Medical Practices Blend Health and Faith

Doctors, Patients Distance Themselves From Care They Consider Immoral

Sandwiched between a swimming pool store and a spice shop on Lee Highway in Fairfax, the Tepeyac Family Center looks like any other suburban doctor's office. But it isn't.

The practice combines "the best of modern medicine with the healing presence of Jesus Christ," a brochure at the reception desk announces. An image of the Madonna greets every patient. Doctors, nurses and staff members gather to pray each day before the first appointments.

The center is one of a small but growing number of practices around the country that tailor the care they provide to the religious beliefs of their doctors, shunning birth-control and morning-after pills, IUDs and other contraceptive devices, sterilizations, and abortions, as well as in vitro fertilization. Instead, doctors offer "natural family planning" -- teaching couples to monitor a woman's temperature and other bodily signals to time intercourse.

Proponents say the practices allow doctors to avoid conflicts with patients who want services the practitioners find objectionable, as well as to provide care that conforms with many patients' own values. The approach, they say, provides an alternative to mainstream medicine's reliance on drugs and devices that, they argue, carry side effects and negatively affect couples' relationships.

"I want to practice my faith," said John T. Bruchalski, the obstetrician-gynecologist who started Tepeyac. "I'm not interested in pushing it on other people. But this allows me to practice medicine without having to do something that I wouldn't see as positive or healthy."

Critics, however, worry that the practices are segregating medicine along religious lines and may be providing inadequate care by failing to fully inform patients about their options. The critics are especially alarmed about the consequences in poor or rural areas with few alternatives.

"Welcome to the era of balkanized medicine," said R. Alta Charo, a bioethicist at the University of Wisconsin at Madison. "We've had this for years with religious hospitals. What's happening now is it's drifting down to the level of individual practitioners and small group practices. It essentially creates a parallel world of medicine."

The American College of Obstetricians and Gynecologists has no formal position on such practices, but its officials say the approach can offer a way for religious doctors to work and serve religious patients as long as they are upfront about their limitations.

"If women know before selecting them, then it's quite a legitimate thing to do and might meet the needs of many women and doctors," said Anita L. Nelson of the University of California at Los Angeles, speaking for the organization. "But if you hang out your shingle that says 'All-purpose OB-GYN' and don't offer certain services, that's false advertising."

The phenomenon is another manifestation of the tensions arising between religion and medicine with the rise of religious expression in the United States and medical advances that create moral dilemmas for some. Natural family planning, or NFP, practices are seen as a way of sidestepping confrontations over abortion, the morning-after pill and other types of care that some religious health workers refuse to provide, asserting a "right of conscience."

"This is a way that some of us have found to practice medicine that is consistent with our beliefs," said Kathleen M. Raviele of the Catholic Medical Association, which, along with groups such as the American Association of Pro Life Obstetricians and Gynecologists, promotes natural family planning.

"It's definitely a new trend, and it's a refreshing trend," said Theresa Notare of the U.S. Conference of Catholic Bishops, which has workers in at least half its dioceses trying to enlist more doctors to open such practices. "This is a trend that we should be excited to see grow."