Time for Health Care Renewal

A ZENIT DAILY DISPATCH

Time for Health Care Renewal

Part 1

Interview with Catholic Family Physician

By Genevieve Pollock

NEW YORK, 24 JULY 2009 (ZENIT)

A doctor who launched a new network for Catholic and pro-life physicians is affirming that now is the time for a renewal to occur in health care.

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 completely committed to following the teachings of the Catholic Church.

In this interview with ZENIT, she spoke about the importance of a developing movement of health care workers that includes a network she is launching.

Part 2 will appear Sunday.

ZENIT: What has been your experience as a new Catholic doctor, recently out of medical school and having just completed your residency?

Mielnik: During the past seven years of medical training, I became aware of a disturbing trend in the education of future physicians in the area of medical ethics.  

The conscience debate that is occurring at the national level in U.S. politics is only one piece of a much deeper problem.

In my experience, there appears to be a deliberate attempt in medical education to teach future physicians to ignore, rather than sharpen and strengthen, the dictates of their consciences.

More emphasis is placed on "facilitating a patient's choices" than on learning how to think critically through ethical dilemmas and to commit to always doing what is right.

At my medical school and in what I read in commentaries in some of the major medical journals today, the "take-home" message seems to be:

"It's fine for you as a physician to believe whatever you want to believe about medical ethics, but when you go to work, your professional responsibility is to leave your 'personal beliefs' at home, and 'facilitate the choices of your patient.'"

This is truly terrifying.

Prior to entering medical school, I had studied medical ethics in college. I was thus familiar with the process of applying ethical principles in making "real world" decisions about dilemmas.

But at the medical school I went to — and from what I've heard from other medical students, this is occurring in schools around the country; medical ethics is being reduced to a distorted understanding of one principle — "respect for patient autonomy."   

All of the other ethical principles — non-maleficence, beneficence, justice — are presented as being secondary to and trumped by "respect for autonomy," and physicians are encouraged to understand this "respect for patient autonomy" as a mandate to facilitate any "legal" choice a patient may make.

This is particularly true in the area of reproductive health and at the end of life.

In subtle ways, I see an entire generation of physicians being taught, in effect, that their responsibility is to deliberately ignore their consciences.

Thus, good people, who know the difference between right and wrong, who believe in the sanctity of human life and in particular Catholic physicians, who know what the Church teaches in the areas of reproductive health and in care at the end of life, are taught from the earliest years of their medical education that they should ignore the voice inside of them that tells them what is right, and do whatever their patient wants.

Ethics is becoming relativism, where no "right answers" exist and critical reflection is discouraged.

Because the students are not hearing anything else, this is wha t they believe — and then do in practice.

They believe that what it means to be an ethical physician is being willing to put aside the dictates of their conscience, rejecting them as "your own personal beliefs," which have no place in medicine.

They believe that somehow being faithful to doing what is right makes you a bad doctor.

In response to this message being taught at our medical school, I and several other students started a pro-life student group at that school. We then started a citywide medical student pro-life group.

We brought in speakers — older physicians and an ethicist from the National Catholic Bioethics Center — to testify before the students that what we were being taught was not an authentic medical ethic and was not the way other physicians practice. Our goal was just to get the word out there that there is a different way of looking at medical ethics.

Through the course of working with those pro-life groups, I learned more about the Church's teaching in the area of reproductive health.

Going into medicine, I knew the Church's basic teachings about Natural Family Planning, and I was committed to being faithful to them — I never planned to prescribe contraception.

But during this time, I really began to learn about the writings of John Paul II known as the Theology of the Body. As I learned about the purpose and dignity of the human body and of human sexuality, understanding this teaching became a passion. I see these teachings as being the key to a truly authentic approach to medical ethics.

I also began to understand in a deeper way that the natural methods of family planning are just phenomenal. And thanks to decades of research, we now have proof that these methods are highly effective. They also strengthen marriage and the family.

ZENIT: How did you come up with the idea to form this network of Catholic, pro-life doctors?

Mielnik: That actually just came about to fulfill a need.

Over the past one or two years, as I have travelled around the country researching models for the centers I am starting in New York City, I've networked with a lot of different Catholic and pro-life physicians.

A common theme keeps recurring, with many physicians saying, "I keep having this stirring within my prayer life, feeling like God is calling me to start a Catholic health center in my community, to leave my practice, or step out and start my own practice offering health care that is completely faithful to the Church."

Having heard it so many times, it occurred to me that maybe God really is calling us to build an alternative health care system — or to work to renew and strengthen the Catholic health care system that currently exists.

Over the past year, some physicians have already begun to look at a formal way to do this — create an independent network of authentically Catholic health care centers. I also know that the U.S. bishops, too, are looking seriously at how to strengthen Catholic health care in the country.  

With respect to the listserve, I was having dinner with one such physician in Omaha, Nebraska, who has a similar sense of feeling called to step apart and create an independent health care center in his community.

As we talked about how to bring this about, he said, "It would be so nice if there was a place where Catholic physicians could network and just talk about how to actually do this, as well as find support from other physicians who share our beliefs."

The listserve was thus created to be a place where health care providers, and physicians in particular, feeling this movement of the Holy Spirit, could network and support each other.

It is a place for physicians, residents, medical students and other health care providers to talk about the challenges they face as Catholics, the challenges in the area of medical ethics and the challenges they will face in starting independent businesses.

It is also a place to discuss ways we can unite in a public way to affirm our commitment to pro-life health care, to discuss ways to address all the issues currently being debated in medicine, particularly on the issue of physician conscience, and to dialogue about how to deal with the very real threats coming from our government, as well as the very real threats coming from within medicine itself.

ZENIT: What kind of effect would an alternative health care system have on the larger society?

Mielnik: I really believe that abortion — or the so-called war on abortion — is going to be won not by a law that eliminates abortion, but by creating an alternative approach to women's health care that is so far superior to it, that only the rarest, most hardened individuals would even consider abortion to be "health care."

I believe that if abortion is made illegal, people are still going to have abortions. Doctors are still going to perform abortions, and women are still going to seek out illegal abortions.

I'm all for a law and believe it is critically necessary to work to pass laws which protect the sanctity of all human life from the first moment of conception. I would do everything I could to create and support such laws — but that is not enough. We have to go further if we want to truly eliminate abortion.

At this point, some 35 years since Roe v. Wade, so many women have suffered the consequences of having an abortion that I believe it's only a matter of a time before it becomes public that women are not happy about the choices they have made, that their abortion "choice" was harmful to them.

People are going to begin to see that abortion, far from being an expression of a woman's free choice, is actually an act of violence against her.

That's what I have seen in my clinic practice, as I have been seeing my own patients over the last three years.

The other co-founder of the John Paul II Center for Women, Joan Nolan, has witnessed the same thing in her work with women.  

She leads small group studies of John Paul II's teachings on women, using a program called ENDOW, and the stories women share of what they have suffered, both because of the birth control pill and because of abortion are devastating and heart-wrenching.  

In light of what Joan and I have heard from women and experienced in working with them, we truly believe women themselves are ready to stand up and speak out on these issues.

As women go through this conversion process, recognizing that contraception and abortion are not good for them, they're looking for an alternative approach to health care and family planning, one which respects the integrity o f their body and the dignity of their vocation as woman.

This is the alternative we hope to create.  

If the alternative exists in a very public way — if there are set apart pro-life health care centers where women and communities know the doctors are different, are committed to protecting the sanctity of human life at all of its stages — it draws that proverbial "line in the sand."  

Patients will then be free to choose and will actually have to choose, practically speaking, between the "culture of life" and the "culture of death."  

Patients will have to ask themselves as they make decisions about where to receive their health care, "Am I going to go to the doctors who support abortion, which I believe is taking a human life, or am I going to support the pro-life doctors who are committed to the same principles that I believe in?"

Further, just as patients are faced with the choice of where to receive health care based on ethical principles, health care providers will be faced with the same decision: "Am I going to practice in the health care system which supports abortion and euthanasia or choose to work for the alternative system which operates according to principles which I share and believe in?"

We saw in the Gallup poll that came out a few weeks ago that Americans are really beginning to identify themselves as solidly pro-life. I think it was the first time ever that 51% of Americans identified themselves as pro-life, the first time that the scales had tipped.

This is also what I have seen in medicine — I honestly believe the majority of doctors are pro-life, but many are utterly silent, because they are afraid of the consequences of speaking out on these issues.

When I started the medical student pro-life groups when I was in medical school, a number of people would come up to me privately and say: "Thank you for doing this. I completely agree with you, this is how I want to practice, I just can't tell anyone."

Part 2

Interview With Catholic Family Physician

By Genevieve Pollock

NEW YORK, 26 JULY 2009 (ZENIT)

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 Medicine" 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 thes e 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 sile nce of a few good men.

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

This article has been selected from the ZENIT Daily Dispatch
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