Morning Light Ministry has received many inquiries from parents about Catholic Church teaching in regards to an adverse prenatal diagnosis. We include these church documents to help clarify the Church's teaching on the sanctity of life from conception regardless of a fatal or non-fatal prenatal diagnosis. If you are a parent whose baby has received an adverse prenatal diagnosis please visit our web page HOPE IN TURMOIL We can offer you information and support in carrying your baby to term despite an adverse prenatal diagnosis.

1 - "Evangelium Vitae" On the Value and Inviiolability of Human Life,
March 25, 1995, His Holiness Pope John Paul II
2 - NCCB (U.S. Bishops) Statement on Anencepphaly, Published in L'Osservatore Romano,
the newspaper of the Holy See, Vatican, September 23, 1998
3 - Commentary by Peter Cataldo, Published iin Ethics & Morals,
Vol.22, No. 1, Pope John Center For The Study of Ethics
4 - Commentary by staff at NCCB, Published iin L'Osservatore Romano, the newspaper of the Holy See, Vatican, September 23, 1998.
5 - Commentary by Fr. Benedict Ashley, O.P. Published in L'Osservatore Romano,
the newspaper of the Holy See, Vatican, September 23, 1998
6 - RECEIVING A CHILD WITH JOY, by Archbishoop T. Prendergast, S.J.,
GOD'S WORD ON SUNDAY column, December 22, 2002, The Catholic Register
7 - NCBC (National Catholic Bioethics Centerr) Statement On Early Induction of Labor, March 11, 2004, Boston, Massachusetts.

 
 

Some have attempted to argue that anencephalic children may be prematurely delivered, even when this would be inappropriate for other children. This argument is based on the opinion that because of their apparent lack of cognitive function and in view of the probable brevity of their lives, these infants are not the subject of human rights or at least have lives of less meaning or purpose than others. Doubts about the human dignity of the anencephalic infant, however, have no solid ground, and the benefit of any doubt must be in the child's favour. As a general rule, conditions of the human body, regardless of severity, in no way compromise human dignity or human rights.

The "Ethical and Religious Directives for Catholic Health Care Services", Directive 45, states: "Abortion (that is, the directly intended termination of pregnancy before viability or the directly intended destruction of a viable foetus) is never permitted. Every procedure whose sole immediate effect is the termination of pregnancy before viability is an abortion, which, in its moral context, includes the interval between conception and implantation of the embryo".
The phrase sole immediate effect is further explained by Directive 47 which states: "Operations, treatments and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman are permitted when they cannot be safely postponed until the unborn child is viable, even if they will result in the death of the unborn child".
In other words, it is permitted to treat directly a pathology of the mother even when this has the unintended side effect of causing the death of her child, if this pathology left untreated would have life-threatening effects on both mother and child, but it is not permitted to terminate or gravely risk the child's life as a means of treating or protecting the mother.

Hence, it is clear that before "viability" it is never permitted to terminate the gestation of an anencephalic child as the means of avoiding psychological or physical risks to the mother. Nor is such termination permitted after "viability" if early delivery endangers the child's life due to complications of prematurity. In such cases it cannot reasonably be maintained that such a termination is simply a side effect of the treatment of a pathology of the mother (as described in Directive 47). Anencephaly is not a pathology of the mother, but of the child, and terminating her pregnancy cannot be a treatment of a pathology she does not have. Only if the complications of the pregnancy result in a life-threatening pathology of the mother, may the treatment of this pathology be permitted even at a risk to the child, and then only if the child's death is not a means to treating the mother.
The fact that the life of a child suffering from anencephaly will probably be brief cannot excuse directly causing death before "viability" or gravely endangering the child's life after "viability" as a result of the complications of prematurity.
The anencephalic child, during his or her probably brief life after birth, should be given the comfort and palliative care appropriate to all the dying. This failing life need not be further troubled by using extraordinary means to prolong it (see "Ethical and Religious Directives", Directives 57 and 58). It is most commendable for parents to wish to donate the organs of an anencephalic child for transplants that may assist other children, but this may never be permitted before the donor child is certainly dead.

The profound and personal suffering of the parents of an anencephalic child gives us cause for concern and calls for compassionate pastoral and medical care as the parents prepare for the pain and emptiness that the certain death of their newborn child will bring. The mother who carries to term a child who will soon die deserves our every possible support. The baptism of the child assures the parents of the child's eternal happiness, and the provision of Christian burial of the deceased infant gives witness to the Church's unconditional respect for human life and the recognition that in the face of every human being is an encounter with God.
 
 

The Human Nature Of The Anencephalic Infant

   On September 20, 1996, the NCCB Committee on Doctrine issued a statement entitled “Moral Principles Concerning Infants With Anencephaly.” The statement provides helpful clarification on the ethics of caring for anencephalic infants. The condition of anencephaly, which can be diagnosed early and accurately by ultrasound imaging, is described in this way,

Anencephaly is a congenital anomaly characterized by failure of development of the cerebral hemispheres and overlying skull and scalp, exposing the brain stem. This condition exists in varying degrees of severity. Most infants who have anencephaly do not survive for more than a few days after birth. (Origins, vol. 26, no.16, p. 276. All quotations herein, unless otherwise identified, have this same reference.)

Doubts about the human dignity of the anencephalic infant, however, have no solid ground, and the benefit of any doubt must be in the child’s favor. As a general rule, conditions of the human body, regardless of severity, in no way compromise human dignity or human rights.

According to the well-established teaching of the Catholic Church, the rights of a mother and her unborn child deserve equal protection because they are based on the dignity of the human person whatever the condition of that person.

Operations, treatments and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman are permitted when they cannot be safely postponed until the unborn child is viable, even if they will result in the death of the unborn child. (Directive 47)

The Issue of Emotional Trauma

   The attempt to prevent physical or psychological risks to the mother when no such risks exist by terminating the life of the infant uses the death of the infant as the means for risk prevention:
Hence, it is clear that before “viability” it is never permitted to terminate the gestation of an anencephalic child as the means of avoiding psychological or physical risks to the mother. Nor is such termination permitted after “viability” if early delivery endangers the child’s life due to complications of prematurity.
   The NCCB statement provides an answer to the longstanding question of whether the alleviation of a mother’s emotional anguish and trauma that is sometimes associated with this sort of pregnancy is itself a proportionate reason for terminating the life of an anencephalic infant. In particular, the statement addresses directive 49 of the Directives: “For a proportionate reason, labor may be induced after the fetus is viable.” The NCCB statement shows that the psychological state of the mother does not qualify as a proportionate reason for terminating the life of the infant by inducing labor either before or after viability. The emotional trauma of the mother is in response to the condition of anencephaly, but the statement shows that the act of terminating the pregnancy is in itself directed at the infant not the mother: “ Anencephaly is not a pathology of the mother, but of the child, and terminating her pregnancy cannot be a treatment of a pathology she does not have.”
   If emotional suffering is the condition of the mother (and father), then direct treatment ought to be given for it. The statement acknowledges this problem and calls for appropriate care:

The profound and personal suffering of the parents of an anencephalic child gives us cause for concern and calls for compassionate pastoral and medical care as the parents prepare for the pain and emptiness that the certain death of their newborn child will bring. The mother who carries to term a child who will soon die deserves our every possible support.

Postnatal Issues

   The statement explains that the moral obligations regarding postnatal care for the anencephalic infant are the same as those for any patient whose death is imminent. First, the moral obligation to conserve human life must be fulfilled proportionate to the individual condition of the child:

The anencephalic child, during his or her probably brief life after birth, should be given the comfort and palliative care appropriate to all the dying. This failing life need not be further troubled by using extraordinary means to prolong it.

It is most commendable for parents to wish to donate the organs of an anencephalic child for transplants that may assist other children, but this may never be permitted before the donor child is certainly dead.

The Pope condemns the "conspiracy against life" (n. 17) which endeavours, among other things, to "eliminate malformed babies" and those with disabilities (n. 15). The Holy Father reaffirms the Church's teaching that "the direct and voluntary killing of an innocent human being is always gravely immoral" (n. 57), as is evidenced in "selective abortion" aimed at preventing "the birth of children affected by various types" of physiologic anomalies (n. 63). The Pope calls for the fostering of "a contemplative outlook", one which recognizes "every individual as a 'wonder'" (n. 83). We must all develop a posture which makes "unconditional respect for human life the foundation of a renewed society" (n. 77), enabling us "to see in every human face the face of Christ" (n. 81). With this outlook in mind, we "accept [life] as a gift, discovering in all things the reflection of the Creator and seeing in every person his living image" (n. 83).
This perspective does not falter when confronted with those who are sick, suffering, marginalized or dying. Rather, we are "challenged to find meaning ... precisely in these circumstances" (n. 83) and perceive in the face of every individual an encounter with God.

The Church recognizes anencephalic infants as truly human and worthy of the unconditional respect and reverence befitting every person. The 1987 Vatican Instruction On Respect for Human Life in Its Origin and on the Dignity of Procreation affirms this point: "The human being is to be respected and treated as a person from the moment of conception; and therefore from that same moment his rights as a person must be recognized, among which in the first place is the inviolable right of every human being to life" (n. 1:1).

Pastoral care personnel, with the assistance of a hospital's ethics committee, can be a supportive presence to both the family and medical community in confronting the complex emotions involved in caring for anencephalic infant. As our Ethical and Religious Directives for Catholic Health Care Services (1995) affirm, pastoral care truly "assists those in need to experience their own dignity and value, especially when these are obscured by the burdens of illness or the anxiety of imminent death" (Part II: Introduction).
Parents of an anencephalic infant often experience a sense of failure, of anger over dashed hopes, and of fear of the unknown. Within this experience of immense personal suffering, it is important that they find within the Church a ready embrace and heartfelt assurance that they did not fail in their role as parents. The death of a child is indeed one of the most difficult losses to mourn, and the Church should be sensitive to this in providing for the Christian burial of deceased anencephalic infants. Pastoral care personnel should make every effort to collaborate in the development and implementation of comprehensive prenatal and postnatal bereavement programmes that will assist families in dealing with the loss, emptiness and sorrow which are ever pervasive in these circumstances.
Second, it is to be considered a serious violation of the rights of the infant in utero to induce delivery prior to viability. Viability refers to the point in pregnancy at which the infant will be able to survive outside the womb, generally occurring at about 25 weeks of gestation. The Ethical and Religious Directives remind us that the directly intended termination of a pregnancy before viability constitutes a procured abortion and is never permitted (n. 45).

Some physicians and health-care providers advocate the delivery of previable anencephalic infants in order to eliminate the anxiety, fear and trauma especially on the part of the mother. The question must be asked, "What are we here and now purposely doing when we directly cause the delivery of an anencephalic infant before viability? What is the purpose of this action"? The Church evaluates this action as a directly intended abortion since the sole immediate effect of the act is the certain death of the foetus. The Ethical and Religious Directives are clear on this point: "Abortion (that is, the directly intended termination of pregnancy before viability or the directly intended destruction of a viable foetus) is never permitted. Every procedure whose sole immediate effect is the termination of pregnancy before viability is an abortion ..." (n. 45).
Consequently, delivery before viability of an anencephalic infant cannot be justified by the use of the principle of double effect, as the delivery of the infant in this case constitutes a direct killing of the foetus. For, as the Ethical and Religious Directives teach: "Operations, treatments and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman are permitted when they cannot be safely postponed until the unborn child is viable, even if they will result in the death of the unborn child" (n. 47).
Because this intervention in the pregnancy of an anencephalic infant results in a direct killing of an innocent human being, the only suitable and ethical response is to allow the infant to reach viability, to baptize the infant immediately upon birth (Ethical and Religious Directives, n. 17), and to allow the parents to hold the infant as he or she is allowed to die. Labour may be induced after the foetus is viable, for a proportionate reason (n. 49).

Third, even though the anencephalic infant often does not live beyond a few hours or days, he or she is still a member of the human family and must be assured "comfort care" such as warmth, air, sanitary conditions and bonding with the parents if they wish. Care for the dying anencephalic infant must be humane and dignified. The Declaration on Euthanasia (1980) teaches: "When inevitable death is imminent in spite of the means used, it is permitted in conscience to take the decision to refuse forms of treatment that would only secure a precarious and burdensome prolongation of life, so long as the normal care due the sick person in similar cases is not interrupted" (n. IV).
The Ethical and Religious Directives confirm this same point: "The inherent dignity of the human person must be respected and protected regardless of the nature of the person's health problem.... The respect for human dignity extends to all persons who are served by Catholic health care" (n. 23).
In other words, the fundamental reason for limiting care (e.g., not using antibiotic therapy to combat infection) is that, for example, counteracting an infection and thus briefly prolonging the infant's life will not benefit the infant.

The Ethical and Religious Directives are instructive: "A person may forgo extraordinary or disproportionate means of preserving life. Disproportionate means are those that in the patient's judgement do not offer a reasonable hope of benefit or entail an excessive burden, or impose excessive expense on the family or the community" (n. 57).
Finally, some attention is due here to the question of the use of anencephalic infants as organ donors. The Ethical and Religious Directives allow for the donation of organs (nn. 63-65) but warn that "such organs should not be removed until it has been medically determined that the patient has died.... The use of tissue or organs from an infant may be permitted after death has been determined and with the informed consent of the parents or guardians".
The Holy Father likewise condemns the removal of vital organs "without respecting objective and adequate criteria which verify the death of the donor", calling such attempts a "furtive" but real form of "euthanasia" (Evangelium vitae, n. 15). In the United States, regulations do not permit organ donation from anencephalic infants because brain death criteria are not fulfilled.
A controversy surrounds attempts to override this "brain death" criterion. Some desire to revise the Uniform Anatomical Gift Act to allow removal of organs from live patients; others want to include anencephaly as a variant of "brain dead"; while others would hope to define anencephalic infants as nonhuman. The Church evaluates these approaches as misguided and reaffirms its teaching that: "The determination of death should be made by the physician or competent medical authority in accordance with responsible and commonly accepted scientific criteria" (Ethical and Religious Directives, n. 62).

This is an excellent commentary by Fr. Benedict Ashley. Due
to lack of space we are unable to include the entire
commentary. You can find the entire commentary at http://www.catholicculture.org/docs/doc_view.cfm?recnum=543
If this link does not work, contact us mailto: mlmhopeinturmoil@rogers.com
and we will email you the entire document.

Conclusion
Thus the statement by the Committee on Doctrine of the U.S. National Conference of Catholic Bishops, in conformity with the teaching of the Holy See on the dignity of human life and the evil of abortion and euthanasia, seeks to advocate the right to life of the child with anencephaly, grave as is the child's organic pathology, because the child is a living person. It urges parents, even at the cost of great personal sacrifice. It especially urges the medical profession to give the parents of these children all needed support in this serious obligation. Ordinarily this responsibility is to see that the child has the benefit of a normal gestation before and after "viability". Only when the mother suffers from a life-threatening pathology may the child's life, even after viability, be gravely risked and then only as the indirect effect of the necessary treatment of the mother's pathology. After the child with anencephaly has been delivered alive it must be given whatever care that is to the child's benefit and which manifests respect for the child's dignity as a person. It is not obligatory, however, to give the infant with anencephaly forms of care or treatment whose benefit to the child is not proportionate to the burden to caretakers. When the child's death has certainly occurred, but only then, the child's parents or other proxies may give consent to the immediate removal of the child's organs for transplantation. The purpose of this pastoral statement from the Committee on Doctrine of the U.S. National Catholic Bishops' Conference, therefore, is to apply the authoritative teaching of Pope John Paul II in The Gospel of Life, as well as other documents of the Holy See, to this sorrow-laden situation of the child with anencephaly. It joins the Holy Father in making "a vigorous reaffirmation of the value of human life and its inviolability, and at the same time a pressing appeal addressed to each and every person in the name of God: Respect, protect, love and serve life, every human life! Only in this direction will you find justice, development, true freedom, peace and happiness!".²⁹

RECEIVING A CHILD WITH JOY

NCBC STATEMENT ON EARLY INDUCTION OF LABOR
March 11, 2004

BOSTON, MA— The National Catholic Bioethics Center wishes to assist individuals and institutions working
with the ethical issue of early induction of labor. The following is the NCBC position regarding the application
of Catholic moral teaching and tradition to the issue.

The application of Catholic moral teaching and tradition to this issue is directed toward two specific ends: (1)
complete avoidance of direct abortion, and (2) preservation of the lives of both mother and child to the extent
possible under the circumstances. Based upon these ends, the Ethical and Religious Directives for Catholic
Health Care Services provides directives which set the parameters for the treatment of mother and unborn
child in cases of high-risk pregnancies:

47. Operations, treatments, and medications that have as their direct purpose the cure of a proportionately
serious pathological condition of a pregnant woman are permitted when they cannot be safely postponed
until the unborn child is viable, even if they will result in the death of the unborn child.

49. For a proportionate reason, labor may be induced after the fetus is viable.

The principle of the double effect is at work in each of these two directives. Actions that might result in the
death of a child are morally permitted only if all of the following conditions are met: (1) treatment is directly
therapeutic in response to a serious pathology of the mother or child; (2) the good effect of curing the
disease is intended and the bad effect foreseen but unintended; (3) the death of the child is not the means
by which the good effect is achieved; and (4) the good of curing the disease is proportionate to the risk of
 the bad effect. Fulfillment of all four conditions precludes any act that directly hastens the death of a child.

Early induction of labor for chorioamnionitis, preeclampsia, and H.E.L.L.P. syndrome, for example, can be
morally licit under the conditions just described because it directly cures a pathology by evacuating the
infected membranes in the case of chorioamnionitis, or the diseased placenta in the other cases, and cannot
be safely postponed. However, early induction of an anencephalic child when there is no serious pathology
of the mother which is being directly treated is not morally licit, emotional distress notwithstanding. Early
induction of labor before term (37 weeks) to relieve emotional distress hastens the death of the child as a
means of achieving this presumed good effect and unjustifiably deprives the child of the good of gestation.
Moreover, this distress is amenable to psychological support such as is offered in perinatal hospice. Lastly,
induction of labor before term performed simply for the reason that the child has a lethal anomaly is direct
abortion.