Supreme Court to announce ruling on conscience v. coercion

Excerpted from commentary by Jennifer Marshall,"HHS Mandate: Only the Beginning of Obamacare’s Conscience Problems," Daily Signal, June 17, 2014 - Any day now the U.S. Supreme Court is expected to rule in the case of Hobby Lobby and Conestoga Wood Specialties—family-owned businesses that have gone to court to challenge a provision under Obamacare that requires them and nearly all other employers to cover abortion-inducing drugs, contraception and sterilization, regardless of their religious beliefs.

The suits, brought by the Green family, evangelicals who own Hobby Lobby, and the Hahn family, Mennonites who run Conestoga Wood, are among 49 filed by family-owned businesses challenging the Obamacare HHS mandate. The Obama administration has been unwilling to compromise. Meanwhile, 51 lawsuits have been joined by hundreds of non-profit religious organizations seeking to preserve their religious independence to set internal policy consistent with their faith. All told, 300 plaintiffs.

But it is important to remember that all this commotion is the result of one small aspect of one set of regulations concerning preventive care under Obamacare. And that means we’ve only just begun to see the potential conscience problems that could come from this massive overhaul of our health care system.

Handing the moral compass to remote bureaucrats to navigate this territory is a bad idea. The centralization of more decision-making about the benefits that health plans must provide means that such determinations are more likely to be made without respect for Americans’ differing beliefs on these issues.

That’s why we need patient-centered health care. Americans should be free to choose the health care plans that meet their needs and reflect their moral convictions. Individuals and families need to be able to direct their health care in accord with their conscience; that includes the benefits, treatments and procedures financed through their health insurance.

Commentary

CMA VP for Govt. Relations Jonathan Imbody: “My friend and colleague Jennifer Marshall realizes what our founders and the ancient philosophers knew--that left unchecked, Government will compete with God for the people's allegiance, replacing His universal standards with State ideology and mandating submission. Consider the following observations:

Plato: “[T]here exist divine moral laws, not easy to apprehend, but operating upon all mankind. God, not man, is the measure of all things.”ⁱ
Cicero: "True law is right reason in agreement with Nature; it is of universal application and everlasting; it summons to duty by its commands, and averts from wrong-doing by its prohibitions."ⁱⁱ
Augustine: "True justice has no existence save in that republic whose founder and ruler is Christ....ⁱⁱⁱ [T]there can be no people, and therefore no republic, where there is no justice."^iv
Thomas Jefferson: "[O]ur rules can have authority over such natural rights only as we have submitted to them. The rights of conscience we never submitted, we could not submit. We are answerable for them to our God."^v
James Madison: "Religion, or the duty which we owe our Creator, and the manner of discharging it, can be directed only by reason and conviction, not by force and violence; and therefore all men are equally entitled to the free exercise of religion, according to the dictates of conscience."^vi
Charles Colson: "Both church and state assert standards and values in society; both seek authority; both compete for allegiance. As members of both the religious and the political spheres, the Christian is bound to face conflict."^vii

When Government replaces God and His universal standards, the only standard left is the sword of the State, which it wields with coercive power (fining Hobby Lobby $791 million dollars a year^viii) to enforce its own ideology. Take a stand with the Green and Hahn families as they fight in the courts for religious freedom. As Mordecai explained to a hesitant Queen Esther,^ix this edict also has you in its crosshairs.

Resources
CMA Supreme Court brief in Hobby Lobby religious freedom case
CMA’s Freedom2Care website on freedom of faith, conscience and speech
CMA commentaries

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)

ⁱ Cited in Russell Kirk, The Roots of American Order (LaSalle, Ill.: Open Court, 1974), 81.
ⁱⁱ Charles Colson and Ellen Santilli, God and Government, Grand Rapids: Zondervan, 1987, updated 2007, Kindle location 4917.
ⁱⁱⁱ Colson, location 1482.
^iv Colson, location 14479.
^v Thomas Jefferson (1743–1826), U.S. president. Notes on the State of Virginia (1787), Query 17, p. 159, ed. William Peden (1954).
^vi James Madison (1751–1836), U.S. president. Virginia Declaration of Rights, 1776. W.T. Hutchinson et al., The Papers of James Madison, vol. 1, p. 175, Chicago and Charlottesville, Virginia (1962-1991).
^vii Colson, Kindle location 2223.
^viii http://townhall.com/columnists/hankadler/2014/03/29/hobby-lobby--when-is-26-million-really-43-million-n1815062/page/full
^ix Esther 4:13.

Contraception's impact on abortion disputed

Excerpted from "Does Contraception Really Reduce the Abortion Rate?," commentary by Michael J. New, National Review Online, June 17, 2014 - Last week, the Guttmacher Institute released an analysis of the recent decline in the incidence of abortion. Overall, the abortion rate declined by an impressive 13 percent between 2008 and 2011 and reached its lowest level since 1973. This Guttmacher analysis joins a chorus of pundits — including Andrew Sullivan — who were quick to credit contraception for this decline in the abortion rate. And like most Guttmacher studies, this analysis is quick to downplay pro-life laws and other pro-life efforts.

The author makes a fair point that the abortion decline was fairly consistent throughout the country and was not concentrated in states that were active in passing pro-life laws. He correctly points out the sharp increase in state-level pro-life laws took place after the abortion decline already happened. However, the study presents a false dichotomy between either crediting legislation or crediting contraceptives for the falling abortion numbers. Indeed, it neglects other factors such as public opinion. In 2009, for the very first time, Gallup reported that a majority of Americans described themselves as “pro-life.”

A longer term analysis of abortion trends reveals insights which weaken Guttmacher’s case. Last month, the Charlotte Lozier Institute released a study by Susan Wills analyzing the U.S. abortion decline from 1990 to 2010. The key finding is that the abortion decline has not been uniform among age groups. The declines have been the greatest in both absolute and percentage terms among teens and women in their early 20s. This is important for two reasons. First, Long Acting Reversible Contraceptives (LARCs), which are touted by Guttmacher, tend to be unpopular with this subset of women. Second, there is a growing body of data showing declines in teen sexual activity since the early 1990s. As such, contraceptive use may be playing less of a role in the long-term abortion decline than the Guttmacher analysis would indicate.

Additional analysis further weakens Guttmacher’s argument. According to its own statistics, the number of abortions has fallen by roughly 34 percent since 1990 and the abortion rate has fallen by 38 percent since that time. It is true that contraception use has increased since the early 1990s, but it’s also true that contraception use has been rising steadily since the early 1960s, and obviously predates the abortion decline by a significant number of years. More importantly, even though contraceptive use has gone up, the fertility rate and unintended pregnancy rate have both actually increased slightly since the mid-1990s. All in all, pro-life efforts to change the hearts and minds of women facing crisis pregnancies might be more effective than commonly realized.

Commentary

CMDA Executive Vice President Gene Rudd, MD – “When I recently asked an accountant for a financial report, her response was, “What do you want the numbers to be?” I had heard this as a joke, but she seemed serious. When I told her I wanted the numbers to be accurate, she explained that she could make a variety of assumptions and chose different methodologies that would produce somewhat different results. If I had a preference for how the numbers should look, she would make decisions that would influence the numbers in that direction. To me it sounded like cooking the books; essentially asking what I wanted 2 + 2 to equal.

“And it is not only in accounting. The medical and scientific literature are replete with similar biases and influences that determine outcome, intentional or not. A survey published in the journal Natureⁱ revealed the magnitude of the problem, from poor record keeping (27 percent) to outright fraud. And these were the researchers themselves admitting wrongdoing! Actual misbehavior may be higher.

“We should be wary that those with social or political agendas will cook the books, reporting data the way that serves their purpose. What do you think the Guttmacher Institute (founded and funded by Planned Parenthood) wants the numbers to be?”

Resources
CMDA Resources on Abortion

ⁱMartinson BC, Anderson MS, de Vries R. Scientists behaving badly, Nature 435/9, June 2005.

Administration moves to enforce same-sex "marriage" ideology

Excerpted from "Freedom2Care blog posting," "Jackbooted 'Tolerance,'" by Jonathan Imbody, June 6, 2014 - The Obama administration appears prepared to enforce its ideology regarding same-sex marriage with trademark inflexibility and atypical efficiency. Administration officials have begun inserting into federal grants notices and other official policies sweeping new requirements and definitions of marriage.

While the new policies cite as their rationale a need to implement the Supreme Court's recent Windsor decision on same-sex marriage, the way agencies are applying that viewpoint to grants appears aimed at eliminating from the public square any groups that disagree with the administration's ideology.

Exactly what this flood of apparently inflexible new policies means to groups with values that differ from the Obama administration will play out in the upcoming months and meanwhile requires legal analysis. The broad, sweeping language of the new policies make it difficult to determine precisely how and in what specific areas the Obama same-sex doctrine will be applied.

Meanwhile, the outlook appears ominous, for example, for:

• Faith-based organizations that maintain fidelity to Judeo-Christian sexual norms in their policies and personnel practices.
• Sexual education programs that emphasize the benefits of saving sex for (traditional) marriage.
• Adoption agencies that recognize in their policies the benefit to children of having a father and mother.
• Health organizations that emphasize the health benefits of male-female monogamy.

Policies enforcing the administration's marriage ideology (conveniently couched in the context of Windsor) are cropping up across federal agencies, including this one from the Health Resources Services Administration:

Federal Recognition of Same-sex Spouses/Marriages
[A]ll grant recipients will be subject to a term and condition that instructs grantees to recognize any same-sex marriage legally entered into in a U.S. jurisdiction that recognizes their marriage....

Within days, the Supreme Court will announce its decisions in cases involving the Obama administration's trampling of religious freedom in its drive to enforce its ideology regarding contraception and abortion. The administration's new policies enforcing its ideology regarding same-sex marriage will make good summer reading for the justices, since they can expect a raft of related cases next term.

Resources
CMA’s Freedom2Care website on freedom of faith, conscience and speech
CMDA Human Sexuality Ethics Statement
CMA commentaries

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)

Understanding palliative care

Excerpted from "Teaching doctors when to stop treatment," commentary by Diane E. Meier and Health Affairs in The Washington Post. May 19, 2014 — For years I had tried to understand why so many of my colleagues persisted in ordering tests, procedures and treatments that seemed to provide no benefit to patients and even risked harming them. I didn’t buy the popular and cynical explanation: Physicians do this for the money. It fails to acknowledge the care and commitment that these same physicians demonstrate toward their patients.

Patients and families often assume their doctors are trained and knowledgeable about end of life. Patients and families also assume that doctors will tell them when time is running out, what to expect and how best to navigate these unknown and frightening waters. But many doctors don’t do these things. Most, in fact, have no training in this. Medical school and residency have traditionally provided little or no instruction on how to continue to care for patients when treatments no longer work.

Physicians are trained to make diagnoses and to treat disease. Untrained in skills such as pain and symptom management, communication about what to expect in the future and achievable goals for care, physicians do what we have been trained to do: Order more tests, more procedures, more treatments, even when these things no longer help. Even when they no longer make sense.

So how do we fix this? To change behavior, we must change the education and training of young physicians and the professional and clinical culture in which they practice. New doctors should learn about the management of symptoms such as pain, shortness of breath, fatigue and depression, with intensive training on doctor-patient communication: how to relay bad news, how to stand with patients and their families until death and how to help patients and families make the best use of their remaining time together.

Commentary

CMDA Past President and Oncologist Al Weir, MD: “The author describes an unusual case history to suggest two important questions: As doctors, do we know how to resist making life longer when it’s no longer likely and instead focus profoundly on making life the best it can be? Do we know how to ask others to help us in this task?

“Sometimes we, and our patients, may cling to hopes that are no longer realistic. Instead, we should be open and honest and help our patients navigate their way through a new truth of life. Such a shift in effort does not come naturally for most of us; time, skills and compassion are required. Palliative care teams are often the best way to supplement the capabilities and time we may be lacking.

“Even experienced doctors should seek to sharpen their skills and become mentors for our next generation, so that these younger doctors may be more adept at compassionate end of life care than we have been.

“Today was an unusual day for me in which I had the privilege of sharing bad news and redirecting life goals with three patients, while a medical student leaned silently against the exam room wall. After the last such conversation I probably surprised him by saying, “You know, though the circumstances are horrible, I actually like having these conversations. In such moments, I can be the one who shares this awful truth with kindness and love. I trust myself to do this better than others, because I really care for them. I did the work to help them live longer. Now things have changed and I can do the work to help them live better.”

Resources
End of Life Care Resources
Medical Futility Ethics Statement
When Your Doctor Has Bad News by Al Weir, MD

Are you interested in learning more about bioethics? Join us in Deerfield, Illinois on June 19-21, 2014 at The Center for Bioethics & Human Dignity’s 21st Annual Summer Conference – Bioethics in Transition. With a variety of workshops and courses, you will examine the rapid advances in medicine, science and technology that continue to reshape the scope and landscape of bioethics.

The statistics of today’s patient totals

Excerpted from “How many patients should your doctor see each day?” commentary by Lenny Bernstein in The Washington Post. May 22, 2014 — In light of the allegations that some Veterans Affairs Department health clinics used elaborate schemes to hide the records of patients who had waited months for care, I began to wonder what a normal caseload would look like for an average physician outside the VA system. And if your doctor has a larger-than-average caseload, is he or she able to give you the attention you need?

The numbers are pretty stunning. A 2012 article in the Annals of Family Medicine noted that the average primary-care physician has about 2,300 patients on his “panel”— that is, the total under his or her care. Worse, it said that each physician would have to “spend 21.7 hours per day to provide all recommended acute, chronic and preventive care for a panel of 2,500 patients.”

According to a 2013 survey by the American Academy of Family Physicians, the average member of that group has 93.2 “patient encounters” each week — in an office, hospital or nursing home, on a house call or via an e-visit. That’s about 19 patients per day. The family physicians said they spend 34.1 hours in direct patient care each week, or about 22 minutes per encounter, with 2,367 people under each physician’s care.

In 2012, the Physicians Foundation, a nonprofit group, surveyed 13,575 doctors across the United States and found that 39.8 percent see 11 to 20 patients per day and 26.8 percent see 21 to 30 a day. In an email, Lou Goodman, president of the foundation, wrote that “physicians are working fewer hours, seeing fewer patients and limiting access to their practices in light of the significant changes to the medical practice environment. The research estimates that if these patterns continue, 44,250 full-time-equivalent physicians will be lost from the work force in the next four years.”

Commentary

CMDA Member Thomas Eppes, MD:“The article from the Post raises multiple questions and thoughts from multiple perspectives in seeking to answer the question of how many patients a doctor should have under their care. If you are the patient, the answer is easy, one and it’s me. If you are the physician, the answer is enough to survive, enough to ‘bring home the bacon, enough to pay back the loans, enough to meet the requirements of my contract, enough for whatever your financial goals might be, etc. If you are the physician’s spouse, just enough to support the family and still get home to be with them and the kids. We could go on and on.

“The world is creating multiple pressures on physicians to see more patients, more efficiently, more electronically, with higher quality and even perfect quality, at no greater cost.

“Solutions for individuals include abandon ship, to retire, to go part-time, to do concierge practices or to build highly efficient teams. The days of seeing patients on a merry-go-round at full speed ahead are quickly disappearing as we move from volume driven care to quality proven population management. The proven and comfortable model of the past has to be altered in a quantum way as new and unproven ‘solutions’ pop up. It is quite unsettling, especially for those nearing the end of their practice life.

“What did our Lord do? Obviously, if there ever was one under a time constraint it would have been He. Yet He never ran anywhere, and He was fussed at for not being timely by others not being cared for at that moment. Yet the Bible tells us He met every ‘patient’ where they needed to be met.

“As each of us struggles with our individual station in our walk on this earth, we need to be ever mindful that we are accountable to only our Lord for how we meet His calling for our lives. We should each day see each patient encounter as our opportunity and appointment to glorify Him as we do His work on this earth, whether it be one patient, 30 or 100. This is what those who are trusting us to care for them want and deserve. Prayerfully, each healthcare professional can do this only if our eyes are on Him as He gives us the wisdom, energy, grace, insight and stamina to do His will every day.”

Resources
Faith and Health Resources

Christian physician in Egypt faces death for her faith

Excerpted from “Only a court can release Sudanese Christian woman on death row,” CNN. May 31, 2014 — Mariam Yahya Ibrahim was condemned to die by hanging after she declined to profess she is a Muslim, the religion of her father. Sharia law considers her a Muslim and does not recognize her marriage to a Christian. She is unlikely to change her mind despite giving birth in prison, says her husband Daniel Wani, who also is a Christian. Some Western media outlets have reported that Ibrahim would be released in a few days, but her husband said that only the appeals court could free his wife.

Technically, the president of Sudan cannot pardon her, so the judiciary might be the only way out for the government, which is coming under increased international pressure to release Ibrahim. The court convicted her of apostasy and adultery two weeks ago. At the time, she was eight months pregnant. She gave birth to a baby girl this week at a Khartoum prison, where she’s detained with Martin, her 20-month-old son.

Despite languishing in prison with two infants, she’s holding firm to her beliefs, according to her husband. “There is pressure on her from Muslim religious leaders that she should return to the faith,” Wani told CNN. “She said, ‘How can I return when I never was a Muslim?’”

Wani said his wife is a practicing Christian, more so than him. “I know my wife. She’s committed.” His wife, he said, was raised a Christian by her mother, an Ethiopian Orthodox, after her Muslim father deserted the family when Ibrahim was 6.

Commentary

Family Physician and Women in Medicine and Dentistry (WIMD) Chair Amy Givler, MD: “Forced faith is an oxymoron – if faith does not come from inner conviction, then it is not faith at all.

“Meriam Yahya Ibrahim, a fellow physician, has shown tremendous courage in not denying her Christian faith. This week, the Sudanese appeals court could rule on her case. Over the weekend, a Sudanese official stated she would be freed within days, but this was denied by the spokesman for the Sudanese foreign ministry. Growing international pressure is calling for Sudan to dismiss the case and free Dr. Ibrahim from prison, along with her newborn daughter and 21-month-old son.

“If not freed, Dr. Ibrahim faces 100 lashes within a few weeks (for the adultery charge) and death by hanging (for the apostasy charge). Ideally, as Islamic law allows, she would have two years to care for her infant before her death, but I am concerned whether, in prison, she will receive the nourishment needed to continue to breastfeed her daughter.

“Of course, being freed from prison doesn’t guarantee Meriam’s safety in a country where many Muslims, including family members, would feel justified in killing a woman whom they perceive as apostate. Refugee status in the U.S. could be authorized by President Obama, or her visa application (filed years ago after she married her U.S. citizen husband) could be expedited by Secretary of State Kerry.

“If there is the political will to do so, tremendous pressure from the U.S. could be placed on the Sudanese government, which receives around one-fourth of its budget from foreign aid. The U.S. gives the largest share of this, mostly through the U.N. ($216 million) for humanitarian aid, as well as $11 million in direct aid to Sudan’s government.”

Action
Urge Your member of Congress to support resolution calling for release of imprisoned Sudanese Christian Meriam Ibrahim
Urge Secretary of State Kerry to work to bring Meriam Ibrahim to the U.S.

Resources
Press release from Senator Roy Blunt