Last December, the resident Catholic bishop of Phoenix, Ariz., Thomas J. Olmsted, declared that St. Joseph Hospital could no longer call itself Catholic because medical professionals at the hospital had performed a direct abortion to save a woman’s life. According to Directive 45 of the Ethical and Religious Directives for Catholic Health Services, direct abortion, which is “the directly intended termination of pregnancy before viability or the directly intended destruction of a viable fetus, is prohibited in Catholic hospitals.”
On behalf of the corporation sponsoring the hospital, Catholic Health Care West, Carol Keehan, D.C., president and chief executive officer of the Catholic Health Association, the national organization representing Catholic hospitals and long-term care facilities, disagreed with the bishop. Both Sister Keehan and Catholic Health Care West maintained that the act upon which the bishop based his decision and disciplinary action was not a direct abortion.
Are there grounds for deciding that the procedure was a non-direct abortion, in which the death of the fetus was not included in the intention of the moral act but was a foreseen side effect?
The medical team at St. Joseph Hospital made its decision based on a judgment that both mother and child would die unless action were taken to remove the cause of the underlying medical problem. It seems that preserving the life of the mother was the intention of the act because the infant would die no matter what was done or not done. Its death during the surgery was foreseen but not intended and so a non-direct abortion. There are responsible Catholic theologians and medical personnel who maintain that in these circumstances (including an inability to save the infant from eventual death), the principle of self-defense justifies removing the fetus from the mother’s womb.
Despite a plea by Catholic Health Care West for a more prolonged theological study and a paper defending the thought of the ethics committee of the hospital, Bishop Olmsted issued a statement declaring that a direct abortion had been performed and imposed penalties: specifically that the hospital could no longer call itself Catholic and could no longer provide for the celebration of Mass or reserve the Blessed Sacrament. These penalties were in addition to an excommunication declared earlier by the bishop upon Margaret Mary McBride, R.S.M., the Phoenix hospital administrator who represented the hospital ethics committee in the medical decision that led to the death of the fetus.
On the Horns of a Dilemma
Later Sister Keehan seemed to change course. In a letter to Archbishop Timothy M. Dolan, president of the U.S. Conference of Catholic Bishops, she stated that the Catholic Health Association “has always said to sponsors, governing board members, managers and clinicians that an individual bishop in his diocese is the authoritative interpreter of the Ethical and Religious Directives.” The E.R.D. issued by the conference of bishops is the official guide for the delivery of health care in the name of the church in the United States. Was Sister Keehan contradicting herself? Not really, but a proper response to a bishop’s pronouncement in such a case is quite complex.
The situation was accurately explained in a statement issued a short time later by Archbishop Dolan: “I am convinced that Sister Carol believes she serves the bishops as much as she serves the hospitals.... She feels that the decision [of Bishop Olmsted] was terrible, but she knows that the bishop of the diocese is the authentic interpreter and implementer” of the U.S. bishops’ Ethical and Religious Directives.
This explanation demonstrates a well-known dilemma in regard to official teaching of the church and the reception of that teaching by the faithful: The diocesan bishop has the right to teach with authority, a right firmly established and affirmed by the Second Vatican Council, but that right is not without limitations.
In an article in Theological Studies in 2003, Thomas O’Meara, O.P., discussed these limitations. He argued that the grace of the Holy Spirit does not replace the need for study, learning and reflection on the part of bishops. This is an application of the insight of St. Thomas Aquinas that “grace does not replace nature but rather draws it toward fulfillment” (Summa Theologiae I,1,8). Father O’Meara also maintained that the doctrinal teaching of the magisterium calling for assent is not the same as a disciplinary statement requiring obedience—a distinction also made by Nicholas Lash in his article “Teaching or Commanding?” (Am., 12/13/10).
How can the people affected by a bishop’s decision respond? For a Catholic who respects the teaching of the church, there seem to be two possible ways of responding: (1) accept the statement and follow it as the rightful teaching of the church, even though one disagrees with it; or (2) accept the authority of the statement but disagree with its reasoning and so not follow it because doing so would violate one’s conscience. This second option is what the Board of Trustees of Catholic Health Care West and Sister Keehan seem to have done, and it prompted the letter of Sister Keehan to Archbishop Dolan.
The first response is not unreasonable. To accept a bishop’s judgment while disagreeing with it is not a suppression of conscience but rather an acknowledgement of other elements besides one’s personal conviction. It implies that the recipient of the teaching implicitly realizes that his or her objections to the teaching may not be as well reasoned as the teaching of the resident bishop and that the bishop has the assistance of the Spirit (charism) when teaching. Indeed, the virtue of faith impels Catholics to consider seriously this type of response.
The second response is more difficult to understand and apply. Volumes have been written on the role of conscience in relation to the teaching of the church. An instruction issued by the Congregation for the Doctrine of the Faith (5/24/90) and a commentary on the instruction by Avery Dulles, S.J., (Origins, 3/28/91) provide guidance. The following is a brief synopsis of the pertinent ideas in both the instruction and the commentary.
If a bishop acting in union with the pope states an infallible church teaching, then it must be accepted by Catholics. Were a resident bishop to declare, for instance, that abortion is contrary to moral law, his statement should be accepted by Catholics because that is “the constant teaching of the church.” But if a resident bishop states that a particular action was a direct abortion, that is not a constant teaching of the church. Usually a disciplinary statement of this nature should still be accepted, but there may be arguments to support a contrary decision.
Noninfallible statements are of two sorts: “reformable” or “prudential” statements. “Reformable” does not imply that the statement could be reversed but rather that in the future it might be better expressed, the better to be understood and to be more adequate to the truth it conveys. Reformable statements that are formal teaching should be accepted, in the words of the Second Vatican Council, with “religious submission of intellect and will.” This form of response is not an act of religious faith in revealed truth; rather it is an internal intellectual assent. One should follow church teaching unless one has serious reasons for offering only external respect for the teaching.
If the statement is a prudential application of church teaching based upon “contingent and conjectural elements,” it may be proven to be “not free of all deficiencies.” Then it may be challenged for objective reasons and in time even be reversed. Even prudential papal teachings have been reversed. At the press conference introducing the C.D.F. instruction in 1990, then Cardinal Joseph Ratzinger gave several examples of teachings that have been reversed: statements promulgated by the Holy See in regard to ecumenical activities, to relations between church and state, to personal freedom and the rights of conscience in choosing a religion and declarations of the Pontifical Biblical Commission made at the beginning of the 20th century.
If one follows this second type of response to a bishop’s noninfallible teaching, the instruction advises:
• Contrary opinions must be based upon objective historical and theological reasoning, not upon subjective “rights of conscience.”
• When people object to church teaching, “rights of conscience” often become more important than truth.
• Statements of the hierarchy should not be rejected because they are hard to follow.
• Decisions of individuals contrary to those of resident bishops should not be presented as normative for other institutions or individuals.
• Opposition to a statement of teaching or discipline should not be a “media event,” which may be harmful to the church, though opposition may be expressed in serious forums or journals.
• Responses of this nature, “when a person cannot give intellectual assent,” are called “personal difficulties.” Both Cardinal Dulles and Nicholas Lash indicate that “dissent” is not a fitting term for this type of response. Mr. Lash prefers to label them “disagreements.”
A well-formed conscience is an important part of one’s spiritual life. Thus, any decision of conscience that seems to be contrary to a statement of a church authority, for example, of a local bishop, should be made with caution and a clear view of the common good as well as the personal good of the individual. Authoritative statements of church officials are not mere opinions based on hearsay or weak evidence. Rather, the issuing authority seeks to found them on sacred Scripture, prior teaching of the church and a desire to foster the common good of the particular communities to which they are directed. Disagreements with such teaching must be based upon fact, not opinion. Hence, the first inclination toward official statements should be to follow the teaching or disciplinary statement, even if the teaching is not an infallible statement.
The church, however, admits that statements of church teaching are not all of equal authority. Infallible statements are not frequent. Most statements, especially those of local bishops, are in the noninfallible category. Moreover, the church admits that statements issued even by the highest authority may be subject to revision or correction. The document of 1990, referred to earlier, states: “One must take into account the proper character of every exercise of the magisterium considering the extent to which its authority is engaged…. The authority of the intervention becomes clear from the nature of the document, the insistence with which the teaching is repeated, and the very way in which it is expressed.”
In regard to a moral decision involving facts and challenges of contemporary society, it seems bishops should not make statements based solely on their own experience and knowledge. The people immersed in a particular moral situation may have unmatched knowledge valuable for a sound decision. This is especially clear in regard to moral questions arising in modern health care. In addition, the principle of subsidiarity opts for the right of people other than the bishop to speak to moral issues. The teaching authority of bishops is recognized by members of the church, but in order for that authority to be effectively exercised it must include the voice and expertise of other individual members of the people of God.