The Excommunication of Sr Margaret McBride

The issue of abortion remains a highly controversial one for Christians. Recently, Sr Margaret McBride, a senior administrator in a hospital in Phoenix, Arizona, USA, was on a committee that agreed a procedure to terminate an early pregnancy, 11 weeks old, to save the life of the mother. Bishop Thomas Olmstead, the Catholic Bishop of Phoenix, promptly excommunicated her. Excommunication is the severest penalty that the Catholic Church can confer on a person. It means they are considered a stranger to the Church, with no right to receive communion, or any of the sacraments.

Most Christian Churches recognise that in cases where the life of the mother is in jeopardy, an abortion is justified, if not actually a good. This can be thought of as something similar to self-defence. Within the Christian tradition killing is sometimes justified to defend life, such as in the Just War theory that allows for proportionate use of force, even lethal force, for a just reason. Also, execution of certain criminals is sometimes considered justifiable for reason of public safety. More commonly, self-defence of an individual can also warrant lethal force that is justified in Christian eyes. Though these three examples are acceptable within the Catholic tradition, the application of this kind of moral thinking to abortion is not recognised.

Within the Catholic tradition there is a possibility governed by something called double effect whereby a procedure designed to save the live of a mother, may have the unintended secondary consequence of leading to the loss of the pregnancy. Examples of this are found in ectopic pregnancies where the fallopian tubes are removed to prevent the death of the mother, or in cancer of the womb of a pregnant mother where the womb must be removed or treated. In these cases the Catholic Church differentiates between the intention of the doctor (which is to save life) and the outcome which includes a second unintended consequence, the loss of the life of the unborn. Intentions clearly matter in moral thinking. If a child refuses an axe wielding murderer who asks him the whereabouts of his father we would not begrudge the child saying he could not say where his father was for he is under strict instructions not to speak to strangers. The intention is to do good. The intention of a doctor treating a pregnant mother in the ways described here are good.

However, in the case of Sr Margaret McBride, the termination was not a secondary effect. The patient was suffering from pulmonary hypertension. Were the pregnancy to continue the mother’s life would be seriously endangered – a heart attack could occur. This is caused by the pregnancy itself. The abortion was carried out to remover the risk to the mother. The Bishop decided that such an abortion cannot be considered permissible under the double effect ruling. The problem in this case seems to be that it is the pregnancy itself which causes the risk of death. Ending the pregnancy means ending the life of the unborn. The two ethical perspectives seem inseparable.

Some argue that this shows a flaw in the application of double effect theory. Tina Beattie argues that it is questionable whether you can split intention from secondary outcome. She suggests that this example shows that the two are interconnected and that the rule of self-defence is a more helpful one to apply. She suggests that the alternative, of allowing the pregnancy to kill the mother, is to impose martyrdom on the mother, which should never be the case as martyrdom should be chosen not imposed. Beattie also thinks that Britain’s abortion rate is unacceptably high and regrets that women theologians are not involved in the pronouncement of Church teaching.

Of course there is arguably a difference between self-defence in cases of just war, the death penalty or literally fighting off an attacker, and abortion. In the first three categories there is an adult aggressor. In abortion there is an unborn innocent. So perhaps this is why the different approach is justified in Catholic teaching.

However, that case is not so straightforward. Suppose, as part of a just war, it was decided that a military installation had to be bombed. Perhaps weapons of mass destruction were being developed there. Suppose that it had been located next to a maternity hospital with pregnant mothers, women in childbirth and mothers and babies were based. Even a targeted bombing raid could easily inadvertently directly strike the maternity hospital with horrific consequences. In other words innocent people die as a result of the self-defence rule.

A further challenge is how we make sense of the spontaneous abortions that women suffer in one in every three pregnancies, and the reality that if abortions are not permitted in some medical situations, both mother and unborn may die. This approach of letting nature takes its course seems almost unique in moral decision-making. For some abortion is a unique case, requiring unique moral consideration hence the double effect provision. For others it can be included through the application of the self-defence rule. One thing these moral dilemmas reveal is that it is rather difficult to separate moral theories from moral issues.

Use the Internet to research the question of Sr Margaret McBride and convene a panel of ethicists to examine all aspects of the case. Identify as many ethical dimensions to the case as possible (such as the role of a nun on an ethics panel in a hospital) and then decide which are central to the judgement and which are secondary.

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