General practice docs, obstetrics and palliative care
This article originally appeared in the
Reproduced with permission.
. . .in spite of their rights being recognized, many
doctors don't want to publicize their views, especially in the press, where
their views are often distorted and sensationalized. They prefer to make "no
comment." Or they speak "on background only." They want to remain anonymous.
They fear the wrath of a profession and a society that have accepted
abortion as ordinary and artificial birth control as natural. . .
They're doctors. And they practice what the Church preaches:
respect-for-life medicine: they do no sterilizations; they deliver babies,
instead of abort them, they teach natural family planning, instead of
prescribing artificial birth control; they respect all, not just the
fittest; and they endorse hospice-palliative care, not euthanasia.
Their profession's regulatory bodies, the colleges of physicians and
surgeons across the country, recognize their right to practise according to
their beliefs: nobody can force them to prescribe medicines and treatments
that they find offensive and repugnant. They have the right to refuse to do
abortions, and nobody can force them to refer patients to abortionists.
However, according to Dr. Peter Seland, deputy registrar of the B.C.
College of Physicians, doctors must inform their patients thoroughly: "there
is an implied consent between a patient and his doctor: When a patient goes
in to seek help, he is saying, 'Doctor, I expect you to give me all the info
that is pertinent to my concern,' so doctors cannot simply present the side
of a story with which they are most comfortable any more than a surgeon can
present only the surgical options," while ignoring the medical treatments.
When a patient is seeking an abortion, her doctor does not have to engage
in a long, detailed discussion, says the College's ethics spokeswoman
Sandra: "Telling a patient that she must seek an abortion somewhere else is
perfectly acceptable to the College." The only condition is, "doctors are
not allowed to proselytize."
However, in spite of their rights being recognized, many doctors don't
want to publicize their views, especially in the press, where their views
are often distorted and sensationalized. They prefer to make "no comment."
Or they speak "on background only." They want to remain anonymous.
They fear the wrath of a profession and a society that have accepted
abortion as ordinary and artificial birth control as natural. They're
inclined to believe that the practice of medicine is "going completely
secular and God help you if you object."
Nevertheless there are many who aren't afraid to speak out, to identify
themselves as pro-life, to proclaim that they practise respect-for-life
medicine. Some of them suffer for doing so.
Ontario family doctor
Stephen Dawson is facing his college's discipline committee. He refuses
to prescribe the birth control pill to single women. Four women have
complained. He also refuses to prescribe Viagra to single men, but no men
have complained. And he refuses to do abortions.
Two B.C. doctors, Thomas McBride of Powell River and Howie Bright of
Chilliwack, feel that Dr. Dawson got himself into hot water because he
lectured the women on their morality.
Drs. McBride and Bright are Catholic converts who changed their practices
in order to bring them into keeping with their new faith.
Dr. McBride says "the key here is that when I made the change it was for
the sake of my soul, not my patients' souls. I think he stepped over that
boundary when he implied that he was concerned with his patients' souls. If
he had simply said, 'Look I am not going to do this for my own reasons,'
they would have accepted it."
Katheryn Clarke of the Ontario College of Physicians says that the
"manner with which Dr. Dawson refused to prescribe oral contraceptives to
four women" is the issue. "It is fair to say that physicians have the
freedom to give care in accordance with their conscience but when declining
to provide a medical service they must do so in a professional, respectful
"Also," McBride adds, "you have to be consistent and show no
discrimination, so I don't prescribe the birth control pill at all." Whereas
Dr. Dawson "was refusing to prescribe it to unmarried couples or unmarried
women. So he will prescribe for married but not unmarried, which is
discriminatory, implying a judgment that a sexually active single woman is
doing something wrong."
Dr. McBride also serves as an anesthesiologist. He refuses to do so for
sterilizations, and the local surgeon accommodates his stand. Dr. Bright
says that he gets the same respect from his colleagues.
Neither doctor suffered any noticeable loss of patients when they
converted. When Dr. Bright converted his practice, he spent a year informing
his patients that he no longer referred for abortions or sterilizations and
he no longer prescribed birth control.
"Women," he explains, "come for an annual pap smear and renewal of their
birth control pills, so I had to go through a year of telling them that I'd
changed my tune. And in that year I had only two patients who were upset
with me. Interestingly, they are still my patients. They got mad at me but
they saw that I was doing what I had to do and they stayed with me. I may
have lost a few patients I'm not aware of because of converting the practice
but I've always found it interesting that the two who got irate are still my
Those who insist on being on the pill, or other artificial methods of
birth control, get it from their doctors' partners or colleagues. It's a bit
awkward but it works. And those who want abortions don't need referrals to
Dr. Agnes Tanquay is a cradle Catholic who has always practised her
profession according to Church teachings. She trained in the East and served
as a Canadian army doctor before settling in Chilliwack as a family doctor.
She delivers about three babies a month.
She works with doctors who also refuse to refer for abortions, but they
do prescribe birth control. However, like her, they don't prescribe the IUD
or the abortion pill or the morning after pill."
Dr. Tanguay says that as "a lady doctor" women expect that she will fill
all their needs. "I do their pap smears-I do a lot of papping- and they say,
'By the way, I want the pill,' and I say, 'By the way, I don't prescribe the
As is the case with other doctors, her patients who insist on the pill
get it from her partners and colleagues.
Dr. Tanguay says that other medical staff "just think" that she's "weird"
when she informs them of my pro-life practices.
A doctor who practices according to the Church's teachings, she says, can
feel very isolated. "It becomes very heavy. You feel like the Lone Ranger.
If your patient doesn't feel that contraception is wrong, she will go to
another doctor for it and come back to you for her general care, so it is a
bit awkward sometimes.
"You know that people are talking about you. They say that you are a big
nut, ha, ha, ha, or that you are a religious fanatic. That hurts. Most
people are respectful to your face but they're different behind your back.
Some comments get back to me:"
For instance, Dr. Tanguay had advised a friend with four children why she
felt a tubal ligation is not a good option. Her friend told her doctor of
Dr. Tanguay's opinion, and the doctor quipped, "Ah, Dr. Tanguay is Catholic;
she wants women to have as many babies as they can, ha, ha, ha."
So, Dr. Tanguay says, you can see that your friends and colleagues simply
Like Dr. McBride, Dr. Tanguay has never informed her college of
physicians about her practices so she's not sure it knows about her stand
even though some patients have threatened to complain about her. But there
have been complaints concerning other pro-life doctors.
"A couple of years ago," she explains, "there was a complaint against a
doctor who would not prescribe the 'morning after pill,' and so now the
college is saying that doctors do not have to do anything against their
Emergency care, of course, is given without question, which poses a
hypothetical problem to Dr. McBride: some might consider the 'morning after
pill' as emergency care since, ideally, it should be given within 72 hours
of intercourse. If there's no other doctor or pharmacist around, can the
doctor be compelled to prescribe it?
Being sued for wrongful birth is another hypothetical problem that Dr.
McBride poses: a 14-year-old comes in for an abortion. Her doctor refuses to
do the abortion and he refuses to refer for one. She's too immature to
consult other doctors and carries the baby to term, and her parents sue her
doctor for wrongful birth-hypothetical, but possible.
The government, Dr. McBride adds, could also argue that doctors are
obligated to refer for abortions because the provincial plan pays them;
however, in order to avoid this public-funding argument, pro-life doctors
don't charge the system or the patient for time spent explaining
respect-for-life medical practices.
Dr. McBride no longer volunteers to relieve doctors in isolated posts
because being the only doctor leaves "no reasonable alternative" for
patients who insist on anti-pro-life practices, which could leave him open
to legal action.
He says the pressure to conform to secular medical practices is very much
there for medical students and residents. However, "once you're a licensed
physician, you're quite an independent contractor."
Dr. Karen Stel is a recent family practice graduate who has just
completed an extra year of obstetrics. She's now a licensed physician in
Ottawa. She's currently doing locums.
She has always taken an anti-abortion stand so she never had to wrestle
with whether she'd do abortions. It was birth control that caused her
"When I started my family medicine residency about three years ago," she
explains, "I was still undecided about whether I would prescribe
contraceptives but once I read about it and its potential complications I
decided not to prescribe. Throughout my residency, I made it clear when
working with doctors that I do not prescribe contraceptives." She does not
renew birth control prescribed by those she relieves.
Her respect-for-life practices "did not affect" her "clinical
evaluation," she says, but at the end of each "rotation" her "preceptors
would suggest" that she "reconsider" her refusal to prescribe
contraceptives. But Dr. Stel remains pro-life." And now when physicians
approach me to do locums for them, I make it clear that I can if I don't
have to go against my pro-life convictions."
When interviewed, she was replacing a pro-life doctor who's completely
sympathetic with her respect-for-life practices, but she was about to take
over for a woman who could not believe, initially, that "in this day and
age" there are doctors who do not prescribe contraceptives.
"To be quite honest," says Dr. Stel, "there is quite a shortage of
doctors these days, so doctors are more than willing to accommodate pro-life
views in order to get somebody to take over their practices."
Dr. Stel describes herself as a Protestant brought up "knowing and
believing" that human life is "formed inside the womb and that God knows our
every stage of creation."
She was one of two pro-life residents in the family medicine residency.
The other one was a male.
"For him," she says, "it was more difficult because people felt, 'He's a
man. He doesn't understand.' They respected my convictions because I am a
female, but overall, I don't think being pro-life affected his evaluation."
For work she plans to do in Africa, Dr. Stel just completed an additional
year of training in obstetrics.
When she applied for the extra training, she fretted about whether she
should tell those running the obstetrics course that she does no abortions
and no tubal ligations.
Her preceptor at Kingston told her, "Well, Karen, I wouldn't bring it up
unless they bring it up in the interviews." The interviewers never asked.
She didn't raise the issue till she started doing C-sections. Since tubal
ligations are often done with C-sections, she would tell each surgeon before
going in that she would be standing aside for the tubal ligation. It "raised
a few eye brows."
Only one doctor balked at her refusal to do sterilizations. He felt them
to be part and parcel of obstetrics. However he got used to her stand once
they'd hashed it out with the program director: Dr. Stel would observe only,
stepping in to help only if there were complications, which is the approach
she'd taken all along anyway.
Dr. Stel takes the made position on abortion: "If there is a complication
from an abortion by all means I will help. I am not going to allow a patient
to bleed to death, but I will not initiate an abortion."
Dr. Stel says, in general, doctors recognize that abortion is repugnant
to some, so it's rarely a matter of contention. Consequently, she's more
concerned about artificial birth control: "If we prescribe contraception, we
're working contrary to God's design of the sexes. It brings the man and the
woman together for procreation and if I am interfering with it I am stepping
out of bounds as a human, not just as a physician."
She wishes doctors would give more consideration to contraception. Far
too many, she says, profess pro-life views but the prescribe birth control
The doctors interviewed have the greatest respect for natural family
planning, NFP. Many if not all of them teach it. Dr. Tanguay finds that it
can be "99.5%" effective for those who are "very motivated" and "do the
follow up." She teaches the Billings method.
Dr. McBride explains Pope John Paul II's writings on the matter: "At all
times, a spouse must be treated as a subject, never an object. As soon as
contraception is used, it is almost inevitable that spouses will treat each
other as objects, which is demeaning.
And, he adds, "by abstaining during fertile periods you are not excluding
God," but acknowledging "the true complementarities of men and women. It's a
high goal. And we all fall short of it most of the time but it is where we
should be striving to go, treating each other as people. NFP virtually
demands that we treat each other with respect . . . as subjects, not
objects" by means of "communication, respect, and chastity."
Michael Brear, retired family doctor and father of eight, expresses the
same idea somewhat differently: "The husband who does not love his wife's
fertility does not love his wife totally. He rejects her fertility, her
essential femaleness, thus introducing the language of rejection into the
language of love."
All the doctors say that contraception or sterilization alters marriages,
weakening them, making them more prone to divorce.
Dr. R. L. Walley, a professor of obstetrics and gynecology at the
Memorial University, in Newfoundland, says NFP has never been taught to
doctors and nurses. It has been seen "as well-meaning stuff that comes from
organic gardeners," an attitude that has scuttled popular use of the natural
Dr. Walley is developing an NFP course with education credits that he
hopes to make available to physicians over the Internet, and he wants to
provide information about breast cancer and abortions because "there seems
to be strong evidence-growing evidence-that there's a link between the two,
the information is being kept quiet."
Surviving as a pro-life obstetrics professor has not been easy. [See
Pro-life OB-GYNs Left Out in the Cold - Administrator] When asked his
opinion of doctors and pharmacists and nurses who refuse to comment
publicly, Dr. Walley said, "To be honest, I don't fault them for it. It is
exceedingly difficult. I don't think Church people, and that includes the
hierarchy, appreciate what pressure obstetricians and gynecologists have
been under for the past 25 to 30 years; and, you know, we all have to
The selection committee at Memorial University's medical school didn't
ask him his views on birth control and abortion and euthanasia and eugenics
when they hired him, but when his stand became known, there was an effort to
get rid of him.
"They didn't realize what they'd got until I was in. And the funny thing
is, one of the strongest pro-abortionists supported me all the way down the
line. I'll never forget him. He'll be in my memoirs. His name was David
Charles. Dr. David Charles, a Welshman. He got me tenure. With people out to
expel him and with "no support from the Catholic community, Dr. Charles came
up from Boston; he was under indictment down there over the abortion issue,
and he came up to support me."
"He had the guts to support me when there were other people so-called
Christians and so on who would have been quite happy to get me out because I
was just this irritating sore. They didn't want somebody who kept on and on
about the abortion issue."
"There were many people who wanted to be the [only] Catholic physician
and the Catholic obstetrician in town."
Dr. Walley says he survives because the school "has accepted" his
pro-life "stand to come extent" and because he has been "successful,"
introducing programs, doing joint research, getting published, winning
awards, and forming MaterCare
International, which provides care for poor countries: the obstetric
fistula project, midwife training, emergency transport with blood
transfusion, developing simple treatment for post-partum hemorrhage, and
raising money to build a birth trauma center in West Africa.
As for those who question his practices because they fear the so-called
population explosion, Dr. Walley says, "There isn't one, and the U.N. admits
Life begins with conception and birth and ends with dying and death. Dr.
Michael Brear says patients need their doctors to be strong when their
facing death: " You have to let the patient know that he is dying and you
have to be cheerful about it; after all, we all die. There's no point in
being glum about it. Being very positive with the patient gives him that
little bit of confidence."
"I always found," he continues, "that by and large the average person
facing death faces up to it. Usually, the nursing is good. And families are
good, usually, and so there's lots of support. I've always found it is no
Pain control is usually good, Dr. Brear explains, so quite often when a
patient complains that he's in pain, he is, in fact, complaining about fear,
fear of a painful death or fear of not being in control of his death.
Dr. Brear illustrates this point with an anecdote about an elderly
patient admitted through emergency. He spent two days in intensive care
before Dr. Brear returned from days off.
"He was an elderly patient, an Irishman, a smoker, a lovely man. And when
I went in to him, he said, 'Doctor, get me out of here. I've died seven
times.' That's what he said."
He called in the Irishman's family. They discussed his condition. They
gave "it another 24 hours" and finally Dr. Brear suggested a change in
He told them, "I think we should put him in a bed and hold his hand and
look after him. And that is what we did, and he died about 48 hours after
I'd taken the tube out.
"I'll never forget that man. Wonderful man. You see, if I'd been in
emergency to admit him, he'd have taken whatever treatment I advised. He
knew that I knew him and that I'd be acting in his interest. But I was not
there. I was on a weekend off."
Changing a dying patient's treatment is not
euthanasia, defined as treatment given with the intent to kill--murder.
But it's legal in some jurisdiction, like Holland and Oregon.
However, Dr. Romayne Gallagher, head of UBC's palliative (hospice) care
unit, points out that euthanasia accounts for only one per cent of deaths
where it is legal. Patients want to live as long as possible if they can die
in peace and comfort; so, if they have the choice, they choose
palliative-hospice care, which strives to relieve physical, emotional and
In Holland, she adds, they've noted that those who do choose euthanasia
are rarely in physical pain; they're usually in "intractable" emotional or
spiritual pain, "which is often hard to treat."
Dr. Gallagher realizes that many people are "confused and wound up about
the issue." Polls say that 80 per cent of the public wants euthanasia but
what they actually want "is the right to stop treatment if it is not doing
them any good, which is a right that they already have under the Health
She tells of many elderly patients who, when she was in general practice,
came to her suffering from "enormous breast cancers and they didn't want to
go through the surgery and the chemo," so she offered "them medication that
controlled the cancer" explaining to them that they did not in fact have to
have surgery and chemo. "Absolutely, it's everybody's right."
However, if a younger patient declines treatment, a doctor finds out what
might be affecting his decision: Pain? Depression? Incompetence? Early
The opposite can also happen. A patient might say that he will take all
the treatment available and then feel he cannot change his mind if his case
proves hopeless. It's up to the doctor to review treatment with patients.
But Dr. Gallagher says that you can't assume that those in old age face
death and dying more easily than their juniors: "Some people, if you can
believe it, get into their 80s without ever having thought about the
possibility that they would die. They go through this enormous 'Oh, my God,
I am going to die.' It is really quite amazing. I don't think people face
death any-well perhaps a little easier if they're older and they've kind of
thought about it. But people still love living; even at 80, it is often hard
to let go."
Near the end, when death is imminent and further treatment is hopeless,
the patient and doctors have recourse to Do Not Resuscitate Orders: no
heroics. Pain control and comfort are the only concerns.
"If people are dying," explains Dr. Gallagher, "and we know they're
dying, I'll just say, 'We'll keep you comfortable, but, when you die, we
will not come in and put you on a respirator.' People reply, 'Of course not,
why would you do that?'"
Often, too, Dr. Gallagher finds that patients believe that modern
medicine is much more miraculous that it actually is. TV leaves the
impression that we can resuscitate 70 per cent when in fact we can do only
three per cent. "Healthy people who suddenly drop on the street from heart
attacks have a 20 per cent chance; patients with cancer who are dying have
no chance. But what people perceive from TV is that they can be resuscitated
no matter what."
The press, she adds, likes the sensational: "It sounds good to be
championing the person who is suffering, as Svend Robinson does, saying,
'Those bully doctors. How can they keep dah, de, dah, de, dah.' They really
feed on people's fears. We need to keep explaining what we can do for people
and how we can make them comfortable."
Dr. Gallagher points out that when Svend Robinson was speaking for Sue
Rodriguez's desire to die, pain wasn't the issue, control was: "It was just
a control issue. Our society is so used to controlling everything, including
when and how we die. The people who've I've seen grow the most are those who
've been able to say, 'OK, today is today. I am alive. I am going to live it
the best I can.'"
Gallagher acknowledges that patients' wanting more control over your
health care is "completely understandable. That's why we're trying to get
patients to make advance directives, laying out whether they want
life-sustaining treatment, or whether they want big interventions; that's
the way for patients to have the control they want, not by advocating
Unfortunately, though, people do still die in pain, probably because the
patient and doctor aren't 'communicating' with each other, says Dr.
"Sometimes it is due to the physician's lack of knowledge, and we are
trying hard to correct that. I am a firm believer that, if we educate the
public, they will know better and say, 'Hey, wait a minute, I am not
supposed to be in pain. I am going to let my doctor know and make sure it
gets treated.' A lot of time, though," Dr. Gallagher says, "family members
project their own suffering on patients. So I think: Well the patient is
unconscious, so the person who is suffering here is actually the family
member.' Sometimes that's because dying is not understood so if we give them
some pamphlets to read so that they know what's going on. They have a much
better understanding if they know what role they can play."
Perhaps the secret to palliative-hospice care is realizing that pain "is
a very subjective emotion"-physical, psychological, spiritual-"and that fear
of pain can make pain worse."
"I find that people feel much better once I explain what I can do to
treat their pain and so on. They feel better because they feel somewhat in
control" knowing "that somebody's paying attention and that somebody has a
Dr. Gallagher says she has family members tell her that they're quite
surprised that their mother's or father's death was so peaceful. But she
doesn't feel complimented by their praise; rather she feels that "people
have seen too many TV deaths, which are far too dramatic, and not enough
However, Dr. McBride of Powell River says that there are always the
exceptional cases. For instance, people can build up a resistance to a
narcotic, so that you get a paradoxical effect: giving more narcotic causes
more pain instead of relieving it. Switching to a different drug can get
around the problem, or, if all else fails, nerves can be numbed or deadened.
Dr. Gallagher also instructs students. "It can be confusing for students
because they're taught a lot about the autonomy of the patient." If she's
seeing a patient who's pleading with her to speed up his death, students
will often wonder why she doesn't comply without question. "If that is what
he wants, why not give it to him?"
She has to explain that treating dying patients is not "like taking an
order at McDonald's." The patient is in fact trying to say something else,
something other than a wish to die. Rather than begging for euthanasia or
assisted suicide, he's more than likely telling the physician that he's in
pain, or that he's afraid of being a burden, or afraid of being plugged into
a machine, indefinitely. The patients' autonomy she says has to be balanced
with whatever unmet needs or misperceptions or fears he might have.