Forcing conscientious objectors to participate in same-sex marriages

(Excerpted from " Jim Crow laws for gays and lesbians?" column by Kirsten Powers, USA Today, Feb. 19, 2014) - What's the matter with Kansas? A bill protecting the religious freedom of businesses and individuals to refuse services to same-sex couples passed the state House of Representatives last week. It was blessedly killed in the state Senate on Tuesday.

Similar bills have cropped up in a half-dozen states in an effort to protect anti-gay religious believers against lawsuits. A florist in Washington state, a Colorado baker and a New Mexico photographer have been sued for refusing to serve gay couples getting married. They say to do so would be to "celebrate" nuptials at odds with their Christian faith.

It's probably news to most married people that their florist and caterer were celebrating their wedding union. Most people think they just hired a vendor to provide a service. It's not clear why some Christian vendors are so confused about their role here.

Whether Christians have the legal right to discriminate should be a moot point because Christianity doesn't prohibit serving a gay couple getting married. Jesus calls his followers to be servants to all. Nor does the Bible call service to another an affirmation.

Christians backing this bill are essentially arguing for homosexual Jim Crow laws.

Some claim it's because marriage is so sacred. But double standards abound. Christian bakers don't interrogate wedding clients to make sure their behavior comports with the Bible. If they did, they'd be out of business. [Pastor Andy] Stanley said, "Jesus taught that if a person is divorced and gets remarried, it's adultery. So if (Christians) don't have a problem doing business with people getting remarried, why refuse to do business with gays and lesbians."

Maybe they should just ask themselves, "What would Jesus do?" I think he'd bake the cake.

Commentary

CMA VP for Govt. Relations Jonathan Imbody – “The bill that Kirsten Powers' acerbic commentary rails against would simply prohibit coercing people into performing marriage ceremonies or providing adoption or business services that are ‘contrary to sincerely held religious beliefs’ ‘regarding sex or gender.’ Powers cites the Bible and several pastors to argue that Christians should love and serve everyone regardless of sexual preference, suggesting that unchristian bigots who decline to bake cakes for or take photos of same-sex weddings deserve no protection for contrary convictions.

“What Powers overlooks is that our 1st Amendment guarantees that even if your beliefs do not comport with the Bible, even if your conscience goes against the current of the culture, the government must not compel you to violate your convictions. Christians and non-Christians alike enjoy the same protection of conscience, a bedrock of our country's founding and an essential foundation for comity and tolerance today.

“Americans' historic commitment to conscience is so strong that we do not even force conscientious objectors to join the Army when the nation is at war. Nor do we force Catholic physicians to participate in the death penalty, or Jewish deli owners to serve pork barbecue, or commercial photographers who support animal rights to supply shots for fur coat ads.

“People may disagree as to whether or not a Christian is bound by biblical principles to participate in same-sex weddings. But legally speaking—and that's the focus of this fight—the government should not be determining the answer for us.

“Unfortunately, many proponents of same-sex marriage apparently do not feel it's enough to have gained the legal right to marry; now they want to compel everyone to participate in same-sex wedding ceremonies. How ironic it would be to turn a wedding won through a campaign for ‘equality and freedom’ into an event of subjection and coercion.”

Resources
CMDA Right of Conscience Resources
CMDA Sexuality Resources
CMDA Marriage Related Ethical Statements

Action: Use our easy pre-written customizable message to support Marriage and Religious Freedom Act (Senate bill) - S 1808 and Marriage and Religious Freedom Act (House bill) H.R. 3133

CMA commentary in LA Times responds to religious freedom editorial

LA Times editorial
(Excerpted from, "Critics want to overturn the Religious Freedom Restoration Act, but that's going too far," by The Los Angeles Times editorial board, February 4, 2014, Copyright 2014, Los Angeles Times.)

Two decades ago, Congress overwhelmingly approved and President Clinton enthusiastically signed the Religious Freedom Restoration Act. But now that the 1993 law is being used to challenge the Obama administration's requirement that employer health plans include contraceptive services, some supporters of the law are having second thoughts, and several organizations want the Supreme Court to declare it unconstitutional. That would be a mistake.

Congress passed the Religious Freedom Restoration Act, which says the government may "substantially burden a person's exercise of religion" only if necessary to further a "compelling government interest" and only if the law in question is the "least restrictive means" of achieving that interest.

Next month the Supreme Court will hear arguments in two cases in which owners of for-profit businesses argue that the law allows them to disregard the contraceptive mandate because of their religious objections. We hope and expect that the court will reject their claim. The law refers to burdens on "a person's exercise of religion," not a corporation's, and the burden must be substantial. Providing insurance coverage for a woman who uses it to obtain contraceptives no more implicates an employer in her decision than does the payment of her salary, which can also be spent on birth control. Finally, ensuring that women have access to preventive healthcare is clearly a compelling interest.

CMA response - published in LA Times

By Jonathan Imbody, CMA VP for Govt. Relations (Published Feb. 4, 2014 in The Los Angeles Times) – The Times rightly defends but wrongly interprets a federal law that forbids the government from imposing ‘substantial burdens’ on the exercise of religious convictions and requires federal officials to pursue the ‘least restrictive means’ of achieving any ‘compelling interest.’

The Times neglects 1st Amendment principles in defending the administration's attempts to force employers with conscientious objections to bow to the government's edict to provide controversial contraceptives and sterilization surgeries.

The government easily could avoid restricting religious freedom by directly supplying poor women with contraceptives, just as it does worldwide.

Just as the 1st Amendment protects the free speech of citizens and corporations such as The Times, it also protects the free exercise of religion by citizens and employers. When the administration attempts to force even elderly nuns to violate their religious convictions, clearly the government has trampled on sacred 1st Amendment ground.

Resources
CMDA Right of Conscience Resources

Action
Use our easy pre-written customizable message to support H.R. 940 - Healthcare Conscience Rights Act (House bill) and S. 1204 - Health Care Conscience Rights Act (Senate bill)

FDA examines genetic tinkering

(Excerpted from "FDA raises concerns about three-parent embryo procedure," USA Today, February 26, 2014) - In two days of hearings ending Wednesday, a federal committee proved quite skeptical about research that might help some patients birth healthy children — but might also open the door to human gene manipulation. The procedure being considered, called mitochondrial transfer, would mix the genes of two women in hopes of creating a healthy baby.

Although the panel, which advises the federal Food and Drug Administration, did not take a vote, many members questioned the ethics of the procedure, and whether the research into it is as far advanced as some supporters claim.

All people carry two sets of genes in every cell: the 20,000 genes in the cell's nucleus, which determine traits like height, eye color and intelligence; and the 37 genes in the mitochondria, which provide energy for each cell. The mitochondrial transfer procedure would combine the nuclear genes from the mother with the mitochondrial genes of a donor woman. When fertilized, it would lead to babies with genetic material from three "parents."

The procedure promises to help women who carry defective genes that can lead to devastating mitochondrial problems in children, including blindness, organ failure and stroke. It might eventually also help resolve some types of infertility.

The committee considered what scientists would need to do before they could try the technique in people, and whether it would be possible to design a clinical trial to answer the many outstanding questions about the procedure. David Prentice, a cell biologist and senior fellow for life sciences at the Family Research Council, a conservative advocacy group, told the panel he strongly objects to any mixing of genetic material.

"The individuals created are experiments," he said by phone after the meeting ended. "You're actually creating and destroying young human life which we object to. It just seems a very wrongheaded way to proceed."

Commentary

Breaking News...

CMDA CEO Dr. David Stevens debated this issue with Ethicist Arthur Caplan on the Fox and Friends national news program, cohosted with Elisabeth Hasselbeck this morning. Dr. Stevens noted the destruction of human embryos in the proposed procedure and non-destructive alternatives to pursuing the cure. He also highlighted the ethical issue of foisting genetic changes, with unknown consequences, on successive generations.

"Germ line manipulation is something that has been prohibited in science all over the world up until the present time," Dr. Stevens noted.

Dr. Caplan replied, "I understand the concern about where we might go. I'm going to worry about that when I get there."

Watch the video here

CMDA CEO David Stevens, MD, MA (Ethics): “Dr. Caplan is not a scientist so maybe he doesn’t understand the grave dangers that germ line manipulation can cause. In some mice studies using ‘mitochondrial replacement therapy,’ there were decreased survival rates, developmental delays, fertility problems and behavioral changes in progeny. No one knows what will happen if it is tried in humans, but we do know that if problems occur, they will continue through every generation. We should be worrying about that now, not when ‘we get there.’ By then, it will be too late.

“As an Ethicist, Dr. Caplan should be concerned that the scientists experimenting on the unborn can’t get informed consent from that child’s granddaughter before doing experiments that will affect her life. He should be concerned that two of the methods of replacing ooplasm require cannibalizing another human embryo causing their death.

“Forty-one years ago, the Supreme Court decided a child could be destroyed if a woman didn’t want it. The FDA is now deciding whether a woman has the right to construct the child she wants. That decision is based on a genetic mutation problem that only causes serious disease in 400 to 600 of the four million babies born each year. If women get this new right, how can society deny them exercising it to correct more serious problems like obesity, diabetes or heart disease, if this ability becomes available through germ line manipulation? Look at all the money society would save on healthcare! Wouldn’t people be happier?

“While the scientist is tinkering, why stop at just making members of that family tree skinny? Why not add making them all six-foot tall, blue eyed and athletic? Welcome to the brave new world of designer babies and two classes of humans, the enhanced and unenhanced.

“As a society, we should not cross the clear line in the sand prohibiting germ line manipulation. It’s science too dangerous to use.”

Executive Director of The Tennessee Center for Bioethics & Culture D. Joy Riley, MD, MA: (from her testimony before the FDA, Feb. 25, 2014) – “It is remarkable to note that while more than 40 nations have prohibited germ line modification, we are contemplating stepping over that bright line. It is imperative that we reflect upon the words of philosopher George Santayana, who presciently wrote, ‘Those who cannot remember the past are condemned to repeat it.’ This applies in several ways.

“First of all, consider that this change is being evaluated by the ‘Cellular, Tissue and Gene Therapies’ Advisory Committee of the FDA. While this is your purview, it is not merely cells, tissues or genes which are being affected by this decision. No, it is human beings – human beings at their earliest stages – who are the subjects of this research. These are your and my children, grandchildren, nieces, nephews and cousins being considered here today. Their Petri dish appearance should not confuse us. They are very much human.

“Secondly, consider codes of international standing:

“The Declaration of Geneva proclaimed for physicians worldwide, ‘The health of my patient will be my first consideration.’

“The Declaration of Helsinki stated, ‘In medical research involving human subjects, the well-being of the individual research subject must take precedence over all other interests.’

“In the Council of Europe’s Convention on Biomedicine and Human Rights, intervention on the human genome is countenanced ‘only if its aim is not to introduce any modification in the genome of any descendants.’

Finally, a major requirement of research on human subjects is that of fully informed consent by the human being whose life, health and posterity will be impacted by the proposed human experiment. This is not therapy for the ones undergoing experimentation. Their very formation is the experiment under consideration here. They are not able to give consent; neither are all their descendants who come after them able to give consent, yet the proposal is to experiment on all of them by virtue of altering their germ line for all time.

Resources:
CMA Letter to FDA on Oocyte Modification in Assisted Reproduction
CMDA Genetics Resources

New method for growing stem cells

Excerpted from “Acid bath offers easy path to stem cells,” Nature. January 29, 2014 — In 2006, Japanese researchers reported¹ a technique for creating cells that have the embryonic ability to turn into almost any cell type in the mammalian body — the now-famous induced pluripotent stem (iPS) cells. In papers published this week in Nature², ³, another Japanese team says that it has come up with a surprisingly simple method — exposure to stress, including a low pH — that can make cells that are even more malleable than iPS cells, and do it faster and more efficiently.

“It’s amazing. I would have never thought external stress could have this effect,” says Yoshiki Sasai, a stem-cell researcher at the RIKEN Center for Developmental Biology in Kobe, Japan, and a co-author of the latest studies. It took Haruko Obokata, a young stem-cell biologist at the same centre, five years to develop the method and persuade Sasai and others that it works.

Obokata says that the idea that stressing cells might make them pluripotent came to her when she was culturing cells and noticed that some, after being squeezed through a capillary tube, would shrink to a size similar to that of stem cells. She decided to try applying different kinds of stress, including heat, starvation and a high-calcium environment. Three stressors — a bacterial toxin that perforates the cell membrane, exposure to low pH and physical squeezing — were each able to coax the cells to show markers of pluripotency.

Obokata has already reprogrammed a dozen cell types, including those from the brain, skin, lung and liver, hinting that the method will work with most, if not all, cell types. She now wants to use these results to examine how reprogramming in the body is related to the activity of stem cells. Obokata is also trying to make the method work with cells from adult mice and humans. “The findings are important to understand nuclear reprogramming,” says Shinya Yamanaka, who pioneered iPS cell research. “From a practical point of view toward clinical applications, I see this as a new approach to generate iPS-like cells.”

Commentary

CMDA Member and Senior Fellow for Family Research Council David Prentice, PhD: “Stress a Cell, Get a Stem Cell. It seems every time one turns around there’s a new non-embryonic stem cell discovery, each more amazing than the last. The latest in the journal Nature is no exception: simply stressing normal adult cells can transform them into embryonic-like stem cells, similar to the Nobel prize-winning induced pluripotent stem (iPS) cells made by Dr. Yamanaka. But unlike Yamanaka’s technique, these ‘STAP’ cells transform from mature mouse cells into stem cells under the influence of stressors such as acid or stretching, without genetic manipulation and in a much shorter time period. And don’t be confused by some of the stories, including the Nature news report. These are not adult stem cells as found in body tissues, nor are these new stem cells inherently embryos or able to form embryos, despite the fact that these mouse STAP stem cells can form placental as well as body tissue types. It takes more than haphazard production of all tissues to form an organism, as has already been seen with human embryonic stem cells. Dr. Maureen Condic has produced an in-depth review of the range of stem cell potency.

This new technique shows once again that there are many acceptable, ethical routes to stem cells, and absolutely no necessity for life destroying embryo research. Adult stem cells from tissues, which are the gold standard for patient treatment, as well as iPS cells and STAP cells, emphasize that ethical, life preserving science is also the best science.

Resources
CMDA Ethics Statement on Stem Cell Research
Scientific Demagoguery in the Stem Cell Wars by David Stevens, MD, MA (Ethics)

Brain-dead patient taken off life-support

Excerpted from “Brain-dead Texas woman taken off ventilator,” CNN Health. January 27, 2014 — A wrenching court fight—about who is alive, who is dead and how the presence of a fetus changes the equation—came to an end Sunday, January 26 when a brain-dead, pregnant Texas woman was taken off a ventilator. The devices that had kept Marlise Munoz's heart and lungs working for two months were switched off about 11:30 a.m. Sunday, her family's attorneys announced.

Munoz was 14 weeks pregnant with the couple's second child when her husband found her unconscious on their kitchen floor November 26. Though doctors had pronounced her brain dead and her family had said she did not want to have machines keep her body alive, officials at John Peter Smith Hospital in Fort Worth had said state law required them to maintain life-sustaining treatment for a pregnant patient.

Sunday's announcement came two days after a judge in Fort Worth ordered the hospital to remove any artificial means of life support from Munoz by 5 p.m. Monday. The hospital acknowledged Friday that Munoz, 33, had been brain dead since November 28 and that the fetus she carried was not viable. Her husband, Erick Munoz, had argued that sustaining her body artificially amounted to "the cruel and obscene mutilation of a deceased body" against her wishes and those of her family. Marlise Munoz didn't leave any written directives regarding end-of-life care, but her husband and other family members said she had told them she didn't want machines to keep her blood pumping.

Commentary

Since there are a variety of opinions on this difficult ethical issue, we have included 2 commentaries.

CMDA CEO David Stevens, MD, MA (Ethics):"While the medical technology being applied to Mrs. Munoz’s body might be considered “organ support” for her, it was “life support” for her unborn child. At the time of her death the baby was a few days from reaching 24-weeks gestation when survival rates approach 50%. Every day of continued life support improved the odds of the baby’s survival.

"A few days ago, on February 9th, Robyn Benson had a premature baby boy. Just after Christmas she suffered a cerebral hemorrhage resulting in her own brain death. She was maintained on life support until her baby was delivered. The ventilator was disconnected the day after her child was born. According to reports, the baby is doing well in the NICU.

"I don’t have access to the medical records in either of these cases, but a CNN article on the Benson case makes an inadequate effort to ethically differentiate between her baby’s situation and Mrs. Munoz’s. First, they let you know that one child was wanted by its father but the other was not. The worth of a human being does not depend on whether it is wanted or not. Secondly, the Munoz lawyer’s reported that an incomplete ultrasound had shown the baby had hydrocephalus and possibly other malformations. We should recognize that disposing of the disabled is unethical and simply eugenics. Who decides when a person is disabled enough for elimination?

"CMDA does not have an official ethics statement dealing with this complex issue. Maybe we should. You can contribute to the discussion of what it should say by clicking on the comment link below."

Clinical Ethicist and CMDA Trustee Robert D. Orr, MD, CM:“Marlise Munoz was dead, but her 14-week old fetus was alive. If Mom’s organs could be successfully perfused for another 12-14 weeks, her unborn baby could survive and be delivered by C-section. It is possible, though clinically very challenging. But should it be done?

“Marlise’s family did not want artificial support continued, and they were convinced she would not want it. The hospital believed Texas law prohibited removing life support from a pregnant woman. The legal issue was straightforward: Marlise was dead, therefore the support was not ‘life support’ for her, but ‘organ support’ for the benefit of the fetus. Continued support was legally optional.

“But what about the ethical dilemma? Who should decide? What factors should be considered? Some believe it is morally obligatory to do everything possible to prevent fetal death. Others believe that ‘doing everything’ is not always obligatory, making this comparable to high risk, high burden prenatal fetal surgery, i.e., optional, decided by her family based on their understanding of her wishes and values.

“Not all believers will agree. We will agree that we are stewards of our lives, our bodies and our resources. And we will likely agree it is immoral to intentionally end prenatal life for trivial reasons. The intention in continuation was to possibly benefit a second life. The intention in stopping was to discontinue ineffective and unwanted treatment. I personally believe continued support in this case was discretionary. And I believe we should not harshly judge the Munoz family’s decision.”

Resources

CMDA Ethics Statement on Vegetative State
Resources on End of Life Care

A new study shows religion helps toughen the brain

Excerpted from “Religion, Spirituality May Build Resilience Against Depression by Toughening the Brain, Study Suggests,”Psychiatric News Alert. January 9, 2014 — The reason that religion or spirituality appears to protect people with a familial risk of depression from developing the illness may be because religion or spirituality thickens the cortices of the brain, Columbia University researchers Lisa Miller, PhD, Myrna Weissman, PhD, and colleagues report in JAMA Psychiatry.

Their study included 103 adults who were either at high familial risk or low familial risk for depression. The importance they placed on religion or spirituality was evaluated at two time points during a five-year period. The thickness of their brain cortices was measured with MRI at the second time point. The researchers found that the brain cortices of subjects who placed a high importance on religion or spirituality were thicker than the brain cortices of those who did not, but that, in addition, the cortices were especially strong in those individuals who placed a high importance on religion or spirituality and who had a high risk of depression.

"This study points to measurable, beneficial effects of presumably healthy spirituality, especially for individuals with biological predispositions to depression," Mary Lynn Dell, MD, told Psychiatric News. The study, she continued, "adds to substantial and growing evidence that psychiatrists should support healthy development in that sphere of patients' lives. Studies such as these may also inform the particular ways and methodologies religious professionals...employ to care for and work with depressed individuals, while at the same time staying true to their particular religious beliefs and traditions."

Commentary

Sr. Vice President, CMDA Gene Rudd, MD: “A single study finding that the cerebral cortex is thicker in people who place a high priority on religion or spirituality obviously requires additional investigation. But it is only one new addition to the large amount of literature linking many positive health outcomes with religion and spirituality. That accumulative data is impressive – more than 1,500 studies and counting.


“So if faith is so good for health, why are we not introducing it more in clinical care? In surveying Christian doctors, we found that the great majority have a desire to engage the spiritual lives of their patients, but the obstacles that prevent them are 1) concerns about time, 2) fear of ethical concerns, and 3) ignorance of how to appropriately do so. Would it surprise you to know that there are excellent answers and solutions to each of these concerns?

“To help Christian doctors overcome the obstacles, effectively engage the spiritual needs of patients and improve overall healthcare delivery, CMDA has developed a curriculum called Grace Prescriptions. Visit www.cmda.org/gracerx to find information as to where and when these seminars will be held in the coming months. While the live seminar experience is the best way to gain this knowledge and skill, we are also developing a video curriculum that can be used by groups in their local communities. The video curriculum is expected to be released by summer 2014.

“As a means of honoring Christ’s command that we be salt and light, and as a means of broadening the scope of healing care for your patients, we hope you will join us in learning how to provide Grace Prescriptions.”

Resources
Grace Prescriptions
Faith and Health