I want to start this post by apologizing for the extremely muddled thinking going on in yesterday's post; I blame late night noveling, excess caffeine, allergies, and Benadryl (tm). In that order. :)
No, seriously, I do know that simply delivering an extremely pre-viable child in a dangerous situation isn't a moral option. There has to be an underlying pathology of the uterus itself; the classic example is removing a cancerous uterus that unfortunately also removes the pre-viable baby. Where I erred in yesterday's post was not pondering and describing exactly what others were saying about the condition of the uterus should it be badly infected by infected amniotic fluid, infected placental tissue, etc. and also--if I may be totally honest--in thinking in my muddle-headed way that 17 weeks was closer to viability than it actually is. I've made this mistake before; the record for survival is held by a baby born at 21 weeks and 5 days gestation, but I always think survival has happened earlier than that until I go check the records. Could a woman in a potentially fatal crisis situation whose unborn baby was at least 20 weeks gestation attempt delivery with a full neonatal intensive care team on standby in the hopes of making medical history, or would such an attempt be morally invalid? That is the sort of thing a well-trained Catholic moral theologian would have to answer, but it's clear that 17 weeks is much farther away from the record survival age to make the attempt in any serious way at this time with today's medical technology. But can a doctor remove badly infected amniotic fluid and placental tissue which is actively killing the mother knowing that his action will have the side-effect of making it necessary to remove from the uterus a baby who cannot survive outside of it? That is the situation that might--I stress that word--be able to be discussed from a double-effect standpoint. Whether or not it would be morally possible to make that call is something I'm not prepared to state definitively, but I will say that it would seem to be within the realm of a morally valid, though tragic, option; I would appreciate any knowledgeable person weighing in on that, by the way, as I would like to learn more about this.
But, again, the problem in the case of Savita was not that nobody wanted to discuss difficult moral options; it is that a real possibility of medical negligence exists. I think we'll find out more eventually about this specific case.
With that, though, I'd like to discuss something I've been pondering in regard not only to this case, but to the underlying principles.
I think that most practicing Catholics, when we discuss what may or may not morally be done in these extreme situations, really do want to form our minds according to Church teaching. We're not looking for loopholes or "outs" that will let us tiptoe right up to the line of abortion. That's because the guiding principle here is "Save both the mother and the baby, and take heroic action to do so if necessary and possible," not "How can we get away with abortion without calling it that?"
Unlike the internet discussions of torture among Catholics, then, the principle "Save them both," remains the clear guiding principle. When the topic is torture, "Treat prisoners humanely" should be the guiding principle, but it often isn't. I think we can see a difference; with all the speculation on Catholic blogs about what could have or should have been done to save Savita, I have not seen any sincere Catholic saying or even hinting that the Church should just accept abortion in hard cases; but Catholics regularly seem to say or to hint that waterboarding or enhanced interrogation should stay on the table in the hard cases--the ticking time bomb scenarios, and so on.
The danger of stepping away from the clear principle is that we start looking for justifications to do evil instead of the best ways to do good. If Savita's health care workers at that Catholic hospital had been committed to the principle of saving both the mother and the baby even if heroic measures were necessary, I doubt we'd even be having these conversations right now. Instead, though, it seems (again, if the news stories are accurate, which as some have pointed out is a pretty big "if") as though poor and even possibly negligent care of both the mother and the baby is what led to the tragic outcome.
I would caution those commenting on this story to avoid one thing, and that is playing into the hands of the pro-abortion stereotype out there which accuses Catholics of being deeply misogynistic and not caring what happens to a pregnant woman--in other words, having a bias toward saving the baby at the expense of the mother, or of promoting the idea that some pregnancies are fatal and we should just accept that as God's will. Sure, life itself is fatal, and none of us are getting out of it alive; but that doesn't mean that we should stop treating diseases or no longer fight to save lives in emergencies ranging from car crashes to fires to trauma to various forms of sickness. I can't imagine anybody saying, "Well, sometimes a car crash will be fatal, so maybe we should just accept the possibility of a fatal car crash as the risk of driving instead of working to avoid crashes and rushing crash victims to hospitals, etc." and yet I've heard people take a similarly dismissive attitude about pregnancy and especially those pregnancies made riskier by diseases or infections. What we should do, if we really want to follow Catholic principles, is work to promote greater understanding of pregnancy and how to recognize early warning signs of risks; encourage better prenatal care across the board; aid pregnant women in the task of effectively communicating their symptoms and health concerns with their doctors; support doctors who are trying to come up with new and better ways to treat women in high-risk pregnancies or crisis situations; and support medical interventions designed to save the lives of both mother and child, including, perhaps, a future possibility of delivering a 17-week fetus and placing him or her immediately in some sort of high-tech incubator that will actually allow him or her to continue to grow and develop in those situations where no other option is possible.
And part of that, for us Catholics especially, would be a more realistic understanding of the benefits of natural family planning and the abandonment of a fatalistic attitude about pregnancy and childbirth which fails to treat women with their proper measure of inherent dignity. But I think that that is a post for another day.