[Editor’s Note: Lisa Gilbert, MD, FAAFP is a family medicine physician at Ascension Via Christi in Wichita, Kansas. She completed the healthcare ethics certificate at the National Catholic Bioethics Center and the medical consultant program with the Pope Paul VI Institute. She is also a FACTS speaker for fertility awareness-based methods. She spoke to Charles Camosy ahead of this week’s vote by the American Medical Association on physician-assisted suicide.]
Camosy: Tell us a bit about your journey to become a doctor and professor of Family Medicine? How did your Catholic faith fit into all of this?
Gilbert: My journey into medicine actually began in Africa. I was raised in Kenya and Togo and along with observing and participating in the many joys of the Kenyan people, I also often saw the plight of those who were ill and poor, particularly children who lived on the street and infants born with HIV. As a ten-year-old, I remember once visiting a home of a couple who had begun taking in these orphans and I quietly promised myself to return to help them when I was grown-up.
After high school, I returned to the U.S. for several years of college and then decided to take a year off college to move with my parents to Cape Town, South Africa. Somewhat in fulfillment of my childhood promise, I decided to spend the year volunteering at a nearby Catholic orphanage for HIV positive children at the base of the beautiful and iconic Table Mountain. During this time, I found myself visiting the children when they were admitted to the hospital, as they often were, and it was here that I decided to pursue medicine.
As for faith, I had always been a faithful Christian. I attended residency in family medicine in a Catholic hospital system (Via Christi Family Medicine in Wichita, Kansas) and slowly began exploring Roman Catholicism as well as Eastern Orthodoxy, after learning more about the Early Church. After my three years of residency, I completed a fellowship in International Family Medicine which took me to a full-spectrum mission hospital in rural Niger, West Africa.
Afterwards, I took another year off to study at a small Classical Christian college called Augustine College in Ottawa, Canada, founded by a retired physician and public speaker, Dr. John Patrick. At the end of that year, about four years ago, I was received into the Ukrainian Greco-Catholic Church through chrismation (confirmation) at Pascha (Easter).
I then moved to a rural town in Western Kansas for about two and a half years to a full-spectrum practice and have since come back to Via Christi to teach and incorporate some of my passions in rural and international medicine, bioethics and fertility awareness methods. Trying to be better equipped as a Catholic physician, I attended the Pope Paul VI Institute course on NaProTechnology for medical providers and the National Catholic Bioethics Center Healthcare Ethics Certificate program, both of which I highly recommend. I’ve taken on the roles as chair of our Ethics Committee at the hospital and as well as president of our local growing Catholic Medical Association guild.
What can you say about Catholic health care as practiced in the U.S. today? My sense is that there are hospitals and providers which are serious about their Catholic identity and those which are not. What’s your sense of this landscape as someone who is in the thick of it?
In my limited experience, I would say that there is a great deal of diversity in how Catholic medical providers integrate their faith with their healthcare vocation. Some of this, I suspect, has to do with the usual trappings of our highly independent and reductionistic culture. Many have privatized their faith, at best, or reject the faith altogether, at worst. And there is still fall-out from the original dissent from Humanae Vitae, a dissent against the Church herself, which has sadly never fully cleared. For my part, I personally came to understand and appreciate the truth of Humanae Vitae long before I had any interest or understanding of Catholicism.
The lie of the contraceptive mentality, the health and social impacts on women, and by extension their families, and the truth of the Church’s understanding of human anthropology impacted me greatly in my fourth year of medical school. Although not entirely sure where I stood morally, I hesitated to prescribe contraception and Via Christi, at that time, did not allow physicians to write prescriptions or perform office procedures for contraception. I knew it provided a safe haven for someone still discerning their position on this topic.
However, despite the truth of this encyclical, Humanae Vitae and Catholic teaching more broadly still causes a great deal of division and often leads to challenging situations, especially since physicians increasingly are part of large systems and rarely practice in isolation. What our partners do, or don’t do, impacts the whole system and impacts us as faithful providers.
Half the art of being a Catholic physician is navigating this tension and learning how to find like-minded folks in the thick of the battle. On that note, I have been deeply encouraged in my faith by the Catholic Medical Association, now with some 2300 members and 100 guilds. Our local guild has some 20 physicians, residents and students and we recently participated in a White Mass hosted at our hospital’s beautiful chapel at Ascension Via Christi.
As for hospital systems and institutions, many are certainly striving to live out a genuine authentic Catholic charism through healthcare. However, there is always the strong pull towards compromise and to cooperate with secular systems in ever more entangled ways, including practices that the Church would formally condemn. Financially, it is difficult for healthcare systems to resist permitting contraception, fearing that physicians will simply leave if forbidden to engage in such activities.
Now, we are just beginning a new battle as transgender prescriptions and surgeries become pushed by medical societies, even without evidence to back up such recommendations. Some Catholic healthcare systems are willing to stand up for a proper anthropology of the human person and his or her dignity, while others are beginning to yield to this “ideological warfare” as Pope Francis described it, which stands against truth and right reason.
And this strong drive to give into the world becomes even more present when there are often few faithful Catholics in administration, medical leadership roles, or the ethics and mission departments of these hospitals. With the void of religious orders in hospital settings as Sisters retire and resign, it becomes far more difficult to educate about the mission and ethos of the Catholic hospital without falling into secular ethics, humanistic social justice frameworks, and a faux spirituality that lacks the quintessential heart of the Gospel.
Often, even convincing medical staff to read the Ethical and Religious Directives is a challenge, much less trying to illuminate and live out the fullness and beauty of an authentic Catholic worldview, rooted in Christ and the wisdom of the Church. Some Catholic healthcare systems even subtly attempt to downplay their Catholic heritage in order to compete with secular hospitals, overlooking that the Catholic hospital is intended to be a direct explicit ministry of the Church.
As the culture continues to fracture about fundamental understandings of the good, it is now clear we have no idea what basic concepts like “health care” and “dignity” mean. This manifests itself most clearly, for me, when we look at debates over assisted suicide. Some health care providers argue for it on the basis of dignity while other health care providers argue against it on the basis of dignity. When you do your training of family physicians, do your students have a sense of what this basic concept means?
It is a challenge to provide and educate on a Catholic worldview and the proper understanding of innate human dignity, which includes not preemptively killing oneself or involving others in that decision. Indeed, this is a much-needed area of spiritual formation and Ascension, our hospital system, thankfully has begun to develop formation materials for residents and other employees. Many of our residents and students certainly do understand the innate dignity of the human person and how healthcare is part of the common good.
Many also understand the concept of natural law, in that organs and body systems are ordered to a proper end and using this language of “what the body is for” can be helpful as a start. Unfortunately, of the four secular ethical principles, autonomy, rather than non-maleficence (first do no harm) or beneficence (doing what is good in charity) has become prized as the supreme ethical principle. We are taught not to patronize or impose “our view” on others, even if such a view is actually reflective of the underlying truth about man and his dignity and what is best for him.
Thus, when a patient requests to die, most residents and students are able to understand this as a cry for help, to explore the issues that have led a patient to make such an extreme request. However, I worry that younger generations are so deeply influenced by post-modern understandings lacking in absolute truth that, after a superficial evaluation, they will simply acquiesce to whatever a patient requests, even if it is harmful or fatal for the patient.
A couple weeks ago I saw a tweet storm of yours which led with this provocative claim, “Last night, I realized I’m going to be training future killers, professional killers, even likely my own killer. For someday I’ll be old, frail, suffering and alone. A young family physician will hold out towards me deadly pills to kill myself, as tempting as Eden’s fruit.” Can you say more about this?
In an egregious act against the common good, the American Academy of Family Physicians (AAFP) had just changed its stance on physician assisted suicide to one of “engaged neutrality” and resolved to use the deceitful language of “medical aid in dying” instead of “physician-assisted suicide” in order to make it more palatable. They are now advocating for the American Medical Association to do the same. One family medicine student then tweeted that 80 percent of polled students and residents had apparently supported this change to neutrality.
I have no idea how the poll was taken or how accurate, but I’m not completely surprised, based on other polls such as MedScape. Many younger physicians have not wrestled with death on a personal level or seen the beauty that comes from a genuine accompaniment of patients in these final days and weeks, leading to reconciliation of the patient to family and friends and an acceptance of natural death.
The idea of accompanying others in suffering, the true understanding of compassion, is certainly much harder in our screen-dependent yet isolated, individualistic world. We saw this in cases of abortion, which fixes the perceived “problem” as the proverbial tip of the iceberg while also ignoring killing the life of a child. Yet we know that abortion does not accompany the woman out of the situation that led her to where she is, and we know that most women do not want to abort but rather believe they have no other choice and lack support to do what they would otherwise wish.
The same is now true of the elderly, who often feel abandoned, alone, or a burden to their family or friends. Oregon’s statistics even show that the reasons for such requests are almost universally due to lack of autonomy, fear of being a burden and decline of function rather than pain. Honestly, it is not pain or even fear of pain that drives most to request lethal medication, since our ability to support people through palliative care and hospice is quite good. Instead, they deprive their family and friends, and us as medical providers, of the privilege and joy of allowing ourselves to care for them and the peace that they often come to in their last days as they prepare for death.
As for my tweet-storm, while perhaps a bit melodramatic, I still believe it is likely that I will train students and residents who may participate in hastening deaths and assisted suicides. In our post-modern world, most students no longer take the Hippocratic Oath which includes the phrase “I will give no deadly medicine to anyone if asked, nor will I suggest such an action.” But students may wrongly believe that ending the lives of their patients could be justified if the patient requested it and certainly one of these students may someday even offer to end mine.
Will I be immune to the temptation to end my life through a similar fear of being a burden, due to a sense of loss of autonomy, or to loneliness in my elder years? Or will I accept the experience of passing through the shadow of death as a true and necessary part of the end of life? Surely, I pray for the courage to endure and accept my own dying as a true gift from God, for my salvation and sanctification, in keeping with our theology of redemptive suffering. I do not wish to sidestep this important piece of common human existence and what God may teach me through this process. But I hope that there will be someone there to hold my hand and accompany me, not to offer me an easy way out or neglect me to die alone or in pain, unnecessarily.
What can Catholics who have an interest in non-violent health care do to resist our cultural slouch toward assisted suicide?
For one, I think Catholics can and should seek out physicians who hold to Hippocratic medicine. Many pregnant women have asked if their physician practices abortion and sought other care if she did. So ask if your doctor is okay with assisted suicide! If she is, tell her that you need to find another physician!
Another thing is to encourage your children and grandchild to go into healthcare. We need more faithful Catholics in nursing and medicine, in administration and leadership throughout hospital systems, if we want to see authentic healing ministries continue.
We also need to prepare more for our own deaths. Pray about it! I also recommend the End of Life guide by the National Catholic Bioethics Center and encourage all to set up a Durable Power of Attorney. Talk to your loved ones about how you plan to approach death. Also, be aware that withdrawing or declining various medical interventions is permissible if they are too burdensome or provide no benefit. This is not the same as ending your life by active euthanasia or physician assisted suicide, but rather a recognition that just because an intervention is possible does not mean you have to do absolutely everything. A priest can help you think through these issues.
Talk to your friends and family at your parish and other places about physician-assisted suicide. Remember that it is generally not because of pain that people seek this out. Instead it is because of fear of loss of autonomy, being a burden, and being alone. Challenge the idea that depending on others means a loss of dignity. We all depend on each other to some degree and more so at various times in our lives more than others. Human autonomy is not the prime virtue, but rather it is love, the giving of ourselves to each other, and having compassion on those in their most desperate hours.
Encourage your priest or minister to give a symposium on this topic so that more people can be prepared to face the challenges to come. Parishes could have retired nurses walk through the dying process with families, helping them navigate difficult decisions and being an advocate in a very confusing and emotional time. If people are supported, very few will ever request assisted suicide.
Finally, I encourage people to contact the AAFP and make your views known, that there can be no neutrality on the issue of killing our patients. Contact the American Medical Association as well, especially this week, as it holds its own vote about physician-assisted suicide on Nov 12th. Let them know how you, as patients, feel about this issue.