This exchange is the latest with Pediatric Cardiologist, Judith Becker, M.D. whose opinion is that Sr. Margaret McBride made the right call in signing off on an abortion in a patient with Pulmonary Hypertension.
Dr. Judith Becker
Since I am being quoted in this string I feel I should speak for my self as I have being quoted out of context and though I answered Dr Nadals questions, he apparently did not see that portion of my response. I also asked for some clarifications of his response and I have not yet seen a response from him.
As you will read in my final entry on the prior string this morning, I would respond here as well to Dr Nadal, “You may argue this all you want from the perspective of canon law, but do not use my words to argue it from a medical perspective. And, if, in fact in it’s infinite wisdom, the church rules that it is less sinful to lose two lives than save one, I can understand why there is a crisis of faith.”
In context my responses can be found at:
This discussion began on the 17th and my first 2 responses occurred on May 20.
May 20 10:30 AM:
I am a pediatric cardiologist whose expertise is in fetal diagnosis and care. In this capacity I see patients with pulmonary hypertension far more frequently than my colleagues. I also see other complications of pregnancy as a direct result of my work. I have 3 times in my 20 years of practice seen patients turn up in an emergency room in pulmonary hypertensive crisis without having known they had significant pulmonary hypertension prior to that time. Two of those patients never left the hospital but rather died over days to weeks in out ICU. A patient in that condition may or may not be easy to transfer elsewhere, depending on how much support she needed. There are experimental medications for pulmonary hypertension (including viagra and similar pulmonary vasodilators) but these therapies have a spotty performance record and it would not be known for months whether they had done enough to improve the patients condition significantly. Pregnancy effects the heart in these mothers in two ways. First it puts an increased volume load on the heart which if already failing can push it over the edge. Then in the process of straining, the right heart can acutely fail with this disease leading to sudden death.
The upshot of all this is:
1 – Yes, the mother could have arrived at the hospital for the first time in poor condition, could have required stabilization and may have been too sick to move.
2 – An abortion early in the pregnancy of a patient like this is far safer than taking a wait and see
3 – To deny this mother lifesaving medical care at the time of the admission denied her access to long term therapies that might save her life. Also without her survival, the fetus could not survive so on the logic of not killing the fetus, we condemn both to death or murder, if you like. We also deny the previously delivered children of this mother the care of that mother in the future.
As a physician, this is an ethically untenable position. We take an oath when we complete our training to do no harm…..In a terrible situation like the one being discussed therefore it is far better to save the mother than lose both the mother and the child.
May 20 12:35 AM
Dr Nadal I have to take issue with you on this case. As Linda points out and as you yourself say, no one knows all the details, yet further on in your article you then rush to judge that a Bishop’s but not a nun’s word should be taken for whether an ethical line was crossed. I would, given that none of us know the specifics, and that both sides of the issues are represented by those in God’s service, tend to respect the nun’s position since she was right there at the time hearing ALL the arguments on both sides. If that is not good enough, then how about bringing the case into the light (without exposing the name or identifying info of the patient) and let us all be presented with all the known facts on both sides before running to judge?
I know it’s a bit off issue, but why have there not been ANY excommunications of priests who are recognized by the community to have rape multiple children, but a nun is excommunicated in a murky controversy of preserving the rights of the mother over that of an ultimately nonviable fetus.
In answer to your questions about my post above, the two deaths I mentioned related to Pulmonary hypertension were not preceded by an abortion. We had another case where a young mother was admitted and found to have free aortic insufficiency (another abnormality where pregnancy can be lethal and is contraindicated). That mother was counseled that her best hope for a good outcome was to ‘terminate the pregnancy’ (medical terminology), have her aortic valve replaced, and then go on to become pregnant with a functioning valve. She did choose that course, and as a result has a healthy heart which will function properly in future gestations.
When you comment: “Other of your colleagues would beg to differ with you on this approach to the management of both patient’s lives.” I have to ask if those are physicians who have cared directly for patients with Pulmonary hypertension in this situation?
May 22 8:22AM:
Dr Nadal has chosen to speak for me but he is taking my words out of context to make his own case and in the process has no regard for his own warning that we do not know all the facts and therefore should be careful about our assumptions….he is over and over making a huge assumption and it is inappropriate for him to use my words to support that assumption when in fact I was suggesting he not assume and that the opposite could be true.
Let us be clear.
1 – Pulmonary hypertension is a terrible disease and is very commonly quite lethal
2 – It is something that cannot quickly or easily be fixed or even improved WITH ANY KNOW MEDICAL THERAPY. It carries an unacceptably high mortality rate when it occurs, and IT RARELY REARS IT’S HEAD BEFORE THE PATIENT IS QUITE ILL AND THE HEART IS FAILING bringing them to medical attention.
3 – Fortunately it is uncommon, BUT THAT IS VERY DIFFERENT FORM CONTENDING IT IS NOT LIKELY TO HAVE HAPPENED IN THIS CASE. If it was a common enough occurrence a consult to the ethics committee would not have been necessary.
3 – Fortunately it is an uncommon disease BUT it does happen and FROM A MEDICAL PERSPECTIVE, if that was the case, Sister McBride and her medical staff DID EVERYTHING RIGHT.
You may argue this all you want from the perspective of canon law, but do not use my words to argue it from a medical perspective. And, if, in fact in it’s infinite wisdom, the church rules that it is less sinful to lose two lives than save one, I can understand why there is a crisis of faith.
Dr. Gerard M. Nadal
You raise several issues in your posted comments, and I shall address them, I hope to your satisfaction.
First, as to your contention that Bishop Olmsted is missing data and not in a position to know with certitude if a line has been crossed, that simply is untrue from the standpoint of Roman Catholic moral theology and the bioethics that issue forth from those moral norms. I am certain that you are well-acquainted with the Principle of Double-Effect, which in essence allows for the removal of a diseased organ in order to save the life of the mother. The stipulation is that the organ containing the child (tube or uterus) is sufficiently diseased that it would certainly kill the mother prior to bringing the baby to viability at 23-25 weeks. In performing the procedure, the unintended consequence is the death of the baby, which is nevertheless an objectively evil action.
In the Phoenix case, the deliberate and intended action was the killing of the child. It was a direct targeting of the baby for death.
In Roman Catholic Christian anthropology and moral theology, both mother and child have equal human identity and moral standing as human beings, as human persons. It is impermissible to deliberately kill the one in an attempt to save the other. Bishop Olmsted, a Doctor of Canon Law, understands the rationale behind this better than most. Sister McBride too understood this, as well as the penalty for formal cooperation in procured abortion. The penalty is automatic (latae sententiae) excommunication. It is not imposed by a bishop or court, but is an automatic cutting off of oneself from the Body of Christ by one’s very actions. It ranks with desecration of the Eucharist and murdering a Pope.
As for your gratuitous dig regarding pedophile Priests not having been excommunicated, that is a line of argumentation made this week by NPR.
The line of argumentation in the NPR article that suggests as much illustrates a dangerous conflation of issues and ignorance of morality and justice.
There is no doubt that the sexual abuse of children is truly horrifying, whether by a Priest, a parent, a school teacher, scout leader, or any other person betraying a position of authority and trust. Whether or not that abuse merits excommunication is an argument that I would love to see vetted by moral theologians and canon lawyers.
Suppose it were an offense that merited excommunication? Further suppose that pedophile Priests incurred the penalty. Excommunication is a penalty intended as a medicinal remedy. Readmittance to the Church is made through confession to a Bishop (unless he delegates that authority to his Priests). Even if all of that were already operative, it would have no bearing on the intrinsic merits or demerits of the case in Phoenix.
Further, the Pope is the one with the authority to promulgate canon law. The NPR piece deceptively leads one to the erroneous conclusion that Bishop Olmsted, or any other Bishop, has discretion in excommunicating pedophiles, when in fact he doesn’t. Bishops can only adjudicate as much as Church law allows them to adjudicate, and I have not heard of Bishop Olmsted being implicated in cover-ups of pedophiles.
Yet this will be the new narrative when going after other abuses, “But what about the pedophiles…?” The pedophiles are now being dealt with decisively.
Returning then to your concerns, I do believe that I characterized your position well from your initial comments. If I have not, please detail for me how this is so.
I take issue with the following that you wrote:
“Fortunately it is uncommon, BUT THAT IS VERY DIFFERENT FORM CONTENDING IT IS NOT LIKELY TO HAVE HAPPENED IN THIS CASE. If it was a common enough occurrence a consult to the ethics committee would not have been necessary.”
In your initial comments, you claim to have seen only three sudden, acute cases of PHT in twenty years as a specialist. That’s one case every 6.7 years, which qualifies as rare. Though there are medical treatments both standard and experimental, you stated in your original post:
“2 – An abortion early in the pregnancy of a patient like this is far safer than taking a wait and see
3 – To deny this mother lifesaving medical care at the time of the admission denied her access to long term therapies that might save her life.”
However, Catholic bioethics and morality requires that every effort be made to save both patients’ lives. Your approach in #2 is a direct contravention of this principle and practice.
Further, the convening of a bioethics panel for something which is expressly forbidden is an exercise meant to give cover to the institution for something a priori known to be morally evil. We do not engage in morality by consensus in the Catholic Church.
The ethics panel made a decision, and now would mandate that the entire Magisterium of the Church be guided by their decision’s precedent, effectively usurping Apostolic Authority, particularly divinely instituted Papal Authority of the Pope as the sole law-giver.
No. The answer is no.
This same group has engaged in a slow, selective leak of information to carefully craft a narrative wherein they are the heroes. Along the way they have essentially betrayed this woman’s identity by divulging her age, month of admission, pregnancy, condition, and course of action. Anyone who knows this woman knows the identity of the individual being discussed, and can divulge that to all the world if they so choose. It’s a dirty, scummy tactic that may well comprise a violation of HIPAA law. To say the least it is unethical, but to quote Scarlet O’Hara after she murders the Yankee soldier in Gone With The Wind,
“I done murder; I can do anything.”
And they will do anything, including this smear campaign against Bishop Olmsted.
I suspect that what hasn’t been said of this case says much in defense of Bishop Olmsted’s actions in removing this excommunicated nun from her post.
The hard reality, Dr. Becker, is that we simply do not see the child as lacking humanity or full moral worth. That’s the real issue between us.