Issue 21 / 14 June 2011

THE spectre of thalidomide looms large, despite its rehabilitation in recent years as a cancer treatment.

As you’d expect, patients taking the teratogenic drug are given detailed advice about contraceptive precautions — or at least they should be.

But what happens when this clinical imperative collides with the Catholic Church’s opposition to birth control?

The Sydney Morning Herald reported last week that doctors at Newcastle’s Calvary Mater Hospital had been forbidden from providing specific written contraceptive advice to patients participating in trials of the closely related drug, lenalidomide.

Instead, the newspaper said, the hospital provided a “statement of reproductive risks” that told women they must not become pregnant during treatment, but offered no information on how to avoid this.

Although it is run by a Catholic health care organisation, Calvary Mater is a public hospital and the main provider of cancer treatment in the Newcastle region.

When I contacted the hospital last week to check the accuracy of the information in the Herald report, I was sent a written statement that said its doctors provided comprehensive written and verbal information on the risks associated with trials. Women were advised to talk to their doctor as they must avoid pregnancy during cancer treatment, the statement said.

That would seem to indicate, as reported, that the hospital stops short of providing written specific contraceptive advice to participants in trials of a teratogenic drug.

Now, you might think most women know how to use contraception without the need for detailed written instructions but, as one doctor pointed out last week, patients who have just been diagnosed with cancer are likely to have a lot on their minds and may easily overlook verbal advice.

The recommended precautions for lenalidomide are also particularly stringent. The manufacturer advises women of childbearing potential to use two effective means of contraception simultaneously while taking the drug and for 4 weeks after cessation of treatment.

There is also a risk that the drug can pass into semen, so male patients are advised to use latex condoms over the same period, even if they have had a vasectomy.

It is hard to believe an Australian hospital would seek to prevent doctors from providing that information in written form to their patients, as is being alleged here.

Individuals are entitled to their opinions, but it seems to me an establishment that is given the status — and government funding — associated with being a public hospital does not have the right to impose views that are so at odds with general community attitudes.

And is an organisation that is apparently unwilling to provide contraceptive advice really the right place to conduct a trial of a teratogenic drug?

Jane McCredie is a Sydney-based science and medicine writer.

Posted 14 June 2011

22 thoughts on “Jane McCredie: When religion and medicine collide

  1. Steven Donohue says:

    Catholic teaching opposed to ‘artificial’ contraception is not absolute. For example, putting someone onto the pill for another medical indication is OK… Rather than being a fundamental clash, it seems to me this could be easily sorted out by the ethics bodies of the institution and trial respectively. If they cannot agree, then take the trial somewhere else.

  2. Nobbys says:

    I have worked at the Calvary Mater Hospital as a doctor and I must say it provides an excellent service to the region and is a wonderful place to work. I have no doubt that it’s Catholic roots and ethos have much to do with this. As a physician my commitment to my patients is my priority and that means FULLY informing them of the risks and benefits of all proposed treatments – that is my obligation in my role above all else, at the Calvary Mater and all others. I think you will find a similar philosophy amongst most medicos, and one which prevails above the idiosyncrasies of institutions in which we work.

  3. Abou ben Adhem says:

    Hasn’t this problem with Catholic run churches come up before? StV didn’t want to move out to St Georges and made the St Georges docs aware that they wouldn’t be allowed to provide post-coital emergency contraception – or any other sort of contraception. Wasn’t one of the reasons for keeping the second children’s hospital in Brisbane (Mater) within a bull’s roar of the Royal Brisbane Women’s and Childrens because the catholics running it wanted to provide a public obstetric service which denied contraceptive advice?
    There are areas in the US where its impossible to get an abortion – well, it can be difficult in areas of Australia. But in the US there are not only towns with no family planning services, but pharmacists may refuse to stock any sort of contraceptives including the pill, so precriptions can’t be filled locally. We don’t want to go this route – and paying a religious organisation to run a public service not available elsewhere in that town and allowing them to impose their restrictions on patients with no choice of provider is not only iniquitous in itself but provides a dangerous precedent.

  4. Sue Ieraci says:

    Like JD, I don’t see this as such a dramatic incident. Certainly, it might be more appropriate for contraception to be prescribed by one’s GP than by an oncologist coordinating a trial. On the other hand, any doctor, Catholic or not, needs to exercise judgement and be responsible for the outcome. I don’t think there is any formal dogma that says that the provision of contraception is worse than iatrogenic teratogenesis. While I don’t support religious principles overriding clinical ones in publicly-funded health services, I’m sure, like JD says, a “workaround” can be found. I highly doubt that an ethical doctor prescribing contraception in this case would be either excommunicated or sacked.

  5. Sal says:

    Perhaps Bob the builder should do some reading on Christianity before accusing Rob the physician of being ‘bonkers’ for stating what many Christians would actually agree is a central part of the Christian faith!

  6. Bob the builder says:

    I think Rob the physician maybe a bit bonkers!

  7. Rod brown says:

    Blind adherence to religious dogma can be a dangerous thing for all concerned, none more so than the inoccent bystander. Witness the well chronicled opposition by various religious groups, the Catholic Church among them, to the promotion and provision of condoms in HIV ravaged Africa.
    The consequences of a pregnancy in the lenalidomide trial would almost certainly be the recommendation and acceptance of a therapeutic termination – better for all involved, particularly the Church, that as much as is humanly possible is done to avoid such a catastrophe.

  8. JD says:

    Perhaps I’m a not particularly knowledgeable Catholic, but I would have thought for the doctor involved in the trial this is a matter of individual conscience (and I don’t see ethics and conscience necessarily being very separate, although they may not be the same, on occasion). I do know there are those in the Church who would vociferously disagree that we should just let conscience be our guide, but there are those who hold that view, and there are millions of Catholics who use contraception and practice their religion.
    If I were confronted with such an edict from “administration” in the privacy of my consultation room, I would do what I have always done in the face of “administrative difficulties”: I would advise them in their interests, in great detail if need be, but I would say “You didn’t hear this from me …”.
    I suspect that a lot of this goes on in medicine, particularly where we see things on a daily basis which we have no power to change directly, but we have to use a “work-around”.
    As far as this specific case, I’m not sure I’d like to be getting my contraception advice/script from an oncologist, written or otherwise; my GP would be a better resource person.
    @ Michael Pearcy: Trials don’t save lives. They’re scientific experiments, and if done properly, there’ll be a control group on an alternative treatment which may be proven to be inferior.

  9. Alan Dinehart, MD says:

    If Calvary Mater Hospital is a public Hospital and receives public money, the Catholic Church should be banned from determining what its doctors can and can not do pertaining to patient care. If the “Church” can not abide by this than either remove the “Church” from the hospital and replace it with another governing body or remove all public money from the hospital. The problem will be over before anyone knows it.

  10. MICHAEL PEARCY says:

    So would you deny these women access to potentially life-saving cancer trials? What other hospital in that region could they turn to?

  11. Adam Doyle says:

    Re Nathan Kotzur
    “Now, seeing that all of their obligations have been met, for what reason do most of the previous comments criticize religion?” The reason why religion is being held at least partially responsible is that (A) the doctors involved in the trial were reportedly FORBIDDEN from giving written information on contraception to the participants in the trial and (B) catholicism preaches that contraception is immoral. The natural conclusion is that the reason for A is that the hospital believes in B, which is considerably offensive to many of us given that Calvary Mater is a PUBLIC hospital, and that the effects of pregnancy in these circumstances are dire. However, as I’ve said above, I think administrators making bad decisions hold greater responsibility than religion here. People CHOOSE to believe in the teachings of religion, and if it’s absurd and dangerous nonsense, then I think the person believing it should be held accountable.

    Re: Rob the Physician
    “Christianity is NOT a religion,it is a RELATIONSHIP… the Creator making Himself/His ways Known to His creation !!!” What point are you trying to make here? Of course christianity is a religion. Insert the name of any other religion into that sentence in place of christianity and you will see how meaningless a statement that is.

  12. Bruni Brewin says:

    I have seen the outcome effects of Thalidomide. I would want more than a mere statement that two effective forms of contraception must be used. A whole family’s life can be ruined by failure to make sure the couple do not fall pregnant.

    I would expect that I be given written advice – we know that patients often forget, and that advice underlines the dangers of falling pregnant and why, and told to either go to my GP or a Family Planning committee, with a phone number to ring for the latter for referral to their closest centre.

    Are we to blame religion that has this twisted view that if they do accidentally fall pregnant it is God’s will? Maybe, or are we to blame the incompetence of the hospital for not taking due care to protect their patients. Whichever, this needs addressing for the patients’ sake.

  13. Anonymous says:

    The advice to use two effective methods of contraception tells me neither is adequately effective. And if this fails? …. well we told them so!
    A researching organisation has an obligation to fully inform and disclose risks, and equally a participant has the right to refuse recruitment.
    If there is a risk to a potential pregnancy, the researchers are not obliged to write one (or two) contraceptive scripts, but they are obliged to fully inform. Equally the participant may, upon being informed, explore other or all options of avoiding pregnancy, including post-ovulatory intercourse or even abstinence. If a script were not wished for, or if for some unknown reason they were not able to get a script from most doctors practising in Australia, I don’t see a problem. After all, we are talking about investigating a trial therapy with known teratogenic effects, the facility will be ‘informing’ fully, but may not be ‘treating’ fully. Is this a problem?
    I am concerned that an HREC Chair is making comment, apparently without all the details.

  14. Nathan Kotzur says:

    I am really dismayed by the comments left in response to this article. OK, so the people in the trial were not specifically told how to use contraception to avoid becoming pregnant. They were directed to talk to their GP. They were warned of the risks of becoming pregnant and told that they must not become pregnant. The article does not specifically say, but one assumes that the patients were referred to the manufacturer’s information which states that two effective forms of contraception must be used. This seems to me to meet the organization’s responsibility for full disclosure. Now, seeing that all of their obligations have been met, for what reason do most of the previous comments criticize religion?

  15. Rob the Physician says:

    I need to ask the author of ‘said article’ what SHE means by
    “religion”? For it is my understanding that religion is man’s
    ie; humans attempt to find ” a higher inteligence ” outside of
    him/herself to provide explanation for that which he/she cannot
    explain.Christianity is NOT a religion,it is a RELATIONSHIP…
    the Creator making Himself/His ways Known to His creation !!!

  16. Diane Campbell says:

    The Mater Hospital in Newcastle has a history of claiming “Catholic values” for some of their most appalling indiosyncrasies. At least, that is the explanation I received from the medical administrator (who was also the complaints officer, and when the HCCC asked why there was no Patient Advocate for me to contact as suggested by the Health Ministers office, she claimed that title too!.) The “Catholic values” as interpreted by the Mater was repeatedly allocating women with gynaecological malignancies to a ward otherwise filled with male patients, presumably as their God no longer recognised them as women. Incidentally, the agreement with the HCCC was that they would henceforth include information about the HCCC on their patient brochures and hang some of the posters but they defaulted.

  17. Richard Middleton says:

    Perhaps the hospital should not have been permitted to participate in the trial without giving a commitment to enter the 21st century?
    I daresay there is a little bit of money involved that they might have missed.. Maybe I am being mean atheist suggesting that the RCC is a business.

  18. Dr Michael Nixon says:

    Any participant in an ethics committee approved trial in Auustralia is required, under NHMRC Ethical Guidelines, to be fully informed of all the consequences and side effects than can occur when they participate in a research trial. In this particular case “FULLY informed consent” seems to be lacking?? The ethics commiittee that approved this trial at this hospital should immediately revist the “Participant Information Sheet” and “Consent Form” – A formal complaint to the HREC should cease this research here until a satisfactory resolution is agreed to. I would think it inappropriate that this trial be undertaken at this hospital. Indeed some religions are way behind in acknowledging the God-given advances we are blessed with today in modern medicine and science.
    Dr M Nixon. Chair NT DoH/MSHR Human Research Ethics Comittee and Anglican Priest. Darwin NT.

  19. Adam Doyle says:

    As much as I dislike religion in all its forms, I think the problem here is not religion itself, but the misguided ethical framework of the hospital administration. Although this position may be inspired by religion, it is certainly not a position that all proponents of catholocism would support. Working effectively in medicine (really, any scientific field) requires the willing ignorance of some of the more silly explanations that religion has to offer on our universe and our morality. A sensible doctor would be able to appreciate this and act appropriately. I don’t think religion can be blamed for someone purposefully ignoring their responsibilities to the patient. Such people should not call themselves doctors.

  20. Anonymous says:

    I think that a very valid point is raised. That within the constraints of a certain religious doctrine, it is hard to remain patient centred and ethically sound. For this reason, if such hospitals accept government funding there should be a caveat to disclose all information to the patient for informed consent, regardless of the particular beliefs of the doctor or the institution involved. This transparency of information is of greater importance than any religious or ethical viewpoint of the healthcare provider. Perhaps there should be a call to all hospitals in receipt of government funding. Respecting the basic rights and autonomy of a patient should comfortably sit within the ethical framewoork of a Christian organisation.

  21. Anonymous says:

    Thanks Jane.
    How is it morally right to experiment with a teratogenic drug and at the same time morally right to not protect women from pregnancy with the potential for a child with life long problems.
    I remind medical students frequently
    “do no harm”…..

  22. Mike Busby says:

    Another example of the lunacy of religion. It’s amazing how smart people can believe dumb things.

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