History / Histoire
Executive
Committee
Bureau
Main Events
Principaux
évènements
| • 2000 • |
| • 2001 • |
| • 2002 • |
| • 2003 • |
Texts / Textes
Regions / Régions
Newsletter
Bulletin
Bioethics
Bioéthique
International
Cooperation
Coopération
internationale
Classified
Advertisements
Petites annonces
Links / Liens
Site Map
Plan du Site
Contact us
Contactez-nous
Website: http://www.fiamc.orgINTERNATIONAL MEETING OF CATHOLIC OBSTETRICIANS
AND GYNAECOLOGISTS
June 17-20, 2001, Rome
The future of Obstetrics and Gynaecology:
The fundamental human right to practice and be trained according to conscience
PROGRAM AND ABSTRACTS
ABSTRACTS OF THE INVITED LECTURES
The Protection of Human Life in a Changing World: The Responsibility of the Catholic Obstetricians and Gynaecologists
Archbishop Javier Lozano B., President, Pontifical Council for the Health Pastoral Care
There are a lot of threats against the life that we must protect. The Pope John Paul II in "Evangelium Vitae" speaks of threats coming from the nature, violence, anger and envy, egoism, poverty, wars, ecological destruction, drugs, sex perversion, contraceptives, abortion, euthanasia, meaningless of pain, sterilization, mass media. The recent World Population Conferences of Cairo and Peking, and Cairo +5 and Peking +5, have added to the pontifical considerations: sexual revolution, the new concept of family as those who live under the same roof, homosexuality, free sex specially for the teenagers, sexual information and orientation to the children without their parents' consensus, the morning after pill, the teenagers privacy (against the parents'consensus), the gender. Nowadays the Malthusian mentality is present everywhere, the son is conceived as a fruit of the egoistic desire, the life is considered only as productivity, there is hunger, poverty, illness, war, genocide, genome manipulation, manipulation of the embryo stem cells and embryo tissues. There is HIV-AIDS, Ebola, mother-child increasing mortality, alcoholism, and traumatic injuries.
The Pope said that the causes of those threats are several: the notion of freedom as an absolute autonomy, pretended altruism toward malformed foetus, thinking that life is a matter that concerns only the parliamentary discussions and votes, the eclipse of the sense of God and of man, the concept of the life as absolutely manipulable, the body reduced to pure materiality, sexuality only as an instrument for selfish satisfaction and personal affirmation, the deformity of the moral conscience.
We must appeal to the inner responsibility of health professionals, because they have an internal finality and exemplarity in the life of the Risen Christ. They must affirm the culture of life, the victory of the culture of death by the Risen Christ, the dignity and the sacrality of the human life. The guidelines for them are prayer and orientation, especially in bioethics, following the principles of Personalism.The State of Health of Motherhood; Trends and Policies Affecting Obstetric Practice
Professor R. L. Walley, Medical Director - MaterCare International, Discipline of Obstetrics and Gynaecology, Memorial University of Newfoundland , Canada, Consultor, Pontifical Council for the Apostolate of Health Workers
Developments in contraception and the legalisation of abortion in most parts of the world have led to both being the basis of the health care of mothers. This has profound ethical, moral and practical significance for the Catholics, in training or in the practice of obstetrics and gynaecology. No other branch of medicine has been so affected by these developments. It has simply not been appreciated, that obstetricians from the very beginning of these developments, have had to take a fundamental stand in defence of human life. This has caused them, and their families, considerable pain. Working in health services and academic institutions through out the world, they have seen their careers ruined and in many circumstances they have been forced to leave home, family and country or even leave the speciality, in order to survive.
In very personal ways Catholics and their families have been subjected to professional and social ostracism and they are perceived as an "embarrassment" because of their public stand. Catholic ob/gyns, faithful to the Magisterial teaching, are considered to be ultra conservative, professionally outdated and even possibly negligent and are subjected to the displeasure of the profession. It is not surprising then, that very few Catholics are entering these specialities and some who do, separate what they do from what they believe. This should be a source of grave concern to the Church and to all pro-life organisations.
The questions that must be considered are; what effect does all of this have on women and mothers? Where will they obtain opinions and treatment for their health problems, which are in accordance with their moral convictions; are women being unduly influenced by doctors or nurses who do not understand or care about religious convictions?. In other words who in the future will make any practical reality of the Church's teaching on reproductive health care? Obstetricians have a right to be trained according to their moral convictions. The question that we must answer is how is this to be done. This paper will offer possibilities.
It is unacceptable to MCI:
- That modern maternal health care should be dominated by an anti-life, anti-natalist, culture of death.
- That mothers in the developing world are experiencing unimaginable suffering and that 585,000 mothers are dying annually because of a scandalous lack of effective care during pregnancy and labour.
- That tens of thousands of mothers in the developing world should suffer the consequences of the birth trauma known as obstetric fistula, which results in permanent incontinence of urine and faeces and that little is being done to relieve their suffering.
- That abortion and contraception should have become the basis of modern maternal health care in the developed world and of the international safe motherhood initiative in the developing world.
MCI intends to "breath life" back into maternal health care through new programmes of maternal service, training, research and advocacy on behalf of motherhood which are firmly based on the ethics of the Gospel of Life. MCI's current projects in Ghana, East Timor and elsewhere will be described.The Importance of the Practice of Obstetrics and Gynaecology to the Health Ministry of the Catholic Church
Gian Luigi Gigli, MD, President of the World Federation of Catholic Medical Associations, Member of the Pontifical Council for the Health Pastoral Care
The role of laymen who are active as professionals in the health care world has always been fundamental to demonstrate the attention of the Church for every man, even when weak and forsaken, and to help him question himself on the sense of existence as he comes to face birth, suffering, death.
Contraception, legalized abortion, prenatal diagnosis, in vitro fertilization, use of embryonic cells for transplants or for research changed the idea itself of pregnancy and motherhood. A son is no longer a gift, but an object of desire, and medicine is concerned more about quality of life than about life itself, while anti natal practices are imposed on developing countries as a condition for international aid. Great emphasis is placed on reproductive health, a concept including contraception, abortion and sterilization and very little help to maternal mortality. The role of the specialists is obstetrics-gynaecology has become ever more important in the pastoral of the Church, with respect to the changes in sexual life, reproduction, pregnancy and motherhood. While they feel upon themselves the responsibility of being the doctors of the youngest and weakest among men, of those who have no voice nor right to vote, they feel a heavy social pressure. The conflict between the responsibilities of morality and the new ideologies can lead, in some situations, to such conflicts of conscience that the doctor gives up his profession or makes a compromise of conformity.
The ways in which pressure is exerted are many and refer to all the phases of specialist training and activity, arriving in certain cases to forms of direct discrimination. In addition, catholic obstetricians, and more generally pro-life ones, are presented to the public opinion as ultraconservative physicians, possibly outdated in their scientific views. It is not surprising therefore if, under this pressure, the number of catholic obstetricians faithful to the Magisterium is decreasing world-wide.
The risk is a reduced cultural resistance to abortion, embryonic manipulations, eugenic selection. An even more important consequence is the lack of any possibility for catholic women to receive an opinion both scientifically and ethically grounded, enlightened by faith, on the most intimate aspects of their lives that are very important for the pastoral of the Church, such as family planning, sexual life, unexpected pregnancies, sterility, etc. A wrong advice on these aspects could also be devastating for the future of many families. Not only, without catholic obstetricians future research and teaching on reproduction would probably be without any moral concerns. John Paul II in Evangelium Vitae (n.74) invites us to vigilance and action so that the fundamental human right of obstetricians to study and work according to their conscience be respected both formally and substantially. The invitation of the Holy Father requires different forms of interventions.
Local Churches keep attention focussed on the medical profession, proposing the ideal of a profession respectful of life, standing by those who are respectful of the right to life, particularly obstetricians-gynaecologists, favouring their getting together and cultural expression.
The denouncing of cases of violation of the right to be trained and practice according to conscience must be co-ordinated and systematic; it must reach the desks of the media, of professional associations, of national and international organizations for the defence of human rights.
Catholic Universities and Hospitals must fully respect the indications of the Magisterium, both with regards to research involving embryos and in all the instances of obstetric-gynaecologic practice, while Bishops should feel responsible for vigilating in order to prevent misconducts that, despite everything, continue to take place. The same Institutions should provide a qualified and internationally recognized teaching network, to allow the possibility of specializing in obstetrics and gynaecology to those physicians who suffer discrimination or unacceptable pressures on their moral beliefs.The Impact of International "Secular Bioethics" on the "Sanctity of Life Ethic" and on the Correct Formation of Conscience
Dianne Nutwell Irving, Dominican House of Studies, Washington, D.C., and Georgetown University, Washington, D.C.
The "debate that no one really wants to have" concerns the personal identity and sanctity of the life of the early human embryo from the beginning of his/her existence immediately at fertilization or cloning. This presentation will explain several major reasons why this debate has not yet taken place. It identifies the replacement of "the sanctity of life" ethic with "secular bioethics". It also briefly details the historical account of the recent "birth of bioethics" in 1978 in the United States with the Belmont Report of the National Commission for the Protection of Human Subjects, followed by a short analysis and evaluation of this particular theory of ethics, and the false human embryology it has globally perpetrated since then. The vast consequences of the destruction of "the sanctity of life ethics", and its replacement with this "bioethics theory", include among other things, the corruption of the human intellect -- and therefore the human will --, the callusing of the human conscience, followed by the rapidly increasing inability of Catholic ObGyn's globally to practice medicine according to their well-formed consciences. Several practical remedies will be discussed.The current political climate in the Rights of Mothers
Catherine Vierling, European Forum for Human Rights and Family, Brussels, Belgium
Within the Feminist Movement world-wide, mothers issues are the forgotten piece. This means that women's rights are not taking into consideration one of the most fundamental rights for a woman, which is the right to give birth. This denies the most fundamental anthropological reality aimed to ensure the future of generations and the survival of civilisations.
The threat on motherhood expresses itself in various forms: mothers can be denied their most fundamental needs such as food, safe water, access to basic healthcare, shelter, education and so on. Apart from societies based on the Judaeo Christian principles, mothers are not guaranteed any long term social status within their "marriage": they can be legally repudiated in many societies.
Moreover, during the last century, new threats have been raised: in developing countries, mothers are threatened in their capacity to give birth by new means which violate their fundamental dignity: forced "preventive" sterilisation, abortions for various reasons (sex selection, organs harvesting, etc.), and the international aid is almost always linked with a population control programme. Even the first micro-credit initiatives in Bangladesh were promoting small size families as a condition to be included in their programmes. This is totally contrary to the role of the family in countries where children represent the only "social security" for the elderly.
Another threat on mothers is coming more directly from some groups acting at the UN level: the "gender" pressure has become a major weapon for some delegations at UN conferences: this ideology attempts to redefine "the family" to include homosexual couples, and redefine gender from "male and female" to a "social construct" that could be changed at will…This has lead a Minister for family affairs to resign, and several developing countries are accepting to change their definition in order to be granted by "donors countries", Foundations, and UN Agencies.
In Europe, at the Council of Europe or at the European Union, the word "Mother" will never be included into an official legal text. Feminists will accept the term "Women with children" but nothing more. The European Union has nevertheless adopted several legal tools promoting parental role in children's education. These documents may need to be promoted.
Demographic threats challenge our politicians: facing the dramatic ageing of our societies, on the one hand, they advocate for women's involvement in the labour force. On the other hand they need to promote more labour flexibility to ensure that they will be able to give birth and to raise their children: it is clear that women who are mothers-to-be may offer the only solution to counterbalance the demographic deficit.
These realities are severely challenged at the EU level: the Pope himself clearly expressed his concern that the new EU Charter of Fundamental Rights "denies God and the Family", and during the process for the UN World Summit for Children, officials consider "problematic" that youth groups are demanding specific protection for the foetus and recognition that the "foetus is a basic phase of childhood", and that these young people are asking to focus the discussion on issues relating to the family, parental rights, and chastity. Some EU officials at the UN fear what they call the "Right-wing governments and groups who are also attempting to insert language that would strengthen parental authority and control to the detriment of established children's rights". We must remain very vigilant and get involved as much as we can to promote the family.Activities of the Pontifical Academy of Life: Information for Gynaecologists and Obstetricians
H.E. Elio Sgreccia, Vice-President of the Pontifical Academy of Life
It has been thought useful to inform gynaecologists and obstetricians who wish to place themselves at the defence of unborn life about the goals and activities of the Pontifical Academy for Life. This Pontifical Academy was founded by the Holy Father John Paul II on 11 February 1994 when the preparations for the Conference of Cairo - which drew up the 'Plan of Action for Reproductive Health' - were fully underway during the International Year for the Family.
According to its statutes, the Pontifical Academy for Life has the character not of a pastoral body but of a scientific-cultural institution whose specific task is to study, to educate and to inform. This is to be done both to help the decision-making, and pastoral, bodies of the Church, and for the benefit of the general public as regards questions and issues of a scientific, philosophical and legal nature connected with the defence of human life and its dignity. At a practical level, many subjects which today are placed under the heading of bioethics belong to the Pontifical Academy's sphere of interest and concern.
In this context, the Pontifical Academy has drawn up a methodology of work which envisages first and foremost the creation of a task-force of specialists, both from within and from outside the Academy, for every subject chosen for study, for which the task-force prepares an interdisciplinary approach to the subject which is then submitted to the General Assembly.
This methodology, which seeks to achieve an interdisciplinary epistemological 'unifying survey' of the individual subjects, has favoured the preparation and the publication of a series of volumes which are the fruit of interactive work between many specialists and of investigation by all the members of the Academy. Other subjects have been dealt with by workgroups which have carried out studies on special subjects prior to the drawing up of 'official documents'.
The list of works of the Pontifical Academy contains the following volumes which have always been published in English but which have also in many cases been translated into other languages or are about to be translated into other languages:
1) Commentario Interdisciplinar a la Evangelium Vitae (Spanish edition, Biblioteca de Autores Cristianos (BAC), 1996), 811 pp.; Commento Scientifico Interdisciplinare alla Evangelium Vitae (Italian edition, Libreria Editrice Vaticana, 1997), 823 pp.
2) Evangelium Vitae e Diritto (Libreria Editrice Vaticana, 1997), contains texts in many languages, 629 pp.
3) Identity and Statute of Human Embryo (English edition, Libreria Editrice Vaticana, 1998), 458 pp. There are also editions of this work in Italian, Spanish, Hungarian and Croat. A French edition of this volume is in the press.
4) Human Genome, Human Person and the Society of the Future (English edition, Libreria Editrice Vaticana, 1999), 509 pp.
5) Biotecnologie animali e vegetali (Italian edition, Libreria Editrice Vaticana, 1999), 197 pp.
6) The Dignity of the Dying Person (English edition, Libreria Editrice Vaticana, 2000), 479 pp.
7) Evangelium Vitae Five Years of Confrontation with the Society (English edition, Libreria Editrice Vaticana, 2001), 548 pp.
All these subjects are of bioethical relevance and are of close concern to the interests of gynaecologists. The workgroups have also produced a number of official documents which have been distributed in major languages: 'Reflections on Cloning', and 'Declaration on the Production and the Scientific and Therapeutic Use of Human Embryo Stem Cells'. A document on xenotransplantation is currently being prepared. This work is the outcome of co-operation between the Pontifical Academy and scientists and specialists from various universities in the world.The Role of Catholic Universities and Hospitals in Specialist Training Programs
Luis Jensen, MD. Director of the International Scientific Institute "Paulo VI" for the Study of the Human Fertility and Infertility, Catholic University of the Sacro Cuore, Rome. Department of Obstetrics and Gynecology of the Catholic University of Chile
1.- The current situation: Maybe the only difference today between a doctor and also between a gynaecologist from different universities is the best professional training acquired. In the treatment of matter related with life and love there is no difference at all. This is a very hard affirmation, but unfortunately it is true. In the Pontifical Universities, of course, they can't do abortions, give contraceptives or do an IVF. But, the fact that some members of the staff do these things in their private practice or in another centers after they leave the catholic hospital is known everywhere. Other current practice is to refer their patients to a "safe place" where they can get the "medical" solution... the gynaecologist fellow does the same thing.
2.- Possible explanations and its consequences: Nobody has any doubt about the degree of excellence of medicine and training at Catholic Universities. They are well described as the place where everybody competes to know the "last paper" about the subject and to domain the last technology. This is necessary and wonderful. The point is that we, as catholics, have to do something more. We have to understand that we are working with two of the most important things for the realization of each person: the way they love each other and the way they cocreate, conduct and serve life. These two things are related with the vocation of each person to love and with the central aspect of each human being: its liberty. As doctors and much more as gynaecologist we have to take care of these aspects of our patients, especially because today our culture has a big misunderstanding of all these concepts.
Here rests one of the central teachings of our church. In order to complement our formation to give a better contribution to our culture it is necessary to understand our church contribution in all its richness. Therefore, we have to study the magisterial documents very hard, until understanding the anthropology that is behind this proposal and assume the bioethics consequences derived from that conception. My question is: Which training center has this curriculum?, which gynaecologist performs this by itself?
The consequence of this lack is the current simplification where the "catholic way" is reduced to many "no" norms and to the use of "natural method" to do the same thing that the others do: the so-called "Natural Family Planning". This is the way through many gynaecologist are convicted that our church is wrong and that in a near future the church has to change its position. This fact, and also the lack of research in this field, explains the actual situation above described. During the last 40 years almost all of the research is in the field of contraception and, in the last years, in "assisted fertilization". It's not rare that gynaecologists that used to study and work at Catholics universities today are leading members of the centers of contraception or assisted fertilization.
3.- The future challenges and some probable ways of changes: To create conscience about the richness we have to conceive our patients as persons called to love and cocreate life, instead of an individual with sexual and reproduction rights. We also have to congregate efforts with bioethics to prepare a new specialist with all this "humanistic" tools and improve their clinical and training practice. We should develop multicenter clinical trials to demonstrate scientifically the catholic gifts. And also we have to try to translate to a more familiar language our vision of men and women, marriage, family and love... especially through our personal testimony.Reflections from the perspective of Residents in Obstetrics and Gynaecology
Susanne van der Velden, Almut Hefter, Residents in Obstetrics and Gynaecology, Germany
1) Personal training Situation
S. van der Velden, now 5th year of residency: Personal questions:
- Is there an objective definition of a Catholic specialist in O&G?
A.Hefter, now 6th year of residency: Personal questions:
- Conflict between patients claiming medical treatment according to current medical practice and my personal conscientious objections against these treatments
- Is NFP the only option for everybody?
2) Actual training situation in different countries:
• difficulties in every country
• difficulties at different levels:
• political / personal / within professional body
• examples from Great Britain, Switzerland and Germany
3) Options and Conditions for the Future
A. Personal conditions to become a Catholic specialist in O&G:
• clear and total decision
• support
• flexibility
B. Desirable support in pursuing career:
a) giving a structure to already existing training possibilities:
• list already existing training centres
• list all catholic gynaecologists and places welcoming Christian doctors
• analysis of obstacles in training and practising in different countries
b) Is a combined medical and bioethics catholic training centre possible ? Where ?
c) contact between Catholic specialists in O&G
d) making a career more attractive - publicity
4) Conclusions
- there are personal conditions to become and to stay Catholic specialist in O&G
- there are options that have to be offered to young students/doctors to choose for the catholic way of practising Bo/Gyn
- there is reason for a positive definition of the Catholic way to practise O&GAccess to Appointments: The Effect of Discrimination on Careers
T. Everett Julyan, GP Trainee, Glasgow, UK, Medical School Secretary (Glasgow), Christian Medical Fellowship, UK
Introduction
The practice of discriminating between applicants for posts within obstetrics and gynaecology on the basis of their beliefs about the status of the embryo is becoming increasingly common. This affects not only the individual discriminated against, but also medicine and society as a whole. When this discrimination is faced because of a desire to please the God of the Bible it is more accurately described as persecution (Matthew 5:10-12).
Effects on the individual
The effects of this persecution on the individual may be vocational, social, financial, emotional or spiritual. These include influencing ultimate choice of career, rejection by colleagues, unemployment in extreme cases, disappointment, disillusionment and temptation towards compromise. The only positives may be the maintenance of personal integrity and promise of heavenly reward.
Effects on medicine & society
Excluding all those who refuse to end a human life simply because its existence happens to be inconvenient to another does medicine a disservice. It is antithetical to historical medicine which calls for self-sacrifice on the part of the doctor in order to preserve the patient according to an established ethical code. It seems that contemporary medicine only wants doctors who follow the status quo by changing their ethical framework to suit the wishes of their patients. The logical outcome of this kind of thinking is that autonomy may be considered to be of greater value than human life in a variety of clinical situations. But medical practice will become unethical if doctors are expected to give treatment which they consider to be inappropriate, such as killing an unborn child.
The practice of medicine is in danger of becoming a commodity marketed with the expedient business ethic of supply on demand, where the value of human life can fluctuate as a relative integer. Denying employment to those who seek to preserve life instead of destroying it is a logical step of pragmatism in a culture where abortion is on demand. But medicine should not be a business designed to supply every demand indiscriminately when the demand may not be in the patient's best interests. If medicine evolves by defining good practice simply as what the patient wants then society will ultimately become a victim of its own unethical requests (cf. Romans 1:28-32).
Conclusion
Discrimination against those who refuse to include ending human life as part of their job description is becoming increasingly common. However, this serves neither doctors nor patients and is a symptom of a relativistic view of medical ethics. Its detrimental effects are far-reaching, affecting individuals, the medical profession and society in general. Those who see the dangers in this trend have a duty to protect society, the future of medicine, their colleagues and themselves from wrongly redefining beneficence and non-maleficence.National and International Organisations in support of pro-life Obstetricians. The possibility of future action.
Nuala Scarisbrick, Hon. National Administrator of LIFE UK
When the pro-life movement began (over thirty years ago in the UK) most of us believed that we should work within our culture. We believed that the medical establishment would largely stand firm against abortion. We were confident that, such was the strength of our case on behalf of the unborn child's right to life and the mother's right to be protected against male exploitation, our society would come to its senses and reject abortionism as vigorously as it had rejected, say, the transatlantic slave trade. We were wrong. Things have gone from bad to worse in many ways. We witness today widespread public acceptance of the mass destruction and trivialisation of human life in abortion clinics, IVF units, etc. Obstetrics has been profoundly corrupted and, incidentally, paediatrics and geriatrics are also in peril. Abortionism has close allies in eugenics and the euthanasia lobby.
This means three things. As we have heard, pro-life obstetricians are becoming a rare breed; it is increasingly difficult for young pro-lifers to enter the profession; it is increasingly difficult for pro-life couples to find doctors and nurses whose hands are clean.
Of course, pro-life organisations give support to those doctors who have remained loyal to the high traditions of their profession. But in the long run the only way we can now challenge the Culture of Death is by creating a pro-life counterculture. By this I mean, among other things, an alternative, pro-life health service which provides absolutely pro-life training in obstetrics, paediatrics, and geriatrics, a complete career structure for pro-life doctors and nurses and guaranteed pro-life treatment in clinics, hospitals and hospices for pro-life patients. We have tried to embark on such programmes in the UK with the LIFE Fertility Programme and the LIFE Health Centre. But to make this vision a reality world-wide requires an enormous effort. Only the Catholic Church can make this possible, especially through the vision and generosity of religious orders who, as their numbers tragically decline, have major assets available for new use. We urge that guided by their superiors and Rome's Congregation for the Religious the Church develops a co-ordinated strategy which will enable the fruits of generations of Catholic piety and generosity to be turned to serve the Gospel of Life.
ABSTRACTS OF THE FREE COMMUNICATIONS
Conscientious Objection on the socio-political Background of Ethical Relativism
Nikolaus Zwicky-Aeberhard, M.D., Private Practice for Internal Medicine, President of the Swiss Association of Catholic Doctors
After a short illustration of the situation in Europe we try to justify our claim on conscientious objection on the basis of the Swiss Federal Constitution and the United Nations Universal Declaration of Human Rights.
Our claim is as follows: Regarding abortion, technically assisted procreation, contraception and sterilization operations we demand the right of refusal by reasons of conscience without undergoing handicaps or even impossibilities of studies or professional work. The stipulation of conscience must not only cover the right of free decision but include also the prevention of possibly resulting disadvantages.
It is worthwhile to remember Cicero and his controversial opinions against ethical relativism in his work "De Legibus": "Because Nature brought forth common ideas for us and planted them in our souls in such a way, that the ethical conscience is realised in the virtue and in the rejection of viciousness. But to conclude, that this is based on a mere opinion and not regards the natural circumstances is entirely absurd".
For our purpose The Holy Father Pope John Paul II states in his encyclical "Evangelium Vitae": "The ethical relativism is a great threat to the peaceful coexistence and cannot be justified with the institution of democracy" (EV 70).The Possibilities of Education of Catholic Gynaecologist in Slovakia &endash; personal experience
Marek Drab, Association of Catholic Doctors of Slovakia
I am a 28 years old doctor from Slovakia. After graduating from the faculty of medicine in Bratislava I started my work at the department of gynaecology and obstetrics in a state hospital. I thought that I could fulfil my goals and desires by serving people and life given by God, that made me choose gynaecology and obstetrics as my vocation. But soon after I started working I found out that practising the Christian principles and acting according to my conscience means for me a war.
In wars people usually kill in order to get the territories, some benefits or stand for somebody's concerns. But the war I have experienced is the most unfair one in the history even supported by our laws. I want to testify my own experience that could be confirmed by any gynaecologist in Slovakia who raises the moral law above the civil law related to legalized abortion.
I refused to provide abortion the result of which was that I was made not just to leave the hospital where I worked for another one but at same time to leave gynaecology so that I could continue being a practising doctor.Dual Testimony from the Gynaecological-Obstetrical Front-line
André O. Devos, MD, Gyn-Obs, co-founder and medical adviser, NFP-Vlaanderen, (Natural Family Planning Flanders, Belgium), and Timothy Devos, MD, Resident Internal Medicine, Catholic University, Leuven, Belgium
The first testimony will be my own experience as a gynaecologist in a Catholic hospital and illustrates the first theme of this meeting: the fundamental right to practice according to conscience. The second testimony comes from my son Timothy and will illustrate the second theme of this meeting: training in Obs-Gyn, according to conscience.
• In 1988, after a merger between our hospital and the other Catholic hospital in the city of Bruges, I was soon forced to join the 4 colleagues of the bigger St. Luke hospital and to share alike in a common financial pool. Since a fair amount of their income was the result of contraception and surgical sterilisation, I refused to join in the pool, for obvious moral and ethical reasons. According to my conscience, I could not accept any part of that income. I soon was dismissed, loosing hospitalisation and surgical privileges. The letter of dismissal was signed both by our Mother Superior and the Executive Director of St. Luke, a Reverend Cannon, who at the same time was one of the secretaries of our Bishop. Providentially was I then granted full privileges in our "pluralistic" City Hospital; and although the medical director was a convinced atheist, I could perform my medical duty according to the "Evangelium Vitae" principles until my retirement this year.
• My youngest son Timothy after obtaining his medical degree wanted to become a gyn-obs specialist and started gyn-obs internship training with confidence and full of enthusiasm, at the same Catholic University Leuven, where he graduated from, knowing that ethical and moral problems might arise which he thought he could face. He was soon faced with the daily routine of surgical sterilisations, chronic and acute chemical contraception, meaning prescription of contraceptive pills and "emergency contraception", IUD-insertion, prenatal diagnosis and the step motherly treatment of the natural family planning methods. In two months time two patients with questionable abortions for "medical indication" came under his care. He truly was affected by the moral shock put upon a young doctor with a catholic background, being dropped in this world of ambiguity and duplicity, a world, nevertheless, where his vocation had directed him to.
For a long time he was thinking about a "realistic compromise" keeping in the back of his mind the idea that : "if every young catholic doctor pulls back, nothing will ever change". This was the battle between "Realpolitik" and the great basic principles, as you would call it in political terms. Still, after a few months it became perfectly clear that he hardly could go on all alone, since nobody was around in the department who showed true understanding for his dilemma. At that very moment the position as a young trainee is particularly shaky: on the one hand you have to live up to the expectations of the medical staff, so you don't jeopardise your final candidacy, on the other hand, you come under moral pressure either directly, but more often indirectly.
At night you start to think and you realize that you are involved in a system that you basically disapprove, against which your conscience and your whole soul revolts.
It is not indeed a matter of exceptional and intricate problems, eventually susceptible for a compromise, no, the biggest problem was that the basic philosophy of the gynaecology staff was miles away from the moral teaching of the Church.
The other source of concern is the question of where and in what hospital to practice at the end of your training, being a "strange bird", unwilling to assume several activities for moral reasons; the question also of how to support a family, in the event that you could temporarily numb your conscience during the training period.The Situation in Switzerland in General and a Casuistic Report
Rudolf Ehmann, M.D., Director of the Department of Obstetrics and Gynaecology, Government Hospital, Stans, Switzerland; and Niklaus Waldis, M.D., General Practitioner, Bulle, Switzerland
In March 2001 the Swiss National Assembly decided to allow the termination of pregnancy within the first 12 weeks which means legal abortion within this period. Immediately after this decision was published the referendum was held, which means that the Swiss people have the opportunity to publicly vote in order to achieve the final decision.
As there are no official abortion clinics in Switzerland the argument in the past years manifested itself in the idea, that abortions should be treated actually as "order of service" (In German: Leistungsauftrag). Therefore the study and professional work of colleagues who do not wish to terminate pregnancies or contribute to abortions is already nowadays continually growing difficult. Almost impossible is the study however, if such colleagues should refuse to be involved with contraception and technically-assisted reproduction and operations of sterilization. Although the Commission of Justice of the National Assembly has asked the Federal Government to take measures to allow doctors and nurses to refuse involvement without being discriminated, it remains to be seen how far these admonitions will improve the situation of ethical-minded gynaecologists, midwives, nurses, anaesthetists and psychiatrists. The casuistic report of a then young doctor is not very encouraging in view of a real respect of Swiss Authorities regarding colleagues who want to work according to the Magisterium.Obstetrics and Gynecology in Austria
Tamás Csáky-Pallavicini (Soon Bo/Gyn Candidat), Vienna, Austria
In Austria there are no possibilities to specialize in obstetrics and gynaecology without hurting basic moral principles. The reasons are the following:
1) The official legal OB/GYN curriculum and training (Facharztausbildung) requires the practical participation in some techniques, which must be acquired etc. which are immoral.
2) In Austria there are few catholic hospitals with ObGyn departments. The largest catholic hospital complex belongs to the "Barmherzige Brüder Austria". They created guidelines for catholic doctors in an "Ethic Codex" available via internet (http://www.barmherzige-brueder.at/ethik.htm)
The "Ethic Codex" of the "Barmherzige Brüder Austria" a guideline for catholic hospitals states in the OBGYN section:
a) "Conflicts with pregnancy have to be prevented by prevention, even by artificial contraception. Contraception is the "minus malum" if at all it is a "malum" (http://www.barmherzige-brueder.at/etschwan.htm)
b) "Direct sterilisation is allowed in cases it helps the personal wellbeing of the woman (e.g . premenopausal state). (http://www.barmherzige-brueder.at/etsteril.htm)
c) "IVF (in vitro fertilization) is ethically justified as a "ultima ratio" within a marriage, if other medical therapies don´t show any success to get a child" (http://www.barmherzige-brueder.at/etfortpf.htm)
d) "Invasive risky prenatal diagnostic procedures (amniocentesis, chorion villus sampling, chordocentesis, fetoscopy) are justified to reduce the fears of the pregnant women to get a malformed child, a child with a genetic disorder, to help women prepare better for a handicapped child, to prepare the birth modalities, to prepare for fetal surgery etc. The free choice of the woman has to be respected. (http://www.barmherzige-brueder.at/etprae.htm)
As we can see there are profound contradictions in this ethic codex with the teachings of the Roman Catholic Church.
If a catholic doctor wishes to specialize in obstetrics and gynaecology he faces a hostile immoral legal and ethical environment. Every doctor must acquire practical experience in pre-conception counseling, prescribing oral contraceptives, inserting IUDs, performing tubal ligations and carrying out other forms of sterilisation like unnecessary hysterectomies, performing prenatal diagnosis of fetal malformations using ultrasound, amniocentesis, chorion villus sampling as early as possible etc. and performing at least medically indicated "state of art" first and second trimester abortions.
Catholic hospitals should become models for a "Culture of life" in obstetrics and gynaecology through counseling in NFP, offering prenatal diagnostic procedures like ultrasound, fetal nuclear magnetic resonance imaging, genetic analysis of fetal nucleated erythroid cells through maternal blood sampling, which don´t put at risk the precious life of our unborn children. Ethical prenatal diagnosis does not promote eugenic selection by using unnecessary early and risky prenatal diagnostic procedures, but it helps prepare for optimal therapy for those seldom diseases where fetal surgery and therapy gives life a chance. Catholic doctors together with the Church should fight to get a legal environment in accordance with basic moral principles to serve the needs of our little patients.
Proposed solution:
1) A Charta of fundamental Rights for Catholic OB/GYNs which must be respected at least by catholic hospitals.
2) International Preparation of an OB/GYN Textbook for catholic OB/GYN specialists permanently updated using the internet.
3) Better international cooperation of catholic hospitals in training of catholic OB/GYNS especially when local hostile circumstances don´t allow Bo/Gyn Training according to conscience.
4) Negotiations with state authorithies to change law for specialisation in OB/GYN regarding some immoral paragraphs respecting the conscience of catholic OB/GYNs
5) Catholic Bo/Gyn departments should allocate resources in a way which is adapted to the real needs of pregnant and non pregnant women. For example US screening shortly before delivery is far more effective to prepare optimally for birth and diagnose illnesses of the fetus which really can be treated earlier and better.
6) Catholic OB/GYNs should cooperate far better with catholic schools and institutions in promoting the catholic approach to OB/Gyn issues. (Natural family planning, preparation for family) Catholic hospitals should teach professionally NFP in the hospitals and send teachers to schools.
7) Local dioceses should evaluate the ethical codices and practices in their local hospitals and forbid the misuse of the good catholic name for openly immoral practices.Implications of the Precepts of the Catholic Church in Ob-Gyn Practice at a Catholic Medical College Hospital
I.K. Rosily (Dr. Sr. Rose Jophy)*, A. Mhaske**r, and Rev. Dr. T. Kalam***, Department of Obstetrics and Gynaecology, St. John's Medical College, Bangalore, India
India is a plural society where various religious practices co-exist. Christians are a minority here, Catholics are still less in number. St. John 's Medical College, Bangalore, India is the only Catholic Medical College in India. The admissions to St. John's are based on merit giving preference to Catholics, 50% boys, 25% girls and 25% religious sisters. All students after completing the M.B.B.S. course are compulsorily required to work in a rural health centre for two years.
A national policy for population control has been implemented with effect from April 1976. Both temporary and permanent contraceptive measures and medical termination of pregnancy are practiced in the country. However, this institution holds on to the teachings of the church with regard to population control. In our experience, at St. John's, Obstetrics & Gynaecology can be practiced without performing medical termination of pregnancy and advising artificial methods of contraception. We have been training graduates and postgraduates in Obstetrics and Gynaecology without giving practical training in these skills and our students have been able to render commendable service in rural India.
The aim of this study was to assess: whether the graduates and post graduates of this institution
(1) were at a disadvantage in imparting medical care when compared to their peers of other institutions;
(2) faced any discrimination during undergraduate examinations;
(3) had any problems for admission to Post Graduate courses elsewhere;
(4) faced any discrimination during Post Graduate course and examination.
Appropriate questionnaires were administered to interns, postgraduates and faculty members who are Johnnites. The results of this study will be presented at the meeting.
*Assistant Professor, ** Professor and Head, Dept. Ob. and Gyn., *** Director, St. John's Medical College, Bangalore, India.The Practice of Obstetrics and Gynaecology and Natural Law
Eamon O'Dwyer, Emeritus Professor of Obstetrics and Gynaecology, University of Galway, Ireland
To understand Natural Law and appreciate its significance, its development has been traced from its origin in Aristotelean philosophy to its fulfilment in the Summa Theologiae.
Law is a rule or measure of action in which one is led to perform certain actions and restrained from the performance of others; it must be directed towards the well-being of the whole community. As St. Thomas Aquinas observed "rational creatures derive from reason itself a natural inclination to such actions and ends as are fitting." This ability to discern good from evil, through the light of natural reason, is the Natural Law, which is universal, everlasting and immutable. Natural Law is more than a theory of natural rights - it is the Golden Rule which "contains all that makes for the preservation of human life and all that is opposed to its dissolution."
Many practices or procedures undertaken by obstetrician/gynaecologists offend against Natural Law. Two of them, emergency contraception and procured abortion have been chosen for consideration.
The author maintains that emergency contraception is abortifacient and insists that, in relation to procured abortion, there are no circumstances where a mother's life can only be safeguarded through the deliberate, intentional, killing of her unborn child.
In conclusion, the hope is expressed that the voice of Catholic obstetricians will be heard in the defence of the unborn, and that out of the Rome meeting will emerge, the acceptance of MaterCare International, in witness to Pope John Paul's Encyclical Evangelium Vitae, as the
authority with regard to the practice and training in obstetrics and gynaecology for Catholic graduates in medicine.Human Rights and Obstetric Practice. Legal Issues
Alberto Mazza, M.D., Professor of Obstetrics and Gynaecology, former Minister of Health of the Republic of Argentina
Both in the practice of medicine and in the number of related professions involved in medical assistance, very often the professional has to face serious conscientious objections. This is especially true about the gynaecological obstetric practice related to sexual health, human reproduction and the protection of the life of the nascitutrus.
The conscientious objection, which is raised by the professionals, entails a problem of clash of rights and forces us to establish limits as regards fundamental rights.
There is no doubt whatsoever that this objection, which is born in the field of the individual conscience, arises when we are faced with a concrete legal obligation which has no other alternative of fulfillment and forces the professional to explain his refusal to fail to comply with a certain legal norm.
The scientific advances in the field of health today make possible a number of practices and treatments which sometimes place the professionals who have to apply them in a clear dilemma whereby they question the goodness of such practices and not just their legality.
In an increasingly pluralistic society, there will be more and more practices that a doctor may object to such as sterilization, abortion in all its means, contraception, the solution of pregnancies, non-therapeutic genetic modifications, etc.
It would imply a severe injury to the doctors' rights if they were left aside for refusing to undertake certain practices for personal convictions.
In this respect, we would like to draw your attention to the Doctors' Union Law in Uruguay and to their 1995 Ethical Medical Code, Chapter IV, 2, which says, "The rights of the doctors, "says article 30, "All doctors have the right not to be coerced for ideological or economic reasons to perform his profession in a way unworthy to his own science and art". And in article 32, "He has the right to abstain from performing practices which are opposed to his ethical conscience although they are approved by the Law. In that case, he has the obligation to refer the patient to another doctor."
Along these lines, the Spanish general council of official colleges of doctors, in the words of the Central Commission of Deontology, medical right and visa, says, "the refusal by the doctor to perform, for ethical or religious reasons, certain acts which may be commanded or tolerated by the authorities, is an act of great ethical dignity, when the reasons put forward by the doctor are serious, sincere and constant and refer to important and fundamental questions. The objector feels a profound moral rejection for the acts he objects to, to the point that were he to comply with the request, he would be betraying his own identity and conscience."
In Argentina, a bill was approved by the Lower House (Chamber of Deputies &endash; House of Representatives) creating the National Programme of Sexual Health and Responsible Reproduction and another bill was approved modifying the law of the practice of medicine adding Article 19b which says, "The medical professionals and assistants that work in a state or private institution, when required to use preventive, diagnostic or therapeutic methods, will be able to express their conscientious objection rightly substantiated, insofar as no damage, immediate or ulterior, will happen to the patient". Both bills are now expecting approval by the Senate.Understanding of Human Life Value and Violation of its Protection in Lithuania, the Land of St. Mary
Vilune Intaite, Dep. of Ob/Gyn, Kaunas Medical University Hospital, Lithuania,
and Rolandas Ziobakas, Woman Clinic of Vilnius University Hospital, Lithuania
Nowadays special attention in Lithuania is given to reproductive health, that is an important organ system of family prolongation. Community's life and women's health are two closely related things. "Be fertile and reproduce yourself, fill in the earth and rule it" PR 1,28.
The Population in Lithuania is approximately 3,7 million. There are two major problems in the Lithuanian community: abortion and diminishing birth rate caused by bad family material status.
Material conditions have undoubtedly influenced human reproduction and birth rate, but it doesn't correlate. The total birth index in Lithuania in 1995 was 1,54. However, in many countries, where family material conditions are better, the birth rate was less: in Italy (1992) it was 1,33; in Germany (1994); in the Western part 1,34, in the Eastern part 0,77; in Austria (1993) 1,45; in Switzerland (1994) 1,49. In some highly developed European countries the total birth rate was significantly higher: in Denmark (1994) it was 1,84; in Norway 1,87; in Sweden (1994) 1,88; in Iceland (1994) 2,14. However, in the poor regions of Africa and Southeast Asia the birth rate is very high. Induced abortion in Lithuania was legalized in 1955, during soviet occupation. Official data about abortion became available after regaining the independence in 1990. These data are still not precise because they are incorrectly registered or presented by private clinics.
The abortion index in Lithuania (the number of abortions per 1000 fertile women per one year) is quite high (40,53 in 1995; 29,9 in 1996; 24,3 in 1997), but less than in neighbouring countries: in Latvia (1994) 70,4; in Estonia (1994) 66,3; in Russia (1992) 98,1. In highly developed European countries the abortion index is not so big: in the Netherlands (1992) 5,2; in Switzerland (1994) 7,7; in Finland (1994) 11,0. The average of abortions per 1000 15-44 years old women in Western Europe was 14,0.
In Lithuania an induced abortion is quite a big problem for Catholic gynaecologists because only in university hospitals gynaecologist have official right to refuse inducing the abortions.
By the decision of member of WPDS Lithuanian Association "Pro Life", all Catholics of Lithuania must seek for legislation, protection of human life and defence of foetus rights.Fertility is not a Disease: How to correct a culture gone awry
Hanna Klaus, M.D.,Executive Director, Natural Family Planning Center of Washington, D.C., USA
Anyone who does not consider fertility to be a disease which must be isolated out of the body of a man or a woman by medical or surgical modalities has a hard row to hoe in the medical and ancillary professions. While this effects Roman Catholics especially, there are many others who have a similar philosophical or religiously based position. While modern natural family planning is the obvious means to assist couples to control their fertility without introducing physical or chemical barriers. The self-evident effectiveness of this approach has not yet caught on for reasons of ignorance of basic data about, and effectiveness of natural family planning, aggressive marketing of contraceptives, and presumed inability to maintain periodic continence.
Successful models of proactive educational counterweights to each of the above barriers will be presented, including proactive educational remedies:
1. Enabling women to reclaim control of their bodies through natural family planning.
2. Dissemination of information about NFP by trained providers who do not have to be medically trained but have achieved proficiency as teachers of their particular methodology.
3. Regional training centers for teacher education and quality control.
4. Proactive sexuality education to adolescents before they become co-opted by the "contraceptive culture", with concurrent parent education and involvement.
5. Creating a demand for natural methods by women of their physician providers coupled with their refusal to accept the status quo.
6. Educating physicians to the existence, effectiveness and utility of natural methods of family planning.
7. Ongoing basic and clinical research to enhance currently available method.Training in Maternal-Fetal Medicine and Pro-Life World View
John M. Thorp, Jr., MD, Professor, Obstetrics & Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
Discrimination against trainees who would ascribe a moral status to an embryo or fetus that precludes their involvement in performing elective abortions exists only on ad hoc basis in the United States. Formal exclusion of such learners from residency programs in obstetrics and gynaecology is perceived by most academic institutions to be exclusionary and discriminatory. Such is not the case for fellowship training in maternal-fetal medicine (MFM) in the United States. MFM training with its emphasis on prenatal diagnosis and its "therapeutic" correlate, pregnancy termination, makes obtaining this credential for the clinician whose conscience is troubled by these linkages difficult. The reliance on prenatal diagnosis for patient referrals and practice income by North American academic health centers further hinders the pro-life MFM specialist. Paradoxically, many pro-life clinicians and patients practice and accept prenatal diagnosis without fully contemplating the moral implications of such. Is it moral to refuse to perform elective abortion but profit from procedures that would not exist if elective abortion were not an option? Is it moral to put normal fetuses at risk with invasive procedures to detect abnormal fetuses whose lives would continue sans abortion? I believe that pro-life obstetricians and the Catholic Church are obliged to respond to these dilemmas and in so doing refute the siren songs of utility and eugenics used to justify the "detection and treatment" of diseases in utero.American Association of Pro-Life Obstetricians and Gynaecologists (AAPLOG)
Byron C. Calhoun, MD, FACOG, FACS, American Association of Pro-Life Obstetricians and Gynaecologists, Tacoma, Washington, USA
The American Association of Pro-Life Obstetricians and Gynaecologists was formed at Bal Harbour, Florida, USA by 31 Obstetricians and Gynaecologists (OB/GYN) in April, 1973 in the wake of the Roe v Wade Supreme Court decision. Our membership is open to all OB/GYN physicians in North America. Our membership now numbers over 2,000 pro-life OB/GYN physicians with the stated goal of becoming the leading educational information source to pro-life OB/GYN's. We provide position statements on life issues, member newsletters, a website with carefully screened pro-life links, a locater list of pro-life OB/GYN's for the public to access, low-cost or no-cost prenatal care and support for unwed mothers, and unbiased pro-life information to the general public. We function as a recognized Special Interest Group of the American College of Obstetricians and Gynaecologists (ACOG) with a yearly presence at the ACOG Annual Clinical meeting AAPLOG Mission Statement:
As members of AAPLOG we affirm:
1. That we are responsible for the care and well being of both the pregnant woman and her preborn child
2. That the preborn child is a human being from the time of conception.
3. That elective abortion at any stage of pregnancy constitutes the wilful destruction of an innocent human being; and that this procedure will have no place in our practice of the healing arts.
4. As physicians trained in both the art and science of the medical practice of obstetrics and gynaecology, we are deeply concerned about the profound, adverse consequences that unrestricted abortion imposes on women, children, and families of our nation. Therefore, we pledge to use our talents and skills to educate our patients, the public, our colleagues, and our students in order to promote respect for life in all stages of development and, thus, to enhance the well-being of our entire society.Changes in the Practice of Obstetrics and Gynaecology: A 25 Years experience in the U.S.A.
Thomas W. Hilgers, MD, DIP, ABOG, ABLS, SRS, Senior Medical Consultant, Obstetrics, Gynaecology, Reproductive Medicine and Surgery Director, Pope Paul VI Institute for the Study of Human Reproduction,Omaha, Nebraska, USA
This is a reflection on 25 years of obstetrics, gynaecology and reproductive medicine practice and research in the United States within the context of Catholic medical and moral ethics. The introduction of contraception, sterilization, abortion and the artificial reproductive technologies has dramatically changed the practice of obstetrics and gynaecology. It has impacted physicians and their training, the relationships they have with each other, the view of hospitals and other agencies who pay for health care services, and has a devastating impact on the women who are served.
The oral contraceptive has become a medical treatment for many gynaecologic conditions but it does not treat them it only suppresses the symptoms. It has become the "standard of care" for gynaecology. It has developed a monolithic network of support for its use with an extraordinary economic backing. With high risk obstetrics the solution is now abortion rather than applying medical expertise to the solution. In addition, artificial reproductive technologies has become the foundation for treating infertility. In the United States the prematurity rate has increased to nearly 12% and breast cancer and sexually transmitted diseases have become epidemic.
The current practice of obstetrics and gynaecology borders on fraud. To treat dysmenorrhea, endometriosis or recurrent ovarian cysts with oral contraceptives or premenstrual syndrome with antidepressants or a woman with ruptured membranes at 20 weeks of pregnancy by aborting that pregnancy or a woman with a history of two previous classical Cesarean Sections who, in the treatment of her current infertility problem, has her ovaries hyperstimulated and conceives quintuplets, is fraudulent and borders on malpractice.
Patients who have religious objections to this approach to treatment are not respected by the physicians who work from this perspective. The first amendment to our United States Constitution is designed to protect against those who might force us to receive medical care contrary to our religious beliefs but it is laughed at. The Catholic obstetrician gynaecologist who wishes to practice according to his beliefs faces no end of prejudice and discrimination from the medical schools, the residency programs, the insurance carriers and government programs that pay for health care.
The medical ethics of the Catholic Church offer great hope in the medical care of women and my own research and educational program development of the last 25 years is focusing on this in the publication of our new medical textbook on NaProTECHNOLOGY®. There is an extraordinary need that exists for Catholic women throughout the world within the practice of medicine. A Christian anthropology demands that we approach the medical care of our patients from a perspective contrary to current approaches. This is founded upon long held medical principles of establishing a diagnosis, looking for the cure or the appropriate treatment and implementing it.
I encourage the Church to speak out with boldness and confidence in the theology and philosophies that have been expressed from Humanae Vitae through Evangelium Vitae, to have the courage of its conviction and to be a true light to the world in these areas where the Church has for so many years been made to think that it is embarrassingly naive and unable to cope with the real world. And to work to protect Catholics everywhere so that they have access to sound medical care consistent with their moral beliefs.Abortion Training in Obstetrics and Gynecology in the United States
John W. Seeds, MD, Professor and Chairman, Department of Obstetrics and Gynecology, Virginia Commonwealth University/Medical College of Virginia
Every fetus is a genetically unique human creation. When, if ever, is it acceptable to kill another human being? In 1973, the United States Supreme Court ruled that a woman's right to privacy in her relationship with her doctor supersedes the fetus' right to life. Since that ruling, abortion appears to have become a more accepted event of life in an increasingly secular society. However, in the past decade fewer physicians are active in the abortion movement, fewer clinics are offering elective abortion, and abortion proponents are lamenting the increased difficulty a woman faces in obtaining an abortion in many regions of the country. Training in obstetrics and gynaecology in the United States is regulated by the Accreditation Council for Graduate Medical Education (ACGME) through its Residency Review Committee (RRC) for Obstetrics and Gynecology. Without accreditation by the RRC for Bo/Gyn of the ACGME, no graduate of a residency training program may sit for the certification examination given by the American Board of Obstetrics and Gynecology. Without board certification, hospital privileges will not be granted and the physician cannot practice. In 1995 the RRC proposed regulations requiring abortion training in every residency in Bo/Gyn in the United States. Objection by residencies based in church affiliated hospitals failed initially to change the RRC edict, but Congress passed legislation preserving the personal and programmatic right to religious or moral objection.
The current RRC regulation governing this issue was a result of legislative mandate and is as follows:Program Requirements for Residency Education in Obstetrics and Gynecology
Section V: A; 2
Paragraph e, in part
No program or resident with a religious or moral objection shall be required to provide training in or to perform induced abortions. Otherwise, access to experience with induced abortion must be part of residency education.The Code of Ethics of the American Medical Association specifically supports a physician's right to decline to participate in any procedure or therapy to which he or she morally or ethically objects. Furthermore, there is a small but growing movement with Bo/Gyn in the form of the American Association of Pro Life Obstetricians and Gynaecologists (AAPLOG), with 2500 members, a web site, and status as a Special Interest Group within the American College of Obstetricians and Gynaecologists. All of these developments support the success of pro life physicians seeking training in Bo/Gyn in the U.S. without fear of forced participation in abortion.
However, a review of the 254 accredited Bo/Gyn residency programs in the U.S. shows that only 17 (7%) are church affiliated, and these are training only 236 (5%) of the 4700 residents in training in the U.S this year. It is clear, therefore, that the many Catholics and other pro life residents training in secular programs represent the largest pool of pro life professionals that must be supported and nurtured.
The church bears the brunt of the responsibility to actively and aggressively support and protect these trainees in their quest for abortion free training. There is though, sadly, the perception that in many diocese, the focus on and against abortion has been lost. These trainees will find support and inspiration no where else. This focus must be regained.
I serve as a department chairman of Obstetrics and Gynecology in a state sponsored medical school in which abortion is not prohibited by law and has been available. I have been Residency Program Director at two major university programs. My Catholic faith and my pro life position is well known. I have presented ethical discussions to the residents and medical students on the topic of abortion and the physician's moral and ethical obligations to the patient. I have not kept my position secret. About half of our residents are Catholic. I have also seen a diminished presence of pro abortion physicians in the department over the five years I've been Chair and an increased proportion of pro life faculty. Pro life faculty need no less support and inspiration than pro life trainees. The focus against abortion from the pulpit must be regained. If we are to grow the pro life movement within the ranks of obstetricians and gynaecologists, we must encourage the development and maintenance of residencies affiliated with church sponsored hospital systems that are of the highest possible quality to attract the highest quality trainees and faculty. No less aggressively, however, we must encourage every diocese and parish to consistently speak to the issue of abortion and the unethical practices of many abortion clinics. Only with a two tiered effort, both within catholic affiliated programs committed to excellence, and through support for a pro life position from the pulpit can the pro life movement with the profession be promoted.Challenges in Infertility
Adrian Thomas, MD, FRCOG, FRACOG, Consultant Obstetrician and Gynaecologist, Mercy Hospital for Women, Melbourne, Australia
The field of obstetrics and gynaecology presents challenges for practitioners and hospitals trying to accommodate patients' requests while at the same time following the teachings of the Church. Such challenges are also faced by patients and probably the greatest of these exist in the field of infertility management. Once simpler means have failed, often the only option available is assisted reproduction - GIFT, IVF, ICSI, etc. The couple is then torn between the possibility of achieving a pregnancy through such means and the desire to follow the teachings of the Church which oppose these modalities of treatment. An actual example will demonstrate this issue.
A 28 year old woman has had previous abdominal and pelvic surgery which has led to bilateral tubal damage demonstrated on hysterosalpingogram. Laparoscopy is considered too dangerous because of the risk of damage to the bowel and open tubal surgery is unlikely to be successful. At present, their only realistic hope of having their own children is through IVF itself or possibly ICSI with intrauterine replacement prior to syngamy (to which there may not be quite the same moral objections as IVF) adoption is not an option in most of the developed world these days. Their chances of natural conception would be reduced even further if her husband had oligospermia and they would be under even more pressure to pursue ICSI. It seems cruel to ask these patients to forgo these options when there are no alternatives available which would be in accordance with the teachings of the Church.
The other side of this issue is that, at least in Australia, subspecialty training in Reproduction requires a certain time to be spent doing IVF, and even if this were not the case, all centres doing advanced reproduction training are doing IVF. Those with more objections to IVF are therefore most unlikely to pursue this field leaving the whole area and the discussion of issues within it, largely to those whose ethical position is often diametrically opposed to those who respect life from its earliest beginnings.
We must therefore address these issues seriously and consider how we can
(1) help our patients in their trying times, (2) assist practitioners who wish to pursue this field but have ethical objections to some of the procedures, (3) sponsor research into alternative procedures that are not in conflict with the principles underlying Church teaching.Catholic Medical Education In Obstetrics & Gynecology
Paddy Jim Baggot, M.D. and Michael Gerard Baggot M.D., University of Southern California, USA
In the 1990's, much of routine obstetrics and gynaecology is contrary to Catholic teaching in medical ethics. Many allege that practising OB-GYN in accord with the Vatican would be unworkable and impossible. Catholic hospitals and medical schools sometimes tolerate or engage in practices which are, from a Catholic moral perspective, unethical.
The fact that Catholic hospitals and medical schools engage in these practices does not go unnoticed. Many decent non-Catholics look to them for guidance but they are confused. They assume that if some practice or procedure occurs in a Catholic institution, it must be ethical. Others conclude the Churchs position on medical ethics must indeed be unworkable, otherwise Catholic institutions would adhere to it. Teaching of error undermines the truth.
The lack of an acceptable Catholic alternative is harmful to many. Patients who seek treatment in accord with Church teaching are too often unable to find it. A few students attend Catholic medical schools to avoid participation in practices they know are wrong. Non-Catholic physicians might embrace Catholic medical care, but they are unaware of its existence. Western society as a whole is widely perceived to be undergoing a broad and profound moral decay. Society needs the examples and leadership that should come from Catholic institutions practising medicine in a Catholic way.
Patients, medical students, and other have related to me incidents wherein Catholic institutions are doing things considered immoral by the church. Medical students at Catholic medical schools have told me that some patients with maternal disorders were advised to have abortions. Some fetuses with birth defects were delivered early so as to end the pregnancy-a fetal form of euthanasia. Some students were drawn into tubal ligations or other forms of contraception even though they tried to avoid them. Newspaper reports suggest that assisted reproduction techniques are being used at catholic medical schools and hospitals.
When Catholic medical schools duplicate secular practices, they undermine church teaching and Catholic medical ethics. Patients who want and/or need Catholic medical care cant find it. Pro-life medical students avoid OB-GYN residency training because they feel they will be subjected to "academic apartheid." Even students at Catholic medical schools feel they would be persecuted for their pro-life beliefs.
Even otherwise faithful Catholic physicians go along with fetally- or maternally-indicated abortions, in vitro fertilization and contraception.
Catholic medical care in Obstetrics and Gynecology needs to be a top priority for every Catholic teaching hospital, and especially for Catholic medical schools. There is a crucial need for obstetric departments which see Evangelium Vitae, Humanae Vitae, and Donum Vitae as their primary mission.The Amelioration of Standards of Human Life Protection in Poland, after the 1993 Law on Abortion and Foetus Protection
Antoni Marcinek, MD, Obstetrician/Gynaecologist, Cracow, Poland
Discussing the problem of the discrimination of gynaecologists-obstetricians who oppose abortion and do not perform artificial pregnancy termination one has to consider the legal status in Poland at present and before January 7, 1993, that is before the law on family planning, human foetus protection and the conditions for the permissibility of abortion was passed.
In Poland's post-war history there have been two legal acts concerning family planning, human foetus protection and pregnancy termination conditions. The first of them was passed by Sejm (the Diet) of the People's Republic of Poland in 1956. It allowed pregnancy termination due to so-called medical or social indications. In the medical circles it resulted in dropping the profession by many gynaecologists-obstetricians who, owing to their convictions, including religious ones, did not accept the killing of the human foetus. One can say that during the communist rule there was negative selection of doctors for specialisation in gynaecology and obstetrics. A doctor had to face the fact that he could be forced to perform an abortion and his refusal to do so might put him to discrimination.
According to the data presented by G_ówny Urz_d Statystyczny (General Statistical Office), from 1965 to 1993 (the year of passing the said law) 830 889 abortions were performed in Poland. Those numbers are official; actual numbers of abortions including illegal ones are even five times higher .
In 1993 Sejm passed a new law on family planning, human foetus protection and the conditions for the permissibility of an abortion. This law was temporarily changed by the communist fraction of parliament which came to power in 1994 and permitted so-called abortion by social indication. Trybuna_ Konstytucyjny suspended above mentioned change in 1997. This law protects the life of conceived babies and has not had any of the negative effects predicted by its opponents. The number of abortions classified as spontaneous which in fact were induced by women themselves has not grown. The number of abortions has dropped from 51 802 in 1992 to 41 568 in 1999. The number of children abandoned has not grown contrary to the predictions made by the opponents. The total number of children abandoned was 28 in 1992 and 46 in 1999. The number of infanticide cases has not grown, either and totalled 31 in 1999, whereas in 1992 it was 59.
The opponents of the law believed that the number of hospitalised cases and severe complications as a result of illegal abortions performed in primitive conditions would increase. No such tendency has, however, been observed and the number of deaths resulting from pregnancy, delivery and puerperium was 30 in 1998 compared to 51 in 1992.
An increase in the number of juvenile mothers has not been observed since the law was passed. The number of deliveries of mothers under 19 years of age was 8% in 1990, whereas in 1999 it was 7%. Non-governmental organisations providing aid to pregnant women and mothers as well as their families have been supported financially. Towards the end of 1998 there were 28 vacant places in lonely mothers' homes.
The stance of medical authorities and public opinion make the work easier for gynaecologists and obstetricians who opt for the protection of human life from the conception. The national consultant for gynaecology and obstetrics professor Bogdan Chazan says that "the ovum, from the moment of the conception, is called the embryo, but no doubt it is a human being...".
Urz_d Badania Opinii Spo_ecznej (Public Opinion Polls Bureau) reports that as few as 2% of Poles think that the 1993 law violates their human rights, that is the right of freedom and the right to decide about an abortion. The same bureau, in its assessment of the public opinion during John Paul II's latest visit to Poland in 1999, reports that 34% of Poles thought that what had been positive in Poland over the previous two years was the protection of the life of unborn babies.
The majority of young and adult Poles questioned by CBOS (Centre for Public Opinion Polls) in 1998 opted for abortion not being allowed in the case of women not willing to have a baby. Such is the opinion of 62% of youths and 58% of adults. 55% of Poles believe that a difficult financial situation should not be an indication for abortion. On the other hand, 65% say that abortion is allowed in the cases when pregnancy is the result of rape or incest, and 44% say it is allowed when a baby is known to be born defected. Abortion is accepted by 64% of Poles in the case when the mother's health is at risk, and by 80% when there is a threat to her life. Comparing the investigation results from 1998 and 1992 we can observe a lowering tendency concerning all the cases for which the public opinion admitted the possibility of abortion. There is still a growing number of those who opt for the protection of human life.
Owing to the current legal status, public opinion and the lack of the requirement of being able to perform an abortion in order to obtain the specialisation degree in obstetrics and gynaecology (guaranteed in the specialisation curriculum) there is a favourable atmosphere for the training and professional activity of obstetricians and gynaecologists who do not perform abortions.Training of the Catholic Gynaecologist in the United States
T. Murphy Goodwin MD, Chief, Division of Maternal-Fetal Medicine, University of Southern California
The objective of this paper is to review what is known about the training of the Catholic gynaecologist in the United States. For the purposes of this discussion, the term 'Catholic' refers to one who accepts the Catholic Church's views on reproductive medicine. This is meant to include non-Catholics whose views are in accord.
Background data:
• Gynaecologists affiliated with the American College: 40,000
• Self identified Catholic gynaecologists: 40&endash;60
• Residents in training: 4,700
• Identifiable Catholic residents in training: 8&endash;12
• Accredited training programs in Gynaecology: 254
• Programs known to actively support a Catholic view: 1-2
• Programs presumed to be open to a Catholic in training: 30
• Catholic women of reproductive age 12 million
• Women identifying NFP as method of fertility regulation 3 million
Most Catholic women will receive their reproductive health care from gynaecologists trained in an educational milieu indifferent or antithetical to the Church's teachings. Some reasons for this "missing generation" in the United States are summarized below.
Few Catholic physicians are entering training in Obstetrics and Gynaecology. This is due to self selection from a field perceived as hostile and controversial. The few programs that do support Catholic teaching may not be perceived as among the best programs academically, further discouraging candidates. Programs that would tolerate a Catholic gynaecologist in training are difficult to identify and changeable as key personnel change. Subspecialty training has evolved so that physicians trained in Reproductive Endocrinology and Infertility must participate in assisted reproductive techniques; physicians training in Maternal-Fetal Medicine feels strong pressure to promote termination of pregnancy as an option for the anomalous fetus of the ill gravida. Few communities support the Catholic gynaecologist strongly enough to enable one to make a living, although there are notable exceptions.
Some suggestions for approaching this crisis will be discussed. These include:
1. Identification of an alternative, Catholic approach to women's reproductive health (explicit vs. implicit?)
2. Active promotion of the field of Catholic reproductive health to Catholic college and medical students.
3. Systematic identification of programs that promote and others that accept the Catholic gynaecologist in training.
4. Encouragement of research and special training in methods and techniques consistent with the Catholic view either through receptive established academic institutions or by promotion and establishment of parallel, independent institutions.
5. Encouragement to the Catholic community to seek out and support the Catholic gynaecologist.Indonesian Obstetric and Gynaecologic Specialist Perspective: Education and Practice
A. N. Kurniawan; J.M. Seno Adjie, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
The training of obstetrics and gynaecology in Indonesia follows a written Study Program which consists of 7 semesters and takes about 4 years time. Obstetrics training covers an important part, due to the need of capable doctors, and midwifes the like, to meet the problems of high maternal mortality and morbidity in the community.
Catholic residents, a small minority, do not face problems objecting to do procedures which relate to their beliefs or spiritual principles, particularly in cases of menstrual induction or termination of pregnancy. In family planning methods, more loose attitudes are taken against church's standpoint, due to the need to find effective methods to reduce population increase and to support the Safe Motherhood program.
Catholic ObGyn specialists can freely do their practice in private hospitals, including in catholic hospitals. Recruitment as teaching faculty staff member is possible, the selection of which is not based on religion. What procedures are done in their practice are solely upon the conscience of the doctors.The Obstetric-Gynaecological Practice in the Czech Republic during the Communist Regime and in the present days
Miloslav Nesyba, Department od Gynaecology and Obstetrics, Hospital Karlovy Vary, Czech Republic
Not only medicine, but also our whole society was strongly influenced by communist ideology. Denying any and all Christian values was in our branch especially remarkable in dampening and denying respect to the conceived and unborn child. The embryo was a thing, which could be manipulated as wanted. The pregnancy interrupting -abortion -was considered to be a routine; it helped to get rid of an unpleasant and bothering burden. And to stress that it was not interrupting of pregnancy, ending a life, it was even called the "menses control" in the 80s.
All the young, starting from basic schools, were educated in such an attitude and girls and women were being convinced that it was only them who had the right to decide what would happen to the conceived child and if they did not want to be pregnant that there was a public facility, which would take care of everything and a doctor, thinking socialistically, who would solve the situation.
The entire process of pregnancy interrupting was under the state control. There were so called abortion committees established under the District People's Committee, which, upon the woman's request, decided about being or not being of the conceived child. The committees also decided when and who would be allowed to undergo an abortion. Although such committees should have represented a certain restriction, the abortion was not a problem at all due to high corruption. The attitude of the socialistic state with regards to this problem was also apparent in the committee structure.
The committees were formed by members of parliament who did not have any medical, psychological or social education and they also were not professionally familiar with the problem. I myself remember a structure of the committee in Karlovy Vary, where at that time a shop-assistant from the vegetable shop was a chairman, a sift department worker of a big company was a member together with another state administration clerk -but all of them with excellent political background. It is true that a doctor-gynaecologist was invited to the committee proceedings, but he/she should only confirm that a request for abortion made due to health problems met the particular Ministry decree. He/she could not influence the decision of the committee.
The committees were dissolved in 1986 when the act on "artificial interrupting of pregnancy" was upgraded. The paradox is that the act was much more liberal and according to the act, it was just a woman who decided when, where and how many times she would undergo the abortion. Actually, the only limit is that the woman can ask for abortion twice a year at the most but there exist a lot of exceptions, which make it possible to undergo abortions e.g. each month.
The abortions could have been done only in hospitals, the doctor-gynaecologist was forced to and had to perform them, if he/she had refused, they had to leave the field in which they worked and had to go to another one or to an ambulatory department where their duties were to fill in applications for abortion. The lack of respect to even an unborn child led to such situations that children, who were born in advance or were immature and seriously ill, were not provided any care (not even basal) in order not to influence prenatal and postnatal mortality (and by that the socialistic health service as seen by the surrounding world). Children who died in such a way were proclaimed to be born as dead even in front of the parent and were dying somewhere in the hospital nooks. When the political situation was changed after the year 1989, the situation concerning abortion has not changed a lot. Still, the same very liberal socialistic act of 1986 is in force. The amount of abortions has decreased maybe because of bigger possibilities of birth control and change in thinking of a number of women (concerning middle aged women). But abortion is still something normal for young women and girls! (In our department more than 1000 artificial interruptions a year were normally done there in the 80s, while at present the number is 250 a year.)
But the attitude towards unborn children has changed remarkably. At present, in any or all obstetric departments the relevant care has to be provided to a new-born of any weight categories. I think that it is also influenced by the fear of legal proceedings.
The change of the political system brought a great change in the work of doctors- gynaecologists. No doctor is forced to perform abortions or has to be involved (particular investigation, pre-surgical preparation, anaesthesia, etc.), without stating reasons. This is only a brief introduction of a great number of problems. In our consuming society, where there is still a lack of Christian values, a few Czech Catholic gynaecologists can act on an open wide evangelical sphere.Conditions for trainees and access to Ob.& Gyn. profession in the Benelux Countries
Guido Verstraete, secretary St. Luke's Medical Guild, Ghent Belgium
In the Benelux countries permission of interruption of pregnancy has been legalised until 12 weeks amenorrhoea, practically on demand. Abortion for heavily handicapping affections of the foetus may be performed later. An acknowledged ethical committee functions in every Medical Institution, has to be consulted and gives advice.
In most Catholic medical centers interruption of pregnancies is not allowed, but in some medical institutions interruption of pregnancy is performed, after a procedure of evaluation for indication of life danger of the pregnant women, a nonviable affection or fatal prognosis of the fetus, a genetic, organic or infectious affection leading to a serious handicap for survival or autonomy for the infant.
In Belgium the selection Ob.-Gyn. traineeship, organised and supervised by the seven Universities (with two Catholic Universities) is based on scientific criteria and limited by the numbers of open places for residents in the universities or affiliated medical centers.
Conscience objection to participate in pregnancy interrruption is nearly never an impediment to be accepted as a trainee, neither to finalise the curriculum.
Even at the free-mason University of Brussels a candidate has been accepted and respected on the condition not to propagate his moral norms.
Regarding the access in most medical institutions and the practice of obstetrics and gynaecology, the moral objection to abortion is not questioned neither to the midwife nor to the gynaecologist. In the Benelux countries the law permits abortion nearly on demand of the early pregnant woman, but the law also protects the conscience objection on the condition that the pregnant woman gets the information where she eventually can have interruption of pregnancy.
The data of this description of the Benelux situation have been collected by interviews of several Professors and colleagues in Belgium and many Catholic colleagues in the Netherlands.
