When I was briefly at business school in Ontario the primary teaching method was the case study, followed by a demanding discussion. The measurement of each episode’s success was the degree to which it brought out conflicting issues leading to a decision. This week I have a case study for you which, sadly, is based on real life – although space obliges me to simplify some of the detail.
The scene is a Catholic hospital in America. The protagonist is a mother, 11 weeks pregnant, with pulmonary hypertension. Her condition has deteriorated as a result of the developing pregnancy, and her chances of survival are virtually nil. After discussion between mother, doctors and the hospital’s ethics committee, it is decided to terminate the pregnancy. And this is done.
The local bishop declares that participants are excommunicated for participating in abortion – including a senior nun, a hospital administrator who was serving on the ethics committee. Later, when the hospital refuses to accept that it has behaved wrongly – and taking into account what he holds to be other irregularities – the bishop declares that the hospital may no longer be called Catholic. Nor may Mass or Eucharistic reservation continue. This decision is of course within the authority of the diocesan bishop. The hospital accepts the ruling but continues to defend its actions.
End of story? Not quite.
The Church’s settled teaching in this matter is clear. It is always wrong to take the life of the baby directly (or the life of the mother, for that matter) to save the life of the other. In certain instances – for example, when the pregnancy takes root in the fallopian tube – it is permitted for proportionate reasons to remove the diseased tube even though this will indirectly bring about the death of the baby. The baby’s death is an unintended, though inevitable, secondary effect of the lawful operation.
The hospital argued that “consistent with our values of dignity and justice, if we are presented with a situation in which a pregnancy threatens a woman’s life, our first priority is to save both patients. If that is not possible we will always save the life we can save, and that is what we did in this case.”
A moral theologian who investigated the principles at issue argued that the baby’s death was indirect, and not desired as such. The diseased organ was in fact the placenta. In performing its normal function the placenta brought about cardiogenic shock in the mother; the placenta also became unable to get enough oxygen. In fact, the theologian argued, both the mother and the baby were in the process of dying. The hospital could not save the baby’s life but it could save the mother by removing the pathological placenta. It might be further argued that, since the death of the baby is inevitable in any event, one cannot in fact choose or intend a death which is already in the process of taking place.
So, what do you think?
One view might well be that the bishop is right. Clearly the removal of the placenta destroys the baby just as cutting off the oxygen from a deep-sea diver kills the diver. I would imagine that, in most cases of “mother and baby”, the placenta will play a part since it is the organ of transmission between the two. Consequently it can nearly always be argued that it is at least a contributor to the problem and so can be lawfully removed. What then is left of the strongly defended moral teaching that the baby may not be killed to save the mother? And since that teaching is based on the inalienable rights of human beings, its neglect has the most serious consequences.
Furthermore, the bishop has ruled with full authority that this is in fact direct abortion. Thus every Catholic in the diocese ignores his authority at his peril and, arguably, can never do wrong in following it.
On the other hand, one might claim that this is a matter of conscience; that this has been formed with care by the hospital in this case appears to be likely. The theologian’s argument is well summed up by the hospital’s statement that this was not a matter of taking life but of saving the only life which potentially could be saved. In any event, the effect on the baby was incidental and an unintended side effect of removing the toxic placenta.
Another might claim self-defence against an aggressor. The baby is an innocent aggressor – as a schizophrenic waving an axe may be – but an aggressor nevertheless, against whom one may act in self-defence.
A more direct view, which its proponent would surely style as simple common sense, is that, once you strip away all these casuistic arguments, you are left with a clear issue: which is more pro-life: to allow both to die or to save one? Anything else is cheese-paring.
I hope you do not expect me to plump for any one of these arguments. First of all I am not a moral theologian so I cannot guide anyone with authority. Second, that is not the purpose of a case study. But exploring the strong and weak points of these arguments (and any others which you think are relevant) helps to focus and practise the mind in moral issues. I hope that such a discussion will take place on Secondsightblog.net. I have in fact arrived at my own conclusion but I will benefit much from the thoughts of others – particularly if they show me to be wrong.
Anyone who would like more details of this case can obtain them from here, where you will find links to several relevant documents.