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The Contraceptive Mandate

Posted by MDViews on January 8, 2013

Birth control. Who can be opposed to birth control?

Isn’t birth control just having the babies you want and no more? Isn’t that just common sense? Who can afford more than two kids anyway? Who wants more than two kids any way? Do you have any idea how expensive day care is? And who wants to clean some rug-rats bodily fluids off the leather seats in the back of your Beemer? Do you have any idea how the other passengers look at you if you take your kid on an airplane to go to the Bahama’s for a vacation? Besides, maybe you’re a teenager and a pregnancy would ruin you life. Shouldn’t you be on birth control? Come to think of it, maybe you should be required to take birth control. I mean, isn’t over-population a big problem? Shouldn’t we all have fewer kids, like China? And how are you going to climb the corporate/educational/governmental ladder if you have to worry about day care/dance lessons/soccer/after-school care? Kids! What a noose around your neck! Plus, what if you end up with some disabled kid who cost even more? Do you know what day care is for a kid with autism? (Well, I think they have homes you could put someone like that in, don’t they? I mean, you shouldn’t have to care for a kid like that, should you?)

Let the Duggers have 19 kids. Let those weird Catholics who actually believe Pope John Paul’s Humana Vitae use natural family planning and have 8 kids. (Is it legal to have that many kids? Maybe we should do something about that, too. )

And anything that’s as important as birth control should be covered by insurance, shouldn’t it? I mean, $4 a month at WalMart seems like a lot to me.

And so it goes. The arguments for birth control in general and the contraceptive mandate in particular.

But let’s separate some facts from the fog and see what this contraceptive mandate is really about.

First, define birth control, because you cannot separate birth control from abortion.  Most of you probably don’t know that the government, drug companies, IUD’s companies, birth control pill companies, progesterone-only birth control companies and the “morning-after” pill companies define abortion as pregnancy loss after implantation. That means an egg is fertilized, becomes an embryo, travels down the fallopian tube over 4 or 5 days, but then, instead of implanting in the wall of the uterus, passes through unnoticed because the “contraceptive” made the uterine wall hostile to implantation. One package insert said it prevents the “egg” from implanting in the uterine lining! To those entities above, that is birth control, not abortion. All of the package inserts for the birth control pill, IUD’s, progesterone-only birth control pills and shots and the “morning-after” pill companies list a hostile uterine environment as one of the mechanisms of action. (For birth control pills, the primary method of action is stopping ovulation, but it doesn’t stop ovulation all the time.)

For those of us who are pro-life, that mechanism of action means 1) possible, occasional abortion for the birth control pill, 2) likely abortion for IUD’s and progesterone-only pills and shots and 3) almost certain abortion for the “morning-after” pill.

I’m an OB/GYN doctor and have wrestled with these issues in my conscience for many years. I quit placing IUD’s shortly after I started in private practice, but did place them during my residency. I quit prescribing progesterone-only pills and shots many years ago and I quit prescribing the birth control pill two years ago. I feel good about all of those decisions.

So defining “birth control” helps us, I think, realize why the “contraceptive” mandate is a deep moral affront to pro-life people on its face. “Contraceptives” should be called “contra-gestational” agents, meaning they prevent a pregnancy from “gestating” or growing in the uterus, but don’t prevent “conception.” At least not all the time. In that regard, they are all potential abortifacients, some more than others.

Second, our devout Catholic friends, both patients and doctors, are required by the teachings of the Catholic church to only use periodic abstinence (natural family planning) to prevent pregnancy. I’m much more aware and informed of that teaching now that I work in a clinic with all Catholic physicians who hold to the teachings of the Catholic church. That means they advocate for natural family planning, (specifically NaPro Technology) and never prescribe any artificial birth control agents. It’s easy to see why the mandate would be unacceptable to them. Also, that means requiring a Catholic organization or a Catholic employer to pay for condoms, spermicides, tubal ligations and vasectomies in addition to those other forms of  “birth control” is a moral outrage and mocks our first amendment right of freedom to practice our religion as we choose.

One can argue that our taxes already pay for abortion in the United States, and that is true in some states (Minnesota, for one, where I live) through the Title 19 program.

But our tax dollars already fund program after program I find morally objectionable. I have no choice about paying taxes. When Jesus said to give to Caesar what is Caesar’s and to God what I God’s, the Roman empire was not exactly a morally upstanding place.

However, requiring payment for “contraceptives” by purchased private health insurance when health insurance is a voluntary fringe benefit offered to employees from an organization or employer bears no similarities to a tax. It’s the government interfering in a private fiduciary relationship between an employer and an employee.

It is clearly the heavy hand of government violating the first amendment right of freedom of religion for those organizations and employers who find “contraceptive benefits” morally objectionable.

As my little vignette above describes, the real reason secular people (and many evangelical Christian and Catholic couples) use birth control is, well, because they don’t understand the gift of life. Children are a de facto burden, not a blessing; a curse to be avoided, not a life to be cherished; a pet to be shown off when convenient then shuffled off to daycare, not an integral part of the family to be fully accepted, loved, valued and included; a carbon footprint to be viewed with a jaundiced eye, not a treasure created in the very image of God.

Pro-life Christians and Catholics are in cross-hairs of the liberal establishment because we embrace a morality from outside of who we are, a morality codified first in the tablets from Mt. Sinai and expanded by Jesus and the apostles in the New Testament. Liberals fly by the seat of their pants inventing their morality as they go along, mostly by what ever would increase their personal happiness at that moment in time, whether morally right or wrong (situational “ethics”, or a better description, situational lack-of-ethics). We now live in a liberal echo chamber in which the establishment has never met a death (embryo, fetus, handicapped baby, or elderly ill person) it didn’t like–except for those convicted of capital crimes in which death is a deserved punishment–those deaths they fight against always.

It makes sense, dear Christian friend. God is not surprised, fooled or unaware. Their behavior is nothing new. Read what the Psalmist says in Psalm 106:36-39 and see if it doesn’t describe the current state of our culture to you.

They served their idols,
which became a snare to them.
They sacrificed their sons
and their daughters to the demons;
they poured out innocent blood,
the blood of their sons and daughters,
whom they sacrificed to the idols of Canaan,
and the land was polluted with blood.
Thus they became unclean by their acts,
and played the whore in their deeds.
(Psalm 106:36-39 ESV)

And, we know that we will suffer for Christ’s sake if we take a moral stand. It’s a guarantee from God. Paul’s phrase from I Thessalonians 3:4 makes it clear he knew he was to suffer affliction and then did suffer affliction.

    For when we were with you, we kept telling you beforehand that we were to suffer affliction, just as it has come to pass, and just as you know.
(1 Thessalonians 3:4 ESV)

So the contraceptive mandate is not a surprise to God and should not be a surprise to us. In our culture, what’s right is what’s wrong and what’s wrong is what’s right. Since liberals control the reigns of power in government, entertainment, education and large corporate businesses, we are at the mercy of the laws they pass, the courses they teach, the movies and TV programs they make and the rules they make for employment as they employ many of us. But we don’t have to watch their movies and TV programs which always portray us a incompetent, stupid, bigoted troglodytes. We don’t have to buy the products of those companies actively supporting the goals of more birth control and abortion. We can home-school and choose to attend conservative colleges and universities. And when the laws become too onerous to follow, we can use civil disobedience (and go to jail? Yes, and go to jail). In the mean time, we must fight, protest, vote our hearts and throw every roadblock we can in front of them whenever we can.

Posted in Abortion, Family, Medical Issues, Politics, Pregnancy | 4 Comments »

Suffering and what Matters

Posted by MDViews on February 27, 2012

Suffering is a promise of God. You, dear reader, will suffer. Everyone will suffer. The world brims with suffering.

As an OB/GYN physician,  I often hear that I must have the happiest job in the world. And it’s partly true. I cherish helping new life enter the world. Hearing the newborn cry still ranks with me as the most precious sound in the world. But sharing in suffering, real life suffering, dominates my days.

Recently, I met a young woman and her husband who came in for an early ultrasound to confirm her new pregnancy. Newly married, she was about 8 weeks pregnant, her first pregnancy. As the scanner revealed the contents of her womb, my trained eye immediately recognized a problem. The pregnancy sac had an irregular shape instead of the smooth, round shape I would usually see. Further scanning showed the baby–but the baby clearly had no heartbeat. Her baby was dead. She would miscarry. “I’m looking at the baby right here on the screen,” I said softly. “But I just do not see a heartbeat. I’m afraid this is a miscarriage.” The shocked, stunned look on her face said it all. Tears followed, lots of tears. I spoke with them in my office after she dressed. I discussed miscarriage at length and assured her she was not to blame. After talking a while, I asked if I could pray for her. She readily consented. I asked God to wrap His warm arms of love and comfort around her, to help her family and friends provide her love and support, to grant an uncomplicated, safe miscarriage with good healing. I asked God to bend his sovereign arm and mercy and grant my request, if it be His will. My eyes watered. I promised to see them through this event and encouraged them to get whatever comfort they could from family and friends. So young they were. Such a surprise trauma and possibly their first encounter with suffering and loss. I prayed as they left that my words provided comfort and helped them find the path, the right path, through this suffering. Age matters.

My next patient also came for an early ultrasound scan. She was older with half a gaggle of children at home. My scan revealed the same thing–a miscarriage. The process started again, but it was different this time. She had experienced a miscarriage before. Tears, talk, prayer and promise followed. Sadness, yes; more suffering and loss, yes; but this time, no deer-in-the-headlights look of disbelief and shock. Experience matters.

The next day I saw back a patient with infertility. I remembered her surgery from two years earlier. “She has terrible pelvic pain and has been trying to conceive without success for five years,” I said to the OR team after my patient was asleep. She so wanted a family she had told me. When I looked inside, I saw severe endometriosis and scarring, her tubes damaged. Her surgery took almost four hours as I carefully tried to restore her normal anatomy. She and her husband were morally opposed to in-vitro so this was her only hope for a family save adoption. Her pain was less, but over those two years, she had not conceived. We discussed her situation and plotted a new course. As we prayed, she started to weep. But as she dried her eyes, she smiled and said, “I haven’t given up hope, Dr. Anderson.” Hope matters.

I saw a 62 year old new patient with pain. She came from the radiologist’s office where she had undergone a pelvic ultrasound, a test ordered by her family doctor. I obtained her history and performed her exam. Clearly, she had a large ovarian mass on her exam which was suspicious for ovarian cancer. After she dressed the ultrasound report came over the fax confirming my suspicions. We talked in my office after she dressed. “Your ovary is quite large,” I told her. “Based on my exam and this report, it’s very likely this is a cancer of the ovary.” Tears. sadness. Questions I couldn’t answer, but I saw no despair. She suspected something serious she told me. I arranged an appointment with an oncology surgeon for her. She called her husband and I talked with him as well. I asked if I could pray for her before she left and she consented. I asked God to give her peace and strength in the coming months. Then, through her tears, she prayed, too. I promised to help with her care however I could. She hugged me and thanked me before she left. When I saw her for a follow-up visit, her prognosis was uncertain, but she told me about her dependence on God and the value of her church family. “I don’t know how anyone could go through what I’ve gone through without Christ,” she said. Faith matters.

My list is not complete, I know. Our responses to bad news–infidelity, depression, pain, stillbirth, the list is endless–are as individual and varied as each of us.

Through the years, I’ve seen Christians and non-Christians shake their fist at God and become bitter and angry when confronted with suffering. But without a doubt, my patients who trust Christ and the providence of God are the ones who endure suffering with the most grace, dignity and peace. Even if our only hope through suffering is death and the blessed Hope of seeing Christ face to face, I know and I’ve seen–God is good. All the time. God is good.

In His providence and good pleasure, God visits us with suffering for our good, even if that good is to die. Since I’m older now and have lots of experience with suffering, my own included, I take comfort that Christ suffered so that I “may not grow weary and lose heart.” (Heb 5:3) I have faith God is sovereign and is good, always good. I take heart in the blessed Hope that one day the dark glass will be removed and I will see Him face to face.

Posted in Doctoring, Faith and the Glory of God, Medical Issues, Politics | Leave a Comment »

Muddying the Water: The New England Journal of Medicine (NEJM), Health Care Reform and Abortion

Posted by MDViews on February 11, 2010

It’s been a while since I’ve posted. OK, more than a little while.  Anyway, following is an article I wrote hoping to get published, which it was not. I still think it worth the read. I hope you enjoy it as much as I enjoyed writing it.

Muddying the Water: The New England Journal of Medicine (NEJM), Health Care Reform and Abortion

The NEJM in its 12-31-09 issue granted George J. Annas, JD, MPH a platform to defend the Senate version of health care reform as meeting President Obama’s promise that no federal funds would be used for abortion. Because passage of the bill may hinge on abortion, Mr. Annas makes his argument by providing understanding of the Stupak amendment and the current laws on federal funding for abortion.

He rightly states the Stupak amendment prohibits use of federal funds for abortion and prohibits funding for health benefit coverage of any plan that includes coverage of abortion services. Abortion would be permitted if the pregnancy endangered the mother’s physical life or if the pregnancy resulted from rape or incest.

Mr. Annas sites the influence of Catholic bishops and, more importantly, a Christian group of political leaders who meet together outside of Congress as primarily responsible for the Stupak amendment. He refers to this Christian group of leaders as a fundamentalist, previously-secret group called the Family or the Fellowship.

He states abortion opponents defend the Stupak amendment as merely continuing the Hyde amendment, an amendment attached to every HHS Appropriation Act since 1976. He acknowledges that the Hyde amendment prohibits federal funding for any “health benefits coverage that includes abortion.”

He further acknowledges the health bill requires states to offer at least two health plans to the uninsured, one allowing abortion and one not. The plan allowing abortion must “segregate out” the source of funding allowing only state money, not federal money, be used for abortion. Additionally, insurance companies would receive subsidies, including those companies offering abortion. The Secretary of HHS would set the price to cover abortion services.

He adds that Senators Hatch and Brownback who have promoted the Stupak amendment in the Senate would oppose health care reform in general and therefore would vote against it even if the bill outlawed federal funding of abortion.

He then asks and answers three questions: Do the health care reform bills meet President Obama’s no-federal-funding promise? Do they follow the Hyde Amendment tradition? And do they represent good public health policy?

In response, Mr. Annas’ views regarding the influence of the Catholic bishops and this Christian group of leaders in promoting and passing the Stupak amendment ignore public feeling regarding government-funded abortion in the new health bill. A Quinnipiac poll of likely voters found 72% opposed government funding of abortion in any new health care system created by the government. Is such overwhelming public opposition insignificant? Certainly not. Does public opposition influence legislation? Yes, of course. In addition, are private meetings of Christian leaders allowed outside the halls of Congress? Isn’t freedom of association one of our most basic rights? Yet, Mr. Annas implies a sinister motive behind their association.

Mr. Annas has no trouble dispatching the abortion opposition of Senators Hatch and Brownback as disingenuous since they oppose this health care bill in general. However, his argument makes little sense. Just because they oppose the bill in general does not lessen their desire to eliminate abortion coverage from the bill.

Regarding his three questions, he answers yes to the first, assuring us the health care reform bill fulfills the Presidents wish of no federal funds for abortion. He explains the plan would require funds for abortion come from insurance companies or the states, not the federal government. He adds opponents call this language a “bookkeeping trick.” However, the contention that the funds for abortion come only from the other sources clouds the truth. The federal government provides funds to state plans for the uninsured including those offering abortion and provides funds to insurance companies who offer abortion. The federal government claims innocence as if one hand does not know what the other is doing. But the federal funds are there, subsidizing these plans which offer abortion. A “bookkeeping trick” is an accurate assessment of this proposal. He then equates the salary a federal worker gets from the government as the government funding abortion. His statement ignores what everyone knows. Once a person receives a paycheck, the money belongs to that person to use as he or she would please and is no longer a government fund. Private use of private funds is not government funding of abortion. Also, since the secretary of HHS sets the price the states will pay for abortion services, what is to prevent the secretary from setting the price at any rate? The states and insurance companies contribution for abortions could be next to nothing depending on the whim of that one person.

To the second question Mr. Annas implies the Stupak amendment goes far beyond the Hyde amendment in restricting abortion. A closer look finds otherwise. With the Stupak amendment, any insurer on the government-mandated, government-approved exchange could not offer abortion services effectively eliminating expansion of abortion much like the Hyde amendment. Without the Stupak amendment, however, the government could approve admission to the insurance exchange for a plan offering abortion service and deny admission to the exchange for a plan not offering abortion services since the bill mandates government approval of plans. Thus, abortion coverage could be greatly expanded, the opposite of the effect of the Hyde amendment today. Had the government required approval for every health plan in the US in 1978, the Hyde amendment would have been worthless.

Mr. Annas answers his third question by contending the Stupak amendment eliminates medically necessary abortion, defining medically necessary as allowing abortion for the health of the mother. Therefore, the Stupak amendment is not good public health policy. But, the health exception opens the door for abortion for nearly any reason, reasons as minor as “I’m stressed by the pregnancy.” That statement qualifies as anxiety, a diagnosis which would allow abortion to improve the woman’s “health.” The Stupak amendment rightly closes that door.

In spite of President Obama’s recent assurances, his past statements make clear his commitment to seeing abortion included in any health care reform law. The Senate version clearly allows that.

Matt Anderson, MD

Posted in Abortion, Doctoring, Politics | Leave a Comment »

Extreme Prematurity, Extreme Hard-Heartedness

Posted by MDViews on September 11, 2009

Extreme Prematurity, Extreme Hard-Heartedness

The Daily Mail (www.dailymail.co.uk) from the UK reports that a woman in Great Britain held her baby for two hours until he died while doctors stood by, refusing to help. Why? Because he was born two days too soon. Guidelines in Britain hold that any baby born prior to 22 weeks not be resusitated because such resustation would be futile and the baby would die anyway. Little Jayden was born at 21 weeks and 5 days.

Even if the mother pleads for help? Which she did? Sorry—no can do—was the message to her.

Such is the effect of clinical care guidelines on medical practice, guidelines in Britain developed by a think-tank called the Nuffield Council on Bioethics, guidelines which extinguish human compassion from the care equation and provide cover for doctors to deny care and for the NHS to save money.

I find it difficult to picture an actual physician refusing a patient’s plea in such a circumstance. Theory is one thing. But standing toe-to-bed watching a mother holding her dying child and saying, “No,” chills my soul.

Extreme prematurity is not an easy issue. The earliest survivals on record occurred at 21 weeks 5 days and 21 weeks 6 days. Many times, the babies who survive such prematurity are left with lifelong physical and mental disabilities and always the cost of such care startles our fudiciary sensibilities. (Over a million dollars is not unheard of.) Thus, those who see no value in imperfect life or fail to see the worth of expensive life often carry the day in committees that set guidelines.

The article describes the British Association of Perinatal Medicine doing some fast back-tracking following this incident and her complaint, saying the guidelines were not meant to be a “set of instructions.” But guidelines soon become protocols and protocols morph into rules; rules which, if broken, require explanations and result in discipline for the rule-breaker. Rules which, if followed, save the National Health Service (NHS) millions of pounds.

Looking back on my long years of practice, I’ve been in similar situations. There have been times I’ve told mom and dad that resusitation would be futile and that they should cherish the short time they have with their child prior to his passing. I’ve never fallen back on a guideline to justify my actions, however. I’ve simply told the parents the baby would not, could not survive our best efforts. But I’ve also never turned down a request to help a baby if asked. And I’ve also made sure my statements were true.

One night in my residency, a young woman experienced preterm labor. She was deemed too early for intervention (but was close to the line) and went on to experience an unsuspected breech birth which I attended. Unfortunately, the baby’s head became stuck in the mother’s cervix making delivery impossible and death certain for the struggling premature baby. I cut the mother’s cervix to release the baby’s head, much to the parent’s relief. The baby died in spite of resusitation efforts. Although my superiors criticized this intervention, I can still see the faces of the parents as their baby struggled and wiggled, half in and half out. I’ve no doubt I did the right thing.

The medical cutoff for extreme prematurity is a target in motion, with modern technology resulting in survival of more and more premature babies. Such a moving target contradicts hard and fast rules and should require the best judgment of those physicians at the bedside. Doctors should bring together all the information possible—the stage of the baby’s development, the parent’s wishes, the availabiltiy of treatment, the doctor’s skills—then reach a compassionate and appropriate decision with mom and dad on board.

Matt Anderson

Posted in Doctoring, Medical Issues, Politics | 5 Comments »