Time for Health Care Renewal (Part 2)

Interview With Catholic Family Physician

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By Genevieve Pollock

NEW YORK, JULY 26, 2009 (Zenit.org).- A doctor who launched a new network for Catholic and pro-life physicians is explaining the risks of health care workers today, and is encouraging collegial public witness in the field.

Doctor Anne Mielnik, a family physician, is the cofounder and executive director of the John Paul II Center for Women and Gianna Health Care for Women, pro-life centers committed to following the teachings of the Catholic Church.

In this interview with ZENIT, she spoke about a developing movement of health care workers that includes a network she is launching in response to growing ethical concerns.

Part 1 of this interview was published Friday.

ZENIT: What are the main ethical concerns of pro-life doctors these days?

Mielnik: The most fundamental problem is this: Both in medical and government policymaking, there is a move to define what are called “standards of care.”

Groups of supposed experts in a given area of medicine define as “the standard” what a physician “should do” in a given situation. This usually refers to defining the appropriate medical or surgical treatment approach based on research. But it is increasingly being used to define the “appropriate ethical approach” as well.

Because medical ethics has gone so far down the path of moral relativism — of framing all ethical decision-making in the context of doing whatever the patient wants, regardless of whether it is right or wrong, or even whether it’s harmful to the patient — the growing trend in medicine is to define as the “standard of care” actions such as abortion and euthanasia, which are morally and ethically wrong.

The definition and widespread acceptance of such standards in medical ethics puts Catholic physicians and health care systems at risk on multiple levels.

As a physician, or as a health care system or practice, if you violate a standard of care, you can be held liable for medical negligence and face the very real threat of a malpractice lawsuit.

Furthermore, a physician can lose his license to practice medicine if it is considered a gross enough violation of the standard.

At the level of law, which is being modeled on these standards, there is another very real risk that the government could mandate participation in things that are unethical.

I don’t know that the law would go so far as to make it a criminal act to refuse to participate in certain actions which we as Catholics believe are unethical, but I could certainly foresee the loss of one’s medical license and the threat of a lawsuit.

These risks are dramatically increased by the laws being considered by our government, and are very real things that Catholic and other pro-life physicians are afraid of when it comes to these ethical issues.

With respect to the passage of laws regulating health care, I believe the government would have a hard time mandating the provision of abortion because it is such a divisive issue. But they certainly can mandate referral for abortion — and that is what all of the major medical societies are pushing for.

That would mean that as a Catholic physician, I would actually have to take concrete action to guarantee that my patients have access to abortion. However, as a Catholic physician, that is something I cannot and will not do.

Even more concerning is the issue of contraception. On abortion, the nation is deeply divided, so I don’t think the government would ever go so far as to say physicians have to do it.

But contraception absolutely could be mandated as part of what President Obama recently referred to as a “reasonable conscience policy.” It could then be considered a violation of the “patient’s rights” to not provide contraception or to fail to guarantee patient access to it, which brings up the dilemma of formal cooperation for the doctor.

The same concerns apply to end of life issues, which has so many grey areas that you need a solid foundation in medical ethics to even begin to make these decisions.

At the end of life, even before you get to the point of promoting active euthanasia, there are actions which constitute passive euthanasia, and which again are becoming the mainstream approach in medicine, with some pushing to define these actions as the “standard of care.”

Once something becomes widely accepted in medicine, it commonly becomes the standard, and if as a physician you don’t follow that rule then you’re at risk of being accused of negligence or even maleficence.

So euthanasia, abortion, and contraception are probably the biggest areas of concern for Catholic physicians when it comes to law and policy. I don’t think anyone’s going to mandate participation in stem cell research, but that’s something that we, as Catholic physicians, need oppose as well.

If we don’t speak out on this issue, who will?

The other major area where Catholic physicians have reason to be concerned about defining “standards of care” is in the treatment of infertility.

I don’t think anybody would mandate the provision of artificial reproductive technologies, but they certainly could mandate referral and participation to some degree. We have more effective, ethical alternatives for the treatment of infertility in an approach called NaProTechnology, so I hope that our progress in this area will afford us some protection against this particular threat to conscience.

ZENIT: Is this why it is such a danger to lose the conscience protection clause?

Mielnik: Exactly. The original conscience laws passed in the decades since Roe vs. Wade have not been rescinded by the current administration, and President Obama has said that he does not plan to reverse these previously existing conscience laws.

The administration does, however, intend to rescind the conscience law that President Bush passed at the end of his last term, which was intended to strengthen conscience laws already in place by mandating documentation of compliance with such laws.

This most recent law was passed in response to testimony from physicians, residents and medical students who report widespread discrimination based on their moral and religious beliefs.

I and many of my pro-life classmates personally experienced this while interviewing at residency programs, being told directly by some of the programs to which we applied that we would not “fit in” or “be welcome” there, despite our qualifications, due to our beliefs on abortion.

This is technically illegal, according to existing conscience laws, but the laws are not enforced and so discrimination is widespread.

Furthermore, current conscience laws could be further weakened by the government if it does not take the threats to conscience rights seriously because as I said, even if the government doesn’t pass specific laws limiting provider rights of conscience, these protections are already being threatened by the definition of “standards of care,” as I previously described.

One area where this assault on physician conscience is most evident is in the written opinions of some of the major medical societies which have, in a very clear, dramatic and political fashion, come out in favor of penalizing physicians who are not willing to provide services and are not willing to guarantee patient access to them.

ZENIT: Who is responsible for writing these “standards of care?”

Mielnik: Generally, groups of experts collaborate to define these standards based on medical evidence and research.

When it comes to ethical issues, however, it is not based on research but on opinion, and specific agendas are promoted by groups with a vested interest in them.

For instance, the American College of Obstetricians and Gynecologists, which is believed by the lay public to represent OB/GYNs in the United States issued a “committee opinion” on “The Limits of Conscientious Refusal in Reproductive Med
icine” in 2007.
This document essentially argued that physicians have a moral obligation to facilitate a patient’s access to all legally available options, regardless of their “conscientious objections.”

It argued that those who do not provide abortion, contraception or artificial reproductive technologies either should provide them against their ethical judgment if it is in the “best interest” of the patient, such as in the case of contraception, or should be willing to make sure the patient has access to those services through direct referral, such as in the case of abortion.

This document even went so far as to state that physicians who are not willing to provide contraception and abortion should not practice in areas of the country with few physicians, where patients might not be able to obtain these from a different physician and further stated that in such areas, physicians and hospital systems should be mandated to provide even access to abortion.

This is extremely troubling.

Not all OB/GYNs belong to this college, and their opinion was strongly opposed by the American Association of Pro-life Obstetricians and Gynecologists, the Catholic Medical Association, and the Christian Medical and Dental Association.

But the college is considered the authority on women’s health issues, so formal statements like these have a tremendous amount of influence on medical policymaking.

There is a lot of rhetoric on these controversial issues in the medical literature, but the more that is written about it and published, the more the negation of individual physician conscience becomes the standard.

ZENIT: What would you say to Catholics who are hesitant to get into the health care field, or are leaving it, because of the challenges that are facing them in keeping true to their values?

Mielnik: It definitely happens. There are many Catholic and pro-life doctors who don’t go into obstetrics and gynecology or other areas of medicine because of the ethical issues and because of the very real challenges they will face, just getting through their medical training.

But honestly, I truly feel that in this time, in this culture, when millions of unborn children are being massacred by our colleagues, it is we, Catholic physicians, who have to be willing to stand up, to fight tirelessly to rebuild a culture of life in medicine.

The way the medical field works, no one else can do it. No one else has the power to transform medicine that physicians have; we have to be willing to challenge our colleagues, always with love, of course.

I think if we, as Catholic physicians, felt called to go into medicine, we need to recognize that our vocation calls us to sacrifice. There is a very real chance that there will be very real losses.

I honestly believe that if it does come to be that physicians take this public step of creating an alternative pro-life, Catholic health care system, if we bear witness against the culture of death by uncompromisingly opposing abortion and euthanasia, there are going to be consequences for many of us — but it is this very thing that is most needed at this time.

Because I really believe that it is the silence of good doctors that has let things go this far. As they say, all it takes for evil to thrive is the silence of a few good men.

— — —

On ZENIT’s Web page:

Part 1: www.zenit.org/article-26538?l=english

For more information about the network, contact Dr. Anne Mielnik at: amielnik@jpiicenterforwomen.org

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