The incident rapidly became a touchstone in the
culture wars in the
United States. The hospital's spokesperson explained that while the hospital follows the
Ethical and Religious Directives for Catholic Health Care Services, these directives do not answer all questions. Those who reject this argument note that Directive 47 (which refers to "operations, treatments, and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman") applies only in the case of the death of the unborn child as an unintended consequence, according to the "
principle of double effect", while the preceding Directive 45 in the same document explicitly states: "Abortion (that is, the directly intended termination of pregnancy before viability or the directly intended destruction of a viable fetus) is never permitted. Every procedure whose sole immediate effect is the termination of pregnancy before viability is an abortion, which, in its moral context, includes the interval between conception and implantation of the embryo. Catholic health care institutions are not to provide abortion services, even based upon the principle of material cooperation." However, critics condemned the decision and suggested that it reflected larger trends.
Jacob M. Appel, a leading American
bioethicist, questioned "if women are safe in Catholic hospitals" following Olmsted's announcement. Appel wrote that, "Like many Catholic hospitals, St. Joseph's has long had two conflicting policies regarding
maternal-fetal conflict on its books. One directive states that abortion is never permitted, even to save the life of the mother, while the other notes that "operations, treatments and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman are permitted [...] even if they will result in the death of the unborn child. [...] Until this recent incident, pregnant women could safely assume that Catholic hospitals would follow both the law and widespread standards of medical ethics in allowing the second directive to trump the first. Suddenly, that time-honored understanding appears to be in jeopardy."
Catholics for Choice, an independent
pro-choice organization, also expressed concerns regarding the decision. Its president, Jon O'Brien, said, "While not all the facts are available, it is clear that the Vatican's hard line on abortion led to this terrible situation. Sadly, we see situations like this time after time, both here in the US and abroad. The Vatican's outright ban on all abortions is insensitive and reflects an unwillingness to acknowledge the reality of women's lives, including the difficult decisions that often have to be made during a pregnancy." The Reverend
Thomas Doyle, a well-known
canon lawyer, noted that the bishop "clearly had other alternatives than to declare her excommunicated." Doyle argued that this case highlights a "gross inequity" in how the church chooses to handle scandal. He noted that at the time no priest had been excommunicated for
sexual abuse, suggesting a double standard within the church; this is now no longer the case, since pedophile priest
Jose Mercau was excommunicated by
Pope Francis. The theologian Michael Liccone stated: "The Church does not condemn '
indirect abortion': abortion that is a foreseen but unintended side effect of a medical procedure designed to preserve the mother's life"; he added that McBride, considered an ethics expert at the hospital, had explained her decision by telling Olmsted that she saw the abortion in this scenario as indirect. Liccone said that Olmsted's decision to say that McBride had excommunicated herself, rather than to excommunicate her
ferendae sententiae "by his own juridical act", raised questions.
Steven J. Jensen, a professor of philosophy at the
University of St. Thomas, criticized accounts trying to justify the Phoenix case as based upon an incoherent account of intention. He did not believe the principle of double effect applied, saying the doctors intended to kill via
dilation and curettage. "This cutting is a kind of violent harm to the baby. The harm is not distinct from the cutting but is precisely that cutting insofar as it relates to the baby. [...] This cutting is a cause that the doctor must include within the means he chooses". ==See also==