By Ann Carey

Catholic physicians encounter multiple challenges

Following Church teaching leads to discrimination and loss of patients, but Catholic doctor says there are also rewards

George Isajiw, M.D., is board certified in internal medicine and has been in private practice in Lansdowne, Pa., since 1978. The recipient of several pro-life awards, he has been very active in the Catholic Medical Association (CMA), the largest professional association of Catholic physicians and health care providers in the United States. He has served as president of both the Philadelphia Guild of the CMA as well as the national CMA, and he served three years as vice president of the World Federation of Catholic Medical Associations. Isajiw and his wife, Patricia, are the parents of seven children.

He recently spoke with Our Sunday Visitor about some of the challenges confronting Catholic physicians in their practices today.

Our Sunday Visitor: How did you develop your perspective on how a Catholic physician should practice medicine?

George Isajiw, M.D.: I owe an incredible debt to those early years when I had personal mentoring from other physicians who were, at that time, members of the local Philadelphia CMA. This was crucial to me, because I didn't learn these things in medical school or residency, even though I was a resident in a Catholic hospital.

OSV: As a Catholic doctor, what challenges do you encounter dealing with patients?

Isajiw: There is the obvious issue of people looking for abortions, whether they be my own patients or patients referred to me by the local crisis pregnancy center. That is a very hard experience, but nevertheless a very rewarding experience, even when you don't succeed 100 percent of the time.

Here's the challenge for the Catholic physician: Some doctors just say, "I'm Catholic and don't get involved with that; if you want an abortion, go somewhere else." But that's not the right attitude; you have to sit down with the woman and say, "Abortion is no good because it's harmful and it kills the baby."

And you need to talk about alternatives; that's an important thing for a Catholic physician to do.

OSV: What other issues present challenges?

Isajiw: By far the hardest issue that I've found is counseling against sterilization and contraception. Abortion, deep down inside, is not that difficult to understand, especially for a pregnant woman. But 86 percent of Catholics contracept; so, often, when you say that you're not going to cooperate in this with them, they often will name other Catholic doctors who will.

OSV: So have you lost patients over that?

I've lost patients over that, absolutely. I don't just tell patients that the only thing I accept is natural family planning, but I sit down and tell them why the pill is harmful -- not only because of physically harmful effects on the woman and because it's abortifacient sometimes, but also because there is psychological, spiritual damage that can't be repaired. Once you transgress against nature, it's very difficult to correct that.

Likewise, with so many people asking for sterilization -- again, such a common thing, even with Catholics -- I have to explain why that harms you.

OSV: Do you find that because you take this position there is also professional ridicule?

Isajiw: Absolutely, not the least of which is from other Catholic physicians who have no problem with it. Often, under HMO coverage, the primary physician has to make a referral, and I won't do that for sterilization or contraception. Some people then tend not to come back to you as a patient. Then their physicians, when they realize you painted contraception or sterilization in a negative way, they're not as eager to send you referrals, either. Non-Catholic physicians tend to accept your viewpoint, but with the Catholic physicians -- as with Catholic women -- I think there is a certain guilt feeling, and they get more angry with you.

OSV: What other ethical-moral issues do you encounter?

Isajiw: Being in internal medicine, I mostly see older people, and so I encounter the end-of-life issues and issues about extraordinary versus ordinary treatment. The problem now is twofold: the perception of people and also institutional and health system problems. I see more problems with this in Catholic hospitals than non-Catholic hospitals.

OSV: Why is that?

Isajiw: In a Catholic hospital, an ethics consult is often recommended by staff, not only for end-of-life cases, but also for patients who are very sick, but not dying. I know Catholic ethicists who openly dissent from Church teaching on hydration and nutrition, and I've had experiences where I proposed an ordinary treatment for a patient, but the ethics committee at the Catholic hospital incorrectly advised the family that there was no moral requirement for the treatment. The family then changed doctors, and within days the patient was dead.

From the family's standpoint, it's a burden to care for a loved one who is ill, so there is a temptation not to treat a very sick person. So when somebody in authority says it's OK to withhold ordinary treatment -- especially if a priest or nun says it's OK -- what more do they need to give into that temptation? That makes it difficult for me, a Catholic physician, to do things according to Catholic moral-medical teaching. In a secular hospital, there is a similar attitude, but there's no ethics consult: It's between the doctors and the families.

It is also difficult when health plan restrictions or institutional rules do not permit my dying patients to have ordinary treatments such as IVs that are essential for their comfort and hydration during their dying days.

OSV: What advice would you give young Catholics who are thinking about a career in medicine?

Isajiw: Definitely do it, but understand that it's a big, big challenge. And understand you're not going to climb up the pyramid to success like some others, especially people in academic medicine, because if you stick to your views and Catholic principles, you're going to have a lot of discrimination.

But you can do it. I have found by hard experience that I could still be successful enough to survive and to have a very rewarding practice. And I've been able to go on to see some of the people I did counsel succeed in doing the right thing, and what a reward that is. I've had women who have had an abortion against my advice, and five years later they come back pregnant again and want my help. So, it's definitely worth doing.

You're going to struggle with these issues and with deciding how far to go if patients reject your advice. You must realize you won't win them all, but the baby you save may be the next one!

Of course, you have to be prepared and have the knowledge, so find good Catholic physician mentors, and contact the national or local CMA for information and assistance.

Finally, you really have to trust God. I never understood the value of prayer as much until I had to face these problems. Also, pray for your patients and for God's help, because it's amazed me how many times when you think that all is lost, something comes through. It's truly miraculous: Somebody steps in and saves the day, and I'm sure that's the way the Lord works.

Providers' social responsibilities

In their introduction to Part I of their "Ethical and Religious Directives for Catholic Health Care Services," the U.S. bishops outline five principles that should inform the social responsibility of Catholic health care services.

Right to life: Catholic health care ministry should be rooted in a commitment to promote and defend sacredness of every human life, from conception until death.

Care for poor: Health care ministry should work to ensure that health care in the United States delivery system provides adequate care for the poor.

Common good: Catholic health care ministry should seek to contribute to the common good.

Responsible stewardship: A Catholic health care ministry will be concerned both with promoting equity of care -- to assure that the right of each person to basic health care is respected -- and with promoting the good health of all in the community.

Conscience rights: Catholic health care does not offend the rights of individual conscience by refusing to provide or permit medical procedures that are judged morally wrong by the teaching authority of the Church.

For more information, visit www.usccb.org/bishops/directives.shtml

Ann Carey writes from Indiana. To learn more about the Catholic Medical Association, visit www.cathmed.org.