Legalized recreational pot

Excerpted from "Colorado, Washington first states to legalize recreational pot," Chicago Tribune, by Keith Coffman and Nicole Neroulias. November 7, 2012--Colorado and Washington became the first U.S. states to legalize the possession and sale of marijuana for recreational use in defiance of federal law, setting the stage for a possible showdown with the Obama administration. But another ballot measure to remove criminal penalties for personal possession and cultivation of recreational cannabis was defeated in Oregon, where significantly less money and campaign organization was devoted to the cause. Supporters of a Colorado constitutional amendment legalizing marijuana were the first to declare victory, and opponents conceded defeat, after returns showed the measure garnering nearly 53 percent of the vote versus 47 percent against.

The Colorado measure will limit cultivation to six marijuana plants per person, but "grow-your-own" pot would be still be banned altogether in Washington state. "The voters have spoken and we have to respect their will," Colorado Governor John Hickenlooper, a Democrat who opposed the measure, said in a statement. "This will be a complicated process, but we intend to follow through." He added: "Federal law still says marijuana is an illegal drug, so don't break out the Cheetos or gold fish too quickly."

Critics say the social harms of legalizing pot - from anticipated declines in economic productivity to a rise in traffic and workplace accidents - would trump any benefits. Backers point to potential tax revenues to be gained and say anti-pot enforcement has accomplished little but to penalize otherwise law-abiding citizens, especially minorities. They also argue that ending pot possession prosecutions would free up strained law enforcement resources and strike a blow against drug cartels, much as repealing alcohol prohibition in the 1930s crushed bootlegging by organized crime. "It's no worse than alcohol, and it's widely used in Colorado anyway," said Jean Henderson, 73, a retired resident of Broomfield, explaining her vote in favor of legalization. "The state can benefit from the taxes rather than put people in jail." Click here to read full article.

Commentary

CMDA CEO David Stevens, MD, MA (Ethics): “VISIT ASPEN – great vistas, marvelous skiing and you can grab a joint of Supergrass before you hit the slopes this Christmas season! I can see this or similar ads on billboards and the internet in the next month when recreational marijuana becomes available. Far-fetched? There are no restrictions on advertising marijuana in the Colorado law passed this month. Along with Washington state, children and teenagers in the state will be getting the message loud and clear: smoking a joint is no different than drinking a beer and then thinking, 'Why wait until I’m 21?'

"The bill passed because medical marijuana has been more tightly regulated in Colorado than any other state. It’s planting, growing, processing and shipping is all under constant video monitoring. The referendum backers advertised that marijuana had been regulated until it was safe, and that allowing recreational use would bring millions of dollars of tax revenues that was now going to cartels into the state for education.

"The uncounted medical and societal costs of this decision will be evident in the years ahead. Alcohol use and related illnesses skyrocketed after the end of Prohibition. Marijuana worsens symptoms of psychotic illnesses, contributes to depression and increases attention deficit and memory problems. Traffic accidents and fatalities will increase and there is presently no easy way to test drivers to see if they are driving under marijuana’s influence. Marijuana is often cut with mind-altering drugs like PCP, LSD, heroin and cocaine. Its use delays people looking for the emotional causes of their problems as it puts a Band-Aid on their psychic wounds. Many experts see marijuana as a gateway to the use of even more dangerous drugs. One-third of users, who now will be able to grow up to six marijuana plants in their backyard in Colorado, show signs of dependence. Parents will have one more reason for not allowing their children to go over and play at the neighbor’s house.

"How will Colorado and Washington deal with the economic issues of price, supply and demand? Monitoring production for so-called medical use is ridiculously simple compared to the quantities demanded as use skyrockets, 'potheads' move to the state and marijuana attracts tourism. Will the state Department of Agriculture promote it as a new cash crop instead of allowing its import from outside the state? With the state tax of 15 percent, will people still grow it illegally and drug runners run it across the state line to avoid the added cost? How will law enforcement know what marijuana is taxed and what has not been once it is in the user’s possession?

"If the supply is more than adequate, will the price drop fuel increased usage and an increase in the tax rate? According to priceofweed.com, marijuana now costs $152 to $254 dollars an ounce in Colorado depending on quality. Where can it be sold? If it is treated like alcohol sales in the state, residents may soon find it in the grocery store between the basil and rosemary. In the medical marijuana trade, there are popular marijuana-infused edibles, oils and even drinks. With the harms of inhaling smoke, will restaurants in Colorado and Washington soon be offering marijuana-infused desserts?

"Bottom line, I view the legalization of marijuana with sadness. It is another step, a giant one, along the path of the decline and ultimate destruction of our culture and our country. It is another clear indicator of the need for Christians to be shining lights in the growing darkness."

Faith at crossroads in US: Poll reveals decline in faith affiliation

Excerpted from “Nones”on the Rise survey report by the Pew Research Center, October 9, 2012 - The number of Americans who do not identify with any religion continues to grow at a rapid pace. One-fifth of the U.S. public – and a third of adults under 30 – are religiously unaffiliated today, the highest percentages ever in Pew Research Center polling.


In the last five years alone, the unaffiliated have increased from just over 15 percent to just under 20 percent of all U.S. adults. Their ranks now include more than 13 million self-described atheists and agnostics (nearly 6 percent of the U.S. public), as well as nearly 33 million people who say they have no particular religious affiliation (14 percent).

This large and growing group of Americans is less religious than the public at large on many conventional measures, including frequency of attendance at religious services and the degree of importance they attach to religion in their lives.

These findings represent a continuation of long-term trends.

The religiously unaffiliated population is less convinced that religious institutions help protect morality; just half say this, considerably lower than the share of the general public that views churches and other religious organizations as defenders of morality. Overwhelmingly, they think that religious organizations are too concerned with money and power, too focused on rules and too involved in politics.


CMA VP for Government Relations Jonathan Imbody: “I've prepared an analysis of and strategies to respond to this poll's findings, which represent a wake-up call to Christians nationwide. We must not, however, conclude on the basis of this poll that Christians should get out of public policy.


"First, many of those who disapprove of advancing Christian values through public policy--regarding homosexuality, abortion and premarital sex, for example--will naturally want Christians to get out of politics, so they themselves can prevail politically. Christian involvement in politics for such people is not somehow preventing them from embracing Christ; it is preventing them from pursuing their own ideological political agenda and personal values.

"Second, if Christians were to leave public policy to those who do not share our faith values on the sanctity of life, defending the defenseless and caring for the poor, what kind of laws and policies do you think would result?

"Imagine where this nation would be today without the historical and continuing political influence of the faith community on issues such as slavery, abortion, civil rights, assisted suicide and religious liberty.

"The first two chapters of the book of Romans teach us that when people defy God as revealed in nature and in their consciences, by making evil choices counter to God's principles, they end up with a depraved mind and a hardened heart. Consider that the reverse is also true: When individuals act in accordance with God's revelation through nature and their consciences, by making good choices consistent with His principles, they maintain an open mind and a softened heart toward God. They also experience God's principles working in their lives, which can lead them to embrace His fuller revelation through Scripture and the Good News of a personal relationship with Jesus Christ.

"Therefore, when followers of Christ help individuals (through relationships and counseling) and our society (through public policy) to make choices consistent with God's principles, we are actually participating in evangelism. We Christians participate in public policy--by voting, advocating politically and voicing views in the public square--not because we think that laws consistent with Christian principles will save people spiritually, but because we realize that such laws can help keep minds and hearts headed in God's direction, to the One who can save."

Action

• REGISTER to VOTE

!

Contact lawmakers

Track bills

Resources
View or download "Faith at crossroads," a CMA PowerPoint analysis of and strategies related to the Pew poll survey

CMA fights HHS mandate in court

Excerpted from "Battle against abortion mandate," Baptist Press, Oct. 15, 2012 - A friend-of-the-court brief filed Oct. 12 asks a federal appeals court to reverse the dismissal of two lawsuits against the controversial abortion/contraception requirement under the 2010 health care law. The brief supports challenges by Wheaton College, an evangelical Christian school in suburban Chicago, and Belmont Abbey College, a Roman Catholic institution in North Carolina, to the mandate that employers provide workers with health insurance that covers contraceptives and abortion-causing drugs.
[Eleven] evangelical organizations joined by invitation in a brief filed by Christian Legal Society (CLS) in support of the colleges' appeal on religious liberty grounds to the District of Columbia Circuit Court of Appeals. The lawsuits seek the overturn of a rule by the Department of Health and Human Services (HHS) that includes -- in coverage paid for by employers -- drugs defined by the Food and Drug Administration as contraceptives, even if they can cause abortions. Among such drugs are Plan B and other "morning-after" pills, which can prevent implantation of tiny embryos, and "ella," which -- in a similar fashion to the abortion drug RU 486 -- can act even after implantation to end the life of the child.
Though the 2010 health care law says it is not to affect conscience protections regarding the performance of or funding for abortion, the HHS mandate "tramples religious employers' conscience rights and thereby discredits the time-honored commitment to respect religious conscience rights in the health care context," the brief says.
[Organizations] signing onto the CLS brief included the Ethics & Religious Liberty Commission, the Christian Medical Association, Prison Fellowship, National Association of Evangelicals, Patrick Henry College, Association of Gospel Rescue Missions, Association of Christian Schools International and Institutional Religious Freedom Alliance.

Commentary

CMA VP for Government Relations Jonathan Imbody: "The Christian Medical Association has participated in 34 court cases to vie for principles our members value. This latest brief counters the administration's efforts to limit the scope of religious freedom by narrowing the definition of which organizations are 'religious enough' to qualify for exemption from the new health law's contraceptives and sterilization mandate. The mandate forces U.S. employers to have included in their health insurance plans a new requirement under Obamacare to provide 'free' contraceptives and sterilization surgeries to anyone on demand.


"Our legal brief asserts:

'The mandate’s inadequate definition of 'religious employer' departs sharply from the nation’s historic bipartisan tradition that protects religious liberty, particularly in the context of abortion funding. Exemptions for religious objectors run deep in American tradition. Exemptions for religious conscience have been a bipartisan tradition in the health care context for four decades. The mandate’s definition is so narrow that many religious congregations may fail to qualify as a 'religious employer.' The mandate’s 'religious employer' definition certainly does not cover most religious ministries that serve as society’s safety net for the most vulnerable.'

"Other examples of assaults on religious liberty and conscience rights include the gutting of the only federal conscience regulation in health care, the denial of federal grant funds to a ministry simply for opposing abortions and the administration's court action to restrict faith-based organizations' hiring rights. Unless we halt this trend of governmental restricting of religious and conscience freedoms, you will find yourself subject to increasing pressures--motivated by ideologies opposed to your beliefs--to violate your faith principles in your professional practice and ultimately in your personal life."

Action

1. Sign the petition to Stop the HHS contraceptives / sterilization mandate
2. Sign the Healthcare professional petition to Congress and the President to uphold conscience rights

Resources

• Read the CMA brief against the HHS mandate
• CMA legal briefs summary

Treating a difficult patient

Excerpted from "Treating the difficult patient," Medscape News, by Batya Swit Yasgur, MA LMSW. September 20, 2012--Some patients warm your heart. They help you remember why you went into medicine. Other patients make you wish you had become anything but a physician. They yell or whine, manipulate or threaten. Some ignore their treatment plan and blame you when they don't improve; others insist they know more than you do. Some don't pay their bills, and others fail to show up for appointments. Hard as it is to admit, you wish they'd go away. "Many physicians feel they 'should' be loving and tolerant toward all patients, but that's not realistic," said Auguste Fortin, MD, Associate Professor of Medicine, Yale University School of Medicine, New Haven, Connecticut. "In every setting in life, we all get along better with some people than with others, and medicine is no exception." Although everyone has their own positive and negative traits, there are several categories of unpleasant behavior that may cast a very dark cloud over the patient visit.

Anger Outbursts - Some patients may periodically erupt. "Anger in a patient is one of the most difficult emotions for a physician to deal with," observed Neil Baum, MD, a New Orleans-based urologist. There are several reasons why a patient may snap at the physician. However, not every patient who displays anger has an identifiable "reason." Some people are easily irritable and don't restrain their anger in any aspect of their life. Still, it's up to the physician to diffuse or deal with that anger.

The "Dependent Clinger" - James E. Groves, MD, Associate Clinical Professor of Psychiatry, Harvard Medical School, Boston, Massachusetts coined the term "dependent clingers" to describe excessively needy patients who require endless attention and reassurance. They seem to regard themselves as having "bottomless needs" and the physician as being able to provide an inexhaustible stream of services.

An Impatient, Demanding Patient - "Physicians complain about patients who want their medications to bring an instantaneous cure. These patients call the office, screaming that their treatment isn't working," said Dennis Hursh, Esq, Founder and Managing Partner of Hursh and Hursh, PC, a Pennsylvania-based law firm specializing in physician-related legal issues. Some patients make unethical demands, such as asking for documentation supporting a disability claim when there is no disability, or opioid drugs when they are not truly experiencing pain, cautioned Hursh. In these situations too, explain to the patient that you are unable to fulfill their request. And be sure to document all of these discussions in the patient's chart.

"I'll Never Get Better! - Some patients remain perpetually ill, despite your best efforts -- not because their illness resists treatment, but because they reject medical interventions, believing that no treatment will help them, says Dr. Groves. They seem smug when they return to your office, time after time, complaining that your latest treatment has been useless. According to Dr. Groves, these patients are not seeking relief from illness but rather an "admission ticket" to a relationship with the physician that can exist only when the symptoms remain. Many of these patients are depressed, but typically they refuse to see a psychiatrist.

The Stubbornly Non-adherent Patient - When a patient disregards the necessary treatment regimen, a physician may begin to feel like a parent dealing with a rebellious teenager. Dr. Groves added, "I think there are 2 prongs to dealing with noncompliant patients. The doctor should decrease the expectation that all patients can be helped, and should look for ways to make small changes -- and keep looking. "The second is to realize that sometimes the best you can do is to keep the relationship going and trust that this alone is doing some good for the patient, at least in providing a humane environment," says Dr. Groves.

Latecomers, No-Shows, and Bill-Dodgers - "Patients who are always late, don't show up for appointments, or don't pay their bills are devastating to a practice," said Dennis Hursh. "If it happens repeatedly, you need to make it clear that your practice cannot tolerate it."

"When dealing with difficult patients, bear in mind that in the profession of medicine, we tend to see people at their worst, not at their best," Dr. Fortin commented. "We don't have to deny our own human needs, but we need to build skills that will help us treat even the most difficult people." Click here to read full story.



CMDA Past President Al Weir, MD: "Certainly, we have patients who cause us to groan a bit when we see them coming and we have those who surprise us with their anger or inappropriate behavior. We also care for patients who may behave appropriately but whose personalities grate against our own, simply because we view life differently.

“Some patients are more difficult to care for than others but none are less important. Just as we have cool drugs that put some malignancies into remission with a simple prescription, while other tumors require complex, multidisciplinary management, some patients are a cinch to deal with, while others require hard work. Whole person health is our business with the entire person package of disease, personality, education, income, spirit, relations and emotions. Just as there are skills to gain in order to manage disease, there are skills to gain that will help us manage these other aspects of patient care. We should seek to improve our performance in these areas through courses, literature and counsel with our mentors. We should develop support systems within our offices, using ancillary personnel to provide the additional time necessary to assist our difficult patients.

"And, as Christian doctors, we need to remind ourselves that Jesus did not die only for nice people. The foundation of our care for difficult patients should be the blood that flowed on Golgotha for difficult people like you and me."

CMDA Ethics Statement: Sharing Faith in Practice

Medical Devices that Dissolve in Your Body

Excerpted from "Scientists Create Tiny Medical Devices that Dissolve in Your Body," Time, by Malcolm Ritter. September 27, 2012--As consumers we want our electronic gadgets to be durable. But as patients, we might want them to dissolve — inside our bodies. Scientists reported Thursday that they succeeded in creating tiny medical devices sealed in silk cocoons that did the work they were designed for, then dissolved in the bodies of lab mice. It’s an early step in a technology that may hold promise, not only for medicine, but also for disposal of electronic waste.

Doctors already use implants that dispense drugs or provide electrical stimulation, but they don’t dissolve. The new work is aimed at making devices that do their jobs as long as needed and then just dissolved, without need for surgical removal or risk of long-term side effects. In the experiment, the devices — which look like tiny computer chips — were designed to generate heat, a potential strategy for fighting infection after surgery by killing germs, said John Rogers of the University of Illinois at Urbana-Champagne, an author of the study.

Someday for people, similar devices might be programmed to monitor the body and release drugs accordingly, or produce electric current to accelerate bone healing, Rogers said. The researchers used the protective cocoon envelope because silk can be processed to stay intact for varying periods of time — from seconds to weeks and potentially for years, he said. The device’s circuitry itself was built from other materials that degrade in the body, such as magnesium and silicon. Click here to read full story
.

CMDA Member Thomas Eppes, MD: "The era of nanotechnology is quickly approaching. Studies such as the one discussed above show us that scientist and physicians may do many incredible and wonderful things in the future in the name of health. The future seems bright and endless.

“Where there is potential for good, just around the corner is potential for disaster. Each and every medicine, procedure, surgery and even counseling session has an equal opportunity to go ‘bad.’ One only has to look at the two countries that were leaders of the 1930s eugenics movement to see where misguided physicians can lead society. Whether it was racial purification in Nazi Germany or sterilizing those not worthy of parenting at the Central Virginia Training Center in Lynchburg, Virginia, physicians can do as much harm as good in the name of science.

“Our only hope is to have scientific research and efforts led by physicians who are grounded in ethics. The world believes in the moral neutrality of ethics which we are fortunate to realize is a myth. We are so fortunate that our Lord has given us a guide to ethics in His Scriptures. He has blessed us with an amazing capacity to use our brains in understanding His principles in living and changing this world. We must understand the infinite complexity of His creation, how it at times goes astray due to the sin in this now imperfect world, and what and how we can use our knowledge to do good to His glory, not ours. If we keep our sights set on His way and act as we perceive His will, then we will hear, ‘Well done, good and faithful servant’” (Matthew 25:23, NIV 1984).

CMDA Ethics Statement: Eugenics and Enhancement
History of Eugenics

Trafficking in the USA hits close to home

Excerpted from "Sex trafficking in the USA hits close to home," U.S.A. Today, by Yamiche Alcindor. September 27, 2012--Asia Graves looks straight ahead as she calmly recalls the night a man paid $200 on a Boston street to have sex with her. She was 16, homeless, and desperate for food, shelter and stability. He was the first of dozens of men who would buy her thin cashew-colored body from a human trafficker who exploited her vulnerabilities and made her a prisoner for years. "If we didn't call him daddy, he would slap us, beat us, choke us," said Graves, 24, of the man who organized the deals. "It's about love and thinking you're part of a family and a team. I couldn't leave because I thought he would kill me."

By day, she was a school girl who saw her family occasionally. At night, she became a slave to men who said they loved her and convinced her to trade her beauty for quick cash that they pocketed. Sold from Boston to Miami and back, Graves was one of thousands of young girls sexually exploited across the United States, often in plain sight. A plague more commonly associated with other countries has been taking young victims in the United States, one by one. Though the scope of the problem remains uncertain -- no national statistics for the number of U.S. victims exist -- the National Center for Missing and Exploited Children says at least 100,000 children across the country are trafficked each year.

Globally, the International Labor Organization estimates that about 20.9 million people are trafficked and that 22 percent of them are victims of forced sexual exploitation. The growing number of human trafficking cases handled by U.S. Attorney MacBride's office -- 14 in the last 18 months -- reflects the domestic trend, experts say. The familiar echo of these crimes reaches the other side of the country, too, says Alessandra Serano, an Assistant United States Attorney for the Southern District of California. "You can sell drugs once," she said. "You can sell a girl thousands of times."

Since 2006, the U.S. Department of Education has focused on the problem and worked on training with several schools, said Eve Birge, who works for the agency's Office of Safe and Healthy Students. In doing so, they collaborate with the White House, the FBI, the Departments of State and Justice as well as other agencies. "For a lot of these kids, school can be the only safe place they have," Birge said. Click here to read full article.

CMDA Member and Founder of Gracehaven, Jeff Barrows, DO: “When the average person hears the words ‘human trafficking,’ they first of all think of women and girls being sold for sex in other countries like Thailand or Cambodia. Most individuals don’t realize that trafficking is happening right here in the United States in every major city. The most common form of trafficking in the U.S. is child sex trafficking of minors under the age of 18. The story of Asia in this article is being repeated all across the United States in every state! Like Asia, most of these victims come out of abusive/neglected homes.

“While it is good that President Obama recently drew attention to this horrible plague, the announced $6 million grant program is hardly enough to have a significant impact on the tremendous need for specialized services. Currently there are less than 200 specialized beds for 100,000 victims of child sex trafficking. Physicians and dentists have a major role in identifying these victims while they are being trafficked. Some important identifiers mentioned in the article are:

• Signs of physical abuse
• Truancy
• Homeless youth
• Sudden ability to possess expensive items
• Older boyfriends or girlfriends
• Frequent travel

“In addition, physicians and dentists are needed to provide the medical and dental care these victims need after they are freed. CMDA has a Trafficking in Persons Task Force that is developing a 11-part human trafficking training curriculum that provides continuing education credit and can be found online here."

Human Trafficking Resource Page
Human Trafficking Continuing Education
Human Trafficking - Trade of Innocents Trailer

HHS mandate bypasses parents on contraceptives for children

Excerpted from "HHS mandate allows minors free contraception, sterilization," Catholic News Agency, Sep 25, 2012--Minor children on their parents’ health care plans will have free coverage of sterilization and contraception, including abortion-causing drugs, under the controversial HHS mandate – and depending on the state, they can obtain access without parental consent.

Matt Bowman, senior counsel for the religious liberty legal group Alliance Defending Freedom, said the mandate “tramples parental rights” because it requires them to “pay for and sponsor coverage of abortifacients, sterilization, contraception and education in favor of the same for their own children.”

The Department of Health and Human Services ruled in January 2012 that most employers who have 50 or more employees must provide the coverage as “preventive care” for “all women with reproductive capacity.” The mandate also requires the coverage for beneficiaries, including minors, on the affected health plans, Bowman told CNA Sept. 20. That means that a minor on her parents’ plan could be sterilized if she finds a doctor willing to perform the procedure.

“She can be sterilized at no cost,” Bowman stated. “Whether her parents will know and/or consent might differ by state. But the Guttmacher Institute and other abortion advocates explicitly advocated for this mandated coverage of minors so that access without parental involvement might be able to increase.”
The Guttmacher Institute, in a Sept. 1 briefing on state policies, said that an increase in minors’ access to reproductive health care over the last 30 years shows a broader recognition that “while parental involvement in minors’ health care decisions is desirable, many minors will not avail themselves of important services if they are forced to involve their parents.” The institute, the former research arm of abortion provider Planned Parenthood, said that 26 states and the District of Columbia allow all minors 12 years and older to consent to contraceptive services. At least one state, Oregon, allows 15-year-olds to consent to sterilization.

There are presently 30 lawsuits challenging the HHS mandate in federal court on religious freedom grounds.

Commentary

CMDA Executive Vice President Gene Rudd, MD: “'Beware of Greeks bearing gifts.'
"Sadly, in today’s society, we as parents have to warn our children to avoid adults who try to lure them into doing things that might be dangerous, even deadly. Stereotypically, it is the shady character on the street corner who invites your child to pet his dog or enjoy his candy.

"But what do we do when it is the government or an agency operating with government funds doing this? They also have an agenda, and they wish to entreat our children to take part in that agenda even when we as parents do not approve. And worse, our laws have morphed to make it legal! Yes, there are some differences between their agenda and that of a pedophile, but the outcomes can be just as destructive to the wellbeing of the child and the family.

"So now we must warn our children that adults serving in public positions, those with an element of authority over their lives, might also lure them into behavior contrary to their moral training and dangerous to their health. And as a more definitive step, we must take steps to reverse this social engineering.

"I realize there is an argument to be made for providing care for children in exceptional circumstances, but allowance for the exception has become the rule for all. We must now require our government leaders to scrap the onerous rule that allows for this (included in the Affordable Care Act) and replace it with healthcare reforms that do not undermine the family."

Top Federal Health Slots Eyed for New Administration

Excerpted from "Romney Team Preps to Fill a Cabinet," The Wall Street Journal, September 11, 2012--Mitt Romney's presidential transition team, stocked with veterans of the George W. Bush administration, is studying personnel and policy moves that would prepare Mr. Romney to reorder federal spending and quickly propose a budget, should he win the White House. President Barack Obama's preparations are less cumbersome. But he would likely see significant turnover if he wins a second term, including the planned departures of Secretary of State Hillary Clinton and Treasury Secretary Timothy Geithner.

The transition team is looking at the Department of Health and Human Services with an eye toward fulfilling Mr. Romney's promise to repeal the president's healthcare law.

Mike Leavitt, the former Utah governor who is overseeing the Romney transition team, briefed campaign donors on the planning process during the GOP convention in Tampa. Participants said his description was reminiscent of a corporate takeover. Mr. Leavitt served under Mr. Bush as head of the Environmental Protection Agency and secretary of the Department of Health and Human Services. Also shepherding the group is Jamie Burke, a former White House liaison to Health and Human Services.

Editor's note: As a nonpartisan organization, CMDA does not endorse any political candidate or party and has worked with administrations of both parties on many issues. As a pro-life organization, we naturally find increased invitations and opportunities for our members to serve at the federal level during administrations that share this conviction.

Commentary

CMA VP for Government Relations Jonathan Imbody: "The CMA Freedom2Care Federal Registry provides an avenue for you to explore health-related opportunities for federal service, including top-level slots that would open in a new administration. Our contacts with key leaders can help get your CV in front of decision-makers. Examples of top health-related positions include:

• Secretary - Dept. Health and Human Services (HHS)
• Assistant Secretary for Health - HHS (ASH)
• Director, Centers for Disease Control and Prevention
• Commissioner, U.S. Food and Drug Administration (FDA)
• Surgeon General
• Administrator, Health Resources Services Administration (HRSA)
• Director, National Institutes of Health (NIH)
• Director, HHS Office of Global Affairs
• Assistant Secretary, Administration for Children and Families (ACF)
• Administrator, Centers for Medicare and Medicaid Services (CMS)
• Administrator, Substance Abuse and Mental Health Services Administration (SAMHSA)
• Director, Indian Health Services
• Director, Agency for Healthcare Research and Quality (AHRQ)
• Director, Agency for Toxic Substances and Disease Registry (ATSDR)
• Inspector General HHS

"The above top slots typically require proven experience working with large budgets and staff, consistency with the president's policy objectives and a tough skin. Besides these positions, numerous positions in health agencies and the White House offer opportunities for qualified medical professionals. Senior Executive Service (SES) positions serve just below the top Presidential appointees, do not require Senate confirmation and in 2012 garnered salaries ranging from $119,554 to $179,700.

Two other opportunities: CMA works with administration officials to advance candidates for health-related federal commissions, and members of Congress contact the CMA Washington office for background counsel or expert testimony from medical professionals."
Action

1. To advance your consideration for a federal health position, send your CV to the CMA Washington office at cma@netscape.com.
2. Complete the Freedom2Care federal service survey to indicate your experience and interests.
3. Join the Freedom2Care group on LinkedIn to receive updates on opportunities for landing federal jobs, serving on commissions and providing counsel to Congress.

Court protects pharmacists' conscience rights

Excerpted from "Illinois cannot make pharmacists give 'morning after' pill: court," Reuters, Sep. 21, 2012--An Illinois appellate court Friday affirmed a lower court finding that the state cannot force pharmacies and pharmacists to sell emergency contraceptives - also known as "morning after pills" - if they have religious objections. In 2005, former Illinois Gov. Rod Blagojevich mandated that all pharmacists and pharmacies sell "Plan B," the brand name for a drug designed to prevent pregnancy following unprotected sex or a known or suspected contraceptive failure if taken within 72 hours.

Some anti-abortion advocates object to the drugs, which work by preventing the release of an egg, preventing fertilization or stopping a fertilized egg from attaching to the uterus. In 2011, an Illinois judge entered an injunction against the rule, finding no evidence that the drugs had ever been denied on religious grounds, and that the law was not neutral since it was designed to target religious objectors.

The Illinois appellate court agreed that the Illinois Health Care Right of Conscience Act protects pharmacists' decision not to dispense the contraceptives due to their beliefs. "This decision is a great victory for religious freedom," said Mark Rienzi, senior counsel for the Becket Fund, quoted in a statement about the decision. The American Civil Liberties Union of Illinois, which had filed an amicus brief on behalf of the state, expressed dismay at the court's decision.

Commentary

CMA Vice President for Government Relations Jonathan Imbody: "Pro-life legal groups represented the Christian Medical Association in two amici curiae (friend of the court) briefs in this case. Our briefs, written by the Christian Legal Society (CLS) and Americans United for Life (AUL), argued the following:

"CLS brief: The government is prohibited from coercing health care workers to provide health care services that violate their religious beliefs. The rule violates plaintiffs' rights under the Illinois Religious Freedom Restoration Act. The rule substantially burdens the plaintiffs' free exercise of religion and is not narrowly tailored to advance the government's purported interest. The circuit court properly held that the rule is not narrowly tailored; nor is it the least restrictive means of achieving its interest.

"AUL brief: There is no 'problem' of access to 'emergency contraception.' The potential post-fertilization effect of 'emergency contraception' is objectionable to a large number of health care providers and provides ground for the right to object to its provision. The Right of Conscience is guaranteed under the Illinois Healthcare Right of Conscience Act and the Illinois Religious Freedom Restoration Act. The Right of Conscience is a historical right supported by the First Amendment.

"Thankfully in this case, the court recognized that the government of Illinois overreached in asserting its power over the religious liberty interests of pharmacists. Now we need a similar handcuffing of the federal government, which under the new health care reform law has wrongly asserted a coercive contraceptives and sterilization mandate over the religious liberty interests of faith-based nonprofits, educational institutions and other ministries. Next month CMA will be submitting amicus briefs in two consolidated cases--Belmont Abbey College v. Sebelius and Wheaton College v. Sebelius--in the D.C. Circuit Court of Appeals, to protect religious liberties and conscience rights from the Obamacare contraceptives and sterilization mandate. Pray for justice to prevail."

Is Prostitution Harmful?

Is prostitution harmful?," Journal Medical Ethics, by Ole Martin Moen, Professor of Philosophy at U. of Oslo, Norway. August 28, 2012--A common argument against prostitution states that selling sex is harmful because it involves selling something deeply personal and emotional. More and more of us, however, believe that sexual encounters need not be deeply personal and emotional in order to be acceptable—we believe in the acceptability of casual sex. In this paper I argue that if casual sex is acceptable, then we have few or no reasons to reject prostitution. I do so by first examining nine influential arguments to the contrary. These arguments purport to pin down the alleged additional harm brought about by prostitution (compared to just casual sex) by appealing to various aspects of its practice, such as its psychology, physiology, economics and social meaning. For each argument I explain why it is unconvincing. I then weight the costs against the benefits of prostitution, and argue that, in sum, prostitution is no more harmful than a long line of occupations that we commonly accept without hesitation.

Commentary

CMA VP for Government Relations, Jonathan Imbody: "For the wrath of God is revealed from heaven against all ungodliness and unrighteousness of men who suppress the truth in unrighteousness…. [T] hey became futile in their speculations, and their foolish heart was darkened. Professing to be wise, they became fools…" Romans 1:18, 21, 22 (NASB)

"In "The God Who is There, Francis Schaeffer traces the fallacies of modern philosophers, such as this author, for "defining terms without dealing with meaning and purpose." They reject the biblical notion of the knowable reality of God, revelation and absolute truth in favor of their own opinions. Philosopher professor Ole Martin Moen, the author of this article, asserts that "sex need not always be romantically significant in order to be permissible" (emphasis added). What does he mean, permissible? Morally? On what grounds, since he denies absolute truth and morality?

"Moen suggests that the harms of prostitution may not be inherent but simply the result of stigma and laws prohibiting prostitution. He cites past stigma against homosexuality as a parallel, arguing that "statistics [on disease and other harms experienced by homosexuals] were insufficient to establish that there was anything harmful inherent in being a homosexual or in engaging in homosexual practice." Certainly stigma can inhibit testing for the AIDS virus, but to suggest that physical harms such as contracting disease are not an inherent risk of sexual behavior outside marriage is quite a stretch. "Moen argues that "prostitution--though, like most occupations, it has its downsides--is not harmful either."

"This Portrait of Exploitation timeline photo of prostituted women visually drives home the results of prostitution. Few if any physicians, who daily see real prostituted patients who have been violently and sometimes lethally harmed by real diseases and abuse, would condone prostitution. Nor would parents who have lost their children to prostitution."

Christian Doctor's Digest interview with Dr. Bill and Laurie Bolthouse

Trade of Innocents Story

CMDA Human Trafficking Resource Pages

Human Trafficking Continuing Education Credits

Are doctors burned out?

Is your doctor burned out?," CNN, by Alexandra Sifferlin. August 28, 2012--Job burnout can strike workers in nearly any field, but a new study finds that doctors are at special risk. Nearly 1 in 2 U.S. physicians report at least one symptom of burnout, with doctors at the front line of care particularly vulnerable, the study found -- a significantly higher rate than among the general working population. Overtaxed doctors are not only at risk for personal problems, like relationship issues and alcohol misuse, but their job-related fatigue can also erode professionalism, compromise quality of care, increase medical errors and encourage early retirement -- a potentially critical problem as an aging population demands more medical care.

Led by researchers from the Mayo Clinic and the American Medical Association, the study asked participating physicians to fill out a questionnaire asking about their feelings of burnout -- including "emotional exhaustion" or losing enthusiasm for their work; feelings of cynicism or "depersonalization"; and a low sense of personal accomplishment. The 22-item questionnaire, called the Maslach Burnout Inventory (MBI), is considered the gold standard for measuring burnout; the doctors also completed a shorter, modified version of the MBI, the answers to which researchers used to compare with the general population. Researchers also asked doctors how long they worked each week, how satisfied they were with their work-life balance, and whether they had any symptoms of depression or thoughts of suicide.

The data showed that rates of burnout were high: 45.8 percent of doctors experienced at least one symptom of work-related burnout. "Our finding is concerning given the extensive literature linking burnout to medical errors and lower quality of care," says study author Dr. Tait Shanafelt of the Mayo Clinic. "Most previous studies of physicians from individual specialties have suggested a burnout rate of 30 percent to 40 percent. Thus, the prevalence of burnout among physicians appears to be higher than in the past." In addition, while higher levels of education were associated with less risk of burnout for people in other professions, doctors' advanced degrees didn't afford them the same protection from job-related stress. "While individuals in other professions do experience burnout, it seems to be largely driven by the hours," says Shanafelt. "In addition to their high work hours, there appears to be factors related to the nature of the work that increase the risk for physicians." "Unfortunately, little evidence exists about how to address this problem," the authors write, urging additional research to figure out what can be done to support doctors at the individual, organizational and societal level. "Policy makers and health care organizations must address the problem of physician burnout for the sake of physicians and their patients." Full story can be found here.

Commentary

CMDA Member and Chair of Women in Medicine & Denistry, Leslie Walker, MD: "This important but distressing study on burnout shows the first large sample of U.S. physicians across specialties compared to the general population. The results of the study show that levels of depression (on a two-question online screen) and suicidal ideation were similar to the general population, but that rates of burnout were significantly higher among physicians. "Burnout or depression can occur when we have limited autonomy but high levels of responsibility, especially in unpredictable and punitive systems. Medical internship is one of the best examples, and previous studies linked medical errors by residents to high levels of burnout and depression. In the past, doctors expected more autonomy after residency, along with increasing levels of responsibility, respect from patients and more control over schedules to balance work and personal activities, all of which reduce the risk of burnout. But that’s not necessarily the case today.

"'Treatment' for burnout typically involves taking a break, contemplating one's goals and considering whether the schedule or the type of work should be changed. While I do see physicians who take the time to do this, most burned-out doctors just keep working. The authors suggest reducing burnout may require changing the entire U.S. medical system. However, current suggestions for change are likely to increase burnout. Successful practice is increasingly based not on clinical expertise but on 'outcomes' that have less to do with a doctor's skills and more to do with monitored data in computers.

"Vibrant faith in Christ does not universally prevent burnout, but it does remind us that our identity and worth as God's children have nothing to do with how well we've met a series of benchmarks. As Christians, we gain strength from the body of Christ. If you dread going to work or see patients as just a means to a paycheck, take a break to engage with one of CMDA’s resources such as the Completing Your Call program or Grasping Power through Surrender retreats for women physicians and dentists. Join a local CMDA group where you can pray with like-minded colleagues and consider what changes might help you find joy again in the work God called you to do. This community is one of the best weapons against burnout. It serves as a reminder that you are not alone."

Completing Your Call Symposium
CMDA's Resident Community
Standards4Life: Faith and Health

Thoughts on the Upcoming Elections

Excerpted from "Thoughts on the Upcoming Election," The Chuck Colson Center, by Dr. Timothy George. August 27, 2012--Earlier this year, in the midst of the presidential primary season, I was asked to address a group of Southern Baptist pastors on the question of Christian faith and political engagement. Though no one knew for sure who the candidates would be at that time, the first question I was asked was, “How should an evangelical Christian decide who to support in this election?” That was a legitimate question, and has prompted me to think of some wider implications.

1. We should be grateful to live in a representative democracy where the right to vote and the rule of law are respected. Vote!
   
2. The American republic was founded on a clear distinction between church and state, as the First Amendment shows, but this has never meant the separation of faith from public life. What we believe about ultimate matters has a direct bearing on how we deal with issues of everyday life. Distinguish!
   
3. In the Manhattan Declaration, Chuck Colson, Robert George and I (Dr. Timothy George) made a public argument, based on biblical wisdom and the right use of reason, that the three most pressing moral issues of our time are the sanctity of every human life from conception to natural death, marriage as a lifelong covenantal union of one man and one woman and religious freedom for all persons. Of course, there are other issues that also call for Christian engagement: racial reconciliation, care of creation, immigration, education, care for the poor and sex trafficking, among many others. But today, life, marriage and freedom are threshold issues that provide a basis for our concern about many other things. They are also the issues most under assault at this moment in our culture. Discern!
   
4. There is a difference between Christian discernment and partisan politics. The Kingdom of Christ cannot be equated with any political party. Examine!

Regardless of who wins the election in November, the spiritual and moral issues that ought to inform our political acts will remain on the agenda. In seeking to make a wise decision based on a rightly informed conscience, we need to listen to God’s voice in the Scriptures, learn as much as we can about the candidates and what they stand for, and turn to God in prayer. These words spoken by God to the people of Israel long ago are still pertinent today: “If my people, my God-defined people, respond by humbling themselves, praying, seeking my presence, and turning their backs on their wicked lives, I’ll be there ready for you: I’ll listen from heaven, forgive their sins, and restore their land to health” (2 Chronicles 7:14, MSG). Pray! Click here to read full article.

Commentary

CMDA CEO David Stevens, MD, MA (Ethics): "The most astute thing I can say to Timothy George’s piece is, ‘Amen,’ though I would like to expand upon one comment. Dr. George comments that we should each ‘learn as much as we can about the candidates.’ What should we learn?

“While getting my evening exercise the other night, I listened to the Your Move iTunes podcast of Andy Stanley’s August 19th sermon in his series ‘Recovery Road.’ He hit the nail on the head as he related the story of Nehemiah rebuilding the walls for Jerusalem. Nehemiah not only used his own funds to pay the debts of downtrodden Jews so they could focus on building the wall, but he also faced down the local wealthy Jews who endeavored to loan the poor even more money knowing that Nehemiah would cover their debts. Nehemiah called a meeting to confront them and they all backed down, swearing to never charge interest to another Jew. Why? Because Nehemiah didn't just talk the talk, he walked the walk. Though the Persian king made him governor, he did not levy taxes or enrich himself from the powerful position he held for more than 10 years.
“What did Nehemiah have? He had incredible integrity in every aspect of his life which gave him moral authority as a leader. He was trustworthy.
“Personal integrity does matter, especially for those in politically powerful positions. If a candidate for any office does not have personal integrity, we shouldn't vote for him or her. If they aren't generous with their own money in taking care of the poor, how can we trust them to spend our money wisely to take care of the disadvantaged? If they don't manage their own funds well, how can they wisely manage our tax money? If they are dishonest in their speech, how we can trust that they are telling us the truth? If they are unfaithful to their spouse, how can we believe they will keep the promises they make to us? If they devalue a helpless unborn life, how can they truly value our lives and liberties?
“It makes little difference whether a candidate is a Democrat, Republican, Libertarian or Tea Party candidate. If they have integrity, they are going to be able to honestly and faithfully work with others in government to deal with the huge problems we have in this country. What we need to learn about each candidate is not whether they are the member of the party we favor but simply this, ‘Are they a Nehemiah?’"

GOP platform addresses abortion and marriage

Excerpted from "GOP OKs platform barring abortions, gay marriage," CBS News, August 29, 2012--Republicans emphatically approved a toughly worded party platform at their national convention Tuesday that would ban all abortions and gay marriages, reshape Medicare into a voucher-like program and cut taxes to energize the economy and create jobs.


The platform affirms the rights of states and the federal government not to recognize same-sex marriage. It backs a constitutional amendment defining marriage as the union of one man and one woman.

The party states that "the unborn child has a fundamental individual right to life which cannot be infringed." It opposes using public revenues to promote or perform abortion or to fund organizations that perform or advocate abortions. It says the party will not fund or subsidize healthcare that includes abortion coverage.

Editor's note: CMDA, which takes no position on political candidates, has signed onto letters to both political party platform committees urging platform planks that encourage respect for conscience rights and religious liberty.


CMDA Executive Vice President Gene Rudd, MD: “As the editorial note above states, CMDA is non partisan. Though we are sometimes accused of taking sides when we advocate a particular issue, we do not think or intentionally act in ways that advance a candidate or party.


“However, while we do not support candidates or parties, we are delighted when candidates or parties support our positions. Such is the case with these party planks on abortion and same-sex marriage. CMDA holds that humans are made in the image of God, sacred from their earliest beginnings and deserving of our protection. CMDA also holds that homosexual behavior and same-sex marriage are outside God’s design for us. We can also cite the negative health and social implications of failing to heed God’s command.

“Would that all parties and candidates hold these positions. To that end, CMDA continues to be a voice for our members to our culture, particularly to our leaders. May God grant us favor.”

CMDA Ethics Statement: Human Sexuality
CMDA Ethics Statement: Homosexuality
CMDA Ethics Statement: Abortion

Global Fund fights AIDS, TB and malaria while reforming itself

Excerpted from "Nigeria: Nation Receives U.S. $225 Million Grant for HIV, TB, Malaria," AllAfrica, August 26, 2012-- The Minister of Health, Professor Onyebuchi Chukwu in Abuja, on behalf of the federal government received $225 million from the Global Fund to fight the three pandemic diseases: HIV/AIDS, tuberculosis and malaria.


Global Fund is an international financing institution dedicated to attracting and disbursing resources to tackle these diseases. "The special thing about these grants we are signing today is that the Global Fund board, to my knowledge, for the first time approved the full funding amount available which allows us to include an additional $50 million for bed nets, upon further funding commitments by the government of Nigeria."

The health minister said data from the country's 2010 malaria indicator survey show that Nigeria is working hard on the new initiatives on controlling and eliminating malaria.

He stated, "This money coming in is going to contribute significantly to the total funding of malaria elimination program in Nigeria. The proposal as approved by the Global Fund...should be implemented with all due diligence. Nigerians should look forward to significantly reducing the burden of malaria before 2015."


CMA VP for Government Relations, Jonathan Imbody: "The United States has provided the lion's share of funding for the internationally managed Global Fund, to the consternation of many in the faith-based medical and relief communities, who point out that precious little of that money has ended up in the hands of faith-based health groups overseas.


"I recently met privately with the Global Fund's new General Manager, Gabriel Jaramillo, for a candid conversation about this problem. I noted that the World Health Organization released a report revealing that between 30 and 70 percent of the health infrastructure in Africa is currently owned by faith-based organizations. The Gallup World Poll asked sub-Saharan Africans in 19 countries about their confidence in eight social and political institutions. Overall across the continent, they were most likely to say they were confident in the religious organizations (76 percent) in their countries. Yet less than five percent of Global Fund grants ever reach faith-based health organizations.

"We discussed potential reforms including more active oversight by the Global Fund of what goes on at the country level. Based on experience with discrimination against faith-based organizations in U.S. government agency grants for AIDS work, I noted the benefit of previewing grant opportunity requirements for anti-faith discrimination issues.

"The Global Fund leadership has embarked on an aggressive program of reform of both personnel and policies. Former U.S. Dept. of Health and Human Services (HHS) Secretary Mike Leavitt, with whom I also met recently to discuss conscience rights and religious liberty issues, has led a commission that has provided the Global Fund with recommendations to transform the organization, including reforms related to transparency, accountability and communication."

Resources
Learn more about the Global Fund at www.theglobalfund.org/en/
ACTION
Share your opinion on how to reform the Global Fund by sending an email to: BetterGrants@theglobalfund.org
To help with tracking, include:

1. Your name and institution
2. Your Global Fund constituency and home country
3. Any current or past involvement with the Global Fund (for example, as member of a CCM, recipient or sub-recipient of a grant)
4. The name, date and location of the consultation session

CMDA Ethics Statement: AIDS

Administration pushes HHS lawsuits beyond election

Excerpted from "Wheaton HHS lawsuit dismissed," World magazine, July 12, 2012-- A last minute policy change absolving a Christian college from fines has enabled the federal government to avoid another legal challenge to its mandate for contraception coverage. On Friday, a federal judge in Washington D.C. dismissed a suit brought by Wheaton College against the government. The judge ruled the evangelical school in Illinois no longer had grounds to challenge the requirement that it cover contraceptive and abortifacient drugs under student and faculty health insurance policies.

As part of the 2010 healthcare reforms, the U.S. Department of Health and Human Services (HHS) announced last year that all employers would be required to cover contraceptive and abortifacient drugs. The rules offered an exemption to churches but not other religious employers, including schools and social service agencies. The mandate caused an uproar among Catholic and evangelical Protestant institutions, which vowed to fight the new rules. In an effort to delay the confrontation, the government offered religious employers a one-year reprieve, giving them until August 2013 to comply.

But Wheaton could not take advantage of the yearlong "safe harbor" because it had unknowingly offered coverage for abortifacient drugs Ella and Plan B, commonly referred to as "morning after" pills, under previous insurance policies. Without the reprieve, Wheaton faced thousands of dollars in fines every day. But with the latest policy change, the government succeeded in postponing Wheaton's suit for at least a year.
"The government has now re-written the 'safe harbor' guidelines three times in seven months, and is evidently in no hurry to defend the HHS mandate in open court," said Kyle Duncan, general counsel for the Becket Fund for Religious Liberty, which represents Wheaton. "By moving the goalposts yet again, the government managed to get Wheaton's lawsuit dismissed on purely technical grounds. This leaves unresolved the question of religious liberty at the heart of the lawsuit."

CMDA CEO David Stevens, MD, MA (Ethics): "Trampling on right of conscience and religious liberty does not play well in the news in an election year, so I’m not surprised that the government kicked the ball down the field. Unfortunately, there has been no reversal in the government's core belief that religion is a private matter to be relegated behind the walls of churches, synagogues and mosques. The administration's position in this mandate and in other policies and court cases betray an ideology that would leave religion no place in the public square. History reminds us what happens when an individual's responsibility to the State is made to trump responsibility to God.

"It is critical to understand that the contraceptive mandate is not the big issue. The greatest danger is that if the new, exceedingly narrow definition of who qualifies as 'religious enough' to conscientiously object, enshrined for the first time in this regulation, is not completely excised it will metastasize throughout all levels of government. We will then have completely lost our 'freedom of religion' and replaced this most basic of all rights with merely an anemic 'freedom to worship.' That will have a greater impact than when the courts radically redefined the meaning of the Establishment Clause to an absolute 'separation of church and state' and began to push religion out of virtually every publicly funded institution and arena.

"We dare not let this new definition stand. Our forefathers fought and died to give us our religious freedom. Like them, we must summon our boldness and courage to resist this tyranny, lest future generations consider us at best foolish and at worst cowards."

Resources
Visit CMA's Freedom2Care website, which provides daily news updates, legislative resources, background documents on conscience rights and religious freedom and action items including petitions to government officials.

CMDA Ethics Statment: Right of Conscience
Right of Conscience Resource Page

Berating, Belittling and Behaving Badly

Excerpted from "The Bullying Culture of Medical School ," New York Times, by Pauline W. Chen, MD August 9, 2012--For 30 years, medical educators have known that becoming a doctor requires more than an endless array of standardized exams, long hours on the wards and years spent in training. For many medical students, verbal and physical harassment and intimidation are part of the exhausting process too. It was a pediatrician, a pioneer in work with abused children, who first noted the problem. And early studies found that abuse of medical students was most pronounced in the third year of medical school, when students began working one on one or in small teams with senior physicians and residents in the hospital.

The first surveys found that as many as 85 percent of students felt they had been abused during their third year. They described mistreatment that ranged from being yelled at and told they were "worthless" or "the stupidest medical student," to being threatened with bad grades or a ruined career and even getting hit, pushed or made the target of a thrown medical tool. Nonetheless, many of these researchers believed that such mistreatment could be eliminated, or at least significantly mitigated, if each medical school acknowledged the behavior, then created institutional anti-harassment policies, grievance committees and educational, training and counseling programs to break the abuse cycle. One medical school became a leader in adopting such changes. Starting in 1995, educators at the David Geffen School of Medicine at the University of California, Los Angeles, began instituting a series of school wide reforms. They adopted policies to reduce abuse and promote prevention; established a Gender and Power Abuse Committee; mandated lectures, workshops and training sessions for students, residents and faculty members; and created an office to accept confidential reports, investigate and then address allegations of mistreatment. To gauge the effectiveness of these initiatives, the school also began asking all students at the end of their third year to complete a five-question survey on whether they felt they had been mistreated over the course of the year. The school has just published the sobering results of the surveys over the last 13 years. While there appears to have been a slight drop in the numbers of students who report experiencing mistreatment, more than half of all medical students still said that they had been intimidated or physically or verbally harassed.

While their findings are disheartening, Joyce M. Fried, lead author of the paper and assistant dean and chairwoman of the Gender and Power Abuse Committee at the medical school and her colleagues continue to believe that medical student mistreatment can be significantly reduced - but only if all medical schools come together to work on the issue. "We're talking about the really hard task of changing a culture, and that has to be done on a national level," Ms. Fried said. Such an effort would include shared training programs, common policies regarding mistreatment and greater transparency about the mistreatment that currently exists in medical schools. Full story can be found here.

CMDA’s National Director of Campus & Community Ministries J. Scott Ries, MD: "They called him 'Mad-Dog Madden' (last name changed to protect the guilty, but the moniker is sadly accurate) and I was fortunate enough to be assigned to his 'A-team' surgery rotation as a brand new, first-month-on-the-wards third year medical student. Mad-Dog was indeed a talented, respected and experienced surgeon. However, he was infamous for chewing up and spitting out students and residents faster than yesterday’s rawhide bone.

"One of my first OR experiences witnessed Mad-Dog berating a PGY-2 resident so badly (including dangerously throwing instruments around the OR) that the resident decided to drop out of his surgical residency altogether, even though he had 'made the cut' from his intern year to a resident. I believe he is a radiologist now.

"Though I escaped Mad-Dog’s rotation without a personal assault myself, many of our students even today are not so fortunate. One of our CMDA students posted last month on Facebook a quote from his attending directed toward him on the first day of his surgery rotation, 'Is that medical student standing in the corner going to actually do something or is he going to continue standing there like a retard?'

"I certainly would agree with Dr. Chen that this mistreatment of learners should be curtailed. But in what ways can we as followers of Christ personally help mitigate the decades-old belittling traditions? Here are three things for us to individually consider, whether we are in an academic center or a community practice.

1. Self-check. Do I have a tendency toward critical comments of my staff, colleagues…and especially students and residents when they fall short of my expectations? Are my responses generally flavored by harsh criticism or by the fruit of the Spirit? (Galatians 5:22-23)
   
   
2. Affirm others. Most all of us learn best when instructed in a gracious manner. Do I provide necessary instruction in what went wrong while not letting my student forget what they have done right? Do I affirm while correcting?
   
   
3. Set the standard. The buck stops here. Will I set the tone by how I treat my students and staff? Do I have the moral courage to confront a colleague about their demeaning treatment of others in effort to be a part of the restoration of the standard?

"A seemingly small change of attitude on our part can have a profound impact on many, multiplying a culture of respect and grace over one of fear and bullying. We have a great opportunity to show a better way, regardless of how things were 'when I was a student.'”

Campus Ministries
Life Skills for Students and Residents

Sick Kids to Be Given 'Futile' Treatment?

Excerpted from "Deeply Held Religious Beliefs Prompting Sick Kids to Be Given 'Futile' Treatment," Science Daily, by Andrew Hough. August 13, 2012--Parental hopes of a "miraculous intervention," prompted by deeply held religious beliefs, are leading to very sick children being subjected to futile care and needless suffering, suggests a small study in the Journal of Medical Ethics. The authors, who comprise children's intensive care doctors and a hospital chaplain, emphasize that religious beliefs provide vital support to many parents whose children are seriously ill, as well as to the staff who care for them. But they have become concerned that deeply held beliefs are increasingly leading parents to insist on the continuation of aggressive treatment that ultimately is not in the best interests of the sick child. It is time to review the current ethics and legality of these cases, they say.

They base their conclusions on a review of 203 cases which involved end-of-life decisions over a three year period. In 186 of these cases, agreement was reached between the parents and healthcare professionals about withdrawing aggressive, but ultimately futile, treatment. But in the remaining 17 cases, extended discussions with the medical team and local support had failed to resolve differences of opinion with the parents over the best way to continue to care for the very sick child in question. The parents had insisted on continuing full active medical treatment, while doctors had advocated withdrawing or withholding further intensive care on the basis of the overwhelming medical evidence. The authors emphasize that parental reluctance to allow treatment to be withdrawn is "completely understandable as [they] are defenders of their children's rights, and indeed life." But they argue that when children are too young to be able to actively subscribe to their parents' religious beliefs, a default position in which parental religion is not the determining factor might be more appropriate. They cite Article 3 of the Human Rights Act, which aims to ensure that no one is subjected to torture or inhumane or degrading treatment or punishment. "Spending a lifetime attached to a mechanical ventilator, having every bodily function supervised and sanitized by a care giver or relative, leaving no dignity or privacy to the child and then adult, has been argued as inhumane," they argue.

And they conclude: "We suggest it is time to reconsider current ethical and legal structures and facilitate rapid default access to courts in such situations when the best interests of the child are compromised in expectation of the miraculous." In an accompanying commentary, the journal's editor Professor Julian Savulescu advocates: "Treatment limitation decisions are best made, not in the alleged interests of patients, but on distributive justice grounds." In a publicly funded system with limited resources, these should be given to those whose lives could be saved rather than to those who are very unlikely to survive, he argues. "Faced with the choice between providing an intensive care bed to a [severely brain damaged] child and one who has been at school and was hit by a cricket ball and will return to normal life, we should provide the bed to the child hit by the cricket ball," he writes. In further commentaries, Dr Steve Clarke of the Institute for Science and Ethics maintains that doctors should engage with devout parents on their own terms. "Devout parents, who are hoping for a miracle, may be able to be persuaded, by the lights of their own personal...religious beliefs, that waiting indefinite periods of time for a miracle to occur while a child is suffering, and while scarce medical equipment is being denied to other children, is not the right thing to do," he writes. Leading ethicist Dr Mark Sheehan argues that these ethical dilemmas are not confined to fervent religious belief, and to polarize the issue as medicine versus religion is unproductive, and something of a "red herring." Referring to the title of the paper Charles Foster of the University of Oxford, suggests that the authors have asked the wrong question. "The legal and ethical orthodoxy is that no beliefs, religious or secular, should be allowed to stonewall the best interests of the child," he writes. Full story can be found here.

CMDA CEO David Stevens, MD, MA (Ethics): "The Science Daily significantly toned down their reporting of the article in The Journal of Medical Ethics (the same journal that recently published an article advocating ‘post-birth abortion’, i.e. infanticide). The original paper was so anti-religious and anti-parental rights that it generated newspaper headlines around the world castigating the religious for ‘torturing’ their children.

"The article espouses a stark utilitarian ethic claiming, without supporting data, that other children are denied lifesaving interventions because of these parent’s decisions. They also argue that parent’s religious beliefs should have no sway in the care of their children since the children cannot 'subscribe' to any religious view. Therefore, according to their reasoning, a secularist worldview should guide the state in making life and death decision for severely disabled children.

"All of us have taken care of patients where hope or denial outweighs their reasoning in making healthcare decisions, but there are better alternatives than steamrolling over their religious beliefs, attempting emotional blackmail or denying parental rights. Alternatives include:

• Transfer care to a physician who better understands and is more supportive of the parent’s religious persuasion. Parents are more likely to accept their advice.
• Allow time for parents to work through their denial and time for the healthcare team to build rapport and fully explain their assessment.
• Build trust. Marshall the family’s pastor, priest, rabbi or other religious leader whom the parents already trust. They may help the family work through the decision.

"In reality, the authors demand a new paternalism rather than autonomy. Doctors and ultimately the state would become the final arbitrator over life and health. They dangerously redefine parental beneficence as maleficence. While they claim they are for justice, they single out those with religious beliefs to be stripped of it.

"Sadly, this is another example of having more 'ethicists' than ever before but being less ethical.”

Standards4Life: Faith and Health

Genetically engineering babies

Excerpted from "Genetically engineering 'ethical' babies is a moral obligation, says Oxford professor," The Telegraph. August 16, 2012--Professor Julian Savulescu said that creating so-called designer babies could be considered a "moral obligation" as it makes them grow up into "ethically better children." The expert in practical ethics said that we should actively give parents the choice to screen out personality flaws in their children as it meant they were then less likely to "harm themselves and others". The academic, who is also editor-in-chief of the Journal of Medical Ethics, made his comments in an article in the latest edition of Reader's Digest.

He explained that we are now in the middle of a genetic revolution and that although screening, for all but a few conditions, remains illegal it should be welcomed. He said that science is increasingly discovering that genes have a significant influence on personality – with certain genetic markers in embryo suggesting future characteristics. By screening in and screening out certain genes in the embryos, it should be possible to influence how a child turns out. In the end, he said that "rational design" would help lead to a better, more intelligent and less violent society in the future. So where genetic selection aims to bring out a trait that clearly benefits an individual and society, we should allow parents the choice. To do otherwise is to consign those who come after us to the ball and chain of our squeamishness and irrationality. Indeed, when it comes to screening out personality flaws, such as potential alcoholism, psychopathy and disposition to violence, you could argue that people have a moral obligation to select ethically better children.

Rational design is just a natural extension of this, he said. He said that unlike the eugenics movements, which fell out of favor when it was adopted by the Nazis, the system would be voluntary and allow parents to choose the characteristics of their children. "We’re routinely screening embryos and fetuses for conditions such as cystic fibrosis and Down’s syndrome, and there’s little public outcry," he said. "What’s more, few people protested at the decisions in the mid- 2000s to allow couples to test embryos for inherited bowel and breast cancer genes, and this pushes us a lot close to creating designer humans." Whether we like it or not, the future of humanity is in our hands now. Rather than fearing genetics, we should embrace it. We can do better than chance. Click here to read full story.

CMDA Member, Moral Revolution Board member and “Ask the Doc” blogger Andre' Van Mol, MD: "Eugenics/master races are false promises that consistently lead to cruelty. Genes determine predisposition, not destiny. Heritability is not inevitability. Genotype is not fixed to a single phenotype. Genetic contributions to behavior are best categorized as small by those who deal in this field.¹ The professor’s premise is replete with logical fallacies and misunderstanding of behavioral genetics, yet he is willing to 'screen out' pre-born children based on it. Notice, 'screen out,' not treat. Eugenics usually means genocide.

"So what happens when the currently or allegedly 'undesirable' genes turn out later to have had some considerable 'up' side, even a group survival advantage? Bummer for us. We already abort 90 percent of Down Syndrome children.² Are we kinder and gentler for it? Does compassion spring forth from abolition of imperfection? And what happens when your or my imperfection is next on the chopping block? Second bummer.

"A previous article in the press spoke glowingly of prenatal screening possibilities for 3,500 problems.³ Notice once again, they don't mean screening to treat, but screening to terminate. A Dutch palliative care specialist Dr Ben Zylicz noted that once you allow physician-assisted suicide/euthanasia, you eliminate the motivation to solve difficult problems, and then learning stops.⁴ Why bother when the 'problem' is 'solved' for $50 worth of termination medicine? Likewise, selecting out supposedly inferior preborn children won't do much to spur perinatology, neonatology and pediatrics on to greatness in working out difficult problems. This is the road to nowhere."
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1. Dar-Nimrod, I., & Heine, S.J. (2011b). Some thoughts on essence placeholders, interactionism, and heritability: Reply to Haslam (2011) and Turkheimer (2011). Psychological Bulletin, 137(5), 829-833.
2. Mansfield, C, et al. Termination rates after prenatal diagnosis of Down syndrome, spina bifida, anencephaly, and Turner and Klinefelter syndromes: a systematic literature review.Prenat Diagn. 1999 Sep;19(9):808-12.
3. Adams, A. Unborn babies could be tested for 3,500 genetic faults. www.telegraph.co.uk. 06 Jun 2012.
4. Hugh, M. “Better palliative care could cut euthanasia” Hugh Matthews, BMJ 1998;317:1613 (12 December) News.

A History of Eugenics
Eugenics Through Abortion
CMDA Ethics Statement: Eugenics and Enhancement