The United States Food and Drug Administration is expected to rule later this year on a controversial proposal that would allow oral contraceptive pills to be sold over-the-counter. If approved, this ruling would eliminate physicians as the middlemen between their patients and this very popular drug. A small but growing number of Catholic physicians have already taken themselves out of this loop by refusing to prescribe oral contraceptives for moral and medical reasons. Physicians who bear witness to the teachings of Humanae Vitae in their medical practice are taking to heart much of their medical school training, risking the professional and financial relationships they have with their partners, and introducing their patients to a way of life far removed from our contraceptive culture, which many of them flatly reject.

Many physicians, especially Catholics and Christians, willingly take the first step towards a pro-life medical practice by refusing to perform abortions. Very few of them take the next step—refusing to prescribe contraceptives or perform sterilizations—either because they do not accept the moral principles outlined by the Church or because it is such a radical decision from a professional standpoint. Oral contraceptives have become a pharmaceutical mainstay of practicing medicine in the United States. Birth control is only one application. It has grown into a medication nearly as all-purpose as aspirin for women’s health problems.

“Birth control has been around in various formulations since the 1960s, and it is used to treat acne, menopause, and everything in between,” according to Steve Koob, director of One More Soul, an Ohio pro-life organization whose mission is to educate people about the harms of contraception and the blessings of children.

“There are doctors who would never do a surgical abortion, but they find themselves prescribing contraceptives because they missed the fact that oral contraceptives are an abortifacient mechanism. It shows it right in the [Physicians Desk Reference], but they feel they have been trained to do it. It is what their profession and what their patients expect,” stated Koob.

And the pharmaceutical companies and advocates of this form of birth control have worked hard to raise patient expectations for the Pill in recent months. Several articles have been printed in big circulation publications (the New Yorker, Glamour, and the Chicago Tribune, among others) touting the medical benefits of the newer low-dose pill, which contains 30 micrograms, compared to 50 micrograms of estrogen in the previous generation of oral contraceptives. They downplay the risk of side effects such as stroke and blood clots in healthy, non-smoking women and recommend life-long use of the Pill for a host of women’s health problems such as acne, irregular periods, menstrual cramps, endomitriosis, migraine headaches, osteoporosis, and perimenopause. Some physicians even suggest that taking the Pill may reduce the risk of endometrial and ovarian cancers.

Facing the challenges
During medical school, physicians-in-formation are steeped in the contraceptive mentality, and as their training progresses, very few residency programs, even at Catholic institutions, offer them much information about natural family planning or non-contraceptive alternatives to treat women’s health disorders.

“The biggest problem in medical school is that you get desensitized,” stated Dr. Ann Moell, an Ohio family practice physician who quit prescribing contraceptives. “They don’t really talk about morality, it is all biological. That is where you get down the wrong track.”

Catholic physicians who get back on the right track are often led there by some kind of conversion experience. At Steve Koob’s request, Dr. Janet E. Smith, a professor at the University of Dallas and an expert on Humanae Vitae, made an audio tape several years ago called “Contraception: Why Not?” One More Soul has distributed thousands of copies of the tape, and it has been a catalyst for many Catholics, physicians and priests among them, to have a change of mind and heart about contraceptives.

“What I had hoped to accomplish through the tapes was to get people to reconsider their acceptance of contraception. We have been successful beyond my wildest dreams,” Smith said. “Some priests and deacons are now preaching on the topic and giving out tapes at Masses. We have had a policy of free tapes to seminarians from the beginning and have been thinking about free tapes for med students as well. A young man here in Dallas at Southwestern Medical School has had some impressive success handing out copies to his classmates.”

Smith’s tape was the impetus for Moell to translate her personal decision not to contracept into a professional principle for her medical practice. “I listened to the tape and it totally hit the nail right on the head socially, morally, medically, and spiritually, from every angle you can look at, and I knew that if it was wrong for us, it was wrong for others,” Moell said.

Moell’s Christian partners in her medical practice accepted her decision not to prescribe contraceptives, and although she lost a few patients, her medical practice did not suffer financially. Family practice physicians such as Moell see patients of all sexes and ages, not just women in their childbearing years for whom contraception is an issue.

When Dr. Paul Hayes announced his decision to honor Humanae Vitae to his patients, “$30,000 a month in tubal ligations walked out of my practice in Florida.” He added, “I had a routine gynecology practice doing tubal ligations, the most common form of family planning, and prescribing contraceptives. I did everything but surgical abortions.”

Then in 1993, Hayes’ conversion began when he saw a billboard about praying the Rosary, and he began to do so on his knees with his wife and children. He was raised Catholic but left the Church as a teenager and explored New Age religions for a number of years. He and his family rejoined the Catholic Church in 1994. “On a Saturday we returned to the Sacraments and my patients got a letter the following Monday,” Hayes recalled.

Hayes said that because contraceptives have become the drug of choice which the medical community prescribes for a myriad of women’s health problems, OB/GYNs have to seek additional training to learn about alternative treatments in order to stay in practice.

Hayes moved to Omaha, Nebraska, to do a year-long fellowship in association with the Pope Paul VI Institute for the Study of Human Reproduction, which is directed by Thomas W. Hilgers, M.D. The institute, which is named after and inspired by Paul VI, author of the letter Humanae Vitae, is the leading center in the US for education and research concerning the natural regulation of human fertility and the development of reproductive health services that are both morally and professionally acceptable. The institute houses the Creighton Model Fertility Care System, which the staff at the institute describe as “a medically standardized modification of the Billings Ovulation Method” of natural family planning. Physicians and other medical professionals from around the country attend the institute for continuing education, all of which is fully accredited through the joint sponsorship of the Pope Paul VI Institute and the Creighton University School of Medicine.

While in Omaha, Hayes met Bishop Fabian W. Bruskewitz of nearby Lincoln who invited him to join a Catholic medical practice in his diocese known as Holy Family Medical Specialties. Even in such an unabashedly pro-life professional environment, Hayes is frustrated that more Catholic patients do not seek out physicians who do not make moral compromises regarding birth control.

“The OB/GYN has to put his entire practice on the line—our peers think we are religious fanatics. At the same time, the Catholic patient isn’t really asked to make any sacrifice at all…. The frustrating thing to me is that even people who are sensitive to Natural Family Planning and want to make sure they are doing the right thing medically don’t have any problem seeing doctors who are doing very immoral things, as long as they don’t ask the doctors to do that. Catholic patients in droves say, ‘I wouldn’t ask Dr. X to do that to me, but what he does for other patients is none of my business,’” Hayes said.

Hayes fears that the health insurance companies may eventually insist that doctors offer the entire gamut of OB/GYN services to their patients if business is not good for pro-life physicians. “It is a terrible crisis in health care, and unfortunately, what it is going to boil down to for the Catholic patient is that they are going to lose any ability to make a choice,” Hayes said.

Hayes is not the only physician who experienced some professional challenges when he stopped prescribing contraceptives. Cleta Hartman compiled a book full of such stories called Physicians Healed. She heard many of the stories first-hand when she and her husband, Dr. John Hartman, a family practice physician, traveled to Omaha to study at Hilgers’ clinic to become certified medical consultants in the Creighton method of natural family planning.

“Over the years of his practice, my husband could see that marriages have a very difficult time staying together, and he started to associate it with using contraception,” Mrs. Hartman explained. “He decided to learn more about natural family planning.”

At Hilgers’, the training program starts at 7 in the morning. Then at night, people would have coffee and dessert together and tell their stories about why they came to get this training, even though everyone would think they were nuts for doing this. Those stories were so encouraging to us.

To be certified as a medical consultant by Hilgers’, you have to sign a paper saying you are not going to prescribe [contraceptives] for people who are unmarried. In our class, half signed. On the plane ride back to Kissimee, Florida, my husband said he wouldn’t prescribe it at all.

Mrs. Hartman recalled:

He thought he was going to get this horrible backlash of people going out of his practice, but he only got positive responses. A number of people took the time to write him to say they may not agree with him, but admired him for speaking up about his convictions. He even has some patients now who travel from Jacksonville and Tampa to see him.

Offering an alternative
Hartman said that she put together the book Physicians Healed to offer support and encouragement to other physicians who decide to discontinue prescribing artificial contraceptives, but also to underscore the fact that the alternative, natural family planning, is so medically sound.

“We hope that doctors turn to NFP because it is undeniably good medicine for their patients,” said Hartman. “We are hoping maybe younger physicians will be trained in it before they make the decision to prescribe contraceptives.”

Moell, whose husband is a pro-life pediatrician, is currently on a leave of absence from her medical practice to spend more time with their four children. But she said that she thinks there is a real need for physicians who apply Humanae Vitae to their professional lives and who are not afraid to treat the whole patient.

If I went out there and advertised my practice as being true to the Church, I would draw a lot of patients for family care. When women were having their sixth pregnancy, I wouldn’t look at them like they were crazy. When you know you are practicing in accordance with your morals and you are not afraid to tell people that, I think they respect that even though they don’t quite agree. I think they would like the idea of someone like me taking care of their terminal illness or their other needs.