Tuesday, November 17, 2009

Conscience and health care reform: a personal view

A little over a year ago, the DMC Pharmacy opened amid great fanfare and some mild protests in an otherwise nondescript shopping plaza in Chantilly, Virginia. What makes this particular pharmacy unlike other local pharmacies (besides its nonprofit status) is that it is one of only 7 pharmacies in the nation that has a "pro-life mission," declining to stock condoms, contraceptives, and "morning after" pills. DMC Pharmacy's parent organization, Divine Mercy Care, includes the Tepeyac Family Center, the Ob/Gyn practice that delivered my son.

My wife and I chose Tepeyac - easily an hour's drive from our home - over dozens of geographically closer practices because we were seeking physicians who practiced medicine that was consistent with our faith. They would understand, for example, why we immediately declined the triple screen test despite the increased risk for birth defects associated with my wife's age. Under absolutely no circumstances would either of us consider an abortion, a conviction rooted in our mutual faith and my personal experience in medical school, when I observed firsthand, with increasing horror and revulsion, several second-trimester abortions during my obstetrics rotation.

The recent passage of the House version of the health care reform bill included language that has come to be known as the Stupak amendment (after the representative who proposed it), which instantly became a lightning rod for praise from some quarters and criticism from others. It is clear that the House bill would not have passed without the amendment (supported by most Republicans and 64 Democrats), which essentially forbids federally funded or subsidized insurance from paying for abortions. Nonetheless, many in Congress have loudly declared their intent to remove it from the final legislation, or failing that, seem willing to let this incarnation of health care reform die so (not to put too fine a point on it) unborn babies can go on dying as well.

I recognize that my describing abortion in such language may be viewed as inflammatory by some. On the other hand, I don't believe that we can honestly tackle these thorny issues of conscience, and, especially, of faith, in health care without being painfully direct about it. Unlike some pro-life activists, I don't dispute the legal right of a woman in the U.S. to have an abortion for any reason - what I, and apparently a majority of congressmen and women, dispute is their right to have one using my tax dollars.

While I sincerely hope that the current health care reform effort, imperfect as it is, won't be derailed by people on either "side of the aisle" seeking to score ideological points, the point I'm making is that for me and many others, ideology isn't the issue at all. As a family physician who has worked in the underserved communities of Washington, DC, I understand more than most that the lack of access to or ability to afford quality primary care is itself a profound moral issue, and it pains me to have to balance my desire to give all people in the U.S. a 21st century health system with my conviction that that health system neither condone nor encourage a medical intervention that is unique in ending, rather than protecting, life. There needs to be another option - there must be a better way - and I implore all who are reading to seek it while there's still an opportunity to do so.

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