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May 22, 2010

Catholic hospital in Phoenix attacked by its bishop for saving the life of a critically ill mother

It's like a bad Monty Python skit. Someone dressed as a bishop piously expresses his determination to fight for his principles "to the last drop of her blood." Another incident in the news, and our Church is left with another big black eye--looking as if it has no heart and no common sense.

Last week in Phoenix, the bishop condemned a Sister of Mercy working in his diocese because she served on a hospital ethics committee that approved an emergent abortion to spare the life of a pregnant mother of four children. The bishop seemed content with the possibility that, had he been making the decisions himself, both the woman and her baby would have died.

This patient's condition, a severe case of pulmonary hypertension, was morally no different from an ectopic pregnancy, where the baby has no chance of survival and the mother's life depends on removing the involved fallopian tube. Under circumstances of a normal pregnancy, the circulation to a woman's lungs increases significantly while the resistance of the blood vessels falls--resulting in no net change in the pressure within the circulatory system of the lungs. In the case of a woman with pulmonary hypertension during pregnancy, this resistance remains high despite the increased blood volume being pumped into the lungs. This results in a potentially tremendous increase in the work performed by the right side of the heart as it circulates the blood through the lungs. Even under normal circumstances, a woman's heart undergoes tremendous changes during pregnancy, with eventual enlargement of the pumping chambers, enlargement of the individual heart muscle cells, and often a leakiness of the heart valves prior to delivery.

The mortality of pulmonary hypertension in pregnancy is very high, and the cause of death for the mother is usually right heart failure. When occurring early in pregnancy, as in this case, deterioration typically occurs during the second trimester with fatigue, shortness of breath, and loss of consciousness. This decompensation occurs in part because during pregnancy there is a substantial increase in both blood volume and cardiac output, which is further severely exacerbated during labor.

The particular details of this woman's medical condition are not known, but she was so ill that she could not be transferred to another hospital. Indeed she was far more symptomatic than most women with this condition in the late first trimester of pregnancy, and the baby was not remotely close to the point of viability. Although there are many potential contributing factors to the development of pulmonary hypertension in pregnancy, there is at least an indirect role played by the fetal placenta--since removing it alleviates the condition in most cases.

Thoughtful discussion of this issue is rooted in a set of principles attributed to St Thomas Aquinas, who wrote about "double effect" in his Summa Theologica regarding the circumstances under which one tragic outcome is avoided through a course of defensive action. In this case, the intended effect was to save the woman's life, not to terminate a desired pregnancy. The effect of not performing the procedure would have been the greater evil of the death of both the mother and the fetus.

The Catholic Medical Association, an organization for conservative physicians, issued a statement supporting the bishop. Their statement pays no heed to the futility of continuing a pregnancy that is likely to result in the deaths of both mother and child. As such, it shows both a contempt for reason and a willfull disregard for the most fundamental principles of medical ethics. Unlike the bishop, who may not have understood the threat posed to this mother's life, these doctors show a callous disregard for the patient, her husband, her extended family, and her four children by favoring her death in support of their principled stance.

Because conservative political strategists have succeeded in persuading some US bishops to make opposition to legal abortion the principal litmus test of fidelity to the Church, these bishops have painted themselves into a corner where they cannot allow themselves to countenance any nuance on the issue. There is circumstantial evidence that abortion rates among Catholic women, on average, are rising compared to the general population. As the number of parishes and priests shrinks, the ability of the Church to engage morally in the personal life struggles of Catholics is receding. There is a forest of need in the Church that is being overlooked, while conservatives focus on chopping away at a few tall trees at the center of the tragi-comedy that is the current debate over abortion.

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