California's Democratic attorney general Sept. 30 sued a Catholic hospital he accused of refusing to provide an abortion in emergency circumstances to a pregnant woman amid an "immediate threat" to her life.
The case has also raised concerns from Catholic health care experts and ethicists, who have pointed out that morally licit miscarriage care treatment options in line with the church's own ethical directives -- including one procedure named by the attorney general -- seem not to have been pursued, and have now created a religious liberty issue.
Attorney General Rob Bonta accused Providence St. Joseph Hospital in Eureka of having a policy that "discriminates against pregnant patients" due to its policy forbidding performing an abortion where a fetal heartbeat is present.
The Catholic Church teaches that all human life is sacred and must be respected from conception to natural death, and as such, opposes direct abortion. But the U.S. bishops' "Ethical and Religious Directives for Catholic Health Care Services," or ERDs, outlines how this teaching plays out in practice in Catholic medical settings. The document's Directive 47 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."
Bonta's lawsuit seeks a court order to require the hospital to perform abortions in emergency circumstances.
In a statement provided to OSV News, a spokesperson for the hospital said while it does not perform elective abortions, Providence St. Joseph Hospital does not deny emergency care and provides necessary interventions to save the lives of pregnant women in complex circumstances.
"Providence is deeply committed to the health and wellness of women and pregnant patients and provides emergency services to all who walk through our doors in accordance with state and federal law," the statement said, adding, "We are heartbroken over Dr. Nusslock's experience earlier this year."
The statement added, "due to patient confidentiality" the hospital cannot comment on the specifics of the matter. However, the hospital said it was committed to high quality care and was reviewing the event "to understand what happened and take appropriate steps."
The statement was referring to Anna Nusslock, a Eureka chiropractor named in the lawsuit as the patient. She alleged Providence did not perform an emergency abortion after she was diagnosed with previable premature prelabor rupture of membranes in February. Previable PPROM carries a major risk of maternal infection and death, and low chance of survival for an unborn child before 24-weeks gestation given current medical technology and treatment options.
Nusslock said she was told her unborn twins would not survive, but since doctors could still detect heartbeats, an abortion would violate policy.
"At only fifteen weeks gestation, there was no possibility of surviving outside the womb or of prolonging Anna's pregnancy until there was such a chance," the complaint stated. "Worse still, Anna's diagnosis meant she was at increased risk of serious complications with every minute that passed. Indeed, for patients with PPROM, infection can take hold within hours; hemorrhage within minutes; and doctors cannot easily predict the point at which these complications may suddenly threaten permanent harm or imminent death."
The complaint said Nusslock "urgently needed" either "an induction or a dilation and evacuation procedure (D&E) -- to protect against these risks and to preserve her health and ability to have children in the future." Those techniques referenced are used not just in an abortion, but are also employed in morally licit circumstances to treat incomplete miscarriages.
The attorney general's complaint further alleged, "Instead of providing the emergency medical care she needed, Providence Hospital offered her a bucket and towels," before Nusslock was instructed to drive to another hospital 12 miles away to get an abortion and was hemorrhaging by the time she reached it.
Providence St. Joseph Hospital Eureka's response, as outlined in the complaint, is raising questions among Catholic health care experts and ethicists who say that while the church does not condone direct abortion, there are morally licit ways to address life-threatening pregnancy complications, even though the attempt to save the mother's life may indirectly cause the death of an unborn child.
"In tragic situations when the mother suffers from an urgent, life-threatening condition during pregnancy, Catholic health clinicians do provide medically indicated treatment, even if it poses a threat to the unborn child or may result in the unintended death of the child," explained the Catholic Health Association in a statement provided to OSV News.
"Such treatments are both clinically and ethically required," the association's statement continued. "Catholic health care values the provider-patient relationship and informed consent, respects patients' preferences and beliefs, and works with them to discuss their treatment options. Catholic hospitals do not offer direct abortions, which is consistent with our deep commitment to caring for women and children and is rooted in our reverence for life, from conception to natural death."
Joseph Meaney, president of the National Catholic Bioethics Center, explained that Catholic health care's approach is "to do everything possible to treat both the pregnant mother and child while refusing to commit evil."
"The ERDs are clear here, as well in Directive 47, that medical interventions to cure a proportionately serious pathological condition that cannot be postponed until after an unborn child can be viably delivered, even if they will result in the death of the unborn child, can be ethically permitted," he told OSV News. "A hypothetical example frequently used of this is performing a hysterectomy on a pregnant woman who has uterine cancer that cannot be treated effectively in any other way."
Meaney pointed out that a D&C (dilation and curettage) -- one method mentioned in the attorney general's complaint for addressing the pregnancy emergency brought about by preterm rupture of membranes -- would not be licit while fetal heartbeats were detected.
"There is no ethical problem with doing the D&C after the preborn child has died, but it would be a direct abortion to do one while the baby is alive and that is not permissible," he said.
However, Meany expressed concern that in terms of the particular case of Nusslock described in the complaint, it appeared she was not treated appropriately. He stressed that a Catholic medical response in that case should have considered a range of both life-affirming and clinically appropriate treatments.
"It's definitely not the case that the right Catholic response would be just to throw your hands up and say, 'We can't do anything here.' (There's) a lot of things it can do," Meaney said.
In an interview with OSV News, Dr. Stephen Doran, a deacon of the Archdiocese of Omaha, Nebraska, as well as a neurosurgeon and bioethicist, said that while he was not privy to the specific details of the case, his view of the details in the attorney general's complaint was that "in a general sense, you know that there's more ethical ways" to treat preterm ruptured membranes in a pregnant woman.
Deacon Doran explained that the ERDs forbid treatment that directly ends the life of an unborn child, agreeing that a D&C would not be an ethical approach while the unborn twins were alive.
But he said there are interventions "that may result in the unintended death of the baby that are morally acceptable," and inducing labor in this case would likely have met that threshold.
"I think the general approach in a case like this would be induced labor," he said, adding, "While the details of this particular case are still not yet fully known, it is reasonable to say that early induction of labor may be morally permissible in the setting of premature rupture of membranes."
Providence hospital's leadership has also acknowledged that Nusslock's experience did not appear to have met its standards of care.
"We are heartbroken over the experience this patient had while in our care and reached out to her today in an effort to express our profound apologies," Garry Olney, CEO of the Providence Northern California service area, told hospital employees in an Oct. 1 message.
"This was a tragic situation that did not meet our high standards for safe, quality, compassionate care," Olney said. "We are immediately re-visiting our training, education and escalation processes in emergency medical situations to ensure that this does not happen again and to ensure that our care teams have the training and support they need to deliver the best possible care for each patient we serve."
He added that "we can't begin to imagine what the patient and her family have been through. We will learn from this and renew our commitment to ensuring that the care and experience we deliver are aligned with our high standards, every time and in every care setting."
However, some experts who spoke with OSV News expressed concern that Providence hospital's apparent failure to provide high quality miscarriage care in line with the church's ERDs has given California's attorney general an occasion to put pressure on Catholic hospitals' religious freedom to provide health care that is not in line with Catholic teaching.
Bonta said in a statement, "California is the beacon of hope for so many Americans across this country trying to access abortion services since the Dobbs decision," referencing the 2022 Supreme Court ruling that overturned Roe v. Wade, which had held abortion to be a constitutional right.
He emphasized that "abortion care is a constitutional right" in California.
"With today's lawsuit, I want to make this clear for all Californians: abortion care is healthcare. You have the right to access timely and safe abortion services," he said. "At the California Department of Justice, we will use the full force of this office to hold accountable those who, like Providence, are breaking the law."
Louis Brown Jr., executive director of Christ Medicus Foundation and the former acting deputy director for civil rights at the U.S. Department of Health and Human Services Office for Civil Rights, told OSV News that some elected officials "have been creating a false conflict" between care for pregnant women and their unborn child, even amid "various pregnancy complications, ranging from ectopic pregnancies to miscarriage" that Catholic medical professionals treat "without resorting to the intentional killing of an unborn child."
Brown expressed concern that such litigation could present a "threat to Catholic health care."
He argued this showed the need for the Weldon Amendment, a provision attached to federal funding bills that prohibits the HHS from requiring health care entities to provide or refer for abortions, and bars HHS funding going to state or local governments that discriminate against health care entities and providers that refuse to provide or refer for abortion. Brown said this measure protects faith-based health care providers from participating in procedures that present a violation of conscience to them, such as abortion.
"Catholic hospitals and other Catholic medical facilities have successfully cared for millions of pregnant mothers and their preborn children, even in circumstances where there are pregnancy complications," Brown said. "And the Ethical and Religious Directives for Catholic health care are outstanding in providing guidance to Catholic medical professionals, Catholic hospitals and other Catholic health entities, in providing safe, dignified care for both mother and baby."
