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An excerpt from following article. ERDs stand for “Ethical and Religious Directives for Catholic Healthcare”:I’m pretty sure the medical facts would run contrary to any such statements particularly in this case. The hospital neither disclosed the condition to her or the medically necessary action to treat it, they claim because of that directive. Mrs. Means suffered from preterm premature rupture of membranes resulting in severe acute chorioamionitis and acute funisitis, which left her in increasing agony and placed her at risk of death and infertility as the futile pregnancy continued and the hospital wouldn’t treat it or even disclose the condition or those risks to her.
Tamesha was only 18 weeks pregnant and how many of the above guidelines did the hospital follow? Zero. They ignored the condition because the fetus had to come out.
Ms. Means was 18 weeks pregnant when she suffered from a premature membrane abruption – her water broke. Within 72 hours of abruption, she delivered her baby who died after 2.5 hours. There is much we do not know that would be needed to determine whether or not Ms. Means has a legitimate claim of negligence with respect to those aspects of her care (and the question of what information she was given regarding her condition). For example, was she given appropriate antibiotics and corticosteroids – which are the basic standard of care in cases of premature rupture of membranes? The answer is unknown as all of this information is protected by HIPAA.
When Ms Means returned to the hospital with a 100.4 fever and acute chorioamniotitis diagnosed, standard medical care involved inducing labor to remove the amniotic fluid. The claim is that she was not induced or medically treated during the miscarriage because of the ERDs and that when questioned on the failure to induce in 5 cases; the Vice President of Mission Services referred to the ERDs. While each case must be evaluated individually, claiming the ERDs automatically prevent inducing labor is a misreading of the ERDs by failing to apply the principle of double effect.
At the heart of this controversy and lawsuit are the ERDs 45 and 47 which establish the guidelines regarding abortion and maternal fetal conflict. While ERD 45 offers an unequivocal prohibition of all directly intended termination of a pregnancy and all procedures “whose sole immediate effect” is the death of the fetus. It is ERD 47 which applies to this case:
Considerable ink has been spilled as moral theologians, hospital ethicists, and healthcare professionals apply these two directives to complex and heart wrenching cases. Too often, the ERDs are attacked without attention to the entire set of directives for such cases. In this particular medical condition, one does not come to an impasse – early induction of labor even though it is before viability falls under the principle of double effect.“47. Operations, treatments, and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman are permitted when they cannot be safely postponed until the unborn child is viable, even if they will result in the death of the unborn child.”
The Principle of Double Effect guides moral decisions where there is both a good effect and an unintended bad effect (this principle is central for both bioethics and just war theory). Healthcare ethicists Benedict Ashley, OP and Kevin O’Rourke, OP lay out four elements to double effect, which I then apply to this case
The directly intended object of the act must not be intrinsically contradictory to the true ultimate goal of human life. In this case, the goal/intention is to save the woman’s life.The intention of the agent must be to achieve the beneficial effect and as far as possible to avoid the harmful effects. Here, the intention is to remove infected amniotic fluid; one would save the child’s life if one could. If this rupture occurred post-viability both mother and child would be saved through the induction.The foreseen beneficial effects must be at least equal to the foreseen harmful effects. The moral value of the mother’s life equals that of the child’s life.In many Catholic healthcare textbooks, the case of early induction due to serious infection (acute chorioamniotitis) is an example used to teach the principle of double effect in medicine. The ending of the pregnancy is neither intended nor the desired effect when treating a woman 18-23 weeks with acute chorioamniotitis. The unborn child is not considered the pathogen nor was the child directly acted upon. In fact the child lived for 2.5 hours. The ERDs do not prohibit early induction in these cases of acute chorioamnionitis as it does not constitute a direct abortion.The beneficial effects must follow from the action at least as immediately as do the harmful effects. It is the removal of the amniotic fluid/infection not the child’s death that is the means to save the woman’s life. In fact, the baby lived for 2.5 hours, a factor which supports the approach of the ERDs to consider both mother and baby as patients.
Ms. Means illness, the death of her child, and the trauma she suffered are all great tragedies. There are many important questions to be raised by this case (failure to admit, informed consent, bedside manner, and others which must be examined for negligence) but the ERDs are not to blame.
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