Providence details its guidelines for inducing labor
At the request of Archbishop Roger Schwietz, Providence Health System has written more detailed guidelines for the practice of inducing labor in pregnant women. However, the guidelines are a refined articulation of existing policy on the procedure, not a shift in policy, ethicists for the Seattle-based Catholic health system said.
Providence, the archbishop and the National Catholic Bioethics Center, a Boston organization the archbishop consulted, have each approved the guidelines.
Inducing labor in pregnant women is a common and usually uncontroversial procedure, but from the Catholic point of view, in certain cases it could be the moral equivalent of abortion. For example, if the direct intention of the procedure is to end the life of the fetus, the church would consider it abortion.
Last year Alaska Right to Life publicly accused Providence Alaska Medical Center of using the procedure to, in effect, abort fetuses that doctors determined would be incapable of life outside the womb. Providence denied that it allowed anything that the church would consider abortion, and Archbishop Schwietz initiated the process to refine hospital policy on early induction.
The archbishop told the Anchor last week he was happy with Providence’s new guidelines and with the process that produced them.
He said the language contains "very delicate and very precise phrases" that "mean more to those involved directly with medicine than to me, but the ethical aspect of it seems to be very much in keeping with our moral and ethical principles."
The principles in question are spelled out in the U.S. Conference of Catholic Bishops’ Ethical and Religious Directives for Catholic Health Care Services, a list of 72 statements on ethical health care. Directives 45, 47 and 49 deal with early induction and abortion.
Early induction is "complex because even with those principles you have to take each case on its own merits and go through the ethical evaluation of it with an ethics committee to make sure that this is the proper route to take," Archbishop Schwietz said.
The guidelines are for internal use only and are not being released to the public, Al Parrish, chief executive of Providence Health System in Alaska, told the Anchor.
"All I can say is that we have specifically ruled out anything that is anywhere near abortion," Archbishop Schwietz said.
Asked to summarize the guidelines, Providence system ethicist Jan Heller, Ph.D, said they "give clinicians specific clinical guidance about when they can do early inductions under Catholic teaching, under the Ethical and Religious Directives. At the same time they’re trying to provide a rationale for those same teachings."
Heller and Dr. Maria Wallington, head ethicist at Providence Alaska Medical Center, said the guidelines do not represent any changes in their understanding of the bishops’ directives, but rather are a detailed written expression of that understanding.
"The practice is not different," said Wallington, a pediatric cardiologist. She said she doesn’t foresee any change in the number of early inductions done at the medical center.
The new guidelines provide examples of specific medical conditions when early induction could be considered, Heller said, but he declined to name any of the conditions.
However, he did describe the general rule of thumb: "Prior to viability, without some definitive threat to the mother, we would not induce. And then after viability we would induce only under certain circumstances."
Today, the age of viability is about 24 weeks.
The bishops Ethical and Religious Directives, or ERDs, are not specific. No. 49, the only one that mentions labor induction, says simply: "For a proportionate reason, labor may be induced after the fetus is viable."
The vagueness of that directive in particular spoke of the need to "get more concrete" in interpreting the meaning of "proportionate reason," Heller said.
In the context of early induction, the term means that "the risk to the fetus must be severe enough to justify the physical risk of early induction to the mother, and vice versa; if the mother’s at risk it has to be a severe enough risk to justify the risk to the life of the fetus."
Alaska Right to Life, which isn’t a Catholic group but frequently sides with the church on life issues, has focused its criticisms of Providence on cases involving fetuses that are so malformed that they cannot live outside the uterus. Early induction in such cases shortens the baby’s life.
Alaska Right to Life executive director Karen Vosburgh said early induction should only be done if it is necessary to save the life of the mother.
"But that’s it; not because the baby’s imperfect," she said. "That’s just not a good reason to kill a baby."
Providence doesn’t kill babies, and doesn’t allow labor to be induced solely because a baby has imperfections, Wallington said. The hospital has babies and infants in its care "who are so ‘imperfect’ that they’ve been here for years," she said. The children are too much for their families to care for, but "they’re alive and we love them."
"It’s such a complex situation that trying to make it black and white is just impossible," Wallington said. "It’s heart wrenching because it’s always a tragedy. There just isn’t a mother who comes to us who’s eager to be rid of her baby; she just wishes she had a more normal baby."