Breakdown of family life
Not long ago I attended a GP refresher course lecture, in which we learned about a study in Exeter investigating the effect of divorce or separation on children. The study has confirmed what I think most people could deduce by common sense - the effect is often harmful. In fact it has been found that even if the parents are constantly quarrelling, it is better for the children if the parents stay together.
The lecturer asked us what we would say to patients contemplating divorce who came to us for advice. We agreed we should encourage them to do everything in their power to stay together, and we should tell them the findings of the above study. Later, I pointed out that prevention is better than cure, and that there is something which doctors can do at a much earlier stage. I will come back to this at the end.
There has been an increasing incidence of breakdown of family life in this country, and more and more children now come from broken homes. The implications are serious. The children involved in these marriage breakdowns are affected mentally, emotionally and sometimes physically. They tend to be more disturbed, unhappy and unsuccessful than children whose parents remain together, and they have a greater tendency to turn to delinquent behaviour.
Having the example of their parents to follow, they are less likely to form stable, life-lasting relationships with the opposite sex when they reach adulthood, and so the vicious circle continues. (Presumably children of parents who cohabit and then separate - or who never even live together - are similarly disadvantaged.)
Why are we in this situation?
Why are we in this situation today? Underlying it all is the fact that our society is increasingly pagan. More and more, God and his laws are rejected. Having said this, there are several factors involved. I believe that one of the biggest factors - if not the biggest - is that of sexual immorality.
Nowadays it seems that most young people (and many older ones too) consider it both normal and acceptable to engage in extramarital sexual intercourse. Young people who refuse to do so may be derided and regarded as abnormal and defective in some way. (I know this, because a member of my own family experienced such attitudes at university.)
Common sense tells us that whether or not there is a causal relationship, this behaviour must be associated with a loss of respect for the institution of marriage and a loss of stability in all sexual relationships - and this is borne out by the statistics. A man and wife are more likely to divorce if they have engaged in extramarital intercourse, and a cohabiting couple is more likely to split up than a married couple.
Contraception and promiscuity
As I have mentioned, today's situation arises because our society is becoming increasingly pagan. God and his laws have to a large extent been rejected. However, the explosive increase in promiscuity over the last few decades is temporally related to the availability of reliable methods of contraception - and I believe this is no coincidence. The knowledge that an act of intercourse could result in an unwanted pregnancy must have a restraining influence. Reliable contraception removes this restraint.
GPs are expected to provide their patients with contraceptive advice when they ask for it. This was the situation I found myself in when I came into general practice in 1983 after 16 years on the mission field. Many of those requesting contraception are unmarried, and they are asking us, to put it bluntly, to enable them to fornicate without restraint. How was I to react to this situation?
As far as I know, all orthodox Christians agree the Bible teaches unequivocally that sexual intercourse outside the marriage relationship is sin. More than that, it is a very serious sin and an abomination in the sight of God. The many references in the Bible to 'fornication' or 'fornicator' (Authorised Version) make this absolutely clear. Jesus himself listed fornication, together with evil thoughts, murders, adulteries, thefts, false witness and slanders, as something which comes out of the heart of man and defiles him. (Use of the word 'man' here includes woman.) Unanimity among Christians in this matter is, I think, far greater than in the question of abortion.
Yet fornication is practised so widely nowadays that many who disapprove of it (even some Christians) have become hardened and are no longer shocked by it. Several people have said to me with an air of helpless resignation: 'We don't like it, but this is the way people do things now'. Some seem to think that if enough people disobey one of God's laws, that law somehow becomes less important - disobedience is somehow less of a sin than it used to be. This is nonsense of course. Fornication is just as much a sin as it always has been. God does not change his laws because people disobey them!
Fornication is harmful
Apart from this spiritual aspect, the practice of fornication is ultimately destructive and harmful, both in the lives of the individuals concerned and in society as a whole. Physically, there are the dangers of sexually transmitted disease (including AIDS), carcinoma of the cervix, and unwanted pregnancies followed by abortion. Mentally and emotionally, there is that lack of total commitment and trust between the partners which leads so often to the breakdown of the relationship (and subsequent relationships). Socially, there is the harm done to children and the catastrophic effect on society of the breakdown of family life.
Considering the above, I think it is surprising that many Christian doctors seem to feel they have no choice but to provide contraception to all or most of those who ask for it. Although there are probably many who counsel unmarried patients not to have intercourse, my impression (right or wrong) is that the doctor who refuses to provide contraception after his or her advice has been rejected is quite rare (except among Roman Catholics). The belief seems to be that we have no right to force our opinions on our patients.
Married couples only
I came to the conclusion that I could only provide contraception to married couples, and that my contraceptive advice to unmarried couples would be limited to that of advising them not to have intercourse. I would advise them that if they rejected my advice they should go elsewhere and obtain their contraception from another doctor. I was not forcing my opinion on them, because they were perfectly free to reject my advice and obtain their contraception elsewhere. I believe that extramarital sexual intercourse is thoroughly evil and destructive and it would be wrong for me actively to assist people to indulge in it. I would be allowing the world to force me into its mould and would become part of this evil system.
It has not been easy for me to take this stand and I am afraid I have sometimes done it rather badly. I have had to face real anger and abuse. Patients have been incredulous that anyone in this day and age can be such an outdated, fundamentalist freak. Sometimes the surgery door has been slammed in fury and perhaps patients have been lost to the practice.
Personally, I often find it difficult and embarrassing to take this line; but not to do so would be against my conscience. With younger patients it is easier. Often they are ready to listen, even if they do not take my advice. The older unmarried patient, usually on the contraceptive pill already, is more difficult. In practice, I start by telling them that I only provide a contraceptive service for married couples; so if they want contraception, they will have to go to another doctor. I offer to explain why this is my policy, and if they accept my offer, I explain. I do not tell them unless they ask. Often I regret not having said more; but I find it difficult enough to say what I do say. I am reluctant to say anything which might be perceived as ramming my opinion (although, of course, it is much more than 'my opinion') down somebody else's throat.
Better than an unwanted pregnancy?
Christian doctors justify providing a contraceptive service to unmarried patients by saying that it is better to have extramarital intercourse with contraception than to have an unwanted pregnancy, followed by an abortion. This view has a certain logic; but I think it is shortsighted. It fails to take into account the broader picture which I have outlined above.
If we follow this policy, we are actively helping and encouraging patients to do something which is both evil and harmful to themselves, to their partners (both present and future), to their children (both present and future) and to society as a whole. The long-term effects of extramarital intercourse are so disastrous that I think the statement 'extramarital intercourse with contraception is better than an unwanted pregnancy' is extremely questionable.
In any case, by refusing to give contraception I am not condemning patients to unwanted pregnancies and abortions - they are perfectly free to abstain from sexual intercourse or, failing that, to consult another doctor. Incidentally, the contraceptive supply form FP1001 is a separate contract which a woman can make with a doctor who is not her own GP.
Contraception prevents unwanted pregnancies; but it also has the effect of enabling and encouraging people to fornicate - because it frees them from the fear of pregnancy. I suggest that if reliable contraception were not available, a large proportion of those who fornicate would not fornicate at all. By providing contraception to unmarried people, we are actually making ourselves part of a system which facilitates, perpetuates and increases promiscuity - with the associated breakdown of family life leading to a rise in crime, poverty and homelessness etc. Perhaps we cannot beat the system; but that does not mean we have to join it.
As an influential group of Christians, should we not be taking a clear and definite stand against this undoubted evil? I realise that if all Christian doctors elected to provide contraception to married couples only, we might lose a lot of patients - but does that justify what we are doing now? How can it be right actively to assist people to fornicate?
Passing the buck?
Perhaps some Christian doctors feel that if we refuse to give contraception to these patients, we are simply 'passing the buck' to another doctor. I am quite certain that we need not feel this at all. If our patients had no alternative but to fornicate, perhaps it would be a case of passing the buck. But fornicating is not something they have to do - it is something they choose to do. Fornication is not only evil and harmful - it is also unnecessary. When we refuse to provide contraception and advise abstinence, we do it for the good of the patients themselves, the good of their partners, the good of their children and the good of society at large.
If they choose to reject our advice and go to another doctor to get what they want, they will later be doing something which is morally wrong, harmful and unnecessary - and be doing it of their own free will. We are under no obligation to help them do evil. Quite apart from what God's will is in this matter, not even the government says we have to do it. It is recognised and accepted that some doctors have a conscientious objection to certain procedures and treatments, and this is respected. If the government were to make it compulsory for us to supply unmarried people with contraceptives, I believe that our response would have to be 'We must obey God rather than men'.
Losing touch with patients
Another reason sometimes given for providing unmarried people with contraceptives is that if we do not do so, they may not come back to see us again. Thus we lose touch with them and are unable to help them in the future.
This sounds very laudable; but I believe it is based on human reason and not on the word of God. It is equivalent to saying 'Let us help them to do evil in order that good may come'. It is right to try to get alongside people and understand their problems and sympathise and help them; but this should not extend to helping them do evil - and the Bible clearly indicates that fornication is evil.
God uses many methods to draw people to Christ; but getting us to help people do evil is surely not one of them. If we want to help them, we must do it God's way, not our own way. He simply requires we do his will and trust him concerning the consequences (both for ourselves and for our patients) which may follow from this.
Opposition to the stand
In actual fact, I think very few have left the practice or refused to see me again because of the stand I have taken. But we must expect anger with the stand we take, and opposition to it. Jesus warned his disciples that they would be reviled and persecuted, just as he was; because the world prefers darkness to light.
If we try to please everyone and avoid saying anything that could upset anyone - and thus avoid any kind of opposition or abuse - we are failing in our witness. My own belief is that helping people to fornicate is not only morally wrong but also does them no good at all in the long run. They are far more likely to be helped if I stand up for what is true and good, even if it makes them angry at first.
If anyone should say that I have no right to bring my morals into my place of work and inflict them on other people, my reply would be that God commands us to do his will at all times. He wants us to be 'salt' and 'light' in 'the world'. I have no right to force people to do what I believe is correct, and no wish to try - but they likewise have no right to force me to do what I believe is wrong. I believe helping them fornicate is wrong.
Many Christian doctors refuse to help patients to procure abortions (except in certain special cases); so why are there apparently so few willing to take a stand on this issue? The wrongness and harmfulness of immoral sexual behaviour is without question; so why do so many of us go along with it?
To return to that lecture I attended - I pointed out that research has shown that married couples are more likely to divorce if they have had extramarital sexual intercourse, and cohabiting couples are more likely to split up than married couples. It follows that if we counsel patients not to have extramarital intercourse, we are doing something to prevent family breakdown, rather than simply trying to clear up the mess after disaster has occurred. Nobody in the lecture room disagreed with me.