Doctor's Dilemma

Teresa Gonzales is the wife of a bricklayer living in Colonia Mexicana, the dirt-poor shack town of Brownsville, Texas. Now 35, Mrs. Gonzales has had four children in 13 years. The first died in infancy. The next two, both girls, were delivered by dangerous high-forceps methods. Fortnight ago, Teresa Gonzales was to be delivered of her fourth child.

The family physician, Dr. John M. Stephens, 37, a rangy, mustached Calif or-nian, had his patient Xrayed. The fetus, he found, was lying in a wrong position and its head was much too big for normal delivery. Delivery by Caesarean section (less risky than high forceps) was decided on. Worried Husband Mariano Gonzales asked the doctor to do something to keep his wife from having more babies. Dr. Stephens said he would see about it.

The Law & the Rule. Dr. Stephens was in a dilemma. He believed that another pregnancy might endanger Teresa Gonzales' life, and that therefore sterilization was medically advisable. It would also be legal. But Brownsville's only hospital is run by the Roman Catholic Sisters of

Mercy; its rules forbid such an operation, and Dr. Stephens had signed a promise to abide by the hospital's rules.

Dr. Stephens delivered the boy baby by Caesarean section. It took but a minute for him to tie off the Fallopian tubes with surgical thread, so that Mrs. Gonzales would not become pregnant again. Dr-Stephens closed the peritoneum (the membrane lining the abdominal cavity).

Standing by in the delivery room at this time was Sister Mary Adele, in charge of Mercy Hospital's obstetrical department. She asked to see the patient's tubes. She was told that they were all closed up. The sister asked Stephens whether he would admit that he had tied them. He did. She told him that he would have to untie them.

Again Dr. Stephens was in a dilemma. He felt that he could not defy the sister. He decided it would be quickest, and least dangerous for the patient, to reopen the peritoneum and untie the tubes. That is what he did.

The Doors of Mercy. For violating its code of ethics (which it shares with other Roman Catholic hospitals in the U.S.), Mercy Hospital denied Dr. Stephens the use of its facilities for his patients. Within hours, another of his patients reached the hospital, going into labor. She was told that she would have to get another doctor. She went back home, where Dr. Stephens delivered her baby.

In the ruckus last week over the case, most of Brownsville's townspeople backed Dr. Stephens. So did fellow doctors, though none could raise his voice for fear that he, too, would find the doors of Mercy Hospital shut in his patients' faces.

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