By Burman Skrable
In early 1994 Dr. John Bruchalski moved to Fairfax, VA, intending to set up his own OB-GYN practice. He called it Tepeyac, after the hill where the Virgin Mary appeared to the humble Indian Juan Diego, and where Dr. Bruchalski had received his interior call to become a pro-life physician. His practice began modestly. For about nine years he worked alone–initially out of his house, later in office space borrowed from two doctors until some priests and families loaned him enough money to rent his own office. Twenty-three years later, Tepeyac comprises five OB-GYNs, all dedicated to Dr. Bruchalski’s original philosophy and vision. That vision is a fully Catholic OB-GYN practice, applying the most up-to-date medical technology and technique in ways that are fully faithful to the teachings of the Church and natural law regarding the nature of the human person and his relationships. Although it functions within the overall contemporary structure of medical care and payment practice, Tepeyac rejects most of the operational, economic, philosophical, and anthropological assumptions that underlie modern medical and economic practice. Below we illustrate the Tepeyac difference according to three main defining dimensions: the view of the nature of man; medical practice; and the medical care system. It is readily seen that Dr. Bruchalski’s approach to medical service stands in stark contrast with today’s predominant approaches. The presentation intentionally lacks nuance to focus briefly on essential points and heighten the contrast.
In the modern Western view, mankind is a collection of autonomous (self-ruling) individuals resulting from unplanned, random evolution. Although humans have their spiritual and bodily sides, the real person is the spiritual side: the conscious, spiritual, choosing self. The human person has no nature but what he or she chooses for himself. This true person is essentially a consumer, and as a consumer he owns his body, which is somewhat arbitrarily assigned at birth and is a form of physical machine. The person may thus manipulate his body at will, and is even free to reject it partially (e.g., it’s the wrong sex) or completely (suicide). The true person is not by nature a “social animal” but may choose to be in relationships if this is what pleases him at any given time. In this world of autonomous consumers, the only real virtue is justice: the right to get what one has paid for.
In the Tepeyac View, the person is intentionally created by God in His image, and with a definite nature. This person is as a mind-body-spirit unity designed to thrive in community, within a complex matrix of relationships. As the poet John Donne put it, no man is an island. Humans by nature are embodied creatures; we are our bodies as much as our spirits. The body is designed for a purpose and is not to be manipulated or mutilated; its deficiencies are to be repaired to work properly according to its natural, God-given design. Physical illness is often a symptom of spiritual, emotional, and relationship deficiencies or defects as well as problems within the body. Curing the patient thus involves understanding the whole person, not just the body and its deficiencies.
Modern Medical Practice.
In the modern Western view, mankind is a collection of autonomous (self-ruling) individuals resulting from unplanned, random evolution. Although humans have their spiritual and bodily sides, the real person is the spiritual side: the conscious, spiritual, choosing self. The human person has no nature but what he or she chooses for himself. This true person is essentially a consumer, and as a consumer he owns his body, which is somewhat arbitrarily assigned at birth and is a form of physical machine. The person may thus manipulate his body at will, and is even free to reject it partially (e.g., it’s the wrong sex) or completely (suicide). The true person is not by nature a “social animal” but may choose to be in relationships if this is what pleases him at any given time. In this world of autonomous consumers, the only real virtue is justice: the right to get what one has paid for.
In the Tepeyac View, the person is intentionally created by God in His image, and with a definite nature. This person is as a mind-body-spirit unity designed to thrive in community, within a complex matrix of relationships. As the poet John Donne put it, no man is an island. Humans by nature are embodied creatures; we are our bodies as much as our spirits. The body is designed for a purpose and is not to be manipulated or mutilated; its deficiencies are to be repaired to work properly according to its natural, God-given design. Physical illness is often a symptom of spiritual, emotional, and relationship deficiencies or defects as well as problems within the body. Curing the patient thus involves understanding the whole person, not just the body and its deficiencies.
The Nature of the Human Person.
In the modern Western view, in this world of consumers, medical care is a product just like any other. The consumer-patient should be free to choose whatever he or she wants, and the doctors are seen as one among many vendors. People choose to become doctors for the same reasons they would choose to become any other type of “vendor”: this is how their natural skills enable them to make the most money.
Actually, medicine could be seen as an extension of the vending machine: put in your money and out comes your fix. The patient is free to do whatever he or she wants with his body, so medical care is only limited by what is technologically possible—a frontier being pushed out exponentially. Thus, OB-GYNs typically encourage and prescribe contraceptives, perform sterilizations and abortions, and perform or refer for the full range of assisted reproduction procedures (e.g., in vitro fertilization)– whatever the patient desires. (“Whatever Lola Wants, Lola Gets…” a song from the 1950s musical “Damn Yankees”, could have been titled with modern medicine in mind.)
If the body is seen as just another machine, the doctor becomes essentially a mechanic. Medical service is on the order of: this is your problem, take this course of medication or undergo procedure X and you’re back on the road. Contact between patient and doctor tends to be scanty because once the problem with the “machine” has been diagnosed, the repair should be done quickly and with minimal extraneous contact. The underlying driving assumption is that the doctor is there to diagnose your problem, fix it with medication or surgery, and get you out of the office quickly, never forming much, if any, of a relationship with you and your family. In any case, the relationship is essentially individual consuming patient to individual providing doctor (or practice); the broader community is not involved unless the doctor happens to choose it, and the community is not involved in payments except in the case of socialized medicine.
At Tepeyac, the doctor works to serve others and bring the love of Christ through medicine, not to make a lot of money or become famous. To be a doctor is form of personal vocation. It is a special calling, and God gives special gifts to enable this way of serving God’s people. Because humans are designed for a purpose, proper medical care involves understanding that purpose and working within the design to remedy its deficiencies. The patient is not an autonomous consumer who may redesign his or her body at a whim, and the doctor may not cooperate in such “redesign.” Instead, the doctor must cooperate with the Creator’s design to help the patients understand that design and work within it, regardless of what modern science has made possible. According to God’s design, the continuance of life is accomplished through loving sexual intercourse, which both unifies the couple and is the act of procreation. Neither of these aspects of the procreative process is to be thwarted or bypassed in order to conceive, or avoid the conception of, a child. Promoting health involves promoting and establishing relationships, encouraging patients who have received the doctors’ sacrificial love to show that same kind of love to others.
The Medical Care System.
In the modern Western view, medicine is part of the consumer-driven world. The consumer-patient is entitled to buy any services he or she can afford from the vendor-doctor. In typical developed western countries, however, payment for medical services is mediated through various kinds of insurance arrangements. Most of these are not insurance in the classic sense, like auto or homeowner. Instead, they are essentially packages that combine liability coverage in the case of well-defined, very low-probability, high-cost medical events with what amounts to a form of prepayment for medical treatment. In the U.S. “free market” or “mixed insurance” model, such insurance can be bought from numerous insurers and can have a variety of characteristics, some of which closely resemble traditional liability or casualty insurance (i.e., “high deductible” plans). In many countries (e.g., Britain and Canada), medical care is socialized; a government agency is the only insurance company. Where medical payment is insurance-based, the services a patient can get depend on having the right insurance or insurance package, and the decisions of the insurer to cover certain procedures. (This is particularly evident in socialized medicine systems, which emphasize preventive care and “biggest bang for the buck” basic public-health care out of the limited government budget, and thus refuse to provide certain services, especially state-of-the-art care for certain diseases or services to people past their life expectancy.) In the U.S., many if not most doctors who take insurances severely limit the insurances they take. Some take no insurances, only direct payments, and refuse to see patients who cannot pay or who do not have the proper insurance.
Tepeyac works within the insurance-based medical payment system, but refuses to be bound by it. Tepeyac sees the patient as deserving to receive medical care because she is a person, not because she can pay a fee or has the requisite insurance. She deserves the best quality of care the doctor can deliver because love always tries to deliver the best. Further, every community comprises the well-off and the not-so-well-off. In the Christian vision, all members with the gift of abundance are responsible for helping with the care of the poor members. Because their special gifts typically result in their ability to earn above-average incomes, doctors have a responsibility to be open to seeing and caring for the poor in their “own backyard,” in their own communities. But the responsibility is not theirs alone. All who have an abundance should be willing to help doctors care for poor patients so that the burden of meeting the medical needs of the poor in their community is shared equitably. Divine Mercy Care strives to build and sustain a community structure in which the wealthier regularly contribute to the care of the poorer members as far as OB-GYN care and related matters (e.g., infant care) are concerned.