A little arm-chair medicine and the Phoenix Affair

It is hard to make long-distance determinations about the facts of a case when those facts are sketchy.

That said, a reader sent the following:

Just a bit of medical knowledge related to the abortion/Phoenix scandal:

I spoke with the head of Ethics/Chief Medical Officer at my place of work on the issue.  He-a retired Ob/Gyn surgeon and Catholic/pro-life-stated after ~5000 deliveries he personally performed and overeeing more as an administrator at Catholic hospitals, never has he seen a case where a mother was in danger of losing her life with an abortion as the answer[Guess there is case 5001, but it doesn't look good for those who prescribe abortion, does it?] In the recent case-to his limited knowledge on the said situation-the doctors could have gotten her through a few more weeks and decided which was a safer place for the life: in the womb or in an intensive care unit.  Again, he cannot imagine in his experience that an abortion would even help the mother-and even if id could, you still do not perform [it].  (I am not even sure if an action of “double effect” could be done, like, for example, with an ectopic pregnancy.)
It’s diffiult once people know you are Catholic-they usually only see their individual rights!  I am very tired-but extremely glad-to defend Mother Church.
Some food for thought when considering the Phoenix Affair.

If there are some Catholic physicians reading, they might chime in.

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23 Responses to A little arm-chair medicine and the Phoenix Affair

  1. bmccoy says:

    This situation happened to one of my teachers who was pregnant with twins. Being Catholic she refused the reccomrnded abortion and waited in intensive care for a few weeks. They then proformed a c-section. A couple months in one twin died. The other is now a healthy little girl that she wouldn’t trade for the world. In short abortion never really seems to be the only option.

  2. Charles E Flynn says:

    For a clear example of a rare execption, see:

    http://www.ncregister.com/blog/bishop-strips-abortion-hospital-of-catholic-status/

    Search for:

    “ERD #47″

  3. asophist says:

    Let us say, for the sake of argument, that this latest abortion at St. Joseph’s hospital never happened. Even so, it appears that the hospital’s violations of Catholic ethics were so numerous, on-going, and egregious that Bp. Olmstead ought to have revoked their Catholic status, regardless. I therefore fail to see that the argument turns solely on this last case, whether the good bishop was mistaken in his judgment about this particular abortion or not.

  4. Joan M says:

    Charles E. Flynn: Actually “ERD #47? is not a “rare exception”, since direct abortion is not called for in these cases. There is, rather, the unintentional death of the baby caused by treatment for the condition, usually cancerous.

  5. priests wife says:

    I think the doctor might be talking about an active abortion- but what about inducing a delivery and trying for the best when the baby is delivered? With my last baby, I was quite sick from about 22 weeks (throwing up every bit of food, elevated blood pressure, etc) By 32 weeks, they finally tested protein output and decided I couldn’t stay pregnant, so they did a c-section- I was in ICU for 9 days and the baby (healthy!) was in the NICU for 5 weeks basically for feeding issues

    I believe if I had been just a bit sicker and was induced earlier, the principle of double effect would apply. I would have been devastated to lose the baby, but it wouldn’t have been an abortion

  6. catholicmidwest says:

    Bmccoy, good observation. When people feel like they’re in a crisis situation, they usually see far fewer alternatives than there usually are. And this is especially true if someone is yelling in their ear (father, boyfriend, husband, mother, friend, etc). This is an important thing to remember whenever you are under pressure. Search for as many alternatives as you can before making up your mind what to do. The one that occurs to most people first is seldom the best one.

    PW,
    You know, I’m not sure I would have typed that into the internet about a living kid who will one day read, whether it were true or not. Things that don’t have to be contemplated are most wisely left uncontemplated, particularly in cases like this.

  7. We need more doctors to speak out. The abortion advocates are winning sympathy based on fallacy.

    As an aside, Phil Lawler just posted on Lloyd Dean’s connections to CHA.

    http://www.catholicculture.org/commentary/otn.cfm?id=746

  8. Jerry says:

    @priests wife – “I believe if I had been just a bit sicker and was induced earlier, the principle of double effect would apply.”

    For the principle of double effect to even be considered, termination of the pregnancy must be a side effect of some other treatment, not the direct intended act. For example, in the case of uterine cancer the direct act is removal of the uterus; while termination of the pregnancy necessarily coincides with the hysterectomy, it is not the intended act. Based on the description you have given, it appears the delivery of your child was the intended and primary act: as such it would have been immoral if attempted before the age of viability, whether attempted as a live delivery or an abortion.

  9. Scott W. says:

    Even so, it appears that the hospital’s violations of Catholic ethics were so numerous, on-going, and egregious that Bp. Olmstead ought to have revoked their Catholic status, regardless.

    Exactly and the above should be tattoed on everybody’s arm. This ain’t just a mean ol’ bishop throwing his weight around on an admittedly hard case–it is the final outrage in a string of violations that indicate the hospital does not want, and has not wanted for some time, to adhere to Church teaching.

  10. isnowhere says:

    The “double effect” argument where the fallopian tube is removed for an ectopic pregnancy thus killing the child is bothersome. I rarely hear about “embryo transfer” method being discussed as a moral alternative to just removing the tube. Those not familiar with the process…. the tissue the embryo is connected to is removed. The tissue and the embryo is then implanted into the uterine lining. This procedure has been performed successfully many times, with one of the earliest recorded successes taking place in 1915. By success, I mean that the once ectopic pregnancy was made viable for mother and baby, and that the baby was born. Those looking for more information can look into:
    William E. May, Catholic Bioethics and the Gift of Human Life (Huntington, IN: Our Sunday Visitor, Inc., 2000) and T. Lincoln Bouscaren, Ethics of Ectopic Operations (Chicago, IL: Loyola University Press, 1933). If I can find the hard copies I have, I will scan them in and post a link on my web-log.

  11. bdang says:

    As a respirologist, primary pulmonary hypertension, which I believe is the main medical condition the patient had, is one of the conditions I deal with directly. From a completely medical perspective it is a very complicated illness with lots of mortality and morbidity. The long term prognosis of anyone is poor (though newer treatments are improving this slowly). Depending on severity of the disease any stresses which is added upon the person risks straining the heart. The classic symptoms include dyspnoea, congestive heart failure and syncope.
    Thus in pregnancy, in which cardiac output (amongst other things) must increase, can strain the heart and those with severe pulmonary hypertension, can lead to complications and, sadly, even death. Medications to treat this condition must also be used cautiously and a lot of the advanced drugs have not been well tested in pregnant patients for effects of the child. Any person with this condition, who gets pregnant is usually advised of the risks and doing so as the chance for complications are quite high.
    That being said, certainly one should not and cannot forbid a person from becoming pregnant just because the risks are higher. If that were the case we would do that for a whole host of illnesses; even the pregnant state itself, renders people in normal health, with higher risks. Once a person is pregnant, a physician is obliged to help them all they can and to deal with the complications as best they can. Successful pregnancies have certainly occurred in pulmonary hypertension as have unsuccessful ones but there are no guarantees in life. For myself, I could never countenance abortion as a solution except in case of immediate and imminent threat to life (eg. the mother is in or near cardiac arrest and delivery may help the situation- because if nothing were done both mother and child would perish) but alas I know certainly that in the medical profession, some outside the Church, would have absolutely no problems recommending it as an option at any stage; even if there was no immediate threat on the life of the mother or child. It would certainly be the “easy” way out for all involved.
    Hope this helps clarifies the situation. I also want to add if I have said anything above that is contrary to the teaching of the Holy Roman Church and Her supreme pontiffs, it was done so unwittingly and should it come to my knowledge from competent authority I would renounce such statements immediately.

  12. Clinton says:

    Scott W., that is absolutely correct–the Bishop of Phoenix has been struggling to get
    St. Joseph’s to give more than lip service to the ERDs for going on seven years now.

    Catholic Healthcare West insists that it followed the directives that outline how a Catholic
    hospital should respond to a situation such as this. One assumes that the hospital would
    be privy to all relevant medical information in this case–yet they were unable to make a
    case that could persuade the Bishop that they had not acted wrongly. While the hospital
    maintains it adheres to the ERDs, #71 states that the Bishop has final responsibility for
    assessing and addressing issues of scandal. If they follow the ERDs, they must admit that
    the Bishop has the final word, no?

  13. jarthurcrank says:

    I think Martin Rhoneheimer in his book “Vital Conflicts in Medical Ethics” describes (rare) cases where it is morally certain that the mother will in fact die if the “abortion” is not performed. My copy of the book, however, seems to have disappeared into presumably the same place where my missing dirty socks go. Maybe I’ll find it and report back.

  14. I have only recently qualified and my experience in ob/gyn is rather limited, so I can’t say too much on the medical issues in question. As for the moral ones – I am not a moral theologian, so I can’t speak with any authority on those. So instead let me speak as a – hopefully – commonsensical Catholic layman.

    Even though I believe and profess that abortion is murder and as such morally wrong, I do not think it is fair to judge the sort of cases we are dealing with here too strongly. After all, there are many injustices the world over which we don’t get nearly as worked up over – such as the fact that nearly 1,000 children in the Global South will starve to death during the few hours it takes us to gorge down our Christmas dinner. There are also many Conservative – and, God forbid, Traditionalist – Catholics who accept the war in Iraq, even though it has been condemned in no uncertain terms by two successive Popes, and even though a ‘pre-emptive’ war, when an attack by an opponent is not imminent (as it certainly wasn’t in the case of Iraq), is about as justifiable as an abortion when the life of the mother is not in imminent danger. I think a sense of proportion is in order.

  15. Brad says:

    St. Gianna. She’s a saint now. Wonder why? Heroic virtue.

  16. priests wife says:

    Jerry- I obviously need to study this issue more

    some thoughts- There are two patients- mother and child and lots of issues to consider about toxemia, a quite common disease of the mother that only delivery can cure

    1. how bad is bad for the mother-patient? (in terms of blood pressure, protein in urine, kidney failure, liver failure- I was close to total failure)
    2. When is viability? This changes BUT we all know that getting to at least 32 weeks in the goal usually the baby will be over 3.5 pounds, lungs probably are mature, there will be sucking ability

    I would love to see some canon law on this

  17. “Even though I believe and profess that abortion is murder and as such morally wrong, I do not think it is fair to judge the sort of cases we are dealing with here too strongly. After all, there are many injustices the world over which we don’t get nearly as worked up over – such as the fact that nearly 1,000 children in the Global South will starve to death during the few hours it takes us to gorge down our Christmas dinner. There are also many Conservative – and, God forbid, Traditionalist – Catholics who accept the war in Iraq, even though it has been condemned in no uncertain terms by two successive Popes, and even though a ‘pre-emptive’ war, when an attack by an opponent is not imminent (as it certainly wasn’t in the case of Iraq), is about as justifiable as an abortion when the life of the mother is not in imminent danger. I think a sense of proportion is in order.”

    That’s nothing but false dichotomies. Just because people are unjustly dieing somewhere in the world, does not justify someone else dieing unjustly here and now. The war in Iraq, starving children in the southern hemisphere, or the price of rice in China have absolutely nothing to do with this case of a direct and intended murder of an unborn child in a hospital that claims to be Catholic.

  18. gambletrainman says:

    I always thought that the real hero would be the mother, when, if she knew she was in such a predicament, she would say, “let me die so my child could live”. Then, let the doctors do what they could to save both lives, and leave the rest in God’s hands.

  19. jcn0903 says:

    I am a practicing physician, though not an OB/GYN, and I know that lacking the clinical information about this case we are all talking out of our hat if we are trying to decide whether the abortion saved this woman’s life or not. Heck, most of the time even with clinical information, we simply can’t know the outcome of an intervention in advance. We make educated guesses. What bothers me, a devout and rather traditional Catholic, about this case is the utter lack of any sense of faith in God and the utter trust given in the word of doctors. You want to talk about doctors playing God! Those educated guesses we make have as much to do with our moral and cultural grounding as with clinical experience. These physicians made the recommendations they made because they were worried about the outcome of the pregnancy; the conflict hinges on the fact that for us who believe, the outcome is not what matters. We cannot control if we live or die, we can only control the choices that we make. We believe that our choices must be ordered to make manifest the love of God. It is no surprise whatsoever to learn of past behavior of this institution, it is clear they have long ago abandoned themselves to the false god of socially acceptable outcomes.

  20. lizfromFL says:

    @Priests wife, re: age of viability: I think it is way earlier than 32 weeks nowadays. My now 12-year old son was born at 27 weeks. The problem becomes whether people want to risk having a child with significant medical issues. 32 weeks is pretty much a low risk of issues. The earlier you go, the more the issues, even though these babies actually can survive. My son has cerebral palsy but gets along quite well now, after a lot of hard work from us all. I had him early after contracting an infection in week 11 of that pregnancy – I had been told I may want to abort. At the time I was 22 years old and “could have more.” Not for a second do I regret my son who has basically grown up along with me.

    I am by no means a medical professional, but I have heard esp. when the partial birth abortion stuff was hot news; they were using “health of the mother” as a reason to do this disgusting thing, and several doctors came out saying that there is basically no health reason that this procedure would help. I would assume this is the same thing.

  21. sacerdos97 says:

    There needs to be a significant clarification regarding “double effect” as it is being used in this thread. The clarification is this: it is impossible to foresee a consequence and not intend it. In other words, the “unintended” consequence must also be “unseen.”

  22. priests wife says:

    sacerdos97- Then the age-old example of removing a cancerous uterus doesn’t work as double-effect. Of course if you remove a cancerous uterus, the baby might die (perhaps if the baby is 22+ weeks modern medicine could save the baby)- is the fact that the baby might live enough to make a possible death an “unseen” consequence- so removing a cancerous uterus is double-effect if the baby is 22+ weeks, but removing a cancerous uterus is immoral when the baby is younger than that?

  23. COLRE says:

    I have only just seen this thread which is now a little old, but I will add my thoughts anyhow. I am a practicing OBGYN and faithful Catholic in the UK. It is not always easy to act according to one’s conscience, but thank God I have thus far always managed to do so. I have found my colleagues to be supportive of my faith based position and I have not felt under pressure to act contrary to the Church’s teaching. I agree though that these ‘hard’ cases are hugely difficult to deal with. The prinicple of double effect sounds straightforward enough, but in reality there is always uncertainty when approaching any medical decision. Fetal viability occurs at 23-24 weeks gestation, meaning that survival of the infant is at least a possibility from that point. I can readily accept that in dealing with a case of severe pre-eclampsia – a potentially life threatening condition for the mother, the cure for which is delivery – that one should induce labour. But what if the fetus is only 22 weeks gestation? An induction then, with no chance of survival is surely a termination. And what about the inherent uncertainty involved in dating the gestation in the first place, as even with ultrasound the accuracy can only be determined to within 5-7 days. Does anyone get the benefit of the doubt?
    To put these cases in perspective however, I have never seen a case in 21 years of practice where a direct termination was the only effective life-saving treatment for a pregnant patient. I need to acknowledge however that exceptionally difficult cases could in principle arise. My hope is to go to my grave never having had a hand act or part in terminating a pregnancy. If I am honest though, I am ‘helped’ by the availability of colleagues and a legal framework that allows terminations under at least some circumstances. If I was the only Obstetrician in my area, then it is likely that I would run foul of the law which requires me to act if there is a grave threat to a woman’s life.