Sister Margaret McBride is Vice President of Mission Integration at St. Joseph’s Hospital and Medical Center. She has spent a total of 32 years at Dignity Health, formerly Catholic Healthcare West (CHW).
While serving on the hospital ethics committee in 2009, Sr. Margaret encountered a young mother of four, 11 weeks pregnant, presented in extremis due to pre-existing pulmonary hypertension the medical experts involved felt the woman would die if the pregnancy wasn’t terminated within 48 hours. Further, she was too sick to transfer to another facility. Faced with two deaths, mother and child, or one, Sister Margaret, with the rest of the ethics committee, voted to abort the fetus in accordance with the mother’s wishes. Based on this decision, Bishop Thomas Olmsted ex-communicated Sister Margaret. In addition, the bishop required the sister to resign her position as a mission leader and mandated education for others so that a similar event did not happen again. The bishop saw the decision as black and white. If it was God’s will for both mother and child to die, so be it.
My Conversation with Sister Margaret
Why did you vote to terminate the pregnancy?
We felt we were following the religious and ethical directives, which allow for procedures that save the life of the mother if the fetus wasn’t viable. I did not feel I was violating these directives. Unfortunately, the bishop felt we had participated in a direct abortion, which is against Catholic teaching.How do you feel about the policy of transferring patients to another facility—thereby enabling an abortion—in the case of a medical emergency?
How do you feel about the policy of transferring patients to another facility—thereby enabling an abortion—in the case of a medical emergency?
This is a slippery issue. The Catholic Church first looks at (the level of) cooperation, so it would say we cooperated in the decision to transfer this patient. (At the time) we had decided that transferring the patient to another hospital that was not Catholic was one way we could handle the situation.
Did you have any thought that the decision to terminate would cause these repercussions?
I had absolutely no idea. People have asked me if I would make the same decision now that I know what the repercussions were for the bishop. And I still think we made the right decision, and that I would do the same thing again. His recommendation that we should have let both the mother and the baby die didn’t seem a viable option. I don’t think anyone today in the United States would allow something like that to happen. I also think our doors would have been closed as a hospital.
Were there any other family members involved? What about the father? What were his feelings about this?
That added another twist to the story. The mother of four other children, she did not have a husband at the time. Her boyfriend wanted the pregnancy to continue because this was his child. He told her, how about we wait until we can deliver the baby. We had to tell him that she had about 48 hours. He just couldn’t comprehend that. We had to be really frank with him that she would not survive even a couple more days. That was a hard conversation to have. They finally made the decision to terminate the pregnancy.That often seems to be the case, that family members don’t have the complete information. It becomes a very difficult decision.
That often seems to be the case, that family members don’t have the complete information. It becomes a very difficult decision.
That’s very true. We have our own language, and we think that everyone understands when we say it’s really serious. With this couple, it took many conversations. Once they understood it, they were willing to make the decision. Now, if the mother had said don’t terminate the pregnancy, we would not have terminated it.
How was it to be ex-communicated? That’s got to be traumatic. Are you still excommunicated?
Yes, (it was). I had been in the community almost 42 years as a Sister of Mercy. Then the ex-communication means that you can’t really go to church and you can’t receive Communion. So the sacramental life of the Church is excluded. (But) there’s a process that the Church allows (for the ex-communicated) to go to Confession and admit a level of guilt, and the ex-communication can be lifted. And that’s exactly what happened. But the other piece of this story was that if I didn’t go through the process of removing the ex-communication, my community would have had to make the decision if I could remain as a Sister of Mercy or not.
For that did you have to say that you wouldn’t do the same thing again, that you would make a different decision?
So you were able to stand by your thought process and still be rejoined to the Church.
Did you try to appeal to a higher power? Cardinals or even the Pope?
At the time I had a canon lawyer supporting me. The hospital had a second canon lawyer, and there was another for the health system. We all had to work together on what was the best thing to do. If it had escalated, there was an appeal process, but it’s not easy and it takes a couple of years. So the decision was not to appeal anything. We come back to this: a bishop in a local diocese can make the decision he wants to. Typically it doesn’t go to a cardinal or the Pope. That’s what we had to respect.
Could you have moved your practice and become a nun in a different region under a different bishop who could make a different decision?
Yes. It could have been different. Another bishop could have made a totally different determination.
I trained here at St. Joe’s back in the 90s and I remember it being Catholic Healthcare West.Now of course it’s called Dignity Healthcare. Do you think this case had anything to do with that transition from Catholic Healthcare West to Dignity Healthcare?
It did. Bishop Olmsted brought to the Bishops Committee—a meeting of all the bishops in the United States—his question of the unique structure in Catholic Healthcare West. We had both Catholic hospitals and community hospitals, and his concern was how you can have a Catholic health system that has community hospitals that can and do behave differently than a Catholic hospital. (For example) sterilizations are performed in our community hospitals that typically are not allowed in our Catholic hospitals. So he proposed (a change) to the Catholic Bishops, who were challenged by how to interpret this. It actually went to the Archbishop of San Francisco where our corporate offices for Catholic Healthcare West are located. The archbishop had to come up with a plan, and that’s really the formation of Dignity Health. Now we are no longer a Catholic healthcare system. We’re a faith-based organization that has Catholic hospitals. Our religious sisters have responsibility for the management of the Catholic part of the health system through a sponsorship council. So it did change our structure.
That’s amazing. I’d like to continue this conversation. My bet is that this influenced how you look at end-of-life and other issues. One final question before we leave this segment: Has this whole excommunication / re-communication thing changed the way you look at your Church?
I think there was a change in me. I probably became a little more kind and a little more merciful. It caused me to think there are times we just can’t judge the actions of others. We have to assume the best of people. We often don’t understand what struggles people have. So it made me a much more compassionate person in having to make really hard decisions…and I’m probably less judgmental as a result.
That’s certainly a good thing but I’m sure it was difficult being disconnected from your community.
Sister, I thank you very much. On Part 2 I’d like to talk a little bit about end of life and how this has influenced some of your thought processes. Thanks so much for your time.
When it comes to healthcare, decisions are not black and white. For me, Sister McBride is a hero. Even knowing the personal sacrifice, she made the decision she felt was in the best interest of her patient. When faced with issues of faith and life’s reality, Sister Margaret tries to thread a difficult needle.