Wednesday, November 15, 2017

Quaeritur: Is there an obligation for Catholic medical students to become OB/GYNs?

I was recently asked:
If most OB/GYNs were Catholic already, I would not consider the specialty. I certainly enjoyed my OB rotation, but I also enjoyed other specialiteis just as much. Therefore, why not do a specialty that would allow me to spend more time with my my wife and children? Do you think that a Catholic OB/GYN could help women, marriages, and families in a significantly different way than a standard OB/GYN? Is a Catholic OB/GYN that big of a deal and worth all the extra time, effort, and controversy? Do you think by being a Catholic OB/GYN, I could lead more souls to Heaven? Are these questions too spiritual? Should I be focused more on the medicine, my interest in various specialties, and traditional decision making for most medical students?
"The Dedication" by Edmund Blair Leighton
Img credit: Micione, Wikimedia Commons
These are excellent questions. These are the questions you will be glad you asked yourself when residency makes life tough. I do think that a Catholic OB/GYN is a much better doctor for women and for our country than a standard (contraception-prescribing, napro-not-recommending) OB/GYN. I love to persuade people to become strong, Catholic OB/GYNs. But I would not push you that direction.

Your vocation is the way God made for you to become a saint. Your vocation is that of a husband and father, and this will always come before medicine. Your first responsibility is to the salvation of your soul, followed closely by your wife's and your children's. If you save a hundred souls by being a Catholic OB/GYN but aren't available to your family, what good is that?

Most OB/GYNs aren't Catholic, pro-life, or pro-NFP. It is generous for any Catholic medical student to consider the need for more Catholic OB/GYNs, just like it's generous that young men consider the priesthood even if they end up called to marriage. God is so grateful for your generosity. But the existence of a need does not mean you have to meet it. Your family's needs come first. OB/GYN residency is 75 hours a week, on average, and sometimes you're at work for twelve or twenty days in a row.

This calls for careful discernment and a well-trained spiritual director can help open the doors to God's light.

Monday, October 30, 2017

Quaeritur: Transgender follow-up

Img credit: Bill Barrett, Wikimedia Commons
Some time ago a medical student and I had a great interchange on
care of patients with gender dysphoria. The student followed up some time later with the following email:
I’ve come to the conclusion that nobody can change their gender. ...[O]ur maleness and femaleness are defined by our participation in the ability to create life within the marital act. So, “maleness” shouldn’t be defined as a Y chromosome, male genitalia, or a “male brain” (whatever that means). This means that if a man who has fathered a child suddenly claims that he is actually a woman “on the inside", this is an impossibility. The same would probably apply to all people who are born with functioning and properly developed reproductive organs.

With all that being said, I consider all the proposed treatment options for transgender persons not as actually changing someone’s sex or gender, but providing a coping mechanism for their gender dysphoria, which is a mental illness with a biological component. So, I would probable propose the least irreversible “treatments” first such as maybe wearing clothes typical of the opposite gender, and then if the gender dysphoria does not resolve and their mental health worsens, I would even consider some more drastic, irreversible steps such as hormones and/or gender-reassignment surgery.

I understand that many theologians see the concept of changing one’s gender an impossibility and I agree! However, I think that in some cases, especially for a patient with severe gender dysphoria the more drastic measures could be taken following all other options fail.

I know that many moral theologians have difficulties with this topic, and I understand why! I’m still exploring and keeping an open mind, and I know that if the Church were to propose an answer that definitely concluded that these “treatments” are immoral then I will gladly stand behind her judgement!
I really admire that you're committed to obeying the Church's judgment should she speak in a definitive way on this topic. I wish more Catholics were like that. I'm that way about embryo adoption: I think it's licit, and I'm going against some big names in that. But if the Church were to come out and say that I am wrong, I would accept that.

Women with AIS and related DSD.
Credit: Ksaviano, Wikimedia Commons
I agree with you that gender is not modifiable. It's really interesting how you define it! You define it by a person's ability in the marital act. (Did I read you correctly?) If a person is able to father a child with a woman, he is male. If a person is able to conceive a child with a man, she is female. For some reason I think that's amazing. I struggle to identify exactly what gender is. It's not a phenotype, or a set of traits/likes, or even (I hesitate) a genotype. (AIS, anyone?)

I think we disagree on whether medical and surgical transition therapies are good for men and women. (I'm not sure about dressing differently but I even think complete cross-dressing is not a good treatment.) Dysphoria should be addressed at its root and a man helped to love his masculinity, a woman helped to love her femininity. In the process of helping this love, societal roles should be tossed if necessary and clothing/hair should be evaluated objectively and not with too many cultural attachments. But I don't think dysphoria should be palliated by altering or amputating parts of the body or creating imitations of genitalia. Mutilation is wrong.