Costello, J. Bernard

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The Linacre QuarterlyVolume 32 | Number 1 Article 24February 1965Letter from CanadaJ. Bernard CostelloFollow this and additional works at: http://epublications.marquette.edu/lnqRecommended CitationCostello, J. Bernard (1965) "Letter from Canada," The Linacre Quarterly: Vol. 32 : No. 1 , Article 24.Available at: http://epublications.marquette.edu/lnq/vol32/iss1/24wise. It might be thought that some of these are psychological, but I feel that this is unlikely, since the women I selected for the research I have known for years and were individually screened for stability. The commonest complaint was transient nausea on first taking the medication in the initial cycle; this did not recur on subsequent cycles. Many who had habitually ex­perienced premenstrual tension with a variety of symptoms, related that these no longer occurred. Since every pa­tient had expressed the intention of having more children, it cannot be relief from fear of pregnancy that is responsible. It is superfluous to add that single women also find this to be a distressing time. Several of the group have vari­cosities in varying severity; none has had any aggravation of symptoms on the program. In fact, eight patients had had superficial thrombo-phlebitis post-partum. . � am not disturbed about the possi­bility of teratogenic effects as far as patients who conceive while on the program. Over the years I have had patients on oral progestational agents 10 the latter half of the cycle on which they conceived, and I have never ob­served masculinization in the female infant�_nor do I personally know anyobstetncian who has. I question whether the small amount of medica­tion over a period of ten days on this program-during which time the pa­tient conceives, the fertilized ovum tr_averses its customary path, �nd n1dates--could possibly affect the de­velopmental process of the foetus. 72 SUMM. Thirty-five womc fertility, who have any artificial method were medicated frorr: of each cycle. 1. 100% had a erwith 4-5 days of rr. gardless of previous 1 2. Ovulation occu by the following test (a) Basal Body T( b) Glycogenesis( c) Cervical arbor(d) Maturation Inpool Pap( e) Endometrial cExcept for Test Da onstrates the endomc effect of the medicati conducted prior to m. cycle. Such a program ec female procreative cy, able ovulation and trium pattern. of established .ver employed contraception, y 15 to day 25 of 28-29 days e rate flow, re-1strual pattern. d at Day 14 1perature cervical mucus ,.tion x from vaginal _psy 23 which dem­um under the , all tests were ication on each regularize the ;; with predict· )rmal endome· ACKNOWLEDGMENTS: am grateful to Mr. Charles Richardso Administrator of the Norwood He pita!, and the trustees of the hospit�.· who extended to me every facility in the furtherance of this work withouc reservation or stint. Dr. Duncan S 'lythe and Dr. Walter Casale who ev· luated the cyto­logical and histologicai slides were my governing eyes an� unscrupulous critics. Their high order of personal and· professional ethics were a con· stant source of encouragement to me. LINACRE QUARTERLY Letter from Canada There are differences between Can­ada and the United States beyond population, geography, and culture that are perhaps of more interest and are more apparent to a physician. In Canada, for many decades, the ;d_i�g­nostic services and treatment faC1ltt1es of public health have been ava�lable and free to physicians and patients. In more recent years, and varying somewhat from province to province, free pathology services h_ave been p�o­vided for all whether 10 or outside of hospitals, as well as free cytology interpretation services. Within the last ten years we have seen develop in each of the provinces a compulsory hospital insurance service. Even more recently two provinces have introduced a form of medicare and the Hall Com­mission has made its recommendations for long range establishment of a na­tional system of "free" medical care. The reaction of the medical pro­fession as to what has already taken place and what it contemplates is about to take place has certainly varied with individuals but, in general, it has been �avoura�le to the principles involved ID makmg good health care and hos­pitalization available to everyone. It � true that a large number of physi­CJans have migrated and others have made preparations for departure to the U�ited States to escape the regime of SOC1ali2ed medicine. However, most doctors feel that these changes in Canada are inevitable no matter which government is in power. The medical prof�sion is doing its best to try to obtam the most equitable type of scheme when it does come. All these social changes in medical care are threatening to raise moral P�l�. All hospitals remain private IIIStituttons at present. However, since tbc Government is paying their per P!aUAlY, 1965 diem rate it is largely controlling all expenditures including capital expendi­tures. It is also keeping the medical audit and other statistics so that it is not hard to foresee a time when it may well decide to step a little further into the very control of medicine with­in the hospital. Such an issue has already arisen in a small town where the only hospital serving the area is a Catholic insti­tution. The physicians who practice there desire to carry out procedures not permitted by the code of Catholic hospitals, such as sterilizations, and these doctors have been able to raise considerable publicity and apparent sympathy for their cause. Perhaps as a result of this, there has been a move to establish a body of doctors en­tirely outside of hospital staffs and hospital controls. This body would pass judgment on sterilizations, etc., with the recommendation that the doctor be given the right to carry out their recommendations in any hospital, thus, bypassing the control of hos­pital regulations. This is not yet a re�lity but it is a threat in the future. In one of our hospitals the regula­tion of mandatory consultations for a D & C,' hysterectomy, and others, was being so operated as to eliminate personal responsibility for the pro­cedure involved. Consultation had, in effect, become merely a rubber stamp. As an experiment, this hospital dropped the mandatory portion of its consultation requirements and left it to individual doctors to call consulta­tions when it was felt necessary, thus returning responsibility to the indi­vidual. However, the Department of Obstetrics and Gynaecology goes through each chart individually, check­ing history for indication and pathol­ogy for results. This detailed checking 73 .,. ' of all charts has proved far more ef­fective than the previous system in preventing surgery of questionable necessity or morality. There are three Catholic Physicians' Guilds in Canada but currently only the one in Manitoba is affiliated with the National Federation. However, I believe all members subscribe to THE LIN ACRE QUARTERLY. Several years ago the Manitoba Guild staffed a booth at the national CM.A. conven­tion and recently the Guild in British Columbia held as part of the official CM.A. program a panel discussion on medical practice in a Catholic hos­pital. Excellent cooperation was ob­tained from the executives of the C.M. A. and this may help establish a precedent for the inclusion in future scientific programs topics pertinent to religion, ethics and medicine. In non-Catholic hospitals tubal liga­tion is a frequent procedure, requir­ing only the written consent of the parties involved and of two consul­tants. It is nearly a routine procedure at third caesarean. So-called "thera­peutic" abortion is becoming less fre­quent as the consultants seem to be finding less reason to be able to jus­tify it; however, press releases from our official medical organizations would give the impression that the 74 medical and legal 100% in favour of and sterilization leg� The absence of a in helping to regula is reflected by the st� doctors. Their sugges the current epidemil and the rising vene are the provisions c by the schools and i formation in the sd is presented as the r morality is not even It is in 'a backgro, our Guilds have had to play-not to entt paper debate with t. but to develop leader all fields and to ed· by cooperating with faiths, advocating me all problems. ,fessions were aking abortion Jrocedures. ,e moral code people's lives ·nents of somel remedies for Jf illegitimacy 1 disease rate sex education th control in-1ls. Pregnancy ,blem, the im­ognized. d such a s  this e largest roles into a news· ,e suggestions of thought in ,te the pub�c 1eople of all -1 solutions toThis is our problen · n Canada and am sure it .is not 1rs alone, nor for long. By furthe, ·ommunication I am sure we can ; lp each other meet local problems a· l provide lead· ership to overcome ,e decline of morality throughout t' . .: world. J. Bernard Ct· tel10, M.D.Vancouver B tish Columbia,Canada LINACRE QUARTERLY DR. CUNNINGHAM IN AUDIENCE WITH POPE PAUL VI On November 25 1964 it was the great privilege and honor of Dr. Clement P.Cunningham, immediat� past president of the National Federati?n to meet our HolyFather, Pope Paul VI. He is photographed here presenting His Holiness with theManual of our Federation activities. Speaking in English, the Pope conveyed his greathappiness to learn of the numerous Guild projects and their development. He askedDr. Cunni�gham to convey to all the members .and their familie_s his special Apost�ltcBlessing along with good wishes for the success of the works m which the organiza­tion is engaged. Following the audience, .Dr. and Mrs. Cunningharn left by plane from Rome fly­ing to Bombay, India to attend the Third Asian Congress of Catholic Doct?rs and the Eucharistic Congress then in progress. The trip to Bombay was very delightful and made even more impressive as they traveled in the company of the Papal Delegat�, His Eminence, Cardinal Agagianian, who is aware of the efforts of our Federat10n m the medical mission world. . The Third Asian Congress provided three days of intensive study o_f the popula­tion problem, particularly as reflected in India. It seemed somewh�t iromc _to Dr.Cunningham that in the United States where so many consider family planning thec�untry's most pressing problem, in India it occupies seventh plac_e with prioritiesgaveg to more urgent needs such as food, education, health, economics, and others . . The inauguration of the Asian Federation took place during this . meetin?. andPlans are being developed· to join the International Federation of Cath_oltc Physaoan�.�rom observing the activities of this newly formed group, Dr. Cunnmghan:1 feels _ at11 the responsibility of American doctors to communicate as much as possible withPhrsicians in other areas of the world. Opportunities will be available d�ring t_heDut four years when the International Federation will meet in October 1966 m Manda 111d two years later the Fourth Asian Congress wil I meet in Tokyo, Japan. F'aa.UAIY, 1965 75 

Letter from Canada

The Linacre QuarterlyVolume 32 | Number 4 Article 22November 1965Letter from CanadaJ. Bernard CostelloFollow this and additional works at: http://epublications.marquette.edu/lnqRecommended CitationCostello, J. Bernard (1965) "Letter from Canada," The Linacre Quarterly: Vol. 32 : No. 4 , Article 22.Available at: http://epublications.marquette.edu/lnq/vol32/iss4/22there are vast areas in Africa andother emerging lands in the worldthat are also most worthy of our fullsupport. , 1:he individual Guild mission' '.l.Irm:n will be contacted to make . ,cfimte commitment to an area in < .ntral and South America to imple­:nent th_e use of local physiciansthere with monies and materials The type and scope of this effort wili360 have to be determin, amount of ground , laid but we are wili effort in this direction conduct meetings ii States or in South A �uss with responsibi implementation of a help. Joseph A. Gra James H. Mast 1fter a lair , has been to expend d if feasible he United rica to dis­people the plans for M.D. ;on, M.D.LINACRE QUARTERLY Letter from Canada Since my letter of 1964, Canadi­ans have "advanced?" another large mile toward a Welfare State. This has not occurred as a result of grass roots pressure for such measures nor the upsurgence of socialistic political parties. Rather, it seems to be the result of all political parties trying to out-promise each other in the sp ending of the  wage-earner's money. To the politician the Wel­fare State seems a worthy goal to be pursued without regard for consequences. Already, the tell-tale symptoms ofassociated disease are making ap­pearances. The efforts of the gov­ernment towards. a Welfare State have lessened or almost removedtalization; 2. medical care; 3. provi­sion by savings, etc., for the future; personal responsibility for: I. hosp:-4. unemployment or its lack. · · This near elimination of r,ersonalresponsibility has been brought about by the introduction. and/or implementation of national univer- · sal �ospitalization with only token per diem payments. Provincial health plans are in operation in many prov­mces and a national compulsory "�rs� dollar" plan is threatening w1thm two years. A national com­pu!sory contributory pension plan is bemg started with such extensive coverage that it is likely to go broke as presently scheduled or at least cripple the contributors. This same defect befell the National Unem­ployment Insurance Fund. Many employables find it nearly as profit-NOVEMBER, 1965 able and more to their liking to work only part of the year and deliberately draw unemployment benefits for the remainder. The incentive to seek employment is removed. Canada is a large country with many natural resources, such as water, power, oil, gas, minerals and timber. Its population is small but this is a time of expanding economy. Government incomes are very high but so is government spending. It is these current circumstances that have so far allowed the politicians to promise the sky and leave our children's children to pay for the present megalomania. · I am not against government spon­sored help to individuals to pay their hospitals or their doctors, nor am I. opposed to aid while seeking employ­ment, nor even to providing a meas­ure of social security in portable pensions. However, when personal responsibility is removed or nearly eliminated purposes are lost. Third party bureaucrats develop, manipu­late and control these social meas­ures-not often with reference to need of community and the indi­vidual but nearly always for reasons recognized as valid only in a political sense. The foreseeable end results of such lack of personal responsibility are already in evidence: - hospital stays are prolongedunnecessarily.- physician attendance is soughtfor ridiculously minor com-361 plaints. Ncuroticism is fostered without penalty. - credit spending becomes thenorm of family living with noprovision for the future. - deliberate attempts are made�o get "paid back" money paid mto the Unemployment Insur­ance Fund by becoming delib­erately unemployed. cure must be sought that is, educating 0 public in general t, costs someone someth and the government a living. education 'es and th; everything -the world not owe us and labour work week .Jut help so ·oductive as T�e ca�s: of this disease is politi­cal m ongm but it exists in the greed �f.each of us. We are victims of poht1cal promises because we want something for nothing. The The goal of politici should not be a shor and earlier retiremen that all can remain long as possible. It is much better tc )ve than to receive. J. Bernard C stello, M.D. Vancouver If the next issue of this journal should be delivt �d to adifferent address, please advise AT ONCE Th t t . , e re . rn pos -age and cost of remailing this publication is becomi,19 more and more prohibitive. your cooperation ·,n k eepmg us up-to-date with your address will be most helpful. In the future : will be necessary to complete Form 3579 furnished yo;y the Post Office, sending same directly to The LinacreQuarterly office. Copies .of the journal will riot be remailed.362 LINACRE QUARTERLY Current Literature: :Jul6 anJ At6lracl6 • • • Material appearing in this column is thought to be of particular interest to the Catholic physi­cian because of its moral, religious, or philo­sophic content. The medical literature consti­tutes the primary but not the sole s01lrc.e of such material. In general, abstracts are intended to reflect the substance of the original article. Parenthetical editorial comment may follow the abstract if considered desirable·. Books are re­viewed rather than summarized. Contributions and comments from readers are invited . Barton, R. T.: Sources of medical morals. J.A.M.A. 193:133-138 July 12, 1965. Historically, codes of medical ethics began with the shaman ( or tribal leader) and continued with Imhotep (3,000 B.C.), Hammurabi (2,500 B.C.), Asclepius, Hippocrates (500 B.C.), Avi­cenna, and Maimonides. Modern sci­ence, perhaps dating from the' time of Harvey, has stimulated Percival's Code (1�00) and such contemporary codifi­c:it1ons as the AM.A Code, Declara­tion of Helsinki, Geneva Declaration and Nuremberg Code. In terms of e�ical theory, there is a moral ellipse with _two limbs, each originating in Mo��:c law. One limb ("Christian ethic ) progresses via Aristotle, Cicero, Aquinas, and Kant to the natural-law theory of morality. The other ("Tal­mu?") evolves via Protagoras, Plato, Maimonides, and the Empiricists to �e p�agmatic theory of value, with a diversionary but parallel stream via the a_nalytic philosophers to the existen­tialists. "The natural-law theory of morality contends that man has NOVEMBER, 1965through creation been given an insight into nature's purposes and values"; this theory has the following characteristics: it is aprioristic, conservative, authori-.tarian, antiscienti{ic, and absolutist. The pragmatic theory of value, on the other hand, "restores man to the posi­tion of centrality in moral questions, rather than some higher code of divin­ity .... It is a method for living in this world rather than a doctrine for getting into another world." This theory has the following characteris­tics: it contends that our concepts of right and wrong are acquired through human experience, it is liberal, it is pluralistic, it demands continued in­quiry, and it is relativistic. What is the influence of these ethical theories on modern day medical morals? Al­though these approaches seem diver­gent and antipathetic, they appear "to borrow from each other and often end up saying somewhat the same thing" and, indeed, tend to converge to com­plete the "moral ellipse" mentioned earlier. 363 l ' 

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Letter from Canada

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