctity of life in a cynical age. It is more cultic than Catholic. I find it profoundly depressing.
“It is merely a clever moral nicety to claim that a . . . ”
Come on, William, Kathy obviously sees the distinction as relevant. I don’t, but she does. Let’s consider it without calling it names.
“It is merely a clever moral nicety to claim that a . . . ”
Come on, William, Kathy obviously sees the distinction as relevant. I don’t, but she does. Let’s consider it without calling it names.
OK, I sincerely apologize for my intemperate speech. I can’t understand this distinction on which so much depends.
Before Kathy even answers our question, I have to admit that I think that emotionally, at least, the idea of killing anyone directly seems to be one of the cases where the emotion is highly relevant. Normal people in normal circumstances are repelled by any such action, whether abortion or war or whatever. And that feeling has undoubtedly been useful for the preservation of the species, as the evolutionary psychologists would undoubtedly tell us — hating to kill people helps keep us from doing so.
But, again, that is only an argument from emotion, shall we call it. Further, in such cases as this one there are counter-emotions on the other side. Which makes it a terribly hard case, both emotionally and intellectually.
So there are two points that the bishop is making: 1) an abortion took place, and 2) he has the authority to exercise apostolic judgment in matters of faith and morals in his diocese.
But to do so, the bishop chose to play fast and loose with the facts while taking a gratuitous shot at the hospital staff. Here’s the money quote (emphasis added):
Does anyone believe ‘there were no problems with the pregnancy’ or that the removal of placenta and 11-week fetus was not intended to treat the disease?
Just a note to say that I’ve been impressed with the tone of this conversation, which isn’t easy when the disagreements are so serious and momentous. So thanks to everyone.
More later.
In my opinion, the bishop chose to distort the facts in order to soft-pedal or hide the implications of official Catholic doctrine. I.e., There is no recourse in such situations but to do nothing and accept the death of both mother and child.
Well, Kathy, if I gave offense, I do regret it. I have valued your even-handed tone throughout.
I would have had much more respect for the bishop if he had been as forthright as Kathy here has been about the hard, but necessary truth as he sees it, speaking for the Church, sees it. His misrepresentation of the situation does a disservice to everyone.
Since there is no high-level, authoritative document that defines direct, what is a direct abortion in one diocese may be a “non-direct” abortion in another. Certainly it is not only on this issue that two bishops in communion with Rome may have different opinions.
I mentioned earlier that Ireland, which has the most stringent anti-abortion legislation in the EU or North America, allows abortion in the case we’ve been discussing. It would be interesting to know if any Irish bishop has ever sanctioned a hospital for this reason.
William,
I’m not offended. It’s been a good conversation.
Q: In Bouscaren’s justification for salpingectomy, was the viability of the pregnancy a factor?
“To propose anti-abortion laws that in no way penalize women who have abortions on the grounds that they will, in the future, make their decisions under pressure and deserve compassion not punishment ” David N.
It would be difficult to find any “pro-life” politician, no matter how strident, who would advocate that women who have abortions should be sanctioned in any way. How paternalistic is that for goodness sake?
No wonder we have a feminist movement.
It isn’t the little lady’s fault, it is those nasty doctors and her husband that made her do it.
William, your sentiments echo mine from an earlier thread, which I paraphrase here:
I reiterate the illustrative example from a horrible real-life local case: an estranged father hired a hit man to kill his ex-wife and ventilator dependent son, in order to get control of a very large legal settlement that supported the son’s vast medical needs. The hit man shot the wife and unplugged the ventilator — I don’t think the prosecutor detained himself for even a nanosecond in considering whether the hit man wasn’t culpable for the son’s death because he didn’t smother the boy using his own hands. That’s about the same distinction that I find between what happened in Phoenix and a salpingectomy. It is an unfathomable fixation on physical means without regard to the overall context in which the actions are taking place, and the ultimate goal and effect of those actions. Obviously, I can understand the “difference” between cutting out a tube and infusing it with methotrexate — but I fail to see the moral significance of that difference, or the difference between the salpingectomy and the d&c that the physicians in Phoenix performed, when all three examples are viewed in light of the usual criteria we apply to evaluate the morality and intention of acts.
And honestly, if I were the hospital or the physicians in that case in Phoenix, I would seriously consider suing the Bishop for defamation for suggesting that I performed an abortion as an alternative (“instead of”) treating this woman through other means.
The sympathy of the pro-life movement for women who have abortions is laudable. The problem is that what certain pro-lifers are saying is that the pressure to abort is so overwhelming in a great many cases that the women who choose to abort cannot be reasonably expected to resist. The proposed solution, however, is not to remove the pressure, but to try to make it impossible for the woman under pressure to obtain an abortion. So to modify the old cliché somewhat, certain pro-lifers realize that a woman with an unwanted pregnancy is between a rock and an abortion, and their solution is to remove the possibility of abortion so that the woman is between a rock and a hard place. Or in some cases, such as the one we are discussing, the problem is “solved” not by leaving the woman between a rock and a hard place, but by letting her die.
It is easy to assume these pro-lifers are taking a political expedient position, and I think it is a politically expedient position if you are trying to criminalize abortion to give assurances that women will not be prosecuted. But I don’t think it is warranted to claim that these pro-lifers are taking the position because it is politically expedient. They seem to genuinely believe that women are victims and should not be held responsible for procuring abortions. It seems extraordinarily inconsistent to me, particularly because it is the exact opposite position of canon law. In canon law, the offense is procuring the abortion. The woman is the one who commits the offense, and all others involved (including the abortionist) are excommunicated because they are accomplices.
David,
As you know I’m one of those who believes that abortion should be illegal, but that the woman should ordinarily not be prosecuted for procuring one.
My reasoning for this (this came up in a thread a couple of years ago) is that the woman procuring an abortion is ordinarily not deliberately killing a human person. She is removing a problem from her life–a problem that is serious. At the same time, it is a problem that is hidden. Funding sonograms is cutting-edge pro-life strategy, because it takes away this “hiddenness” factor and prevents abortions. Women see the baby as a baby, not as a problem.
Canon law responds to not only the gravity of the situation but also to the potential for scandal. The potential for scandal in abortion is high, precisely because of the “hiddenness” factor. In countries where abortion is legal, this legality provides further scandal.
This is #2272 of the Catechism of the Catholic Church: 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, by the very commission of the offense,” and subject to the conditions provided by Canon Law. 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.
Barbara,
From what I can tell, Martin Rhonheimer makes mincemeat of Bouscaren in Vital Conflicts in Medical Ethics: A Virtue Approach to Craniotomy and Tubal Pregnancies. I say “from what I can tell” because I am reading Rhonheimer on Google Books, and a full preview is not available. But he seems to be saying that Bouscaren presumes the tubal pregnancy and the damaged tube to be two separable conditions, when in fact they are one pathology. He also says that repairing the tube in the very early stages of pregnancy is acting when there is no immediate threat to the life of the mother, but waiting until there is a crisis and the tube bursts (and surgery must be performed to save the mother) is basically plotting to maneuver yourself into a situation where the principle of double effect comes into play so you can do what you have wanted to do all along.
I find the argument for intervention in ectopic pregnancy weaker than the arguments made in the Phoenix case. Saying you are only repairing a damaged tube is a polite fiction, since what you are really doing is taking out the embryo because it is going to continue to grow. Now that ectopic pregnancy can often be dealt with by using methotrexate instead of resorting to surgery, Catholic medical ethics are under growing scrutiny in this area again, since to some of us it seems unwarranted to make a woman undergo surgery when she can accomplish the exact same thing by swallowing a pill.
David, in follow up: even if the tube were damaged, one would not normally treat it through surgical removal. There are potential ways to unblock the tube, for one, and for another, the blocked or damaged tube itself poses no threat to the woman’s health. You would almost never do a salpingectomy absent the presence of a fetus.
Barbara,
Thank you for your focus on the distorted physicalism in the Phoenix case, if that is the right word: [i][b]“It is an unfathomable fixation on physical means without regard to the overall context in which the actions are taking place, and the ultimate goal and effect of those actions.”[/i][/b]
I half hope the physicians and hospital are following this thread and consider such a lawsuit. What a great idea! Are you perhaps game (grin)? IMHO and sadly, most bishops really only seem to sit up straight when the courts intervene. Otherwise, the laity has less influence than a speck of dust, as survivors well know.
(If the bold italics come through, hurrah that finally I learned how to implement those formats, and can now avoid shouting ALL CAPS)
David,
Would you prefer that Catholic moral teaching disallowed salpingectomy? From what I understand, it’s a concession, and in the direction in which you would like concessions to be made. Why are you arguing against it?
Kathy,
I think Bouscaren is a kind of hero, but as I have said before, he and others who tried to come up with a “solution” to the problem of ectopic pregnancy clearly were going on an intuition that it was wrong to force women to risk their lives when something potentially life-saving could be done. One can only be thankful that he came up with something that gained the acceptance of the majority of ethicists, but I simply find the critique of his reasoning to be convincing. This is probably unfair of me to say, but I have a feeling that many ethicists don’t want to look too closely at Bouscaren’s arguments because it is obviously better to save women’s lives than it is to have a rock-solid argument based on double effect for doing so. I think people want to accept Bouscaren’s argument, because the consequences of rejecting it require either rejecting a life-saving treatment for women or rejecting the authorities in the Catholic Church who declared other “solutions” unacceptable. I would argue that considering a life-threatening embryo a materially unjust aggressor is a much better approach than trying to build an argument on the principle of double effect. Certain pronouncements made over a century ago are crippling Catholic medical ethics because current arguments have to be “backward compatible.”
So I am finding fault with Bouscaren not because I don’t want women with ectopic pregnancies to be forbidden life-saving treatment. I am arguing that viewing the issue of life-threatening pregnancies from another angle makes more sense in the case of ectopic pregnancy as well as in the Phoenix case and all life-threatening pregnancies.
As I have said before, when your premises and your arguments lead you to the conclusion that in some cases both the mother and her unborn child must be left to die when one of them can be saved, the only thing to do is to question either the premises or the argument, because something has resulted in an unacceptable conclusion.
Kathy, the salpingectomy exception was a polite fiction created to avoid an intolerable result, instead of honestly re-examining the moral reasons underlying why, for most people, the result was — and remains — viscerally intolerable. In other words, it avoided rather than addressed the moral complexity of the situation, and it undermines the Church’s moral authority to continue insisting that this exception is somehow “different” from other comparable situations based on largely irrelevant physical details.
Kathy –
Speaking as one of the old-ladies in the pews, I have to emphasize that this theology of ‘not giving scandal” needs to be re-thought. Much too often it is used as a crutch to avoid unpleasantness (see the sex scandal, above all).
I agree with Barbara that it is a scandal in itself that the Church keeps trying to shoehorn inadequate ethical solutions into inadequate ethicall principles that never could accommodate all the facts of many cases of abortion. In the olden days pregnancy was much more dangerous than now, and many, many women did die in childbirth. But even though the St. Jos. problem is rare now, the way some bishops totally misrepresent the problem is itself still scandalous.
If this thread has shown anything it is that Catholics on *both* sides accept the fact that the matter is of tremendous moral concern. None of us is simply talking about blobs of cells. It’s high time the hierarchy recognized that fact and started to participate in the discussions. That would help eliminate scandal, not cause it.
Ann,
There’s scandal and scandal. Scandal in the sense of “Eww, that is messy, we don’t want to deal with that” is part of life, and part of the life of the Church. That’s not scandal in the sense that the Catechism means it here.
Real scandal is a stumbling block. It’s a stumbling block to salvation. It happens when good deeds go undone because they are thought bad, and bad deeds are done because they are thought good or neutral.
Abortion in any situation is not good or neutral. The Church has to speak against it for the sake of the eternal life of the mothers, doctors, and others involved. It is about the babies, yes, but it is much more about the grownup agents–the people doing the bad act.
“Certain pronouncements made over a century ago are crippling Catholic medical ethics because current arguments have to be “backward compatible.””
David N. –
The problem with the old ethics is not that the ethics is *old* but that the ethics is sometimes wrwong. You wouldn’t toss out ‘Murder is forbidden” or “All men deserve equal treatment under the law” would you?
I get testy about this because too young people use the inadequacy of some of the old stuff as justification for total revolution. That never has worked. Especially in the U. S. “old’ is consistently used perjoratively. Too bad. The Constitution is old, isn’t it?
By the way, Boomers, congratulations — this week some of you made it into the officially old cohort :-)
The definitions of abortion and direct vs. indirect abortion are too simplistic to describe what occurred in Phoenix, the analytical tools too crude.
“Abortion in any situation is not good or neutral. The Church has to speak against it for the sake of the eternal life of the mothers, doctors, and others involved. It is about the babies, yes, but it is much more about the grownup agents–the people doing the bad act.”
Kathy –
Yes, the Church has to be contrarian when it thinks that right ethics is not being upheld. The other thread today about the bloodlands certainly makes that point abundantly clear.
Yes, there is such a thing as giving scandal — but simply resisting current ;mores or simply making problems known is not always a bad thing. Often it is a very good thing indeed. Who was the German farmer beheaded for refusing to fight for Germany and hs since been rightly canonized?
However, the culture of the official Church has so obviously resisted this truth world-wide (see the sex scandal) I shouldn’t even have to note that overwhelming fact. Yet Rome continued to appeal to the principle of “not giving scandal”. Bilge.
I will only note once again that the official Church has never been of entirely one mind about the matter of abortion. Yes, it has mainly condemned it. But not always. I’ve even read that for Aquinas early abortions were not mortal sins because he thought there were no persons involved. (No, I don’t have a reference for that, but it’s consistent with his teachings.)
Complexity, complexity.
The problem with the old ethics is not that the ethics is *old* but that the ethics is sometimes wrwong.
Ann,
I have no quarrel with what you say. My point is that authority in some of these issues has a tendency to win out over rational argument. Once the Holy Office/CDF has said something, even though it may not be infallible (or even persuasive), it is so authoritative that you have to argue around it rather than against it. That is why I spoke of “pronouncements” made over a century ago. It is no more difficult to argue against a position put forward a century ago than it is to argue against a new position. But once an authoritative pronouncement in the Church is made, it is pretty much carved in stone.
There are interesting discussions taking place on Vox Nova at the moment that kind of turn this whole process on its head. Pope John Paul II made about as strong a statement against the death penalty as was possible for a Catholic to make, and many conservative Catholics are arguing that it was just a “prudential decision” on his part, and the long history of Catholic teaching in favor of the death penalty means JPII’s pronouncements against it in Evangelium Vitae do not require religious assent. So in the case of the death penalty, the argument “You can’t change Catholic teaching” is being used against the pope.
There’s something about Kathy’s use of “concession” from a post earlier post today that makes me uneasy. I don’t want concessions or exceptions; I want clarity in the face of complexity. These are not inconsistent, I think.
The definitions of abortion and direct vs. indirect abortion are too simplistic to describe what occurred in Phoenix, the analytical tools too crude.
William,
Or it might be just the opposite. Human beings lived for thousands and thousands of years without the principle of double effect. Jews has no problem making judgments about life-threatening pregnancies on much simpler terms: Do pretty much whatever is necessary to save the mother’s life. I am not sure that if moral theologians spend the next thousand years analyzing life-threatening pregnancies, they will come up with any better analytical tools than we have now. Maybe we are overintellectualizing.
David,
I should have said that the tools offer false promise of moral insight and intellectual rigor but prove inadequate. Or they are inexpertly used. In either case, we are become trapped in disheartening legalisms.
When so many god-fearing persons in other faiths stand agreement about the sacredness of life but will not stand with a segment of Catholics on the Phoenix case, that disagreement suggests a need to look more carefully at things.
“Once the Holy Office/CDF has said something, even though it may not be infallible (or even persuasive), it is so authoritative that you have to argue around it rather than against it. ”
David N. –
Indeed. Actually, I’m one of the ones who thinks that Pius IX’s the CDF’s notion of infallibility is defective, so I’m really not one to give automatic support to Rome, though one one certainly cannot just toss out its teachings without extremely good reason. There is simply too much of great value offered by the Church the last 2000 years not to take it most seriously. (Yes, the Holy Spirit at work!)
Unfortunately, there is the further fact that since JP II there has been this added problem of “creeping infallibility” (under the linguistic ploy of calling some statements “definitive”). And now with the death penalty we have some conservatives who even reject JP II’s teaching on the death penalty. Oh, the irony of it all.
As I see Rome, it isn’t hard-hearted. It just seems incapable of admitting that the official Church has ever made an actual mistake. The Vatican cardinals would choke if they tried to utter the words, “Yes, the Church erred in the matter of X”. (And the bishops wonder why the faithful is impatient with them for not talking back to Rome. Sheesh.)
But it’s a New Year, and it seems we might have a Pope who is willing to change his mind a little bit — about condoms and about praying with people of other religions. He hasn’t actually *said*, “I’ve changed my mind a bit”, but actions speak louder than words.
God help us all.
In the Catholic Encyclopedia under “Abortion” (Copyright and Nihil Obstat 1907) at newdvent.org, I found background useful for one not well versed in the relevant historical documentation. It mentions, as of 103 years ago, much that has been discussed here and is particularly careful with defining most of the key terms, although not all (e.g., directly). It deals with ensoulment, a concept that seems to be rarely mentioned in today’s debates. It appears to fall back on establishing truth by assertion when the Aristotelian concepts are found inadequate for the desired conclusion. Similarities to and differences from the 12-Days-of-Christmas discussion above are revealing.
http://www.newadvent.org/cathen/01046b.htm
“It appears to fall back on establishing truth by assertion when the Aristotelian concepts are found inadequate for the desired conclusion. ”
Jack –.
Indeed. Truth by assertion seems to me to be the m.o. of the recent encyclicals on morals (the ones I’ve read, anyway). They repeat the old conclusions, but don’t give the old evidence — or new evidence either. (See, for instance, JP II’s theology of marriage on the differences between men and women.) And they call this “natural law morality”. What these non-persuasive exercises in rhetoric do is give natural law ethics a bad name.
Jim McK: Thank you for you reply to me on 12/31, 1:02 pm. Both that explanation and the earlier comment you refer to are very helpful in shedding light on the nature of the condition and why the medical decision might be defensible.
And with that, I am officially crying “uncle” on this thread, as it creeps ever closer to 600(!) comments. No doubt, we will all have the opportunity to rehash some of these issues at some future date, hopefully in a less voluminous way :-)
Barbara,
…the salpingectomy exception was a polite fiction created to avoid an intolerable result, instead of honestly re-examining the moral reasons underlying why, for most people, the result was — and remains — viscerally intolerable.
David,
Once the Holy Office/CDF has said something, even though it may not be infallible (or even persuasive), it is so authoritative that you have to argue around it rather than against it.
But even though the St. Jos. problem is rare now, the way some bishops totally misrepresent the problem is itself still scandalous.
Certain pronouncements made over a century ago are crippling Catholic medical ethics because current arguments have to be “backward compatible.”
…we are (or) become trapped in disheartening legalisms.
Ann,
Yet Rome continued to appeal to the principle of “not giving scandal”. Bilge.
Unfortunately, there is the further fact that since JP II there has been this added problem of “creeping infallibility” (under the linguistic ploy of calling some statements “definitive”).
Jack,
to fall back on establishing truth by assertion
———
I thank you for these comments that bring excited “yes”(es) as I read them. I wish Benedict and the bishops would “listen” in Benedictine fashion to the discussion here.
I, too, am signing off, having offered too many random thoughts. I thank everyone for the wise and challenging comments.
At last an end?
I think Jamie Manson”s article at NCR reflects the proper reaction apart fro mall the theological/philosophical arguments here and is grounded in the real world of faith.
This is the way the thread ends
This is the way the thread ends
This is the way the thread ends
Not with a bang but a whimper.
Bob,
I have to disagree about the Jamie Manson article. I am more than willing to side with St. Joseph’s Hospital against Bishop Olmsted, but Manson sounds so rapturous about them that she almost sounds like she’s writing about the Second Coming.
I found this particularly egregious:
Guilt by association with the Vatican! If you want to make Olmsted out to be a misogynist of some kind or another (and I wouldn’t rule out trying), nail him for his own actions, not for being a product of the Vatican. And to be fair to the Vatican, although Brazilian Archbishop Cardoso got support from Cardinal Re, Prefect of the Congregation of Bishops in Rome, he was criticized by Archbishop Fisichella, the President of the Pontifical Academy for Life.
And Fisichella’s complaint was that the starkness with which the penalty was announced was unfortunate–he didn’t complain about the penalty itself. Plus, wasn’t Fisichella then punished for even going that far?
But yes, Olmsted is responsible for what Olmsted says or does, not what the Vatican crew does, unless he goes out of his way to concur.
Plus, wasn’t Fisichella then punished for even going that far?
Lisa,
I didn’t know this part. There were apparently a lot of complaints about Fisichella’s article (including from within the Pontifical Academy for Life itself), and the CDF issued a clarification as a result.
Apologies for prolonging the inevitable here, but it appears that, just as dotCommonweal has exhausted every possible angle on this issue, the rest of the media is just catching up.
WSJ: Anne Hendershott: Catholic Hospitals vs. the Bishops.
http://online.wsj.com/article/SB10001424052970203731004576046443911321586.html?KEYWORDS=ANNE+HENDERSHOTT
George Weigel in First Things: Reaffirming Catholic Identity.
http://www.firstthings.com/onthesquare/2011/01/reaffirming-catholic-identity
David,
Surely you knew that Fisichella is no longer head of the Pro-Life issues, but instead heads the new Council on the New Evangelization. The article you cited even tells us that Fisichella was punished for something he wrote at the request of Cardinal Bertone, ie that he has support at the highest level of the Vatican. I am not sure if all this is “punishment”, as Chiesa would have us believe, or a promotion.
http://www.catholicnews.com/data/stories/cns/1004179.htm
From the Weigel column:[I]n 2009, a “therapeutic” abortion was performed at Phoenix’s St. Joseph’s Hospital, a part of the Catholic Healthcare West system.
“Therapeutic abortion” as if to say a ‘so-callled therapeutic abortion’.
Can anything new be said after 560 comments?
A slightly different tack: This “de-Catholicizing” of an institution in such an odd way may ultimately result in a complete lack of Catholic institutions other than parishes. Universities, in particular, must look at this whole incident with dismay. As some get kicked out, others may simply opt out by themselves to avoid damage to their reputations.
On the other hand (and I’m working without a net here!), my recollection is that Catholic Healthcare West has not been the most union-friendly of institutions. If that be so, where were Bishop Olmsted and other bishops? Shouldn’t they have been complaining about lack of adherence to Catholic doctrine in that case?
mjc
“This “de-Catholicizing” of an institution in such an odd way may ultimately result in a complete lack of Catholic institutions other than parishes.”
Definitely. And for a Church whose active population is hemorrhaging, the Bishops who are politicizing medical institutions are doing so at risk to Church survival — indirectly if not directly. I’m glad he clarified, although he may feel ambivalent about his statements as they pertain to outcomes. The clarification puts every pregnant woman on notice that her life will be valued less than that of her fetus — whether she is or is not Catholic herself. Though a practicing Catholic myself, I would never (now) go to a Catholic hospital to deliver. My family does value my life, big time.
John Allen in his MCR post of 1/7 talks about “picking the brain of ” of the “leading thinker of the US Bishops, Cardinal George.
The good Cardinal talks about the Bishops more activeluy pursuing “punsihment” in their governance role.
That seems to be apropos of Phoenix and the broader discussion deseves its own thread.
I think the Cardinal, though widely bok read, and the bishop of Phoenix are both sadly lacking in pastoral and common sense!
Jimmy Mac asked if anything new could be said. After reading through all the comments, albeit not every word of every post, let me try. I guess most who read this are doing their best to follow the example of Jesus in their lives, in their decisions. I assume that those involved in the decisions being critiqued are, as well. Would He not tells us to love the other as ourself, especially in these unique circumstances? How would each of the actors in this tragedy do that? I will focus only on the one for whom it is most difficult to imagine, the child. S/he was not able to make a rational decision, or, indeed, any decision. Can we impute what all would hope for her/him in that circumstance, a loving decision? Would that be, seeing that s/he and his mother were in mortal danger, that his mother could do nothing to save him/her but could save herself, push her as well as her/his doctors to do the only loving thing to do in that situation?