Catholic Health Care Advocates Papers
Challenges to Catholic medical training
James J. Joyce, MD
Abstract:
A brief narrative on the challenges to Catholic medical training as experienced by the author in a "catholic" medical school and the difficulty of finding obstetric training tolerant of practicing Catholics and finally the need to resort to secular family practice training in order to complete training and provide Catholic health care.
As a Catholic, familiarity with martyrdom should have prepared me for my pursuit of a vocation in medicine. I now understand more fully the degrees of martyrdom a Catholic health care provider must endure. We as catholic health care providers can perform an excellent service to other Catholics by outlining a "bill of rights" for Catholics with broad as well as specific freedoms and responsibilities in health care.
Several of my catholic classmates in medical school specifically avoided Obstetrics as a career choice due to the "prevailing practice" and their desire to remain catholic. I on the other hand decided in my naivete to press on with a desire to provide catholic health care to the obstetrical patients I was imagining would be anxious for the respect and dignity for their bodies, spouses and families. The decision to choose medicine out of a host of options was the result of a 54 day Novena to the Blessed Mother and I thus had no difficulty passing entrance exams and achieving acceptance to Medical school as a Junior in college. The challenge came after the work started on a NEW CLASS in medical school called Medical Ethics, which was semester long. The Jesuit Priest that taught it did an excellent job, but my classmates had a tough time getting the point. The discussions after class usually ended in "you are too idealistic." The heat was turned up in the third year when the resident overseeing us told me to write a prescription for oral contraceptives. I was able to explain that I couldn't. He made it clear that he was Catholic too but knew better with regards to this teaching and that I would do well to shape up. The attendance at C-sections even if a sterilization was performed was mandatory and by the time I was able to object I felt as if my hands were bloody with it even though I was only observing.
I was fortunate enough, about this time, to run across a pamphlet on Natural Family Planning in the back of a little church in O'Neal, Nebraska during the time I was engaged to Kathleen (divine providence). We began classes at the university hospital and I later completed a medical consultant's degree in NFP at the University, a little known degree even among catholic physicians at the university.
I began my search for a residency that would provide an environment for obstetrical care in the catholic context by selecting eleven Catholic Health Association residency programs and found that "uterine isolation"(sterilization) was just about as common here as elsewhere or there was the "AM transfer" of the patient to another hospital for post partum tubal ligation presumed to be done by the residents following the patients or if the patient was too ill for transfer then the hospital ethics committee could grant "emergency dispensation" to perform sterilizations on site. Contraception was "of course" dispensed at a dizzying rate.
Most program directors assured me that following catholic practices would not be a problem in their residency program but a quick discussion with the residents clearly indicated that a practicing catholic would really interrupt the status quo. The computer match placed me in one of the programs I felt most optimistic about and where the director and I had had the best opportunity to discuss the impact a practicing catholic might have on the residency routines in a Catholic hospital.nThree months into the Residency I was approached by the chief resident who said that I had an inordinately high number of patients using natural methods of family planning. I assured her that I discussed all options of family planning from abstinence to abortion with risks and benefits but the patients were choosing natural family planning based on low risks and high effectiveness. The retort was that I must have something against women and that I was to be under observation (double secret probation?). She discovered that I did fail to mention the cervical sponge once but this was with a woman who had used Natural Family Planning for all of her five children and intended to continue using it. Thank God for this beautiful Hispanic mother on that day.
From that point on each of my preceptors was warned to watch out for this resident but no specifics were given. I just needed to put out 110% effort during my 36 hours on call and rest during the 12 hours off call. I subsequently lost about 17, developed a twitch in my eye, and began watching out for everything.
I was told to talk with one of the OB staff who had "seen the light" regarding the church's teaching and even though his father didn't prescribe birth control he did and maybe he could "bring me around on this thing." We had a nice talk regarding these issues and how the patients could still get their "emergency birth control refills" without my material cooperation and it seemed that all was well. I did rather well on the in service exam in the third quarter of the first year and was ready to see this thing through when the assistant director of the program announced that the residents had "all" (5 of 8) decided that they just could not tolerate this practice and that if I wanted to go to another OB program, they didn't know or care if there was one that would tolerate this belief system, they didn't know what they could even write as far as a recommendation.
Thank God for the Pro life mass that we attended regularly with friends and well-wishers.
The decision to change to family practice versus attempt legal action while trying to raise my family and complete training was one of practicality, resignation, and divine intervention.
The secular residency in family practice that I changed to maintained an atmosphere of tolerance which allowed practicing Catholics to practice even if other Catholics in the program chose not to. From this point on my medical practice has had only the usual resistance to seeing the value of fertility and the importance of marital bonding and regular communication.
I have learned that since I have left that OB residency the attending physician that I had the nice talk with has "come around" to the Church's teaching and is an NFP only physician.
I currently belong to a practice of five family practice physicians: some Catholic, some not; some practicing, some not. No barriers to safe, effective and honest health care are perceived or found in our practice and my insights are sought out during discussion of referral for various conditions in the prolife area.
With this experience in mind, I feel that an effective outline for the acceptance of Catholic health care as a reasonable and responsible approach to medicine can be achieved. We as catholic health care providers have a responsibility to assist others who are struggling in their faith or are being persecuted for their faith.
Catholics need to be aware that martyrdom is not a dirty word but a sanctifying act. Dying to one's own comfort or easy path, even for a short time, is a form of martyrdom. Catholics in every age are asked to be martyrs for the truth. We all need to pray for the living martyrs, for the belief that love and life are linked by a bond that requires respect and preservation.
I hear from physicians and physician assistants periodically who still struggle with some of the directors of programs and fellow students who don't see this as a matter of truth, morality, or even ethics. Pope Paul VI and John Paul II have done heroic work on these topics but I believe that it is time for us to assist their efforts by our defense of the truth. I believe that letters from local bishops to residency directors would be of benefit. Attending physicians can help students and residents remain firm in their faith. I believe that Catholics need additional encouragement to take up Catholic obstetrical care as a mission in this country. The abortion/contraception link needs to be made clearer so that the decision to avoid contraception can be better understood.
