"It Gives the Mother the Best Chance for Her Life": U.S. Catholic Health Care and the Treatment of Ectopic Pregnancy.

Abstract

“It Gives the Mother the Best Chance for Her Life”: U.S. Catholic Health Care and the Treatment of Ectopic Pregnancy Jessica Martucci (bio) It is widely understood that the Catholic Church prohibits abortion.1 Few women today would likely approach a Catholic hospital with the hope of obtaining an elective abortion. That this is so normalized in our society is a reflection of both a long history of Catholic influences in American health care and the Catholic Church’s long-standing position on the matter.2 This association between Catholicism and antiabortion politics dates back to the 1869 proclamation by Pope Pius IX that officially declared abortion at any point in gestation—either its conduct or its procurement—to be an excommunicable offense.3 Yet despite the apparent clarity and consistency of their convictions, the implementation of this position in Catholic health care institutions has never been quite so straightforward. In her prescient 2002 essay, “The Evil of Abortion and the Greater Good of the Faith,” religious studies scholar Kathleen M. Joyce argued that leaders in Catholic medicine had learned to strategically diminish their “condemnation of practices their church deemed evil in the pursuit [End Page 48] of . . . the preservation of a Catholic voice in the American health care system.”4 Here I examine this characterization and perhaps push it even further. As nursing historian Barbra Mann Wall has demonstrated, Catholic medical organizations have a long history of evolving and negotiating to maintain and grow their success.5 In the pages that follow, I discuss how one of the staunchest antiabortion forces in America has grappled with the limits and consequences of a religious ban on procedures that are central to the provision of women’s health care. Through a brief analysis of the case of ectopic pregnancy, I emphasize the historical weight behind what has become a well-known mantra in modern reproductive health activism, as well as the namesake of a proposed bill in the U.S. Senate: “Abortion is Healthcare.”6 From a Fatal Condition to Lifesaving Treatments Sometimes described in the historical medical literature as an “extra-uterine” pregnancy, ectopic pregnancy describes a condition in which a fertilized egg implants somewhere other than in the main cavity of a woman’s uterus and begins to grow. The most common presentation of this is a tubal pregnancy, which occurs in the Fallopian tubes due to preexisting infections, endometrial growth, or a structural abnormality.7 Once implanted, the embryo attempts to form connections with the blood vessels in the tube. The tube wall swells and weakens as the embryo develops, and if left untreated, the tube can burst, causing hemorrhage and death for the embryo and often the mother. The condition is considered so pathological that contemporary bioethicists have suggested we stop referring to it as a “pregnancy” at all.8 The condition was first described in an eleventh-century Arabic medical text, but the development of lifesaving interventions did not emerge until the late 1800s as anatomical knowledge and antiseptic methods improved. Medical data collected by nineteenth-century physicians suggested a 25 percent survival rate without intervention. Those who lived faced a life-time [End Page 49] of complications as a result of the ordeal.9 As early twentieth-century obstetrician Joseph B. DeLee wrote in 1915, “The prognosis as to health is also bad, because the condition leaves peritonitic adhesions, which often result in sterility; if untreated, decomposition and abscess cause hectic fever, invalidism, etc.”10 Given these poor outcomes, it is no wonder that the 1884 report of a successful surgical treatment for ectopic pregnancy by a Scottish gynecologist and surgeon named Robert Lawson Tait caused such a stir in the late nineteenth-century medical world. By 1888, Tait had operated on a total of twenty-eight patients who suffered from a ruptured tubal pregnancy and had lost only one, a feat made only more remarkable at the time by his complete disavowal of germ theory and aseptic and antiseptic techniques.11 The new technique made ectopic pregnancies a treatable condition and saved lives. Between 1876 and the turn of the twentieth century, the documented mortality rate for a ruptured ectopic pregnancy fell from...