Keeping the mission of the divine physician

Dr. Ashley Womack recalls her unique pathway through her medical residency at a Texas hospital.

“When I started my required family-planning rotation in my second year of OB-GYN residency, there were no alternatives presented other than going to Planned Parenthood,” Womack said. “There had been a precedent set that even if you express that you would not like to go to Planned Parenthood, you were still expected to go. There was no ‘opting out’ of going, only ‘opting out’ of performing the abortions at the clinic.”

So Womack went to the Planned Parenthood clinic the first day, thinking at first she might be able to do some good there, but “my experience was anything but productive,” she said.

Womack knew she had the legal right to opt out of abortion training entirely, so she refused to return to Planned Parenthood and insisted on an alternate program for the rotation. After meeting with her program director and department chair, she was told she could design her own alternative family-planning curriculum.

That’s when she got together with administrators and doctors from the St. John Paul II Life Center, Vitae Clinic, the University of Texas Dell Medical School, and Ascension Seton Medical Center, all in Austin. Through their efforts, the Vitae Family Planning Curriculum (VFPC) was developed to provide a prolife, pro-fertility-awareness education for OB-GYN resident physicians who wished to opt out of abortion training.

“Being in the same conference room as pro-life physicians and ‘pro-choice’ abortion providers was quite the experience,” said Womack, now a fellow in minimally invasive gynecologic surgery at Banner- University Medical Center in Phoenix. 

This year, four years after Womack’s rotation experience and a year after the VFPC was implemented, the Vitae Clinic welcomed its first participating resident, Dr. Kelsey Williamson.

Clinical trials

“People have no idea what young physicians in their medical residency program are required to do,” said attorney Tim Von Dohlen, a Legatus member, and board president and co-founder of the St. John Paul II Life Center, which offers pregnancy help services to women. After completing medical school, a physician enters a residency of three to seven years, depending on their specialty, before they can see patients on their own, explained Von Dohlen, a Legate of the Austin Chapter. Residents rotate among departments or disciplines, and so many doctors enter a “family planning” rotation that typically includes participating in an abortion — part of their training required by the Accreditation Council for Graduate Medical Education (ACGME), the body authorized by Congress to set standards for medical residents nationwide.

That presents a moral dilemma for physicians who understand that abortion takes the life of an innocent unborn child. “If the resident is pro-life and brave enough, she or he can opt out of participating in an abortion,” Von Dohlen said. “All the residents, except those opting out, are expected to perform an abortion.”

Often, he said, a pro-life resident who opts out of performing an abortion is berated or intimidated for that choice.

“This is happening all over America,” said Von Dohlen. “The discrimination is real and can still result in the resident who opts out of performing an abortion giving tacit support to abortion against one’s conscience.”

There’s an adage in medical training that says, “First you see one, then you do one, and then you teach one.” Some pro-life physicians who once performed abortions say that observing and then assisting at abortions during their residencies had the effect not only of dehumanizing the child, but also of desensitizing the young physicians themselves to what abortion truly is.

And whereas physicians once used to swear to uphold the traditional Hippocratic Oath, which pledged to “keep [patients] from harm” and to “not give to a woman an abortive remedy,” most U.S. medical schools today use modern oaths that exclude such language.

Peer pressure

Dr. Jeremy Kalamarides, medical director at the Vitae Clinic, trained as an osteopathic medical student and fulfilled his OB-GYN residency at a Catholic hospital that lived by the Ethical and Religious Directives for Catholic Health Care Services (ERDs) first promulgated by the U.S. Conference of Catholic Bishops in 2009.

“I purposely avoided programs that would pressure residents into doing abortions and instead had good role models for the kind of practice I had in mind,” Kalamarides said. The hospital performed no abortions or sterilizations and did not promote contraceptives. In order to receive ACGME accreditation, residents who desired traditional family planning training that would include contraception and abortion had to seek it elsewhere.

Still, he said, at times he “felt uncomfortable” for expressing his pro-life views on abortion and family planning. During his internship year, for example, he gave a class presentation on natural family planning that elicited spirited objections from a third-year family practice resident who was “deeply offended” by it.

“He literally yelled at me,” Kalamarides recalled. “He thought it was anti-women’s rights and that the Catholic Church had an agenda,” even though he had not proselytized or even mentioned Church teaching during his lecture.

Kalamarides said the young doctor had not received any training in Fertility Awareness Based Methods (FABMs) of family planning. “He revealed he had some bias against learning about FABMs,” he said. “He and other physicians would probably miss out on meeting the needs of patients who seek care while using FABM methods of family planning.”

Dr. Blake Weidaw, OB-GYN and natural family planning medical consultant at the Vitae Clinic, joined nearly her entire class in opting out of abortion training during her residency 18 years ago at the University of Texas in San Antonio. Today, she feels stigmatized by many colleagues for not providing contraceptives or sterilization services in her practice.

“I feel judged for sure,” Weidaw said. “It doesn’t bother me, but I know that our colleagues don’t understand our route of treating women since it is so different from what we are taught in our training.”

Curriculum pro vitae

Von Dohlen said the VFPC is the first of its kind.

“Until now, there are no alternative education programs available to the residents that educate on the medical science of Natural Procreative Technology (NaProTechnology), that treats a woman holistically and individually, actually curing problems with her reproductive health,” he said.

This alternative curriculum also is important, he added, “to provide an ethical framework to put forth the sanctity of life and to offset the advancing efforts to allow assisted suicide, euthanasia, and gender reassignment, each of which demeans the life of the human person.”

Kalamarides, a former research assistant under Dr. Thomas Hilgers, developer of NaProTechnology, said the VFPC emphasizes FABM family planning and alternatives to abortion.

“Residents will be responsible for readings and testing of knowledge of traditional contraception-based family planning and abortion — but without any requirement of active participation in prescribing contraception, placing contraceptive implants, performing sterilizations, or performing induced abortions,” he explained. Residents will gain knowledge of the scientific foundation, methods, and effectiveness of FABMs and how to integrate them into an OB-GYN practice.

Although it is not an exclusively Catholic curriculum, he said, it looks to the U.S. bishops’ ERDs as a resource for its principles of natural-law ethics, “especially regarding beginning of life, autonomy, and end of life issues because they are so consistent.”

The VFPC curriculum begins with lectures, readings, and activities on basic anatomy, physiology, and an introduction to various methods of natural family planning. Rotation begins in the second year, where the resident physician learns advanced topics such as NaProTechnology to evaluate, treat, and manage various gynecological issues in conjunction with FABMs.

Such methods make the woman patient a full partner in her own health care, he indicated.

FABMs “create a dialogue between the woman and partner, and the woman and her physician,” Kalamarides said. “In this way the proactive charting she does, that documents the presence or absence of her fertility, becomes a health record invaluable for her reproductive lifetime.”

Von Dohlen hopes the VFPC can be made available nationwide. Working in concert with the Philadelphia-based National Catholic Bioethics Center, the next objective is to “take this program first to Catholic medical schools and Catholic hospital residency programs, and then to secular residency programs across America,” he said.

GERALD KORSON, editorial consultant for Legatus Magazine, is based in Indiana.