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IS CATHOLIC ETHICS A “HOUSE DIVIDED”?

by Nancy Valko, RN
Ethics & Medics, A Commentary of the National Catholic Bioethics Center
May 2012

The recent decision of Catholic Healthcare West to divest itself of its Catholic identity will undoubtedly provide the media with yet another opportunity to present the Church as rent by internal division. These media presentations typically take the same form: brave progressives who are battling for truth, justice, and the American way against hidebound bishops whose principal goal is to force people to do what they do not want to do and what no sensible person would want to do.

There is no question that traditional Catholic health care ethics is under fire, especially in the media. From nightly crime and medical dramas to the standard news stories of the day, Catholic ethics is routinely portrayed as cruelly rigid, inscrutable, or even outright dangerous to public health. A case in point is the December 4, 2011, lead story for the CBS Sunday Morning show. The story, titled “The Catholic Church: A House Divided?,” focused on the 2010 decision of Bishop Thomas Olmstead of Phoenix, Arizona, to remove the Catholic status of St. Joseph’s Hospital and Medical Center in Phoenix, because of an abortion performed there on an eleven-week-old unborn child whose mother was ill with life-threatening pulmonary hypertension. The chief medical officer at St. Joseph’s Hospital stated in an interview that the abortion was medically necessary to save the mother’s life. Adding fuel to the media fire, the CBS show reported that Bishop Olmstead excommunicated Sister Margaret Mary McBride, RSM, administrator and member of the ethics committee at St. Joseph’s Hospital for approving the abortion.

The story portrayed the issue as one where abortion was the only medical solution. But was this true? CBS suggested that Sr. McBride, and American women religious in general, were being punished by a dogmatic and out-of-touch Catholic hierarchy. Again, was this true? And what exactly were the details surrounding the excommunication of Sr. McBride? Was it, as the CBS show implied, an arbitrary exercise of power?

The Untold Story

The real story behind the St. Joseph’s Hospital abortion tragedy and its consequences is much more complicated than that depicted by the CBS show. Unfortunately, the average Catholic is unlikely to encounter clear and
thoughtful explanations of the Church’s governing principles in cases such as this, especially if he or she depends primarily on the media for information. Thus it is not surprising that Catholic patients and families who are suddenly faced with ethical dilemmas find themselves confused and troubled by differing opinions about what is the best course of action, even at Catholic hospitals. This is a grave problem that I have seen often during my forty-two years as a nurse.

In the case of the abortion at St. Joseph’s Hospital, not surprisingly, given media hostility toward the Catholic Church, quite a lot of information was left out of the CBS Sunday Morning report, that is, facts that would have been helpful to future patients and families who will face similar decisions. Too often, Catholics find themselves on the defensive because they do not know the actual teaching of their own moral tradition. The Church’s prohibition against direct abortion makes both moral and practical sense because it is rooted in natural moral law and in scientific fact.

In the case at St. Joseph’s Hospital, the Church’s prohibition against direct abortion was not a hard-hearted dogma designed to force the death of a mother, but rather it was a commitment to both lives involved. There is an enormous difference between terminating the life of an unborn child (a direct abortion) and treating a serious or even life-threatening condition of the mother that may lead to the unfortunate but foreseeable death of the unborn. The classic example of a pregnant woman with uterine cancer, where the diseased organ must be removed along with the unborn child, is justifiable under the principle of double effect. The object of the act is the removal of an unhealthy organ. The death of the child is foreseen but not intended.

In the case at St. Joseph’s Hospital, there was no dis- eased organ to be removed, and the child, of course, was healthy. Although women with pulmonary hypertension are advised to avoid pregnancy because the risk of
pregnancy-related death is substantial (reported to be 30 to 50 percent1), tremendous advances have been made in treating pulmonary hypertension in pregnant and non-pregnant patients. In addition, although the media rarely report it, abortion poses physical and emotional risks to even a healthy mother in the first trimester of pregnancy. Bishop Olmstead determined that the hospital’s medical staff and ethics committee had decided to perform an abortion rather than treat the woman’s disease.2The CBS program ignored these facts. The other major controversy presented in the report was whether Bishop Olmstead had overstepped his bounds by revoking the Catholic status of the hospital and by excommunicating Sr. McBride. Were these actions a sudden and rash decision of an authoritarian monarch, as most secular media and even some Catholic critics claimed? Hardly. There was a long and complex history behind these events, a history that continues to show itself in Catholic Healthcare West’s recent decision to abandon its Catholic identity.

As Bishop Olmstead made clear in his December 2010 statement, he spent months discussing with officials of the hospital and Catholic Healthcare West not just this abortion but what the bishop determined to be a pattern of behavior that violated the Ethical and Religious Directives for Catholic Health Care Services, the governing document for Catholic health care institutions. According to Bishop Olmstead’s, this behavior included administering contra- ceptives, contraceptive counseling, voluntary steriliza- tions, and abortions in cases of rape, incest, and even for the benefit of the mental health of the mother—a dubious medical claim. Bishop Olmstead expressed his reluctance to remove the Catholic status of the hospital and stated that “the Catholic faithful are free to seek care or to offer care at St. Joseph’s Hospital, but I cannot guarantee that the care provided will be in full accord with the teachings of the Church.” 3

Bishop Olmstead said that he had had discussions for years with Catholic Healthcare West, the parent company of St. Joseph’s Hospital, about resolving violations of the Ethical and Religious Directives but that CHW had refused to comply. Those directives recognize a bishop’s essential responsibility over Catholic health care institutions: “As teacher, the diocesan bishop ensures the moral and religious identity of the health care ministry in whatever setting it is carried out in the diocese.” 4

The CBS Sunday Morning show criticized Bishop Olmstead for excommunicating Sr. McBride, but in fact he privately informed her that she had incurred an excommunication latae sententiae, that is, that it happened automatically at the procurement of the completed abortion. Canon 1398 states, “a person who procures a completed abortion incurs a latae sententiae excommunication.” Of course, there are extenuating circumstances, such as intention or coercion, that could mitigate the penalty of excommunication, but this is far from the liberal feminist cause célèbre that the CBS Sunday Morning show would have its viewers believe.

A Deeper Problem

As troubling as is the media criticism and lack of depth, it is the confusion spread by Catholic sources that is arguably the most damaging, for Catholics and non-Catholics alike. The United States Conference of Catholic Bishops issued a thoughtful statement on the case, ignored, of course, by the media.5 But it was also ignored by prominent Catholic organizations and theologians.

The Catholic Health Association, claiming to include more than six hundred hospitals and 1,400 long-term care and other health facilities in all fifty states, issued a strong statement in support of the abortion and of the hospital.6 Marquette University professor and theologian M. Therese Lysaught, hired by St. Joseph’s Hospital to provide an “independent” analysis, denied that the termination was a direct abortion.7 Such events lead many devout Catholics to scratch their heads. They wonder whom they can trust when it comes to making health care decisions in the light of Catholic teaching.

The real-world consequences of such division within the Church are frightening. The American Civil Liberties Union, citing the abortion case at St. Joseph’s Hospital, already complained to federal health officials that “no hos- pital—religious or otherwise—should be prohibited from saving women’s lives and from following federal law.” 8 The Obama administration’s February 2011 revision of a federal protection of conscience rights regulation has left both health care professionals and institutions vulnerable to litigation and coercion.

A consistent ethical standard of care is crucial for protecting patients as well as Catholic health care itself. Reliability builds trust, an indispensable component of good health care that appeals to both Catholics and non- Catholics alike in this uncertain health care environment. At a time when hospitals are competing for patients, Catholic hospitals can stand out by offering both the best technology and the best standard of ethics.

Bishop Olmstead’s difficult decision to revoke the Catholic status of St. Joseph’s Hospital exposed the problem of Catholic institutions and ethicists who ignore or reinterpret many of the clear and definitive principles of the Ethical and Religious Directives to justify certain practices. Generations have gratefully entrusted their confidence, respect, and donations to Catholic health care institutions in order to build up the wonderful system of care that we have. Catholic institutions must now prove themselves worthy of that trust.

Nancy Valko, RN

Nancy Valko, RN, is a contributing editor for Voices, president of Missouri Nurses for Life, and a spokesman for the National Association of Pro-Life Nurses.

1 Scientific Leadership Council, “Birth Control and Hormonal Thera- py in Pulmonary Arterial Hypertension,” Consensus statement, available at http://www.phassociation.org/page.aspx?pid=1255.
2 Thomas J. Olmsted, “St. Joseph’s Hospital No Longer Catholic: Statement of Bishop Thomas J. Olmsted,” December 21, 2010, http://www.arizonacatholic.org/wp-content/uploads/2010/12 /DIOCESE-OF-PHOENIX-STATEMENT-122110.pdf.