A Catholic nun and longtime administrator of St. Joseph's Hospital and Medical Center in Phoenix was reassigned in the wake of a decision to allow a pregnancy to be ended in order to save the life of a critically ill patient.
The decision also drew a sharp rebuke from Bishop Thomas J. Olmsted, head of the Phoenix Diocese, who indicated the woman was "automatically excommunicated" because of the action.
Neither the hospital nor the bishop's office would address whether the bishop had a direct role in her demotion. He does not have control of the hospital as a business but is the voice of moral authority over any Catholic institution operating in the diocese.
The actions involving the administrator, mostly taken within the past couple of weeks, followed a last-minute, life-or-death drama in late 2009. The patient had a rare and often fatal condition in which a pregnancy can cause the death of the mother.
Sister Margaret McBride, who had been vice president of mission integration at the hospital, was on call as a member of the hospital's ethics committee when the surgery took place, hospital officials said. She was part of a group of people, including the patient and doctors, who decided upon the course of action.
The patient was not identified, and details of her case cannot be revealed under federal privacy laws.
The Catholic Church forbids abortion in all circumstances and allows the termination of a pregnancy only as a secondary effect of other treatments, such as radiation of a cancerous uterus.
The hospital defended the ethics committee's decision.
In a statement, Suzanne Pfister, a hospital vice president, said that the facility adheres to the Ethical and Religious Directives for Catholic Health Care Services but that the directives do not answer all questions.
"In this tragic case, the treatment necessary to save the mother's life required the termination of an 11-week pregnancy," Pfister said.
Pfister issued the four-paragraph statement on behalf of the hospital, its parent company Catholic Healthcare West, and the Sisters of Mercy, McBride's religious order.
McBride was part of the discussion about the surgery, described as urgent. It involved a serious illness, pulmonary hypertension. The condition limits the ability of the heart and lungs to function and is made worse, possibly even fatal, by pregnancy.
In a statement issued to The Republic late Friday, the diocese confirmed that Olmsted learned of the case after the surgery.
"I am gravely concerned by the fact that an abortion was performed several months ago in a Catholic hospital in this diocese," Olmsted said. "I am further concerned by the hospital's statement that the termination of a human life was necessary to treat the mother's underlying medical condition.
"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."
Olmsted added that if a Catholic "formally cooperates" in an abortion, he or she is automatically excommunicated.
Excommunication forbids the person from participating in church life. Remedies are available through an appeal to the Vatican or confession.
"The Catholic Church will continue to defend life and proclaim the evil of abortion without compromise, and must act to correct even her own members if they fail in this duty," the bishop said.
It is unknown whether the bishop took action against the others who were involved in the matter, and Pfister would not answer questions about the physicians involved in the surgery.
Neither Olmsted nor his spokesman at the Phoenix Diocese would answer additional questions.
Although Olmsted does not have direct control of the hospital, his authority as bishop over Catholic institutions is substantial. For one thing, religious orders work in the Valley at his invitation.
In an e-mail, Pfister said McBride has been transferred "to another position in the hospital to focus on a number of new strategic initiatives."
According to the medical directives that the hospital follows, abortion is defined as the directly intended termination of pregnancy, and it is not permitted under any circumstances - even to save the life of the mother.
On the other hand, a second directive says that "operations, treatments and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman are permitted . . . even if they will result in the death of the unborn child."
A letter sent Monday from Catholic Healthcare West, signed by Sister Judith Carle, board chairwoman, and President and CEO Lloyd Dean, asks Olmsted to provide further clarification about the directives. Agreeing that in a healthy mother, pregnancy is "not a pathology," it says this case was different. The pregnancy, the letter says, carried a nearly certain risk of death for the mother.
"If there had been a way to save the pregnancy and still prevent the death of the mother, we would have done it," the letter says. "We are convinced there was not."
James J. Walter, professor of bioethics at Loyola Marymount University in Los Angeles, a Catholic university, said that is a tough argument to make. He said a pregnancy may be terminated only in limited, indirect circumstances, such as uterine cancer, in which the cancer treatment takes the life of the fetus.
Catholic teaching, he said, is that a pregnancy cannot be terminated as a means to an end of saving the life of a mother who is suffering from a different condition.
Asked if the church position prefers the mother and child to die, rather than sparing the life of one of them, Walters said the hope is that both would survive.
Not all faith groups see things the same way.
The Jewish tradition, the Mormon Church and the Evangelical Lutheran Church in America are among the groups that frown on abortion on demand but permit it when the life of the mother is at stake or if the mother is impregnated by rape or incest.
McBride declined to be interviewed. She was the highest-ranking member of the Sisters of Mercy at the hospital, which the order founded in 1895.