In this 1989 federal appellate court case, the plaintiff was taken to Freeman Hospital’s emergency room after being raped. In response to the patient’s request for information about the morning-after pill, the hospital authorities refused to provide such information, believing that they could not, on the grounds that it was a Catholic hospital. Specifically, the hospital did not inform the patient that if she wanted such treatment it must be obtained within 72 hours to be effective. The court reasoned that a patient has the right to make her own decisions regarding treatment, and therefore, adequate disclosure of information must be provided so the patient can make an informed decision. The court concluded that a rape victim who is denied information about access to the morning-after pill may bring a medical malpractice action. This means that liability may arise if the patient can show: 1) that a skilled practitioner would have provided such information and access under similar circumstances; 2) that she would have elected such treatment; and 3) that "damages" (in this case, pregnancy) resulted from the failure to provide such information. In a footnote to its decision, the court indicated that "access" to such treatment could include transfer of the patient to another medical facility or another physician.
More critical for Catholic-sponsored hospitals, the court also reasoned that the morning-after pill constitutes the "prevention" rather the than "termination" of pregnancy. It therefore concluded that the conscience clause under the state’s abortion statute did not immunize the hospital from liability for failure to refuse to provide such information. However, since human life begins at conception (fertilization) and not merely after implantation of the embryo, the relevant moral question from the Catholic perspective is not whether or not there is a pregnancy, but whether or not there is another innocent human life to be respected (see Ethical and Religious Directives, n. 45). Those "contraceptive" measures that operate solely through the prevention of implantation are morally equivalent to abortions in Catholic moral theology, and are therefore impermissible under the Ethical and Religious Directives (both then and now). Nevertheless, the court did not accept this moral distinction as relevant for its ruling.
If Catholic hospitals face a similar situation, they may ethically,
in keeping with the principle of informed consent, include in their protocol for the care of rape victims a requirement that victims be informed that such procedures and drugs can be obtained through their private physicians or non-Catholic facilities, but that Catholic facilities do not use them because they risk causing abortion. The decision to be satisfied with the Catholic facility’s mode of care or to go elsewhere thus remains with the victim [Ashley, B. and K. O’Rourke, Ethics of Healthcare (St. Louis, MO: Catholic Health Association, 1986) 138].
Legal opinion obtained for the Catholic Health Association supports such an approach:
It seems rather clear that a decision, based on religious principle, to refrain from performing abortions and sterilizations falls on the "beliefs" side of the [belief-action] dichotomy. It would contravene the separations of Church and State for government to require Catholic health care institutions to violate its principles in favor of a physician or patient who believes otherwise [In Defense of Values (St. Louis, MO: Catholic Health Association, 1984), 15].
The court ruling itself stated that Catholic Hospitals have the responsibility "to provide information concerning, and access to, estrogen prophylaxis for rape victims." [Source: Second Appellate district, Brownsfield v. Daniel Freeman Marina Hospital, March 2, 1989.]
Having said all this, it must be stated that if, after appropriate testing, it can be established with reasonable or moral certitude that the patient has not already conceived, it would then be appropriate for the Catholic hospital to treat the patient with medications that would in these circumstances prevent ovulation, sperm capacitation, or fertilization (see Ethical and Religious Directives, n. 36). Under these strict parameters, so-called "emergency contraception" would be permissible. This is appropriate because rape is not an act of mutual conjugal love. Rather, it is an extremely violent act that should not be confused with the moral obligations attendant to the inherent meaning of conjugal love. Under other circumstances, some of those same medications might function as abortifacients, which then would not be permissible. [For further reading, see: Ashley, B. and Kevin O’Rourke, Healthcare Ethics: A Theological Analysis (Washington, DC: Georgetown University Press, 1997), 302-307.]
Principles & Concepts: religious freedom, autonomy, respect for autonomy, right to life, human dignity, informed consent, respect for persons, beneficence, institutional & professional integrity, justice.
