One of the defining and moderating aspects of the contemporary American debate surrounding the legalization of abortion is that the controversy only applies to elective procedures where the life of the mother is not in serious jeopardy. In contrast, the right of a woman to choose her own life over that of a fetus or embryo has not been seriously questioned in the United States and, except in a handful of cases involving women in comas, no American court or legislature has challenged this principle in recent memory. Even the Catholic Church, whose official doctrine demands that women be sacrificed in order to preserve fetal life, has for many years made no attempt to impose such a draconian policy upon its vast network of hospitals in the United States. Until last week. In a radical move that is likely to inflame the abortion debate even further and, more disturbingly, to endanger the lives of millions of expectant mothers, Thomas J. Olmsted, the Catholic bishop of Phoenix, Arizona, has condemned and excommunicated a highly regarded nun who approved an abortion necessary to save a pregnant woman's life.
The Irish nun at the center of the case is Sister Margaret McBride, an administrator at St. Joseph's Hospital and Medical Center in Phoenix. McBride was part of a hospital ethics committee that approved the termination of an eleven-week-old fetus after the mother developed a case of pulmonary hypertension that threatened to kill her if she continued with her pregnancy. Although the specific details of the case have not been revealed for reasons of patient privacy, Catholic Healthcare West, which operates the hospital, has described the woman's death, in the absence of termination, as all but certain. In response, Mr. Olmstead declared that the nun was "automatically excommunicated" and warned that: "While medical professionals should certainly try to save a pregnant mother's life, the means by which they do it can never be by directly killing her unborn child. The end does not justify the means." Although St. Joseph's Hospital defended its decision, it subsequently demoted McBride -- an obvious signal to other well-intentioned clergy at other Catholic healthcare providers. Like many Catholic hospitals, St. Joseph's has long had two conflicting policies regarding maternal-fetal conflict on its books. One directive states that abortion is never permitted, even to save the life of the mother, while the other notes that "operations, treatments and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman are permitted...even if they will result in the death of the unborn child." Until this recent incident, pregnant women could safely assume that Catholic hospitals would follow both the law and widespread standards of medical ethics in allowing the second directive to trump the first. Suddenly, that time-honored understanding appears to be in jeopardy.
Mr. Olmsted has a reputation as a particularly stone-hearted and intransigent figure, even by the orthodox standards of Vatican hierarchy. He previously gained notoriety for refusing communion to a ten-year-old autistic child who could not swallow and later spearheaded an effort to incorporate local church parishes individually in order to shield the Phoenix archdiocese from suits by sex-abuse victims. He has also been a fierce and vocal critic of President Obama. But Mr. Omsted's pronouncement--rather than the deranged cries of a renegade cleric--reflect a broader, deeply disturbing trend that is reshaping Catholic healthcare. Earlier this year, I drew attention to the revision of Directive 58, which now prohibits Catholic hospitals from honoring the wishes of patients--both Catholic and non-Catholic--who wish to be removed from unwanted life support equipment such as ventilators. The new policy, like the new abortion rule, is both patently illegal and widely regarded as unethical by mainstream secular and religious thinkers. Inevitably, both policies will be challenged in the courts. However, in the interim, pregnant women must ask themselves whether they can trust their care to any Catholic hospitals in the United States. Without overt assurance from the Vatican, I fear that the answer is a resounding NO.
Exactly how much risk to accept before terminating a pregnancy is certainly a difficult choice for any woman and any family. If I served on a hospital ethics committee, I would permit a pregnant woman with capacity to forgo an abortion, even if that meant her certain death, although I would do so with profound sadness. Competent adults have a right to make their own decisions -- no matter how misguided the rest of us may view them. That is the fundamental underpinning of contemporary medical ethics. Unfortunately, it appears that principle may no longer apply at Catholic hospitals, which provide approximately one-third of medical services in the United States. As a matter of public policy, these hospitals -- as public institutions that survive on public funds -- should be and are compelled to terminate pregnancies in medical emergencies. But if my life were at stake, or that of a woman I loved, I would not want to risk the chance that a woman less enlightened or flexible than Sister McBride was the ethicist ruling on my case in a medical emergency. So let me make this clear: At the present moment, as a physician, I would not feel comfortable with a woman I cared about seeking obstetric services at a Catholic hospital. In fact, I would not want a pregnant woman I cared about obtaining any medical treatment at a Catholic hospital. From this point forward, I will tell my pregnant patients, in all but the most emergent and high-risk circumstances, to instruct any ambulance that picks them up to avoid Catholic hospitals. That is tragic, because these institutions have a long and noble history of providing care to this nation's needy and most desperate. Alas, thanks to men like Mr. Olmsted, obtaining obstetric care at a Catholic hospital has become a dangerous game of Russian roulette.
Of course, as a pregnant woman, one is never certain that even a secular hospital will honor one's wishes. Anyone who reads this column is familiar with the case of Jana Bures-Forsthoefel, a rogue obstetrician who allegedly held patient Samantha Burton as a legal hostage for several days when the patient sought a second opinion from a different provider. (Of note: Five months have elapsed since the ACLU publicized this tragedy and, to my knowledge, Bures-Forsthoefel remains unwilling to explain her conduct or to refute in public the grave charges against her.) The Burton case arose at Tallahassee Memorial Hospital, a private, non-denominational institution. At the same time, I have no doubt that some Catholic-run hospitals remain safe, loving and respectful places for women to give birth. Some Catholic hospitals will let a woman decide if, and when, she wishes to die to preserve the life of her fetus. Regrettably, at the present moment, there is no way to know which hospitals are which -- to separate the wheat from the chaff.
The St. Joseph's incident, coming only months after Directive 58, should force Americans to reconsider the relationship between the Catholic Church and our healthcare system. Catholic hospitals, although run by the Vatican, survive only because American taxpayers subsidize them through Medicare, Medicaid, tax exemptions, research grants, residency training payments and scores of other benefits. But if the Church cannot agree to honor the basic tenets of medical ethics -- such as respecting end-of-life wishes or letting a mother choose her own life over that of an eleven-week-old fetus -- maybe the Catholic Church has no place providing healthcare at all. Moreover, maybe the public should regard its healthcare institutions with greater scrutiny. You shouldn't get a free pass from criticism just because you wear a cassock.
As a religion, which seeks to instruct its own adherents, the Catholic Church is entitled to do as it pleases. As an institution that has played an integral role in furthering art and culture for two thousand years, it is deserving of respect. On the other hand, as a political ideology that seeks to impose its most fanatical and potentially lethal ideas on non-believers, often clandestinely through hospital bylaws, Catholic extremism should be resisted as fiercely at home as we oppose the Taliban abroad. Mr. Olmstead, of course, is entitled to his opinion. As, indeed, are Mr. Ratzinger and his minions in Rome. So are the mullahs in Afghanistan and the proponents of sharia law in Saudi Arabia. It's a free country, so to speak. The fundamental difference is that we don't allow the Afghan mullahs or the Saudi Wahhabi to run our hospitals.
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