Caught in a Non–Kosher Pickle

Abstract

Caught in a Non–Kosher Pickle Anonymous Two1 I want to share two stories that come from my work at a Catholic hospital. Both stories concern matters of reproductive ethics. It is well known that the Catholic Church has special commitments regarding the protection of prenatal life. These and other ethical commitments are spelled out in the Ethical and Religious Directives for Catholic Health Care Services—better known as the “ERDs.” All Catholic hospitals are expected to follow the ERD’s. At least three principles from the Catholic tradition are relevant to the stories I’ll share. I will try to translate them into lay terms without distorting their essence. First, from the time of conception until a natural death, all human life is sacred and deserves protection. So in the sphere of reproductive ethics this means that we have to be as concerned about the dignity of the fetus as the dignity of the mother. Second, under certain conditions an act may be performed that has foreseen good and bad effects. Crucially, the bad effect cannot be intended and nor can it be the means by which the good effect is accomplished. Further, there must be a proportionately serious reason for performing the act. This is called the principle of double effect. Third, sometimes an individual or institution may cooperate with the wrongdoing of others. Cooperation is more likely to be permissible when it is as far removed from the act as possible. And again, the wrongdoing cannot be intended by the cooperating party. This is called the principle of material cooperation. It is, for example, the principle used to justify paying taxes even when the government engages in some actions that the Church deems immoral. These principles have been in use for hundreds of years in Catholic moral theology. Case 1: A Prolapsed Umbilical Cord The first story I want to share concerns a woman who was 20 weeks pregnant. She arrived at the hospital with an overt prolapsed umbilical cord. This means the umbilical cord dropped through the cervix into the vagina. She was not in labor. Both her primary OB and a consulting OB agreed it was not possible to place the cord back in the uterine cavity. Neither believed the baby would survive. Both were concerned for the well–being of the mother. They called the cord a “wick” meaning it would expose the mother to infection. Ordinarily labor would be induced. However, the ERDs have two directives directly relevant to this case. First, “For a proportionate reason, labor may be induced after the fetus is viable (Dir 49).” In this case both obstetricians agreed the baby was not viable. Second, “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 (Dir 47).” This directive rests squarely upon the principle of double effect. So any action that [End Page 13] would end the life of the baby prematurely needed to have a proportionately serious reason. Both physicians agreed that the prolapsed cord posed a serious threat to the mother. However, the consulting obstetrician, who was a very conservative Catholic, felt that the ERD’s would not permit induction of labor until the mother showed signs of fighting an infection such as elevated fever. The hospital lawyers and I disagreed with this position; however, the consulting obstetrician was adamant. He also was in regular communication with the local bishop’s office. Administration was deeply concerned that the procedure might be described as an abortion and the bishop would initiate disciplinary actions against the hospital. In the end, the mother’s primary obstetrician transferred her to another hospital and induced labor within the hour. I had advised the hospital in a manner I believe was true to the hospital’s faith tradition and my own conscience. But I knew that my advice increased the hospitals risk of disciplinary action. It was a profoundly uncomfortable situation. It may have adversely affected my reputation among the more conservative elements at...