A nun being excommunicated for saving a woman's life is not the real story

Some of you may have heard about the excommunication of Sr. Margaret McBride in Phoenix, AZ.

The background (via NPR):

Last November, a 27-year-old woman was admitted to St. Joseph's Hospital and Medical Center in Phoenix. She was 11 weeks pregnant with her fifth child, and she was gravely ill. According to a hospital document, she had "right heart failure," and her doctors told her that if she continued with the pregnancy, her risk of mortality was "close to 100 percent."

The patient, who was too ill to be moved to the operating room much less another hospital, agreed to an abortion. But there was a complication: She was at a Catholic hospital.

"They were in quite a dilemma," says Lisa Sowle Cahill, who teaches Catholic theology at Boston College. "There was no good way out of it. The official church position would mandate that the correct solution would be to let both the mother and the child die. I think in the practical situation that would be a very hard choice to make."

But the hospital felt it could proceed because of an exception — called Directive 47 in the U.S. Catholic Church's ethical guidelines for health care providers — that allows, in some circumstance, procedures that could kill the fetus to save the mother. Sister Margaret McBride, who was an administrator at the hospital as well as its liaison to the diocese, gave her approval.

The woman survived. When Bishop Thomas J. Olmsted heard about the abortion, he declared that McBride was automatically excommunicated — the most serious penalty the church can levy.

[You can also view a 'Today Show' segment on this here.]

Now you may be thinking -- especially if you're not Catholic -- that this is merely a story about an interesting theological or philosophical debate, but that ignores the larger issue.

Why should non Catholics be concerned?

I. Faith-based, not medical-based care

All Catholic health care institutions are required to follow the Ethical and Religious Directives for Catholic Health Care Services ("5. Catholic health care services must adopt these Directives as policy, require adherence to them within the institution as a condition for medical privileges and employment, and provide appropriate instruction regarding the Directives for administration, medical and nursing staff, and other personnel.").

This document includes policies such as:

24. ...The institution, however, will not honor an advance directive that is contrary to Catholic teaching.

36. Compassionate and understanding care should be given to a person who is the victim of sexual assault...It is not permissible, however, to initiate or to recommend treatments that have as their purpose or direct effect the removal, destruction, or interference with the implantation of a fertilized ovum.

42. Because of the dignity of the child and of marriage, and because of the uniqueness of the mother-child relationship, participation in contracts or arrangements for surrogate motherhood is not permitted.

45. Abortion (that is, the directly intended termination of pregnancy before viability or the directly intended destruction of a viable fetus) is never permitted. Every procedure whose sole immediate effect is the termination of pregnancy before viability is an abortion, which, in its moral context, includes the interval between conception and implantation of the embryo.

47. 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.

48. In case of extrauterine pregnancy, no intervention is morally licit which constitutes a direct abortion. [Usually referred to as an ectopic pregnancy.]

52. Catholic health institutions may not promote or condone contraceptive practices but should provide, for married couples and the medical staff who counsel them, instruction both about the Church's teaching on responsible parenthood and in methods of natural family planning.

53. Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health care institution.

68. Any partnership that will affect the mission or religious and ethical identity of Catholic health care institutional services must respect church teaching and discipline. Diocesan bishops and other church authorities should be involved as such partnerships are developed, and the diocesan bishop should give the appropriate authorization before they are completed. The diocesan bishop's approval is required for partnerships sponsored by institutions subject to his governing authority; for partnerships sponsored by religious institutes of pontifical right, his nihil obstat should be obtained.

II. You may not have a choice of a non Catholic hospital

First, some stats:

Via Catholics for Choice:

According to a 2003 survey, there are 611 Catholic hospitals in the US (12% of all hospitals).

More than a quarter of Catholic hospitals are located in rural areas, meaning that there are often no other viable health care options for people living in those areas, especially the poor, who may not be able to afford to travel to another institution.

The number of people in the US treated each year in a Catholic acute care facility each year 1 in 6.

Four of the top 10 largest nonprofit health care systems are Catholic owned, including the largest.

Via Women's News:

In 1998, the group says, Catholic hospitals were the sole providers of medical care in 91 communities--a 20 percent increase in a single year.

Via RHRealityCheck:

According to a study by Catholics for Choice, half of merged secular-Catholic hospitals suspended most or all of their reproductive health care services. Eighty-two percent denied emergency contraception to rape victims -- and more than a third refused to provide a referral.

Additionally, your managed care insurance may not give you a choice of non Catholic care and, of course, if you are rushing to the nearest emergency room you may not be thinking about what directives it's functioning under.

Moreover, a 1995 study by Catholics for a Free Choice showed that only 27% of women understood that being part of a Catholic hospital system could limit their reproductive care.

[On a personal note, I have to add that when UPMC South Side hospital became an outpatient center center, in all the outrage over losing a local hospital, I don't recall hearing that it would become a Catholic institution. I only realized this when I took someone there and saw that it was now had "Mercy" in its name.]

Conclusion

We have a system where health care institutions who receive government aid in the form of Medicare, Medicaid, and which "benefit from tax-exempt status, obtain low-cost financing through tax-exempt government bond programs and, in some cases,use municipal buildings and even manage publicly-owned hospitals" and which may be the only readily available provider can and do refuse on the basis of faith alone to provide legal procedures and to follow best and appropriate medical practices arguably to the point of malpractice.

And, this is not limited to abortion, but also includes refusal of: birth control, tubal ligation, infertility treatments, emergency contraception, end-of-life directives and comprehensive HIV/AIDS prevention information.

In the specific case of St. Joseph's Hospital, while the NPR article mentions Directive 47, that directive does not allow direct abortions even to save a woman's life. What it does allow, for example, is chemotherapy for pregnant women with cancer as a fetus can survive these treatments especially after the first trimester.

The 27-year-old mother of four, however, had pulmonary hypertension which required an abortion to save her life and which directly violated Directive #45.

Fortunately, cooler (and rational) heads prevailed -- a nun put her "soul" at risk rather than the actual life of another woman -- and four children were not orphaned.

A woman was not allowed to die (this time).

And, now you know what risks you may face if you end up at the wrong hospital.