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The Evil of Abortion and the Greater Good of the Faith: Negotiating Catholic Survival in the Twentieth-Century American Health Care System

Published online by Cambridge University Press:  18 June 2018

Kathleen M. Joyce
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Extract

In 1949, the critic and controversialist Paul Blanshard launched a broadside attack on the Catholic hierarchy in the United States with the publication of American Freedom and Catholic Power, his harshly critical exploration of the Catholic church's involvement in American public life. An instant best-seller, American Freedom and Catholic Power went through eleven printings in its first year and continued to draw new readers throughout the 1950s. Blanshard's mission was to alert Americans to the movements of a Catholic hierarchy that was becoming, he charged, “more and more aggressive in extending the frontiers of Catholic authority into the fields of medicine, education, and foreign policy.” He reserved some of his most stinging commentary for the church's intrusion into the world of medicine.

Type
Research Article
Information
Religion and American Culture , Volume 12 , Issue 1 , Winter 2002 , pp. 91 - 121
Copyright
Copyright © Center for the Study of Religion and American Culture 2002

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References

Notes

I wish to thank Scott Appleby and the Cushwa Center for the Study of American Catholicism at the University of Notre Dame for inviting me to present an early draft of this paper in September 1997. I also benefitted from the comments and criticisms offered by fellow participants in the Young Scholars in American Religion seminar sponsored by the Center for the Study of Religion and American Culture at Indiana University-Purdue University Indianapolis: Ava Chamberlain, Tracy Fessenden, Laura Levitt, Elizabeth Mc Alister, Leonard Primiano, and Jennifer Rycenga. Special thanks are due to our seminar leader, Deborah Dash Moore, for her careful reading of the manuscript. Finally, I would like to thank Peter English, Ronald Numbers, Rickie Solinger, and Keith Wailoo for their comments and advice.

1. Blanshard, Paul, American Freedom and Catholic Power (Boston: Beacon Press, 1949), 4 Google Scholar. To contextualize Blanshard and his crusade, see Welter, Barbara, “From Maria Monk to Paul Blanshard: A Century of Protestant Anti-Catholicism,” in Uncivil Religion: Interreligious Hostility in America, ed. Bellah, Robert N. and Greenspan, Frederick E. (New York: Crossroad, 1987), 43–71 Google Scholar.

2. Blanshard, American Freedom and Catholic Power, 108.

3. Ibid., 111.

4. Ibid., 112-13.

5. Edwards, Edward J., Dark Enemy (New York: Longmans, 1954)Google Scholar; Robinson, Henry Morton, The Cardinal (New York: Simon and Schuster, 1950)Google Scholar.

6. Curiously, although this scene is the one recalled by everyone with whom I have discussed the film version of The Cardinal, it is not given much attention in film reviews. I have learned most about the film's reception by talking to Catholic movie-goers of the period. In early November 1998, the film, and this scene specifically, came up in a discussion on the listserve Sister-L, an international electronic discussion group focused on the history and contemporary concerns of women religious. For film reviews, see Bosley Crowther, “Episodes of a Man of the Cloth,” New York Times, December 13, 1963; Moira Walsh, “The Cardinal,” America, January 4, 1964; and Catholic World 198 (February 1964): 327-28. To access the Sister-L digest for October 29-November 6, 1998, go to SisterSite at www.Geocities.com/Wellesley/1114.

7. For a survey of the involvement of Catholic women religious in American health care, see Liptak, Dolores and Stepsis, Ursula, eds., Pioneer Healers: The History of Women Religious in American Healthcare (New York: Crossroad, 1989)Google Scholar.

8. On the changing character of hospitals in the United States during this period, see Rosenberg, Charles, The Care of Strangers: The Rise of America's Hospital System (New York: Basic Books, 1987)Google Scholar, and Stevens, Rosemary, In Sickness and in Wealth: American Hospitals in the Twentieth Century (New York: Basic Books, 1989)Google Scholar. On the expansion of the physician's role and enhancement of the profession's status, see Stevens, In Sickness and in Wealth, 52-79. On diagnostic developments, see Howell, Joel D., Technology in the Hospital: Transforming Patient Care in the Early Twentieth Century (Baltimore: Johns Hopkins University Press, 1995)Google Scholar.

9. On the history of Catholic hospitals, see Kauffman, Christopher J., Ministry and Meaning: A Religious History of Catholic Health Care in the United States (New York: Crossroad, 1995)Google Scholar; Kathleen M. Joyce, “Science and the Saints: American Catholics and Health Care, 1880-1930” (Ph.D. diss., Princeton University, 1995); and Bernadette McCauley, “‘Who Shall Take Care of Our Sick’: Roman Catholic Sisterhoods and Their Hospitals, New York City, 1850-1930” (Ph.D. diss., Columbia University, 1992).

10. The classic history of Protestant fears about Roman Catholics is Billington, Ray Allen's study, The Protestant Crusade: 1800-1860 (New York: Macmillan, 1938)Google Scholar. For a more recent examination of Protestant perceptions, see Franchot, Jenny, Roads to Rome: The Antebellum Protestant Encounter with Catholicism (Berkeley: University of California Press, 1994)Google Scholar. On the high number of Protestant physicians associated with Catholic hospitals and the correspondingly low number of Catholic physicians, see Joyce, “Science and the Saints,” 175-93.

11. On the “physicians’ crusade,” as well as on the general history of abortion policy in the nineteenth-century United States, see Mohr, James, Abortion in America: The Origins and Evolution of National Policy, 1800-1900 (New York: Oxford University Press, 1978), 147-70Google Scholar. A more recent study by Leslie Reagan is an excellent companion to Mohr's valuable work. Reagan offers a cogent analysis of the therapeutic clauses in state abortion legislation. See Reagan, Leslie, When Abortion Was a Crime: Women, Medicine, and Law in the United States, 1867-1973 (Berkeley: University of California Press, 1997), 13 Google Scholar. For a survey of the relationship between allopathic physicians and the “medical counterculture,” see Starr, Paul, The Social Transformation of American Medicine (New York: Basic Books, 1982), 30–144 Google Scholar.

12. These indications for induced abortion were given routinely in textbooks and medical Journals on obstetrics. See, for example, Williams, J. Whitridge, Obstetrics: A Text-book for the Use of Students and Practitioners (New York: Appleton, 1903), 338-40Google Scholar, and Culbertson, Carey, “Therapeutic Abortion and Sterilization,” Surgical Clinics of Chicago 1, no. 3 (June 1917): 608-10Google Scholar.

13. Noonan, John T., ed., The Morality of Abortion: Legal and Historical Perspectives (Cambridge: Harvard University Press, 1970), 27–31 CrossRefGoogle Scholar.

14. Ibid., 39.

15. Ibid., 40-42.

16. Many standard medical textbooks instructed students to respect the particular teachings of the Catholic church on therapeutic abortion and the religious beliefs of patients in general. See De Lee, Joseph B., The Principles and Practice of Obstetrics (Philadelphia: Saunders, 1913), 1007 Google Scholar; Williams, Obstetrics, 632; and Norris, Richard C., ed., An American Text-Book of Obstetrics: For Practitioners and Students (Philadelphia: Saunders, 1895), 917-18Google Scholar.

17. For an example of the work of a theologian who labored to provide a satisfying interpretation of Church teachings that would leave room for life-saving intervention on behalf of the mother, see Bouscaren, T. Lincoln, Ethics of Ectopic Operations (Milwaukee: Bruce Publishing, 1943)Google Scholar. For insight into early-twentieth-century perceptions about the “value” of infants, in this case infants with congenital defects, relative to the value of older children and adults, see Pernick, Martin, The Black Stork: Eugenics and the Death of “Defective” Babies in American Medicine and Motion Pictures since 1915 (New York: Oxford University Press, 1996)Google Scholar. Compare the social attitudes Pernick describes with Viviana Zelizer's study of the same period in her book, Pricing the Priceless Child: The Changing Social Value of Children (New York: Basic Books, 1985).

18. On the unjust aggressor analogy, see Noonan, The Morality of Abortion, 24-32, and Kelly, David F., The Emergence of Roman Catholic Medical Ethics in North America: An Historical, Methodological, and Bibliographical Study (New York: Edward Mellen, 1979), 294-95Google Scholar.

19. Sanford, Alexander, Pastoral Medicine: A Handbook for the Catholic Clergy (New York: Joseph F. Wagner, 1905), 238-39Google Scholar. The “pastoral medicine” of Sanford's title was a uniquely Catholic concept. At this time, the field of medical ethics as it is understood today did not exist. When the term “medical ethics” was used, it referred to rules of professional etiquette and conduct. In the eighteenth and nineteenth centuries, Catholic pastoral medicine texts were generally written by priests for other priests living in rural communities in which the services of a doctor often were not available. In the late nineteenth Century, the authors and audience remained the same, but pastoral medicine texts were no longer emergency medicine manuals. Instead, they typically drew on moral theology to communicate Catholic teachings on the sacraments and issues related to birth and death. For a discussion of pastoral medicine, see Kelly, The Emergence of Roman Catholic Medical Ethics, 42-81.

20. Bonnar, Alphonsus, The Catholic Doctor (New York: R J. Kennedy and Sons, 1937), 48–52 Google Scholar; see also Capellmann, Carl, Pastoral Medicine (New York: F. Pustet, 1882), 177-78Google Scholar.

21. Bonnar, The Catholic Doctor, 79-80.

22. See Bowen, John, Baptism of the Infant and the Fetus: An Outline for the Use of Doctors and Nurses (Dubuque: M. J. Knippel, 1939), 4 Google Scholar; Capellmann, Pastoral Medicine, 140-42; Burke, Edward, Acute Cases in Moral Medicine (New York: Macmillan, 1929), 85 Google Scholar; La Rochelle, S. A. and Fink, C. T., eds., Handbook of Medical Ethicsfor Nurses, Physicians and Priests (Montreal: Catholic Truth Society, 1944), 216-32Google Scholar; and Sanford, Pastoral Medicine, 93-94.

23. The 1917 Code of Canon Law (canon 746) required the extraction of the fetus from the womb when maternal death occurred prior to delivery. In most countries, civil legislation had long required this as well. These statutes reflected concern about saving the life of the fetus as well as, in Catholic countries, concern that the fetus be properly baptized. On the issue of priests performing the procedure, see “The Caesarean Operation—Post Mortem Matris,” American Ecclesiastical Review 2 (May 1890): 358-67; and Klarmann, Andrew, The Crux of Pastoral Medicine (New York: F. Pustet, 1905), 163-67Google Scholar.

24. O'Malley, Austin, The Ethics of Medical Homicide and Mutilation (New York: Devin-Adair, 1922), 181 Google Scholar. O'Malley's use of the word “viable” in this context is confusing. His definition of therapeutic abortion includes the premature induction of labor in the second and third trimesters of pregnancy. He is arguing that such a procedure is permissable only when the fetus is at an advanced stage of development and is likely to survive outside the womb. If the fetus cannot be safely delivered, he contends, both the mother's illness and her pregnancy must be allowed to run their natural course, even if that course leads to death.

25. Burke, Acute Cases in Moral Medicine, 37.

26. Finney, Patrick A., Moral Problems in Hospital Practice: A Practical Handbook (St. Louis: B. Herder, 1922), 138-39Google Scholar.

27. Keating, John M. and Coe, Henry C., eds., Clinical Gynaecology: Medical and Surgical (Philadelphia: J. B. Lippincott, 1895), iv Google Scholar.

28. Ashton, William E., Essentials of Obstetrics Arranged in the Form of Questions and Answers, Prepared Especially for Students of Medicine, eighth ed., rev. McGlinn, John (Philadelphia: Saunders, 1916), 240-41Google Scholar; McGlinn, John A., “Fetal Dystocia as an Indication for Operative Delivery: The Relative Propriety of Such Procedures as They Affect the Interests of Mother and Infant,” American Journal of Obstetrics and Diseases of Women and Children 86, no. 6 (1917): 1–6 Google Scholar.

29. “Round Table Discussion on Operating Room Technique,” Hospital Progress 4, no. 9 (September 1923): 334; “The Question Box,” Hospital Progress 1, no. 7 (November 1920): 320; Sister M. Paschaline, “Authority and Duties of the Operating Room Sister,” Hospital Progress 7, no. 2 (February 1926): 64-65; and Sister M. Beata, “Responsibility and Education of Obstetrical Supervisors, Hospital Progress 11, no. 12 (December 1930): 508-9.

30. Access to historical information on the CHA is limited both because a great deal of material from its early years has been either lost or destroyed and because the association does not make the material that has survived available to private researchers. My discussion of the CHA draws on the following sources: Robert Shanahan, “The Catholic Hospital Association: Its First Twenty-five Years (1915-1940)” (Ph.D diss., St. Louis University, 1961); the revised and somewhat condensed version of Shanahan's dissertation, Shanahan, Robert J., The History of the Catholic Hospital Association, 1915-1965: Fifty Years of Progress (St. Louis: Catholic Hospital Association, 1965)Google Scholar; Kauffman, Christopher J., A Commitment to Health Care: Celebrating 75 Years of the Catholic Hospital Association (St. Louis: Catholic Hospital Association, 1990)Google Scholar; and my reading of the CHA's Journal, Hospital Progress, which began publication in May 1920. Both the Shanahan book and the Kauffman study were authorized by the CHA. Indeed, Kauffman's is a commissioned institutional history. Wherever possible, I have tried to verify information through comparison of these published histories and through reference to contemporary newspapers and Journals.

31. Data is not available to verify Moulinier's claim that Catholics controlled more than 50 percent of the hospital beds in the United States and Canada. The number of Catholic hospitals was quite substantial in this period, and Moulinier's calculation might well have been correct. It is also possible, however, that he overstated the number and size of Catholic hospitals. Shanahan, History of the Catholic Hospital Association, 30.

32. Stevens, In Sickness and in Wealth, 115

33. Davis, Loyal, Fellowship of Surgeons: A History of the American College of Surgeons (Springfield, Ill.: Charles C. Thomas, 1960), 489-90Google Scholar.

34. Shanahan, “The Catholic Hospital Association,” 104-6.

35. Ibid., 181. Straub served as spiritual director to the Hospital Sisters of St. Francis, a community of women religious that owned St. John's Hospital as well as thirteen other hospitals in Illinois and Wisconsin. The rules of the order stipulated that sisters must seek the advice of their spiritual director on matters of any consequence, and this put Straub in an unusually powerful position. All communities of women religious had a designated clergyman who received the sisters’ confessions and offered spiritual counsel, but few submitted to an adviser's direction to the extent that these Franciscan sisters did (or were forced by Straub to do).

36. On fee-splitting, see Davis, Fellowship of Surgeons, 413-36.

37. “Brief Articles on Practical Topics,” Hospital Progress 1, no. 1 (May 1920): 36.

38. “The Question Box,” 320.

39. Shanahan, “The Catholic Hospital Association,” 183.

40. Ibid., 187-89. Theologically, and perhaps ideologically, Straub and Moulinier could not have been more different, and this undoubtedly was a factor in the conflict between them. Moulinier was committed to integrating Catholics into the American mainstream and elevating their social position. Sträub was a staunch defender of tradition. Ethnicity probably also influenced their perspectives, although it is unclear to what extent. Moulinier was American born, but Straub's place of birth is unknown. Straub did, however, clearly identify with the German-Catholic tradition. Still, it is likely that the personalities of the two men did more to exacerbate tensions than any of their personal convictions. Their conflict was a classic clash of authoritarian styles. Both men were single minded in pressing their agendas, and neither was complacent in the face of opposition. Both men wanted to determine and control the direction the CHA would take, but Moulinier proved to be the better strategist. For biographical data on Moulinier, see Shanahan, History of the Catholic Hospital Association, 82.

41. Hamilton, Raphael N., The Story of Marquette University: An Object Lesson in the Development of Catholic Higher Education (Milwaukee: Marquette University Press, 1953), 229-30Google Scholar; Engbring, Norman H., An Anchor for the Future: A History of the Medical College of Wisconsin, 1893-1990 (Milwaukee: Medical College of Wisconsin, 1991), 31–33 Google Scholar; “Takes Issue with Attitude of Fr. Noonan,” Milwaukee Sentinel, May 7, 1920, 1.

42. Letter, medical faculty to the Board of Trustees, Marquette University School of Medicine, Milwaukee, Wisconsin, November 23, 1919; Letter, Board of Trustees, Marquette University School of Medicine to Dr. L. M. Warfield and other members of the faculty of Marquette University School of Medicine, Milwaukee, Wisconsin, December 17, 1919. Correspondence courtesy of the Department of Special Collections and University Archives, Marquette University Memorial Library.

43. “Takes Issue with Attitude of Fr. Noonan,” 1; “Father Noonan Upholds Stand on Childbirth,” Wisconsin News, May 7, 1920, 3.

44. “Justify Killing of Infant to Save Mother,” Milwaukee Journal, May 7, 1920, 1. See also “Sectarian Rule Denied by Dean,” Milwaukee Journal, May 8, 1920, 1; O'Malley, Austin, “Ethics at Marquette School of Medicine, Milwaukee,” Hospital Progress 1, no. 3 (July 1920): 128-30Google Scholar. O'Malley's article was originally published in a Philadelphia newspaper in response to an Associated Press report.

45. “Physicians Who Quit School Upheld,” Wisconsin News, May 7, 1920, 1. For a discussion of women's assertion of their rights to make decisions about pregnancy and childbirth, see Leavitt, Judith Walzer, Brought to Bed: Childbearing in America, 1750-1950 (New York: Oxford University Press, 1986)Google Scholar, particularly 36-63 and 116-41; and Miller, Lawrence G., “Pain, Parturition, and the Profession: Twilight Sleep in America,” in Health Care in America: Essays in Social History, ed. Reverby, Susan and Rosner, David (Philadelphia: Temple University Press, 1979), 19–44 Google Scholar.

46. See “Vacant Chairs at Marquette since Split,” Wisconsin News, May 8, 1920; “Says Marquette Will Never Yield,” Milwaukee Sentinel, May 21, 1920; “‘Socialist Ethics,’ Noonan Replies,” Milwaukee Sentinel, May 23, 1920; and “Calls Resignations at Marquette Benefit,” Wisconsin News, June 18,1920. Clippings file, Department of Special Collections and University Archives, Marquette University Memorial Library. No page numbers are provided.

47. Shanahan, History of the Catholic Hospital Association, 41-43.

48. “The Minimum Standard of the Catholic Hospital Association,” Hospital Progress 3, no. 3 (July 1922): 362.

49. Ibid., 362-63.

50. “Round Table Discussion on Operating Room Technique,” 334.

51. Paschaline, “Authority and Duties of the Operating Room Sister,” 64-65; Beata, “Responsibility and Education of Obstetrical Supervisors,” 508-9.

52. For a description of how standardization could promote ethical purity, see Schrembs, Joseph, “The Diocesan Director of Hospitals as a Factor in Hospital Standardization,” Hospital Progress 1, no. 1 (May 1920): 11–12 Google Scholar.

53. Shanahan, History of the Catholic Hospital Association, 53.

54. On the mid-twentieth-century evolution of medical attitudes toward therapeutic abortion, see Solinger, Rickie, “‘A Complete Disaster’: Abortion and the Politics of Hospital Abortion Committees, 1950-1970,” Feminist Studies 19, no. 2 (Summer 1993): 241-68Google Scholar.

55. Ethical and Religious Directives for Catholic Hospitals (St. Louis: Catholic Hospital Association, 1949). The code was developed in 1948, and that date was used in general references to it.

56. Griese, Orville N., Catholic Identity in Health Care: Principles and Practice (Braintree, Mass.: Pope John Center, 1987), 1–5.Google Scholar

57. Bucar, Liz, “Trends in Brief,” in Caution: Catholic Health Restrictions May Be Hazardous to Your Health (Washington, D.C.: Catholics for Free Choice, 1999)Google Scholar.

58. Ibid., 23-24.

59. Gibson, Cynthia, Risky Business: The Community Impact of Catholic Health Care Expansion (Washington, D.C.: Catholics for a Free Choice, 1995), 6 Google Scholar.

60. For these most recent figures, see “Catholic Hospital Facts and Figures” at the Catholic Health Association's website, http://www.chausa.org/ABOUTCHA/CHAFACTS.ASP; and Bucar, Liz, When Catholic and Non-Catholic Hospitals Merge: Reproductive Health Compromised (Washington, D.C.: Catholics for a Free Choice, 1998), 3 Google Scholar.