A pro-life OB/GYN looks back on the end of Roe v. Wade
Dr. John Bruchalski is an obstetrician and gynecologist in northern Virginia who practices what he calls “life-affirming medicine.” He is the founder of Tepeyac OB/GYN, a non-profit practice that cares for women of all economic statuses. His book, Two Patients: My Conversion from Abortion to Life-Affirming Medicine, was recently released by Ignatius Press. America spoke with Dr. Bruchalski in May to discuss the future of the pro-life movement after the reversal of Roe v. Wade.The following transcript has been edited for length and clarity.
In your book, you describe your vocation as a doctor as a vocation to the practice of “merciful medicine.” One of the prevailing responses of pro-choice women to the Dobbs decision has been fear: fear for their bodies, for their lives, for their livelihoods. How can Catholics respond to that fear with mercy?
I’ve been on both sides of this issue religiously as well as medically. I performed abortions until I underwent a conversion, and I did so thinking—mistakenly—that I was acting with mercy. I can’t throw stones at anyone. I know that we have to build up credibility in order to have these conversations. At my practice, we have been consistent about the gospel of life from day one—not by pushing it on people but by showing that it is the best option for health, wholeness and healing.
America spoke with Dr. Bruchalski in May to discuss the future of the pro-life movement after the reversal of Roe v. Wade.
We have also opened up our doors to the least of our brothers and sisters in the economic sphere and in the racial sphere. We try to help correct, in our own simple way, some of the unjust structures within medicine, by bringing the poor and the disenfranchised into the same practice where we see the insured and the wealthy. Because we’ve done this work for several years, we developed street credibility on both sides of this issue. We live and witness as signs of contradiction in a confused culture. We try to meet people where they are and listen to their stories and then present them with alternatives based on your experience.
We have to listen to where people are coming from and identify that they’re afraid. They have real reasons to seek abortions. But excellent medicine, aided by the advancements of the past several decades, allows us to care for both the mother and her unborn child. We get them as far as we can, as we always do in medicine, balancing the technology and the efficacy and the beneficence of and the justice of care with the person right in front of us.
“We have to listen to where people are coming from and identify that they’re afraid.”
When we’re facing an emergency situation—let’s say we’re dealing with a baby who is only 12 or 15 or 18 weeks old and the mother is suffering from a hemorrhage or an infection—we always treat the disease in front of us. Sometimes that results in ending the life of the child, not directly but indirectly. In an abortion, the doctor intends to end the life of the fetus. But when I am trying to save the life of a patient, that is never my intention. It’s always to save the life of the mother. I can never directly end the life of the fetus.
It’s never good medicine to tell a mother that you had to kill her child in order to save her life. That just chafes against human nature, against the unity of the human family. Instead, we walk with these mothers and we accompany them. Responsibility, encounter, hospitality: These are the basis for how we approach others, even in medicine.
Since the reversal of Roe, many media outlets have published reports that women suffering from miscarriages or ectopic pregnancies will no longer receive adequate care. How has this kind of reporting complicated the work of medical professionals over the past year?
This kind of response from the media is rooted in the idea that we’re supposed to accept abortion as excellent health care, that it should not be couched in shame or hiddenness but should simply be a natural part of medical care. And yet we see countries like Poland that have really cut back on abortion—without seeing an increase in maternal mortality. We see this, too, in states that have placed strict limits on abortion. But when you’ve had abortion in your toolbox for five decades, and it has become the standard answer to many issues faced by women, then our moral imaginations have been constrained.
Life-affirming physicians, who understand why they went into the practice of medicine, deal with issues like this every day. When you hear fear and terror and conflation of abortion with standard medical treatment, now that this is political, not medical. There have been wonderful, life-affirming physicians for millenia—physicians and midwives and nurse practitioners and physician’s assistants and family doctors. We take care of patients. We did it before Roe,we did it during Roe,and we’re doing it now after Roe.
For pregnant women, there are many possible situations which will necessarily involve suffering: the pain of birth, the relentlessness of severe morning sickness, the anguish of watching a disabled child suffer, the uncertainty of providing for a family in a time of economic upheaval. What is the role of the doctor in helping patients to navigate the inevitability of suffering and giving hope in the face of it?
Suffering and pain and illness and anxiety are all part of the human experience, sociologically and anthropologically, as well as theologically. People come to physicians because of these things. We are adept at understanding the human organism and addressing the physiology and the biochemistry of suffering. We do our utmost to relieve it. But because we’re body, soul and spirit, there are some kinds of suffering that are more existential. There’s moral suffering, the suffering of being alone, the suffering of mental illness, the suffering of dealing with chronic illness and chronic pain.
A good physician will look at the whole person and do his or her utmost to alleviate pain. But today we live in a world that struggles to make sense of suffering—and I think that a lot of that has to do with the fact that we eliminate the weakest members of our society, at the beginning or end of their lives. Medicine has lost its foundation of trust.
“We live in a world that struggles to make sense of suffering—and I think that a lot of that has to do with the fact that we eliminate the weakest members of our society.”
The only way to fix that is to really listen. At its core, health is relational. So we listen, we take a medical history, and we perform a physical, and then we treat the root of the issue—as we and the patient understand it. Sometimes we do this more successfully, sometimes less so, but we do our utmost to be present to our patients. We want to give them the confidence that if they are going to continue to suffer, we will help to connect them with services within the community. Many of the most meaningful times in our lives are when we are enabled to lean into pain or difficulty or anxiety by the examples of others who got through similar experiences or by a clinician who is able to sit with us and walk us through our suffering.
When we treat women who are experiencing challenging pregnancies, who decide to pursue an abortion, we always welcome them back. No questions asked, no criticism, because we understand why they picked that option. We’re not interested in judging them. We’re medical doctors. We’re in the business of walking alongside our patients for as long as they are our patients: physically, socially, spiritually. We might come at this from different angles, but we respect the foundational beliefs of the other. And when abortion comes up in the conversation, we talk about it honestly. I think the vast majority of people are grateful for this. This kind of accompaniment works to find a common ground and moves us one step closer towards real friendship and harmony.
From the beginning of your medical practice (and especially since founding Tepeyac OB/GYN in 1991), you have sought to provide care to poor and uninsured women and families. Sometimes this has seemed like unsustainable work. How have you been able to prioritize service to the poor—and how does this fit into your understanding of the role of the doctor?
Having grown up in a Polish family that cared for men and women fleeing from the communist revolutions in Europe, I’ve always had a sense that I ought to help and serve others in whatever way I can, however small. During medical school, I spent several months working in Appalachia. This left a lasting impression on me. I was in a coal town in southwestern Virginia. Corporations had destroyed their ecology, knocked off the top of their mountains, polluted their water system and used the people as widgets to yank coal out of the ground. They were left with damaged lungs, addictions and a dying economy.
At the time, I really thought that they just needed more reproductive care in order to suppress their fertility, to get them into the workforce and to improve their finances. But I was just passing through, imposing my perspective onto their problems. Someone asked me: “Do you think that because we’re poor, we shouldn’t reproduce?” Well, that threw me for a loop. My entire life as a doctor at that point had been shaped by the belief that access to abortion and contraception would liberate a woman from the chains of her fertility.
I would eventually have a religious conversion because of the witness of physicians who were mentors to me and because our Lord and his mother came into my heart in prayer. After that, my desire to care for life was motivated by the realization that we are all brothers and sisters made in the image and likeness of God. The love of God motivated me to love others. It was very clear to me that he was instructing me to do three things.
First, be excellent in medicine and follow excellent science. Second, treat the underserved as well as the served. This meant taking care of my own community. There were people doing free clinics. There were people doing missions and building hospitals in other countries. But my eyes were open to the fact that there were so many people right in my own community who needed assistance. And finally, follow the teachings and the traditions and the Scriptures and the sacraments of the church. That was it.
When we started Tepeyac, our mission was twofold. We set out to be consistent with the teachings of the church about everything from abortion and in-vitro fertilization to Theology of the Body and human sexuality, while also knocking at the foundations of the unjust social structure that exist in medicine. For the first 15 years, we were a for-profit practice. We took whatever margin we had and pumped it back into the practice. We accepted all insurances, including Medicaid. And we also took care of patients who didn’t have any kind of insurance coverage. Because of the economy and because of the way medicine is structured, this became increasingly difficult to do.
For 30 years, we’ve been here doing this work. We’ve made every mistake in the book and we’re still here. We’re still inspiring students and social workers and churches. We enlarge their moral imaginations by showing them that there’s a different way to do things. Every accountant says, “John, you have to compromise.” No. I was told by God to be a sign of contradiction in the culture. I can’t go against what my prayer life and my church tell me to be true, in the moral system or in the sacramental system or in the social system. The Catholic Church is an institution of mercy. Its magisterial teaching is a mercy because I don’t have to rely on my own foibles in order to make these decisions. I can lean on the collective wisdom of the cloud of witnesses that has gone before me.
It’s been a wonderful, crazy, challenging and very worthwhile endeavor, doing “both/and”: both sides of the liberal/conservative divide, the right/left polarization. I think it’s very healing and I think it’s the best way to find common ground with people in the community who might frown upon a more theological foundation. We continually put in the work, with joy and a sense of humor, and we’ve become friends with people we didn’t think we would.