Protection of Conscience Project
Protection of Conscience Project
Service, not Servitude

Service, not Servitude

Changes in the Practice of Obstetrics & Gynaecology

25 Years of Practice in the USA

THE FUTURE OF OBSTETRICS AND GYNAECOLOGY: The Fundamental Right To Practice and be Trained According to Conscience: An International Meeting of Catholic Obstetricians and Gynaecologist

Organised by the World Federation of Catholic Medical Associations (FIAMC) and by MaterCare International (MCI)
Sponsored by the Pontifical Council for the Health Pastoral Care ROME, June 17th-20th, 2001

Reproduced with permission

Thomas W. Hilgers
Senior Medical Consultant, Obstetrics & Gynaecology,
Reproductive Medicine and Surgery Director

My comments at this conference are a reflection on over 25 years of practice in obstetrics, gynaecology and reproductive medicine completely within the context of Catholic medical and moral ethics as well as from my experience as a research investigator into the means upon which a physician can practice obstetrics and gynaecology and reproductive medicine wholly within the context of a Catholic moral perspective while at the same time providing the highest level of women's health care.

In the United States, we are now over 40 years into the era of oral contraception and widespread sterilization, 28 years into the widespread utilization of induced abortion and 23 years into in vitro fertilization and associated artificial reproductive technologies. The introduction of contraception, sterilization, abortion and the artificial reproductive technologies has dramatically changed the practice of obstetrics and gynaecology and, in my view, this change has been to the overall detriment of women's health and clearly to the detriment of the profession itself.

This evolution has impacted the physicians who have practiced in this field, the relationships that they have with each other, the ability to be trained adequately in this area, the view of hospitals and other outside agencies including those who, as a third party, pay for health care services. Furthermore, in some cases, it has had a devastating impact on those women who are subject to these services.

The birth control pill was introduced with the primary purpose of being a contraceptive agent. However, it quickly became a medical treatment for many gynaecologic conditions. In today's world, it is now prescribed as much for the treatment of a variety of medical conditions as it is for contraception itself. However, in reality, the oral contraceptive does not treat any underlying medical condition of women; it only suppresses the symptoms. It has led to a disinterest in making a good diagnosis of underlying diseases while becoming the "standard of care" for practicing gynaecology. In spite of the fact that it is not therapeutic and it only covers up underlying conditions, there is perhaps no medication in all of medicine that has developed such a monolithic network of support for its use. There are many reasons for this occurrence among which would include that it is simple, easy, relatively inexpensive (at least on the surface) and has an extraordinary economic backing for its use.

With the introduction of abortion, the practice of high risk obstetrics has now taken on a similar philosophy. If it apparently cannot be solved medically, and I have seen this occur on any number of occasions, the solution to such a difficult medical problem has automatically become abortion as opposed to applying one's medical expertise to the diagnosis and solution of the underlying problem.

With regard to the artificial reproductive technologies, it has now become the absolute foundation upon which the treatment of infertile women has been built. In fact, the medical philosophy that has accompanied the oral contraceptive and abortion now applies to the treatment of the infertile couple. Do not worry about the underlying diagnosis or the treatment of the underlying condition. The whole philosophy behind in vitro fertilization is a kind of "jumping over" of the underlying disease and this principle has now been applied to the whole spectrum of diseases that confront infertile women.

It is no wonder that in the United States the prematurity rate has now increased to nearly 12%, the incidence of breast cancer is epidemic, and there are no end of other problems such as sexually transmitted diseases which have also become epidemic during this period of time. For anyone to think that the current practice of obstetrics and gynaecology - while on the one hand being considered "modern medicine" - is to be considered a good and effective way to practice medicine, they should seriously think about this. What has happened in the practice of obstetrics and gynaecology over the last 30 or 40 is, from my perspective, a significant decline in the quality of care that has been provided to patients. While it may be true that some of the underlying diseases can be "covered up" and "suppressed" or even "destroyed," it is not true that they can be "escaped."

In fact, the current practice of obstetrics and gynaecology, in many ways, borders on fraud. To say, for example, that you can treat endometriosis with birth control pills or Lupron, is fraudulent. To say, for example, that in a women with ruptured membranes at 20 weeks of pregnancy can be most effectively treated by aborting that pregnancy, is fraudulent. To say, for example, that a women with a history of two previous classical Caesarean Sections who, in the treatment of her current infertility problem has her ovaries hyper-stimulated and conceives quintuplets under the guise that there is no other treatment available to them, is fraudulent and furthermore borders on malpractice. To say, for example, that the only means upon which a woman with severe dysmenorrhoea can be treated is with oral contraceptives is fraudulent. And the list goes on and on with specific examples of cases that I have been exposed to over the many years of my practice. This is indeed, the state of the art of obstetrics and gynaecology in the year 2001, but women's health, in my view, has suffered as a result of it.

Furthermore, there are patients who have very significant religious objections to this approach to treatment and their views are not respected at all by the physicians who work from this perspective. In the United States, where the first amendment to our United States constitution is designed to protect us against those who might force us to receive medical care which goes completely contrary to our religious beliefs is virtually laughed at. To make things more difficult, the physician who wishes to continue to practise as a Catholic obstetrician gynaecologist 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. Ultimately, the health care system would be most happy if there were no Catholic receiving health care or no Catholic physicians wanting to provide health care. At least, that would appear to be the state of things at the present time.

Indeed, there are exceptions to all of the things that I have just enumerated. What I have just enumerated is not universal, it is only nearly universal. The overall health care of women is in deep need of resuscitation. It is in need for intensive care. I personally believe that the medical ethics of the Catholic church offer great hope in the area of the medical care of women and in my own research and educational program development of the last 25 years, we have devoted our energies to accomplishing that. This is now beginning to take focus as we reach the culmination of 25 years of research in the publication of our new medical textbook entitled The Medical and Surgical Practice of NaProTechnology. I am not here to promote NaProTechnology. I am only here to indicate the extraordinary needs that exist for Catholic women throughout the world within the current practice of medicine whose emphasis is on contraception, sterilization, abortion and artificial reproduction. Sometimes we think that modern medicine is an evolution of thought which occurs naturally and evolves in such a way that one would expect in a completed product. That is to say, that there is no other way of approaching problem solving or no other philosophy which may provide "a better way." In fact, a Christian anthropology demands that we approach the medical care of our patients from a perspective which is quite contrary to current approaches. I can guarantee you that this can not only be more effective, but is founded upon long held medical principles of establishing a diagnosis, looking for the cure or the appropriate treatment and implementing it.

I am so grateful for this conference being held. My main reason for participating is to encourage the Church to speak our with boldness, the courage of its conviction and the hope that it can be a try light to the world in these areas where the Church has for so many years been made to think that I is embarrassingly "behind the times," naïve and unable to cope with the dimensions of the real world. I would like to thank, in particular, Dr. Robert Walley for his incredible leadership in seeing that this conference has taken place and I want to encourage the church to speak out with confidence in the theology and philosophies that have been expressed from Humanae Vitae through Evangelium Vitae and to speak this from the highest mountain tops and to work to try to protect Catholics everywhere and those who are not Catholic so that they have access to sound medical care which is consistent with their moral beliefs.