The Trump administration recently proposed new rules for family planning clinics which will prohibit all abortion-related practices – including referrals for abortion – from taking place in clinics that receive federal grants. Bioethicists on both sides of the issue are avidly debating these new rules and revealing just how stark a difference there is between the secular and Catholic view of reproductive health care.
The Pacific Standard recently published an interview, conducted by journalist Francie Diep, with several bioethicists about the new rules which will prevent doctors and nurses from even referring patients for abortion services unless the patient has already made the decision to abort on their own. And even then, clinicians can only provide a list of providers that offer comprehensive health services without identifying which of those providers actually performs abortions. In other words, if the patient wants an abortion, they will have to do much of the homework themselves and not rely upon federally funded clinics to provide this information.
For this reason, reproductive rights activists are calling it a gag rule, as are some ethicists such as Nancy Dubler, Adjunct professor at New York University’s Langone Medical Center Division of Bioethics.
Dubler believes that a physician’s obligation is always to the well-being of the patient and that he or she has an obligation to provide patients with all the information necessary to make an informed decision. She argues that some women don’t know they’re pregnant when they come to the clinic and, when learning this news for the first time, should be given enough information to help them decide whether, or how, to proceed with the pregnancy.
“What Title X does, in this new guise, is to intrude the federal government into the core of the doctor-patient relationship and deform that discussion so that it is guided not by the needs, wants, and desires of the woman, but by the some abstract notion of the appropriateness of abortion,” she said.
The new rule talks frequently about not treating abortion as a family planning method, and even though she personally discourages women from using abortion in this way, she believes women have a right to abortion and that right should be protected.
“There are different ways of planning for your family. I think the majority of them are morally uncomplicated. The use of contraception is, for me, a morally uncomplicated matter. It’s not for the Catholic Church, but I didn’t notice that the government was run by the Catholic Church, the last time I looked,” Dubler said.
Given that abortion is morally controversial, she puts it on “a lower level” of family planning to “keep it within a woman’s reproductive right . . .”
If the new rule goes into effect, Dubler suggests Title X clinics hang a large poster in their window that states: “Please note that under the terms of Title X services, this clinic is not able to discuss matters of abortion or refer anyone to an abortion.”
Nancy Berlinger, a scholar at The Hastings Center, has a similar point-of-view. She believes a woman is “owed” information about their health care, including the option to abort a pregnancy.
In her opinion, any doctor or nurse who objects to participating in, or even talking about abortion, should either step away from a case where it is being considered or not get a job in that clinic.
“The language is being used [in the new rule] about ‘protections,’ but it doesn’t seem that women are being protected. They’re getting less information and potentially diminished access to services.”
She also argues that it deals a heavier blow to low income women because they may not have the insurance to go to a more expensive provider, or to women in rural areas who don’t have a lot of choices for healthcare.
“Patients with insurance and other resources, out-of-pocket resources, have options. They can go to a provider that takes private insurance, but patients who rely on the safety net or who live in rural areas with few providers, don’t have those options. So that tends to be a big concern, that the blow of this falls very heavily on low-income women who use Title X clinics.”
On the other hand, Barbara Golder, Editor-in-Chief of Linacre Quarterly, the official journal of the Catholic Medical Association, believes that abortion is not medical care, let alone basic medical care. For this reason, there’s no problem with a rule that says, “This isn’t medical care. We’re not offering it.”
For the Catholic bioethicist, nothing trumps the need to protect a human being who is unable to protect himself.
“There are always competing principles and you can’t satisfy them all at the same time, so what we tend to do, in bioethics, is narrow it down to the disqualifying principle, the one where if this isn’t met, we can’t do this,” Golder explained.
This is where the difference between the secular and Catholic view becomes glaringly obvious.
For the secular practitioner, the reason why they would reject the rule is because it limits the freedom of the provider to speak about options. But for the Catholic bioethicist, the disqualifying principle is all about whether or not the option requires a doctor to be complicit in an action that takes a human life.
“If you’re talking about distinguishing among things that are morally equal, that might hold some merit to me, but when we’re talking about destroying an innocent human life, that argument falls short. Moreover, I think another fundamental question we haven’t asked as a society is: What is the role of government in this? How much and how far should government go in providing health care?” Golder asks.
Diep then asked if we were living in a perfect world, wouldn’t we have a rule that restricts access to abortion for higher-income women too and not just pass a rule that might disproportionately impact lower-income women.
Golder’s idea of a perfect world goes far beyond that narrow view. “I want a world in which abortion is not so much illegal as unthinkable. You don’t get that just through laws. And the reality of the world is, people with more money always have more options than people that don’t. But I would like women of all kinds to see life in the womb as a gift, as vulnerable and to be protected as a positive thing in their lives.”
It takes great courage and faith to take such a principled stand in a culture of death – but it’s the only way we’ll ever create the culture of life that all human beings deserve.
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It’s important for all of us to learn how to see current medical practices through a Catholic lens. Barbara Golder helps us to do that in this series of shows, “If We Can, Should We? Catholic Bioethics in Contemporary Times.” Click here for more information.