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Whom Should We Refuse to Treat? Pregnant Rape Victims? Surrogates?

By Lachlan de Crespigny and Julian Savulescu

An emergency centre doctor working in Germany has claimed 2 nearby catholic hospitals refused to accept a rape victim who needed treatment, in case she was pregnant  . This was allegedly in line with their ethics committee’s policy to refuse to examine sexual assault victims in an effort to avoid future treatments such as the morning after pill coming into conflict with the hospital’s catholic ethos. The hospitals claim this was a misunderstanding and await an internal inquiry.

The Catholic Church does not support abortion and includes the morning after pill as an abortifacient. It is in violation of Catholic (ethical) standards. The doctor making the claims says that Cologne’s Cardinal Meisner had been consulted.

The Catholic Church insists life must be protected with the utmost care from the moment of conception. From the first moment of his or her existence, a human being must be recognized as having the rights of a person. But in this case, they did not only deny the rape victim access to legal contraceptives, they refused to treat or examine her in any way for any of the resulting injuries of the rape. They did not treat her in her hour of need as a person who deserved the utmost care.

In Australia, a similar case relating to refusal of care for a surrogate mother in a Catholic hospital was reported by the Herald Sun, and shortly afterwards was apparently withdrawn from their website. (The article is quoted here ).

Whatever the details behind these cases, the refusal of Catholic hospitals to offer standard lawful obstetric is harming the interests of many women. In Australia, many abortions are offered in hospitals. A high proportion of obstetric hospitals are run by the Catholic Church. Women who attend these hospitals cannot access abortion (or contraception). This presents a limitation of services in the city which can compromise access for women. But this issue is even worse for rural women who may be denied local services if the only hospital is Catholic. Many Catholic hospitals are totally publicly funded – where it is even more questionable whether restricting lawful services is acceptable.

It is unclear which actions that are contrary to Catholic (ethical) standards can result in a refusal to treat women. The chief executive in the Australian case said the hospital faced no ethical dilemma when treating unmarried mothers despite the teachings of the church on extramarital sex. But what would they say to women who had a previous tubal ligation or abortion? Would they care for a woman who had a fetal reduction in pregnancy, or had conceived with IVF?

Would the catholic hospital refuse to treat a gay person? Like surrogacy they will not ‘reoffend’ in hospital. They will have homosexual sex again, but the woman will probably not have a surrogate pregnancy again.

The Catholic Church continues to care for paedophile priests; surely paedophilia is a greater sin than the compassionate act of delivering a surrogate baby for a friend?

Catholic obstetric hospitals refusing to treat women who have not lived by catholic teachings or who request treatments opposed by the church has the potential to harm many women in society. Troublesome though this is, it is a special concern that it occurs in publicly funded hospitals

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6 Comment on this post

  1. The moral or ethical issue here includes an issue of medical science and an issue of public policy.

    The present scientific understanding is that the mind of a living person is produced by the activity of their brain. The Catholic church’s doctrine of “ensoulment” at the moment of conception is, in scientific terms, blatantly false, because it entails the assumption that a mind can exist in a body that does not have a functioning brain. (Whether souls do or do not exist is beyond the scope of this debate and arguably beyond the scope of science to ascertain.)

    To base medical decisions upon that doctrine is pure quackery: medical fraud. It is no different to treating the flu based upon the ancient Greek concept of “humours,” or prescribing exorcisms for cancer. To conceal quackery behind the protection of religion, is as pernicious as concealing pedophilia behind the veil of the confessional.

    (Further, as a purely ethical matter, the Catholic church’s record on protecting pedophiles fully disqualifies it from any moral standing whatsoever concerning matters involving sexuality: this point should be made loudly and repeatedly any time Catholic officials pontificate about abortion, homosexuality, etc.)

    What we do with quacks is deny them licenses to practice medicine, and prosecute them criminally if they continue. Simple consistency requires the same outcome regardless of whether the quackery does or does not come from religious doctrine, otherwise we end up privileging quacks who have religious excuses, thereby creating an “escape hatch” that all quacks may use.

    As a matter of public policy, hospitals have effective monopolies over urgent health care services in their territories, and we cannot tolerate hospitals making ideological distinctions about life-saving treatments.

    Example: A hospital is run by a religious denomination that condemns alcohol consumption as sinful, and refuses to treat alcohol-related illnesses. An ambulance brings in an automobile accident victim who is urgently in need of trauma surgery, but the emergency room surgeon smells alcohol on the patient, and refuses to provide treatment. The patient is put back in the ambulance, which heads for the next closest hospital, five miles away. En route, the patient dies.

    Similar examples could occur for a range of other behaviors and outcomes, for example a hospital run by a denomination that condemns meat consumption, turning away a cardiac patient who answers Yes to an intake question about eating meat.

    Deontologically, these cases translate to the maxim that life-saving care can always be withheld on the premise that only God has the power to determine who shall live and who shall die, and humans must not interfere with God’s judgement. Clearly a hospital that operated on that basis (“we’ll set your broken leg, but only offer palliative care for your cerebral hemorrhage”) should be shut down post-haste on the grounds of medical malpractice, and a new hospital opened in its place, that operates on the basis of medical science rather than ideology.

  2. juergen martin moeller

    It is not about religion, it is about power. Sex is the medium for manipulative power in the catholic ideology. Priests, a-sexual in theory, play the arbiters in an item about which they have no real knowlidge, only an ideological one.
    There is one quite simple way against all thes clerical abuses: to leave the catholic church, to let this bunch of elderly neurotics alone.

  3. The responses to this post miss the point and suggest that their authors have never actually read any serious Catholic bioethics (or, in George’s case, much serious philosophy of any sort about abortion or personal identity). The point, I take it, is that Catholic hospitals generally do not refuse to treat people who do not live by Catholic teachings; Catholic hospitals ordinarily will treat a person who has become pregnant through premarital sex, or a person who has and will continue to have homosexual sex, or a person who has had previous abortions. Patients in Catholic hospitals do not need to pass morality tests. What the hospital apparently did was to refuse to admit a person out of concern that admitting her would somehow require them to perform a procedure that they regard as gravely immoral. That doesn’t make sense from the Catholic perspective, which is what makes the case so striking and strange.

    It is, I take it, one thing to ask whether hospitals should be permitted by law to refuse treatment to people for reasons like these, and another to ask whether they should be permitted to refuse to perform certain procedures that they deem immoral. The answer to the first question is fairly straightforward; the answer to the second, much less so. Of course, many people would like it to be equally obvious, but that’s no excuse for muddled thinking. I am not sure if any Catholic bioethicists contribute to this blog and will come along to substantiate my claim, but none of the Catholic ethicists I know or have read would defend the refusal to treat a person who does not adhere to official Catholic moral teachings; they would defend the refusal to perform procedures that themselves violate those teachings.

    1. Bob,
      The distinction might apply in the case of the rape victim, but does not apply to the surrogacy case- in that case she just wanted them to assist with the birth which is a procedure with which they have no ethical qualms- but they refused because the birth had come about by a procedure which they believe is immoral- so in fact it is quite a good parallel with premarital sex for example.

    2. George (in California USA)

      Sorry Bob, but in fact I have read extensively on the ethical issues surrounding abortion, and on the issues of personal identity, and on the mind/body problem. What I have not specifically read are documents on Catholic bioethics in the broader sense, but that hardly disqualifies my views, since here we are talking about medicine rather than theology.

      In point of fact I do believe that abortion should be subject to stricter standards after the point at which the fetus has achieved the degree of brain development consistent with personhood under the present scientific standard of material monism (“brain causes mind”). But before that point, “no brain, no mind, no person,” therefore unlimited discretion on the part of women to choose abortion for any reason or for no reason at all. That position is unpopular at both ends: with the religious right because it recognizes an unlimited right to choose before the point where the fetus has a mind, and with strong feminists because it recognizes a limit to that right after the point where the fetus has a mind. Further, I would also obligate the provision of medical care to viable fetuses that have to be removed after the point where they have achieved consciousness.

      But in any case, I see you’ve attempted to make a distinction between “the sinner” and “the sin,” which to my mind is at best a distraction or diversion from the core issue at stake here.

      And that issue is whether religious doctrine or medical science shall govern the provision of health care in a hospital’s emergency room.

      Sorry, but no matter how you wish to reframe the issue, the Catholic doctrine on abortion is, when translated to medical terms, pure unadulterated quackery.

      Furthermore, under your general principle that a hospital may refuse to perform procedures it deems religiously unacceptable, it would also be acceptable to refuse to perform various other forms of lifesaving medicine on the religious basis that “only God can decide” whether someone lives or dies. You can refuse to perform lifesaving medicine in your home or in your church, but not in a hospital. And those who don’t like it should get out of the hospital business.

      Lastly, if you can prove to me that a fetus has a functioning mind when it consists of a microscopic clump of cells, I’ll see to it that you’re nominated for a Nobel. OK?

  4. Regardless of the morals of the Catholic church itself, I would like to raise the ethical issue surrounding the provision of care mentioned. I would argue that under article 25 of the Universal Declaration of Human Rights ((1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.), there is an ethical obligation to provide emergency care to those in need regardless of moral stance on the care provided. While the provision of emergency contraception could be debated under this category, the refusal to examine someone essentially removes your ability to provide them any emergency treatment. While this is possibly a luxury that catholic hospitals in cities can afford, if it were also occurring in areas where there was no alternative treatment it would be a serious ethical breach.

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