Friday, December 31, 2010

The Wall Street Journal Weighs In about St. Joseph's Hospital

I've been following the controversy between Bishop Olmsted of the Phoenix Diocese and St. Joseph's Hospital in Phoenix and its parent organization, Catholic Healthcare West. (See here, here, and here for previous posts.) I'm not Catholic, but I"m moved by the moral seriousness of Catholic healthcare ethics, and have admired the church's strong traditions of social justice since learning about the Berrigan brothers during the Vietnam era.

In an op ed in today's Wall Street Journal, Professor Anne Henderschott of The King's College in New York weighs in with strong support of the Bishop. I've taken the liberty of reprinting the op ed, with my own comments interlaced in bold italics:
Catholic Hospitals vs. the Bishops
Administrators shop for theologians to support practices that conflict with church teachings

The severing of ties last week between the Catholic Church and St. Joseph's Hospital in Phoenix, Ariz., is the latest example of the fraying relationship between the bishops and Catholic hospital administrators. In recent years, some Catholic hospitals have taken greater liberties, authorizing abortions and sterilization procedures that the church strictly prohibits. Earlier this year, for instance, Rev. Robert Vasa, bishop of the Diocese of Baker, Ore., ended the church's sponsorship of St. Charles Medical Center in Bend over the hospital's performance of tubal ligations.

But the Phoenix case breaks new ground. In explaining his decision, Rev. Thomas Olmsted, bishop of the Phoenix Diocese, was the first to explicitly point to the role played by Catholic theologians in providing theological cover for "a litany of practices in direct conflict with Catholic teachings."

The terms "shop for theologians" and "theological cover" are catchy journalism, but cheap shots of this kind are demeaning to what has thus far been a thoughtful, respectful deliberation. The terms presuppose the correctness of the Bishop's position, which is exactly what is being questioned.

The break began more than a year ago, when a Catholic nun and longtime administrator of St. Joseph's Hospital gave permission for doctors to perform an abortion. She claimed the pregnancy was terminated to save the life of the mother. Sister Margaret McBride's decision drew sharp criticism from Bishop Olmsted. After excommunicating Sister McBride, the head of the diocese then turned his attention to the role of the hospital itself.

In the phrase "She claimed..." the op ed again substitutes rhetoric for analysis. "Claim" is defined as "demanding one's due." Guilty parties claim innocence. Children claim the toy is really theirs and doesn't belong to the true owner. A proper description is that Sister Margaret "concluded" that the procedure was morally justified. We might end up thinking she was wrong, but we shouldn't treat her as making an unreasoned "claim."

In a Nov. 22 letter to Lloyd H. Dean, president of Catholic Healthcare West, the hospital's parent company, Bishop Olmsted wrote that he would be moving to revoke the Catholic status of the hospital unless certain conditions were met by hospital administrators. Among other things, the bishop demanded that hospital officials acknowledge in writing that the abortion performed was a violation of Catholic directives for health-care institutions.

But hospital officials have defied the bishop and refused to meet his conditions. Rather than acknowledge that an illicit abortion had been performed at his hospital, Mr. Dean attempted to support Sister McBride's decision by pointing out that "many knowledgeable moral theologians have reviewed this case and reached a range of conclusions."

Once again, the op ed assumes that the procedure was "an illicit abortion" without engaging with the substantive questions at stake.

In a July 6 letter to Bishop Olmsted, Mr. Dean asserted that "this is a complex matter on which the best minds disagree." Citing the opinion of Marquette University Professor M. Therese Lysaught on the permissibility of the abortion performed at St. Joseph's, Mr. Dean appeared to suggest that the teaching authority of the Phoenix Bishop was just one more "opinion" on a "complex matter."

I've had the opportunity to read Professor Lysaught's analysis. In its careful attention to (a) the medical facts of the situation and (b) the complex ethical issues the patient, family, and caretakers were dealing with, it's (c) a brilliant, persuasive analysis. I hope it becomes widely available - I would like to use it in my class on medical ethics as an example of careful reasoning about a topic that is too often drowned in strident rhetoric.

This case points to the real problem in the church. For too long, the authority of bishops has been limited to issuing mere opinions. This is especially true at Catholic colleges and universities, where bishops have little affect on the culture and curriculum.

In the recent health-care debate, it was these same Catholic theologians who joined Sister Carol Keehan, head of the Catholic Health Association, to defy the bishops over the legislation in Congress. Cardinal Francis George, president of the United States Conference of Catholic Bishops, criticized Sister Keehan and her organization for supporting a bill that did not contain provisions to protect life. President Obama was so grateful for Sister Keehan's help in shepherding the bill through Congress that he awarded her one of the 20 pens used in the law's signing ceremony at the White House.

Many theologians, like Prof. Nicholas Healy of St. John's University in New York, write that theologians comprise "an alternative magisterium" to the teaching authority of the bishops. And in cases like the one at St. Joseph's, the alternative magisterium often trumps the true Magisterium of the church. Catholic colleges and hospital administrators now "shop" for theologians who will support their decisions.

As an interested observer of the Catholic tradition, my hunch is that the choice for the church is finding ways to live with the "alternative magisterium" or lose Catholics to other denominations (or to "unaffiliated" status). As I've written in a previous post, the Bishop's conclusion about the Phoenix case is not likely to persuade many of the faithful. The fetus and mother were both in the process of dying. There was no medically imaginable scenario that would have led to birth of a living child. The Bishop's position would appear to have required the caretakers to wait until the fetus had died, hoping that the mother would still be alive and that a D & C could then be done to save her life. Even to those who regard abortion as an evil to be forbidden, I believe the Bishop's position will seem like a tortured effort to hold to an orthodoxy that simply makes no sense by criteria of (a) "common sense," but also (b) by Catholic theology and ethics, seen in the light of Professor Lysaught's analysis.

Bishop Olmsted has refused to allow this to continue. In his letter responding to Mr. Dean, the bishop wrote: "You have only provided opinions of ethicists that agree with your own opinion and disagree with mine."

Concluding that "there can be no tie so to speak in this debate," Bishop Olmsted said, "it is my duty as the chief shepherd in the diocese to interpret whether the actions at St. Joseph's meet the criteria of fulfilling the parameters of the moral law as seen in the Ethical and Religious Directives."

For faithful Catholics, there is relief that the tie between the theologians, the administrators and the bishops seems finally to have been broken. But there remains a sadness that yet another Catholic institution has been lost.

I have no expertise about the theological understanding of the role of the Bishop within the church, but I believe Bishop Olmsted is correct in claiming positional authority to declare what is true church teaching. The problem with regard to the St. Joseph's Hospital situation is that his analysis is not likely to be persuasive. Since the fetus, as well as the mother, was in the process of dying, there was no way to protect the unborn life. The choice was between two deaths, or one.
The comments in response to newspaper articles on the case often invoke the pedophile scandals. This is psychologically understandable, but not relevant to the merits of the Bishop's argument. The pedophile scandals have dealt a severe blow to trust in the church heirarchy, just as the scandals about sex with patients and corruption of medical judgment by commercial interests have diminished trust in the medical profession. Trust is easy to lose and very difficult to regain.

In a previous post I encouraged readers to watch the press conference in which Bishop Olmsted explained his decision. Although I was not impressed by his reasoning, I was moved by his moral passion, as expressed in his response to a question he was asked about being vilified in the media:
I really don’t read the blogosphere. I try to pray each day to find my identity in Jesus Christ… My identity comes from Christ. Christ is present in his living body, the church… That’s my identity, it comes from there. If I am unfaithful to that, then whether I’m looked at one way or another, if I’m given praise or given ridicule doesn’t matter. What I’m called to be is faithful to Jesus Christ and his church.
To my reading, paragraph 47 in the Ethical and Religious Directives for Catholic Health Care Services exactly describes the situation the patient, family, and caretakers faced:
Operations, treatments, and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman are permitted when they cannot be safely postponed until the unborn child is viable, even if they will result in the death of the unborn child.
Had the caretakers postponed the intervention they made, both mother and fetus would have died. In concluding that it was ethically and theologically correct to terminate the pregnancy the patient, family, and caretakers were acting in accord with Jesus's teaching "I was sick, and ye visited me." I was sad to see Bishop Olmsted attach his moral passion to a conclusion that appears to be erroneous within his own theological and ethical tradition.


Anonymous said...

Dear Jim,Points: (1)The media does shop for theologians: they pick one whose views do not conform to the teaching of the Magesterium.I have experienced this many times especially in relation to abortion.There is one Magesterium in the Catholic church and Catholics are morally bound to follow its teaching, but we retain the freedom of will to do as we please,with consequences .The church is not going to change its teaching to fill the pews. Remember Pope John Paul's quote : "Ut unum sint".
(2) The mother was not in the process of dying and the act of killing is much different than dying.She had severe pulmonary hypertension.(3) "Illicit abortion": this was direct killing of the fetus.(4)"Claim vs. concluded" seems clintonesque while "seen in the light of Prof. Lysaght's analysis" is an acceptable phrase!
Thomas Warner, M.D.

Jim Sabin said...

Hello Thomas -

Thank you for your thoughtful comments. You raise important points. I'll address them sequentially:

(1): I'm sure that you're correct about media "shopping." I also know that first hand - I'm often contacted about "ethical cost containment," a topic I've written a lot about. But the op ed author's comment about "theological vover" presupposes (a) that Professor Lysaught was sought out in a duplicitous manner to provide a predetermined conclusion and (b) that her analysis was wrong. Unless she has evidence about the correctness of (a) I'll persist in seeing her words as unearned rhetorical gestures.

(2) I rely on Professor Lysaught's detailed analysis of the medical facts for my assertion that the mother was indeed in the process of dying. Apparently the St. Joseph's medical record (of course I haven't seen the record itself, nor have I had any contact with any of the care team) makes it clear that the patient was in a worsening state of cardiogenic shock. Members of the care team made several notes saying that risk of death was close to 100%. My term "in the process of dying" isn't a precise phrase, since "dying" isn't a state with a precise moment of onset. But my inference is that caregivers at the bedside might well have said to each other "this poor woman is dying."

(3) Bishop Olmsted concludes that the D&C was an "illicit abortion." Professor Lysaught's theological analysis, which draws on a wide range of church teachings, concludes otherwise. Have you had a chance to read her analysis? I found it persuasive.

(4) I don't think "claim vs concluded" is "Clintonesque." Given that the op ed author has demeaned the analysis as "theological cover," to my ear calling Professor Lysaught's conclusion a "claim" has the ring of how we describe the protestations of guilty parties to innocence.

I'm on shaky grounds with regards to the nuances of the Magesterium. My understanding is that the Bishop is entitled to speak for it and to present his conclusion as "true," not simply a "claim." But as I've said in my posts, my guess is that for those who accept the description of the medical facts, the image of standing by while the patient died, either predeceased by death of the fetus or followed by it, will simply not make moral sense to many observant Catholics. (I haven't seen any surveys on this, but that's how friends I've spoken to have reacted to the Bishop's position.)

Again, thank you for your comments!



Anonymous said...

What a revelation to find your blog! I look forward to reading Lysaught's analysis and more of yours. Lori Freedman

Jim Sabin said...

Hello Lori -

Thank you for the kind words!

If you are the Lori Freedman at UCSF you will see that a post that will go onto the blog tomorrow refers to your article "When There’s a Heartbeat: Miscarriage Management in Catholic-Owned Hospitals." I admire and have learned from the work you and your colleagues do. Thank you for it!

Re the Lysaught analysis, I believe that it will ultimately be posted on the Catholic Healthcare West website.