Archive for May, 2010

Today’s article in HeadlineBistro

Word last week that a new, “synthetic cell” has been made by Dr. J. Craig Venter, of Human Genome Project fame, has electrified many in the scientific world. The announcement has led to confusion about what has actually been accomplished, opened the door to possibilities both revolutionary and frightening, as well as rekindling debate over the ethics of manipulation.

What Venter and his colleagues actually did was to synthetically produce the entire chromosome of Mycoplasma mycoides, a type of bacterium lacking a cell wall, and transplant it into its cousin, Mycoplasma capricolum. Though the two are cousins, the M. capricolum began to produce proteins of M. mycoides, whose instructions for being built are carried only in the M. mycoides genome. Read about the back-story more fully here.

Critics of Venter rightly point out that he has not made a truly synthetic cell, as he has ‘merely’ transplanted the genome of one species of bacterium into the preexisting cell of another species. From any perspective, semantics notwithstanding, this is a revolutionary advance in the field of molecular biology. It really matters not that Venter used another species to produce the instructions on the newly introduced chromosome.

We have long been able to introduce foreign genes into unrelated cells for production of novel proteins. This process of Cell Transformation was first discovered by Frederick Griffith in 1927, and shown by Alfred Hershey and Martha Chase, in a Nobel Prize-winning experiment, to be brought about by novel DNA.

The key to getting the activation and expression of foreign genes is to attach to them regulatory DNA sequences recognized by the cell as belonging to one of the cell’s own genes; in effect “tricking” the cell to make something other than what it thinks it’s making. This is how we have been making human insulin in microbes for decades. We simply attach the human insulin gene to a regulatory region of DNA meant for a microbial gene, and trick the cell into producing human insulin.

What Venter has done is bring this process to a level that is orders of magnitude more involved. Under such a paradigm, he doesn’t need to craft an entirely new cell, but that is coming. The possibilities for the future are so large as to be barely capable of being articulated.

Of course, the optimists are attaching to this the possibility of realizing their fondest hopes and dreams. Count me among them. We may well be able to design organisms capable of producing pharmaceuticals, cosmetics, biofuels, fertilizer compounds, or even be able to consume crude oil as their only carbon and energy source. The latter would be a next generation improvement from the current microbes in use, and would be especially helpful in oil spills such as the unfolding disaster in the Gulf of Mexico.

The sky is literally the limit, as we most certainly will design ever-increasingly useful synthetic cells. We have been on this road since Griffith’s discovery of Cell Transformation. It is inevitable. Improvements in biotechnology will accelerate the pace at which these developments will be made.

However, there are some serious concerns over what designer DNA inside of designer cells could do if these organisms were to escape into the wild.

Griffith’s experiment showed that components (now known to be DNA) of heat killed pathogenic Streptococcal bacteria were taken up by non-pathogenic Streptococcal bacteria, transforming these hitherto tame cells into pathogenic strains.

What if some designer DNA was to make it into cells in the wild (called wild-type to distinguish them from their experimentally created cousins)? What if the DNA from the synthetic cells transformed these wild-type cells? Depending on the new capacities, this could cause an ecological disaster. Are we prepared for controlling this new capacity and the possible catastrophic consequences of its misuse, intentional or otherwise?

In the movie, Inherit the Wind, based on the Scopes Monkey Trial over teaching evolution, Spencer Tracy portrays Clarence Darrow and makes this argument to the jury about the price of progress:

Gentlemen, progress has never been a bargain. You have to pay for it. Sometimes I think there’s a man who sits behind a counter and says, ‘Alright, you can have a telephone, but you lose privacy and the charm of distance.’

‘Madam, you may vote, but at a price. You lose the right to retreat behind the powder-puff or your petticoat.’

‘Mr., you may conquer the air, but the birds will lose their wonder and the clouds will smell of gasoline.’

Darwin took us forward to a hilltop from where we could look back and see the way from which we came, but for this insight, and for this knowledge, we must abandon our faith in the pleasant poetry of Genesis.

Similarly, Molecular Biology has taken us to a hilltop from where we could look back on the natural order of the biological world down to its molecular level of order and control. But for this insight, and for the revolutionary advances that will be made, we must be prepared to abandon our comfort in certain knowledge of the natural order, and prepare for a new order of uncertain stability in the biosphere.

This new order will mean new levels of vigilance, of regulation and oversight.

In a sense, we’ve worked out many of these concerns already. Many of the same concerns were raised more than thirty years ago in the creation of transformed cells, which also use antibiotic resistance genes to help select the creation of successful clones by growing in a culture medium laced with antibiotics. These transformed cells were created with a few essential genes that were crippled, so the cell could not grow outside of the lab, where these defects could be artificially remedied with nutritional supplements.

Still, as Andrew Haines, President of the Center for Morality in Public Life accurately points out, “Synthetic cells aren’t bad; they also aren’t new life. But we must proceed with caution nonetheless; since increases in scientific precision often give rise to the opinion that man ought to regulate the conditions of his own being. And this is patently false.”

Similarly, Catholic News Service reports:

Archbishop Rino Fisichella, the head of the Pontifical Academy for Life, told Italian television May 21 that as long as synthetic cells were used “toward the good, to treat pathologies, we can only be positive.” However, if they are used in ways that offend human dignity, “then our judgment would change. We look at science with great interest. But we think above all about the meaning that must be given to life. We can only reach the conclusion that we need God, the origin of life.”

That’s going to be a tough but necessary sell with Molecular Biologists. It is a comparably small price to pay for our ability to do so much potential good.

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After a pleasant evening with my brother Knights of Columbus, I came home to the following reply to my post below showing the Marie Stopes ad for abortion services on English T.V. They must be catching hell for this if they have people trolling the internet to do damage control. The following answer speaks for itself. No need for me to parse it out.

All I’ll say is that this is a tragic come-down for the nation that gave us St. Thomas More, Sir Isaac Newton, Charles Darwin, Literary Giants such as William Shakespeare, Chaucer, Milton, Lord Alfred Tennyson, The Brownings, Thomas Hardy, John Locke, Thomas Hobbes, Carlotte, Emily and Anne Bronte, Jane Austen, William Blake, Percy Bysshe Shelley, Lord Byron, G.K Chesterton, John Donne, J.R.R. Tolkein, George Eliot, Rudyard Kipling, Winston Churchill, and a host of other giants too numerous to list in a post (though it would be great for people to add their own favorites).

Evil always trips itself up. Consider this following news story quote in light of the email I received from this same organization.

” ‘The ad is not about abortion,’ Julie Douglas, marketing manager of Marie Stopes told Fox News, ‘It doesn’t mention abortion. It’s about unplanned pregnancy.’ “

From Marie Stopes:

2010/05/27 at 11:57 PM
At Marie Stopes International we always support a woman’s choice to continue with her pregnancy or have an abortion. If a woman feels that an abortion is in her or her family’s best interests, then she should have access to safe, supportive and non-judgmental advice and help form an expert clinic. No one else should pressure her into either continuing with the pregnancy or having an abortion.

The earlier a woman decides on abortion, the more options are available to her, and the easier and safer it is to perform the abortion.

Abortion is available for free on the National Health Service, but waiting periods vary according to area, and this is a time when days may be crucial. Also, not all women resident in the UK are eligible for NHS abortions: women visiting from other countries, or women living in Northern Ireland, are required to go private.

These adverts will enable women who think or know they may be pregnant, and are considering abortion, to find out where they can get one.

I see you are an American blogger. You may not be aware that in the UK, many public services and charities, including health charities, advertise on TV: TV ads are by no means exclusive to “consumer services”. For example, prior to our recent General Election, the Electoral Commission ran ads to let people know how they could find out if they were registered to vote, and where they could register, and when the deadline was. Doing so did not mean the right to vote was equated to “pizza delivery, internet service, and appliance repair”: those ads were providing the general public with information both useful and necessary. So with our ads.

Marie Stopes International makes clear to all patients who are eligible for NHS treatment that abortion and contraception services are free on the NHS: but all women, anywhere, have a right to choose whether or not to have an abortion. No one else can make this decision for her.

Some of the money from the fees people pay in the UK Marie Stopes centres goes towards supporting the work Marie Stopes International does overseas.

In 2008 alone, MSI provided over six million people in 42 countries with high quality health services, including family planning; safe abortion & post-abortion care; maternal & child health care including safe delivery and obstetrics; diagnosis & treatment of sexually transmitted infections; and HIV/AIDS prevention. Millions of people die unnecessarily each year from health conditions that could be prevented or treated at low cost because they do not have access to basic sexual and reproductive health services. Marie Stopes International is working to change that.

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The following video is of a television commercial by one of England’s largest abortion providers, Marie Stopes. It seems to all outward appearances to be a soft-peddle for abortion. Why else would one of England’s largest abortion providers be offering to “help” with a late period? They aren’t exactly the local Catholic Charities office. Following is a list of Marie Stopes’ services, which evidently do not include helping women bring unplanned pregnancies to term:

Our services include:

Unplanned pregnancy counselling
Abortion information and advice
Help for women needing abortions
Abortion pill and other treatment options
Vasectomy information and vasectomy procedure
Female sterilisation
Health screening for men and women
Company health screening
STI testing

The ethical dimensions seem pretty clear. Abortion is now being pressed home as a consumer service along with ads for pizza delivery, internet service, and appliance repair. This is what western civilization has come to.

{HT: Deacon Greg Kandra}

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In our ongoing exploration of the Phoenix abortion and the application of double effect, commenter Marle asks a great clarifying question:


Dr Nadal, I understand I will never get you to agree with abortion and I’m not trying to convince you otherwise. What I don’t understand about double effect is why abortion is ok if you take the fallopian tube. The fallopian tube isn’t killing a woman in that situation; as evidenced by the fact that in many cases the fallopian tube doesn’t have to be removed. What’s killing the woman in a tubal pregnancy is a fetus growing where it can’t, and it has to be removed. It seems to me that double effect makes it so that abortion is ok as long as the woman is permanently hurt in the process.

Gerard M. Nadal


I don’t think that either of us is convert hunting here. One of the purposes for which this blog is offered is to have a quiet little corner for people to duck in from the maelstrom and explore some of the science, ethics and theology that undergird the pro-life movement. I prefer a quiet and civil, academic tone to the screaming out of the windows at passers-by found elsewhere, and thank you for such a reserved tone.

Let’s walk this through slowly and deliberately to best answer your question.

First and foremost, the difficulty in discussing double-effect (DE from here) is magnified if one of the parties sees no problem with abortion in general. DE seems a sleight of hand at abortion to most pro-choice folks with whom I have spoken.

However, to understand DE, we must assume a starting position that states a categorical prohibition of the direct targeting of the baby (more properly embryo or fetus) for death. In a word: Abortion.

There is a huge difference between an abortion and removal of a fallopian tube containing an embryo, or a hysterectomy of a severely cancerous uterus containing an embryo or fetus. That difference is what DE establishes. To recapitulate the four conditions which establish DE:

First: The action contemplated must be in itself either morally good or morally indifferent.

Second: The bad result must not be directly intended.

Third: The good result must flow from the action as immediately as the bad effect.

Fourth: The good result must be “proportionate to” the bad result.

It must be stressed that all four of these conditions MUST be met for DE to have been established.

Let’s start with an advanced tubal pregnancy first. The embryo has gotten stuck (usually behind a blockage in the tube such as scar tissue from PID). The embryo continues to develop to the point of swelling the tube and eventually bursting it with catastrophic hemorrhaging by the mother. It can be, and is for too many, immediately fatal.

The removal of the tube satisfies the above 4 conditions as follows:

1. The action being contemplated here is not the killing of the baby, but the removal of a tube that is a clear and present danger to the mother’s life. The removal of the dangerously damaged tube is itself a moral good.

2. There is a bad effect in the removal of the tube. There is a baby inside that is going to die when we remove the tube. Current medical science has no way of extracting the baby and implanting it in the uterus. Nevertheless, a bad result will ensue. A baby will die. This result, however, is not directly intended. Intent matters greatly.

3. The good result is that the mother’s life has been saved. The bad result is that the baby died. The benefit to the mother is as immediate as the bad effect because the dangerously damaged tube has been removed.

4. The good result is proportionate to the bad result in that we saved the life of the mother, though unintentionally the baby died

So we see that the removal of an advanced tubal pregnancy satisfies all four conditions for DE.

In the case of an early tubal pregnancy treated with methotrexate, none of the conditions of DE applies.

1. The contemplated action itself is morally bad: the chemical abortion of the embryo.

2. The bad result (death of the baby) is directly intended.

3. The good result does not flow immediately from the action along with the bad effect. (There is no guarantee that the tube will be useful in the future, especially if scarred from PID).

4. The good result (saving a fallopian tube) is disproportionate to the loss of baby’s life (even if the loss were a certainty in advanced tubal pregnancy).

In short, as methotrexate targets the baby directly, it is nothing more than a chemical abortion. There have been reports of early tubal pregnancies where the embryo has dislodged itself. The child deserves the chance, as well as the medical community exploring ways to safely secure that result through medical intervention.

Thus we see through the conditions for establishing DE that certain life-saving procedures may be performed if the direct action is morally good, the bad action is not directly willed or intended, the good action flows as immediately as the bad action, and the good result is proportionate to the bad result.

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I add this explanation of the principle essential to guiding our discussion of the Phoenix abortion.

(Source: Wm. David Solomon, “Double Effect,” The Encyclopedia of Ethics)
Lawrence C. Becker, editor

This principle aims to provide specific guidelines for determining when it is morally permissible to perform an action in pursuit of a good end in full knowledge that the action will also bring about bad results. The principle has its historical roots in the medieval natural law tradition, especially in the thought of Thomas Aquinas (1225?-1274), and has been refined both in its general formulation and in its application by generations of Catholic moral theologians. Although there has been significant disagreement about the precise formulation of this principle, it generally states that, in cases where a contemplated action has both good effects and bad effects, the action is permissible only if it is not wrong in itself and if it does not require that one directly intend the evil result. It has many obvious applications to morally complex cases in which one cannot achieve a particular desired good result without also bringing about some clear evil. The principle of double effect, once largely confined to discussions by Catholic moral theologians, in recent years has figured prominently in the discussion of both ethical theory and applied ethics by a broad range of contemporary philosophers.

Formulation of the Principle. Classical formulations of the principle of double effect require that four conditions be met if the action in question is to be morally permissible: first, that the action contemplated be in itself either morally good or morally indifferent; second, that the bad result not be directly intended; third, that the good result not be a direct causal result of the bad result; and fourth, that the good result be “proportionate to” the bad result. Supporters of the principle argue that, in situations of “double effect” where all these conditions are met, the action under consideration is morally permissible despite the bad result.
Each of these conditions has, however, been a matter of considerable controversy. The first condition requires some criterion independent of an evaluation of consequences for determining the moral character of the proposed action. Moral philosophers who believe that the moral character of an action is exhaustively determined by the nature of its consequences will, of course, object to this requirement.
The second condition assumes that a sharp distinction can be drawn between directly intending a result and merely foreseeing it. This requirement has been the subject of much debate. Some philosophers argue that if an agent recognizes that a certain consequence will inevitably follow from a contemplated action, then in performing the action the agent must be intending the consequence. Others argue, less strongly, that defenders of double effect have failed to delineate a practicable criterion for marking off the intended from the merely foreseen. Defenders of the principle typically respond by pointing to the implicit recognition of the moral significance of this distinction in the moral practices of ordinary persons.

The third condition writes into the principle of double effect the so-called Pauline principle, “One should never do evil so that good may come.” Again, philosophers who reject the view that actions can have a moral character independent of their consequences will find this condition unacceptable.

The fourth condition, by bringing in the notion of proportionality, has seemed to many philosophers to undercut the absolutism presupposed by the first condition. Although the first three conditions have a decidedly anticonsequentialist character, the fourth may appear to embrace consequentialist reasoning. Defenders of the principle typically attempt to accommodate the consequentialist character of the fourth condition while ensuring that it does not render the more complex features of the principle irrelevant.

Applications. The principle of double effect has played a significant role in the discussion of many difficult normative questions. Its most prominent applications are in medical ethics, where it figures prominently in attempts to distinguish among permissible and impermissible procedures in a range of obstetrical cases. The Catholic magisterium has argued that the principle allows one to distinguish morally among cases where a pregnancy may need to be ended in order to preserve the life of the mother. The principle is alleged to allow the removal of a life-threatening cancerous uterus, even though this procedure will bring the death of a fetus, on the grounds that in this case the death of the fetus is not “directly” intended. The principle disallows cases, however, in which a craniotomy (the crushing of the fetus’s skull) is required to preserve a pregnant woman’s life, on the grounds that here a genuine evil, the death of the fetus, is “directly” intended. There there is significant disagreement, even among those philosophers who accept the principle, about the cogency of this application. Some philosophers and theologians, by emphasizing the fourth, “proportionality,” condition, argue that the greater value attaching to the pregnant woman’s life makes even craniotomy morally acceptable. Others fail to see a morally significant difference between the merely “foreseen” death of the fetus in the cancerous uterus case and the “directly” intended death in the craniotomy case.

(Source: Wm. David Solomon, “Double Effect,” The Encyclopedia of Ethics)
Lawrence C. Becker, editor

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The following article by Father Tad Pacholczyk, Director of Education, National Catholic Bioethics Center, was written a year ago. I reproduce it here to offer more foundation to understanding the dynamics behind the controversy in Phoenix.

Thinking About Moral Absolutes

by Father Tad Pacholczyk, Director of Education, National Catholic Bioethics Center

May 2009. When Pope Benedict XVI visited the United States in April of 2008, I had the chance to attend the opening ceremony at the White House South Lawn. As I listened to President Bush’s welcoming remarks to the Pope, I was caught off guard by one line in particular, a powerful statement that seemed almost too philosophical to be spoken by a United States president: “ In a world where some no longer believe that we can distinguish between simple right and wrong, we need your message to reject this dictatorship of relativism and embrace a culture of justice and truth.”

The President was expressing how we live in a time of history marked by moral relativism. This is the belief that there really is no right and wrong, just your opinion and mine about right and wrong, and we should simply “agree to disagree” and learn to get along. That is to say: you may believe that abortion, same-sex marriage, and embryonic stem cell research are fine, and I may not, but there’s really no point in arguing, since everything is relative anyway – morality is up to me and you to decide individually. In such a view, there are no moral absolutes or universals, and morality shifts freely with each person’s perspective.

Ultimately, however, this position is neither reasonable nor logical.

If morality were merely about your and my moral opinions, the results would be disastrous. If I believe racism against blacks and the institution of slavery built upon it are wrong, but you believe they’re okay, can we both go our merry ways and live according to our own morality? Clearly not, and the United States had to undergo a terrible civil war to address this very question. If I believe serial murder and rape are wrong, but you believe they’re OK, can we both go off and live according to our own positions? Clearly not, since both positions cannot be true.

These obvious examples illustrate what each of us already knows, namely, that in the real world “relative” truth doesn’t work. Suppose you and I each drive towards an intersection with a traffic light. If it were up to you and me to make up our own minds about what color the light is, without any reference to its real color, there would certainly be a lot of accidents at our intersections. What many fail to realize is that the moral world works similarly. Many people’s moral lives are crashing and burning because they fail to respect the non-arbitrary markers of the moral roadmap guiding our human journey. They’ve slipped into thinking that they can make up their own rules as they go along, and that it’s all relative to their own desires or circumstances.

In the movie Schindler’s List, much of the action takes place in a Nazi labor camp. The camp commandant decides to take a young, Jewish girl to be his personal maidservant. At one point in the film, this girl has a private and very disturbing conversation with another man, Oskar Schindler, the protagonist of the film. With deep fear in her voice she says to him, “I know that someday my master will shoot me.” Schindler at first can’t believe what he is hearing, and he does his best to reassure her that the commandant is really quite fond of her. But she insists, “No, someday he will shoot me.” She then speaks of what she had witnessed the previous day. She had seen him walk out of his quarters, draw his gun, and shoot a Jewish woman who was walking by with a bundle in her hand. She described the woman: “Just a woman on her way somewhere. No fatter, or thinner, or slower, or faster than anyone else; and I couldn’t guess what she had done [to provoke him]. The more you see of the commandant, the more you see there are no set rules that you can live by. You can’t say to yourself, ‘If I follow these rules, I will be safe.’”

Fr. Raymond Suriani, commenting on this famous scene from the movie noted how this girl was absolutely correct: In a world of moral confusion, in a world of moral relativism, there can be no safety, and, consequently, no peace. She understood that in the “world” of that Nazi labor camp, right and wrong had been blurred to such an extent, that she couldn’t determine what was “right” even in the mind of the commandant. What pleased him at one moment might not please him in the next. And if he happened to have power, or to have a gun in his hand when he wasn’t pleased, she knew she could easily end up being his next victim.

There are certain important truths and universal moral absolutes which speak powerfully to us as humans about how we must relate to ourselves, to others, and to society. We can draw strength from the prophetic and protective voice of the Church, which speaks tirelessly to us of these moral absolutes and points out the threat to our humanity posed by every agenda of relativism.

Rev. Tadeusz Pacholczyk, Ph.D. earned his doctorate in neuroscience from Yale and did post-doctoral work at Harvard. He is a priest of the diocese of Fall River, MA, and serves as the Director of Education at The National Catholic Bioethics Center in Philadelphia. See http://www.ncbcenter.org

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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

Dr. Becker,

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.

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