WASHINGTON — As the Senate begins negotiations on health-care reform, Catholic physicians are struggling to influence legislation that could limit their freedom to practice medicine.

Physicians committed to Church teaching worry about the advent of abortion mandates and health-care rationing. But groups like the Catholic Medical Association, founded to “assist physicians in upholding the principles of the Catholic faith in the science and practice of medicine,” also object to any bills that promise increased government interference in the doctor-patient relationship.

The U.S. bishops’ criticism of the proposed health-care reform bills has focused on abortion policy and related matters. But these physicians believe the sweeping scope of health-care reform contains a broader challenge to their integrity, prompting concerns about the ethical, practical and financial implications of increased government control over the delivery of health-care services.

“If we lose control over financing the institutions in which we work, we will lose the ability to control the care we want to deliver. Federal bureaucrats will decide what we do in our practices and hospitals,” argued Dr. Steven White, a leading member of the Catholic Medical Association and a Daytona Beach, Fla., pulmonologist.

George Isajiw, an internist who practices in Philadelphia, offers the same grim assessment, the fruit of his longtime experience sidestepping the policies of HMO bureaucrats.

“When a private HMO mandated abortion, contraception and sterilization referrals, I refused to participate,” Isajiw recalled. “They let me off the hook and said patients could call them directly, but I no longer had an opportunity to share my views with them,” he said.

“What happened with the abortion referrals could also happen now with end-of life decisions involving my elderly patients,” he continued.

Throughout a long summer of furious lobbying on Capitol Hill, the U.S. Conference of Catholic Bishops has consistently affirmed both the sanctity of human life from conception to natural death and access to health care as a basic right.

But a recent pastoral letter issued by Archbishop Joseph Naumann of Kansas City, Kan., and Bishop Robert Finn of Kansas City-St. Joseph, Mo., has questioned whether the proposed bills violate Catholic social teaching that discourages large-scale bureaucratic solutions to individual social needs.

Released in August, the pastoral letter argues that “subsidiarity” — a key principle of Catholic social teaching that advocates individual responsibility and community-based solutions — should guide reform efforts.

Alternative Plan

Like many CMA members, Isajiw shares this skeptical view of top-down government policies. He fears proposals that include a national advisory board, which would set policy on approved procedures and reimbursement.

Some Catholic Medical Association members back an alternative Republican plan, The Patients’ Choice Act, sponsored by Sens. Tom Coburn, M.D., of Oklahoma and Richard Burr of North Carolina and Reps. Paul Ryan of Wisconsin and Devin Nunes of California. The bill is designed to strengthen the doctor-patient relationship by creating portable insurance plans that compete for consumers based on individual patient needs.

But Republicans lack the votes to pass such proposals, and the USCCB will be lucky to secure amendments that specifically exclude an abortion mandate and provide a “conscience clause” for pro-life physicians.

During the first weeks of September, Republican Sens. Michael Enzi of Wyoming and Charles Grassley of Iowa have pressed for a bipartisan compromise that incorporates these goals.

Medicine as Vocation

Kathleen Raviele, an Atlanta gynecologist who served as past president of the Catholic Medical Association, welcomes legislative measures that protect pro-life physicians from coercive, pro-abortion policies.

“Right now, the language in the proposed health-reform bills is loose enough that it appears to cover abortion,” said Raviele. “When federal funds are available for abortions, they will increase.”

Following the path of other Catholic Medical Association members in sensitive medical specialties like internal medicine, obstetrics and gynecology and anesthesiology, Raviele has struggled to navigate the culture wars in health care.

After a “change of heart” led her to embrace Catholic moral teaching on abortion, contraception and sterilizations, this “NFP-only” doctor concluded that she must work alone or risk legal action from patients who expected to receive such services while she was “on call” for colleagues who offered them. The common practice of performing tubal legations after childbirth also led her to retreat from obstetrics and focus on gynecological medicine.

“The groundwork has been laid to force doctors and nurses to participate in abortions or to refer patients — but not to discuss adoption,” she said. She noted that the American College of Obstetricians and Gynecologists’ Committee on Ethics issued a 2007 document that set forth “limits on conscientious refusal in reproductive medicine.”

Dr. John Bruchalski, an obstetrician and gynecologist, shares his Catholic peers’ frustration with the focus of health-care reform on Capitol Hill. But his unique experience offers an alternative vision that could appeal to other physicians who struggle to practice medicine in a manner consistent with their deepest beliefs.

“We have a responsibility to provide health care for everyone. But the problem with the present plans is that it’s all about insurance. They offer very little to encourage an increase in the delivery of care. The urgent-care facilities and government health facilities have long lines. By adding people, you’ll make the lines longer,” Bruchalski contended.

Almost two decades ago, after his own conversion, Bruchalski began to provide a “holistic vision” of medicine. Offering natural family planning education and one-on-one counseling for at-risk patients, he struggled to work within a system constrained by HMO mandates and Medicaid cutbacks.

Bureaucratic “rules and regulations” ultimately prompted a radical decision to strike out on his own. In 1994, he established Tepeyac Family Center, a nonprofit medical practice open to patients with public and private insurance, as well as the uninsured.

He and his five colleagues, who also work in obstetrics and gynecology, bridge the gap between operating costs and reimbursement by raising funds within the community they serve. Every physician in the practice has taken a cut in pay.

Asked to express his own hopes for health-care reform, Bruchalski suggests that increased reimbursement for Medicaid and Medicare would be a start.

“Our practice is the largest provider of private OB Medicaid services in northern Virginia. It’s part of our charity. Few doctors take it because they can’t make a living. The poor have to go to clinics, and some specialists simply aren’t available locally for Medicaid patients.”

But even as he shares his peers’ trepidation about the likely pitfalls of government-mandated health care, he remains fully awake to the special graces offered through his work with patients. “For the Christian,” observed Bruchalski, “the call to medicine is a vocation.”

Joan Frawley Desmond writes