Providence is refining its policies on induced labor
Providence Health System is refining its policies on a procedure called early induction of labor at the request of Archbishop Roger Schwietz.
Doctors sometimes induce labor in pregnant women in order to deliver the baby ahead of schedule. Providence Alaska Medical Center and other facilities in the Providence Sisters’ Seattle-based health care system do perform the procedure, which some people consider to be abortion in some cases.
Both the health system’s head ethicist and Archbishop Schwietz said they want to make sure Providence’s guidelines on early induction fully comply with Catholic ethical standards.
To that end, Archbishop Schwietz recently asked the National Catholic Bioethics Center in Boston to review the guidelines and suggest improvements. He then asked Jan Heller, Ph.D., director of the Office of Ethics and Theology at Providence’s headquarters in Seattle, to evaluate the bioethics center’s suggested changes "in view of the possibility of incorporating them into the guidelines for an updated version which would be clear and focused."
The process of incorporating the center’s recommended changes is underway, according to Al Parrish, chief executive of Providence Health System in Alaska.
Parrish said last week that "at this point we have no reason to believe" the suggested changes to the guidelines’ wording will "actually change what the overall outcome is in reference to our processes," but that he is still awaiting final word on that point from Heller.
Uncertainty about the health system’s guidelines for early induction originated with Alaska Right to Life, which usually agrees with the church on life issues.
According to Alaska Right to Life president Ed Wassell, he heard about early induction from an employee of Providence Alaska Medical Center who told him in April that the hospital permitted the procedure when babies had such severe complications that they could not survive outside the uterus. A second person at the hospital later corroborated the story, Wassell said.
Wassell did not provide the informants’ names and requested that their jobs at the hospital not be publicized.
Wassell said he immediately requested a meeting with Parrish and other hospital officials, including its director of ethics, Dr. Maria Wallington.
"During the meeting we were very surprised to not get any obfuscation or any excuses," Wassell said. "They came right out and said, ‘Yes, we do this procedure, and we have strict protocols to make sure that it’s done only in cases that are ethically correct.’ "
Wassell, whose organization is not Catholic, said he told Parrish and Wallington, "You can call this early induction of fetuses with anomalies incompatible with life … but Alaska Right to Life calls that abortion."
Wassell told Archbishop Schwietz about the meeting with Providence, and the archbishop asked the hospital to put the procedure on hold while he looked into the matter.
The archbishop reviewed the health system’s written guidelines in light of the U.S. Conference of Catholic Bishops’ Ethical and Religious Directives for Health Care Services, a list of 72 statements relating to medical moral issues.
Archbishop Schwietz told the Anchor it seemed clear to him that Providence’s guidelines were in compliance with the directives, so he contacted Parrish and told him the moratorium on the procedure could be lifted. At the same time, he told Parrish that he wanted some Catholic bioethicists to review the guidelines, and shortly thereafter mailed them to the National Catholic Bioethics Center.
Neither Heller nor Wallington is Catholic.
Last week, Parrish told the Anchor that Alaska Right to Life apparently thought it had uncovered a new procedure being done quietly in a Catholic hospital, but in fact early induction has been practiced for years for good reasons in Catholic and other hospitals around the nation.
He said the bishops’ directives have always been the guide for Catholic health care providers, and that Providence Alaska Medical Center has a multi-layered process in place to ensure that the diagnosis is correct and that the ethical requirements for early induction have been met.
Directive number 49, the only one that deals directly with early induction, says, "For a proportionate reason, labor may be induced after the fetus is viable."
Wallington, the ethics director at Providence Alaska Medical Center, said that there are times and circumstances when early induction would be considered abortion by the church’s standards, but Providence never permits it in those cases.
To even be considered, the procedure must be requested by a woman whose unborn child has reached the age of viability, or 24 weeks, and has been diagnosed with anomalies incompatible with life outside the uterus.
When these preconditions have been met, Wallington brings the case to her team, which consists of two obstetricians, a neonatologist, a genetic specialist and a mission specialist. The team reviews the fetal diagnosis and the reasons that the woman and her obstetrician are making the request.
"If the consensus is that the criterion are met then we say, ‘Yes, you can induce this baby,’ " said Wallington, a pediatric cardiologist.
The hospital does about three early inductions per year in this type of situation, she said.
The ethical decision in these difficult, rare cases boils down to that less-than-precise directive from the bishops that says that labor can be induced "for a proportionate reason," said Wallington and others interviewed for this story.
"The ERDs talk about proportioned good and then they don’t talk about how you decide that," Wallington said.
Archbishop Schwietz said Catholic ethicists around the country are "wrestling" with the bishops’ directives and early induction. "It’s the further refining of how those directives can be applied that we’re still working on," he said.