Last week at a Vatican conference on abortion, Pope Francis “argued that children who were not expected to live long after birth deserved to be treated in the womb ‘with extraordinary pharmacological, surgical and other interventions.’” He intimated that parents who did not use extraordinary measures were not caring for their children, saying that “Taking care of these children helps parents to grieve and not only think of it as a loss, but as a step on a path taken together.”
In other words, according to the Pope, a mother who chooses to care for her dying child by sheltering him in the safety and comfort of her womb, without medical intervention, is an uncaring, bad mother.
And in this most tragic of situations, where death and birth happen together, the Catholic Church shows that it cares more about its anti-abortion zealotry and life-at-all-costs focus on the unborn than honoring its own values concerning care for the dying.
There is a long and well-articulated tradition of Catholic ethics surrounding end-of-life care. In Catholic theological terms, “extraordinary” medical interventions, like the measures Francis advocates, go beyond the provision of the hydration, nutrition, and basic medical care that provide comfort and dignity to a dying person. They are interventions intended to cure a patient, or at least extend life in a meaningful way.
Extraordinary medical interventions almost always involve pain and suffering. We endure surgeries, and condone them for our loved ones, because we expect the suffering will be worth it: we will live better because of them. Surgeries that we expect will cause suffering and only provide marginal benefit are not treatment. They are torture.
The line is often unclear, of course, and physicians, patients, and families do their best to navigate medical decision-making in situations where the outcome is never entirely predictable. It is disturbing that we sometimes mistakenly overtreat and make our loved ones’ dying days miserable instead of comfortable, and yet it is understandable why we sometimes misjudge a situation in our yearning to keep our beloved with us.
But to establish overtreatment as a moral requirement in cases where we know it cannot do good, as Pope Francis seems to do, is not only unconscionable, it is at odds with Catholic tradition. In wanting to speak strongly against abortion, Francis has abandoned Catholic respect for death as a part of life. Instead, he is amplifying an extreme anti-abortion position of preserving life at any cost. It is truly alarming to see him advocate this position.
In pregnancy, of course, the cost of overtreatment is not only to the baby who is tortured with surgeries that can do little to advance their life. You wouldn’t know it from the Pope’s statements, but performing surgery on a fetus is considered risky for mother and child alike, and most fetal surgeries are considered experimental. Despite how it is portrayed on TV medical dramas, surgeons are far from being able to guarantee results; in fact, surgery sometimes precipitates pre-term birth and kills the child. Risks to the woman include infection, hemorrhage, and hysterectomy. The Pope is asking a woman who is carrying a dying child to risk her health and her ability to have another baby in order to endure a likely useless surgery.
This is not a culture of life. It is a culture of un-death.
Extraordinary measures such as fetal surgery disallow a suffering baby from dying at its appointed time. At the urging of clerics, doctors would perform an invasive and painful surgery to keep a baby un-dead for a few more days or weeks. As far as the Church is concerned, risks to the mother do not count until they threaten her life; she may lose her fertility or be physically and emotionally damaged, but all the Church believes it owes to her, morally, is that it try to leave her un-dead at the end of the ordeal.
Of course, Catholic theology has long undervalued the well-being of pregnant and birthing women, given the principles upon which its ethics of pregnancy care have been built. The direct taking of a life is forbidden, even when that life has been established inside of another person. In the early twentieth century, American Catholic physicians’ guilds debated whether it was ethical to remove an ectopic pregnancy even knowing that leaving it in place might kill the pregnant woman, and elaborate theological work-arounds had to be established to allow treatment.1 Even today, many Catholic hospitals remove the fallopian tube with the embryo inside it rather than dissolve the ectopic embryo with methotrexate, thereby damaging the woman’s fertility, if the local Catholic Bishop thinks the latter treatment too directly targets the embryo and therefore constitutes “abortion.” Under a strict reading of the Ethical and Religious Directives that regulate care at Catholic hospitals, conditions such as medically complicated miscarriage and severe pre-viability pre-eclampsia cannot be treated with abortion (which is the only way to treat these conditions) until the abortion is immediately necessary to save the woman from death. Withholding care from women so as not to kill an embryo or fetus, even when that embryo or fetus would die along with the woman, has long been a part of Catholic theology around pregnancy.
Promoting active measures that harm a pregnant woman while marginally extending the life of her baby, however, is something new for Catholic leadership. This impulse may come from ignorance about the suffering involved in fetal surgeries. It may come from an anti-abortion zeal that occludes other considerations. It may come from increasing acceptance of the medicalization of death, and a medical culture in which physicians often feel they have done their job only when they’ve tried everything.
But for the Pope to advocate life at all costs, even the cost of a peaceful death for a beloved baby and a healthy future for a woman, is a profound mistake. There can be no legitimate concept of a “culture of life” without recognition and acceptance of death. A stillbirth or the death of a newborn is a special kind of tragedy, a death in the wrong season of life. But it is not made better if we denigrate the comfort care a mother may choose for her child in the shelter of her womb, and insist on surgeries that, at best, draw out the suffering. Far from promoting life, Pope Francis is neglecting Catholic principles surrounding end-of-life care, and contributing to a culture of un-death.
Monica Casper, The Making of the Unborn Patient: A Social Anatomy of Fetal Surgery (Rutgers University Press, 1998).
- Jessica Martucci, “Religion, Medicine, and Politics: Catholic Physicians’ Guilds in America, 1909–32,” Bulletin of the History of Medicine, v. 92 n. 2, p. 287-316. Return to text.