When it comes to Catholic teaching on abortion, no exceptions are allowed. Even if carrying a pregnancy to term would result in the death of both mother and child, abortion is still not an option.
Which is why a nun who is an administrator at a Catholic hospital in Phoenix this week found herself formally excommunicated -- essentially the sacramental equivalent of capital punishment.
The episode stems from a series of events that began last November, when a 27-year-old woman who was 11 weeks pregnant with her fifth child was admitted to St. Joseph's Hospital and Medical Center in Phoenix. The pregnancy was causing severe health problems for the woman, who suffers from pulmonary hypertension, and her doctors told her that if she continued with the pregnancy, her risk of death was close to 100 percent -- and the baby would die as well.
So the ethics board of the Catholic hospital -- which included Sister of Mercy Margaret McBride, a top administrator at the hospital -- deliberated with the woman and her doctors and decided this was an exception to the the code of Catholic health care directives that govern hospital ethics and care.
The abortion was performed, and the woman survived.
But this month Phoenix Bishop Thomas J. Olmsted found out about the hospital's actions. He disagreed in no uncertain terms and decreed that Sister McBride -- along with any other Catholic involved in the decision, including the patient -- were automatically excommunicated.
"An unborn child is not a disease," Olmsted said in a statement. "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."
"We always must remember that when a difficult medical situation involves a pregnant woman, there are two patients in need of treatment and care, not merely one," he continued. "The unborn child's life is just as sacred as the mother's life, and neither life can be preferred over the other."
Officials of Catholic Healthcare West, the San Francisco-based health system which includes St. Joseph's, wrote to Olmsted on May 17. "If there had been a way to save the pregnancy and still prevent the death of the mother, we would have done it. We are convinced there was not," they said.
While Olmsted does not have direct control of the hospital, his decisions on matters of faith and morals can regulate whether the hospital and its employees maintain a Catholic status.
St. Joseph's has reassigned Sister McBride to another, lesser administrative post (and she can lift the excommunication at any point by going to confession). But the hospital also defended the decision, saying the directives -- which it adheres to -- leaves some gray areas.
"In those instances where the Directives do not explicitly address a clinical situation -- such as when a pregnancy threatens a woman's life -- an Ethics Committee is convened to help our caregivers and their patients make the most life-affirming decision," said Suzanne Pfister, a hospital vice president. "In this tragic case, the treatment necessary to save the mother's life required the termination of an 11-week pregnancy."
In a letter to the The Arizona Republic on May 18, Dr. John Garvie, chief of gastroenterology at St. Joseph's, called Sister Margaret "the moral conscience of the hospital" and said "there is no finer defender of life at our hospital."
"What she did was something very few are asked to do, namely, to make a life-and-death decision with the full recognition that in order to save one life, another life must be sacrificed," Garvie said. "People not involved in these situations should reflect and not criticize."
The chief ethics official of the Phoenix diocese, Father John Ehrich, agreed that it was a difficult decision. But in a two-page statement on the diocesan website, he argued that "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."
"When we try to control every possible situation in life, we end up playing the role of God."
Not surprisingly, the Arizona case has prompted heated and often highly technical moral and ethical debates in Catholic circles and blogs about abortion, such as one at the blog of the Catholic periodical, Commonweal, which is titled, "What Is 'Abortion,' Anyway?"
The Phoenix case also echoes a case in Brazil last year, when a nine-year-old girl was found to be pregnant with twins as a result of being raped by her stepfather, who had repeatedly abused her. The girl, who weighed 66 pounds and would likely have died if the pregnancy were carried to term, underwent an abortion.
A Brazilian archbishop condemned the operation and declared the doctors and the mother (though not the stepfather) excommunicated. But a top Vatican official called for "mercy" in the case and said the excommunications were unjust. Another Vatican official disagreed, and the case has continued to roil Catholic circles and pro-life advocates.
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