Sister McBride

I was sent a link to an article about a health care dispute in Arizona. The details of the dispute seem to be that a woman with severe pulmonary hypertension showed up in an emergency room in extremely critical condition. The medical personnel apparently determined that the patient would die if moved to another hospital and would die if the pregnancy were allowed to continue. After a meeting of the hospital ethics committee, it was determined that it would be best for all if  the hospital allowed the pregnancy to be terminated and the mother allowed to continue living. This would not have made the news except that the hospital happened to be Catholic, Sister Margaret McBride was apparently the administrator on call and participated in the ethics committee discussion, and the Bishop  happened to feel (as expressed by the medical ethics director of the diocese) “There are some situations where the mother may in fact die along with her child. But — and this is the Catholic perspective — you can’t do evil to bring about good. The end does not justify the means.” Because the committee determined that the life of the mother was the paramount concern at this point in the disease process, Sister McBride was pronounced excommunicated by the Bishop.

Pregnancy changes a woman’s blood volume and cardiac function under the best of circumstances. If the woman suffers from pulmonary hypertension and becomes pregnant, those shifts are enough to result in the death of the woman (and of course the unborn fetus). The number of people with pulmonary hypertension are increasing because of advances in medical care. In fact, the number of women with all sorts of conditions which are potentially lethal as the result of a pregnancy are increasing because of advances in medical practice. Before insulin was discovered, type 1 diabetes was uniformly lethal. Now we can easily get a woman to reproductive age but with the very small but real risk that the pregnancy might worsen her disease or result in her death (Steel Magnolias is a fictionalized account, for example, of a very real event). With pulmonary hypertension the risk is MUCH greater that the patient will die if the disease is worsened by the pregnancy. On the other hand, the urge to have children is very strong and many people with such conditions have a normal pregnancy without causing their disease to worsen.

Part of why modern medicine has been so successful has because of the willingness of the health care workers and patients to take certain risks but with the understanding that the  situation might change and the course of action may need to be altered. Ethics committees exist in part to allow the patient and the health care provider to seek multiple perspectives before making a decision regarding a significant (and life changing) decision. In this case, according to news reports, the mother was Catholic, the hospital was Catholic, and the mother had several other children at home who would lose their mother should she  have opted to “die along with her child”.  She is now alive and presumably at home being a mother to her children (and hopefully using an effective contraceptive method).

As someone who sits on a hospital ethics committee, I can tell you that almost all of the cases are not black and white, but offer the opportunity to see the human condition in various shades of gray. As I was reading about this case, I came across a post by Cathleen Kaveny on Commoneal entitled “What is “Abortion,” anyway?”. She points out that the Catholic prohibition is based on “(t)he principle that it is never  permissible intentionally to kill an innocent human being  is a foundational principle of Catholic moral and social thought.  You cannot regard every other human being as an imago dei, as a living icon of God, while at the same time deliberately erasing them from  existence to achieve your own purposes, when they threaten no harm to anyone.” She points out that INTENT is everything; that in this case “The immediate aim (object) of the procedure is simply to separate the baby from its dependence on the mother’s system, not to kill the baby, either as an end in itself or as a means to another end.  The baby’s death does not contribute to the saving of the mother–only the separation does.  If the baby lived after separation, everyone would rejoice. The baby’s death is not intended as either an ends or a means, but is accepted as a terrible side effect of the separation procedure.  Is causing the baby’s death as a foreseen but unintended side effect fair?   In some cases, this might be a difficult question.  In a situation where both mother and baby otherwise would die, I think one could make a strong case that it is fair to go ahead with the procedure .”

These are the types of cases that ethics committees get and the types of reasoning that goes into helping people make some very difficult decisions. I find it disappointing that Bishop Olmstead and the Church  chose to make a different point.