This is my third article this week regarding this issue. It won’t be the last. This afternoon I received a rebuttal from a Pediatric Cardiologist, Dr. Judith Becker. It is presented here with my rebuttal. Your thoughts???
Judith Becker MD
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
attitude.
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.
Judith Becker MD
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Dr. Becker,
Thank you for your thoughtful and edifying note. In conversations that I have had with other physicians regarding this matter, they have conceded that while it is possible for the mother to have suddenly gone into a severe state of pulmonary hypertension, the likelihood is pretty remote. Your experience of only three such cases over twenty years in your field of expertise would seem to support your colleagues’ contentions of such being a rare occurrence, and thus not the likely scenario in this case.
In the cases which you have cited, did the patients who died have an abortion?
In terms of the oath you take as a physician, how you understand that oath and are prepared to live that oath should be a consideration before applying for privileges at a Catholic hospital where competing visions of bioethics are likely to collide.
I take specific issue with contention number two in your comment:
“An abortion early in the pregnancy of a patient like this is far safer than taking a wait and see attitude.”
Perhaps. But this a priori standard is in direct contravention to Catholic bioethics and moral norms in such circumstances. You state a willingness to forgo both standard and experimental treatment in favor of what you deem the safest approach for the mother. Other of your colleagues would beg to differ with you on this approach to the management of both patient’s lives.
I cannot begin to tell you of how many women I have encountered, who were told that abortion was the safest route for the mother, that the child didn’t stand a chance, and who would rather have died than have their child die by their own hand, only to have given birth to a perfectly healthy child.
Perhaps this case was different. Perhaps it was as severe as some have suggested (though with HIPAA law I don’t see where the details would have originated).
In the end, like it or not, agree with it or not, Catholic hospitals are run in accordance with Catholic moral norms. It is the responsibility of the administration to articulate these norms with crystal clarity and leave it to patients and medical professionals to determine if they wish to pursue institutional affiliation in light of the restraints imposed by those moral norms.
All too often, Nuns and laypeople have treated Catholic hospitals as personal prelatures. Bishop Olmsted has spoken with the clarity that was lacking in Sr. McBride. It’s unfair to shoot the messenger.
Gerard M. Nadal, Ph.D.
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Read the second post dealing with Sr. McCabe’s administrative failure HERE.
Coming Home 
Gerard,
“An abortion early in the pregnancy of a patient like this is far safer than taking a wait and see attitude.”
I’m a little confused by something. Assuming that it would not be advisable to take a “wait and see” attitude, couldn’t one just induce pregnancy or remove the baby via c-section to save the mother’s life? Then of course the principle of double effect would apply. I have no idea what would have been the best thing to do medically in this situation, but doesn’t induction of labor or a c-section ALWAYS work as a LAST resort and are moral under the principle of double effect?
Just to be clear, my question is more about teh medical possibility of induction or c-section, not so much the MORAL question of whether or not it would be advisable in this particular situation.
Bobby,
The earliest that a baby is viable in the NICU is 24-25 weeks. Delivering a baby at 11 weeks by induction or C-section is tantamount to a live abortion where the baby is delivered and left to die as Jill Stanek has so aptly described it, “like a fish out of water”. I don’t see double-effect applying here, as we are not removing a diseased organ containing the baby, but directly targeting the baby as the etiological agent of what is perceived as the impending death of the mother.
Bobby, a case like this is always an automatic c-section, an induction would put too much stress on the heart and lungs. But it’s a complicated question that I think would depend on whether delivering the baby would actually reverse the pulmonary hypertension.
In any circumstance, it is a terrible and heartless way to treat women, instead of actual investigation into effective treatment, to be told you ‘need’ to kill your child. Quite similar in texture to just dumping women with treatable hormone imbalances on the Pill and proclaiming them cured.
Great response, Gerard. I’m glad you’re still on this one.
I do have a hypothetical question, though, which I’d be glad if you could answer:
The earliest surviving preterm baby was born at 21 weeks, five days gestation (dating from the mother’s last menstrual period, not from conception). He is now a perfectly healthy adult.
In a situation like this, where a patient presents with pulmonary hypertension and is 11 weeks pregnant, would it be morally permissible to attempt to deliver her baby at 22 weeks (eleven weeks later) IF:
a) her condition had deteriorated to the point where she is in danger of imminent death;
b) delivering the child would significantly improve her chance of survival;
c) a full neo-natal intensive care team were to be present at the birth and every effort made to ensure the child’s survival?
I realize that birth at 22 weeks (though there have been some survivals that early) is likely to be a very risky undertaking, but I wondered whether at this point “double-effect” might allow such an action–that is, if the child’s death is not intended nor even willed, but every effort would be made to keep the child alive outside the womb. Of course, if the mother’s condition were stable and waiting two more weeks were possible, that would naturally be the preferable option. But I think there’s a possible zone between 22 and 24 weeks when delivery might be morally permissible under extreme conditions–would I be off base about that?
Erin,
That’s an excellent question. I could be wrong here, and would defer to a moral theologian or applied ethicist, but it would seem to me that if we were looking at the end here and there is a precedent in the literature for a baby surviving at that early age, then not willing the death of the child, but actually bringing it to its best shot at life, I’m not even certain that this would be double-effect. There is no corresponding unintended evil, (unintentional, but certain killing of the baby). This is an emergent procedure calibrated as a last option at life.
In London Ontario Canada, the Catholic hospital has been doing exactly what Bobby mentioned:
inducing labor which is in effect a live abortion.
The “early inductions” were done primarily for reasons of eugenics – that is the baby had some sort of disability and the parents simply did not want to continue the pregnancy.
As far as I know the matter is not resolved and seems to have fallen off the radar.
This is a very complicated issue but at the heart of it is also the doctor’s apparent certainty that abortion is the only possible treatment.
Doctors are quite often wrong.
My own family experienced just such a situation 51 years ago when my brother was conceived and the doctors told my mother she MUST abort.
Well she didn’t and her ob got her through the pregnancy like he said he would.
He has grown up to be an accomplished scientist.
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Since I am being quoted in this string I feel I should speak for my self 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:
https://gerardnadal.com/2010/05/17/the-bishop-the-nun-the-mother-and-child/
This discussion began on the 17th and my first 2 responses occurred on May 20. Since the first entry is included her, I will only add the other 2
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. Becker,
We’ve been busy celebrating our son’s 11th birthday yesterday and today. I’ll have time later tonight to give your thoughtful comments the time and attention they deserve.
Best,
Gerry Nadal
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