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Answers from our Priests for Life Medical Team

Submitted by: R on  10/6/2010
Answered by: Matthew P. Harrison, M.D.
Topic: As a Nurse Practitioner, Where Do I Draw the Line?
I am a registered nurse who has returned to school to become a Nurse Practitioner. A Nurse Practitioner has expanded authority to diagnose and treat patients, as well as prescribe medications (including birth control). As a Nurse Practioner, I will have a similar role and responsibility as a physician.

As I go through my schooling, I will practice in obstetrics and gynecology where it is very commonplace to prescribe birth control as well as teach safe sex and condom use and more.

The thought of this really bothers me because as a practicing Catholic, I know what is right "for me and my house" but I do not know how to handle this role of counseling others about things that I personally believe are immoral.

I know that it is not my place to judge others - and a large portion of my patients won't be practicing Catholics. Where I live geographically, Catholics are the minority of Christian traditions.

I don't know where to draw the line. For example, if someone asked me to assist in an abortion, it's a no-brainer. I would not participate in the evil of killing a child. But I will be asked to prescribe birth control, counsel teenagers on safe sex, and educate people on other forms of contraception.

I know there are very very few OB/GYNs who refuse to prescribe birth control. In fact, I think the nearest one to my county is 3 hours away. This means there must be Catholic OB/GYNs out there that somehow make peace with this. I don't understand how they justify giving other people contraception.

I have, in my very limited understanding of ethics and morality, tried to rationalize this by comparing my new role with other work environments...

1. If I worked in a video store, I would rent people videos. I would never judge a person for renting a movie I felt was morally wrong to watch. They live out their life in a different way making different choices, it is not my place to judge. It is likely that as a video store clerk I would rent people pornography! I do not picture myself "refusing" to rent porn because it is morally wrong.

2. If I was a real estate agent, I would sell houses. I would sell houses to people who were co-habitating outside the establishment of marriage. I would not make judgements on people to determine whether or not I would sell them a house.

3. If I were a pharmacist, I most certainly would refuse to sell the morning after abortion pill. But how in the world can pharmacists keep their jobs without filling prescriptions for birth control? Birth control in our society is so accepted and uncontroversial. Store clerks sell condoms all the time...

4. If a prostitute came to me for well-woman care and treatment of a sexually transmitted disease, I would treat her. Judgement of her life-style is not my job, but ministering to her body is. I don't believe that taking care of her would make me an accomplice to evil.

Turn the tables from the subject of birth control and consider a divorced man who comes in to request Viagra. I can't make moral judgements on my patients. I will probably not know whether they are Catholic, Protestant or Atheist. My job is to provide health and healing. But I am very concerned about being an accomplice to evil. I don't know where to draw the line.

As a RN, I was not in the control seat. I cared for ill people and did what the doctor prescribed. This was really a non-issue. As a Nurse Practitioner, I will write the prescriptions and my counsel is a voice of authority. It needs to be Godly counsel, yet I am faced with a handful of hypotheticals that are very anti-Catholic.

I certainly don't have to work in settings where immoral counsel is the norm... but I do have to make it through school, through my OB/GYN rotations, and I would also like my conscience properly formed on the matter.

I am a convert to Catholicism and am fairly well catechized in the basic tenants of the faith. I was raised Protestant, so I focused a lot on apologetics, but I am not well-educated in ethics.

I have made several attempts to contact my parish pastor without success. I'd like to sit down and talk this out with someone, but I don't know where to look. I am willing to read, if you have a book or encyclical that might provide some insight into my struggle. I have read Humane Vitae, 'Life Giving Love' by Scott and Kim Hahn.

It isn't an issue of not knowing the theology behind contraception. I get that. I live it and believe it. Rather, I am struggling with how I am ethically tied to others outside of my faith. Perhaps I just need a little correction in my understanding of ethics... I welcome any thoughts and guidance you have time to offer.

Thank you for reading,
Dear R, Thank you for your question and I applaud your desire to follow Church teaching and ethical behavior in you career.  We must remember that as medical providers, we are not gumball machines that dispense whatever a patient wants just because they put in a quarter.  Most states have laws protecting the rights of medical providers to choose not to prescribe medications.  Otherwise drug addicts could demand narcotics, athletes could demand steroids, and women could demand the abortion pill.  Also remember that the medications themselves are not evil, only the improper use of them is evil.  Likewise, guns are not inherently evil, but murder by shooting someone is evil.
When I have been asked by patients or supervisors to prescribe birth control, refer for abortion or sterilization, or give Viagra to single men, I have used a very straight forward, no excuses explanation of why I will not do this.  When a patient comes to me for help, I am responsible for taking care of the entire patient, not just one part.  I care for the physical, mental, emotional, and often the spiritual aspects of illness.  I completely agree with you that we should treat sexually transmitted diseases in prostitutes.  This can be the avenue we use to help them realize their dignity as a woman and a human.  We can offer counselling, safety shelters, and plans for getting out of the culture of human slavery, trafficking and abuse.  Similarly, when a single man asks me for Viagra, I seek the answers to why he is having a medical problem and treat those such as diabetes, hypertension, or medication side effects.  But I also talk to him about abstinence until marriage and that this is the best approach to true love and relationship as well as spiritual unity with another person.  I also explain that I would be a hypocrite to ask a 16 year old to be abstinent but to imply that it is ok for a 50 year old man to be promiscuous. 
The subject of birth control can be approached in many different ways.  First, the vast majority of all birth control methods that use hormones in any way, including pills, shots, implants, etc. can cause early abortions because of the way they change cervical mucus , making it difficult for a newly conceived baby to implant and he or she just flows out with the menstrual flow.  These methods also increase health risks directly to the woman, such as increasing risk of clots, strokes, heart attacks, liver tumors, breast cancer and a myriad of unwanted side effects.  IUDs create such a hostile environment that prevention of implantation is their main method of action.  Barrier methods such as condoms and diaphrams can cause local side effects to skin and and fallopian tubes, but their emotional and spirtual effects are more evident.  Barrier methods, even within marriage, rob the users of giving totally to each other and receiving totally from each other.  Barrier use disrespects the users and the marriage vow.  This leads directly to emotional and mental distress causing depression, anxiety, failed marriages and worse.  If a barrier method fails, then the couple often sees the child they have conceived as a problem.  This is why, even though society was promised less abortions with the use of contraceptives, we have seen an increase in the number of abortions since the widespread use of contraceptives.  Sterilization also destroys what God has created and works properly.  As medical providers, we make a promise to do no harm and that means we do not break something that is working properly.  Once a person is purposely sterilized or is contracepting, they become an object of lust and are used as an object of desire without accepting all of the gifts of the sacramental marriage union.  For a Catholic, this would be like going up to receive Eucharist, taking the Host and then spitting it out to prevent weight gain.  Contracepting is accepting only half of the physical sacramental act and denying the other half, therefore negating Sacrament all together.
As medical providers, we are never in a position to judge the eternal fate of a person's soul, but we are required to differentiate between what is right and wrong for each patient.  This is what they have come to you for and they seek your opinion and expertise.  You are in a unique position to make an enormous difference in their lives on so many different levels, please do not miss this chance.  Seek out physicians that will support your decision to give your patients the best care possible.  As an Intern in training, I made the decision within the first 2 weeks that I would not prescribe birth control, perform or refer for abortions or sterilizations.  I went directly to the Chairman of the Family Practice department and made him aware of my conviction.  Thankfully, he respected the decision and for the next 3 years I completed my training, delivering over 250 newborns, became Chief Resident of my Department and giving seminars on Natural Family Planning.  If you need any help through this process, do not hesitate to contact me.

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