Hull, Edgar

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The Linacre QuarterlyVolume 11 | Number 2 Article 3April 1943Medical Education and Catholic DoctrineEdgar HullFollow this and additional works at: http://epublications.marquette.edu/lnqRecommended CitationHull, Edgar (1943) "Medical Education and Catholic Doctrine," The Linacre Quarterly: Vol. 11: No. 2, Article 3.Available at: http://epublications.marquette.edu/lnq/vol11/iss2/3THE LIN~CBE QU~BTEBLY MEDlqAL EDUCATION AND CATHOLIC DOCTRINE By E~GAR HJJLL, M.D. PaoFE880a, SCHOOL or MZDICIlCE, f-oU1llIAIOl4 STATE UlrlVE.SITY NEW Ou.ulfl, Lo11DIAlfA Freedom to teach what they be-lieve to be right and correct in mutters medical is a .fundamental right of t{jachers in schools of medicine. This right exists, how-ever, only 1f the teachers' opin-ions are ba~ed upon reasoning de-rived from adequate knowledge. Since nearl.y all medical praet.ices have ethical implications, it is im-portant fOJ] the teacher of medi- , cine to hav~ an adequate knowl-edge of the !1cience of ethics, which h~s applicafion in the art of medi-cme. For most medical practices the dhical considerations are without doctrinal i{Dplication; that is, they are thf! same for all physi-c i 11. n s, regardless of religious creed. Physicians who instruct in-terns and residents in hospitals, should of course refrain from teaching Catholic doctrine "Ex Professo," ~ut they are bound to refrain from teachings which vio-Inte this (!octrine and should, when occasipn arises, explain its npplication to medical problems. It is their dear duty, as well, to incorporate ethical considerations which are "vithout doctrinal im-plication into their medical teach-ings. N on-~atholic teachers fre-quently do ~ot give Catholic views regarding problems which have doctrinal irpplications, and for this reason medical students who are Catholi,~s should be encour-aged to participate in the activi-ties of Catholic Organizations, lIuch as the Newman Club, so that they may learn to avoid practices which violate ethical principles. In only three types of prob-I~ms are there doctrinal implica-tions in a consideration of the eth-ical aspects of medical practices. The first relates to the preven-tion of pregnancy, the seco.ld to sterilization, and the third to the , interruption of pregnancy The first two of these problems do not need discussion. It should merely be stated that in the majority of ipstances the reasons for the pre-vention of pregnancy are social or economic rather than medical, and that when medical contra-ipdication to pregnancy exists, continence, either total or dur-irg the fertile period, is to be ad- . vised. Sterilization is permissible only if it is the unintentional sec-ondary effect of some operation performed for the cure or relief of serious or disabling disease. I propose to discuss the third problem, and finally to mention some equally important considera-tions which bear upon ethics but not specifically upon Catholic doc-trine. THE IXTERR UPTION OF PREGNANCY Regarding this problem there is a sharp conflict between Catho-THE L[NACRB QUARTERLY lie doct.rine and non-Catholic be-lief. Cathplic rules for the art of conduct state that it is morally 'lVrpng to sacrifice the life of a fetus i~ or<jer to save the mother, bq~ permits removal of a diseased organ (uterus or tube) whose presenfe threatens the life of the mother eve~ though it may con-tain Ij. living non-viable fetus. lluptured j!ctopic pregnancy is the outstanding example' of ~uch a circumstance. Most non-Catholics, on the other hand, believe that it is ethi-cally permissible to interrupt an early uterine pregnancy provideQ th'lt the pregnancy threatens the life of the mother, and that its interrlwtion affords the mother a reasonable chance of survival. Practical Catholics cannot accept this vie\f, for reasons already mentioned, but it would be well tq inquire into the problem from this point of view, and to consider how frequently interruption of preg-nancy would be indicated. The maternal diseases which most frequently enter into the problelTI are tuberculosis, heart disease, diabetes mellitus" anq hypertension. Tuberculosis. There has never been any good evidence that preg-Pancy has Ii deleterious effect up-on women with tuberculosis. A recent complete report 1 from a Minnesota Sanatorium actually reveah "a lower mortality and a higher incidence of arrested dis-ease in cll-ses of corresponding severity among women who had babies after they had developed tuberculosis than among tubercu-lous women who did not become pregnant during the period of ob-servation. The consensus of pres-ent opinion among modern pthisi-ologists 2 is that pregnancies should not be interrupted in pa-tients who have tuberculosis. Diabetes. Women with diabetes are susceptible to toxemia of preg-nancy, and are apt to give birth to large flabby babies which may be born dead or survive for only a few hours. Recent studies 3 dem-onstrate that some diabetic women who are pregnant excrete in the urine excessive amounts of ehori- I onic gonadotropin and diminished amounts of estrogens. These are the ones who develop toxemia or who bear dead or feeble babies. The abnormality can be detected early "in pregnancy by proper as-say of the urine for gonadotropic hormone, and corrected by the administration of estrogens in large dosage. Toxemia may thus be prevented and normal babies delivered. The consensus of pres-ent authoritative opinion is that the existence of diabetes never constitutes an indication for the interruption of pregnancy. Heart Disease. There is no doubt that pregnancy imposes an added burden upon the circu-' lation. The added burden is slight during the seventh, eighth, and ninth weeks and diminishes during the last four weeks of pregnancY.4 • Labor itself does not seem to place I much additional strain upon the I heart, but immediately after de-livery the cessation of blood flow THE LINAORE QUARTERLY through tpe placenta suddenly throws an increased volume of blood back to the heart, and in-creases its work considerably for several hOUfS. There is ample evi-dence that pregnancy is bad for women witll serious valvular dis-ease which has produced symp-toms of cllrdiac embarrassment before the inception of pregnancy, but no evidence at all that hearts affected by a slight or moderate degree of -ralvular deformity do not adequaj;ely bear the extra bur-den of pre~llancy. The question of interruption of pregnancy would therefore arise only in the case of advanced valv-ular diseas~ with cardiac enlarge-ment and definite electrocardio-graphic abItormality. Such a case occurs only rarely, since fertility is greatly l!educed in women with serious he~rt disease. Even in such cases, the mother is usually safe and the baby is born alive provided thjlt the best of medical care is giv\!n during pregnancy, labor, and the puerperium. Spe-cial observation and care are needed duripg the latter months of pregnancy and during the first hours of the puerperium. Most of the mothers who have died have not had adequate care. The con-sensus of (Ipinion today among qualified cl~rdiologists is that nearly all pregnancies in persons ""ith heart pisease should be al-lowed to cOlltinue. Hypertension: The effect of pregnancy upon pre-existing hy-pertension is not definitely known. In a recent article, Foa, Foa and Peet 5 state: "Some investigators reported that hypertension im-proves with pregnancy, while oth-ers claim that the symptoms be-come more severe and death fol-Jows rapidly." It is well known ~hat some women with hyperten-Ilion die during late pregnancy, )Vhile others carryon in normal fashion through repeated preg-pancies. Some women survive fl-fter the interruption of early pregnancy, while in others the dis-fase progresses to a fatal termi-pation in spite of the performance of therapeutic abortion. Preg-pancy exerts a beneficial effect lIpon experimental hypertension produced by renal ischemia in ani-mals.1i It is thus seen that in the light of present inadequate knQwl-edge no clear indication for inter-ruption of pregnancy exists in ~ypertension. At present we are beginning a study in which at-t~mpt will be made to determine tre effect of pregnancy upon hy-pertension, and the effect of thera- -peutic abortion in such cases. Catholic versus Non-Catholic Viewpoint. The preceding discus-sion has, I believe, shown that in the light of present-day medical knowledge, the Catholic viewpoint forbidding the direct interruption of pregnancy is supported by non-Catholic, qualified medical opin-ion. Catholic physicians should all become thoroughly conversant with modern medical practices in this regard, and give the benefit of their knowledge to their col-leagues, residents, interns, and medical students, as abortions are THE LIN~aRB QU~RTERLY j , stilJ being advised and performed all ~oo frequently by earnest but poorly ~nforJIl~ physicians. Cath-olic teachers in medical schools, anq Catholics on examining boards shoqld discourage use of the fre-queptly as~ed examination ques-tion: '~Lis~ the indications for tperapeutic abortion." Emphasis in instruction and examination shopld rath~r be placed upon the effect of pregnancy on the course of JIlaternal diseases, the care of maternlll diseases during preg-nancy, anq the evil results of therapeutic · abortion. Catholic physici/!ns should not allow their religioqs convictions to prompt them to teach anything in matters meQical that is not strictly true; but an increasing knowledge of scientifjc truth vindicates more anq more the Catholic position. ETHICAL CONSIDERATIONS WITHOUT DOCTRINAL IMPLICATION The medical student receives no fonnal instruction regarding the ethics of medical practice. What he, and most physicians as well, re~ards as medical ethics is a set of rules, consisting mostly of cour-tesies, which have been handeQ down by trp.dition, and which are abstracted in a ,booklet published by the American Medical Associa-tion. These rules are laudable, but superficial. Many young men, of good character, undertake the study of medicine because they see in that profession the opportu-nity to achieve financial success: nothing happens during their un-dergr~duate medical careers to make them see that medicine, properly practiced, cannot lead . 1 to riches, but that success must I ~e in 'service and accomplishment. They graduate with fairly ade-fIuate knowledge, but soon learn, . I subconsciously, that service and ,,"ccomplishment are not necessary for financial success. They cling , only to the superficialities of medi-cine, and gradually deteriorate into mediocre self-satisfied practi-tioners who cannot profit by their . own medical experiences. Students and , young physicians should learn to apply the virtues of justice, humility, and charity to the art of medicine. They must learn to be conscientious, and come to know that they cannot be I truly conscientious if they allow themselves to become ignorant. They should know that they will become ignorant if they do not continue to study, for the sciences and arts of medicine are ever .J changing. They should learn to I be progressive, withput being dar-mg. Students learn the arts of medi-cine by practice under the super-vision of their instructors. A 'great opportunity for the teach-ing of an art of conduct lies with the teacher in the ward and clinic,. and he can teach best by example. Kindness to patients, thorough-ness in case studies, justice to stu-dents, practice of the virtues ~hich he wishes his students to practice in the future, are the best means of assuring a generation of truly ethical practitioners. THE LIN4CBB QU4BTEBLY I~EFEn.ENCES 1. MAaIETrjf' E. S., LAII8ON, L. M., and LITZENBERG, ,T. C.: Treatment of Tuber-culous Wom'itn During Pregnancy. 4m. I. "jI. Be., 201):866-874, JWle 1942. 2. ROUND JABLE DlSC11DIOlf en' Tuua-CULOSIS, 25t~ Annual Clinical Session, American College of Physicians, Boston, 1941. 3. WHITE, P . and HUNT, H.: Predic-tion and Prer ention of Pregnancy Acci-dents in Diabetes. J. 4. M. A., 115:2039-2040, Dec. 14, 1940. 4. CoHEN, M. E . and THOMSON, K. J .: Studies on Circulation in Pregnancy; ~ummary of Studies of Physiology of Circulation of Normal Pregnant Women: New Concept of Nature of Circulatory Burden of. Pregnancy and Its Appllca-ion to Management of Clinical Problems of Pregnancy. J . A. M. A ., 112:14116-J662, Apr. 22, 1989. 5. FOA, r. P., FOA, ~. L ., and' PEET, M. M.: Effect of Pregnancy on Experi-JIlental Renai Hypertension in Rats. Am. J. ~I. Be., 204:35G-856, Sept. 1942. Ratio rtin 9 Dr. Charles F. Wilinsky, Depqty Commissioner of Health, B08- / ton, in an ~rticle in the current issue of the New England Journal of Medicine qn "Hospitals and the Wjl.r," says that the hospitals face the challeJtge of adjusting themselves to curtailed personnel and rising cost and scarcity of supplies while at the same time maintaining the high standards which are important for the preservation of life. "Judgment in its keenest form," he states, "will have to be exer-cised. The use of substitutes and reljl.tively simple methods and proce-dures will be justified. The critically ill must have priority, and there must be a Jlationing, so to speak, of qoctors, patients and hospital beds when that f Ppears necessary." There Have Been Rumors That Pablum Is Off the Market Pabena, the new Pablum-like precooked oat cereal, does not re-place Pablum. Pabena is now being marketed in addition to PablUIq. Pabena offers substantially all of the nutritional qualities of Pab-lum and al) of its advantages of ease of preparation, convenience and economy. The base of Pabena is oatmeal (85%) which gives it a fine flavor and offers variety to the diet. Would you like some of both for use in your own family? MEAD JOHNSON & COMPANY, Evansville, Ind., U. S. A. 

Medical Education and Catholic Doctrine

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Medical Education and Catholic Doctrine

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