In reply to my post on the story of Sister Margaret McBride whom the Catholic Church “automatically excommunicated” for helping to give the go-ahead to an abortion claimed necessary for saving the life of an 11 week pregnant mother, I have already received two interesting replies. The first challenged the medical argument for the necessity of the abortion. I have no medical expertise of any significance so I cannot speak to those remarks but will represent them at the end of this post in case anyone is interested in continuing that discussion in the comments to this post.
What I will address is David Z’s thought provoking remarks about the ethics of the Sister’s decision:
I also disagree with the reasoning from [The Doctrine of Double Effect], supposing for the sake of argument that the write up presents the whole story (and that the above commenter is incorrect about alternatives). But I want to make a distinction that I think is relevant here.
Consider the hospital’s exculpatory statement: the force of the appeal is to the nun’s virtue as one who generally values life, and they note that she did not take the decision to be an obvious one (which is said in her defence). Some of the commenters seem to regard the decision to abort as black and white to a degree that the hospital itself evidently did not.
The hospital touts the nun’s virtue in being able to weigh a “life-and-death decision with the full recognition that in order to save one life, another life must be sacrificed.” The hospital rightly notes the “agony” of such a decision.
So, Question: the appeal to virtue here suggests that there WOULD HAVE BEEN something morally crass–something outside of what the hospital presupposes–had the nun regarded what she did as the purely obvious decision. …Premise-premise-conclusion… But then maybe I, the nun, and the hospital, are just privy to “irrational” religious moral sentiments about the value of human life.
Now I think that we aren’t (obviously), or at least that those sentiments aren’t irrational. In fact, I think that much of what we’re all reacting to, criticizing the Church, is that the bishop has treated this as a purely obvious conclusion from basic premises. It ain’t. But yet if the nun (and hospital) aren’t on the Church’s side, then neither are they on the side of some cool-headed atheist who regards their decision to abort as clear, rational and obvious. In other words, it’s the nun’s agony, and not the bare result, that the hospital used to justify the case.
Yes, that is how the hospital justified the nun’s choice and after putting up my post originally this actually struck me as unfortunate. So, I’m really glad that you have brought this up and forced me to address the problem I see with the hospital’s statement.
There is are distinctions to be made between the rightness or wrongness of an action itself, the rightness or wrongness of a motive for an action, and the feelings one has about one’s action. Something might be the right thing to do, and yet a particular person’s motive for doing it or feelings about doing it could be morally bad. And, yes, sometimes doing an action from a bad motive or with the wrong feelings changes what the action is and makes it less moral.
For example, it would indisputably be the right thing to do to intervene and save a woman from being raped. Yet, if your motive in stopping a rape is to prevent a man from raping her only that you may do so yourself, then your action of stopping her rape, a ceteris paribus clearly moral thing to do, is no longer a moral action. Because all your actions of “saving” her are now oriented towards an evil action, your raping her. What would normally be the act of preventing her violation is now simply the act of fighting over who will be the one to violate her. This example makes clear that what an action is is partly constituted by motive.
Similarly feelings can change what an action is and whether or not it is morally praiseworthy. For example, say a child has an unhealthily rebellious streak that is causing him a lot of strain and stress in his relationships. Say, in order to help curb the child’s behavior I have to discipline the child in a way that causes the child temporary emotional torment as he throws painful temper tantrums or is forced to miss out on pleasurable activities. This sort of difficult task is sometimes necessary in life and clearly moral. It’s painful for a loving adult to have to discipline a child but it must be done for the child’s own sake.
Now, what if while disciplining the child, I inwardly take special relish in the child’s suffering? Maybe I resented the child’s bad behavior and now delight in seeing him suffer for it. Maybe I just hate children and am excited by a morally acceptable opportunity to make one suffer. These motives would, again, make my acts of disciplining the child no longer moral actions. They would now be acts of sadism or revenge and because of my emotional dispositions and intentions, not really “disciplining” actions. They may have disciplining effects still.
In fact, to all outward appearances and in all technicalities of what I’m doing, I may be performing precisely the actions a loving, morally motivated disciplinarian would do. In other words, the act in all its objective outward features and effects may be indistinguishable from morally praiseworthy discipline. But since it’s inwardly the actions of sadism and/or vindictiveness, I’m not really doing the right action of disciplining. I’m taking a socially and morally accepted opportunity to exploit someone. The benefits that come from my actions are only incidental to my action.
So, in these ways, I think that a minimal degree of virtuous sentiment and virtuous motive (or at least the lack of vicious sentiment and vicious motive) is crucial to an action being an actually moral action. So Sister Margaret McBride’s virtuous sentiments which value life are relevant to an extent. If she were secretly a child hater who relished the destruction of infants and fetuses out of her sociopathy or if she suffered from Münchausen syndrome by proxy and was making her hospital patients sick on purpose for the rush of having them pay attention to her and depend on her, then her record would be tainted and her judgment would be all the more worthy of scrutinization.
When the hospital vouches for her integrity, that she’s the conscience of the hospital, that she’s devoted to life, etc., it adds weight to the claim that her judgment was sincere and life-honoring. That’s good and relevant insofar as we may be uncertain about the particulars. Maybe, not being privy to all the fine details of the situation, we cannot tell exactly if it was an absolutely necessary decision. It helps to know that this was not just any one who went ahead with the abortion but a specifically pro-life nun. That adds (or should) add credibility when defending oneself against the Catholic Church on Catholic grounds. Whether or not Catholic grounds are correct is, of course, highly disputable.
But for the hospital it is necessary they argue that way to an extent since they are appealing to the Church over her excommunication and over their relationship to the Church as supporting institution. Obviously, a pro-life nun should carry more weight with the Vatican than a pro-choice feminist whose inclinations in every case would be to save the life of a mother, even when it is only possible but not necessary that her life is threatened, etc.
If the Vatican won’t even listen to a pro-life nun, then they’ve reached the height of legalism and disconnect from virtuous, situational judgment. (This is not to beg the question that pro-life nuns are more right than pro-choice feminists on independent grounds. This post and the previous one are only about the Church’s relationship to its own value priorities and to its own proxies for carrying them out).
So, in all of this, I think I agree with you, Dave and I think it’s perceptive of you to bring these things up. But where I differ is in a couple of places. First, one clearly need not be a pro-life nun to value life in general. Clearly pro-choice people value life and can perform abortions to save lives of mothers precisely out of value of life. In fact, the passion with which the feminist might insist mothers abort fetuses that threaten their own lives is a life-valuing motivation.
But the Church should acknowledge the moral sincerity of pro-choice people (be they atheists or Catholic even). They should acknowledge the moral seriousness of irreligious people more than they do in flippant denunciations of the supposed immorality of the world, etc. But that’s a complaint for another day. Let me move on to the other problem with the hospital’s choice to only defend the character of Sister McBride and her anguish in her decision making process.
Assuming that no vicious motives or sentiments are in play which taint the rightness of the moral act, and assuming we have the facts of the case correct and this was truly a 2 lives vs. 1 life choice, the nun’s action was one we can recognize in the abstract was absolutely correct on principle. And, as such is defensible regardless of whether or not she agonized over it.
I think that the nun’s agonizing is ultimately irrelevant if she winds up making an immoral choice and unnecessary if she makes a correct choice. Her agonizing may soften the immorality of a bad choice—in that we might say she was simply confused and emotionally in conflict because her reason was uncertain. That surely makes a bad decision more undertandable than a negligent one would be.
But, nonetheless, in such a situation, if it’s 2 dead or 1 dead (assuming we have been presented the facts correctly of course), the rational decision is 1 dead not 2. PERIOD. And had she been a coldbloodedly moral consequentialist who looked at the situation and said, decisively and with no agonizing (and no insidious corrupting vicious motives or sentiments), “we must abort”, then she would have been equally morally praiseworthy for doing the right thing.
Now, maybe emotionally we would say someone is more praiseworthy if they have corresponding emotions fit to the severity of their actions. Obviously, she shouldn’t go home unaffected in all ways. She should see this as a lamentable and a tragic choice and not feel as indifferent as if she was doing something mundane. It is appropriate she have such an emotional response. (Even if we don’t grant the premise that an 11week old is a human person worthy of rights, the loss of a desired pregnancy is still a brutal thing for even the most convinced pro-abortion person who thinks that there is no moral personhood whatsoever in such a fetus).
So at least retrospectively, she should feel sorrow for being party to a really undesirable outcome. But she should not have had to agonize as soon as the medical facts were known (assuming they were) that it was 2 lives or 1. If her agonizing was due to uncertainty over whether both could be saved and she agonized over timing of making such a decision, that would indeed be fine. Maybe one needn’t “agonize”—I imagine surgeons have to deal with such tense situations frequently and may be relatively calm even amidst making a possibly tragic decision “any moment now”).
What I worry about is the possibility that the facts are all as we think they are (because if they are different, obviously, it might be a very different decision) and RATHER than having the courage and confrontational spirit to challenge the Vatican’s dogmatically rigid commitment to the Doctrine of Double Effect, they are trying to say, “she’s a life loving person, who agonized, we can trust her judgment.” That’s unfair. Is a pro-choice doctor who makes the same correct judgment on the facts condemnable because he doesn’t orient his values around a “life above all attitude” like a Catholic nun does? I don’t accept that prejudice.
And I don’t accept the attempt that I hear in the defense of her from the hospital which tries to not call the Doctrine of Double Effect into question but rather to live in some nether region where “technically the church is right” but this is a good woman who somehow did the right wrong action with fear and trembling. That’s not a sustainable or fair ethics. Either she did the right thing and it’s universalizable—even for non-pro-life people and even for non agonizers–or she did not do the right thing. Trying to appeal to her personal character and her personal anguish, as though these and these alone exempt her from an otherwise wise Doctrine of Double Effect principle is wrongheaded. The Doctrine of Double Effect needs to be challenged. So that’s what I did in my post.
So, in short, I don’t think it takes particular moral sentiments and motives unique to Catholics or nuns or other religious or pro-life people to justify in the abstract a 2 dead vs. 1 dead choice. An abstract principle is clear here.
And as long as no vicious motives or sentiments corrupted the actions of those who opted to go through with the abortion, even accepting pro-life priorities one should clearly choose the abortion in this case and explicitly challenge the insistence of the Church that the Doctrine of Double Effect be rigidly adhered to. (Even though, it remains a helpful heuristic for moral judgment at other times. It’s not an inherently bad principle to employ at all, but inflexible, dogmatic, legalistic allegiance to it, as in this case, can be bad.) And focusing on the virtues and sentiments of the nun distract from the abstractly clear and obvious rightness of the action—even apart from any especially Catholic sentiments. Such other sentiments are not necessary to justify her actions. Only the absence of vicious sentiments and motives is necessary.
And, finally, here is the medical skepticism of my other commentator, also named David, which attempts to throw the facts of the case in question:
No such thing as a “life-saving abortion”. It’s an oxymoron. I wonder if they tried other methods?
PAH is a disease characterized by narrowing of the pulmonary arteries and increased vascular resistance. Women with PAH should avoid becoming pregnant, as the physiological, cardiovascular, and pulmonary changes that occur during pregnancy can exacerbate the condition. However, several viable treatment options are available to improve the outcomes in this patient population, including inhaled nitric oxide, calcium-channel blockers, targeted pulmonary vasodilators, and sildenafil. Epoprostenol, a naturally occurring prostaglandin and vasodilator, is a pregnancy category B drug. Reproductive studies in rats and rabbits have found no impaired fertility or fetal harm at 2.5–4.8 times the recommended human dosage of epoprostenol. Most of the published case reports describe initiating epoprostenol 2–4 ng/kg/min i.v. several weeks before or near the time of delivery. Iloprost is a pregnancy category C drug but has demonstrated benefit in pregnant patients with PAH, with no congenital abnormalities and no postpartum maternal or infant mortality reported. Sildenafil causes vasodilation of the pulmonary vascular bed and vasodilation in the systemic circulation. Two case reports have described the successful treatment with sildenafil, a pregnancy category B drug, of pregnant patients with PAH. Patients with idiopathic PAH or chronic thromboembolic PAH should receive full-dose subcutaneous low-molecular-weight heparin therapy instead of warfarin for bleeding prophylaxis during pregnancy.
Targeted pulmonary vasodilators are viable treatment options for pregnant patients with PAH. Early recognition and management of worsening symptoms are essential to improve outcomes for both the mother and infant.
An oxymoron is not the same as an actual contradictory concept. Jumbo shrimp exist. A “life-saving” abortion, as in an abortion that plays an irreplaceable role in saving at least someone’s life, even though it ends that of the fetus, is clearly possible. Beyond that, I do not know the merits of the medical case which David makes. Your Thoughts?