When a group of health care professionals opened a Catholic medical clinic in De Pere, Wisconsin, in 2015, it took overcoming logistical and financial hurdles, and the opinions of skeptics who questioned a need for it at all.
"The large majority of people thought it would take a miracle to start a clinic like this," said Dr. Robin Goldsmith, St. Gianna Clinic's co-founder and medical director. "Many, many people felt there was no need for such a clinic. They didn't understand what the difference would be or what the purpose would be."
Eight years later, the comprehensive primary care clinic has a robust patient roster, serving people of all faith and no faith, Goldsmith said, with the tagline "Truly Excellent. Always Faithful." But the move required courage -- a virtue needed like never before, say Catholics in the medical profession.
"Be Not Afraid: Courageous Catholic Medicine" is the theme of the Catholic Medical Association's 92nd annual educational conference Sept. 7-9 in Phoenix. This year's conference chairman Dr. Timothy Millea said the theme was chosen in 2020, and in the short time since, ethical, ideological and legal issues have mounted.
"The last two-and-a-half, three years have been relentless for us," said Millea, a retired orthopedic spine surgery specialist in Davenport, Iowa. "We're dealing with all of the abortion-related issues, national and state." In addition to challenges to Catholic consciences posed by multiple federal agencies, he added the CMA is facing the push for "assisted suicide, state by state."
The conference aims to hold up models of courage who put their Catholic faith and values at the heart of their work, sometimes at the risk of reputation and professional opportunities.
"We're here at this point in time, in history, for a reason," said Millea, who also chairs the CMA's health care policy committee. "Silence is basically surrender, and we've got to be in the game on this."
Millea said the phrase "be not afraid" recalls St. John Paul II's homily from his 1978 papal inauguration Mass, where the newly elected pope urged the faithful to have courage through Jesus Christ.
"We need to remember it's time for us to show up, stand up and speak up, and that's in a voice -- as we're all called to do -- with charity and clarity, looking for the good of the others," Millea said of medical professionals. "And they may vehemently disagree with us, they may attack us in so many different ways. But that doesn't mean we don't continue bringing that message."
Catholic medical professionals need not only courage but also conviction about their values and how their faith informs the care they provide, Millea said.
"Courage is not really optional. If it was optional, we wouldn't have a Catholic Church today," he said, noting that all Catholics can find inspiration in the courage of the apostles and church fathers.
In addition to policy concerns -- especially safeguarding robust conscience protections amid pushback from members of Congress, federal courts and the Biden administration -- CMA members are concerned that changes to residency program expectations or board-certification requirements may affect Catholic doctors and medical professionals pursuing particular fields, Millea said.
"You have a medical student that wants to become an OB-GYN, but he or she is very pro-life. We're on the cusp of a situation where residency programs won't take them" because they will not participate in abortions, he said.
"We are really losing the freedom to choose not just our career pathway, but we're being impeded from ... committing to our beliefs," Millea said. "When that ideology and those types of counterproductive goals are being proposed by the political and legislative and judicial processes, it doesn't matter what the channel is it's coming through. We've got to counter it, whether it's at a local school board level, or whether it's at the level of the White House or Capitol Hill."
Pediatricians, Millea said, are especially under pressure to provide "gender-affirming care" for children and teens, as recommended by the American Medical Association and the American Academy of Pediatrics. Aspiring pediatricians who believe transgender interventions on minors are unethical may be impeded or barred from entering that speciality, he said.
In March, the U.S. Conference of Catholic Bishops' doctrine committee released guidance to Catholic health care institutions that addressed as an "immediate concern" medical care for treatment of "gender dysphoria," especially "surgical or chemical techniques that aim to exchange the sex characteristics of a patient's body for those of the opposite sex or for simulations thereof."
Such interventions should not be performed, the document said, because they "do not respect the fundamental order of the human person as an intrinsic unity of body and soul, with a body that is sexually differentiated."
Challenges to Catholic beliefs across the health care landscape have prompted some CMA members to explore creative ways to practice medicine.
Goldsmith said there are about a dozen other clinics in the United States like St. Gianna Clinic, with an explicitly Catholic mission and adherence to the “Ethical and Religious Directives for Catholic Health Care Services” outlined by the USCCB.
"There are many more (clinics) that are either desiring to start, or trying to start, because there is a great desire among health care professionals to be able to practice according to the faith," said Goldsmith, who is giving a plenary talk at the CMA conference.
Meanwhile, in Maryland and the District of Columbia, board-certified family physician Dr. Marguerite Duane cares for more than 100 patients in their homes through MD for Life, her direct primary care practice.
Duane is speaking at the CMA conference about using accurate language, arguing some terms or their definitions used by medical associations have been revised and should be rejected. Examples include "pregnancy," which the American College of Obstetricians and Gynecologists redefined in 1965 as beginning with the implantation of the embryo, not fertilization, and "birthing person," which has recently appeared in ACOG statements.
Duane also encourages her colleagues to describe themselves as physicians or medical professionals and not "providers," which she said wrongly suggests medicine is merely a commercial transaction between clinicians and patients.
Courage has been at the heart of the decisions she's made, Duane said, both as a doctor aiming to elevate patient care with in-home exams and as a mother who chose to step away from medicine for several years to care for her young children. During that time at home she co-developed FACTS about Fertility, a nonprofit for educating medical professionals about evidence-based fertility awareness methods of family planning.
Practicing medicine as a faithful Catholic doctor in the current landscape requires courage, she said, "because in practicing commonsense medicine, in many ways, unfortunately, it (sometimes) goes against conventional medical practice."
For example, Duane said, "It is so much more empowering to teach women to chart their cycle so they can understand and work with their fertility, rather than simply giving them powerful synthetic steroid hormones to suppress it."
During her time as a medical resident, Duane said she had prescribed patients artificial birth control without understanding the church's teaching against it, or considering how hormonal birth control negatively affects a woman's body by disrupting the normal functioning of her reproductive system. When a colleague pointed her toward fertility awareness-based methods or FABMs -- sometimes also referred to as natural family planning -- she was fascinated but initially unsure about how to credibly incorporate that knowledge into her practice. Ultimately, she sought training on the Creighton Model and other fertility-awareness methods.
She now teaches about fertility awareness-based methods to medical students across the U.S. via a course at Georgetown University in Washington, in addition to her mobile medical practice.
"I just keep trusting and I just keep the faith and I keep moving forward," she said. "I keep feeling like this is where I'm called to serve."