Update: March 02, 2010. I have received further information on the issue discussed in the middle part of this blog, from Catholics for a Free Choice in the USA.Here's an excerpt from a report they published in 1998: 'The US bishops' Ethical and Religious Directives for Catholic Health Care Services, which strongly prohibit abortion in Catholic hospitals, also say that "operation, treatment, 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."
"It may seem that this directive permits all life-saving abortions, but that is not the case. The language closely mirrors Catholic teaching on abortion, which forbids direct abortions in all circumstances, even to save the life of the mother. The word "direct" is critical. Indirect abortions are allowed - but there are only a few cases where this applies. In a case where a woman's life was threatened by pregnancy, abortion is directly intended and therefore not permitted.
"The full meaning of the directive played out in 1998 when a pregnant woman on Medicaid in need of an emergency abortion was denied services at a merged hospital in Manchester, N.H. The 35-year-old patient, who had miscarried in the last year, rushed to Elliot Hospital when her water broke at 14 weeks. When she arrived her physician determined she needed an emergency abortion in order to prevent a life threatening uterine infection and other complications. However, because Elliott had merged with Catholic Medical Center in 1994, abortions were banned in 1997 from Elliot at the insistence of its Catholic partner.'
This week I had a look at how our collection of atheist thought, 50 Voices of Disbelief, is doing on amazon. I was delighted to see that it has received a reasonable 4.5 rating (out of 5) on amazon.com and some 11 or so reviews. Check out the comments some of the readers left behind, here. I thought the most critical review (aka 3*** out of 5) is still quite complimentary. Glad the volume is holding up nicely in terms of sales!
In other news: I have been attacked as 'puerile' by an anti-choice organization in Canada for suggesting in said volume that there are Catholic hospitals where pregnant women are sacrificed for the sake of rescuing the fetus in case there is a conflict between the two. I have not, of course, suggested that this is a standard operating procedure in every single Catholic hospital (if it were, we surely would have heard about it). The anti-choice writer wheeled out that lovely Catholic concept of the Doctrine of the Double Effect (DDE) to explain why I am puerily (I made that word up) off the mark. This Doctrine, in turn, depends on your buying into another distinction, namely that of intention-foresight.
Here's what this argument is all about: The DDE holds essentially that we should distinguish between the intended outcome of actions and outcomes that we are able to predict (or foresee) but that we do not intend. The DDE, historically, goes back to an argument advanced by St Thomas Aquinas. He used the example of permissible homicide in self-defense. Aquinas imagined a situation where someone’s intention is to fend off an attacker. However, while he succeeds in fending off the attacker the attacker dies as a result of the defender’s actions. The attacker’s death was unintentional here, and, according to Aquinas is permissible ‘because self-preservation is a legitimate aim and a person who is unjustly attacked has a greater duty to preserve his own life than he has to preserve the life of the attacker.’ The morally important claim here is that the person who is attacked permits the death of the attacker to occur but does not intend for it to happen. The implicit understanding is that the death of the attacker is something that is undesirable and if possible ought to be avoided. One assumption here is that our victim (ie the attacked person) is acting from good motives. The argument from the DDE relies on us accepting a further concept, namely that of the Intention-Foresight Distinction (IFD). This distinction upholds the view that there is a moral difference between intending a patient’s death and foreseeing that it might or will happen, but not intending it. So, in the case of the conflict that I started of with, the doctor who rescues the pregnant woman and foresees but doesn't intend the death of the fetus could be in the clear, according to this Doctrine. The idea, that there is more to the evaluation of a person’s actions than the consequences that that person’s actions produced, is based on a modus of moral theorizing that is best described as deontological. Consequentialists will maintain that both the DDE as well as the IFD are irrelevant consideration in our evaluation of the morality of actions. However, for many health care professionals, as well as in law, the IFD matters a great deal. In homicide investigations, for instance, the determination of the intention of the assailant will make a significant difference in terms of making a deciding on whether she will be prosecuted under a murder or manslaughter charge. I doubt that this is ethically defensible, but there you go. To my mind outcomes are the only thing that matters.
While it is possible to draw this distinction (it is perfectly possible to say that I foresee that A is going to happen as a result of my intending to achieve B, but that I do not intend for A to occur), I cannot see why I should be any less responsible for the foreseen consequences of my actions. What makes A an acceptable cost to incur is surely the greater benefit derived from achieving B, as opposed to anything to do with my intentions.
In any case, the other question is whether or not there is evidence that Catholic hospitals sacrifice the lives of pregnant women in order to rescue fetuses. The answer to this is unequivocally 'yes'. In Catholic Nicaragua, for instance this position is even government policy (law in this case). As I write this, a cancer stricken pregnant woman is not given access to life preserving chemotherapy in that country, because this would risk the fetus' well-being. Just check out recent amnesty international reports on this matter. There have also been bona fide reports of health care professionals working in Catholic hospitals in the USA transporting pregnant women on to secular hospitals, so they could have access to life-preserving (life of the pregnant woman that is) abortions.
While I understand where the anti-choice position is coming from on this issue, I am surprised that anyone from that political corner would deny that these sorts of things are happening in the Catholicism controlled parts of our little universe. These sorts of policy positions do not come cost neutral no matter how hard they might intend (pun intended) for them to be.
There is more in the anti-choice site's article, in particular a rant on the conscientious objection issue. It is noticeable that the defense advanced there is essentially a legal response to an ethical/political argument I made. I did not argue that conscientious objection is illegal currently, I lamented that it is not. Oh well...
Hey, on to one last thing. I worked yesterday busily with the audio/video folks at Queen's University on a virtual presentation (I just couldn't be persuaded it's worth flying/traveling for more than 30 hours in economy class to do a 30 min presentation). The topic was a bit dicy as I am not really an expert in chronic disease issues, but it's been great fun doing this. Check the video out here. I am looking forward to discussing this with the conference participants in about a fortnight!
