Is Rick Santorum a Hypocrite on Abortion?

Now that Rick Santorum is a top-tier candidate, he's being widely accused of hypocrisy about the issue that is the keystone of his political persona: Abortion.

Far as I can tell, the accusations are unfounded -- and based on one line each from two news stores from some years back. Plus a common misunderstanding of a traditional Catholic doctrine that undergirds Santorum's unrelenting opposition to abortion. The Doctrine of Double Effect isn't exactly normal parlance amongst TV's shouting heads and the larger secular blogosphere.

The basic narrative is the same in all accounts: Back in 1996, Karen Santorum was pregnant. Tests identified a birth defect that would be inevitably fatal. The Santorums chose a highly risky in-utero surgery to correct the condition. Shortly thereafter, Santorum developed a terrible infection in the amniotic fluid. Rushed to the hospital, she went into labor. Born after only 20 weeks of gestation, the child lived only two hours. The Santorums named him Gabriel.

And not long afterward, they were accused of inducing labor -- in effect, a late-term medication-induced abortion. The most contemporaneous and complete response from the Santorums I can find is a 1997 story in the Philadelphia Inquirer. (The only online version I can find is in this blog post.) In it, Santorum explains how the family battled to save Gabriel. The story includes this line:

"Once they agreed to use antibiotics, they believed they were committing to delivery of the fetus, which they knew would most likely not survive outside the womb."

There's no explanation offered of why the antibiotics would inevitably lead to delivery.

A New York Times Magazine profile from 2005 goes over much the same ground. But it includes this passage: "She went into labor when she was 20 weeks pregnant. After resisting at first, she allowed doctors to give her the drug Pitocin to speed the birth. Gabriel lived just two hours."

Pitocin is a hormone that is used to hasten delivery. I've doggedly searched the Internet and done a Nexis database search and I can find no place else that independently claims that the Santorums agreed to the use of that drug. In fact, the earlier Inquirer story says:

"As her fever subsided, Karen -- a former neonatal intensive-care nurse -- asked for something to stop the labor. Her doctors refused, Santorum recalled, citing malpractice concerns.

"Santorum said her labor proceeded without having to induce an abortion."

On Friday, the Washington Post's Melinda Henneberger asked Santorum directly about the birth and death. Santorum repeated that labor was not induced. But he also said that he would have been willing to have had it done.

Which brings us to the accusations of hypocrisy. Absent further confirmation, I'm going to dismiss the New York Times claim of the use of Picotin. I find too many other sources quoting the Santorums that say it did not happen. But let's say the use of the antibiotic somehow made delivery inevitable. Same thing?

The best explanation of double effect I know is the Trolley Problem, a mind experiment created by the philosopher Philippa Foote:

Imagine you're standing by a trolley track and you see a trolley headed your way, and you notice that there are five people stuck on the track who are about to be killed. You can pull a switch that would send the trolley onto a side track and save the five -- but there's one man on the side track who would be killed. Do you pull that switch?

Next version: Same trolley, same five people about to die. But in this case you are standing next to a fat man. If you push him in front of the train, he will die but the five others would be saved. Do you push him?

Most people agree that the first situation is morally justified. Your intent and act is to save the five. The death of the one is an unfortunate and unintended consequence -- a secondary effect. Similarly, most people say the second situation is wrong. Your primary act is to kill your large neighbor. Saving the others is a fortunate consequence that doesn't justify your action.

Star Trek's Spock might disagree, since the logic and math -- five versus one -- are the same. But this common moral intuition is part of traditional Catholic moral teachings. In the Santorums' case, Karen would likely have died without antibiotics. If the antibiotics also had the unfortunate and unintended consequence of making premature delivery and death of the child inevitable, not even the Pope would question it.

But let's also look at the hypothetical that Rick Santorum raised back in 1997 and this past week. What if labor had not proceeded naturally? As he told Henneberger:

"The baby was going to die no matter what, and if she hadn't already gone into labor, it would have been the equivalent of murder not to put her into labor. We did everything medically possible to save both."

Would that have been more like the second trolley problem? What's the official Catholic position here? In this case, the primary act would be to expel the child into certain death, yes? With saving the mother as a consequence? Or does the inevitability of the child's death in either case offer a moral justification?

The one frequently discussed and comparable situation I can find is an ectopic pregnancy. In these cases, the embryo implants in the fallopian tube. Carrying the child to term is impossible. And the rupture of the tube may well kill the mother.

For most people, the sad solution is obvious: Remove the fetus. But there's significant disagreement among Catholic authorities and theologians about exactly what is permissible.

One method of removal that’s sometimes used involves a medication called methotrexate. It unbinds the embryo from the tube wall, which ends the pregnancy. And sounds a lot like inducing delivery. The Rev. Tad Pacholczyk, director of education at the National Catholic Bioethics Center in Philadelphia, wrote a column saying that’s not allowed:

“A significant number of Catholic moralists hold that the use of methotrexate is not morally permissible because it constitutes a direct attack on the growing child in the tube and involves a form of direct abortion.”

A second treatment involves surgical removal of the embryo, ending the blockage. Pacholczyk doesn’t like that, either:

“This approach, like the use of methotrexate, leaves the fallopian tube largely intact for possible future pregnancies, but also raises obvious moral objections because it likewise directly causes the death of the child.”

His only permissible solution: Removal of all or part of the tube itself, including the embryo.

On the other hand, there’s the Rev. William Grogan, recording secretary of the Chicago archdiocesan Bioethics Committee. He wrote a refutation of Pacholczyk's column: “Catholic mothers, physicians and nurses are morally free to use the two surgical and pharmaceutical approaches when it appears the pregnancy will not resolve itself naturally.”

I'm not going to try to settle this intra-Catholic argument. It's obviously not an easy call, even for the experts. So here's my bottom line:

Whatever your position is on abortion, I can find no compelling evidence that Santorum's actions or statements were inconsistent with his.