Friday, December 24, 2010

Advent 2010 and Papal Politics: From Condoms to Therapeutic Abortions--Not

Pope Benedict XVI arrives to celebrate a vespers service to mark the beginning of Advent, the period leading up to Christmas when the faithful mark the birth of Christ, in St. Peter's Basilica at the Vatican, Saturday, Nov. 27, 2010. The pontiff called for politicians, the media and other leaders to show more respect for human life at its earliest stages, saying embryos aren't just biological material but dynamic, autonomous individuals. This year, the Vatican urged bishops around the world to make the service a vigil for "nascent human life". (AP Photo/Pier Paolo Cito) See accompanying article

The Pope's Opening Salvo

This year Pope Benedict XVI heralded the First Sunday of Advent, and the New Liturgical Year, with a Pro-Life Vigil. The Pope's homily (sermon), translated by Vatican Radio, here, lays to rest any speculation on a change of attitude towards contraception--speculation prompted by his statement in the week prior that condoms may be used to prevent death, in the case of a male homosexual prostitute at high risk for HIV/AIDS. In short, in extreme cases of male homosexual risk condoms are tolerated by the Church, but the Church's positions on the role of sex for procreation, against contraception, and the sanctity of life from conception (when the sperm fertilizes the egg) have not changed.

I was more surprised that people, including leading Catholics, had thought that this highly conservative Pope's positions on homosexuality, contraception, or the right to life had altered in any way, than by the fact that he used his New Year's speech to reinforce the more conservative interpretations of Catholic Doctrine. One could easily dismiss the whole episode as false hope from one side and an astute corrective from the perspective of the other, except for the ongoing implications of the Church's stance in a number of health matters, including reproductive health, HIV/AIDS, and physical and mental health.

Pope Benedict XVI prays First Vespers on the First Day of Advent, 2010

For example, while many Catholics do use birth control other than the "natural" or rhythm methods (aka the how to get pregnant whether you want to or not methods), many do not because of Church teachings, or have limited or no access to reliable birth control methods because of finances or restriction in sales and availability in conservative Catholic countries.

As another example, prevention of  HIV/AIDs would be enhanced by the Church relaxing its stance on condom use, and teaching their value in preventing the transmission of sexual diseases, rather than focusing on abstinence, and sex between married couples for reproduction only. Given that one of the major modes of transmission of HIV/AIDS is from husband to wife, then from mother to fetus, heterosexual sex between married couples should also be protected from sexual disease transmission, since even the Church acknowledges that desire and pleasure drive sexual activity.

Multiple pregnancies, with close spacing, can be injurious to a woman's physical health due to complications like gestational onset diabetes, insufficient time to let the body recover its normal weight and muscle tone, uterine prolapse, urinary incontinence, etc. A woman's mental health can be compromised by "having so many children she doesn't know what to do", especially if resources are limited, her husband and marriage are also strained by family size, or there is one or more children requiring special care and attention.

Most concretely the risk of having a postpartum mental illness (depression, anxiety disorder, psychosis) and the severity of the illness and its complications increase with each pregnancy, particularly in women with other biological or psychosocial vulnerabilities to postpartum mental illness. Some women I know have stopped at 2 children because of that. One is herself a child psychiatrist, and would have preferred to have more, but has experienced major postpartum depression with each pregnancy and much more severely with the second, even though the first was severe enough to require her to be off work for 6 months while her anti-depressants took full effect.

Pope Benedict XVI leading prayers during the Holy Vigil, First Sunday of Advent, November 27, 2010

The Bishop's Closer

As Advent draws to a close (ending December 24th daytime), another Church action (on December 21, 2010) shows further how such a conservative Papal stance endangers Catholics, and, by association, those in the broader society. In direct line with conservative interpretations of the Church's stance on abortion, in the last few days the Diocese of Phoenix (Arizona) has been in turmoil and in the international news.

Phoenix Bishop Thomas Olmsted, declared that the Catholic hospital, St Joseph's Hospital and Medical Center in Phoenix, had violated church teachings on birth control, sterilization, and abortion, and could no longer be designated a Catholic hospital. As such it would be required to forfeit the presence of Catholic symbols or mass supplies, remove any indication of affiliation to the Church, and publicly lose its credibility with Catholic patients. There are also budgetary implications, in the withdrawal of financial support, and potential staffing issues especially with nursing sisters or nun and priest administrators being withdrawn. The impact on financial and human resources is compounded when one tries to replace nuns and priests with persons drawing a more competitive salary and benefits package.

Catholic hospitals treat all patients, and are respectful of their religious beliefs, through multi-faith chaplaincy services, and dietary accommodations. One is also free to believe in nothing or not want any religious or spiritual component to one's care. The Catholic hospitals also employ top physicians, surgeons, and other health care practitioners, without consideration for their personal religious affiliation.

Those with an academic affiliation have leading research and teaching units, where researchers and trainees are accepted without regard to religion. The Catholic hospitals' bed capacity, emergency and other outpatient services are figured into a region's planning for health care needs, or in a private health care system, into the marketing analysis about the local needs and competition.

In other words, access to care is affected for all, if Catholic hospitals are closed  or services reduced due to inadequate funding.

Bishop Olmsted began investigating, and threatening St Joseph's Hospital after the hospital ethics board decided in November 2009 to perform a first trimester therapeutic abortion on an 11-week-old fetus, in order to save the life of the 27-year-old mother. The mother was suffering from imminently fatal pulmonary hypertension, aggravated by the hormones required to maintain the pregnancy. To do nothing was deemed by the medical experts to sentence the mother to death, and thus the fetus as well. The woman was also the mother of other young children who would then be orphaned of her.

The ethics board of the hospital reviewed the case, and deemed that it fell within the American Council of Catholic Bishops guidelines on allowing a therapeutic abortion to spare the life of the mother where the pregnancy is a direct harm, and the board deemed this case as analogous to that of a case of a uterine cancer. This could be where a cancer of the uterus presents or is aggravated by a pregnancy, and only therapeutic abortion will spare the mother's life. However, the most conservative interpretation of the Church's position on abortion precludes saving the mother's life, even in this circumstance.

In the most conservative scenario, the only acceptable therapeutic abortion, if there were to be one at all, would be where what seems initially to be a normal pregnancy is in fact a "molar pregnancy". A molar pregnancy is where a hydatidiform mole, an abnormally fertilized egg, implants in the uterus and develops abnormally, usually resulting in a spontaneous abortion (miscarriage), though sometimes becoming cancerous and threatening the mother's life. In the case of a molar pregnancy a therapeutic abortion is warranted to prevent complications to the mother of the unusually high hormone levels and abnormally large pregnancy, and to pre-empt the cancer risk. There is no viable fetus in formation. In that sense, and from the Church's perspective, there is no fetus, hence no abortion, only uterine surgery.

Bishop Olmsted, in keeping with conservative Catholic doctrine, and unlike most more liberal American Bishops, believes the 27-year-old mother with the life threatening pulmonary hypertension aggravated by her pregnancy should have been allowed to die, and her 11-week-old fetus with her, as that would be natural, and God's will. In this, he is as Catholic as the Pope.

As can been seen in this map (full colour key) of national abortion laws, only the red countries prohibit abortion to save the life of the mother in any circumstance: The Vatican, Belize, Chile, The Dominican Republic, Laos, The Maldives (Muslim), Nicaragua, El Salvador, Tuvalu (Protestant), Uruguay (Buddhist). Except where noted, the predominant, and/or official religion is Roman Catholicism. In Malta, also predominantly and officially Roman Catholic, abortion to save the mother's life is legal, but not available.

In Saudi Arabia abortion is illegal except in cases where the mother's life is at risk or there is risk of grave harm to her physical or mental health. In those situations the abortion must be approved by a medical committee if the pregnancy is less than 120 days (before ensoulment), and by a panel of specialists if the pregnancy is more than 120 days (after ensoulment). In all cases, both the woman and her mahrem/guardian (usually her husband, or if not her father, or if he is not living, her oldest brother of legal age, or paternal grandfather or uncle) must sign a written consent.

Other Muslim majority countries, almost all of which follow Islamic Family Law, are more liberal (Bahrain, those of the Levant, for example) or more conservative (UAE, Yemen, for example) in their restrictions of the circumstances, but do allow for legal abortion to preserve the mother's life. The Maldives, a South Asian country off the southwest tip of India, and a republic of mainly Sunni Muslims, is an exception among Muslim majority nations in making abortion to save the mother's life (and under all other circumstances) illegal. Sunni Muslim is officially the only religion allowed there, though small numbers of Buddhists, and  ~300 Christians do live there.

In the United States, abortion laws vary in detail among the states, though federally (Roe v Wade) abortion is legal at a woman's request as long as it is performed by a licensed medical practitioner. Arizona has retained its pre-Roe v Wade laws, though they are technically illegal, and is among the most conservative states when it comes to abortion laws and practices. It is still legal, however, for a medical practitioner to perform an abortion to save the mother's life, and certainly legal to do so in the first trimester of the pregnancy (up to 12 weeks).

In this, Olmsted is more Vatican than Arizonan or American, following Vatican law over the American Council of Catholic Bishop's laws. This has American Catholics and their leaders worried about a precedent that would compromise maternal care in other Catholic hospital. Some are advising pregnant Catholic women to seek obstetrics care in non-Catholic hospitals.

Bishop Olmsted on President Obama speaking at Notre Dame University in 2009

One might ask, "Why not simply transfer the pregnant woman to a non-Catholic hospital for the abortion?". From a Catholic religious perspective that would also be against religious law, and the doctors employed by the hospital would be bound by that restriction along with the other restrictions on performing abortions in a Catholic hospital. Usually those restrictions are that no elective abortions are to be performed, and that therapeutic abortions to save the woman's life will have the official recommendation of more than one medical expert, and of the hospital's ethics review board which follows Catholic teachings.  This was done in the St Joseph's Hospital case, and the nun on the ethics panel, Sister Margaret McBride, also a senior administrator at the hospital, gave her consent too. For that Bishop Olmsted had her excommunicated a few months later, saying she had automatically excommunicated herself with her consent to the life sparing therapeutic abortion, and thus depriving the Catholic health community of one of its most respected and qualified members.

Now, Olmsted has "excommunicated" St Joseph's Hospital, in the closing days of an Advent season that began with Pope Benedict XVI's pro-life vigil, and his homily on the sanctity of life in all cases--except a pregnant woman's life, and that of her offspring too young for viability even with care in a neo-natal ICU.

Let's just say I'm more in line with 90% of the Muslim world on this one, and even more in line with Canadian Law, which leaves abortion to a woman's conscience, and to medical laws governing the necessity of a licensed doctor performing the abortion within medical guidelines regarding the safety of the procedure for the mother's health, and before the age of viability of the fetus, as set by current medical norms.

Whether one would personally choose to have an abortion or not, or as a man to support one, and under what circumstances, one may agree to allow others broader options, particularly life sparing ones.

Related News Articles:
ACLU: Catholic hospitals must save women
Abortion fight at Catholic hospital pushes ACLU to seek federal help
A Matter of Life or Death
Debate over faith and medicine in wake of bishop's decision
Abortion debate opens rift between bishops, hospitals

St Rita of Cascia (1381 – May 22, 1457), the Saint of Impossible Cases, was the victim of a forced marriage to an abusive husband who gave her 2 equally immoral sons. Once widowed she became a nun, and was later beatified (1627) and canonized (1900).

Related Posts:
Advent 2010--The Beginning of the Liturgical Year; Preparing for the Coming of the Christ Child

What is your impression of the Pope's original statement on condom use, and the seeming reversal a few days later? Coincidence or political astuteness?
Allowing for the fact that abortion is a complex and sensitive topic, what are your comments and thoughts on this particular decision by Bishop Olmsted and the broader implications?
Other comments, thoughts, impressions?

Pope Benedict XVI leaves Vesper Prayers on the First Sunday of Advent, November 27, 2010


Wendy said...

I don't know if you watch The View but the women discussed the issue of the abortion and the nun a couple of days ago. The women were arguing that the life of a mother with 4 children at home should absolutely have been spared rather than allow both mother and fetus to die. They also wondered why the nun should have been excommunicated when non of the child abusing priests have been. All good points.
There were very nasty letters sent to the women and Whoopi Goldberg was personally attacked. The attacker who often attacks anyone who speaks against the Catholic church also didn't know that Whoopi was born a Catholic as was Joy Behar. The women really attacked the guy on yesterday's show and good for them to do so.

All of these issues with the Catholic Church and other organized religions reconfirm my personal choice to not be involved in any organized religion.

oby said...

thanks for this post. Just a couple of days ago I was sharing with someone that I was glad that the church had decided to loosen it's stance on contraception particularly how it relates to AIDS especially in third world countries where it is wiping out so many people. I simply believe it is irresponsible to take this stance by the church considering life is supposed to have value and sanctity and yet it is valued little for those with AIDS or those who could potentially get it due to high risk behavior of their husbands.


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