Originally broadcast July 16, 2010

FRED DE SAM LAZARO: Abraham Verghese has all the credentials and degrees befitting a professor at Stanford Medical School. But he is best known and acclaimed for his writing — two best-selling memoirs and a new work of fiction that evoke a different kind of medical vocation.

ABRAHAM VERGHESE: My desire to be a physician had a lot to do with that sense of medicine as a ministry of healing, not just a science. And not even just a science and an art, but also a calling, also a ministry.

DE SAM LAZARO: His goal is to have today’s medical students aspire similarly to a calling­ as much as a career in medicine, to awaken a more basic curiosity as they sharpen their clinical acumen. These third-year medical students were studying abnormalities on a scan, specifically the prominence of certain blood vessels.

VERGHESE: (Speaking to students) This is what’s called pulmonary redistribution. Have you heard that term? It’s an early sign of heart failure. Who’s got good hand veins that I can borrow?

DE SAM LAZARO: Verghese offered a simple physics explanation of why blood vessels should not normally be visible above the level of the heart.

VERGHESE: (speaking to students) The level of her right atrium is about here. So watch what happens as I raise her hand. You still see the veins, nice three dimension, right? See how they’re flattening out? Now they are gone.

DE SAM LAZARO: The bottom line: Well before an x-ray, a doctor might spot telltale signs of disease.

VERGHESE: (speaking to students) And you see their neck veins and they’re not coughing, speaking, singing, straining, they have increased venous pressure.

DE SAM LAZARO: Increasingly, he says students and practitioners of medicine in the West rely on technology in a system that stresses cognitive knowledge and machines over the skill that comes from touch and feel.

VERGHESE: I’m the first to admit that the resolution of a hand feeling the belly doesn’t compare with the resolution of a CAT scan scanning the belly, but only my hand can say that it hurts at this spot and not at this spot. Only my hand can say that. Only my hand can say that this pulsatile mass, which might be an aneurism, is also painful, which is therefore maybe a leaking aneurism. You know, there are nuances to the exam that no machine is going to give you.

DE SAM LAZARO: It’s a theme Verghese has sounded repeatedly over the years, writing in magazines, including the New Yorker and Atlantic, and now in a best-seller called “Cutting for Stone.” It fulfills a long-held desire to write fiction, as he told this book club in Menlo Park, California.

VERGHESE: (Speaking at book club) Dorothy Allison, a wonderful American writer, she says fiction is the great lie that tells the truth about how the world lives.

DE SAM LAZARO: The setting for Verghese’s novel is far from Silicon Valley — a mission hospital in Ethiopia. It is a textured, 650-page narrative, set amid that country’s turmoil in the 60s and 70s. Its stories of medicine, doctors and future doctors at the hospital all illustrate what the author calls the “Samaritan role” of the healer. Verghese went from med school in India to Boston, Tennessee, Texas, then Stanford. He was born and raised in Ethiopia to parents originally from Kerala, India and from its Syriac Orthodox traditions. Faith was a big part of life for this and other expatriate communities in the Addis Ababa of his youth, which may unwittingly have shaped some of the novel’s characters.

Woman at Book Club: You said that what really inspired you to write the book was you wanted to write a book that would get people interested perhaps in medicine. But there was so much in the book about faith and different types of faith, and so how did you come to have so much of this, of another theme in your book?

VERGHESE: Well, you know, the honest answer is I don’t really know. It all just sort of evolved that way. And I think when you’re in medicine, you agonize over matters of faith.

DE SAM LAZARO: The confluence of faith and medicine, and the mission hospital itself, attracted Duke University Divinity School dean Gregory Jones to Verghese’s book. It was a timely find, just before a recent trip to discuss his church’s own mission work.

GREGORY JONES, Duke University: It becomes a shaping institution that plays a really significant role in any developing country and one that we need to pay a lot more attention to. My trip to London was actually to deal with issues around southern Sudan, and so I was struck by the significant role this hospital was playing in the novel about Ethiopia.

DE SAM LAZARO: And even though its setting seems distant, Jones says the novel’s context is very relevant to many students he sees at Duke.

Gregory Jones

JONES: I think a lot of Christians go into nursing or medicine or other health-related vocations out of a deeply formed and felt Christian vocation, but sometimes the practice of health care, in the United States particularly, often pushes those apart. And I think the novel portrays that in a really beautiful way.

VERGHESE: I joke but only half joke that if you show up in an American hospital missing a finger, no one will believe you until they get a CAT scan, MRI and orthopedic consult.

DE SAM LAZAROAll the emphasis on machines, he says, adds cost to the health care system, and comes at the expense of one of our most important rituals — a visit with one’s doctor.

VERGHESE: Rituals are about transformation. You know, we marry with great ceremony to signal a transformation. We are baptized in a ritual to signal a transformation. The ritual of one individual coming to another and confessing to them things they wouldn’t tell their spouse, their preacher, their rabbi, and then even more incredibly, disrobing and allowing touch, which in any other context would be assault. You know, tell me that that’s not a ritual of great significance. If we short-change the ritual by not being attentive, or you are inputting into the computer while the patient’s talking to you, you basically are destroying the opportunity for the transformation. And what is the transformation? It’s the sealing of the patient-physician bond.

DE SAM LAZARO: Ironically, Verghese says, research is emerging that corroborates the importance of this bond, the virtue of the Samaritan healer.

VERGHESE: We’re learning that you can have a powerful effect on patients, or a powerful negative effect on patients based on context, based on your tone of voice. They are actually associated with significant chemical changes in the brain. The Parkinson’s patients’ dopamine levels go up with a placebo. We’re now able to show that the words of comfort trigger biological reactions which are the very things that you want, and you can use drugs to get there, or you can use words of comfort to get there, which would make your drugs so much more effective. It’s an incredible insight, and you know, a couple of decades now of practicing medicine, it’s lovely to come full circle to where I started, but with the science to back it up.

DE SAM LAZARO: For Religion & Ethics NewsWeekly, this is Fred de Sam Lazaro.

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“You cannot understand caregiving unless you do it,” says Arthur Kleinman. “Acts of caregiving come as close to what I think religion is as I could name.” Watch more of Bob Abernethy’s conversation with him.

The post Arthur Kleinman Extended Interview appeared first on Religion & Ethics NewsWeekly.

FRED DE SAM LAZARO: Abraham Verghese has all the credentials and degrees befitting a professor at Stanford Medical School. But he is best known and acclaimed for his writing — two best-selling memoirs and a new work of fiction that evoke a different kind of medical vocation.

ABRAHAM VERGHESE: My desire to be a physician had a lot to do with that sense of medicine as a ministry of healing, not just a science. And not even just a science and an art, but also a calling, also a ministry.

DE SAM LAZARO: His goal is to have today’s medical students aspire similarly to a calling­ as much as a career in medicine, to awaken a more basic curiosity as they sharpen their clinical acumen. These third-year medical students were studying abnormalities on a scan, specifically the prominence of certain blood vessels.

VERGHESE: (Speaking to students) This is what’s called pulmonary redistribution. Have you heard that term? It’s an early sign of heart failure. Who’s got good hand veins that I can borrow?

DE SAM LAZARO: Verghese offered a simple physics explanation of why blood vessels should not normally be visible above the level of the heart.

VERGHESE: (speaking to students) The level of her right atrium is about here. So watch what happens as I raise her hand. You still see the veins, nice three dimension, right? See how they’re flattening out? Now they are gone.

DE SAM LAZARO: The bottom line: Well before an x-ray, a doctor might spot telltale signs of disease.

VERGHESE: (speaking to students) And you see their neck veins and they’re not coughing, speaking, singing, straining, they have increased venous pressure.

DE SAM LAZARO: Increasingly, he says students and practitioners of medicine in the West rely on technology in a system that stresses cognitive knowledge and machines over the skill that comes from touch and feel.

VERGHESE: I’m the first to admit that the resolution of a hand feeling the belly doesn’t compare with the resolution of a CAT scan scanning the belly, but only my hand can say that it hurts at this spot and not at this spot. Only my hand can say that. Only my hand can say that this pulsatile mass, which might be an aneurism, is also painful, which is therefore maybe a leaking aneurism. You know, there are nuances to the exam that no machine is going to give you.

DE SAM LAZARO: It’s a theme Verghese has sounded repeatedly over the years, writing in magazines, including the New Yorker and Atlantic, and now in a best-seller called “Cutting for Stone.” It fulfills a long-held desire to write fiction, as he told this book club in Menlo Park, California.

VERGHESE: (Speaking at book club) Dorothy Allison, a wonderful American writer, she says fiction is the great lie that tells the truth about how the world lives.

DE SAM LAZARO: The setting for Verghese’s novel is far from Silicon Valley — a mission hospital in Ethiopia. It is a textured, 650-page narrative, set amid that country’s turmoil in the 60s and 70s. Its stories of medicine, doctors and future doctors at the hospital all illustrate what the author calls the “Samaritan role” of the healer. Verghese went from med school in India to Boston, Tennessee, Texas, then Stanford. He was born and raised in Ethiopia to parents originally from Kerala, India and from its Syriac Orthodox traditions. Faith was a big part of life for this and other expatriate communities in the Addis Ababa of his youth, which may unwittingly have shaped some of the novel’s characters.

Woman at Book Club: You said that what really inspired you to write the book was you wanted to write a book that would get people interested perhaps in medicine. But there was so much in the book about faith and different types of faith, and so how did you come to have so much of this, of another theme in your book?

VERGHESE: Well, you know, the honest answer is I don’t really know. It all just sort of evolved that way. And I think when you’re in medicine, you agonize over matters of faith.

DE SAM LAZARO: The confluence of faith and medicine, and the mission hospital itself, attracted Duke University Divinity School dean Gregory Jones to Verghese’s book. It was a timely find, just before a recent trip to discuss his church’s own mission work.

GREGORY JONES, Duke University: It becomes a shaping institution that plays a really significant role in any developing country and one that we need to pay a lot more attention to. My trip to London was actually to deal with issues around southern Sudan, and so I was struck by the significant role this hospital was playing in the novel about Ethiopia.

DE SAM LAZARO: And even though its setting seems distant, Jones says the novel’s context is very relevant to many students he sees at Duke.

Gregory Jones

JONES: I think a lot of Christians go into nursing or medicine or other health-related vocations out of a deeply formed and felt Christian vocation, but sometimes the practice of health care, in the United States particularly, often pushes those apart. And I think the novel portrays that in a really beautiful way.

VERGHESE: I joke but only half joke that if you show up in an American hospital missing a finger, no one will believe you until they get a CAT scan, MRI and orthopedic consult.

DE SAM LAZARO: All the emphasis on machines, he says, adds cost to the health care system, and comes at the expense of one of our most important rituals — a visit with one’s doctor.

VERGHESERituals are about transformation. You know, we marry with great ceremony to signal a transformation. We are baptized in a ritual to signal a transformation. The ritual of one individual coming to another and confessing to them things they wouldn’t tell their spouse, their preacher, their rabbi, and then even more incredibly, disrobing and allowing touch, which in any other context would be assault. You know, tell me that that’s not a ritual of great significance. If we short-change the ritual by not being attentive, or you are inputting into the computer while the patient’s talking to you, you basically are destroying the opportunity for the transformation. And what is the transformation? It’s the sealing of the patient-physician bond.

DE SAM LAZARO: Ironically, Verghese says, research is emerging that corroborates the importance of this bond, the virtue of the Samaritan healer.

VERGHESE: We’re learning that you can have a powerful effect on patients, or a powerful negative effect on patients based on context, based on your tone of voice. They are actually associated with significant chemical changes in the brain. The Parkinson’s patients’ dopamine levels go up with a placebo. We’re now able to show that the words of comfort trigger biological reactions which are the very things that you want, and you can use drugs to get there, or you can use words of comfort to get there, which would make your drugs so much more effective. It’s an incredible insight, and you know, a couple of decades now of practicing medicine, it’s lovely to come full circle to where I started, but with the science to back it up.

DE SAM LAZARO: For Religion & Ethics NewsWeekly, this is Fred de Sam Lazaro.

The post Abraham Verghese appeared first on Religion & Ethics NewsWeekly.

BOB FAW, correspondent: At Le Bonheur Children’s Medical Center in Memphis, Tennessee, four-year-old Ethan Barker might seem carefree. But his parents, Chris and Tamara, are frightened about Ethan’s upcoming brain surgery. So when neurosurgeon Dr. Stephanie Einhaus asks if the family would like to pray, they readily agree.

DR. STEPHANIE EINHAUS (praying with family): We come before your throne today, Lord, asking for your blessing on this sweet child of yours.

FAW: Ethan’s surgery is delicate. Einhaus takes a bone from his skull and modifies it to cover a space created by an earlier surgery.

DR. EINHAUS: (in operating room): …the bone of the skull is kind of in two layers and so you can split it like an Oreo cookie…

FAW: For this skilled practitioner, praying benefits her as much as the patient’s family.

DR. EINHAUS: If I’m having a hard time doing something, getting a catheter in a fluid space, I’ll just pause and in my own head I will pray, “Please, Lord, help me get this right.”

FAW: Einhaus says praying with families helps them with the stress and gives them hope.

DR. EINHAUS: It helps them to hold on to something to get through, you know, that crisis that’s going on. Most people want to do it. They’re like, they’re so relieved.

FAW: Eleven-year-old Holly Barkley, about to undergo surgery to drain fluid from her brain, does not face a crisis.

DR. EINHAUS (to patient): How’s your head feeling?

FAW: But her family also wants to pray.

DR. EINHAUS (praying with family): I pray that you will let this family feel your power, let them feel your peace, Lord…

FAW: Prayers like that, family members agree, can bring comfort.

CHRIS BARKLEY: It puts a sense of comfort in you. Normally, doctors don’t do that, and it probably makes people feel closer to the doctor. You want them to care just as much as you do.

LAURA YOUNG (Holly Barkley’s mother): It was more of the Lord was on our side, and it told me then it was going to be okay, and you know I was ready to—if anything came out negative, I was ready to face it.

DR. EINHAUS (to Ethan’s family): Hello. We are all done, and it went great.

FAW: Einhaus, raised Catholic and now a Southern Baptist, was once reluctant to pray with patients in the beginning for fear of being ridiculed. But as time went on she felt more comfortable asking patients if they would like to pray.

DR. EINHAUS: Once you start doing it you realize how much people really like doing it and how powerful it can be as a support for not only the patient but for the families.

FAW: You regard your role as a physician as a kind of ministry.

DR. EINHAUS: I do, I absolutely do.

FAW: In this part of the Bible belt, many patients—like Marletta Scott, facing difficult triple bypass heart surgery at Methodist South Hospital—say they would welcome a chance to pray with their doctor, even though Marletta Scott’s doctor, heart surgeon Alim Khandekhar, happens to be Muslim.

MARLETTA SCOTT: He did explain to me that, overall, that, you know, it was in the Lord’s hands and that he’d be watching over him as well as me during this procedure. I mean, and that’s all that we can ask for.

FAW: That makes you feel good, that gives you comfort?

MARLETTA SCOTT: Yeah, it does.

FAW: in his 32 years of professional experience, Khandekhar says he has found that patients with faith often recover faster.

DR. ALIM KHANDEKHAR: Because they rely not only on the doctors, the medicine, but they rely on a power that is more powerful than all of them, that puts them at ease with themselves, at ease with the decision they are making.

FAW: What all this suggests, especially in this part of the country, is a growing trend by physicians to treat physical and spiritual problems together. After all, says the founder of this Memphis clinic, 50 percent of the patients who come here for primary care do not have medical problems.

DR. SCOTT MORRIS (Founder, Church Health Center, and United Methodist Minister): Many of our physical complaints come about because of our spirits being broken. What they need is a way for us to help them deal with this spiritual devastation.

FAW: So here at the Church Health Center, which since 1987 has treated 60,000 low-income people without health insurance, the spiritual needs of a patient are addressed before they ever see a doctor.

DR. MORRIS: From my point of view, if we want to be healthier, you must have a healthy spirit as well as a healthy body. We know, I think, in our heart of hearts, that being at peace, being bathed in what a person perceives as the love of God, makes people healthier faster.

FAW: But mixing prayer with medicine can cause problems, especially when the goal of reducing suffering conflicts with the wishes of devout patients. For example, a recent AMA [American Medical Association] study found that patients of faith demand and get more aggressive treatment than is medically warranted, and there are also concerns that a patient can be exploited if a doctor uses prayer to proselytize, to promote certain beliefs.

PROFESSOR MARK MUESSE (Associate Professor of Religious Studies, Rhodes College): It might take the form of a particular kind of prayer that the patient might be uncomfortable with. It might include accepting certain kinds of creedal statements that the patient would not otherwise accept.

FAW: At Rhodes College, where he teaches comparative religion, Mark Muesse also worries that praying with a patient could compromise a doctor’s relationship with a patient.

PROF. MUESSE: There could be a boundary crossed there, that a doctor begins to lose his objectivity in relationship to a patient. You’re losing some of the critical distance, I think, that’s oftentimes necessary for proper medical treatment.

FAW: Physicians like Einhaus counter that even if that boundary is crossed, no harm need result.

DR. EINHAUS: No matter what, you’re going to develop a relationship with your patients, okay? So the fact that I’m praying with them may make that bond a little stronger, but in no way would it affect my judgment.

FAW: And that element of compassion, physicians argue, is what is often missing in the training many doctors receive.

DR. KHANDEKAR: During my training, you know, being a cardiac surgeon, I don’t think that part has been stressed enough. It helps me to have another power behind me to do what I do. I do not think enough doctors use this power.

FAW: Here, though, that recognition—that the spiritual can affect the physical—seems to be growing.

PROF. MUESSE: In the past, you know, doctors would take care of the body, and the ministers and the chaplains would take care of the soul, but now we’re seeing that those two things cannot be separated.

FAW: Shortly after his surgery, Ethan was almost as playful as before. Holly, too, was doing just fine. For each, medical technology prevailed.  But in this medical theatre, more and more physicians seem to be sharing a belief that there is more at work here than science and skill.

DR. EINHAUS: We’re not always in control. God’s always in control, and so things may not turn out the way we want them to. We may not like it.  We may not understand it this side of eternity. But we have to trust that he is still in control and that if they go and they die, that heaven is really a good place.

FAW: Here, where there is recognition that when in comes to healing, fixing the body alone is an incomplete, indeed, flawed approach.

For Religion & Ethics NewsWeekly this is Bob Faw in Memphis, Tennessee.

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BOB ABERNETHY, anchor: Have you ever had the feeling that your doctor doesn’t have enough time for you, or, if you’re a doctor, that you are under so much pressure it’s hard to be compassionate with your patients? There is a physician in Northern California who thinks medicine is losing its soul, and she’s trying to rescue it. Rachel Remen is a best-selling author, a popular speaker, and herself a lifelong patient. Kim Lawton reports.

KIM LAWTON: Dr. Rachel Naomi Remen is leading a national campaign to rediscover the practice of medicine as a spiritual endeavor.

Dr. RACHEL NAOMI REMEN (Clinical Professor of Family and Community Medicine at the UCSF School of Medicine and Founder and Director, Institute for the Study of Health and Illness): Medicine for many, many people isn’t a job. It’s a way of life. And it’s a way of life that’s characterized by certain very traditional values — values like compassion and service and reverence for life. These are not the values of science. These are the values of what might be called a spiritual path.

LAWTON: That means helping other doctors transform how they view their profession.

Dr. REMEN (In Meeting): I was taught to cure people, and what that meant was that my relationship with my patients basically was a relationship between me as an expert and my patient as a problem.

LAWTON: Oncologist Jennifer Lucas says she’s become a better doctor by following Remen’s advice and ignoring something they both learned in med school: that in order to maintain professionalism, they should keep an objective distance from their patients.

Dr. JENNIFER LUCAS (Oncologist): There’s this big line that you are not supposed to cross. But people are really looking for ways to connect with you as their physician and to make you human.

LAWTON: Lucas tries to build relationships with her patients by bringing in values such as compassion and empathy — values, she says, that motivated her to become a doctor in the first place.

Dr. LUCAS: I’ve cried with a patient on many occasions. I will share my sadness if something is going on that is particularly difficult for everybody. It’s good for me, it’s good for the patient, it’s good for their families, and they have a sense that, you know, they are really being cared for.

ROSEMARY GUDELJ (Patient): I didn’t expect to have a doctor like her, because it was a serious illness, and she gave me so much reassurance and love from the very beginning.

LAWTON: Dr. Remen believes the medical profession is suffering a severe spiritual crisis. She says the economic pressures of modern medicine, such as the growing influence of insurance companies and a focus on the bottom line, are all taking an overwhelming toll on physicians.

Dr. REMEN: If you are seeing 25 to 40 people a day, there’s very little you can do in the way of connecting to people. And these people are hurting. These are people who are frightened. They need so much more than a prescription. And they go by you in this unending line, you know, seven minutes at a time. It does something to someone to have to face that day after day.

LAWTON: What it does, she says, is generate cynicism and burnout.

Dr. REMEN: What happens is you begin to live below your own level of excellence. If you do that long enough, something begins to die in you, and that something is the soul of your profession.

LAWTON: As director of the Institute for the Study of Health and Illness, Remen encourages doctors to reclaim the soul of medicine. The institute sponsors a project called Finding Meaning in Medicine. Doctors from diverse religious traditions, including some with no religious affiliation, gather once a month in small groups to discuss a chosen theme.

Dr. REMEN: The topic is one of the basic values of medicine. It might be something like compassion, or it might be listening, or it might be grace. And the price of admission to this little meeting is that you bring a story from your professional work as a physician about the topic of the evening.

LAWTON: At this gathering in Dr. Remen’s Northern California home, the topic is relationship.

Dr. DAVID GULLION (Oncologist) (To Group of Doctors in Finding Meaning in Medicine): When you have a relationship, you share your love with patients. And what’s wonderful is how much they share with me.

LAWTON: Oncologist David Gullion says he joined Finding Meaning in Medicine in hopes of sustaining his passion for his emotionally draining work with cancer patients.

Dr. GULLION: In some patients, it seems like you give bad news after bad news, and [you have] to be able to do that without it really wrenching your own insides to the point that it becomes impossible.

LAWTON: He says the group gives him an opportunity to talk about things doctors don’t usually share, especially with other colleagues.

Dr. GULLION: It is a forum where you can really share your heart, share your soul, and know that it’s a safe sanctuary to do that.

LAWTON: Even beyond the world of medicine, Remen is a widely sought-after speaker and author who looks for the spiritual in everyday life. She encourages her audience to consider how they can be a blessing to others.

Dr. REMEN (Speaking at Podium): What matters is who you have touched on your way through life and who has touched you. What matters is becoming a blessing.

LAWTON: Her two best-selling books, KITCHEN TABLE WISDOM and MY GRANDFATHER’S BLESSINGS, are compilations of stories like the ones she urges doctors to share.

Dr. REMEN: A story is a container for meaning and value. That’s why parables are so powerful in all the world’s religions.

LAWTON: Remen doesn’t like to talk a lot about her personal spirituality, but she acknowledges diverse religious influences, including Saint Luke the Physician and her grandfather, an Orthodox rabbi. Her home is decorated with Buddhas.

Dr. REMEN: These are all reminders to stay awake and pay attention, because the mystery that’s at the heart of life can speak to you at any time, anywhere.

LAWTON: Much of her thinking about health, spirituality, and life was shaped by her own illness.

Dr. REMEN: I have Crohn’s disease and I’ve had it for 52 years. I have had eight major surgeries. I am a chronically ill person. I haven’t been a well person in more than half a century.

LAWTON: Doctors told her she would be an invalid who would most likely die by the age of 40. Instead, she says, her illness gave her internal strength and helped her look at the world differently.

Dr. REMEN: I no longer ran from other people in trouble. I actually became stronger as a person, much more loving, much wiser as a person, and in the end my body has never healed from this disease. But I truly believe that I am much more a person because of it.

LAWTON: She says it’s the difference between curing and healing.

Dr. REMEN: You know, we can’t cure everything. Life can’t be fixed, and science is limited. But the ability of people to grow beyond their limitations, to become more than who they are, is really not that limited.

LAWTON: She believes that message can help heal the practice of medicine itself. I’m Kim Lawton in Northern California.

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BOB ABERNETHY, anchor (March 17, 2006): In Washington, renewed debate over access to the emergency contraception drug known as Plan B. Right now, the drug is available by prescription only. But the Food and Drug Administration has repeatedly delayed action on an FDA committee recommendation that Plan B should be made available over the counter. This week, two U.S. senators said they would block President Bush’s nominee as head of the FDA until the agency acts on the over-the-counter decision. Supporters of Plan B say it will reduce the number of unwanted pregnancies. Opponents say it can be a form of abortion when it blocks the implantation of a fertilized egg. Last year, Lucky Severson looked at the moral dimensions of prescribing emergency contraception.

LUCKY SEVERSON: A rally outside the Illinois State Capitol in Springfield. It’s against pharmacists who refuse to fill prescriptions for emergency contraceptives.

RALLY PROTESTORS: Stop discriminating against women, and keep your judgments to yourself. Just fill it. No hassles. Just fill it. No lectures. Just fill it.

SEVERSON: Their complaint is not new, but the chorus is growing.

Another rally, this one outside the Colorado State Capitol, is to ensure that hospitals provide emergency contraceptives to rape victims.

UNIDENTIFIED SPEAKER (At Rally): This bill would require hospitals to provide rape victims with information about emergency contraception which can prevent pregnancy when taken after an assault. On April 5, Governor Owens vetoed this bill.

SEVERSON: Forty-six states have what are known as “conscience clauses” that allow health care workers the right to refuse to perform abortions. What concerns many women and men is that several states are now debating legislation that would expand these clauses to include not only abortion but emergency contraceptives as well. Four states have similar laws in place.

QUIN HOSTETLER (Pharmacist): I’m a hard-line Catholic, so I believe that you shouldn’t use contraception and that you shouldn’t use the morning-after pill.

SEVERSON: Springfield pharmacist Quin Hostetler say his conscience would not allow him to fill an emergency contraceptive prescription.

(To Mr. Hostetler): You personally would not sell emergency contraceptives?

Mr. HOSTETLER: Not the morning-after pills, no; that I have a problem with.

SEVERSON: But he says he would not refuse to refer the patient to another pharmacist.

Mr. HOSTETLER: I don’t believe in forcing my morals down somebody else’s throat, and in return I don’t expect them to do the same to me. If I can help somebody in this instance get the medication that they need, I have no problem doing that, although I would not dispense it myself.

SEVERSON: Luciana Fortune-Bass says she is a churchgoing mother of three who got a call in the middle of the night from a traumatized friend. The young woman couldn’t get the pharmacist, also a woman, to fill her emergency contraceptive prescription.

LUCIANA FORTUNE-BASS (Speaking at Rally): The only thing I knew was that she had sex, the condom broke, and she was at a pharmacy, and the pharmacist refused to fill her prescription or even return it. I was livid.

When I got there, this lady was ridiculing her about the morality and the fact that her soul was in jeopardy and she was going to hell and she was a baby killer.

SEVERSON: The pharmacist eventually gave back the prescription, and Luciana drove her friend to a pharmacy 45 minutes away. Health experts say one of the problems with pharmacists refusing to fill prescriptions is that emergency contraceptives are most effective the sooner they are taken.

(To Ms. Fortune-Bass): What do you say to a pharmacist who says, “This is what I believe”?

MS. FORTUNE-BASS: I say, “You are entitled to your beliefs, but don’t infringe your beliefs on me.”

SEVERSON: It’s situations like that of Luciana’s friend that prompted Illinois Governor Blagojevich to issue an emergency order requiring pharmacists to fill prescriptions.

Governor ROD BLAGOJEVICH (At Press Conference): That if a woman goes to a pharmacist with a prescription for birth control, the pharmacy or the pharmacist is not allowed to discriminate or choose who he sells it to or who he doesn’t sell it to.

SEVERSON: The governor’s emergency decree may have endeared him to many people in Illinois, but not to religious organizations that oppose abortion.

PHILIP KARST (The Illinois Catholic Health Association): When a pharmacist, in their moral thinking, believes that this is an inappropriate activity, I have difficulty with the state or the governor just saying his moral judgment is more important than the moral judgment of some individual in the state.

SEVERSON: In Illinois, four out of 10 hospitals don’t or won’t stock emergency contraceptives. But the real impact is in rural Illinois, where there are fewer hospitals to begin with. The same is true with pharmacies. In neighboring Missouri, nine out of 10 pharmacies don’t stock emergency contraceptives, which can make a traumatic experience all the more traumatic.

LEE JACOBS (Rape Victim Advocate): Just another layer of trauma on top of the trauma of being a victim of sexual violence. If it’s an issue of racism and sexism and classism, people in rural areas have that much more difficult of a time: people who don’t speak the English language, people who don’t have easy transportation to go to another pharmacy. It’s very real for people.

SEVERSON: Recently, 14 states introduced conscience clauses that would cover not only contraceptive services but allow pharmacists to refuse filling any prescription that offends their moral convictions. Opponents say it could open a Pandora’s box.

TOI HUTCHINSON (Assistant to Illinois Majority Leader): Understand that if someone can refuse a prescription for this, they can refuse a prescription for something else. So if you have a child who has ADD, and the pharmacist doesn’t believe that that really exists, can you get your Ritalin prescription?

SEVERSON: Many pharmacists would like to have the same conscience clause as doctors, who are granted considerable latitude in what they can refuse. Emergency room physician Calvin Bell, a Catholic, would not perform an abortion, sterilization, or withdraw a feeding tube in cases like that of Terri Schiavo. His religious beliefs also affect the way he treats rape victims.

Dr. CALVIN BELL (Memorial Medical Center): This woman has at this point in time — she’s been victimized by someone, she’s been raped, she’s undergone a horrible trauma. But on the other hand, you’ve got a potential second life that is totally innocent, that’s done nothing wrong to anyone.

SEVERSON: Dr. Bell refuses to give rape victims emergency contraceptives, sometimes known as Plan B. In his opinion, life begins at fertilization, and the pill would prevent a fertilized egg from being implanted in the uterus.

Dr. BELL: Much of their action of these emergency “contraceptives” occurs actually after fertilization has occurred, so, in a sense, it’s an emergency abortifacient, is what we are talking about.

STEPHANI COX (Nurse Practitioner, Planned Parenthood, Springfield, IL): If the woman has a condom break, it comes off, she’s forgotten her pills, whatever the reason that she fears she may encounter an unplanned pregnancy, this gives her a second chance at preventing that pregnancy.

SEVERSON: Stephani Cox is a nurse practitioner with Planned Parenthood. She says Dr. Bell’s understanding of pregnancy goes against the accepted medical definition — that pregnancy begins only when the fertilized egg is implanted in the uterus.

Ms. COX: If a woman should happen to have an early pregnancy that she is totally unaware of and take Plan B, it will do nothing. It does not cause a pregnancy. It does not harm the fetus. The pregnancy will continue as normal.

SEVERSON (To Dr. Bell): You would advocate to a rape victim that they continue the pregnancy?

Dr. BELL: If one of my daughters or my wife tragically suffered a rape, what would my advice be? My advice would be for them to carry the pregnancy to termination and give the baby up for adoption.

Ms. COX: Plan B, an emergency contraception, can prevent 22,000 pregnancies as a result of rape that end in an abortion. It can prevent 800,000 abortions a year. So, you know, even people who are antichoice should be on board with this. It’s preventing unplanned pregnancies, preventing the need for abortion.

SEVERSON: You don’t think that pharmacists ought to be given a right-of-conscience clause?

Ms. COX: My feeling is that once a pharmacist puts on his lab coat and steps into the pharmacy, it is his professional responsibility to fill every valid, legal prescription.

Mr. HOSTETLER: We have the same right that anybody else does. Just because we are a merchant, we should have the right to refuse to fill different prescriptions if we don’t feel morally correct with that.

SEVERSON: Several states are debating laws that would expand Quin Hostetler’s legal and moral discretion. And a few others are now considering legislation that would restrict them. Pressure on lawmakers will be intense — from both sides.

For Religion & Ethics NewsWeekly, I’m Lucky Severson in Springfield, Illinois.

ABERNETHY (March 17, 2006): Since we produced that story, Wal-Mart has agreed to stock emergency contraceptives and will begin dispensing them on Monday (March 20, 2006). But Wal-Mart is also allowing their pharmacists to refuse to fill Plan B prescriptions if they want, so long as that doesn’t violate state law.

The post Refusal to Treat appeared first on Religion & Ethics NewsWeekly.

BOB ABERNETHY: Health care in this country is a big problem for the poor — not only because they often can’t afford it. Sometimes it just isn’t there. This is especially true in rural areas, which have a hard time attracting doctors.

Correspondent Judy Valente found a doctor in rural Alabama whose practice is an essential part of her religious calling:

JUDY VALENTE: A buzzard stands guard atop a dying tree in tiny Pine Apple, Alabama: population 343 and falling. A town where living conditions often reflect a bygone era. All but two businesses are boarded up now. A tree grows through the roof of this abandoned dry goods store. And on some days, more dogs than people frequent the town’s main street.

Most people here live in houses along dirt roads like these. Some still get their water from spigots in their front yard. More than 90 percent of the people live below the poverty level. For most, the only work available is low-paying, low-skill jobs.

Health care here isn’t a right, it’s a luxury. But one woman has become a literal lifeline for the people of Pine Apple and the rest of rural Wilcox County.

Dr. Roseanne Cook is one of only three doctors serving Wilcox County’s 14,000 residents. She came here in 1986 after graduating from medical school at age 44. But medicine is not her only line of work.

Few of the 5,000 patients Dr. Cook treats on a regular basis know that she is a sister of St. Joseph — a Catholic nun since 1958.

Dr. ROSEANNE COOK: I was praying one evening and it just seemed like there was something the Lord wanted me to do, something with my life, more than I was doing.

VALENTE: Dr. Cook had planned to become a medical missionary in a remote, poverty-stricken area overseas, little knowing her mission would take her to a remote area [here] with tremendous needs.

A colleague, Sister Jane Kelly, was already working at the Pine Apple Clinic as a nurse practitioner. She warned Dr. Cook it wouldn’t be easy, but that hardly prepared Sister Roseanne, as she is also known, for the problems she would find.

Dr. COOK: We have people — you know– 35-year-olds with strokes that cripple them for life. We see people who have had broken bones that were not set and end up with a crooked arm or leg. I had one man come in, he had put cobwebs into a laceration on his hand in order to stop the bleeding.

Mrs. ETHEL LEE WILLIAMS (Patient): I have high blood, nerves, pressure, arthritis, sinus.

VALENTE: Eighty percent of the patients Dr. Cook sees have no insurance, and many suffer from a multitude of ailments, like 72-year-old Ethel Lee Williams.

As with many of her patients, Dr. Cook provides Mrs. Williams with free samples of medication because she can’t afford to buy medicine.

Because there are so few physicians, Dr. Cook spends at least one night a week on call for the emergency room at the area’s sole hospital. By necessity, she often performs procedures that in other places, a specialist would do.

Dr. COOK: We set uncomplicated fractures and put casts on, do skin biopsies, sometimes remove cysts. We don’t have a pediatrician on hand so we take care of children.

VALENTE: She says the problem isn’t a nationwide shortage of doctors, but a “maldistribution” of doctors. Large cities and suburban areas enjoy an oversupply. Rural areas and poor inner-city neighborhoods are underserved.

Dr. COOK: Most doctors want to be in a larger metropolitan area where there are a lot of colleagues that they can call on for consults, for backup. They’re just not interested in living out in the country where you might have three restaurants in town.

VALENTE: There’s a severe shortage of medical technicians as well.

Dr. COOK: We have this wonderful dental equipment that is only about two years old — two well-equipped dental rooms and we have no dentist to provide care for our patients. Many of them, in fact probably most of them, are in need of rescue dental care, much less repair dental care.

VALENTE: Dr. Fitzhugh Mullan, a Washington, D.C. pediatrician and medical writer, has studied the shortage of doctors for the rural and urban poor.

Dr. FITZHUGH MULLAN (Pediatrician): The whole set of problems associated with the distribution of doctors in America is troublesome and not getting better, some would argue getting worse. What we need to do is design a system of care that has the kinds of incentives in it and the kind of strategies in it that will keep and bring doctors and other providers to rural areas.

VALENTE In Pine Apple, Dr. Cook is a well-known and well-loved figure. But earlier this year, she narrowly escaped being murdered during a roadside robbery.

Dr. COOK: Then threw me in the trunk here and said, “You’re dead,” and started shooting and so one bullet went here, here, and here, and another bullet went in here. And amazingly they all missed you. They all missed me except one little grazed me right across the cheek here. But the rest missed me, and I take that as an act of God that I’m here to talk about it.

VALENTE: It’s often a lonely life for Dr. Cook, who shares a small home with her two dogs.

Dr. COOK: There’s very few Catholics in our area, very few Catholics. And you know, in our little mission church, we have maybe 30 parishioners.

VALENTE: Is your Catholicism ever in conflict with your medical work?

Dr. COOK: We don’t advocate abortion. We do have a family planning program, and we don’t impose lack of contraception on our patients by any means. I don’t think most of our patients really know what a Catholic sister is, to tell the truth. They know that we care very much about them.

ROBERT HARRIS (Patient): Does it make any difference to you that she’s a Catholic sister? No, it don’t make no difference. Don’t make no difference. All I want is a good doctor. That’s all I want.

JOHN YOUNG: She’s sweet, she’s been good to my mama that lives right up the road here, and she’s always been just as good as she could to them.

VALENTE: And the patients keep arriving. Like this young mother, who came from 50 miles away because she heard Dr. Cook sees all patients regardless of their ability to pay.

Dr. COOK: Well, I think they know we will help them no matter what. And I think they experience a loving care. They know that they’re not just another client and that we’re not just a provider, and that there’s really a doctor-patient relationship that’s established, and that means a lot to people.

VALENTE: Dr. Cook doesn’t know what will happen to her patients when she has to retire. To find a new doctor, she says, they’ll have to pray hard.

For RELIGION & ETHICS NEWSWEEKLY, I’m Judy Valente in Pine Apple, Alabama.

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