In an amazing shift in the Vatican’s strategy of no dissent from its position that direct abortion is never permitted, even to save a woman’s life, the Vatican’s top bioethics official, Archbishop Rino Fisichella opined that the doctors in Brazil who performed an abortion on a nine-year-old who was 15 weeks pregnant with twins did not merit excommunication. Before any of us breathes a small sigh of relief, we need to take a closer look at what the Archbishop said and understand that an article in the Vatican newspaper L’Osservatore Romano does not constitute official teaching of the church.
While more often than not, the paper toes the Vatican line, it is a space where trial balloons are floated and controversial opinion by mainstream church figures right and left is expressed. Opinions regarding modest changes in the Vatican prohibition on AIDS have been published. It has also suggested that nuns agree to have frozen embryos about to be destroyed implanted in their uteri as a way of saving lives. The Vatican position on condoms, we saw this week, has not changed. And to the best of my knowledge no nun has stepped forward to gestate frozen embryos.
But, this modest deviation by the Archbishop who heads the Pontifical Academy of Life opens the door for Catholics who follow church teachings on reproduction to discuss the possibility that there are some cases officially acknowledged where individuals can choose abortion and have a calm conscience.
Fisichella discussed two aspects of the Brazilian case. He was critical of the “rush” with which Brazilian Cardinal Cardoso Sobrinho announced that the doctors and mother had excommunicated themselves and of the public nature of the announcement. Fisichella noted that automatic excommunication is automatic and therefore “there was no need…for such urgency and publicity.” Sobrinho’s goal, of course, was to use the occasion to warn others who might consider abortion that they would be punished. Fisichella thought the action instead harmed “the credibility of our teaching which appears in the eyes of so many as insensitive, incomprehensible and lacking in mercy.” He suggested that Sobrinho’s first task in this situation should have been pastoral – to care for the young girl.
These comments do not in any way contradict church teaching on abortion. They are rather strategic suggestions about how to handle public dissent from church teaching, and pastoral in that they speak of excommunication as a “meat cleaver” and urge compassion.
What is perhaps more interesting is Fisichella’s take on the difficult decisions physicians need to make and the moral discretion they have. This is at odds with the absolutist approach that characterizes current church teaching on abortion: direct abortion even to save the life of the woman is prohibited. What does this mean in real life? Traditionally, there is a distinction between a medical procedure such as removal of the uterus of pregnant woman if it is cancerous or of the fallopian tube if there is an ectopic pregnancy and other life-saving abortions such as an abortion if the woman has heart disease, renal failure, or as in the Brazilian case, the woman’s health or physical condition makes carrying the pregnancy to term likely to led to her death. In the first two cases, the death of the fetus is the indirect result of the removal of a diseased organ and therefore the goal is not abortion and the procedure can be performed. In all other cases, the intent is the removal of the fetus and its death and the procedure cannot be performed.
It was on this basis that the Brazilian bishop first insisted that the only moral course of action was to continue the pregnancy, and work to save both the life of the young girl and the fetus by a Caesarean section. The church says it cannot decide to save the fetus over the pregnant woman any more that it can decide to save the pregnant woman over the fetus. However futile or preordained the outcome might be, one must follow a course of action that tries to save both.
While this has a certain philosophical elegance, it is a death sentence for the woman.
Fisichella understands and seems to accept this position. He reaffirms that abortion is an “intrinsically wicked act” but suggests that under certain circumstances it might be the lesser of two evils. He accepts that the girl’s life was in danger and asks the important ethical question: how are we to act in such a case? It is, he says, “an arduous decision for the physician and for the moral law.” He goes on: “The conscience of the physician finds itself alone when forced to decide the best thing to do.” Is he suggesting that in spite of the church’s position that objectively abortion is always wrong, the individual has some latitude in deciding when it might be the lesser of two evils and a physician might subjectively in good conscience decide that abortion was morally justified in extreme cases? And, what I ask is an extreme case.
While in the Archbishop’s mind abortion rarely presents a life against life dilemma, the fact that he acknowledges any moral discretion for physicians is extremely important. In a Latin American context, where abortion is increasingly being decriminalized (Mexico City, Colombia in the last two years) physicians are carefully considering their options. In much of the developing world the situation faced by the young Brazilian child is not so rare. More than a half million women a year die in childbirth; some from botched abortions, but many because they could not get an abortion in high risk pregnancies. If doctors had some sense that some, high in the hierarchy, recognized that these situations are moral dilemmas in which conscience must decide what is right or wrong, they might decide that they can provide abortion services. And of course this is what Cardinal Cardoso Sobrinho wants to prevent.
You can bet that there will be an outcry from the ultra conservatives in the church, perhaps a clarification by the Archbishop, but the fact is that he has unlocked a door through which women, doctors and policy makers can creep. I am thankful for small favors.