Monday, January 10, 2011

Catholic Social Vision and the Diocese of Phoenix

With regard to the abortion done for a patient who was 11 weeks pregnant and on a rapid trajectory towards death from pulmonary hypertension at St. Joseph's Hospital in Phoenix, I wondered if Fr. John Ehrich wanted to stand by the comment he made on May 21, 2010:
"She consented in the murder of an unborn child" said the Rev. John Ehrich, the medical ethics director for the Diocese of Phoenix. "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."
I went to his website to find the answer. He does.

Fr. Ehrich graduated from college in 1998, so he's probably in his 30s. A Fox News video from December 23 shows a young man pontificating with great certainty about complex existential issues involving theology, ethics, the patient's personal morality, and medical practice. Fr. John evinces what to my eye was smug assurance, not the loving humility one hopes to see in religious leaders.

What I find most painful about the St. Joseph's controversy is that by what many - including committed Catholics - see as a reasonable interpretation of directive 47 of the Ethical and Religious Directives for Catholic Health Care Services, the care at St. Joseph's hospital was religiously, ethically, and medically the right course of action:
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.
If what the caretakers at St. Joseph's saw as a nearly one hundred percent certainty of maternal and fetal death caused by the increased cardiovascular demands of the pregnancy is not "a proportionately serious pathological condition of a pregnant woman," it's hard to imagine what would qualify as "proportional."

The controversy about St. Joseph's is not a replay of the all-too-familiar "pro-life" and "pro-choice" stalemate. It's about interpretation of Catholic teachings themselves. An excellent 2008 article in the American Journal of Public Health by Lori Freedman and colleagues - "When There’s a Heartbeat: Miscarriage Management in Catholic-Owned Hospitals" - reports on interviews with physicians who practice at Catholic hospitals. At some hospitals ethics committees forbid doing an abortion procedure if the fetal heart is still beating, however tenuously, even if other facts make it clear that the fetus cannot survive to birth. At others, such as St. Joseph's, directive 47 is interpreted as being focused on saving the life of the mother when the fate of the fetus is already sealed.

In the research and teaching I've done in India, I met many Catholic volunteers and health professionals working in NGOs serving patients with HIV who were abandoned by others. Mother Theresa is only the tip of the iceberg for the Catholic social mission. Catholic individuals and institutions committed to caring for the poor embody the best ideals in health care. The moral and religious perspective of the caretakers motivated by the Catholic vision of health ministry would not bless the decisions of the Diocese of Phoenix that condemn an otherwise dying patient who reluctantly agreed to terminating her pregnancy as a murderer!

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