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August 31, 2006

Comments

Philip Howard

It's only "balkanized medicine" if someone makes it that way, contentious that is. Is Dr. Cvetkovich making things hostile for others, or is Charo making it such by terming it as such? Plus, aren't second opinions a time-honored tradition? Do those opinions constitute "balkanized medicine?" I suppose it could be the case that Charo was only making an observation, one that sounds hostile in the piece. But the term 'balkanized' lends itself to culture wars in medicine. - PH

ambrose

Wow. I wish I knew about this a few weeks ago. When I was looking for an OB, I first contacted a woman who was quoted in the local papers as a pro-Life OB/GYN. Unfortunately, she no longer accepts OB patients.

Peggy

For any Catholic in DC Metro, the Tepeyac Center is WONDERFUL. Because of malpractice insurance issues, they've had to go non-profit (under a certain code of law I can't name right now). They treat women regardless of income/insurance and accept charitable donations for that part of their mission.

I was a patient with them until we relocated.

Here in SO-IL, I needed to see an OBGYN. If the issue was pregnancy, my options were VERY LIMITED--another consequence of insurance premiums going sky high.

Brad C

Balkanized medicine is the result of balkanized values. In medicine, for instance, there is no universal agreement on what its goal is. We would probably all agree that the goal of medicine is health, but what is health? Some think it is a proper means to health to destroy a properly functioning faculty, as in the case of sterilization. Some think that only those means that restore proper functioning to our natural faculties can bring about health. Or is medicine something altogether different? Should we understand it on the business model where the doctors provide goods and services and the patients are consumers? Should I be able to purchase an unnecessary medical procedure from a doctor that would actually harm my health?

Why not let doctors practice in accordance with their values? On our first visit to the doctor after my wife got pregnant, the doctor asked us if the child was "wanted". Not "planned" or "unplanned", but "wanted". The office is filled with posters and brochures aggresively pushing contraception and sterilization. My wife and I love our midwife but we would never mention to her that we are Catholic. It would be great if we could discuss NFP issues with her but we get that from our parish and through books instead.

The fact of the matter is, medicine is already balkanized. And it ain't balkanized in favor of the Church's teachings on the life issues. Just talk to any female college student who has been to the campus health clinic. Chances are she feels pressured to conform to the contraceptive mentality of our culture.

Susan S.

I thought the article was fascinating and there's nothing problematic about "balkanized medicine," as long as there aren't additional barriers. I was concerned about the doctor who said she wouldn't give referrals to patients who wanted contraceptives and I do worry about people in rural areas where there isn't the luxury of choice.

Chris

Peggy -
We used Tepyac when we lived in DC, and they were indeed wonderful.

Never missed them so much as when, for the second pregnancy, we were living in Los Angeles and and limited options. The office was much like Brad C described. I'll never forget the first meeting my wife and I had with the doctor. We told him we'd gotten a positive home pregnancy test. His first question: "Is this a pregnancy you plan to continue?" After my wife and I picked our jaws up off the floor, we stammered "Yes! Of course!" Then, and only then, did the doctor smile and say "congratulations."

But here's the thing: my wife ended up doing an excellent apostolate with this young doctor. We were probably the first NFP-using couple he'd met, and was open minded enough to listen to us. He wasn't Catholic, but was honored when we invited him to our daughter's baptism --- and he was all smiles when he showed up at the church.

Don't know what's happened to him since, but I like to think our paths crossed for a reason. We'd much prefer an NFP-only practice, if we could find one, but discovered in LA that God can do a lot of good with any of the circumstances we find ourselves in.

Karen LH

For any Catholic in DC Metro, the Tepeyac Center is WONDERFUL. Because of malpractice insurance issues, they've had to go non-profit (under a certain code of law I can't name right now).

We actually had a pretty bad (and strange) experience with them about ten years ago (they refused to give us the results from some bloodwork, and then billed us for the tests). If they managed to fix whatever problem it was that they were having (we never did figure out what was going on), I'm glad to hear it, because obgyns who follow Church teaching are pretty scarce.

I would hesitate to go back, though, or to recommend them to anyone else.

yvonne

There's one in Fort Wayne Amy.. He's a Family practitioner... ;-)

I also found my OB from the Pro-Life OB/Gyn's website.. Although she is Christian and prescribes BC's, she knows NFP and is an advocate for it.

There's more out there, they just aren't registered with OMSoul..or the CathMedAssoc.

Stacey

Susan S.,
Here's a thought experiment for you. You believe that something, let's say stealing, is wrong. Someone comes to you for help with stealing something. You say, sorry, I can't help you with that because I believe that it's wrong, but, Joe, my friend down the street, has no similar compunctions, so let me give you his contact information and I'll give him a call and let him know you're on your way.

Can you see why a doctor who believes that abortion, contraception, sterilization, and IVF are wrong, would not want to give referrals? Besides, there are TONS of OB/GYNs out there who are perfectly willing to do those procedures/prescribe contraception out there. In fact, you'd be hard-pressed to find one of the few in the country who don't. Given the prevailing culture in this country, Unfortunately, I don't think that a doctor who is an NFP only OB/GYN would have enough patients to support a practice in a rural area, which means those of us who would prefer not to wrangle over these issues with a dr every time we go in are the ones who don't have the luxury of choice.

Clare Krishan

Good topic! I caught a segment on Charlie Rose last night where Amy Farber discussed LAM, a rare disease that mostly affects women in their child-bearing years. Excerpt from brochure at thelamfoundation.org website:

RAISING AWARENESS
It is crucial that we identify the more than
250,000 undiagnosed women with LAM through medical and media awareness. These women unknowingly participate in potentially life-threatening practices, such as birth control pills, pregnancy, smoking, and risky dietary regimens.

Being sensitive to hormone levels, female patients are warned pregnancy is a death sentence - and the usual therapy, birth control pills, also. Seems NFP would be a God send for these ladies... how many doctors are taught this remedy at medical school (is sterilization the more probable suggestion?) and how many researchers into femine health are willing to consider that birth conrol pills are a contributing factor is terminal diseases? Private initiatives like the LAM foundation seem to be an important third leg in defending the already-Balkanised orphan diseases, where the insurance industry would rather just declare "an act of God" so they don't have to cover the costs of caring for folks afflicted by them.

N.B. Charlie Rose's other guest last night was NY City's Director of Public Health who considers the term a misnomer - the systems badly broken, focusing resources on treating infrequent crises with expensive hospital admissions, rather than frequent monitoring by ambulatory care and promoting prevention. Obesity and diabetes are the new scourge. Could our propensity to chose a cheap, poor quality, carb-based diet rather than high quality fruit and veggies be tied to our abandoning the family hearth in favor of the office or TV? It takes time to prepare a good meal from scratch, why bother if you know the kids got a hot dinner at school, snacks will do at bedtime? American values need to embrace that prosperity means being able to discern and select the best quality for our kids, not just provide an abundance of supersized quantity. Rockwell chose to depict Freedom from Want with "a chicken in every pot" not a food pyramid or a WalMart, elevating the value of family time above the potential to manipulate wealth. Sadly his Freedom from Fear is prescient - the focus not on the wartime headline but the juveniles in their bed - on average diabetes with rob them of 15 years of life!

Susan S.

Stacey, doctors are supposed to provide medical information and advice. Since there is no evidence that contraceptives are dangerous and, in fact, are more effective as a form of birth control, any doctor who won't refer me to a doctor who will prescribe contraceptives is violating their obligations as a health care professional.

I have no problem with a doctor saying she won't prescribe contraceptives, but if I've just randomly called this doctor (or my insurer has limited me to just a few doctors), I would expect that she would give me a referral.

Believing a treatment is "wrong" is different from believing it is medically "unsafe."

SouthernComfortable

I am a patient at Tepeyac and love them. I've been ridiculed by doctors in the past for not wanting to use the pill. Tepeyac is such a haven, in my opinion.

Nick

Susan S.,

I don't think you are giving Stacey's hypothetical the slightest considration.

Why should a faithful Cathholic doctor be complicit in a moral evil? By your logic, the doctor would also have to refer for abortions as well. It is after all, an accepted medical procedure.

Beyond that, given that 99.9% of doctors have no problem prescribing the pill, I don't think it would take you that long to find one.

Just open up the phone book or health care provider directory can call another practice.

Karen LH

I have no problem with a doctor saying she won't prescribe contraceptives, but if I've just randomly called this doctor (or my insurer has limited me to just a few doctors), I would expect that she would give me a referral.

Susan,

Why would you need a referral? Just change doctors.

The hard thing is not finding a doctor who will prescribe contraceptives. The hard thing is finding one who won't. Or who understands NFP. Or who knows which fertility treatments are or aren't moral, or which alternatives to immoral treatments exist.

John

Susan S,
I am curious as to your assertion that "contraceptives are ... more effective as a form of birth control" If you mean more effective than nothing you are correct. However they are not more effective than NFP. NFP when practiced properly is 99% effective.(I dont have the citation for the study, I am at work right now, but have it at home)
I am also wondering what oblgations you think exist for health care professionals, are there set of obligations that one agrees to at some point? I know that they have done away with the Hippocratic Oath(that pesky part about not performing abortions was just too much).
Finally, I would ask you if you just randomly called a doctor who refused to refer to someone else, why couldnt you simply randomly call another doctor and chalk the first call up to bad luck? There are certainly far more doctors who are willing to prescribe contraceptives than there are who are not willing.

Susan S.

As long as there is full disclosure that the doctor is not going to offer all medical treatments, I don't think it is problematic and I am glad such practices exist.

My concern is that not all of us live in metropolitan areas with a wide variety of options. Some women live in rural areas or have insurance that limits who they can see. If I have limited options and can't just call someone else up, yet my doctor won't provide a referral or treatment, it can be problematic.

A doctor has many obligations. To their profession, the patient, to themselves, and to their faith. There are times those will come into conflict.

Seamus

Stacey, doctors are supposed to provide medical information and advice.

And here I thought that the practice of medicine involved "the maintenance of health and the prevention, alleviation, or cure of disease." I guess I was wrong, and that it also includes the incapacitation of the natural functionings of a healthy body.

So administering a lethal injection would qualify as the practice of medicine too, I presume?

yvonne

"...I don't think that a doctor who is an NFP only OB/GYN would have enough patients to support a practice in a rural area..."

I would tend to disagree, thats where most large families live- even the drs. themselves. Some of the Drs. Ive met through the CMA forgo the larger salaries etc.. they truly want to provide an ethical no-exception practice that is true to the Catholic faith.

Don't forget too that many women are also seeking midwives and birthing at home. For some, that's not an option due to higher risk pregnancies. But it is a viable one at that.

I have friends who've traveled as much as 125 miles to see a nfp only OB/GYN. For them it was a no-brainer and well worth the driving.

scotch meg

Susan S., you stated that contraceptives are not dangerous. My husband is a neurologist. Would you care to repeat that statement to his teenaged patient who experienced seizures as a direct result of taking oral contraceptives? To the patients he's seen who have migraines? To my friend's daughter-in-law who had an OCP-related stroke? And the problem is NOT that doctors in rural areas are refusing to prescribe birth control. When we lived in northern Maine, I had a great deal of trouble finding the one doctor within 50 miles who did not do abortions -- and he had just dumped his wife and 3 kids for his nurse, so I had a choice between evils. Mind you, he did dispense contraceptives. I would have had to drive nearly two hours to see an NFP-only MD (and there were plenty of others in between me and him!).

Susan S.

All medications have dangers. But that doesn't mean they are "unsafe." People die from taking Asprin, but I assume your neurologist husband wouldn't discourage people from using Asprin, would he?

I don't disagree that it's hard to find doctors who are familiar with NFP. That's why I think it's great that there are people who focus only on that approach. Hurray for them. But no system is perfect and it's worth considering potential pitfalls of doctors who refuse to provide referrals.

Julia

I read the article in the post this morning and also put a link to it in our personal blog. I used the One More Soul website to find my current doctor, though was saddened to hear she did not deliver babies anymore. We had a HORRIBLE experience with kaiser permanente when we recently went through an ectopic pregnancy. i mean AWFUL. in a follow up visit i actually interrupted the doctor and told her to stop talking because i didn't want to hear anything else she had to say. i don't think anyone had ever done that to her based on the look on her face. I am so grateful to have been referred to the OMSoul website. we are planning to relocate in the next year and hope we can find a practice like Tepeyac or like Dr. Raviele here in atlanta. it was such a great experience to be able to take my charts to one of my visits and sit and talk with the doctor about them. at kaiser all they did was tell me to go to a fertility specialist before they had even done any labs.

i myself am in the healthcare field and it took a while for me to realize that i could live my faith at work without feeling ashamed. i talk about prayer and God with several of my families. it's who i am. i want to be characterized by my faith. i don't want my faith to be something i do on the weekends. i want it to be who i am.

also, another good way to locate some nfp practices is to look through the catholic newpaper that your diocese puts out and go through some of the ads.

Katie

A totally pro-life OB - gyn practice in the Harrisburg, PA area is the Center for Women's Health in Camp Hill.

Marion (Mael Muire)

The physician's credo used to be, "First do no harm."

Seems to me "harm" would include prescribing a treatment that exposes the patient to risks more serious than the condition being treated.

That sounds harmful to me.

The state of being fertile is the natural condition of the adult female of the species. It's not a medical condition that needs to be treated. Why would a responsible physican seeing a perfectly normal, healthy woman whose body is functioning in the way a normal, healthy body is supposed to introduce powerful drugs to create an artificial imbalance so that her body no longer functions normally . . . and, by the way, there is a slight chance that she'll experience serious side effects as a result?

A physician should feel obligated to participate in this potentially disastrous exercise exactly why? . . .

Allison

I find the claim that "patients are ridiculed and told they are stupid" a bit off.

I think if it were so blantant, patients would feel more comfortable walking out of that office. Instead, they are told that medically, it's important to "know the risks", to "consider all options". Docs and nurses push hard for genetic screening tests--even after you tell them that you would not consider an elective termination. They still say, "well, let's see", and then depending on the results, again suggest elective terminations if the child even *might* have a chromosomal defect, such as Down's syndrome, etc. But their arguments are almost always about pain, suffering, difficulty--not ridicule.

But I have a question. NFP involves teaching couples how to prevent pregnancy. The Pope Paul VI institute uses the langugae of "to avoid" pregnancy. Does this square with everyone's understanding of Church doctrine? It doesn't with mine. I thought there was more to the teaching than simply "Artificial contraception is sinful." I thought the point was that actively planning, even to the extent of choosing timed celibacy in order to avoid having children, was sinful, because it means you are not open to having children.

Is NFP really correct? Is family planning really right? Is the way that it is taught, and the use of those practices really any different than artificial contraception? (Doesn't the fact that it's 99% effective at preventing pregnancy give away that it's still contraception?)

Allison

I guess, to finish the thought above: as people look for pro-life medical practitioners, it's not clear to me that support of NFP really means that they understand Catholic teaching. Or, in other words, there's still more to Catholic teaching of being pro-life than simply being anti-abortion.

Marion (Mael Muire)

Dear Allison,

Catholic teaching does permit the use of NFP to space births for grave reasons.

His Holiness Pope Paul VI wrote in Humanae Vitae (16): "If, then, there are serious motives to space out births, which derive from the physical or psychological conditions of husband and wife, or from external conditions, the Church teaches that it is then licit to take into account the natural rhythms immanent in the generative functions . . ."

The Church is holy, wise and prudent in this as in all her teachings, and although their circumstances may permit certain married persons to embark on unlimited childbearing and childrearing, those married persons whose circumstances do not so permit and who avail themselves of means permitted by the Church to regulate births are not to be criticized for so acting.

Let it be understood that those who do dare to criticize such couples are basing their criticism upon their own private, personal opinion, and not on any authentic Catholic teaching. To criticize others for failing to act in accord with my own personal views, (however much I may pretend they are Catholic teaching) is both unjust and uncharitable.

Michelle Martin

Well, as a mother of 10 and a wife for 20 years I feel I need to comment on the posts by Allison and Marion above. Yes, there is more to being prolife than simply being anti-abortion.
Our own experience of NFP instruction both as an engaged couple and as marriage preparation instructors at the parish and archdiocesan level was interesting. We did notice that the emphasis was rather on avoiding pregnancy. Many times anecdotal examples of couples who chose to abstain on their honeymoon rather than risk pregnancy were held up as if this was somehow a more virtuous choice! Come on! The marriage isn't a marriage until it's been consummated! I know of one couple who were asked to stop giving NFP presentations because they had a large family. And the decision to go ahead and have a large family in less than ideal circumstances is often spoken of as wrongheaded and the parents spoken of as if they were lacking self-control or were somehow at fault. It is worth thinking about what exactly constitutes grave reason for avoiding pregnancy outside of health concerns or real poverty. I mean, some people consider not having the means to educate a large family entirely in private schools serious enough reason to limit family size. Certainly the choices of another couple are none of my business and are between them and God. But the emphasis of some NFP programs on the avoidance of pregnancy just because a couple wants to for lifestyle reasons does, in my opinion, contribute to a contraceptive mentality.

Seamus

The marriage isn't a marriage until it's been consummated!

Uh, so Our Lady and St. Joseph weren't married?

Allison

I hope I didn't come across as unjust or uncharitable. I deliberately framed my questions to point toward the teaching methods and practitioners for that very reason. The NFP classes I have been to did not stress the grave reasons, gave no moral guidance on what might count, and didn't remind us to go back to our priests to help us discern the truth.

I cannot know someone else's heart; sometimes, I wonder if I know my own. I've had a hard time knowing if my use of NFP was in sin because I wondered if I, in my own mind, could use it and still be open to children. But the emphasis on its effectiveness as contraception seems to again cause confusion.

The process of helping Catholics come into line with Church doctrine is not all at once. It may take a long time to move from a "we must control our destiny" to "God controls our destiny, not us" in terms of birth and life. But it seems that NFP is often framed not to help us discern what God thinks is right for us, but to support our deciding what is right for us.

Michelle Martin

Seamus: I apologize for stating things a little to strongly, got carried away with my argument. What I had in mind was this:

CCC 1640 "Thus the marriage bond has been established in such a way that a marriage concluded and consummated between baptized persons can never be dissolved. This bond, which results from free human act of the spouses and their consummation of the marriage, is a reality, henceforth irrevocable, and gives rise to a covenant guaranteed by God's fidelity..."

JP

Seamus,
The Holy Spirit is Mary's Spouse, and the fruit of thier Union was Christ. St Joseph wasn't Mary's spouse.

Marion (Mael Muire)

It seems to me that there is nothing blameworthy about prudently and prayerfully considering the question of one's vocation, what educational and career goals one will pursue, in what part of the country one will live, whom one should marry, whether my spouse and I will live in the city or in the suburbs, whether we will both work full-time, and, if there are grave reasons, whether we should consider postponing having a child until the present difficulty is better settled.

If Christ is at the center of a young man's or a young woman's life before their marriage, and hopefully, if He reigns at the center of a married couple's life, the couple will pray together, consider, consult together, and make godly decisions . . . in matters of finance, educational and career goals, health issues, where to live, and if necessary whether to postpone having a child - for a serious reason, of course.

I have gotten the impression that some Cahtolics feel that this kind of sober and careful forethought in important life decisions is somehow alien to the true Christian life, that you have to somehow go through your life on "auto-pilot", especially in matters of fertility. Nothing could be further from the truth!

JP

Marion,
You make excellent points; however, the Church uses the word grave -as in grave finanicial reason, or grave health reason - when it speaks of using NFP to space children. If a couple spaces thier children in order for a spouse to attain thier MBA or PHD, or until one earns a promotion, then they are abusing NFP. NFP isn't suppose to be a "lifestyle" choice.

Personally, I don't think NFP is an issue since so few Catholics use it. According to a poll taken during the 90s, Catholic couples use artificial contraception at the same rate of non-catholic couples.

madmax

So what's the alternative if you feel your reasons for resorting to nfp are insufficiently "grave"? Is there an out if you merely abstain, or are you in a state of sin for having that very attitude?

To my mind the dicey economic situation of most single earner couples provides plenty of justification, but that may just be me.

Marion (Mael Muire)

madmax wrote: "To my mind the dicey economic situation of most single-earner couples provides plenty of justification, but that may just be me."

I think you have a good point, madmax. However, JP also has a point, that the decision to postpone having a baby in order to pursue advanced studies may indicate that one's priorities are not properly ordered to Christian marriage.

My point would be that it is truly a mistake to judge what others are doing, individually or in aggregate, since it is impossible to know all the material factors others are dealing with, and where they are in their relationship with Christ.

I think it's true that many Catholics do not yet put Jesus Christ first in their lives, and that is a shame, for they are the ones missing out!

The mistake it is so easy to make for people who do put Christ first, is then to look around at others and point fingers in a critical way. Little do we realize that those struggling, suffering, sinful brothers and sisters might . . . just might be ready to start looking to devout Catholics for a helping hand and an encouraging word, and instead - ouch! - they receive a poke in the eye. For making the wrong choices, for doing the wrong thing.

Yes, it's true, they have made wrong choices, and we realize that, but wouldn't it be better to bear patiently and cheerfully with others in order to keep them in our company, and ultimately to win them over to Christ?

It's not to "paper over" sinful choices, but we don't want to "paper over" the good in others, either. And that's what we do when we turn people off by criticizing and condemning them, refusing to understand them and love them. The way Christ does.

Michelle Martin

To point to a tendency in some NFP instruction towards emphasizing avoidance of pregnancy without, as was mentioned above, any sort of suggestions as to how a young couple might obtain guidance on sorting out what may or may not be a grave reason to limit their family size, is not the same thing as pointing to an individual case and pronouncing it sinful. My own comments above were referring only to what I'd heard in and read about NFP instruction. Of course these things are extremely personal and each couple's circumstances are different. I do wonder about the effects on the whole of NFP instruction that focuses on the avoidance aspect, right from the start of a marriage. I do wonder if, on the whole, it is in part the reason why so many couples give up on NFP and just start using artificial contraception.
It should also be pointed out that the decision to have a large family by using NFP minimally or not at all can also be a prayerfully considered decision made with sober and careful forethought-- it doesn't necessarily mean that a couple is going through life on autopilot, as many people, including other Catholics, are quick to assume. And of course, what's large for one couple may not be what's large for another. One can't make assumptions about a family based on its size, large or small.

Marion (Mael Muire)

Given that the couples who attend NFP classes are Catholic, non-Catholic, or mixed, I think the job of NFP instructors is simply to teach NFP.

Could our parishes in general do a better job promoting a Catholic understanding of sexuality and family life? Absolutely!

Michelle Martin

You are right when you make the point about who might make up nfp classes. My only experience of them has been in the context of Catholic marriage prep.

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