This article appears in the August 2001edition of the Catholic Medical Quarterly
THE FUTURE OF OBSTETRICS AND GYNAECOLOGY:
The fundamental human right to practise and be trained according to conscience
Joint FIAMC and MaterCare Conference in Rome, June 17th 20th 2001
Reported by Adrian Treloar
When the Holy Father addressed this conference he showed how deep is his understanding of the problems faced by doctors who intend to practise in full accord with the teaching of the Catholic Church.
"I greet all those health care workers who, as servants and guardians of life, bear unceasing witness throughout the world to the presence of Christ s Church in this vital field, especially when human life is being threatened by the culture of death". Until recently, he said, "without problems of conscience, Catholic Doctors could generally offer patients all that medical science afforded". Because of Antenatal diagnosis, In Vitro Fertilisation, embryo work and cloning "this has now changed profoundly." John Paul II said health workers should become conscientious objectors rather than compromise their faith.
Pope John Paul II said that times have now changed for Catholic Doctors.:
"The conflict between social pressure and the demands of right conscience can lead to the dilemma either of abandoning the medical profession or of compromising one 's conviction. Faced with that tension, we must remember that there is a middle path, which opens up before Catholic health workers who are faithful to their conscience. It is the path of conscientious objection, which ought to be respected by all, especially legislators."
This is a very important statement. The Holy Father recognises that pressures in the medical profession are extreme, and that they result in abandonment of our conviction or inability to practise in the profession. We know well that, under pressure, many doctors have ended up compromising their own beliefs and doing things that they would almost certainly have previously felt to be unacceptable.
Indeed, some years ago when the BMA commented upon the public rejection of one of the HFEA's consultation proposals it was suggested, "public opinion is not yet ready for such a move". The expectation is that in time, we will accept cloning and much more, but that we have not had enough time to do so yet. Doctors will follow, as they are under such pressure.
The Pope also knows (as a man who lived and fought with communism would) that those who say no will not get jobs, or will lose them. His advocacy of the use of conscience is therefore crucial. A medical profession, which is not allowed to use conscience and to discern right treatments from wrong ones, has lost its soul. Moreover, such a profession moves from being a vocational one to being a group of employees who can simply abide by contracts regardless of the good or harm they do.
We must be grateful therefore, for the Holy Father s strong advocacy of the middle way where conscientious objection is allowed and respected. And yet as someone who lived so long under communism, the Holy Father must know that freedom of conscience cannot be guaranteed. His statements are therefore stern. We cannot do what is evil, and if we are not allowed to use conscience, then we will have to leave the jobs we now hold. We will all fight hard to avoid this, but in the end, LIFE hospitals, Catholic healthcare, and other such options may be essential.
The Holy Father said that he hopes all Catholic medical and health care personnel "will commit themselves whole heartedly to the service of life. I trust that the local Churches will give due attention to the medical profession, promoting the ideal of unambiguous service to the great miracle of life... supporting health workers who respect the right to life by bringing them together for mutual support and the exchange of ideas and experiences."
So we must fight and hope. This was an excellent conference with many doctors from around the globe who have fought, who are fighting, who are excluded from posts and yet who are holding their own and winning. The tales of bravery and adherence to conscience as well as success in promoting proper care should inspire us all to carry on and grow in our defence of Catholic values and ethical medicine. We will continue to need the full support of the Church as we do this.
Dr. Adrian Treloar is Consultant Psychiatrist in Old Age at UMDS, Guy�s & Oxleas Trust.
Reports on talks and sessions given at the conference
This three day conference was called by the Holy See to address the shortage of Catholic Health Care workers who work in Obstetrics and the difficulty faced by Catholics who try to enter this field. It was organized by MaterCare (http://www.matercare.org) and the International Federation of Catholic Medical Associations (FIAMC). MaterCare is a charity set up to provide care to women in the third world who do not have access to proper antenatal and post natal care. It aims to improve care for the most neglected mothers in our world. Its surgeon members work in the Sudan and many other countries repairing women who have been cast Out from society following traumatic childbirth.
The 140 delegates obstetricians, gynaecologists, a few GPs, midwives, bishops, lawyers, and ethicists came from around the globe. Most were between the late 20s and early 40s; men and women were equally represented. Many inspiring obstetricians and gynaecologists were from America. I represented the National Association of Catholic Families, and as a member of the Guild of Catholic Doctors. My particular interest is problems faced by Catholic women, who respect the Church s teaching on family life, particularly during antenatal screening.
I arrived as Rome won the football for the first time in 18 years. This would have been the experience of a lifetime for the football fans in our family! We braved the thick of the exuberant celebrations but finally had to be rescued by an old Roman who drove us and our case the last mile to the Vatican. His comment was notable. 'They have won, but won what? For those at the conference there was a clear vision. The Holy Father s address tous showed that he is well aware of the difficulties faced by those who share the Church s complete vision of human dignity.
We kept hearing 'The Catholic Church has always been for life. Christ loves life. In the first talk I heard more preached on life than! have heard in my life. At the first Mass the Archbishop said that we are called by our vocation to 'Respectfully preserve life . This simple term shows a way forward in some of the more difficult situations in which doctors find themselves. For example, babies born with limited life expectancy have life which is of value in itself and should be given appropriate care to preserve their lives. Conversely while being preserved, frozen embryos appear neither respected nor in a respectable situation. Being in such an atmosphere with like-minded colleagues for several days,! was reminded of how easily we become tolerant of things (such as abortion, cloning etc.) which are actually pathological. We returned home to the story of French IVF twins conceived and implanted in a surrogate sister simply to assure an inheritance. Even the world continues to be outraged by such things when presented in a new way.
Professor O Dwyer (Eire) gave us a personal testimony that he had never seen a case in which a mother needed an abortion to save her life. He also gave a wonderful account of the moral theology of life issues. He reminded us that two countries which do not allow abortion (Ireland and Malta) have the lowest maternal mortality rates in the world. He also told us that in 1990 Poland had frequent abortion and a maternal mortality rate of 70/100,000. Following the change in government, and the visit of the Holy Father, a 300 fold drop in the number of abortions led to a drop in the death rate to 30/ 100,000 by 1998. The under 18 pregnancy rate had also fallen from 8% to 7.7% in that time. So applying the teaching of the Church helps women.
Dr Vigil (Chile) showed the wonderful complexity of cell fusion at fertilisation which some reproductive techniques bypass at the peril of the newly created person. We were also shown how such complexity means that identical twins are not 'just clones of each other as we are often told.
Dr Catherine Vierling, representing the European Forum for the Family - a non profit organisation working in the EU, pointed out that politicians are no longer supposed to refer to mothers. Such people are to be called 'those who care for children'. While we were at the conference it was revealed at the United Nations that reproductive health agendas in the third world means abortion. What hope for mothers if they cannot even be named!
There was communication and support between those attending and the members of the pontifical councils who addressed the group. Sessions of brief talks gave interesting insights from around the world. It seemed that the pressures on medical ethics are worldwide, appearing not to be a haphazard development, but rather an orchestrated at tempt, among other things, to prevent women who truly value life and their fertility from being sup ported by health care workers who will properly support them through pregnancy and childbearing.
There will still be those who, reading this, could ask, "Do we really need Catholic health care workers in this field?" But who else will attend to the needs of the women who suffer? The work of MaterCare is unique: if they do not do it, no-one else does. The Church has always sought to help the most disadvantaged, hence the Church will now support MaterCare s work. Meaningless pain was a term used several times. If there are no Catholic obstetricians or gynaecologists to offer care which respects the human dignity of those with difficult pregnancies, intercurrent illnesses, infertility, genetic diseases, etc., then too many will be left to suffer without care or face those who would force solutions as a remedy to their 'meaningless pain . We know that pain is real, not futile or meaningless. It is easier to tell mothers not to become pregnant or to suggest an abortion, than it is to say 'we will care for you and support you through your pregnancy . MaterCare hope to produce an international journal which will promote good practice and research both in the third and the developed world.
The conference was an optimistic one. With such a clear vision, respectfully preserving life and promoting women s health, I could not help but be impressed by the courage and faith of the health care workers at the conference. The Holy Father called upon Catholic Universities and hospitals to be faithful to the Church s teaching, to offer an internationally recognised teaching network, and to "help doctors who are subject to discrimination or unacceptable pressure on their moral convictions to specialise in obstetrics and gynaecology" Our challenge is clear to support women with proper, ethical medicine. We must not let families down. We need Bishops and Archbishops to help us by being equally courageous in supporting life as was Cardinal Winning. With such help, we can and will succeed.
Dr Josephine Treloar is Clinical Medical Officer
at Greenwich Healthcare NHS Trust.