DEATH at the





ALL too often in our society the prenatal diagnosis of an infant with a terminal illness is regarded as an indication for abortion.  The practice of Perinatal Hospice (or Perinatal Palliative Care) offers an alternative.




 A clinical Case





AN obstetrician asked whether it would be permissible to induce labor at a Catholic hospital in a patient carrying a child with a lethal illness.

THE patient was 24 years old and had previously delivered two healthy infants.  She was in her 28th week of pregnancy which had been normal up to that point; however an ultrasound now revealed numerous bony abnormalities of the fetus.  Further tests and consultations with pediatricians and neonatologists yielded a diagnosis of severe thanatophoric dysplasia of the fetus, an invariably-lethal condition.  In addition, the mother was developing polyhydramnios, a potentially-dangerous increase in amniotic fluid caused by the fetus’ inability to swallow properly.  The obstetrician recommended induction of labor, since polyhydramnios can be associated with other serious complications of pregnancy.  The obstetrician was uncertain, however, whether such an induction of labor would be permitted at a Catholic Hospital “because some might misunderstand it as a kind of abortion”.  He asked the neonatal team at the hospital to discuss the issue with the spiritual care staff and with a bioethicist.

THE spiritual care team, representatives of the bioethics committee, and an ethicist met with the neonatal team to discuss this question.  The neonatologist who had consulted with the obstetrician and arranged the consultation explained that in his opinion, even if the pregnancy were carried to full term there was no therapy that could be offered the child that would result in the child living more than a few hours, or at most a few days; indeed, there was a significant probability that the child would not be born alive. 

THE cause of death would probably be immaturity of the lungs, which would remain immature even if the pregnancy were allowed to progress to full term.  The neonatologist had previously cared for several newborns with this condition, and he strongly advised against attempting any invasive medical treatment after birth (such as CPR or intubation), which would almost certainly be ineffective, and at best could serve only to prolong the dying process by a few hours.  In his opinion, induction of labor would not alter the child’s prognosis in any way.

IT was further clarified that:

1. the goal of the induction of labor was solely to treat the mother’s hydramnios.

2. As described above, the premature induction of labor would not alter the child’s prognosis.

3. the mother and father wished to care for the child after delivery as much as possible, but;

4. since no medical therapy would effectively treat or significantly extend the child’s life, they preferred that no invasive therapies be employed.  Insofar as possible, they wished to care for the child in the mother’s post-partum room.

5. Social services and spiritual-care staff agreed to meet with the parents before induction of labor to make sure the parents received appropriate psychological assistance, and to insure that a chaplain would be available to baptize the infant.

 1) What is Perinatal Hospice?






THE goal of Perinatal Hospice (or Perinatal Palliative Care) is to support parents who choose to continue a pregnancy when the infant they are carrying is discovered to be suffering from a terminal illness.  The following two citations and links to websites illustrate the efforts that are presently being made:


THE family experience with these pregnancies is analogous to that of families with a terminally ill child and their management is well served with a coherent end-of-life philosophy. The concept of perinatal hospice has been proposed as a comprehensive structured approach for the care of these families.

American Association of Pro-Life Obstetricians and Gynecologists

(Website includes ability to search according to state)

[..] IN a beautiful and practical response, some pioneering hospitals and hospices are starting perinatal hospice or perinatal palliative care programs for families who wish to continue their pregnancies with babies who likely will die before or shortly after birth. A perinatal hospice approach walks with these families on their journey through pregnancy, birth and death, honoring the baby as well as the baby's family. Even in areas without a formal program, parents can create a loving experience for themselves and their baby, and health professionals and family and friends can offer support in the spirit of hospice














 Physician & Patient,  Medieval MS. Illum.

Issued by NCCB/USCC, June 15, 2001. Copyright © 2001, United States Conference of Catholic Bishops


Issues in Care for the Beginning of Life


45. Abortion (that is, the directly intended termination of pregnancy before viability or the directly intended destruction of a viable fetus) is never permitted. Every procedure whose sole immediate effect is the termination of pregnancy before viability is an abortion, which, in its moral context, includes the interval between conception and implantation of the embryo. Catholic health care institutions are not to provide abortion services, even based upon the principle of material cooperation. In this context, Catholic health care institutions need to be concerned about the danger of scandal in any association with abortion providers.



47. 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.



48. In case of extrauterine pregnancy, no intervention is morally licit which constitutes a direct abortion.31





49.  For a proportionate reason, labor may be induced after the fetus is viable.





50. Prenatal diagnosis is permitted when the procedure does not threaten the life or physical integrity of the unborn child or the mother and does not subject them to disproportionate risks; when the diagnosis can provide information to guide preventative care for the mother or pre- or postnatal care for the child; and when the parents, or at least the mother, give free and informed consent. Prenatal diagnosis is not permitted when undertaken with the intention of aborting an unborn child with a serious defect.32


PART FIVE: Issues in Care for the Dying



[...] The task of medicine is to care even when it cannot cure. Physicians and their patients must evaluate the use of the technology at their disposal. Reflection on the innate dignity of human life in all its dimensions and on the purpose of medical care is indispensable for formulating a true moral judgment about the use of technology to maintain life. The use of life-sustaining technology is judged in light of the Christian meaning of life, suffering, and death. Only in this way are two extremes avoided: on the one hand, an insistence on useless or burdensome technology even when a patient may legitimately wish to forgo it and, on the other hand, the withdrawal of technology with the intention of causing death.37

Some state Catholic conferences, individual bishops, and the USCCB Committee on Pro-Life Activities (formerly an NCCB committee) have addressed the moral issues concerning medically assisted hydration and nutrition. The bishops are guided by the Church’s teaching forbidding euthanasia, which is “an action or an omission which of itself or by intention causes death, in order that all suffering may in this way be eliminated.”38 These statements agree that hydration and nutrition are not morally obligatory either when they bring no comfort to a person who is imminently dying or when they cannot be assimilated by a person’s body. The USCCB Committee on Pro-Life Activities’ report, in addition, points out the necessary distinctions between questions already resolved by the magisterium and those requiring further reflection, as, for example, the morality of withdrawing medically assisted hydration and nutrition from a person who is in the condition that is recognized by physicians as the “persistent vegetative state” (PVS).39

 5. DIRECTIVES 55-66

5. DIRECTIVES 55-66: Issues in Care for the Dying


55. Catholic health care institutions offering care to persons in danger of death from illness, accident, advanced age, or similar condition should provide them with appropriate opportunities to prepare for death. Persons in danger of death should be provided with whatever information is necessary to help them understand their condition and have the opportunity to discuss their condition with their family members and care providers. They should also be offered the appropriate medical information that would make it possible to address the morally legitimate choices available to them. They should be provided the spiritual support as well as the opportunity to receive the sacraments in order to prepare well for death.


 § 56

56. A person has a moral obligation to use ordinary or proportionate means of preserving his or her life. Proportionate means are those that in the judgment of the patient[:]

[1] offer a reasonable hope of benefit and

[2] do not entail an excessive burden

[3] or impose excessive expense on the family or the community.40


57. A person may forgo extraordinary or disproportionate means of preserving life. Disproportionate means are those that in the patient’s judgment do not offer a reasonable hope of benefit or entail an excessive burden, or impose excessive expense on the family or the community.








THE assessment of the bioethics committee was that in this particular circumstance the requirements of the Principle of Double Effect were fulfilled.  The infant had reached the age of viability; furthermore, the action (induction of labor) is morally neutral and would in this case be beneficial to the mother without harming (changing the prognosis of) the child.  If it had been possible or safe for the mother to carry the child to term she would have done so.  The intention of the parents was to deliver the child in as normal a way as possible and to care for the child as best they could.

WE concluded that the induction of labor could take place, and explained the reasons for this to all the medical staff concerned, especially the labor-and-delivery and post-partum staff.  All were comfortable with the decision.  The induction was performed without complications and the child lived for two hours after delivery, cared for by the mother.






This Webpage was created for a workshop held at Saint Andrew's Abbey, Valyermo, California in 1990....x....   “”.