The care of pregnant women in Catholic hospitals

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: Moral courage and the many cultures of death

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CRACOW. Thanks to the pandemic, it’s been two years since I was last in Cracow, where for three decades I’ve done extensive research and taught great students while forming friendships with many remarkable people. It was wonderful to be back in one of the world’s greatest cities, and soon after I arrived in late June, I took a long walk to see what had changed. The first major difference I noticed was that the plaza in front of the central railway station (named for my late friend Jan Nowak-Jeziorański, a World War II courier for the Polish Home Army and the man from whom the future John Paul II got real news via Radio Free Europe’s Polish service) has a new, strikingly modern memorial, dedicated to the memory of Colonel Ryszard Kukliński.

That name is not well-known throughout a western world that has largely forgotten the meaning and lessons of the Cold War. But if Jan Nowak-Jeziorański was right when he spoke about the Polish colonel in the mid-1990s, Ryszard Kuklinski was a genuine hero of the long, twilight struggle against communist totalitarianism — the man who helped prevent a bloody Soviet invasion of Poland to crush the nascent Solidarity movement.

An accomplished officer in the communist-era Polish Army, Ryszard Kukliński began to doubt the truth of what he had been told about the West when, as a member of an international commission, he met American military men in Vietnam in the mid-1960s. His doubts about communism and its purposes intensified by orders of magnitude in 1968, when the brutal Warsaw Pact invasion of Czechoslovakia ground the Prague Spring to dust under the treads of Soviet tanks, and in 1970, when the Polish army shot Polish workers during labor strife. Privy to some of the Warsaw Pact’s most confidential strategic plans, he became convinced that, if the Cold War turned hot and the east bloc attacked the West, the Soviets would sacrifice Poland as retaliatory western tactical nuclear strikes hit the second wave of Warsaw Pact troops pushing west. So, in 1972, Kukliński, risking his life and his family’s safety, offered his services to the United States and for the next nine years was the West’s most important intelligence asset behind the iron curtain.

His greatest service to Poland and the cause of freedom came in the later months of 1980. Thanks to his efforts, the United States knew the entire order-of-battle the Soviet Union had organized to stamp out Solidarity, which had held its first formal congress in September 1980. With that information, and working in concert with the incoming Reagan administration, outgoing national security adviser Zbigniew Brzeziński, with the help of the AFL-CIO’s Lane Kirkland, was able to organize a comprehensive western response to a potential Soviet invasion of Poland: an international economic blockade that would have severely damaged the already-staggering Soviet economy. Faced with economic ruin, the Soviet leadership backed down and the Warsaw Pact divisions that had surrounded Poland withdrew.

Colonel Kukliński and his family were exfiltrated to the West; two of his sons later died under dubious circumstances that may have involved Russian retribution, and Kukliński lived out his life under an assumed name in the United States, dying in 2004. There was public controversy when he returned to his native Poland for a 1998 visit, with some charging that he had violated his officer’s oath by working for American intelligence for a decade. John Paul II, through various intermediaries, quietly passed the word that Kukliński was to be regarded in Poland as a national hero. Zbigniew Brzeziński, who held the exact same view, put it brilliantly, in a comment that appears on the Kukliński Memorial in Cracow: Colonel Kukliński was “the first Polish officer in NATO.” 

Communism was a distinctive form of the culture of death, for the effort to create “Homo Sovieticus” was a lethal assault on souls. Colonel Ryszard Kukliński took a courageous stand against that particular culture of death, knowing as he did that freedom is never cost-free: freedom lived nobly always requires sacrifice. His example should be pondered by Catholic citizens and Catholic public officials throughout the West today, who are called to resist, with similar moral courage and effect, that form of the culture of death that masquerades as the ideology of “choice.” May we and our elected officials be as principled and brave as the Polish officer who took what John Paul II described at the United Nations in 1995 as the “the risk of freedom.”