So many things are galling about Phoenix Bishop Thomas J. Olmsted's excommunication of Sister Margaret McBride, a member of St. Joseph's Hospital Ethics Committee, for approving the termination of the life-threatening, 11-week-old pregnancy of a 27-year-old mother of four that it's hard to know where to begin. But surely one of the most urgent issues this case raises is the danger faced by any woman who sets foot in a Catholic hospital in the midst of a reproductive crisis.
Just to recap, late last year a critically-ill pregnant woman was brought into St. Joseph's suffering from pulmonary hypertension. Her pregnancy posed such a burden to her heart and lungs that carrying it to term almost certainly would have killed her. Sister Margaret approved the decision of the physicians, the patient, and her family to terminate the pregnancy.
When Olmsted learned that this procedure had taken place, all hell broke loose. Without a scintilla of empathy or sympathy for the dying woman and her family, Olmsted said: "The direct killing of an unborn child is always immoral, no matter the circumstances." Since the abortion was not "indirect" (i.e., the byproduct of another procedure necessary to save the mother's life, such as removing a cancerous uterus), the correct moral action, according to Olmsted and the Phoenix diocese, was this: Let the mother and the fetus die.
We do not know how often such decisions come up in Catholic hospitals. Nor do we know if any go the other way -- that is, the beliefs of the Olmsteds of the Church prevail and discharge is followed by a funeral. What we do know is that Catholic hospitals, charged with abiding by the Ethical and Religious Directives for Catholic Health Care Services, pose a real danger to women's health and lives.
"One of the most troubling areas is in the treatment of reproductive emergencies," says Lois Uttley, director of the MergerWatch Project, which works with communities facing Catholic-non-Catholic hospital mergers to preserve reproductive health services. A miscarriage in progress is an example of the emergencies Uttley is referencing. When it happens so early in pregnancy that the fetus cannot survive, the pregnancy has to be terminated quickly. Unfortunately, explains Uttley, in some Catholic hospitals, this isn't what happens; the fetal heartbeat has to stop before doctors can do the procedure.
The disturbing findings of a report published in late 2008 in the American Journal of Public Health bear this out. The researchers set out to explore the impact of residency abortion training on the medical practices of a sample of ob-gyns. In the course of conducting their interviews, they got an unexpected glimpse into the conflicts posed by the Directives for physicians attempting to manage miscarriages.
One doctor working at a Catholic hospital reported receiving a woman whose pregnancy "was very early, 14 weeks," with "a hand sticking out of the cervix," indicating that "clearly the membranes had ruptured and she was trying to deliver." Because there was still a fetal heart rate, the ethics committee refused to approve the abortion; they sent the woman to another institution 90 miles away.
Another doctor, at an academic medical center, reported that a Catholic-owned hospital called to ask her to accept a pregnant miscarrying patient who was already septic and hemorrhaging. She urged them to do the uterine aspiration themselves, but they refused. That doctor accepted the patient and did the procedure, but saw this case as a form of "patient dumping." She reported the hospital for an Emergency Medical Treatment and Active Labor Act violation.
Obviously and fundamentally, the question is this: Why does a woman lying at death's door have to worry about whether a procedure that will save her life violates the so-called "ethical" Directives of a religion she doesn't belong to or long ago abandoned, Directives that treat women as disposable delivery systems for new humans, while flying in the face of standard, approved medical practice?
One answer is that the original conscience clauses, approved by Congress after the passage of Roe v. Wade, have been bastardized. They now apply not only to people -- physicians and nurses who oppose abortion -- but to institutions whose "consciences" trump not only the patient's own conscience, but also violate her right to informed consent and to medically indicated care.
We need more research into how often and in what ways physicians compromise patient care as a result of the Catholic Directives. But for now, the experience of the nameless, faceless, pregnant woman who Bishop Olmstead would have sentenced to death (rather than having her live "the rest of her existence having had her child killed," which is how the diocesan statement put it) is a cautionary tale.
Unless you are a deeply devoted Catholic and want your local bishop to make your most intimate medical decisions, when the ambulance pulls up, be ready. Have your own ethical and moral directive saying: Do Not Take Me to a Catholic Hospital. If for no other reason than this: there may not be a Sister Margaret in the house.
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