Casuistry is the process of making bad things look good. You just have to tinker with the rules until you get the answer you want. The problem with cauistry is that it makes you look insincere. You lay down the rules, and then you try to find ways to break them.
Abortion is forbidden by Roman Catholic ethics. The pope has said so, and that makes it infallible. But then he says that, no, that’s not quite right, what he opposes is direct abortion, and that if you can find a way to make an abortion look indirect, then perhaps it would be alright. Otherwise, it’s a mortal sin, and you’ll go straight to hell.
That’s why the case of the Phoenix woman with pulmonary hypertension — which just means that she can’t oxygenate all the blood that is needed to keep a foetus alive because the arteries in the lungs are not up to the task – is such a big deal. In some cases of pulmonary hypertension the odds of bringing the foetus to term, so that a child will be born, are pretty steep. And so it happened in the case of the 27 year old woman at St. Joseph’s Hospital and Medical Center, in Phoenix, Arizona. It was clear to the medical staff that both the woman and her foetus were dying, and they had to act.
Why did they have to act? Wouldn’t it have been better to let them both die? That’s what the rules required, or at least seemed to. The important thing about Roman Catholic morality is that you must have a proper moral object, and the proper moral object says that you can’t break any rule in order to bring about something good. In this case, you can’t kill one person, the foetus, in order to save the mother. Well, she isn’t a mother yet (at least for that foetus), but let that pass. If you’re going to save the mother, you can’t kill the foetus in order to do it. Period. But if the foetus isn’t killed the mother will die.
Impossible. Can’t be done. However, there may be one option. It’s okay, in the treatment of disease, to remove diseased organs. But the foetus is not an organ. The foetus is a person. So you can’t kill the foetus. However, if you can find an organ that is diseased, you can remove that, even though removing it would kill the foetus. If that looks tricky, that’s because it is. It’s called the doctrine of double effect, which says that, in doing something that is intended to do one thing, which is an appropriate moral object, and something else happens which you do not intend by doing the first thing, then you’re home clear. Intentions are really tricky though, and it’s hard to say what you really intended. Perhaps the forbidden thing is the really important thing all along. This is especially tricky here, because you know that if the foetus lives the woman will die, and that if you can manage to kill the foetus the woman will live, and there is no way to keep both of them alive together. How do you keep your intentions in separate compartments?
But it gets even trickier. There isn’t a diseased organ in the case of the pregnant woman with pulmonary hypertension. No one knows what causes it. So, if we’re going to use this trick, we’re going to have to pretend that there such an organ. In the Phoenix case they plumped for the placenta, the interface between the woman and her foetus. They assumed that the placenta was the diseased organ responsble for the pulmonary hypertension. If it weren’t for the placenta and its hormonal surge the woman’s body would not be demanding more blood, so that’s where the problem lies, because a pregnant woman needs 40% more blood to feed the foetus that is growing inside her, and to transfer all its wastes away, and this is what the placenta does. It creates a hormonal spike which spurs the heart to produce more blood which has then to be processed by the lungs and …, well, anyway, that must be the problem. Couldn’t be anything else.
So, the placenta is to blame. Remove the placenta, and the woman’s blood production will drop to normal. Quick, snappy, slick solution. But wait, that will kill the foetus, because without the placenta the foetus will die. Well, that’s too bad, but that’s a sad side effect, not intended, mind, but certainly regretted.
And then along comes the bishop who says, “You just killed a kid,” and he excommunicates the person chiefly responsible, namely Sister Mary McBride, who approved the procedure. Bummer! That would be bad enough, but the bishop went on to say, ”I’m the boss of you, and if you don’t approve, you can’t represent the Catholic Church anymore.” Everyone thinks the bishop was unfair — well, almost everyone, anyway — he didn’t understand the complexity of the decision that was just made. Doesn’t he know that a woman would have died, a woman who already had four children? Yeah! He knew. That’s not the point. He has Apostolic authority, and that means that his right to say no comes down to him right from Jesus, through the Apostles, and because of that he gets to boss doctors and nuns around, at least if they sail under the church’s colours, and the church says no, you can’t do that. It’s not only wrong. It’s absolutely wrong. And that one word changes everything.
If something is absolutely wrong, then you can’t do it, period. Even causistry won’t work. It’s one thing to fool around with language, and come up with something like an indirect abortion, which seems to let you off the hook. But there’s another rule, and even indirect abortion breaks this rule. According to the church, life is sacred, from conception straight through to natural death. No exceptions. No indirect killing. Indirect abortion seems alright until you realise that it’s really a case of killing an innocent person. And Roman Catholics are simply up their eyeballs in organisations, associations and other agglomerations of people whose entire reason for being is to get laws which uphold the church’s view on the sanctity of life, or to oppose laws which do not uphold this conviction. The life of a foetus, even of a conceptus a couple days old, is just as sacred as you or me, and has just as much right to life, no matter how short. This means, in case they haven’t noticed, that when you terminate a pregnancy, even because the woman is suffering from cancer of the uterus, you shorten that sacred life. Can’t help it. And there is nothing that can justify this. The most intolerable, escruciating pain and suffering cannot justify it, and it’s hard to think that this changes just because a woman might die unless she has an indirect abortion, because the indirect abortion brings a direct end to sacred life, whatever the intention of the act by which it is done.
But notice one thing. The whole problem doesn’t arise, as long as you simply obey the rules. The rules are what they are and they have the outcome that they do. It’s just as simple as 1 2 3. The only reason to use casuistry, and to try to evade the authority of the rules, and the anger of the god who prescribes them, is compassion. Perhaps if they had started out there, the whole thing would make a bit more sense. The trouble is that the rules are there precisely to keep us from using compassion as an excuse. Start out with compassion, and the rules are simply beside the point. But then, the church wouldn’t have any control, would it?