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Healthcare in America and the Catholic physician

There is a serious healthcare crisis looming in the United States. There are many reasons for this crisis, but its fundamental underpinnings are found in the doctor-patient relationship that changed when medical graduates ceased taking the Hippocratic Oath.

Today the patient is a “client” and the physician is a “healthcare provider.” The relationship is centered on the “fee for service” and the responsible party who pays those fees. The “payor” determines what services will be provided and expects that the physician will provide the service even if it’s not in the patient’s best interest.

Shifting values

Most students enter medical school without realizing that they have, in most instances, responded to a call from God. Students forego sleep, food and time with friends or family as the patients’ needs take priority. However, this sacrificial relationship has been compromised by omitting the Hippocratic Oath’s moral guidelines.

The oath lays the groundwork for the doctor-patient relationship: “I will follow that method of treatment which … I consider for the benefit of my patients. I will give no deadly medicine to anyone if asked, nor suggest any such counsel; furthermore, I will not give to a woman an instrument to produce an abortion.”

The legalization of abortion in 1973 made it impossible to administer the Hippocratic Oath to graduating medical students. Placing the woman’s autonomy above that of her child changed the mother-child relationship with its failure to recognize the inviolability of each human life, but it also began to chip away at the mutual autonomy of the physician and the patient.

Since the legalization of abortion and widespread use of contraception and sterilization in our pluralistic, secular culture, it has become increasingly difficult for Catholic medical students to go on clinical rotations where these practices are happening and enter specialties like obstetrics and gynecology, family practice, urology, pediatrics or internal medicine without compromising their beliefs. Frequently, because of their youth and inexperience, they abandon their faith and follow the secular lead in these practices.

In 1996, the American College of Obstetricians and Gynecologists attempted to mandate that all obstetrics and gynecology residency programs (including Catholic programs) provide abortion training for residents. Fortunately, the federal government stepped. In 2005, Congress strengthened its anti-discrimination statutes.

Last November, however, the American College of Obstetricians and Gynecologists (ACOG) issued an official opinion limiting conscientious refusal. The document placed patient autonomy before that of the physician and said that even if a physician refuses to perform abortions they should refer the patient for an abortion or other reproductive services if asked.

Christian physicians and associations responded to this violation of the right to conscience. In January, the American Board of Obstetricians and Gynecologists (ABOG), the body that certifies Ob-Gyns, changed its board requirements to include adherence to all the ethics opinions of ACOG. This would have ultimately prevented pro-life Ob-Gyns from practicing medicine in the United States. Members of Congress responded to ACOG and ABOG (as did Health and Human Services Secretary Michael Leavitt), reminding these two organizations about the federal laws protecting conscience rights.

Other challenges

Another hot-button issue is Oregon’s legalization of physician-assisted suicide (PAS), which tries to legitimize a practice contrary to the Hippocratic Oath and physicians’ healing ministry. Euthanasia is a grave offense against the dignity of the person seeking it.

There is a ballot measure in Washington to legalize PAS this fall. Pro-death forces hope it starts a chain reaction of states legalizing PAS. Because the population is top-heavy with retirement-aged individuals who will be using a higher proportion of healthcare dollars, it’s easy to see where this is leading. Society has eliminated “inconvenient” children for 35 years. Some want to do the same with the sick, the handicapped and the elderly.

Some believe that nationalized healthcare with a single payor is a solution to our country’s healthcare delivery system. The Catholic Medical Association (CMA) has grave concerns that this will lead to further erosion of the doctor-patient relationship.

In order to alleviate this crisis, there has to be individual ownership of healthcare insurance with refundable tax credits that could be carried from job to job. Large organizations can become self-insured, eliminating practices such as sterilization, contraception, abortion and in vitro from their coverage. Lastly, we need to have comprehensive protection of conscience for Catholic hospitals and physicians. The courts have failed to respect the rights of conscience, necessitating the need to tighten up these laws.

Only through collaboration between the business sector, insurance specialists and the Catholic medical community can we restore the doctor-patient relationship, maintain the autonomy of Catholic institutions and prevent bankruptcy of the finest healthcare delivery system in the world.

Kathleen M. Raviele, MD FACOG, is president of the Catholic Medical Association.