Pregnancy — the promise of a new child, the creation of new life — is a cause of great joy. In some cases, however, that joy can be tinged with grief and fear when the unborn child is diagnosed as having a serious or life-threatening medical condition.
Fatal Anomalies
Such early diagnosis is becoming increasingly common with prenatal technologies such as ultrasound and amniocentesis, which can identify abnormalities such as spina bifida or Down's syndrome more easily than before.
Too often in our culture of death, abortion is offered as a “solution” to women facing these difficult situations.
Although it might be assumed that a Catholic health-care institution would counsel a woman in such circumstances to carry her child to term and support her in that decision, such may not always be the case.
An Our Sunday Visitor investigation has revealed that some Catholic hospitals perform a procedure called “early induction for fetuses with anomalies incompatible with life” — known by its acronym, EIFWAIL, or simply as “early induction.” This procedure induces a woman into labor after her unborn child reaches viability — around 23 to 26 weeks — in cases when the child is known to have a condition that makes death inevitable soon after even a full-term birth. The child born in this way is made comfortable and often held by the mother until death.
The two most common conditions for which this procedure is performed are anencephaly, in which the child’s brain and skull fail to develop beyond the brain stem, and renal agenesis, in which the kidneys and lungs are underdeveloped. Children with these conditions generally do not live beyond a few minutes to a few hours outside the womb (although some anencephalic children have lived for months after birth).
Neither presents an immediate danger to the mother. Anencephaly by itself causes no complications to the mother, according to medical experts consulted for this article. Renal agenesis may lead to complications if the child dies in the uterus, but close monitoring greatly reduces this risk.
Early induction was first brought to national attention when it was reported that Christ Hospital in Oak Lawn, Illinois, was performing the procedure and leaving the newborns to die unattended. Jill Stanek, a nurse at the hospital who blew the whistle on the practice, later helped persuade Congress to pass the federal Born Alive Infants Protection Act, which requires medical professionals to give care and comfort to such newborn patients.
Those Catholic hospitals that we found using the EIFWAIL procedure are Providence Alaska Medical Center in Anchorage, Alaska, part of the 10th-largest Catholic health system in the country, and Loyola University Health System in Chicago. Spokespersons for the other nine largest Catholic health-care systems contacted for this story were either vague about their hospitals’ practices or did not return calls. Only Catholic Healthcare West, which is based in San Francisco and has 41 hospitals in California, Arizona and Nevada, responded unequivocally that it does not allow the procedure.
The Catholic hospitals we spoke with that use this procedure emphatically denied they are anything like Christ Hospital, which is not Catholic-run. But pro-life and other Catholic leaders say the EIFWAIL procedure resembles abortion too closely — and many called it abortion outright.
A 1998 statement on early induction for anencephalic children, issued by the US Bishops’ Committee on Doctrine, clearly sides with the latter opinion.
“Proportionate Reasons”
Yet the hospitals contacted for this article believe their procedures conform to the US bishops’ 2001 publication “Ethical and Religious Directives for Catholic Health Care Services” (ERDs), which sets out the norms and principles for Catholic health-care ethics. One directive is at the heart of this issue: “For a proportionate reason, labor may be induced after the fetus is viable” (no. 49).
But what is a “proportionate reason”? That is what is at issue here.
James LaGrye, a theologian in the US bishops’ doctrinal office, said the word “proportionate” in the ERDs comes from the teaching of St. Alphonsus Ligouri, who used the term for situations in which some grave risk would be incurred if an action were not taken to avoid it.
LaGrye said the mental health of the mother “is a reason” to perform early induction. While he defended the ERD document against charges that it employs moral proportionalism, he said, “There are times when you do need to weigh things.”
According to the 1998 statement “Moral Principles Concerning Infants with Anencephaly” by the bishops’ doctrinal committee, anencephaly is a condition of the child and not the mother, so “terminating her pregnancy cannot be a treatment of a pathology she does not have. Only if the complications of the pregnancy result in a life-threatening pathology of the mother may the treatment of this pathology be permitted, even at a risk to the child, and then, only if the child’s death is not a means to treating the mother.”
Medical and Ethical Issues
Leading Catholic medical ethicists also question the EIFWAIL practice.
“There’s a principle that serves the Church well at the end of life and is applicable to the beginning of life as well,” said Conventual Franciscan Father Germain Kopaczynski, director of education for the National Catholic Bioethics Center in Boston: “When in doubt, choose life.”
This is an ancient principle that must govern all of Catholic health care, Father Kopaczynski added. “We must assume that the safest place for a child, barring serious maternal pathology, is in his or her mother’s womb.”
Early inductions are used in many cases where there is danger to the life of the mother, such as with severe toxemia or pre-eclampsia. But “just because you can have early inductions [for some reasons] doesn’t mean you can do early inductions for any reason,” said Janet Smith, a professor of moral theology at Sacred Heart Major Seminary in Detroit.
Medically speaking, according to physicians who deal with difficult pregnancies on a regular basis, there is no more valid reason to perform an early induction for a baby with fatal anomalies than there is for a healthy unborn child.
Dr. Thomas Hilgers, founder and director of the Pope Paul VI Institute at Creighton University in Omaha, Nebraska, said that “these babies should be allowed to go to term as any other babies are. The bottom line issue is, would you do this to a baby who is normal? No, you would never subject that baby to prematurity.”
Dr. Byron Calhoun, a maternal-fetal medicine specialist at Rockford Memorial Hospital in Rockford, Illinois, said early induction is never necessary. A principal founder of a movement called “perinatal hospice,” which cares for newborns with expected brief life spans, Calhoun said one of his many concerns is that mistakes can be made — the diagnosis of a fatal abnormality in the unborn child sometimes might be wrong, and a healthy child could be forcibly born prematurely.
“We are not omniscient,” he said of physicians.
Dr. John Haas, director of the National Catholic Bioethics Center, concurred. “Remember that medicine is an art, not an exact science,” he said.
Both physicians emphasized that early induction can be done in these situations for the same conditions in which it would be done with normal children, such as when the mother’s physical health is imminently endangered. Yet early induction also presents potential problems for the mother — increased risk for an incompetent cervix in a later pregnancy, for breast cancer and for impaired mental health — so these physicians say this procedure should be avoided at all costs.
The Moral Risks
The Catechism of the Catholic Church, while not directly addressing this procedure, does say, “Prenatal diagnosis is morally licit ‘if it respects the life and integrity of the embryo and the human fetus and is directed toward its safeguarding or healing as an individual’” (no. 2274).
Most often, Hilgers said, the only option presented to mothers facing the probability of carrying a child with fatal abnormalities is to terminate the pregnancy. He was sharp in his criticism of this mindset: “These women are being aborted by the medical establishment,” he said. “This is all part of the abortion mentality.”
Both Providence and Loyola have done these procedures for the mother’s mental health and to relieve “familial distress.” But, Father Kopaczynski said, “I think health-care professionals sell women short.” While “they’re probably well-intentioned,” the professionals tend to treat women as though they are fragile and unable to cope with such a difficulty. “I don’t think that’s the best assumption,” he said.
Haas agreed and wondered “how do you assess or judge” what kind of reaction a woman will have to the news of her child’s condition, or how she will respond to an early induction?
Sacred Heart Seminary’s Smith wholeheartedly concurs with that judgment. “If you present it to the woman that this is the only chance she’ll have to love this baby, why would she go looking for a reason to end that life?”
Hilgers had frank words for Catholics who try to protect other Catholics from necessary suffering: “This is Christianity with an epidural block.”
It’s About Love
“I do believe disabled babies are part of God’s plan,” said Mary Jane Owen, director of the National Catholic Partnership on Disability, based in Washington, DC. “In many ways, they civilize us as a society.
“When you have a bunch of people in an elevator and a mentally retarded child comes on,” Owen said, “they start civilizing that little culture.”
Hilgers wholeheartedly agreed. “I’m convinced these children are conceived for a reason,” he said. “I think the biggest reason is to draw out our ability to love.”
Thomas A. Szyszkiewicz, a frequent contributor to OSV, writes from Minnesota.
(This article originally appeared in Our Sunday Visitor and is used by permission of the author.)
