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1. [2008] Official Response to Legislators who contradict Church teaching; 2. [2010] Phoenix and the aftermath - the Irish (Dublin) Declaration; 3. [2012] Harris on Abortion as Conscientious (and, by implication - heroic)

Recently we had a duty to clarify the Catholic Church’s constant teaching against abortion, to correct misrepresentations of that teaching by House Speaker Nancy Pelosi on “Meet the Press” (see www.usccb.org/prolife/whatsnew.shtml). On September 7, again on “Meet the Press,” Senator Joseph Biden made some statements about that teaching that also deserve a response.

Senator Biden did not claim that Catholic teaching allows or has ever allowed abortion. He said rightly that human life begins “at the moment of conception,” and that Catholics and others who recognize this should not be required by others to pay for abortions with their taxes.

However, the Senator’s claim that the beginning of human life is a “personal and private” matter of religious faith, one which cannot be “imposed” on others, does not reflect the truth of the matter. The Church recognizes that the obligation to protect unborn human life rests on the answer to two questions, neither of which is private or specifically religious.

[1] The first is a biological question: When does a new human life begin? When is there a new living organism of the human species, distinct from mother and father and ready to develop and mature if given a nurturing environment? While ancient thinkers had little verifiable knowledge to help them answer this question, today embryology textbooks confirm that a new human life begins at conception (see www.usccb.org/prolife/issues/bioethic/fact298.shtml). The Catholic Church does not teach this as a matter of faith; it acknowledges it as a matter of objective fact.

[2] The second is a moral question, with legal and political consequences: Which living members of the human species should be seen as having fundamental human rights, such as a right not to be killed? The Catholic Church’s answer is: Everybody. No human being should be treated as lacking human rights, and we have no business dividing humanity into those who are valuable enough to warrant protection and those who are not. This is not solely a Catholic teaching, but a principle of natural law accessible to all people of good will. The framers of the Declaration of Independence pointed to the same basic truth by speaking of inalienable rights, bestowed on all members of the human race not by any human power, but by their Creator. Those who hold a narrower and more exclusionary view have the burden of explaining why we should divide humanity into those who have moral value and those who do not and why their particular choice of where to draw that line can be sustained in a pluralistic society. Such views pose a serious threat to the dignity and rights of other poor and vulnerable members of the human family who need and deserve our respect and protection.

While in past centuries biological knowledge was often inaccurate, modern science leaves no excuse for anyone to deny the humanity of the unborn child. Protection of innocent human life is not an imposition of personal religious conviction but a demand of justice.

On November 5, 2009, medical personnel at the St. Joseph's Hospital and Medical Center in Phoenix, Arizona, performed a procedure that caused the death of an unborn child. Most Reverend Thomas Olmsted, the Bishop of Phoenix, has judged that this procedure was in fact a direct abortion and so morally wrong. Some have argued that the procedure was an indirect abortion and therefore a legitimate medical procedure. Still others have said that even the direct killing of an unborn child is sometimes permitted by Catholic teaching, and that this position is supported by certain provisions of the Ethical and Religious Directives for Catholic Health Care Services, a document issued by the United States Conference of Catholic Bishops containing moral principles to be applied in such cases.

The position that Church teaching supports the direct taking of unborn life has been widely reported at the national level by media outlets, which has caused some confusion among the faithful as to what the Church teaches regarding illegitimate and legitimate medical procedures used in cases where the mother’s health or even life is at risk during a pregnancy. In order to clarify doubt regarding the Church’s teaching on this important matter, the Committee on Doctrine, following its mandate to provide expertise and guidance concerning the theological issues that confront the Church in the United States, offers the following observations on the distinction between medical procedures that cause direct abortions and those that may indirectly result in the death of an unborn child.

This distinction appears in nos. 45 and 47 of the Ethical and Religious Directive for Catholic Health Care Services. ERD Directive no. 45 states: "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." Direct abortion is never morally permissible. One may never directly kill an innocent human being, no matter what the reason.

By contrast, in some situations, it may be permissible to perform a medical procedure on a pregnant woman that directly treats a serious health problem but that also has a secondary effect that leads to the death of the developing child. ERD Directive no. 47 states: "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 difference can be seen in two different scenarios in which the unborn child is not yet old enough to survive outside the womb. In the first scenario, a pregnant woman is experiencing problems with one or more of her organs, apparently as a result of the added burden of pregnancy. The doctor recommends an abortion to protect the health of the woman. In the second scenario, a pregnant woman develops cancer in her uterus. The doctor recommends surgery to remove the cancerous uterus as the only way to prevent the spread of the cancer. Removing the uterus will also lead to the death of the unborn child, who cannot survive at this point outside the uterus.

The first scenario describes a direct abortion. The surgery directly targets the life of the unborn child. It is the surgical instrument in the hands of the doctor that causes the child's death. The surgery does not directly address the health problem of the woman, for example, by repairing the organ that is malfunctioning. The surgery is likely to improve the functioning of the organ or organs, but only in an indirect way, i.e., by lessening the overall demands placed upon the organ or organs, since the burden posed by the pregnancy will be removed. The abortion is the means by which a reduced strain upon the organ or organs is achieved. As the Church has said many times, direct abortion is never permissible because a good end cannot justify an evil means.

The second scenario describes a situation in which an urgently-needed medical procedure indirectly and unintentionally (although foreseeably) results in the death of an unborn child. In this case the surgery directly addresses the health problem of the woman, i.e., the organ that is malfunctioning (the cancerous uterus). The woman's health benefits directly from the surgery, because of the removal of the cancerous organ. The surgery does not directly target the life of the unborn child. The child will not be able to live long after the uterus is removed from the woman's body, but the death of the child is an unintended and unavoidable side effect and not the aim of the surgery.

There is nothing intrinsically wrong with surgery to remove a malfunctioning organ. It is morally justified when the continued presence of the organ causes problems for the rest of the body. Surgery to terminate the life of an innocent person, however, is intrinsically wrong. There are no situations in which it can be justified. Pope Pius XII summed up Catholic teaching when he stated: "As long as a man is not guilty, his life is untouchable, and therefore any act directly tending to destroy it is illicit, whether such destruction is intended as an end in itself or only as a means to an end, whether it is a question of life in the embryonic stage or in a stage of full development or already in its final stages."¹

Pope John Paul II acknowledged that women considering abortion often face very difficult situations.

It is true that the decision to have an abortion is often tragic and painful for the mother, insofar as the decision to rid herself of the fruit of conception is not made for purely selfish reasons or out of convenience, but out of a desire to protect certain important values such as her own health or a decent standard of living for the other members of the family. Sometimes it is feared that the child to be born would live in such conditions that it would be better if the birth did not take place. Nevertheless, these reasons and others like them, however serious and tragic, can never justify the deliberate killing of an innocent human being.²

Nothing, therefore, can justify a direct abortion. "No circumstance, no purpose, no law whatsoever can ever make licit an act which is intrinsically illicit, since it is contrary to the Law of God which is written in every human heart, knowable by reason itself, and proclaimed by the Church."³

¹ Discourse to the Saint Luke Union of Italian Doctors, 12 November 1944; as cited in Congregation for the Doctrine of the Faith, Declaration on Procured Abortion (18 November 1974), no. 7 n. 15.

² Pope John Paul II, Evangelium Vitae, no. 58; see also Congregation for the Doctrine of the Faith, Declaration on Procured Abortion, no. 14.

About 140 Irish medical professionals participated in the International Symposium on Excellence in Maternal Healthcare. The Symposium featured a panel of world-renowned experts in the fields of mental health, obstetrics and gynecology, and molecular epidemiology who presented their cutting-edge research and data gathered over years of clinical experience. The Symposium particularly addressed issues of maternal mortality and morbidity, care for women with high-risk pregnancies, mental health, cancer in pregnancy, and fetal anomaly. Expert presentations addressed new therapies which involve the safe delivery of chemotherapy during pregnancy and the emerging field of in-utero fetal surgery. The published to following statement:

THE article by Dr. Harris to which the following article refers is available as optional reading from the course website. I prefer not to discuss or reproduce it in any more detail than Mr. Cook does in the following, Dr. Harris' article represents the publication in one of America's most prestigious medical journals of an approach to the understanding of “conscience” and “heroism” that is diametrically opposed to that of the Catholic Church; and it defends the moral relativism that is no longer merely pervasive, but is gradually becoming obligatory in the United States.

Vera Drake, a highly praised 2004 film by British director Mike Leigh, painted a portrait of a back-street abortionist in 1950s England. Vera is a warm-hearted, generous charwoman who “helps out girls in trouble” out of the goodness of her heart. Unhappily, one of her girls nearly dies and the police come knocking. Stigmatised as an abortionist, her employers, friends and even her son let the poor woman twist in the wind. The court gives her a harsh sentence “as a deterrent to others”.

Eight years later the image of the saintly abortionist has moved from the cinema to the New England Journal of Medicine. In the September 13 issue, Dr Lisa Harris, of the University of Michigan, Ann Arbor, argues that abortion doctors are brave souls who defy “stigma, marginalization within medicine, harassment, and threat of physical harm” to act in accordance with their consciences.

Dr Harris laments the fact that the pro-life side of the US abortion debate has captured the moral high ground of conscience and conscientious objection.

“the equation of conscience with non-provision of abortion contributes to the stigmatization of abortion providers. If physicians who offer abortion care don’t have a legitimate claim to act in ‘good conscience,’ like their counterparts who oppose abortion, the implication is that they act in ‘bad conscience’ or lack conscience altogether. This understanding reinforces images of abortion providers as morally bankrupt.”

Surely, Dr Harris contends, if there is a place for conscientious objectors, there must also be a place for conscientious providers. “Moral integrity can be injured as much by not performing an action required by one’s core beliefs as by performing an action that contradicts those beliefs.”

Abortion is not completely legal in the US and in many jurisdictions there are limits. In Georgia and Arizona abortions are banned after 22 and 20 weeks. There are no exemptions in the law for abortionists who feel ethically obliged to perform abortions beyond these limits. Why not?

Dr Harris points out that there is great confusion about conscience and its limits. How can the claims of conscience be distinguished from political convictions or personal bias or sheer misinformation? She calls for fresh look at the idea of good conscientious objection. “Failure to recognize that conscience compels abortion provision, just as it compels refusals to offer abortion care, renders ‘conscience’ an empty concept and leaves us all with no moral ground (high or low) on which to stand.”

Whether or not abortion provision is “conscientious” depends on what conscience is. Most ideas of conscience involve a special subset of an agent's ethical or religious beliefs — one's “core” moral beliefs.2 The conclusion that abortion provision is indeed “conscientious” by this standard is best supported by sociologist Carole Joffe, who showed in Doctors of Conscience that skilled “mainstream” doctors offered safe, compassionate abortion care before Roe.3 They did so with little to gain and much to lose, facing fines, imprisonment, and loss of medical license. They did so because the beliefs that mattered most to them compelled them to. They saw women die from self-induced abortions and abortions performed by unskilled providers. They understood safe abortion to be lifesaving. They believed their abortion provision honored “the dignity of humanity” and was the right — even righteous — thing to do. They performed abortions “for reasons of conscience.”3

Though abortion providers now work within the law, they still have much to lose, facing stigma, marginalization within medicine, harassment, and threat of physical harm. However, doctors (and, in some states, advanced practice clinicians) continue to offer abortion care because deeply held, core ethical beliefs compel them to do so. They see women's reproductive autonomy as the linchpin of full personhood and self-determination, or they believe that women themselves best understand the life contexts in which childbearing decisions are made, or they value the health of a woman more than the potential life of a fetus, among other reasons.3 Abortion providers continue to describe their work in moral terms, as “right and good and important,”4 and articulate their sense that the failure to offer abortion care generates a crisis of conscience.5

Persistent neglect of the compatibility between conscience and abortion provision not only misrepresents their relationship, but has consequences for law, clinical practice, and bioethics. First, U.S. federal and state laws continue to protect only conscience-based refusals to perform or refer for abortion, offering minimal legal protection for conscience-based abortion provision.

2. Wicclair MR. Conscientious objection in health care. Cambridge, United Kingdom: Cambridge University Press, 2011.

3. Joffe CE. Doctors of conscience: the struggle to provide abortion before and after Roe v. Wade. Boston: Beacon Press, 1995.

N Engl J Med 2012; 367:981-983September 13, 2012

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