Academic journal article Issues in Law & Medicine

Teaching OB/GYN Residents Bioethics within a Catholic Healthcare Context

Academic journal article Issues in Law & Medicine

Teaching OB/GYN Residents Bioethics within a Catholic Healthcare Context

Article excerpt

Bioethical issues arise out of conflict: whether conflict between provider and patient, patient and family, or patient and societal standards. Perhaps more than in any other medical specialty, the field of Obstetrics and Gynecology raises difficult bioethical questions that may result in conflict. While issues such as abortion and cutting-edge reproductive technology come readily to mind, the Obstetrician Gynecologist (OBGYN) also faces ethical dilemmas regarding end of life care in the field of Gynecologic Oncolog};:

Resident and medical student education in bioethics has focused primarily on the American College of Obstetricians and Gynecologists' (ACOG) recommendations. These broad, secular recommendations, by their very nature, do not address all the bioethical concerns when conflicts arise. Thus residents and students are left with a non-specific and often superficial framework for decision-making.

That Catholic healthcare is an integral part of the American healthcare scene is undeniable. Currently there are four medical schools associated with Jesuit Catholic educational institutions: St. Louis University, Loyola, Creighton, and Georgetown. Additionally, as of 2005, there were 615 Catholic hospitals in the United States, representing all 50 states.1 Even if not trained at a Catholic institution, many OBGYN's will have the opportunity to work at a Catholic hospital during their career. Unfortunately, most will enter that relationship with only a superficial understanding of how and why Catholic healthcare ethics differs from ACOG's ethical positions. This fundamental lack of knowledge ultimately damages relationships between providers and institutions, and unfairly subjects Catholic institutions to derision. For instance, a recent and widely-cited campaign by the American Civil Liberties Union (ACLU), "Health Care Denied," attacked the role of the Ethical and Religious Directives for Catholic Healthcare Services (ERDS) in American Catholic hospitals while simultaneously noting the immense contribution of Catholic Healthcare in this country.2 According the ACLU, "Because of these rules [the ERDS], many Catholic hospitals across this country are withholding emergency care from patients who are in the midst of a miscarriage or experiencing other pregnancy complications."3 Unsupported statements such as these demonstrate the profound disconnect between many in society and the Catholic institutions that serve them.

In 1999, the Accreditation Council for Graduate Medical Education (ACGME) indentified six general competencies held to be of importance for physicians. These competencies were applicable across all medical and surgical specialties, and were the basis for the evaluation of outcomes of a residency training program's stated goals. Thus, each program was required to evaluate how well its training prepared graduates in these six competencies: patient care, medical knowledge, practice based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice. The latter states in part that residents are expected to "work effectively in various health care delivery settings and systems relevant to their clinical specialty," and, "coordinate patient care within the health care system relevant to their clinical specialty."4 By failing to train residents in the ethical framework of healthcare delivery within Catholic hospitals, many graduate medical education programs in fact fall short of this requirement.

In Monty Python's "The Meaning of Life,"5 one musical number contrasts a prolific Catholic family with their neighbors, abstentious protestants who are nonetheless free to use birth control. As the name suggests, the musical number, "Every Sperm is Sacred," parodies a common misunderstanding of Catholic doctrine on contraception. This misunderstanding isn't limited to secular British comedy troupes, however; a basic lack of knowledge of Church teaching is common among practicing Catholics. …

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