The care of pregnant women in Catholic hospitals

Fr. Tadeusz Pacholczyk

At the beginning of December, the American Civil Liberties Union filed a sweeping federal lawsuit against the U.S. Conference of Catholic Bishops over its Ethical and Religious Directives for Catholic hospitals, alleging that the directives, with their prohibition against direct abortion, resulted in negligent care of a pregnant woman named Tamesha Means. Ms. Means’ water broke at 18 weeks, leading to infection of the amniotic membranes, followed by spontaneous labor and delivery of her child. The child lived only a few hours.

During the course of these events, Ms. Means went to a Catholic hospital in Michigan several times, and, according to the lawsuit, was sent home even as contractions were starting. The lawsuit not only suggests that she should have been given a drug to induce labor early on but claims this wasn’t possible precisely because the hospital was Catholic and bound by the directives. It further asserts that Catholic hospitals are not able to terminate a woman’s pregnancy by inducing premature labor “even if necessary for her health,” because to do so would be “prohibited” by the directives.

In point of fact, however, the directives would not prevent the early induction of labor for these cases. Not infrequently, labor is induced in Catholic hospitals in complete conformity with the directives. Directive No. 47 (never mentioned in the lawsuit) is very clear: “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.”

Deciding about whether to induce labor involves the recognition that there are two patients involved, the mother and her in utero child, and that the interests of the two can sometimes be in conflict. In certain situation—for example, when the child is very close to the point of viability and the pregnancy is at risk—it may be recommended to delay early induction of labor in the hope that the child can grow further and the pregnancy can be safely shuttled to a point beyond viability, allowing both mother and child to be saved. Sometimes expectant management of this kind is not possible. Each case will require its own assessment of the risks, benefits, and likely outcomes before deciding whether it would be appropriate to induce labor.

When a woman’s water breaks many weeks prior to viability and infection arises, long term expectant management of a pregnancy is often not possible. In such cases, induction of labor becomes medically indicated in order to expel the infected membranes, and prevent the infection from spreading and causing maternal death. Early induction in these cases is carried out with the foreseen but unintended consequence that the child will die following delivery, due to his or her extreme prematurity.
Such early induction of labor would be allowable because the act itself, that is, the action of inducing labor, is a good act (expelling the infected amniotic membranes), and is not directed towards harming the body-person of the child, as it would be in the case of a direct abortion, when the child is targeted for saline injection or dismemberment. The medical intervention, in other words, is directed toward the body-person of the mother, using a drug to induce contractions in her uterus. One reluctantly tolerates the unintended loss of life that occurs secondary to the primary action of treating her life-threatening infection.

On the other hand, direct killing of a human being through abortion, even if it were to provide benefit for the mother, cannot be construed as valid health care, but rather as a betrayal of the healing purposes of medicine at its most fundamental level. Such an action invariably fails to respect both the human dignity of the unborn patient and his or her human rights. It also gravely violates a mother’s innate desire and duty to protect her unborn baby. If she finds herself in the unfortunate situation of having a severe uterine infection during pregnancy, she, too, would appreciate the physician’s efforts to treat her without desiring to kill her child, even if the child may end up dying as an unintended consequence of treating the pathology.

The application of Catholic moral teaching to this issue is therefore directed toward two important and specific ends: first, the complete avoidance of directly killing the child, and, second, the preservation of the lives of both mother and child to the extent possible under the circumstances.

Based upon these ends, the Ethical and Religious Directives of the U.S. Conference of Catholic Bishops provide important ethical parameters for framing the appropriate treatment of both mother and unborn child in high-risk pregnancies, while simultaneously safeguarding the fundamental integrity of medical practice in these complex obstetrical situations.

COMING UP: Meeting Christ in the Mass and sacraments

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As Catholics, we recognize Jesus’ Eucharistic presence to be the source and summit of our faith. Nonetheless, we can take His presence at Mass and in the tabernacle for granted. We pray through our liturgical rituals, but our words and gestures can lack meaning when we simply go through the motions. When we use the beautiful ritual of the Mass and sacraments to guide our prayer, however, they can lead us into a deeper encounter with Christ.

Two recent books can help us to understand the Mass and sacraments better and to approach them with fresh eyes: Christopher Carstens’ A Devotional Journey into the Mass: How the Mass Can Become a Time of Grace, Nourishment, and Devotion (Sophia, 2017) and Msgr. Nicola Bux’s No Trifling Matter: Taking the Sacraments Seriously Again (Angelico, 2018).

Carstens takes us on a “devotional journey into the Mass” to approach it in “a more profoundly spiritual way” (29).   He writes with a broad sacramental vision which embraces not only the Mass but also the symbols surrounding it. A great example of this comes from the first chapter, “how to enter a church building,” which reflects upon how to approach the physical building of the church itself. “So the door to the parish church, which stands before us now — is no ordinary entrance. It appears different because it is different: it is a mark of God’s house and a sign protecting those within, as at that first Passover. It is an entrance into the Great King’s city and His Temple . . . where we touch God, as in Jerusalem” (13-14). Carstens uses a “sacramental principle” to help us recognize “how God communicates with us through sensible signs” (9).

This devotional journey takes the reader through the stages of the Mass to perceive the deeper reality that we access through faith. In order to reap the fruit that God wants to give us at Mass, Carstens teaches us that “proper disposition . . . is paramount” (88). Through all of the outward actions, signs, and rituals, God aims at “something deeper:  . . . the heart of man. . . . the undivided love of man” (60; 61). For this reason, in the need for intimacy with God, “silence is an essential ingredient for both individual and corporate prayer” (35). The participation and prayers we offer at Mass should foster our relationship with God. The “conversation should take the form of prayer — a prayer of surrender” (92). Taking a devotional journey through the Mass, with Carstens’ help, should prepare us to enter into this conversation of surrender more fully each week.

Msgr. Bux, an Italian priest and professor, takes us deeper into the sometimes-forgotten history, theology, and liturgy surrounding the Mass and the sacraments. He walks us through each of the sacraments, building upon the teachings of the saints (especially St. Ambrose and Padre Pio), but also the difficulty of experiencing the spiritual reality of the sacraments in the modern world. He also leads us deeper into the Mass, “the greatest and most complete act of adoration,” noting the “interdependence between the Eucharist and the other sacraments: . . . they flow forth from the Eucharist and flow together into it as to their source” (86). The centrality of the Eucharist comes from the fact that through it we enter the heart of God.

The other sacraments reinforce this contact, as “we touch Christ” through them. This entry into the divine life begins at baptism and deepens in confirmation. Bux supports restored order confirmation, speaking of the need for strengthening and equipping for battle at an earlier age, rather than giving into the flight that usually occurs after it is received in the teenage years. When it comes to confession, Bux speaks of how “Christ pardons everyone who recognizes himself to be a sinner,” though the sacrament aims at “sincere, overwhelming interior repentance that brings the soul to be reconciled with the Creator” (103; 104). He also speaks beautifully of how through the sacrament of marriage, “spouses participate in the power of [Christ’s] love” in their love for each other. “Their love, responsible fecundity, and humility, their attitude of mutual service and their mutual fidelity, are signs of Christ’s love, present in them and in the Church” (166).

Both authors teach how to appreciate and enter into the Mass and sacraments more fruitfully, so that, in Bux’s words, we can experience “a prolongation of the liturgical life of the Church” in our own lives (196).