The Excommunication of Margaret McBride (2009–2010)

In 2010, the Catholic Church excommunicated Margaret McBride, a nun and ethics board member at St. Joseph’s Hospital and Medical Center in Phoenix, Arizona. McBride was excommunicated latae sententiae, or automatically, for approving a therapeutic abortion, which is an abortion that is required to save a pregnant woman’s life. McBride approved an abortion for a woman who was twenty-seven years old, eleven weeks pregnant with her fifth child, and suffered from pulmonary hypertension, a life-threatening condition during pregnancy. Following McBride’s decision, St. Joseph’s lost its affiliation with the Catholic Church, which it had maintained since the late 1800s. Affiliation with the Catholic Church required that the hospital abide by Canon Law, which is the law of the Catholic Church. Under Canon Law, abortion is serious wrongdoing that could result in excommunication, as it did in the case of McBride. McBride’s excommunication illustrated the impact that affiliation of Catholicism with hospitals had on patients’ ability to receive comprehensive reproductive health care.

In January 2017, 649 hospitals across the US were affiliated with the Catholic Church. That affiliation required hospitals to follow the US Catholic Church's Ethical Guidelines for Health Care Providers. Catholic hospitals are usually the product of the merging of Catholic hospitals and secular hospitals. Catholic nuns, who immigrated to the US from Europe in the eighteenth and nineteenth centuries, founded many of the first hospitals in the US. In 1895, the Sisters of Mercy founded the first hospital in the Phoenix area, St. Joseph’s Hospital and Medical Center. In 1986 St. Joseph’s, along with nine other Sisters of Mercy hospitals, joined together to form Catholic Healthcare West, a nonprofit public corporation that operated hospitals and ancillary care facilities headquartered there. In 2012, Catholic Healthcare West changed its name to Dignity Health and established its headquarters in San Francisco, California.

Any hospital that is affiliated with the Catholic Church must abide by the U.S. Catholic Church's Ethical Guidelines for Health Care Providers, also known as the Directives. According to the laws of the Catholic Church, called Canon Law, if an individual receives, performs, or condones an abortion, they have committed a grave sin. In the Catholic Church, an individual who commits a grave sin will be excommunicated or expelled from the Catholic Church and subsequently will not receive access to heaven. Under Canon Law, Catholic hospitals cannot provide abortions. However, there are exceptions to the rule to protect pregnant patients. In the US Catholic Church's Ethical Guidelines for Health Care Providers, five directives discuss abortion. Directive 45 states that an abortion, or the termination of pregnancy, is never permitted. However, Directive 47 states that operations, treatments, and medications that are intended to cure a serious pathological condition of a pregnant woman are permitted only when they cannot be safely postponed until the fetus is viable, even if they will result in the death of the fetus.

In November 2009, a twenty-seven year old woman, was admitted to St. Joseph’s with chest pain. She was eleven weeks pregnant with her fifth child. Doctors at the hospital diagnosed the woman with pulmonary hypertension, a type of high blood pressure that affects arteries in the lungs and in the heart. Doctors asserted that the woman was too ill to be moved to another hospital, and that an abortion was the only option to save the woman’s life. The doctors who treated the pregnant woman consulted with the St. Joseph’s Hospital ethics board, which included McBride. Under Directive 47, which allows an abortion to be performed if it saves a pregnant woman’s life, McBride and other members of the hospital’s ethics board approved the abortion.

Six months later, Thomas Olmsted, bishop of the Diocese of Phoenix in Phoenix, Arizona, learned of the abortion performed at St. Joseph’s and called McBride and other hospital officials for a meeting to discuss the procedure. After interviewing the parties involved, Olmsted announced that the abortion violated Canon Law and was not protected by Directive 47. He determined that McBride was to be excommunicated latae sententiae, or automatically. Olmsted argued that medical professionals should have tried to save the mother’s life using means which would not directly kill the fetus. On 21 December 2010, Olmsted removed St. Joseph’s Catholic affiliation. The Church removed the Blessed Sacrament, the bread and wine used for a ceremony called communion, from the hospital’s chapel. The Church also prohibited the celebration of Mass, Sunday church service, on the hospital’s campus.

In a December 2011 statement released by St. Joseph’s hospital and its parent organization, Catholic Healthcare West, hospital administrators maintained that the intention of the abortion was to save the only life that could be saved, which was the pregnant woman’s. The statement also claimed that morally, ethically, and legally, the hospital could not stand by and allow the woman to die if the doctors at the hospital were able to save her. The statement also indicated that McBride had met the requirements to be reinstated in the Catholic Church, but the requirements were not included in the statement. McBride continued to be a member of the Sisters of Mercy community and a member of the hospital’s executive team.

The Arizona Republic, and national outlets such as the New York Times, National Public Radio, and the National Catholic Register, all reported on McBride’s excommunication and St. Joseph’s loss of its affiliation to Catholicism. The event contributed to a national debate about the impact of affiliation to the Catholic Church on patients that received care in those hospitals. In a December 2013 report, the American Civil Liberties Union claimed that the Catholic Church's Ethical Guidelines for Health Care Providers posed a risk to patient health. The report stated that between 2001 and 2011, the number of Catholic hospitals increased 16 percent while other types of hospitals declined in numbers. The study also found that the federal government designated thirty Catholic hospitals in 2011 as sole community providers, meaning that they were the only option for patients in those areas. The study claimed that Catholic affiliation had a negative impact on patients’ reproductive health because the Directives that Catholic hospitals follow limit women’s access to proper miscarriage treatment, abortion, and other potentially life-saving medical interventions pertaining to reproductive health.