PHOENIX — When Bishop Thomas Olmsted of Phoenix confirmed the excommunication of a woman religious for approving an abortion that apparently was needed to save a woman’s life, he provoked a wave of criticism and puzzlement from the general public and many Catholics.

But in the wake of headlines pitting the bishop against Sister Margaret McBride, the Sister of Mercy who approved the abortion, Catholic moral theologians, physicians and pro-life activists have come to his defense. The ensuing debate has clarified the Church’s increasingly countercultural stance within a health-care system shaped by liability concerns and a utilitarian cost-benefit perspective. Even in a medical crisis, the unborn child possesses the same inalienable right to life as an adult patient and must be treated with equal respect.

Bishop Olmsted confirmed this point in a public statement issued last month.

“An unborn child is not a disease. While medical professionals should certainly try to save a pregnant mother’s life, the means by which they do it can never be by directly killing her unborn child. The end does not justify the means,” stated the bishop.

“We always must remember that when a difficult medical situation involves a pregnant woman, there are two patients in need of treatment and care, not merely one.”

A veteran neonatologist and former president of the Catholic Medical Association echoed that statement. Dr. Paul Byrne, director of neonatology and pediatrics at St. Charles Mercy Hospital in Toledo, Ohio, argued, contrary to the general assumption that the abortion was absolutely needed to save the woman’s life, that other possibilities existed to resolve the medical issue.

“I know nothing more about the specifics of this case than the public knows: The mother had pulmonary hypertension. That condition alone will not suddenly take the life of a mother that has been pregnant for 11 weeks,” Byrne told the Register June 9. “Simple medical treatment, such as bed rest and oxygen supplementation, can be very effective.”

He said he could not recall any similar situation in which abortion was advised to treat pulmonary hypertension. “In my experience, when you think your way through a medical problem, you come up with solutions that provide better treatment for the mother, and these solutions allow the baby to grow large enough to survive outside the uterus.” (See the complete interview with Dr. Byrne at NCRegister.com, under “Register Exclusives.”)

Bishop Olmsted said that Sister McBride was “automatically excommunicated” by concurring in the hospital ethics committee’s decision to abort the child. A diocesan statement said that Sister McBride “held a position of authority at the hospital and was frequently consulted on ethical matters.”

“She gave her consent that the abortion was a morally good and allowable act according to Church teaching,” the statement continued. “Furthermore, she admitted this directly to Bishop Olmsted. Since she gave her consent and encouraged an abortion, she automatically excommunicated herself from the Church. ‘Formal cooperation in an abortion constitutes a grave offense. The Church attaches the canonical penalty of excommunication to this crime against human life’ (Catechism of the Catholic Church, No. 2272). This canonical penalty is imposed by virtue of Canon 1398: ‘A person who procures a completed abortion incurs a latae sententiae excommunication.’” A latae sententiae excommunication is one that is incurred automatically at the time of the offense.

Sister McBride was also reassigned from her position as vice president of mission integration at the hospital.

St. Joseph’s Hospital issued its own statement — on behalf of the hospital, its parent company, Catholic Healthcare West, and the Sisters of Mercy — which argued that Catholic ethics permitted a direct abortion during specific medical emergencies. “In this tragic case, the treatment necessary to save the mother’s life required the termination of an 11-week pregnancy. This decision was made after consultation with the patient, her family, her physicians, and in consultation with the Ethics Committee, of which Sister Margaret McBride is a member.”

Patrick Lee, the John N. and Jamie D. McAleer professor of bioethics at Franciscan University in Steubenville, Ohio, and the director of the university’s Institute of Bioethics, noted that media reports about the story have focused on the medical needs of the mother but generally neglected the rights and needs of the unborn child. No party in the dispute has provided a complete account of the mother’s medical status, and thus Lee said that he could not address the specifics of the case.

The mother, who has not been identified, was suffering from pulmonary hypertension, a condition that the hospital said carried a near-certain risk of death for her if the pregnancy continued.

But Lee said that the choice to perform a direct abortion — even to save the mother’s life — contradicted a fundamental Catholic moral teaching: One cannot do evil that good may come of it.

“Catholic moral teaching does not permit direct abortion for any reason,” said Lee. The “Ethical and Religious Directives for Catholic Health Care Services” approved by the U.S. Conference of Catholic Bishops confirm this point.

The ERDs allow medical personnel to perform life-saving procedures that might result in the “unintended” death of the patient’s unborn child: “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.”

But the directives also sharply constrain the medical options available in the event of an ectopic pregnancy — a potentially life-threatening condition: “In case of extrauterine pregnancy, no intervention is morally licit which constitutes a direct abortion.”

Lee made the additional point that even “when the death of an unborn child is a ‘side effect’ of life-saving treatment — such as cancer therapy or intervention during an ectopic pregnancy — the Church requires that the unintended consequences of treatment be ‘just’ or ‘fair.’”

John Brehany, executive director and ethicist for the Catholic Medical Association, underscores the increasingly countercultural stance of Catholic moral teaching that guides tough health-care decisions.

“Two principles continue to guide treatment at Catholic hospitals even in ‘touch and go’ situations. First, the life of the unborn child has dignity, and we cannot choose to act directly against that life. Second, you cannot do a moral evil to achieve a good goal or outcome,” said Brehany.

“The world looks at it a different way, and many in the medical profession also have come to look at it a different way,” Brehany added. “In the wake of increased medical-liability judgments, it’s much easier for physicians dealing with medical complications during pregnancy to opt for an abortion. However, I’m not saying that was the case in Phoenix, because we don’t have all the facts.”

A number of Bishop Olmsted’s supporters have suggested that his refusal to rubber-stamp a decision he deemed immoral underscores a deeper reality: Catholic moral teaching affirms God as the author of all life, and when no morally licit treatment is available, trust in his providence remains the only choice.

“We cannot stop all naturally induced tragedies from happening,” agreed Brehany. “But the most important thing we shouldn’t do is choose a substantial moral evil that good may come of it. That’s precisely where the Church would be out of sync with contemporary popular culture.”

Bishop Olmsted’s public statements highlighted the gap between Catholic teaching and mainstream mores on tough medical choices.

“The question might arise: ‘Isn’t it better to save one life as opposed to allowing two people to die?’” said Father John Ehrich, medical ethics director of the Diocese of Phoenix, in a statement. “One thing we must always remember is that no physician can predict what will happen with 100% accuracy. We will never be able to eliminate all risks associated with pregnancy. What we should not do, however, is lower risks associated with pregnancy by aborting children. It is not better for a woman to have to live the rest of her existence knowing that she had her child killed because her pregnancy was high-risk.”

“When we try to control every possible situation in life, we end up playing the role of God,” Father Ehrich continued. “As people of faith, we know that our lives are always in God’s hands. In these situations, the reality of our dependence upon him becomes ever more clear and pronounced.”

Joan Frawley Desmond writes from Chevy Chase, Maryland.