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Doctors Wonder How Federal Mandate Will Affect Practice of Medicine
By Nancy Frazier O'Brien
Source: Catholic News Service
Published: Saturday, February 04, 2012

Dr. Anne Nolte, right, a family physician with the National Gianna Center for Women's Health and Fertility.

WASHINGTON (CNS)—Whether they are just starting out or nearing the end of their careers, Catholics who want to practice medicine in conformity with the church's teachings wonder how a new federal regulation requiring health plans to cover contraceptives and sterilization free of charge will affect their work.

Although the requirement will not directly impact physicians, some said it represents a governmental intrusion into health care that could grow in the future.

Dr. Anne Nolte, a family physician with the National Gianna Center for Women's Health and Fertility in New York, thinks the mandate represents "such a dramatic violation of such clearly defined civil rights" that it is bound to be overturned in court.

But, she said, "If Congress failed to pass an act that provides an exemption for the groups affected by this, and the courts in some incomprehensible way allow (the mandate) to stand, then Catholic health care will have to make a decision to practice civil disobedience."

Dr. Kim Hardey, an obstetrician and gynecologist in Lafayette, La., said he hopes the decision by the Department of Health and Human Services and the Obama administration will cause Catholics and other Christians to rise up against "the liberal left" and "misguided feminists" who would like to see abortion also become a required part of every medical practice.

"If we can allow the infringement of any group's beliefs," everyone's beliefs are threatened, he told Catholic News Service in a telephone interview Jan. 31.

The new contraception mandate, with a narrow exemption for religious organizations, is part of implementing the Patient Protection and Affordable Care Act of 2010, which sets up new preventative health care coverage specifically for women at no cost.

That coverage includes services such as mammograms, prenatal care and cervical cancer screenings. But it also mandates free contraception, sterilizations and drugs (such as ella and "Plan B") considered by the church to be abortifacients -- all of which are contrary to Catholic teaching.

On Jan. 20, Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services, announced that nonprofit groups that do not provide contraceptive coverage because of their religious beliefs will get an additional year "to adapt to this new rule."

Sarah Smith is not a doctor yet, but she worries that the HHS mandate will further sour an atmosphere in which she already finds some challenges to her pro-life convictions.

"The one safe environment -- Catholic hospitals -- is not even going to be safe anymore" if the contraceptive mandate stands, she said in a telephone interview with CNS from Chicago, where she had just completed the last of "14 or 15" interviews for a residency position in obstetrics and gynecology.

A fourth-year medical student at Tulane University School of Medicine in New Orleans, Smith made clear on each interview that her Catholic convictions prevent her from involvement in abortion, sterilization or contraception.

She said she has found that "most doctors as individuals respect my beliefs and my conscience; they might not agree with me, but they'll defend my right to practice medicine." Problems are more likely to arise at the institutional level, where medical students and residents are "culturally at the bottom of the totem pole," Smith noted.

"Some Catholic hospitals make it much easier for medical students and residents to live out their faith," she said. But at a secular hospital where "they are doing 400 tubal ligations a year, you might have the choice not to participate, but the work flow makes it harder," she added.

A native of Natick, Mass., and a 2007 graduate of the University of Notre Dame in Indiana, Smith said she enjoys "working with underserved populations" but might not ever be able to work at a federally funded community health center, since the government requires that all family planning options be offered at those centers.

"I am not at the point in my career where I have experienced" discrimination because of her pro-life beliefs, Smith said. "We are kind of insulated in medical school. But then you get out and you say, 'Wow, all these policies could really affect my practice.'"

After assisting in the delivery of about 6,000 babies over the past 29 years, Hardey has the real-world experience that Smith lacks. He believes that some in Washington would like to drive obstetrician-gynecologists, or OB-GYNs, who won't perform abortions out of business.

"There are not that many of us ... that we'd be too big to go after," he said.

Hardey prescribed contraceptives and even thought they were beneficial for the first nine years of his medical practice. But then he began to see some of their effects -- not only on his patients but on societal attitudes -- and decided to conform his practice to the church's teachings in "Humanae Vitae" ("Of Human Life").

The 1968 encyclical by Pope Paul VI on married love and procreation reaffirmed church teaching that artificial contraception is morally wrong.

At age 58, Hardey said he is thinking of leaving his work as an obstetrician, "not because of the environment the president has brought about" but because of the long hours and erratic schedule required to deliver babies.

"I love my practice," he said. "But to live the OB-GYN lifestyle, you have to really love it."

Nolte, who completed her medical training in 2009, focuses her family practice on providing "authentically Catholic" health care for women, especially in the areas of gynecology, infertility treatment and natural family planning. She sees the Gianna center as "an alternative to Planned Parenthood" in Manhattan.

"We do exclusively women's health care faithful to the" U.S. church's "Ethical and Religious Directives for Catholic Health Care Services," she said.

The directives, most recently revised by the U.S. bishops in 2001, guide Catholic health care facilities in addressing a wide range of ethical questions, such as abortion, euthanasia, care for the poor, medical research, in vitro fertilization, prenatal testing, and nutrition and hydration.

But that doesn't mean Nolte serves only Catholics.

About 40 percent of her patients are Protestants or have no religious affiliation. "Women come from other states just for their annual exams, and they bring their daughters," Nolte said. "They see that we treat patients differently."

Like Hardey, she expressed concern that "this administration is happy to violate civil rights" on the issue of contraception and could then decide to do the same on abortion or other problematic issues. But she said nothing will ever put Catholic health care out of business, even if civil disobedience is required.

"A large number of people would not have access if we get out of health care," she said. "And we can't let that happen."

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