First off, let me say that this is not the post I had wanted to write this Sunday. I wanted to post on Terri Schiavo, I had some thoughts about the literature of ideas and how science fiction can be a near occasion of sin. But an issue has come up and I seem to have rubbed some nerves raw.
I want to take the time, in this my personal space to which you are invited, to explain a bit of why I have spoken as I have. I am not a theologian, I am not a moral philosopher or even a particularly holy person. I do not claim to have any special moral authority beyond that of any educated layperson who has researched and thought through this issue. All I can say that might make me a bit different is that I encounter the situation of an ominous prenatal diagnosis approximately once a year among my patients, and so I have been forced to think this through.
I am also not interested in judging the actions of another person. I am not competent to judge if some one other than myself is a sinner. Mortal sin requires 3 components:
1857 For a sin to be mortal, three conditions must together be met: "Mortal sin is sin whose object is grave matter and which is also committed with full knowledge and deliberate consent." (CCC). God calls us to love the sinner even as we hate the sin.
I was struck at Mass this morning by the second reading from 2 Timothy 1. Here is the King James translation of that reading and the verse just before it.
7:For God hath not given us the spirit of fear; but of power, and of love, and of a sound mind.
8:Be not thou therefore ashamed of the testimony of our Lord, nor of me his prisoner: but be thou partaker of the afflictions of the gospel according to the power of God;
9:Who hath saved us, and called us with an holy calling, not according to our works, but according to his own purpose and grace, which was given us in Christ Jesus before the world began,
10:But is now made manifest by the appearing of our Saviour Jesus Christ, who hath abolished death, and hath brought life and immortality to light through the gospel
and the NAB
7 :For God did not give us a spirit of cowardice but rather of power and love and self-control.
8 :So do not be ashamed of your testimony to our Lord, nor of me, a prisoner for his sake; but bear your share of hardship for the gospel with the strength that comes from God.
9 : He saved us and called us to a holy life, not according to our works but according to his own design and the grace bestowed on us in Christ Jesus before time began,
10 :but now made manifest through the appearance of our savior Christ Jesus, who destroyed death and brought life and immortality to light through the gospel
What got my attention through the post-call mental haze was the second half of verse 8 (which is where the reading began). "Bear your share of hardship for the Gospel with the strength that comes from God" (NAB) or in the powerful language of the KJV -"but be thou partaker of the afflictions of the gospel according to the power of God".
I wanted to say to God, "Hey, you talking to me? to me? I'm not into hardship or afflictions." I have worked hard to get to a point where I am not terribly afflicted (other than a bad back and the usual stuff of daily life). I am not into pain and suffering, physical, mental, or spiritual. I don't want those around me, those for whom I care, to have to suffer either. Yet how many times does it say in Scripture, "take up your cross"? It has been said that the road to Hell is paved with good intentions. I suggest that it has also been paved with misguided compassion.
Those who are young, who were born after Roe vs. Wade, after Griswold vs. Connecticut, after Ashcroft vs. Planned Parenthood, may not be aware that the primary motivation in these decisions was a compassion for women (and men) in difficult circumstances. "Hard cases make bad law" is a truism, but one that does apply. Satan does not usually appear to us as the horned devil, but rather as a more appealing and seductive Lucifer. When we bait a trap for pests, we do not use bitter foods, instead we use attractive foods and conceal the poisin within.
The Father of Lies tells us that we are being compassionate when we commit euthanasia, whether that euthanasia is in the first weeks after conception or decades after birth. Hospice has become a standard of care for dying born persons. Perinatal hospice is an option for the dying unborn. But a misguided compassion often leads those who should know better to offer early termination of the pregnancy - a procedure that goes by the clumsy acronym of EIFWAIL (early induction< of labor >for fetuses with anomalies incompatable with life). Our Sunday Visitor was sufficiently concerned about this to research and write an extensive article on the topic, which I encourage all of you to read. But let me quote Dr. Hilgers from the article. "frank words for Catholics who try to protect other Catholics from necessary suffering: "This is Christianity with an epidural block." "
I spent two years on the ethics committee of a Catholic Hospital. Our guidelines were the Ethical and Religious Directives for Catholic Health Care Services. Let me quote from Part 4:
45. Abortion (that is, the directly intended termination of pregnancy before viability or the directly intended destruction of a viable fetus) is never permitted. Every procedure whose sole immediate effect is the termination of pregnancy before viability is an abortion, which, in its moral context, includes the interval between conception and implantation of the embryo. Catholic health care institutions are not to provide abortion services, even based upon the principle of material cooperation. In this context, Catholic health care institutions need to be concerned about the danger of scandal in any association with abortion providers.
46. Catholic health care providers should be ready to offer compassionate physical, psychological, moral, and spiritual care to those persons who have suffered from the trauma of abortion.
47. 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.
48. In case of extrauterine pregnancy, no intervention is morally licit which constitutes a direct abortion.
49. For a proportionate reason, labor may be induced after the fetus is viable
Please note the definition of abortion. Induction of labor in a pre-viable fetus is abortion. Even in an infant with lethal congenital anomalies there is a border between viability and non viability. When one delivers a baby at 22 weeks, what the baby dies of will be his or her extreme prematurity, not the lethal anomalies. Even at 26 weeks, what generally kills babies is the effects of prematurity more than their medical problems. It is a fine point, and I expect to be accused of splitting hairs or of being concerned with irrelevant minutiae like the number of angels who can dance on the head of a pin. I am also accused of splitting hairs when I speak about the post-fertilization effects of some contraceptive methods. Accuse away.
Our culture has succeeded in redefining abortion to only include destructive methods where the baby in killed during or before being evicted from the mother's womb. Previable induction of labor with a living baby is abortion. When done to a baby who is dying, it is a form of euthanasia.
The directives do allow for induction post-viability for 'proportionate reasons'. This is generally considered to refer to cases where the mother's health and life is endangered AND where continuing the pregnancy would risk both baby and mother. The closer one comes to term (38-42 weeks), the less serious the mother's condition needs to be to warrant induction of labor, as one balances the risks to the mother and the child. Catholic teaching does not support intentionally ending a pregnancy at any stage without medical justification, and that includes induction of labor or scheduled cesarean for convenience.
Every attempt that has been made to restrict abortion in the USA has been struck down for not making exceptions "for the health of the mother". There seems to be a belief that pregnancy carries risks for the mother that are unacceptable unless the baby is perfect. I will be the first to agree that pregnancy carries risks to the mother. I have first hand knowledge of several maternal deaths, either in labor or as a result of pregnancy complications. It is tragic, horrifying, and every effort should be made to provide the kind of care that reduces the risk of losing a mom and/or a baby. But there are moral limits that Catholic Christianity places on this effort.
For example, many were horrified at the NY Times piece
about the mom who reduced her triplets down to a singleton by injecting two of them with Potassium Chloride into their hearts. We see this as horrifying and callous, but based strictly on medical odds, she substantially reduced her risks of having several potentially disabling or fatal pregnancy complications. She gave the surviving baby a better chance for being born vaginally at term with a normal birthweight. Objectively speaking, using strictly medical standards of health, what's to criticize here? And even her decision to end the lives of the identical twins (rather than keeping one and killing the stand-alone baby) has a basis in the statistic that identical twins are more likely than fraternals to have congenital anomalies and other prenatal issues. She decided on abortion based on quality of life issues, but a very strong case could be made (in the absence of a moral base that says every life is equally precious) that she made a sound medical decision.
The church recently canonized Gianna Beretta Molla for deciding to choose the life of her unborn baby over her own health. At that time, there was no way to know whether or not the baby would be perfectly normal or would have lethal anomalies. We didn't have US available at that time except as an experimental technique. X-Rays were available but were not widely used in pregnancy (for obvious reasons) unless there were clinical suspicions of problems including multiple gestations and malpresentations. So she didn't even have the reassurance of knowing that her sacrifice would not be in vain.
Nowadays, prenatal US has become so routine that most major anomalies are detected by 20 weeks of pregnancy. Some are detected even earlier. A few years ago, I had a patient whose trisomy 18 baby had clues to his problems at her 7 week US (done because she had pre-existing diabetes and hypertension and was at increased risk). BTW, she carried to term - the baby died in utero at around 37 weeks and she then agreed to induction of labor. She has told me repeatedly that she has no regrets, even though the pregnancy did accelerate the health damage that her diabetes did to her body.
Anyhow, most moms go to their US appointments not expecting to find any problems. The fact that this is a diagnostic medical examination has gotten lost in the social aspects of "is it a boy or a girl?". Moms are totally devastated to get the bad news that their baby has potentially a problem. Breaking the news can be done in a variety of ways. Usually, the mom is NOT told right out at the time of the US, because the pictures are taken by a technician who is not allowed to share more than very minimal information. Sometimes, there is a subtle abnormality that the technician may not even see. Many times, there are findings that initially seem to be abnormal but on re-examination are found to be within the range of normal. It is always good to get a second opinion. But the most devastating anomalies are usually pretty obvious and the prognosis is also obvious.
I hate having to call up moms to tell them that they need to come in for a follow-up US. Most of the time, it does turn out to be one of the normal variants that is benign, but every 9 months or so it turns out to be one of these horribly terrifying diagnoses. There is no easy way to tell a mom that her baby will die or be disabled. Providers who are uncomfortable with disability can subtly influence moms to end their pregnancies. It isn't easy to give prenatal care to a mom whose baby will die or be disabled. So much of what we do for prenatal care is meant to protect the baby - and when you know that nothing will make a real difference is gets really rough. The temptation is there to encourage the mom to end the pregnancy so that the provider doesn't have to deal with the issues any longer. I watched the doctors with whom I work go through this during the pregnancy of the diabetic mom with the trisomy 18 baby. They were uncomfortable the whole time and some of them were muttering about the mom being in denial and why didn't she just get it over with. I couldn't be her provider because of her diabetes. I just ached the whole time.
Back to today's Epistle reading: "Be a partaker of the afflictions of the Gospel, according to the power of God". What are the afflictions of the Gospel? They include obeying the word of God, despite the pain and suffering that might bring. It means being very careful that we do not get caught up in the lies of our culture, which has established the false gods of comfort and health. It means being willing to speak the truth with love, and to be ready to take abuse for speaking the truth, whether the abuse is verbal, physical, or emotional. It means, over and over again, that we hate the sins even as we love the sinner. And loving the sinner does not mean that we 'make it ok' as they sin. If I see my friend getting ready to rob a bank, and I do not stop him because I have compassion for his financial needs, I am not partaking of the afflictions of the Gospel. If I am silent in the face of injustice, I am as culpable of that sin as the person committing the injustice. If I do not pray for those who disagree with me, for my enemies, or for my misguided friends, I am not obeying the words of God and I will be held liable on the day of judgement.