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Barbara Golder, MD, JDView all authors and affiliationsVolume 92, Issue 1https://doi.org/10.1177/00243639241304807
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What happens when the proper and moral response to a medical situation just isn’t possible? How do Catholics act not only within the constraints of the morally permissible, but also within the realities of the actually achievable?
Last year The New Yorker ran an article1 detailing the death of a young, pregnant woman in Texas, raising the question of how Texas’ abortion law may have played a role in potentially skewing the care offered her. That’s an interesting discussion and one that will play out over the coming months and years as studies and various analyses by those on both sides of the argument surface. Our ultimate responsibility as Catholic physicians would seem to be an openness to understanding what is really happening and a willingness to address both needs and deficiencies when we encounter them.
But for me, the more immediate challenge, both in terms of time and in terms of person, is posed by the description of a woman whose complex medical situation was made even more perilous by her economic status as well as the relative paucity of medical resources in her community and—if we are honest—also affected by the fact that the local hospital was a Catholic rather than a secular one.
I posted the details of this situation to my Facebook community with interesting results.
Almost everyone who suggested a solution put forth one that was not really possible for the woman herself: she should have followed the directions of her physician and gone to bed rest in the hospital with good oversight and care; that way the baby and the mom would likely have been saved. “She should have” became a refrain in the discussion, something my longtime spiritual director would have labeled living in the subjunctive mood (for those needing a remedial English lesson, the subjunctive mood implies a situation contrary to fact, something that is not presently true, nor likely to be). Once the word “should” is invoked, odds are we have left the world of reality for an ideal world that may or may not exist—and usually doesn’t.
On so many levels, what my commenters proposed simply wasn’t possible. And this leads me to pose the next question to myself and in general: Does our responsibility as Catholic physicians and bioethicists end once we have found a moral solution to the problem, even if it is out of reach in practical terms for the person most immediately involved?
I don’t think it does.
I think such a situation raises additional moral questions for those in charge of care as well as for those who would pass judgment on the actions of others. If I take any message from the Gospel, it’s that the problems of the vulnerable and marginalized are my problems, too—though I am very good at dismissing them, in part because they can be so overwhelming and in part because they require of me a personal investment I am not (yet) prepared to make. What am I willing to give up to see that the needs of another are met? What am I willing to do to help meet them for the person right in front of me? And last: what if, due to an accident of life and circumstance, the vulnerable person is an abstraction, not a real person within my sphere of caring and influence?
Bioethical discussions often focus on the details of a situation with as few actors as possible, refining and defining circumstances and principles until a moral answer is either clear or deemed impossible. That’s important; knowing the defining rules and relationships is essential to understanding our role in Catholic health care. But it is not enough.
It is not enough to define the moral path in a society that is skeptical of our positions in the first place. It is not enough to be the beacon on the hill calling people to the light of Christ; some of us must also be the guide on the way, navigating the often rocky, uncomfortable, and sometimes dangerous path to the hilltop as best we can with an often confused, frightened, and reluctant companion.
Years ago, when sitting my final exam for certification in bioethics, the following problem was posed to me: a young couple and their priest come to you for advice. The woman is carrying a child with a congenital anomaly that is incompatible with life; it will make delivery dangerous. What do you tell them?Later, the examiner admitted to me that he was looking for a simple answer: abortion is not an option. My approach was rather different and by now may be familiar to readers of this column:
•What are the medical facts of the situation? It’s important to make certain that the family understands insofar as possible how this situation will play out.
•What are the medical options, whether or not we agree with them? In the end, the answer is up to the patient and her conscience as it is formed at the time.
•What are the relevant moral principles applicable in this situation, and how do the principles rank in importance?
•What is actually possible?
•Given that the priest is along for the discussion, what support is the parish prepared to provide this couple, particularly if they choose to carry the pregnancy to term? Will there be people to share the journey in a real an intimate fashion with more than prayerful support, important as that is?
In short, if we are to expect people to choose the often more difficult, and sometimes more risky, moral option, what is our responsibility to assist them in achieving it? And if there are not means to realistically make the moral choice a possible one, how do we minister to the one who must make the choice anyway and suffer one way or another the consequences?
People have the right to make their own, informed medical decisions, even ones with which we might disagree. Caregivers do not have the right to limit the information on which those decisions are made. Ministers have the responsibility to care for the person before them as and where they are, not just where they should be.
Far too often, the debate over the management of difficult pregnancy has been pulled into extremes by both sides. The one camp promotes abortion without restriction, while the other advocates that killing a baby is never the answer. Little of the discussion centers around the realities of life for poor women in badly served rural communities and how to improve their opportunities, their options, and their outcomes in light of what exists in the here and now.
Nor is this problem confined to the medical world.
How well-prepared are we to address medical situations which might need particular accommodation in marriage prep? Natural family planning works well in some situations, not so well in others, and there are circumstances where avoiding pregnancy is extremely important for a particular couple. As we redesign marriage prep, are we giving consideration to this need, and the fact that the folks most likely to be affected by a failure of NFP are often those least likely to be able to manage the consequences? Are we prepared to acknowledge and communicate—to the faithful and the world—the all too present reality that sometimes, there’s not a good answer to complicated medical situations? Are we willing to accept some imperfect answers as part of the journey towards a world in which the moral and the possible more closely coincide?
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Footnote
1. https://www.newyorker.com/magazine/2024/01/15/abortion-high-risk-pregnancy-yeni-glick