Before Christmas, as the Christian world was preparing to celebrate the birth of the child Jesus, Bishop Thomas Olmsted of Phoenix had to deal with a Catholic hospital that carried out a decision to kill a child made in Jesus’ image and likeness. After months of conversation with the administrators of St. Joseph’s Hospital in Phoenix and its parent network Catholic Healthcare West, in which Bishop Olmsted sought and failed to get the hospital and its network to admit that it carried out abortion and commit never to do it again — and in which it became apparent that the abortion was only one of many violations of the U.S. Bishops’ Ethical and Religious Directives (ERDs) — Bishop Olmsted courageously stripped the hospital of its Catholic status on December 21. He said it was the result of his conclusion that he “cannot verify that this health care organization will provide health care consistent with Catholic moral teaching.”

Just as individual Catholics can lose their way, so can Catholic institutions when their administrators begin to depart from Catholic faith and morals. Over the past few decades, the Church has had to deal with Catholic colleges and universities that have seriously deviated from the teaching and practice of the Catholic faith. The term Catholic is not supposed to be a weak adjective referring to an institution’s having been founded by Catholics once upon a time or that still features a few priests or religious on a board of governors; it’s meant to describe a place where the Catholic faith is institutionally believed, taught and practiced. Catholics have a need and a right to know that there will be truth in advertising when an institution promotes itself with a Catholic label.

When Catholics go to a Catholic hospital, they have a legitimate expectation that the health care they receive will be authentically Catholic. They have a right to expect that, when doctors and ethics boards give them counsel during medical dilemmas, the advice will be trustworthily in line with Catholic principles. When a hospital fails to commit to being Catholic in practice rather than just in name, the bishops have a duty and a right to act in such a way that all the faithful will know ahead of time that sadly they have no guarantee of receiving authentically Catholic care. That’s what Bishop Olmsted did in Phoenix. That’s what Bishop Robert Vasa had to do in Baker, Oregon, with the St. Charles Medical Center in Bend, when the hospital refused to stop doing tubal ligations. That’s what it seems other bishops are unfortunately going to have to do in the future if administrators at Catholic hospitals fail to act by the Church’s ERDs, which apply Catholic moral principles to the typical ethical situations that come up in hospitals.

Bishop Olmsted revoked the Catholic identity of St. Joseph’s Hospital not merely because of the November 2009 abortion, but also because other violations in Catholic Healthcare West facilities in his diocese, such as the provision of contraception, sterilizations and abortions of babies who “endanger the physical or mental health of the mother” or who are conceived through rape and incest. But because the 2009 abortion has received much press attention, it is important to examine it more carefully.

St. Joseph’s Hospital, citing privacy concerns, has not released all the information about the 2009 abortion, but from what has been released, we know that a 27 year-old woman, who was in her eleventh week of pregnancy, developed pulmonary hypertension and doctors thought that she would die if the pregnancy continued. They consulted the hospital’s ethics board, chaired by Sr. Margaret McBride, RSM, which gave the go-ahead for the child to be aborted. After the doctors and ethicists spoke to the mother, the abortion took place. Once Bishop Olmsted became aware of the abortion a few months later, he investigated and declared Sr. McBride automatically excommunicated for her having been a necessary accomplice and formal cooperator in a direct abortion.

The hospital maintained not only that it had done nothing wrong, but that it had followed ERD 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.” This directive refers to situations like ectopic pregnancies or cancerous uteruses in which, in order to save the mother’s life, a medical intervention removes a diseased organ while foreseeing, but not intending or directly causing, the child’s death. In these cases we’re not dealing with an “abortion to save the life of the mother.” Abortion is always wrong and can never be justified. What we’re dealing with is the removal of a fallopian tube or a hysterectomy in which a developing child within that diseased organ is not killed, but simply cannot survive on his own and is allowed to die.

In the case of the abortion at St. Joseph’s, however, the child was not removed as a foreseen side-effect of the extraction of a diseased organ and indirectly allowed to die, but instead was treated as if he were the diseased organ and directly killed. The hospital has not released how the surgical abortion was done, but the vast majority of surgical abortions are either through suction, meaning they basically siphon out the boy or girl in a powerful vacuum cleaner, generally in parts; or dilation-and-curettage, in which the child is dismembered in the womb and pulled out limb by limb.

Bishop Olmsted has always insisted that in the incredibly difficult case of the mother and child at St. Joseph’s, the lives of both needed to be given full respect and neither killed. If we were dealing with a situation in which the hospital, in order to save the child’s life, directly killed the mother, and killed her by dismembering her, there would have been just and universal outrage; everyone would now be saying that, despite the good intention of saving the child’s life, the hospital had committed murder in directly and intentionally killing the mother. We cannot do evil so that good will result. A good end never justifies an intrinsically evil means. The fact that most people are not outraged at the killing of her unborn child — and the fact that ethics personnel and administrators at a hospital claiming to be Catholic permitted and continue to justify the direct killing of one of the two whose lives were at stake — shows just how far the pro-abortion mentality has pervaded our culture.

What should have occurred in this tragic situation? Should the Catholic hospital and doctors have done nothing and allowed both mother and child to die?

Let’s first look at analogous cases to get perspective. If two people are in a circumstance in which it is likely that both will die, is it permitted for one to be killed so that the other live? Can doctors morally kill one Siamese twin to save the other? Can one of two people dying of starvation awaiting rescue morally kill and cannibalize the other to survive? The answer is no. If one of the famished pair dies, then it is licit to consume his flesh in a desperate circumstance, but it is never morally justified to kill him for food. Likewise, if one twin dies, the doctors can obviously seek to separate his body from the surviving brother; and if one dies as a result of separation surgery in which the doctors were seeking to save both, there is nothing morally awry. But it is always evil to kill one in order to save the other. It’s morally better for both tragically to die than for one to survive through the murder of the other.

So in the case of the mother and child in St. Joseph’s Hospital, the moral response is that we cannot directly murder either to save the other. In such a heart-rending circumstance, doctors should treat her pulmonary hypertension while praying for a miracle and hoping that child and mother will survive until the child is viable.

As we all know, there is unfortunately not always a medical solution to every medical dilemma. Someone with kidney failure sometimes sadly dies awaiting a kidney transplant, but our desire to save that person can never justify doing evil to save him, by killing someone else to extract a kidney. The first principle of medical ethics is “primum, non nocere,” “first, do no harm.” This is a principle that should be followed by all hospitals, but when Catholic hospitals do not follow it and justify that failure, they do not merit to be called Catholic.

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