I’m going to go out on a limb by beginning with the suggestion that St. Joseph’s Hospital in Phoenix was not correct in its moral  analysis of the situation in which, to save the life of a pregnant woman, the woman’s foetus was killed and an abortion performed. I believe that, though the compassionate option, the abortion cannot be justified on the grounds of Catholic morality.

Before I am finished I hope my reasons for believing this will become clear. But first, I want to refer you to two documents: first, M.Therese Lysaught’s analysis of the circumstances in which she seeks to justify the act on the ground of Catholic morality (thanks to Griffin for the reference); and second, the National Catholic Bioethics Center’s Commentary on the “Phoenix Case”. These two documents, in addition to documents already referenced in my earlier post, “Catholic Madness,” give us a privileged glimpse into the shadow world of Catholic moral decision-making. What we see in this shadow world is, I believe, deeply troubling.

Let’s begin with a statement made in the NCBC commentary:

As a Catholic health care institution treats and cares for both the mother and the unborn child it must commit itself never to crossing a clear, bright line: it may never directly take the life of an innocent human being as it cares for both patients.

There are several things wrong here. From any reasonable standpoint there are not two patients here, but one, and that one pregnant. Losing sight of this fact is what makes a clear moral analysis of the situation virtually impossible. Second, if the line is clear and bright, there should be no disagreement, but the disagreements are deep and irresolvable, as a comparison of Lysaught’s analysis with the one offered by Robert L. Conte, Jr. will show. Third, the categorisation of the conceptus-blastocyst-embryo-foetus as a human being, while possibly not disputable in Catholic ethics, is, to say the least, idiosyncratic. Throughout the analyses the unborn foetus is called a baby, and this is not strictly correct. The OED does not even include this usage as a figurative expression. A baby, according to the OED — in the only sense relevant to the present discussion — is: “an infant, a young child of either sex. (Formerly synonymous with child; now usually restricted to an infant ‘in arms’.)” The fourth problem here is the context in which the decision is made. It is a context of authority. The NCBC commentary points this out directly when it says that

… one factor which certainly appears to have contributed to the difficulties in Phoenix is that the hosptial was not in consultation with the bishop regarding the appropriate interpretation and application of the Ethical and Religious Directives. (3)

As the bishop himself has made very clear, the hospital, as a Catholic hospital, is under authority, and is not free to interpret the ethical and religious directives within his diocese without consultation with him. He is the one entitled to provide authoritative interpretations of these directives within his diocese, and the hospital, as a Catholic hospital, must be bound by respect for his Apostolic authority. This adds yet another dimension of murkiness to the already inspissated gloom of scholastic detail which is unavoidable in a morality of rules.

With those few concerns in mind, let us take another look at the process of Catholic moral analysis as this is exemplified in the Phoenix case. This case concerns a 27 year old pregnant Catholic woman suffering from pulmonary hypertension (which can be treated, but not cured), already the mother of four children. (The medical specifics are considered in sufficient detail in Dr. Lysaught’s analysis, and will not be repeated here.) Initially, the woman, a faithful Catholic, decided, despite the dangers to her own health, to continue with the pregnancy. However, because of her condition (of pulmonary hypertension), which affected the arteries of the lungs and the right side of the heart, and because pregnancy puts extraordinary stress on the heart and therefore increased demand on the lungs to oxygenate signifcantly increased amounts of blood (40%) required to maintain the health of the placenta and foetus, the woman suffered, as Lysaught’s analysis puts it, “two negative physiological outcomes: the failure of the right side of the patient’s heart and cardiogenic shock.” (2) The result of these two outcomes was that the woman’s life was in peril, and by November 5, 2009, “mother and fetus were both in the process of dying.” (2)

Now, here is the important point, which, to my mind, is the first thing that must make Lysaught’s analysis wrong in terms of Catholic morality. In her analysis she tries to show that the moral object in terminating the pregnancy of the woman in question, was not the death of the foetus, but the removal of the placenta, which is an organ of the mother’s body, and not a human life. (This is, apparently, the consideration on which the hospital Ethics Committee based its own judgement.)  As she says:

… the placenta not only initiated a threat to the mother’s life; it also became the  immediate/presenting cause of the inevitably fatal threat to the fetus. (3)

She had just said that

The cause of the increased blood flow and cardiac demand was not the fetus but rather the placenta — an organ in its own right. (3)

These minute distinctions — the placenta is, after all, the life-giving interface between the woman and the foetus – are necessary in order for Lysaught to come to the conclusion that the description of the act which ended the life of the foetus is not the termination of the life of the foetus but the removal of the placenta which is what, physiologically speaking, immediately threatened the woman’s life. It is simply quixotic to attempt to distinguish the placenta’s role from the role of the foetus in adding stress to the woman’s pulmonary vascular system.

So, the clear, bright line that must never be crossed, according to the NCBC, is not so clear and bright after all. The moral object of the procedure which terminated the woman’s pregnancy — to which Bishop Olmstead took such grave exception — was not, therefore, the termination of the pregnancy, but the removal of the diseased or compromised placenta, an act which the Ethics Committee of the hospital concluded should not be considered a direct abortion (3) — that is, an act of crossing the clear, bright line — but an act of which the death of the foetus was a secondary effect which, while known, was regretted for precisely this reason, that is, that it was known that “the child [would] not survive.” (see Lysaught, 14)

As we have already seen, Robert Conte’s analysis of the act comes to a very different conclusion. According to Conte, the moral object of the act was the termination of the pregnancy. And, as John Paul II declared in his encyclical Evangelium Vitae:

I declare that direct abortion, that is, abortion willed as an end or as a means, always constitutes a grave moral disorder, since it is the deliberate killing of an innocent human being. (§ 62,
Lysaught’s emphasis)

(I think this form of words — viz., ‘I declare’ – means that this is, for Catholics, an infallible utterance of the magisterium.) Lysaught then spends several pages quoting Catholic authorities to the effect that, in the case in question, the direct moral object of the act which saved the woman’s life did not amount to the absolute moral evil of direct abortion. As she says, when she begins her discussion of this question:

Determining the object of an act is one of the most critical steps in moral analysis. (7)

Clearly, if we consider Robert Conte’s analysis there is room for disagreement as to what the moral object of the act which saved the womans life really is. According Lysaught the removal of the placenta was comparable to the termination of ectopic pregnancies, and, in such cases it has been determined that

These actions are not exceptions to the norm prohibiting direct abortion. These actions are properly described as a different category of action [my emphasis] because of their different moral object which is, in the words of Veritatis Splendor, “capable of being ordered to God.” (11, § 80 of Veritatis Splendor, John Paul II’s encyclical on the foundations of Catholic morality)

The heart of Lysaught’s analysis lies in the fact that there is nothing, in the situation, that could have saved the life of the foetus — she calls it “the child”, but that is only because, in Roman Catholic moral theology, the conceptus is a child. She quotes an authority which states that

Only if the fetus would otherwise survive could its death be said to be chosen as a means — and thus caused “directly” in a morally relevant way. (13)

The intervention to save the life of the mother would have been wrong, unable to be “ordered to God”, if there were any chance at all that the foetus could survive, and be brought to the point of viability, regardless of what happened to the woman. Quoting another authority — it’s all, really, a question of authority and interpretation: which authority more accurately represents the magisterium? — it seems that it is possible “to abort without choosing to kill.” Intention is at the heart of this analysis, and intention can only be appraised from the point of view of the acting person. (Veritatis Splendor, § 78) So, quoting the general principle from a Catholic moral authority, in the case of the woman in the Phoenix hospital,

… the proposal adopted is, not to kill the unborn baby, but to have him or her removed from the womb, with death as a foreseen and accepted side effect. An abortion carrying out such a choice would not be an intentional killing. (quote from Grisez, The Way of the Lord Jesus, 501, my emphasis)

If this sounds sophistical, perhaps the reason is that it is! Removing a “baby” from the womb before viability is to kill it. It doesn’t get much more straightforward than this.

But here’s the problem which Lysaught does not deal with. It comes out very clearly in her summary:

Given the medical facts of the case, it was germane to their deliberation that in this instance it was not a matter of weighing one life against another or choosing one life over another; they were faced with a scenario in which without action both mother and child would die and that regardless of the course of action, the child was now terminal. (23, my emphasis)

(By the by, notice how she has upped the ante. The foetus is no longer a baby. It has grown to full stature as a child!) This brings us to the second place where Lysaught’s analysis goes wrong. The problem here is simply this. According to Roman Catholic moral doctrine, human life is of infinite value from conception to natural death. However short a time the “child” in the womb had to live, that life, as an inescapable consequence of the sanctity of life doctrine adhered to by the church, is of infinite value, and may not be terminated. To choose the woman’s life over the life of her foetus, however short a time the foetus had to live, is to choose one life over another. That the life of foetus, because of the pregnant woman’s compromised health, was threatened, is neither here nor there from the standpoint of the sanctity of life doctrine. The church has made this very clear in its opposition to assisted dying. If its condition was terminal, it was incumbent upon the physicians to wait until it had died, before removing it from the womb. To remove the foetus from the womb was to hasten its death — this is inescapable — and, as we know, this is strictly prohibited in Roman Catholic moral theology. Euthanasia or assisted dying are acts which cannot be morally ordered to God, in John Paul II’s rather pregnant phrase, and twist and turn as she likes, Dr. Lysaught cannot escape this consequence.

It is, however, significant to note that not once in Lysaught’s analysis of the Phoenix case does the word ‘compassion’ appear. This is not a matter of compassion, but of rules, and how rules can be manipulated and qualified in order to get what is considered the “right” moral outcome. But there is no reason why one outcome should be considered more moral than another, if the only issue here is the rules and their correct application. This is what, to my mind, is so morally bankrupt about Catholic morality.

Not once in the entire analysis of the situation, then, does Dr. Lysaught consider the woman and her plans, hopes and fears, her relationships, her place in the community, her being loved by her children and husband, or her love for them. Not once does she mention the woman’s children, and the devastation that would follow from their mother’s death. The only important consideration is whether or not the moral object of the act which saved the woman’s life is morally legitimate in Roman Catholic moral theology, whether it can be “ordered to God” or not. But the only reason to manipulate the rules so as to come to the desired conclusion, is the fact that the unmentionable – compassion — is driving the analysis. But so intent is she on getting the desired outcome, that, in the end, Dr. Lysaught is caught off guard, taking the terminal condition of the foetus as sufficient grounds for suggesting that, because the foetus is terminal, the moral object is saving the woman’s life, not hastening the death of the foetus — an act so heinous in the church’s mind that it is prepared to go to practically any lengths to make sure that assisted dying is not legalised, and abortion not performed. Authority and casuistry are more important than compassion. The only way to save the woman is by clever theological reasoning, and quietly suppressing one of the premises. It is not a reassuring picture.