Following the overturn of Roe v. Wade, how can we protect women and children in life-threatening pregnancies?
Just as during end-of-life care when anguishing and careful decisions must be made, so must we approach these questions with reason, sensitivity, and unique care for the mother and her family.
No two women are the same, so in every case of rare but serious complications, doctors must care for her and her child specifically.
What the Church says
The Church has been deliberating on these questions for centuries.
Here in the U.S., Catholic healthcare providers are guided by the USCCB’s Ethical and Religious Directives for Catholic Health Care Services.
Directive 47 guides life-saving interventions during pregnancy: “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.”
The National Catholic Bioethics Center (NCBC) explains the principle of double effect in pregnancy interventions in this way: An intervention in pregnancy is permissible when (1) the medical intervention is morally good and appropriate to treat the mother’s condition, (2) the intent of the intervention is the good effect of the mother’s healing and not the death of her child, (3) the death of the child is not the means by which she is healed, and (4) there is a proportionately serious reason for the intervention.
What does this mean in practice? It means that in life-threatening situations, a woman and child can be humanely separated from one another, making every effort to save them both.
This is not abortion, as the death of the unborn child is not sought.
Let us consider three circumstances: Early delivery, extrauterine pregnancy, and life-limiting fetal diagnosis.
In many cases, early delivery may be needed if a life-threatening condition presents for the mother or her child.
After viability when her child can survive outside the womb, labor can be induced for a proportional medical reason.
Before viability, the NCBC states that induction of labor is permissible when “the pathological condition of the mother resulting from the pregnancy-related condition has progressed to the point where there is moral certitude of significant risk to the mother’s life, and no alternative medical interventions that can save the life of both mother and child are available.”
At this stage in technological advancement, pregnancies that implant outside the uterus cannot be effectively relocated and are fatal for mother and child if unresolved.
In these extrauterine pregnancies, the first step is monitoring the unborn child which tends to miscarry naturally.
If it does not, a procedure may remove the damaged tissue which contains the unborn child. In this case, the directly intended effect is removing damaged tissue that is life-threatening if it ruptures.
In cases of a life-limiting fetal diagnosis, parents should be offered the opportunity to request appropriate prenatal treatment.
Perinatal hospice, like hospice at the end of life, provides dignity and comfort for the mother and family.
Work to be done
Even as our laws offer greater protection to unborn children, there is still work to be done.
We must improve access to affordable, quality healthcare for all women and children and especially work to improve infant and maternal mortality rates.
We must also clear up legal confusion where it exists so healthcare providers do not hesitate to provide life-saving care to a mother and her child.
And finally, as we each engage in these conversations about life at all its stages, let us engage one another with compassion.
To learn more about this topic, please visit the National Catholic Bioethics Center at www.ncbcenter.org
Tia Westhoff is the associate director for human life and social concerns for the Wisconsin Catholic Conference.