CMA advises Supreme Court on embryo-ending drugs

Excerpted from "U.S. Supreme Court Takes Up Healthcare Law Again," AUL blog, Nov. 26, 2013 - “The U.S. Supreme Court again has the chance to defend the constitutional rights of all Americans, in considering the punishing mandates in a landmark, anti-life law,” commented Americans United for Life President and CEO Dr. Charmaine Yoest, on hearing news that the court decided to review two cases challenging Obamacare’s HHS Mandate, Conestoga Wood Specialties v. Sebelius and Sebelius v. Hobby Lobby Stores. “Punishing Americans for their moral objection to life-ending drugs and devices is abhorrently un-American.”

Conestoga Wood Specialties is owned by Christians and operated according to the owners’ Mennonite Christian beliefs. Hobby Lobby is an Oklahoma-based national arts and crafts retailer founded and run by David Green and his family. The Greens attribute God’s grace for Hobby Lobby’s success and over the course of four decades of expansion the Green family’s Christian faith has remained an integral part of the business. Both Conestoga Woods and Hobby Lobby do not oppose all contraception, but those drugs and devices that have been labeled as “contraception” by the FDA although they are known to have life-ending effects.

In our briefs, AUL demonstrates that the life of a new human being begins at fertilization (conception), that so-called “emergency contraception” has a post-fertilization effect that can prevent a new human being from implanting in the uterus, and that forcing employers to provide coverage for such drugs violates their constitutionally protected freedom of conscience.

The briefs were filed on behalf of the Association of American Physicians and Surgeons, American Association of Pro-Life Obstetricians & Gynecologists, Christian Medical Association, Catholic Medical Association, National Catholic Bioethics Center, Physicians for Life and National Association of Pro Life Nurses.

Commentary

CMDA Executive Vice President Gene Rudd, MD– “Some challenge the rights of these business owners because they do not agree with their understanding of the science—that they are protecting early human life. I remember the debate back in the 1970s among those who foresaw the backlash when the public eventually discovered that developing technologies would abort the development of early human life.

“The strategy since has been to diminish our understanding of the continuum of human life. The strategy includes verbal ploys such as ‘blob of tissue’ and ‘pre-embryo,’ all intended to disguise the truth. Has it worked? Yes, some are either deceived or they failed to value and protect life. But not these business owners. They want their business practices to honor life.

“They want to follow the words of Jesus, who said, “My mother and brothers are those who hear God’s word and put it into practice” (Luke 8:21, NIV 2011).

“But the new warning from the government is that you should not expect to have a conviction and also think you can live by it. Our Administration would rather you live by its social agenda.

“Under the guise of promoting healthcare, the Administration seeks to force individuals and their businesses to provide reproductive services which the owners find morally objectionable. Some seek to refuse the owners’ rights because they do not share the same convictions. They would rather abandon 200 years of Constitutionally-protected ‘free exercise,’ forcing these owners to comply with and pay for their social views.

“Will our Supreme Court uphold the rights of these individuals to run their businesses by their convictions? Freedom of religion, freedom to live out your conviction, is at stake.”

Action

Use our Freedom2Care pre-written letters to urge your legislators to support conscience rights and religious freedom in healthcare:

Urge your senators to support conscience rights - S.1204
Urge your Rep. to protect conscience rights - HR 940

Resources
On Embryo-Killing “Contraceptives” from The National Review Online
Endowment for Human Development

CMA lobbies to protect your charity gift tax deduction

Excerpted from "Top senators lobby for charitable deduction," published in The Hill, November 20, 2013 - Two senior tax writers are lobbying to ensure that the charitable deduction remains intact in any tax overhaul. Sens. John Thune (R-S.D.) and Ron Wyden (D-Ore.) say in a new letter that deduction's full value should be kept, to reiterate the government's "long-standing dedication to encouraging private acts of charity and compassion."

"The charitable deduction is unique. It is the only provision that encourages taxpayers to give away a portion of their income for the benefit of others," Thune and Wyden wrote to Senate Finance Committee Chairman Max Baucus (D-Mont.) and the panel's ranking member, Sen. Orrin Hatch (R-Utah).

"For this reason, it is not a loophole, but a lifeline for millions of Americans in need."

Charitable groups have long made a similar argument for leaving the deduction alone in tax reform or deficit reduction efforts. Scrapping the tax break, those groups say, would put a dent in their services, putting more strain on state and local governments that would be forced to make up the difference. President Obama has long called for capping itemized deductions at 28 percent, instead of the top individual rate, currently 39.6 percent.

Commentary

CMA VP for Govt. Relations Jonathan Imbody– “I met with Senators Thune and Wyden some weeks ago to discuss strategies to protect your charitable gift tax deduction and also the idea of sending this letter. Along with colleagues in the non-profit sector, I have been lobbying many lawmakers to help them recognize that the government should not tax you for money you give away to help others.

“Politicians taking aim at eliminating or limiting the charity gift deduction are playing with political fire. Two out of every three Americans (67 percent) oppose reducing or eliminating the charitable tax deduction.ⁱ Some other reasons to keep the charity deduction:

• Any weakening of tax deductions—whether capping the amount you can give or eliminating the deduction if you only give a certain amount—ultimately hurts the people helped by charitable organizations. Experts estimate that changing the charity tax deduction will decrease giving by up to $78 billion.ⁱⁱ
• Cutting charity is not a revenue generator for the government. Any drop-off in charitable giving caused by tinkering with the deduction means the government will have to begin paying for the social services no longer provided by charities.
• One in 10 Americans works for a non-profit, so cutting charity means threatening up to 13.5 million jobs.ⁱⁱⁱ

“I hope you will take a moment to click on this link and use our easy form to send a pre-written note to your legislators, urging them to protect charity by preserving the charitable gift tax deduction. Thank you.”

ⁱUnited Way Worldwide survey, Nov. 29, 2012. http://www.unitedway.org/press/release/americans-agree-charitable-tax-deduction-vital-to-nonprofits/
ⁱⁱ"Should We End the Tax Deduction for Charitable Donations?" Wall Street Journal, Dec. 14, 2012. http://online.wsj.com/article/SB10001424127887324469304578143351470610998.html
ⁱⁱⁱ "Protecting America’s Strong Tradition of Giving," Charitable Giving Coalition website. http://protectgiving.org/about/charitable-giving-coalition/

Resources

Tax reform drive threatens deductions and charity
CMA lobbies senators to protect charitable gift tax deduction

Action
Use our Freedom2Care pre-written message to tell your legislators to preserve the charity tax deduction.

Bill would ban discrimination for marriage convictions

Excerpted from "Archbishop: DOMA ruling, ENDA passage put marriage at 'critical point,'" Catholic News Agency, Nov. 15, 2013 - The Supreme Court's ruling that rendered the federal Defense of Marriage Act unconstitutional, and the Senate's passage Nov. 7 of the Employment Non-Discrimination Act [ENDA] put the legal defense of marriage "at a critical point in this country," said the archbishop who heads the U.S. bishops' Subcommittee on the Promotion and Defense of Marriage. “The Supreme Court's DOMA decision is now being used to judicially challenge marriage laws in more than a dozen states that still recognize marriage as the union of one man and one woman," said Archbishop Salvatore J. Cordileone of San Francisco.

The effects of ENDA, Archbishop Cordileone said during a Nov. 11 presentation at the U.S. bishops' fall general meeting in Baltimore, "go much further" than preventing employment discrimination on the basis of sexual orientation and gender identity to the point where "ENDA-like laws have contributed to the erosion and redefinition of marriage at the state level."

One remedy, he said, could come in the form of the Marriage and Religious Freedom Act, which would bar the federal government from discriminating against those who "act upon their religiously motivated belief that marriage is the union of one man and one woman, or that sexual relations are properly reserved for such a marriage." The bill's scope would include protection for individuals and organizations, both non-profit and for-profit. Archbishop Cordileone pointed to a case in New Mexico where a unanimous state supreme court ruled that a photo studio must photograph a same-sex commitment ceremony "if they wish to remain in business."

Commentary

Jonathan Imbody, CMA VP for Govt. Relations:When professional photographers lose in court for simply declining to photograph a same-sex marriage, on the basis of conscience, it's not at all hard to imagine physicians losing in court for declining to provide IVF services or abortion counseling or for simply discussing the health risks of sex outside of heterosexual marriage. Physicians will remember that in November 2007, the American College of Obstetricians and Gynecologists moved to minimize conscience rights by stating that regardless of convictions, physicians were required ethically to either perform abortions or refer patients for abortions. The healthcare professionals' conscience protection federal regulation that we helped advance during the Bush administration, in response to the ACOG threat, fell prey to the much more restrictive view of religious liberty of the Obama administration, which gutted the reg.

As demonstrated by the current HHS contraceptive mandate, a move to restrict faith-based organizations' hiring rights through a Supreme Court case (Hosanna-Tabor) and other actions (see www.Freedom2Care.org), the administration frames religious liberty as merely the freedom to believe or to worship--not to live out your faith-based conscience convictions on moral issues like abortion, marriage and medical ethics.

Some see this trend and simply shake their heads and wonder what the world is coming to. Better to stand up and have a say in what the world is coming to. We still live in a democratic republic, so your voice can still make a difference. Please consider taking a moment to complete the simple and quick legislative action step below. Thank you.

Resources

CMA Letter Opposing ENDA
Letter Opposing WA HB 1515

Action

Use our Freedom2Care pre-written form to tell your lawmakers to protect you from discrimination because of your convictions on marriage.

Rise in IVF popularity leaves thousands of babies in limbo

Excerpted from “Rise in IVF popularity leaves thousands of babies in limbo,” World Magazine. October 25, 2013 -- More women are using donated eggs for in vitro fertilization (IVF) and more healthy babies are being born through the process, according to a study released in October. While this is good news, the process also creates more embryos than can be implanted, leaving hundreds of thousands of frozen embryos in fertility clinics. For women with viable eggs who cannot become pregnant, IVF involves extracting their own eggs, fertilizing them and then re-implanting them in the uterus. Women who do not have viable eggs go through a similar IVF process using eggs from other women. The number of women who attempted IVF from another woman’s eggs increased from 10,801 in 2000 to 18,306 in 2010. The percentage of healthy outcomes from donated eggs, defined as a baby born after 37 weeks weighing 5.5 pounds or more, increased from 18.5 percent in 2000 to 24.4 percent in 2010.

The study also found that women are increasingly implanting only one embryo in an IVF cycle. Because doctors are unable to predict with certainty which embryos have the best chance of resulting in a healthy baby, many women implant more than one embryo during an IVF cycle, increasing the odds that at least one of the embryos will survive. However, between 2000 and 2010, the percentage of women who transferred only one embryo, and thereby avoided the possibility of multiple births, increased from less than 1 percent to 15 percent.

However, the process is wrought with ethical controversy, as many clients don’t know what to do with the extra embryos created: An estimated 600,000 frozen embryos are stored in fertility clinics throughout the United States. “The vast majority of people don’t have a plan,” says Daniel Nehrbass, executive director of Nightlight Christian Adoptions, an organization that does embryo adoptions. “They don’t want to destroy them because there is finality to that. So they store them and the years go by.” In the face of many grey ethical issues, including the question of whether couples should pursue IVF at all, Nehrbass said NightLight sees two things as black and white: “Embryos are human life, and they deserve a chance to be born.”

Commentary

Medical Director for the National Embryo Donation Center Jeffrey Keenan, MD: “Currently there are more than 600,000 cryopreserved embryos in liquid nitrogen tanks in U.S. fertility clinics alone. Although some 80 percent of couples say that they plan to use these for future reproduction, the reality is that a large percentage of these will never be thawed and replaced in the genetic mother’s uterus. Because cryopreservation has only been performed for about 25 years, no one really knows what the ultimate fate of these embryos will be. It is possible that many will eventually be destroyed, donated to destructive and unfruitful embryonic stem cell research or even left as a sort of ‘inheritance’ for the children (genetic siblings).

“What created this problem is the marked improvement in IVF success rates, an increase in the number of procedures and the more prevalent use of donor eggs as noted in this article (donors generally produce more eggs of better quality with higher pregnancy rates). At the same time, most clinics have not changed their practices which typically involved inseminating ALL eggs regardless of the number or likelihood that there will be additional embryos remaining long after the couple has completed their family building plans.

“Unfortunately, the American College of Obstetrics and Gynecology and other professional bodies do not even consider an embryo a viable being until it has implanted in the uterus. This view has at least contributed to the almost complete disregard for the lives of embryos by most members of our profession.

“The National Embryo Donation Center was founded with the assistance of the CMDA and performed its first embryo transfers in 2003. So far, more than 400 children have been born or are awaiting birth as a result of the NEDC’s efforts, making it the largest and most successful provider of embryo donation/adoption services in the world. The NEDC advocates limiting the number of eggs inseminated with each IVF cycle, as well as increasing the excellent alternative of freezing eggs rather than embryos. NEDC is currently seeking affiliates in multiple cities around the country to perform adoptive embryo transfers.”

Resources
www.embryodonation.org
http://embryoconnection.org
Embryo Adoption: One Family's Testimony
Beginning of Life Ethic Statement
Assisted Reproductive Technology Ethic Statement

Therapists Explore Dropping Solo Practices to Join Groups

Excerpted from “Therapists Explore Dropping Solo Practices to Join Groups,” Shots: Health News from NPR. October 24, 2013 -- In the corporate world of American healthcare, psychologists and other mental health therapists are still mostly mom-and-pop shops. But the business model for therapists is shifting away from solo practices and toward large medical groups, say mental health experts. That change is propelled by the Affordable Care Act, which mandates mental health benefits in insurance coverage, and by the Mental Health Parity Law, which requires private and public insurers to cover mental health needs at the same level as medical conditions — by charging similar copays, for example.

Organizations that advocate for mental and behavioral health — groups that long complained that they were treated as second-class providers — have applauded the federal laws. But inclusion has come with some unhappy caveats, including less pay and more paperwork. Patients used to paying $150 in cash for a therapy session will, with some limitations, have sessions covered by their health plan. That means many therapists will have to figure out innumerable insurance plans and byzantine billing codes for the first time.

In many ways, therapists are encountering what medical doctors have complained about for years: the confusing, confounding and, some might say, hostile insurance bureaucracy that providers must tangle with in order to get paid. The increasing complexity of running a practice has meant more therapists are taking down their shingles or forming groups with other therapists to share the burden, executives at national mental health groups say. Others have joined large medical groups that offer mental health services as part of comprehensive care.

Commentary

CMDA Member and Psychiatrist Robert Rogan, DO, JD: “This article touches on several current issues in mental health affecting our society. One, the loss of autonomy, may be far more serious than we realize. The freedom to serve as we in conscience believe best is something we need as believing practitioners. Conscience issues are already prominent in current medical practice in general. If we can’t ‘choose our clients,’ we may find ourselves being asked to provide therapy in an area we find morally uncomfortable.

“People do seek mental health services and pay ‘out of pocket’ not just for insurance reasons but also for privacy. The HIPAA regulations with compliance that began on September 23, 2013 seem to reflect this possibility.

“Paperwork issues are not just documentation chores but very concerning potential legal traps. Billing is serious business for more than just reimbursement reasons. We need to be truthful but careful in what we write. Also, we need to be ultra-careful what we sign. We need to know every pitfall in contracts we sign. If there is legal terminology you don’t know, look it up or get legal counsel. A subtle term like ‘hold harmless,’ now in very common use, can be the entrance to a professional minefield.

“On the other side, solo practice can have physical dangers with our changing patient demographics. Group practice can provide more collegiality as ‘iron sharpens iron.’ We can be of great use in practices where mental health service is needed by other non-mental health practitioners.”

Resources
Healthcare Right of Conscience Ethic Statement
Augustine College at CMDA CD Set

Ethical dilemmas surround those willing to sell, buy kidneys on black market

Excerpted from “Ethical dilemmas surround those willing to sell, buy kidneys on black market,” CBS News. November 1, 2013 -- Government estimates show 18 people die each day waiting for a transplant, and every 10 minutes someone is added to the transplant list. The need for kidneys is especially high. As of October 25, 98,463 people were waiting for a new kidney in the U.S., the most requested organ by far. Thus far this year, only 9,708 kidney transplants have been completed.

The beauty of kidney donation compared to other organs is that people are born with two of them, making possible donation from a living person. But, the fact that people can live a normal life with one kidney has helped the black market kidney trade flourish.

Some argue that if the donor is made aware of all the potential risks and still consents, he or she should be free to sell a kidney. Advocates say if people are able to sell other body parts like hair or eggs, they should be allowed to get money for their organs. And recent research suggests paying for organs could reduce societal healthcare costs long-term. An Oct. study showed that if people were able to pay $10,000 for a living kidney donation, medical costs -- such as related to dialysis treatments -- would go down overall and patients would get additional quality years of life compared to the current system. However, the practice of getting paid for an organ is illegal everywhere except Iran.

Caplan believes that the current opt-in system of organ donations should be changed to an opt-out. Now, Americans select on their driver's licenses if they'd like to donate their organs, but they're calling for a system where everyone by default is a donor. The bioethicist noted that data show that most people are willing to be an organ donor, so the system should be changed, so the few who are against it can have their decision respected.

Commentary

Trauma Surgeon and CMDA Member Christine Toevs, MD: -- “This article touches on many of the current ethical issues related to organ procurement. The position offered by the organ procurement organizations (OPO) is as follows: organ transplantation is good and many people are waiting for organs; therefore, anything that increases organ donation is inherently good.

“The main solution provided to increase organ donation is to pay for organs; if we pay for organs, more will donate and we will save more lives. The problem with this argument is that studies have shown that paying for organs exploits the poor and very little of that money actually reaches the organ donor, most taken by brokers and middlemen. Since most of the organ donors would likely be poor, the risk of coercion and lack of informed consent increases. The aging of the population has resulted in an increase in chronic renal disease, and this increases the long-term potential health issues of the organ donor. When their kidneys fail, do they now go to the top of the recipient list? Who takes care of the organ donor and their complications when, which although rare, do occur?

“The OPOs have consistently demonstrated a lack of informed consent at any step of organ donation (is checking the box on your driver’s license really informed consent?). It is unlikely that even regulated markets for selling of organs will result in safer protections for the organ donors. People are not commodities with extra superfluous organs that should automatically go to others. There is great need for organs, but that need doesn’t allow for exploitation of others.”

Resources
Organ Donation Ethic Statement
Human Organ Transplantation Ethic Statement

Pushing back against genetically designing babies

Excerpted from "You Can't Predict Destiny by Designing Your Baby's Genome." commentary by Megan Allyse and Marsha Michie, published in The Wall Street Journal, Nov. 8, 2013 - In the 1997 film "Gattaca," wealthy parents regularly use what's called preimplantation genetic diagnosis to pick children with the most desirable characteristics. Using in vitro fertilization, PGD creates several embryos and then uses the most genetically promising one to attempt a pregnancy.

As distant as a Gattaca-style dystopia may seem, recent developments suggest it's not as far-fetched as it once was. California genetic testing company 23andMe announced in October that it has patented a method for determining the traits, including eye color and height, a hypothetical child would inherit from its parents.

Sperm donors deemed genetically inferior--or invalid, in Gattaca terms--will presumably be rejected and have to pass on their genetic material the old-fashioned way. These innovations expand on an existing service for prospective parents called carrier screening. The screening detects gene variants that, when present in both parents, significantly increase the risk of certain diseases in offspring.

The question is no longer whether we can design our offspring, but if we should-and what happens when we try. It may seem like creating the perfect child will eventually be a matter of who can pay for it. But predicting whether a couple's offspring will be the next Mozart or Einstein is about as easy as predicting the precise location and airspeed of a hurricane nine months in advance. That's because our genes are too complex to predict.

Parents have always tried to control their children's destiny, and complex gene algorithms are merely the latest manifestation of those efforts. But these techniques will only reveal that human life is too multifaceted to be reduced to a mathematical formula.

Commentary

CMDA Member and Senior Fellow for Family Research Council David Prentice, PhD: “Our genes are not our destiny. Even with the ultimate genetic selection technology—cloning—the cloned animal offspring are not exact duplicates of the progenitor from which they were cloned. Yes, despite the fact that the cloning process uses the exact DNA of another individual (technically ‘somatic cell nuclear transfer’ is the most common form of cloning attempted) in an attempt to replicate that individual, the few clones that survive show that we are all more than just a readout of a genetic menu. One of the clearest examples of this lack of ‘genetic determinism’ is CC, the ‘carbon copy’ cat, which was cloned in 2001. She has a different coat pattern than the cat from which she was cloned, and different behavioral patterns.

“We are not our genes! Epigenetics (which genes are expressed, when and where) and environment have a huge effect. Even our experiences in the womb help shape who we are.

“This newest eugenic attempt to control our children and their outcomes, whether by ‘screening out’ less desirable traits or individuals, or ‘designing in’ what we might consider more desirable or fashionable traits, is a self-centered exercise that lacks respect for the uniqueness of each individual’s genetic endowment. The new human becomes the created property of another, designed and crafted to meet the maker’s desires; it is man making man in his own image, yet without any higher standard to which the craftsman is held. A key ingredient is lacking—love. Each new human individual is a gift to be loved. We are each of us fearfully and wonderfully made!”

Resources

CMDA Genetics Resources

Court upholds religious freedom in contraceptives mandate case

Excerpted from "Court strikes down birth control mandate," published in The Hill, November 01, 2013 - A federal appeals court on Friday struck down the birth control mandate in ObamaCare, concluding the requirement trammels religious freedom.

The D.C. Circuit Court of Appeals — the second most influential bench in the land behind the Supreme Court — ruled 2-1 in favor of business owners who are fighting the requirement that they provide their employees with health insurance that covers birth control.

Requiring companies to cover their employees’ contraception, the court ruled, is unduly burdensome for business owners who oppose birth control on religious grounds, even if they are not purchasing the contraception directly.

Legal analysts expect the Supreme Court to ultimately pick up an appeal on the birth-control requirement and make a final decision on its constitutionality. In the meantime, Republicans in Congress have pushed for a conscience clause that would allow employers to opt out of providing contraception coverage for moral or religious reasons.

The split ruling against the government on Friday was the latest in a string of court cases challenging the healthcare law’s mandate. Friday’s ruling centered on two Catholic brothers, Francis and Philip Gilardi, who own a 400-person produce company based in Ohio.

"They can either abide by the sacred tenets of their faith, pay a penalty of over $14 million, and cripple the companies they have spent a lifetime building, or they become complicit in a grave moral wrong," Brown wrote.

The Obama administration said that the requirement is necessary to protect women’s right to decide whether and when to have children.

Commentary

Matt Bowman, Senior Legal Counsel, Alliance Defending Freedom– “Two new cases have vindicated religious freedom for people in their everyday professions, and have upped the ante for another Supreme Court showdown, in 2014, with the Obama administration over religious liberty and Obamacare. The U.S. Courts of Appeals for the Seventh and D.C. Circuits, in Chicago and Washington, respectively, both ruled in the last few days that when people of faith engage in a business they do in fact possess the freedom to exercise their religious beliefs when the government commands them to violate those beliefs. The Gilardi family out of Ohio, the Korte family of Illinois and the Grote family in Indiana all run businesses and seek to do so consistent with their Christian faith. They object to the Obamacare mandate to provide abortifacient drugs, contraception and sterilization in their employee health plans.

“On November 9, the Seventh Circuit declared that the Korte and Grote families and their businesses can assert rights against the federal government under the Religious Freedom Restoration Act of 1993 (RFRA), which ‘operates as a kind of utility remedy for the inevitable clashes between religious freedom and the realities of the modern welfare state, which regulates pervasively and touches nearly every aspect of social and economic life.’

“The court went on to declare that the abortifacient/contraception mandate is not justified against religious objectors, because the government merely asserts that free contraception promotes ‘health’ and ‘equality.’ Rebutting the government’s assertion of a so-called ‘right’ to such things as abortion and contraception, the court declared that ‘the government has failed to demonstrate how such a right...can extend to the compelled subsidization of a woman’s procreative practices’ by private citizens.

“On November 26, the Supreme Court will look at three petitions from businesses that have filed similar challenges to the abortifacient/contraception mandate, and it could decide that afternoon to set one or more of those cases for argument in the spring of 2014.”

Resources
Court Cases summary

HHS contraception mandate vs. the Religious Freedom Restoration Act

Action

Urge your senators to support conscience rights - S.1204

Urge your Rep. to protect conscience rights - HR 940

Politics and abortion commentary published in USA Today

Published in USA Today, November 7, 2013, personal commentary by CMA VP for Government Relations, Jonathan Imbody - If only the GOP would throw up the white flag and surrender "hard-line positions on abortion" and other social issues, they might win like Democrats, suggests a USA editorial ("How GOP candidates can win: Our view," Nov. 6).

If Republicans had followed such advice in the nineteenth century, we would still be trading in slaves.

A 2013 Gallup poll revealed that by at least a 17-point margin, women, independents and young voters all favored the GOP position of making abortion illegal in most cases. The movement against abortion on demand garners even more support when the specific abortion issue is parental consent, partial-birth abortion, second and third trimester abortions and informed consent.

Meanwhile, a Brookings Institution poll found that "Republicans have a better opportunity to attract Democratic defectors with … a socially conservative message than an economically conservative message."

Republicans' socially conservative position on abortion clearly syncs with American voters' values. Yet even if polling on abortion ran counter to the GOP platform, who could ever trust a political party that sacrificed on the altar of political expediency its commitment to the "right to life, liberty and the pursuit of happiness?"

Resources

Washington Office More published commentaries by Jonathan Imbody and daily updates via Freedom2Care's blog, Twitter and Facebook.

Participate in CMDA's Voice of Christian Doctors Media Training

Action

Use the pre-written, customizable forms at CMA's legislative action website to encourage your legislators to pass life-honoring bills on abortion.

Sign up for CMDA's Freedom2Care coalition's Federal Registry on LinkedIn (registration is free) and stay updated with notices of opportunities plus tips, updates and discussions.

Obamacare rollout highlights views of government

Excerpted from "An opening for the right," The Washington Post, commentary by Jennifer Rubin, October 27 - The Obamacare debacle challenges a number of liberal mantras that undergird a whole set of policies and campaign appeals. Here are the top 10 liberal tenets threatened by Obamacare:

1. If there is a problem, the federal government should attack it.
2. Government can compel people to act against economic self-interest by passing laws.
3. There is no downside to big government.
4. The welfare state is the best mechanism to help the poor.
5. Those opposed to big government hate the poor.
6. Government is capable of running highly complex systems effectively.
7. When addressing big problems it is best to centralize and standardize.
8. Unintended consequences of government programs are a small price to pay.
9. People will trust the government with private decisions and personal information.
10. Spending more and taxing more are evidence of concern for the poor.

All of these precepts have been challenged by conservatives, but there is nothing like a real example and personal experience to drive home a message. We don’t have just a few “glitches” or even a time crunch for putting up the exchanges, we have in Obamacare a fundamental misunderstanding of the limits of the government and citizens’ aversion to big, complicated entities. The effort to construct one big system with a highly regulated product (Obamacare-standard insurance) may in fact be the entire effort’s undoing.

Commentary

CMDA CEO David Stevens, MD, MA (Ethics):
“Our healthcare system is broken and badly in need of a fix. The root problem is that healthcare costs too much, so individuals and businesses can’t afford insurance. The Affordable Care Act, unfortunately, is built on the premise that most people’s health insurance programs are not adequate and all perceived inequities must be solved. So the law says preventative services and contraceptives must be free. It doesn’t allow surcharges for age or preexisting conditions. Children can stay on their parents’ plans until age 26. There are no lifetime cost ceilings. Plans must contain psychiatric, eye and other coverages that most insurance plans have not provided.

“I like all those things, just like I like all the bells and whistles on a Mercedes Benz 500 with its great ride and exquisite comfort. But I’ve never owned a Mercedes because I can’t afford one, just like most people in our country. I drive a Honda Civic and, you know what, it gets me there. We can’t afford the Affordable Care Act either. It will add a whopping $2.8 trillion to our healthcare costs over the next 10 years. Already, self-insured individuals are experiencing the reality of that sticker shock but they are no longer in a market-driven healthcare economy. They can’t buy a well-used insurance vehicle at an economical price. Only a Mercedes is adequate.

“We very well may be headed for a debacle. The ‘cure’ may be worse than the disease. If so, everyone may be so traumatized that they refuse to even give a hearing to a real solution.”

Should Christians engage in public policy?

Excerpted from "Should we pull back from politics?" blog posting by Russell Moore, President, Southern Baptist Convention's Ethics and Religious Liberty Commission - A recent profile in the Wall Street Journal highlighted a generational change in terms of the way evangelicals approach cultural and political engagement: toward a gospel-centered approach that doesn’t back down on issues of importance, but sees our ultimate mission as one that applies the blood of Christ to the questions of the day. The headline, as is often the case with headlines, is awfully misleading.

I don’t think we need a pullback from politics. I think we need a reenergizing of politics. Millennial and post-Millennial Christians are walking away from the political process, and this is what alarms and motivates me. They are disenchanted with movements that seem more content to vaporize opponents with talk-radio sound-bytes rather than to engage in a long-term strategy of providing a theology of gospel-focused action in the public square.

Those who wish to retreat are wrong. Ignoring so-called “political issues” doesn’t lead to a less politicized church but to a more political church. One cannot preach the gospel in 19th century America without addressing slavery without abandoning the gospel. One cannot preach the gospel in 21st century America apart from addressing the sexual revolution without abandoning the gospel.

A church that loses the gospel is a losing church, no matter how many political victories it wins. A church that is right on public convictions but wrong on the gospel is a powerless church, no matter how powerful it seems.

That means modeling a Christian political engagement that doesn’t start or end with politics alone. It starts and ends with the gospel and the kingdom of God. Those who oppose our convictions will hate us. Those who want to use our church voting lists as their political organizing tools won’t understand us. So be it. Kingdom first.

Commentary

CMA VP for Govt. Relations Jonathan Imbody: (excerpted from "MLK and Wilberforce show why Christians should engage more--not less--in public policy," Freedom2Care blog, October 23, 2013) Imagine a world bereft of the political engagement of Christian religious leaders like Dr. Martin Luther King, abolitionist William Wilberforce and myriad lesser-known leaders like Jonathan Mayhew, whose sermons and writings helped undergird the American Revolution. Christian political engagement has helped secure racial justice, free slaves and throw off tyranny.

We demonstrate our faith in God by defending the defenseless, advocating for the poor, righting injustice. The political process offers one arena for such ministries. Public policy engagement for Christian believers means encouraging our countrymen to take faith steps toward God and His principles. To choose life, to defend the defenseless, to advocate for the poor and downtrodden.

With this perspective, we must not disdain but instead honor the ministry of working in the political realm as an evangelistic ministry. Rather than stepping back from politics, more believers need to engage in public policy, proactively advancing policies promoting the welfare of their countrymen and defensively advancing religious freedom for people of faith.

We can't desert the battlefield just because a few soldiers may have misfired. If some believers have fought political battles in an antagonistic way, let us show how to engage in a winsome way. If others have let bigotry and hubris mar their testimony, let us demonstrate Christ's love with grace and humility. If others have proven emissaries of ill will, let us serve as ambassadors of good will.

"Therefore, we are ambassadors for Christ, as though God were making an appeal through us; we beg you on behalf of Christ, be reconciled to God" (2 Corinthians 5:20).

Read full blog article by Jonathan Imbody

"Roe" abortion decision lacked medical evidence

Excerpted from a book review by Michael J. New in The Washington Times, October 13, 2013 - a review of Abuse of Discretion: The Inside Story of Roe v. Wade by Clarke Forsythe - Clarke Forsythe persuasively makes the case that even under liberal standards, Roe v. Wade is still deeply flawed. That is partly because the public health data and the historical information that Justice Blackmun relied on in his majority opinion were often incorrect, incomplete or misleading.

For instance, public health research that purportedly showed that abortion was safer than childbirth played a prominent role in Blackmun’s opinion. However, of the seven studies that Blackmun cited, none was peer reviewed and none even considered long-term health risks involved with legal abortion.

The concept of viability was never once even mentioned during the oral arguments. Mr. Forsythe presents correspondence between Justices Blackmun, Thurgood Marshall and Lewis Powell showing that their decision to expand the abortion right to viability was not based on any legal argument, but instead because it would mean more access to abortion.

This expanded access to abortion has had a profoundly negative impact on public health. Mr. Forsythe details the numerous abortion clinic scandals that have come to light since 1973. He also ably summarizes academic research that shows that abortion is linked to an increased risk of breast cancer and a higher incidence of various psychological problems. There is no evidence that Roe v. Wade significantly reduced maternal mortality, child abuse, spousal abuse, poverty or the out-of-wedlock birthrate.

Abuse of Discretion should engage readers outside the pro-life movement by making a compelling argument that even under liberal standards of jurisprudence, Roe v. Wade is a deeply flawed decision.

Commentary

Author Clarke Forsythe, Senior Counsel, Americans United for Life:“Abuse of Discretion details and documents the erroneous medical assumptions adopted by the Justices in Roe v. Wade and Doe v. Bolton. The principal medical assumption was that “abortion was safer than childbirth.” That drove the outcome and the shape of the Court’s opinions in Roe and Doe, though there was no evidence or reliable data to support that assumption. Abuse of Discretion thoroughly disputes the accuracy of that assumption in 1972 and today.

“Chapter 8, entitled “Detrimental Reliance,” summarizes the contemporary international medical studies finding increased risks of, for example, pre-term birth after abortion.

“The Supreme Court has three abortion cases before it this fall, though the Justices have not yet decided to hear the merits of any of the cases. However, the medical data will be critical in these cases and in all future abortion cases in the courts.”

Proposed treatment to fix genetic diseases raises ethical issues

Excerpted from “Proposed treatment to fix genetic diseases raises ethical issues,” Shots: Health News from NPR. August 14, 2013 -- The federal government is considering whether to allow scientists to take a controversial step: make changes in some of the genetic material in a woman's egg that would be passed down through generations. Mark Sauer of the Columbia University Medical Center, a member of one of two teams of U.S. scientists pursuing the research, calls the effort to prevent infants from getting devastating genetic diseases "noble." Sauer says the groups are hoping "to cure disease and to help women deliver healthy, normal children."

But the research raises a variety of concerns, including worries it could open the door to creating "designer babies." Specifically, the research would create an egg with healthy mitochondrial DNA (mtDNA). Unlike the DNA that most people are familiar with—the 23 pairs of human chromosomes that program most of our body processes—mtDNA is the bit of genetic material inside mitochondria, living structures inside a cell that provide its energy.

Scientists estimate that 1 in every 200 women carries defects in her mtDNA. Between 1 in 2,000 and 1 in 4,000 babies may be born each year with syndromes caused by these genetic glitches; the syndromes range from mild to severe. In many cases, there is no treatment, and the affected child dies early in life. "We have developed a technique that would allow a woman to have a child that is not affected by this disease, and yet the child would be related to her genetically," says Dieter Egli of the New York Stem Cell Foundation.

But this is all still very controversial. First of all, the baby would be born with genes from three different people: from the father, from the woman trying to have a healthy baby, and from the woman who donated the healthy egg. There are even bigger concerns, which start with whether the technique is safe for the resulting infant, and whether by trying to fix one problem, scientists may inadvertently introduce mistakes into the human genetic code. That's why this sort of thing has always been off-limits — even banned in many countries, according to Marcy Darnovsky of the Center for Genetics and Society.

Commentary

CMDA CEO David Stevens, MD, MA (Ethics): “Germline genetic engineering, where a portion of the egg or sperm’s genome replaced, changed or supplemented, is unethical, unnecessary and unsafe. It crosses a bright line in the bioethical sand labeled, ‘That shalt not!’


“It is unethical because it permanently changes the child’s genes and any unforeseen consequences that occur are passed on to every generation that follows. Thus, it violates the ethical principle of autonomy. How does the doctor get informed consent from their grandchild yet to be conceived? Some of the techniques proposed involve destroying human embryos, not just manipulating women’s eggs. For example, some propose discarding female embryos created and only implanting male embryos to avoid the risk of passing on an inheritable defect.

“It is unnecessary. Women who have an identified high risk with a high mutation load, (under 18 percent mutations of mtDNA, there is 95 percent certainty of no risk) already have the option of not having children, adopting, utilizing a donated egg, preimplantation genetic diagnosis and prenatal diagnosis with abortion. Some of these options are unethical because they destroy life, but they are legal. Scientists are trying to justify germline manipulation so that women with this genetic liability might have the option of having a child with their genes. While this ambition is understandable, because there are alternatives, and because there are significant risks to generations of offspring, we should prohibit this option.

“It is unsafe. This type of genetic manipulation is not human cloning but uses similar techniques that have been associated with serious problems when used in animals—large organ syndrome, malformations and miscarriages.

“The ‘hard cases’ have been historically used to justify crossing the ‘bright lines’ in bioethics. We saw this in abortion, but once society agreed that abortion was justified because the mother didn’t want a child because of rape, incest or a genetic defect, it soon became justified for a woman not wanting a child for any reason. In other countries, physician-assisted suicide was justified for patients who had lives ‘not worthy to be lived’ because they were terminally ill and suffering. Now it is allowed for any reason the patient conceives that their life is unworthy to live. It is not unreasonable to predict if society says germ line manipulation is okay to avoid having a child with an imperfect genome that society will soon open the door for germline genetic engineering in the quest for perfect children.”

Resources
Novel techniques for the prevention of mitochondrial DNA disorders
Position Paper on Human Germline Manipulation
CMDA Resources on Reproductive Technology and Health

Autistic boy “debarked” to prevent screaming

Excerpted from “Autistic boy ‘debarked’ to prevent screaming,” BioEdge. October 5, 2013 -- Controversy has arisen around a procedure performed on an American autistic boy to stop him from screaming. At the request of his parents, Kade Hanegraaf had his vocal cords separated so as to greatly reduce his ability to scream.

The family chose the operation after three years of enduring the boy's uncontrollable screaming—a high pitched cry louder than a lawn mower that he would make more than 1,000 times a day. According to the boy's mother, Vicki Hanegraaf, the behavioral problem was destroying the family. They were unable to take the boy anywhere, and his brother, also autistic, was highly sensitive to the loud cries.

According to a case report in the Journal of Voice, the boy can now only produce a scream half as loud, and his “episodes” have been reduced by 90 percent. The operation, called a thyroplasty, is said to be reversible. The boy's family is happy with the outcome, but others in the autistic community have criticized their decision. Some have described it as torture and compared it to debarking a dog.

Bioethicist Arthur Caplan defended the decision: "21st century medicine gave Kade and his family a solution that has already allowed the boy to live a richer life -- and the solution can be reversed at any time. That seems to me to be cause for celebration, not condemnation."

However, an autism rights activist told Salon that the operation was profoundly unethical. “There is a long history of family members and providers viewing these behaviors as strictly a medical phenomenon and not recognizing they’re important for communication. To violate a person’s bodily autonomy and damage their ability to communicate to serve the convenience of the caregiver is nothing short of horrific.”

Commentary

CMDA Member and former member and chair of the CMDA Ethics Committee Nick Yates, MD, MA (Bioethics): “Parents should be and are allowed to make healthcare decisions for their minor children (and those who cannot be granted decision-making authority) under a best interests model. Traditional and more commonplace care is easier to accept, but sometimes not only is the treatment a bit unusual and unconventional, but the best interests extend from the individual to the family. Patient autonomy and decision-making capacity are extremely important considerations, and thoughtful communication is how these notions are expressed and preserved. However, if one can only communicate in deafening screams and exhibits little social grace, how is autonomy and decision-making imputed in a meaningful manner? These are extremely difficult decisions where pundits—nearly all of whom have not and will never experience the extreme medical situation—love to wage commentary.

“The family followed traditional care recommendations—behavioral and medical management—for nine years with no persistent improvement. Following surgery, vocalization frequency and intensity dropped significantly, socialization improved, he began to speak better and his appetite improved.

“Children do indeed need protection, and social services are appropriate, but children also must have an advocate, and so rights activists and external guardians may be necessary. In this case, neither is necessary as the family's choice is ethically permissible (and medically reversible), and should not be condemned.

Resources
CMDA Ethics Statement on Parental Limits
Autism’s Hidden Blessings by Kelly Langston
Complete Guide to Baby & Child Care

Physicians prepare to deal with increased demand, strain on practices under ObamaCare

Excerpted from “Physicians prepare to deal with increased demand, strain on practices under ObamaCare,” Fox News. October 1, 2013 -- As enrollment in ObamaCare begins, physicians throughout the country are preparing to deal with an influx of newly insured patients – as well as the increased financial demands this will place on their practices. While it will take a few years for doctors to fully determine how they will be affected by ObamaCare, some physicians are already anticipating the need to make major changes to the way they run their practices.

One of the most immediate changes that physicians in these areas expect to see is an increase in patients seeking preventive health care – something many avoided when uninsured. However, scheduling more routine check-ups and screenings may place a strain on already short-staffed practices in rural areas. As a result, some doctors are considering handing over some basic aspects of patient care and education to nurses, nurse practitioners, or physicians assistants in order to treat patients more efficiently. Dr. Jason Marker, of Wyatt, Indiana, is already looking to hire additional staff members in order to meet the increased needs in his community.

Rural areas throughout the country already face a shortage of primary care physicians and doctors like Marker fear that this problem might become exacerbated in coming years, as more patients have the means to seek regular care.

“We know definitively that health insurance coverage and access to a physician are what improve health care outcomes.” Marker said. “We’re about to get changes in coverage, but we don’t have a ready way to say, ‘Here’s another million family doctors.’ So there’s a pipeline problem where it will be another five to 10 years where we are able to get the volume of doctors to take all these patients.”

Marker said Congress will need to step up in order to help fix this problem. “The big weak link is whether or not Congress is willing to put additional dollars into family medicine residential training,” Marker said. “That’s the current bottleneck in the training pipeline, is having residency slots. It doesn’t do good to have residents interested if there aren’t slots to do training.”

Commentary

CMDA CEO David Stevens, MD, MA (Ethics): -- “When we went as missionaries to Africa, Jody knew we would be far from the grocery store yet entertaining many guests, so she bought a cookbook called More With Less. That phrase succinctly describes the focus that every healthcare professional will need as we move forward. There are going to be more patients to see than ever before but not enough physicians to see them. Though more medical schools are opening, including two Christian ones, there are not enough residencies being funded. Physician assistant and nurse practitioner schools are expanding to help fill in the gap, but the problem is bigger than that.

According to leading economic John Maudlin, reimbursement rates are going to plunge by 25 percent in the next five years. (I encourage you to read the eye-opening article.) The Cleveland Clinic now collects $6 billion a year and expends $5.5 billion. They are projecting their income to plunge to $4.4 billion by 2018, despite a significant increase in their patient load, as commercial insurance companies on average go from paying $.38 on the dollar billed to $.26. (Medicare now pays $.23 and Medicaid $.18.) Since 60 to 80 percent of their cost is for personnel, that is where cost savings will have to be realized. That is why you are already hearing of hospitals and practice groups laying off staff and if those staff are rehired elsewhere, they probably will be paid less.

CMDA’s Executive Vice President Gene Rudd, MD, told those attending the CMDA Midwest Regional Conference a few weeks ago that they would all need to become missionary doctors…but not necessarily by going overseas. They will have to have a missionary's mentality of working very hard and not getting paid as much, but doing it because God has called them to minister through medicine.

Though we will all being doing "more with less" I believe that the opportunities to minister through healthcare are going to be greater than ever! God does His best work in the midst of crisis and change if we simply rest and trust in Him!

Resources
From My Viewpoint: Healthcare Reform by David Stevens, MD, MA (Ethics)
Why HR 3200 is No Healthcare “Reform” by Gene Rudd, MD
Affordable Care Act Impact on Doctors and Patients

Doctors Look For A Way Off The Medical Hamster Wheel

Excerpted from “Doctors Look For A Way Off The Medical Hamster Wheel,” Shots: Health News from NPR. August 14, 2013 -- Doctors are on a hamster wheel these days. We're compelled to run faster just to stay in place. It's about to get worse. Obamacare means millions more people will want our services, with not enough primary care doctors to meet demand. Government incentives that are pushing us toward computer-based records mean that doctors now spend as much time documenting our visits with patients as we do examining them.

As the hassles have gotten worse, I've seen many colleagues jump ship. But there might be another way. Dr. Christine Sinsky, an internist in Dubuque, Iowa, has made it her mission to find ways to mitigate the drudgery of modern doctoring. With funding from the American Board of Internal Medicine Foundation, she and four colleagues traveled the U.S. in search of practices that provide top-notch, effective primary care, while making the work satisfying for the doctors and other health professionals. Sinsky and her team found 23 examples of innovative practices from coast to coast, and reported on them in both an academic journal and an in-depth white paper.

Dr. Ben Crocker was so burned out in in 2007 that he lamented, "Working at Starbucks would be better." Now, his practice at Massachusetts General Hospital employs health coaches to work with patients on making the lifestyle changes that doctors recommend but can't adequately teach or monitor. Virtual visits have replaced some in-person visits. Perhaps most incredibly, the practice offers staff downtime each week to come up with innovations.

Sinsky offers examples of tedious tasks that take doctors away from providing undivided attention. No. 1 among them is data entry. "Inbox management" — all the phone calls, emails, forms to sign and prescription refills — can take up to two-thirds of a physician's day. "All of this inbox work can and should be handled by nonphysician personnel, freeing us up," she says. "So many mandatory tasks are crowding out the work of real doctoring.”

Commentary

CMDA Member Julie Griffin, MD: -- “Demanding schedules, flawless precision and an enduring calm in calamity—these are expectations of physicians. We have often placed these ultimatums on ourselves with our detailed, driven personalities pushing us to unattainable perfection. Nevertheless, the culture increasingly demands a new maximum.

Hardly imaginable is Hippocrates rushing around the office, then being paged across town for a delivery. Medicine’s revered father never had to defend his decisions to a third-party payer. We prefer the tableau of a wise, forbearing professional to grateful patients and an engaging professor to eager students. In truth, we were in this picture ourselves as we entered medical school.

Have our dreams run amuck? Perhaps, if we lose the focus of our callings in light of career demands. Yet, if we are confident of our callings and moved with the same compassion which moved Jesus (Matthew 9:36), we will not be distracted from our opportunities to serve.

To be sure, we must employ new methods, including delegation of duties. Medicine is moving to team-based care. This change is neither revolutionary nor futuristic. It is an overdue move toward our biblical heritage. Jesus readily embraced teamwork in ministry, and we as physicians should do likewise.

We must remember our calling and the true Strength by which we fulfill it—paperwork, phone calls and all. We cannot be chased out of our ministries for there is no joy or peace in life apart from our appointments as God’s coworkers in the gospel of Christ (1 Thessalonians 3:2-3).

Resources
In Search of Balance by Richard Swenson, MD
Practical Practice Issues in Today’s Christian Doctor

Obamacare May Trigger Exodus of Christian Doctors

Excerpted from “Obamacare May Trigger Exodus of Christian Doctors,” CBN News. October 1, 2013 -- Thousands of Christian doctors across the nation are considering quitting medicine or working overseas because of concerns over the new healthcare law.

Dr. Gene Rudd, senior vice president of the Christian Medical Association, says they're worried they could be forced to facilitate abortions or prescribe drugs that violate their convictions.

Rudd says many of them have avoided hiring and taking on new patients due to uncertainty over Obamacare.

Thousands of the doctors provide care for the poorest areas of the United States and feel called by God to help the sick, but say they need to be able to do so with a clear conscience.

Commentary

CMDA Senior Vice President Gene Rudd, MD: “I rarely view or read media reports after I have been interviewed. (In part, this is because someone else at CMDA does that.) But being asked to comment on this article that was based on what I said to a reporter reminded me of how the media uses their perspectives and agendas to create the news. Too frequently I find a failure to report ‘the truth, the whole truth and nothing but the truth.’

“Timed to coincide with the beginning of the enrollment for Obamacare, my interview with this AP reporter covered many perspectives on healthcare reform, perspectives I classified as ‘the good, the bad and the ugly.’ My limited comments about Christian doctors were almost an afterthought. But only those comments made the news.

“Among the many perspectives I cited, one ‘good’ aspect of reform is that some of our neighbors who previously couldn't obtain health insurance coverage would now have some basic level of protection. A ‘bad’ aspect is that now healthy individuals and families who did not have coverage and had little healthcare costs will now have to pay either a penalty for failure to participate or pay premiums. Even with subsidies, one estimate placed the average family premium at more than $5,000. That will be a substantial burden to most family budgets.

“One of the ‘ugly’ aspects of the current reform bill is the permission assumed by the Administration to usurp individual rights and undermine the First Amendment. Already we have seen HHS interpret and implement legislation in a way that attempts to force employers to provide coverage that includes provisions they find morally objectionable. And under the guise of providing required services, we will be required to fund abortions. Only with the use of smoke and mirrors do they attempt to claim otherwise.

“Will reporters continue to filter the news to suit their agendas? Of course. But we will continue to speak the truth in love. Will Obamacare survive? I don’t know. But we will continue to contest provisions that are morally unacceptable and dangerous to our foundation of freedom."

Resources
Voice of Christian Doctors Media Training
From My Viewpoint: Healthcare Reform by David Stevens, MD, MA (Ethics)
Nationalized Healthcare – Prescription or Problem?

New Poll Results on Physician-Assisted Suicide

Excerpted from “Should Physician-Assisted Suicide Be Legal? Poll Shows Divide Among Experts,” Huffington Post. September 12, 2013 -- Medical experts in the U.S. remain divided in their opinion of whether physician-assisted suicide (PAS) should be legal, a new poll suggests, indicating that the way in which patients die and the role of palliative care will remain issues of much debate. In the poll conducted by the New England Journal of Medicine (NEJM), about 65 percent of votes were against the idea of permitting PAS. The rate among U.S. voters was similar, with about 67 percent voting against PAS. In PAS, doctors provide terminally ill patients with the means to end their own life - for example, giving them a prescription for a lethal dose of medicine, which the patient can later decide whether to take.


Proponents of PAS say that people, in face of an inevitable death, deserve the right to end their lives on their own terms, without pain and suffering. Opponents say that a physician taking a role in a patient's suicide violates a fundamental tenet of medicine by contradicting the doctor's role as a healer. Oregon was the first state to legalize PAS, with the passing of the Death with Dignity Act in 1997. Two other states, Washington and Vermont, followed suit. In 18 U.S. states, a majority of votes supported PAS. Interestingly, the researchers said, Oregon and Washington were not in that group.

More than 200 comments were posted, in which readers made arguments to support their beliefs. Many commentators on both sides of the divide agreed that palliative care, including hospice, are important for helping terminally ill patients manage their pain and suffering, both physical and psychological.

Commentary

Family physician, ethics consultant and CMDA Board of Trustees Member Robert E. Orr, MD, CM : “The New England Journal of Medicine recently reported that in its international poll, two out of three physicians oppose the legalization of PAS. They also reported several years ago on a survey of U.S. physicians that gave similar results.¹ The good news: (a) most physicians think PAS is a bad idea; (b) the NEJM is willing to report this in spite of their own editorial support of PAS. However, there is also bad news about such polls.


First, it is well documented that the way polling questions are worded can have a significant effect on the results obtained.² Equally important, poll results may (or may not) reveal what people think about an issue, but they cannot tell us whether the issue in question is right or wrong.

It is possible to effectively speak against PAS using arguments based on principle, virtue or consequences.³ For the believer, there is a strong additional reason to oppose PAS: each person bears the image of God and we must not intentionally end a human life.

Another piece of good news from the poll results is that most people, whether for or against PAS, agree that excellent hospice/palliative care is the preferred response to end of life suffering.⁴

Bibliography
¹Meier DE, et al. A national survey of physician-assisted and euthanasia in the United States. N Eng J Med 1998;338(17):1193-1201
²Hagelin J, et al. Surveys on attitudes towards legalisation of euthanasia: importance of question phrasing. J Med Ethics 2004;30:521-523
³Orr RD. What are the arguments against legalization of physician-assisted suicide and euthanasia? Today’s Christian Doctor 2011;42(2):30-2
⁴Orr RD. Pain management rather than assisted suicide. Pain Medicine 2001;2(2):131-137

Resources
CMDA Ethics Statement on Physician-Assisted Suicide
Resources on Physician-Assisted Suicide
What are the arguments against legalization of physician-assisted suicide and euthanasia? by Robert D. Orr, MD, CM

CMDA human trafficking expert teaches doctors and students

Excerpted from "Doctor on a mission to combat modern slavery," (Ky.) Courier-News, August 31, 2013 - As he talked to Louisville doctors and medical students last week, Ohio physician Jeffrey Barrows said he saw familiar expressions on their faces. Shock. It was the same response he had when he began learning about modern slavery less than a decade ago.

Barrows had worked for years with the Christian Medical & Dental Associations, conducting short-term educational trips throughout Asia and Africa. Through a contact with the State Department, Barrows said, he was asked to do research into the health effects of human trafficking as it relates to the global spread of HIV and AIDS.

“The more I read, the more I was shocked,” Barrows, an obstetrician and gynecologist, recalled in an interview Aug. 23 after his Louisville lecture. Many people are still not aware, he said — and his fellow doctors can play a vital role in combating it.

“Of all the sectors within society, health care is one of the most likely to encounter these victims,” he said. Research indicates that a quarter to a half of trafficking victims encounter health care professionals at some point when they are enslaved, Barrows said.

Barrows spoke at Norton Hospital at the University of Louisville Department of Pediatrics Grand Rounds, a continuing-education lecture attended by about 160 students, doctors and other social-service and government representatives. Barrows spends his time educating health care professionals on the signs of trafficking and promoting the development of homes that help recovering victims. He is vice president of Abolition International, a group that works to end sex slavery.

Emergency-room staff and other medical professionals need to watch for the signs of trafficking, Barrows said — just as they have been trained on signs of domestic violence and child abuse.

“Getting the word out is part of the puzzle, getting the people to understand this is happening,” Barrows said. Otherwise, “they’ll encounter a patient and they’ll walk away saying, ‘Something strange is going on, but I don’t know what it is.’”

Warning signs, he said, include:

The victim being accompanied by a highly controlling person — who might even be a family member.
The body language of the patient indicating fear of the accompanying person.
Tattoos indicating a handler’s street name — often a brand of “ownership” by the trafficker.
Signs of abuse.
For sex workers, multiple sexually transmitted diseases.
For manual laborers, such injuries as back trauma or hearing loss.
The victim may also be unaccountably silent on some issues — such as why he or she waited until symptoms became severe to seek medical help.

Commentary

CMDA Health Consultant on Human Trafficking Jeffrey J. Barrows, DO, MA (Bioethics) – “Dr. David McLario, a CMDA member, is on staff at Louisville Children’s hospital and made the arrangements for this presentation. He also did an excellent job organizing a symposium afterward to develop a protocol for their ED to respond to trafficking victims. His reward was encountering a patient the next day who, with further investigation, may turn out to be a victim of trafficking.

“Consider following his example by learning about trafficking and developing a strategy to respond. Every healthcare professional working with patients needs to be educated on human trafficking. Limited studies show between 28 to 50 percent of trafficking victims encounter a healthcare professional while being trafficked.

“CMDA has an excellent educational resource available online at cmda.org/tip. It’s even free if you don’t take the available CME credits. If you need assistance in developing a response strategy, contact me at jeff@abolitioninternational.org.”

Resources

CMDA human trafficking page

Action Take the CMDA education course, optionally with Category One CME credit, on human trafficking.

Washington Post: Zygote is not a "living being"

(Excerpted from "Ken Cuccinelli’s ‘personhood’ travails," Washington Post editorial, Sep. 4, 2013) -- Six years ago, when Virginia’s General Assembly considered the so-called “personhood amendment” to the state constitution, which granted full rights to “preborn human being[s] from the moment of fertilization,” the list of co-sponsors was short. Not only would the amendment have banned abortion, as the sponsors clearly intended, it also provided an opening to prohibit common methods of birth control, including the pill and intrauterine devices.

The practical effects of “personhood” measures … would easily include banning the most popular forms of contraception. This is because the pill, as well as other forms of birth control, work partly by preventing the implantation of eggs in the uterus wall after they have been fertilized. If the “preborn” are protected “from the moment of fertilization,” as the 2007 bill demanded, then contraception — which defeats a fertilized egg’s chances of becoming a living being — could be prohibited.

Commentary

CMA VP for Govt. Relations Jonathan Imbody: The Post is entitled to its own editorial opinions but not its own facts, and scientific fact clearly contradicts the assertion that "contraception … defeats a fertilized egg’s chances of becoming a living being."

Embryology textbooks clarify the lay term "fertilized egg" as "… a zygote or fertilized ovum which is the primordium or beginning of a new human being. Human development begins at fertilization…. This highly specialized, totipotent cell marked the beginning of each of us as a unique individual."¹

"Although life is a continuous process, fertilization is a critical landmark because, under ordinary circumstances, a new, genetically distinct human organism is formed…."²

So contrary to the Post, not only is a "fertilized egg" a living being; he or she is a human being. A human being is by nature a person, defined as "a human being regarded as an individual."³ But political ideology prevents the admission that abortion claims the life of a moving, smiling, hiccupping, grimacing, living human being--a person.

¹Keith L. Moore & T.V.N. Persaud. The Developing Human: Clinically Oriented Embryology, 6th Edition, 1998
²Ronan O'Rahilly & Fabiola Muller, 2001 Human Embryology & Teratology, 3rd Ed.
³Apple Inc. dictionary, ver. 2.21.
Resources

Reproductive Technology and Heath
The Beginning of Human Life
Abortion
Human Life: Its Moral Worth
The Endowment for Human Development

Action
Use the pre-written, customizable forms at CMA's legislative action website to encourage your legislators to pass life-honoring bills on issues such as abortion and stem cell research.

Lawmakers focusing on abortion and harms to women

Editor's note: AUL attorney Mailee Smith, whose commentary appears below, has written several amicus briefs for the Christian Medical Association, which has participated in 40 court cases.

Excerpted from "The state of pro-life legislation, commentary by Mailee Smith, staff counsel at Americans United for Life (aul.org), published in The Washington Times, Sep. 4, 2013 -- In 2013, life-affirming federal and state legislation designed to protect women from the harms inherent in abortion has garnered increasing attention and support from legislators and the American public — and engendered increasing fear and consternation among abortion advocates and their allies.

Abortion advocates appear particularly dismayed with recent legislative efforts to enact laws prohibiting abortion after five months of pregnancy. The reality is that a woman seeking an abortion at 20 weeks is 35 times more likely to die from abortion than she is in the first trimester. At 21 weeks or more, she is 91 times more likely to die from abortion than she is in the first trimester. Legislative efforts to limit abortion after this point directly protect maternal health, no matter how the pregnancy began. Even the liberal Huffington Post recently admitted that Americans overwhelmingly support limitations on such late-term abortions.

Yet abortion advocates oppose banning late-term abortion as well as laws requiring that women be informed of the health risks they face from abortion. The evidence of abortion’s devastating harms to women is overwhelming. Consider this partial list of the short-term and long-term physical and psychological risks associated with abortion:

• Short-term risks include blood loss, blood clots, incomplete abortion, infections such as pelvic inflammatory disease, cervical lacerations and other injuries to organs.
• Premature birth: At least 130 studies have shown an increased risk of subsequent premature birth and low birth-weight infants after abortion. The increased risk of these devastating complications is estimated to be approximately 37 percent after one abortion, 90 percent after two abortions and further increased risk for each additional abortion.
• Placenta previa is the condition during pregnancy in which the placenta covers the cervix, increasing the risks of life-threatening maternal hemorrhage, premature birth and perinatal child death. Abortion increases the risk of placenta previa in subsequent pregnancies by from 30 percent to 50 percent, and much more so for women who have had multiple abortions.
• Breast cancer: It is undisputed that a woman’s first full-term pregnancy reduces her risk of breast cancer. Numerous studies show that abortion may increase a woman’s lifetime risk of breast cancer. In one study funded by the National Cancer Institute, pro-choice researcher Dr. Janet Daling found that “among women who had been pregnant at least once, the risk of breast cancer in those who had experienced an induced abortion was 50 percent higher than among other women.”
• Mental health: A 2011 study in the British Journal of Psychiatry examined 22 studies conducted from 1995 to 2009 and found that women face an 81 percent increased risk of mental health problems following abortion. Women experienced increased risks for anxiety at 34 percent, for depression at 37 percent, for alcohol abuse at 110 percent and for suicide at 155 percent.
• Maternal mortality: Abortion advocates wrongly assert that abortion is safer than childbirth. Many studies show the opposite, including one that found maternal death to be three times more likely from abortion than from childbirth.
• Risks of later-term abortions: Abortion’s risks increase the further into pregnancy it is performed. Beginning at five months of pregnancy, the risk of complications from abortion rises dramatically.

Abortion advocates cannot counter this growing medical data. Instead, they resort to outrageous arguments camouflaging the fact that they are ignoring the health risks of abortion to pregnant women, who deserve our protection.


Resources

Court Briefs Summary
Korte v. HHS Amicus Brief
Isaacson v. Horne Amicus Brief of AAPS et al
Action

Use the pre-written, customizable forms at CMA's legislative action website to encourage your legislators to pass life-honoring bills on abortion.