Thursday, July 31, 2014

CMDA member challenges discrimination with conscience lawsuit

Editor's note: The following story features CMDA member Sara Hellwege, a key leader in CMDA's Atlanta ministry. Please pray for and stand with Sara as she courageously fights for protections that will benefit you and other life-affirming, conscientious healthcare professionals.

Excerpted from "A War on Women’s Health," commentary by Ian Tuttle, National Review, July 24, 2014 - Because it’s usually hidden beneath excuses, justifications, and pretexts, employer discrimination can be difficult to uncover. Not for Sara Hellwege [Hell-VAY-guh]. The aspiring nurse-midwife’s potential employer, a federally funded health center in Tampa, Fla., made its reason for not hiring her unmistakably clear: "Due to the fact ... you are a member of [a pro-life Ob-Gyn group], we would be unable to move forward in the interviewing process."

Hellwege, with the aid of Alliance Defending Freedom, a legal organization that focuses on religious-freedom violations, has filed suit against the Tampa Family Health Centers, Inc. (TFHC), for violating both federal and state law. Hellwege and Matt Bowman, senior legal counsel with ADF and one of Hellwege’s attorneys, contend that TFHC violated 42 U.S. Code § 300a–7d, which states:
No individual shall be required to perform or assist in the performance of any part of a health service program or research activity funded in whole or in part under a program administered by the Secretary of Health and Human Services if his performance or assistance in the performance of such part of such program or activity would be contrary to his religious beliefs or moral convictions.
By all indications, Hellwege’s legal case is about as straightforward as they come. But the legal issues are irrelevant in the feminist blogosphere, where Hellwege has been savagely attacked.

But there is no conspiracy here — the law, at both federal and state levels, is clear, which perhaps explains its curious absence from the discussion at Salon and Wonkette — nor is there an effort to "refuse to provide women’s health care." Hellwege studied a field of care — midwifery — that is strictly for women, and she voluntarily sought out a position where she could serve poor women who often receive subpar care.

"The Left’s mantra of access is hollow," says Bowman, "because they want to deprive women of access to good, qualified nurses — like Sara." Bowman hopes that TFHC will admit wrongdoing and give Hellwege the chance to interview. If not, she and ADF are prepared to pursue their case using all available legal means.

"Many women want a pro-life midwife or nurse or doctor," he adds. "If the federal government can discriminate, women will have no options. There needs to be diversity among health providers, including religious and moral diversity that allows patients to have access to professionals who share their values."


Dr. David StevensCMDA CEO David Stevens, MD, MA (Ethics): “The focus of this lawsuit is not defending a particular position on hormonal contraceptives, but rather defending a healthcare professional’s right to make conscientious decisions, even if that view is a minority position. Religious freedom does not mean simply protecting our own particular views on moral matters but protecting the right of each individual to make moral decisions based on conscience and ethical standards. Thus, we must defend a Muslim woman’s right to wear the hijab and the Jewish man’s right to wear the yarmulke as vigorously as we defend our own right to not be involved in abortions or other objectionable practices in healthcare.

“The position Sara applied for was to provide ‘all outpatient primary care’ so it went far beyond just providing contraception. Disqualifying Sara based on just this one aspect of her job is just like disqualifying an OB/Gyn candidate for declining to do abortions.

“Pray for Sara. She has been under vicious attacks in publications like Jezebel, Slate, Wonkette, Americans United for Separation of Church and State, Styleite, Opposing Views and The Raw Story. She is standing up with the aid of the Alliance Defending Freedom to defend both your conscience freedoms and my conscience freedoms. I applaud her courage. The outcome of her case involving enforcing the Church Amendment could affect us all.”

  1. Urge your U.S. senators to support (or thank your senator for already co-sponsoring) the Health Care Conscience Rights Act - S. 1204 , to protect religious liberty and preserve patient access by providing conscience protections for health care professionals. (Note: You will be provided with editable text based on your senator's sponsorship or non-sponsorship of this bill.)
  2. Urge your U.S. Representative to support (or thank your Rep. for already co-sponsoring) the Health Care Conscience Rights Act - H.R. 940.
  3. Send a message to Sara
CMDA's Freedom2Care website: Freedom of faith, conscience and speech
CMDA's Freedom2Care commentaries in national newspapers
CMDA Freedom of Faith and Conscience resources
Fla. health center denies nursing job to pro-life woman - Alliance Defending Freedom

Will doctors be forced to kill?

Excerpted from "Will doctors be forced to kill?" commentary by Wesley J. Smith, First Things, July 25, 2014 - The wailing and gnashing of teeth in some quarters over the modest Hobby Lobby decision has me worried. Apparently, many on the political port side of the country believe that once a favored public policy has been enacted, it immediately becomes a "right" that can never be altered or denied. More, once such a "right" is established for the individual, others should have the duty to ensure access—even at the cost of violating their own religious consciences.

If such thinking prevails, medical professionals could be forced to participate in the taking of human life, for example in abortion, assisted suicide, and (given the research trends in regenerative medicine) providing treatments derived from the intentional destruction of human embryos or fetuses.

That certainly seems to be the direction in which the ACLU wishes to take the country. Recently, the ACLU of Washington State began trolling for potential clients to sue medical professionals or facilities that refused to participate in certain legal procedures or transactions based on religious objection:
"Have you or members of your family been denied reproductive health care or end-of-life services by a religiously based medical facility? The ACLU believes that everyone in Washington has the right to receive health care that is not restricted by the religious beliefs of others."
The solicitation listed specific procedures—some of which involve the taking of human life—that presumably a patient should have a right to receive. They include:
  • Abortion
  • Information about Washington’s Death with Dignity Act [the law permitting doctor-assisted suicide for the terminally ill];
  • Referral to support organizations or cooperating providers to assist a patient in using Washington’s Death with Dignity Act;
  • Medical providers permitted to participate in Washington’s Death with Dignity Act;
  • Palliative care/nursing support for patients who choose to stop eating and drinking to allow natural death (e.g., participation in suicide by starvation, not a natural death)
  • Pharmacy dispensary (e.g., forced dispensing of drugs used in assisted suicide, RU 486 abortions, etc.)
Moreover, the American medical establishment already opposes conscience exemptions for abortion and the dispensing of contraception. For example, the American College of Obstetricians and Gynecologists (ACOG) published an ethics-committee opinion denying its members the right of conscience against abortion.

Such denial of medical conscience is not yet embedded in American law. But if the anti-religious liberties lobby gets its way, it will be. Indeed, in coming years, medical professionals who believe in the Hippocratic Oath’s prohibition against killing could well be driven out of medicine.


Jonathan ImbodyJonathan Imbody, CMA VP for Govt. Relations: – The US Senate recently highlighted this battle over conscience and autonomy by voting on a bill (the Women’s Health Protection Act, S. 1696) that would, in the words of the National Right to Life Committee, "invalidate nearly all existing state limitations on abortion ... [including] laws allowing medical professionals to opt out of providing abortions, laws limiting the performance of abortions to licensed physicians, bans on elective abortion after 20 weeks, meaningful limits on abortion after viability, and bans on the use of abortion as a method of sex selection." Thankfully, the Senate bill failed, on a largely party-line cloture vote.

The bill reflects the escalating conflict between two camps in American society that hold irreconcilable worldviews: those who follow objective moral and ethical standards outside themselves (such as the Bible and the Hippocratic oath) and those whose only ethic is autonomy, which boils down to "whatever I want." The scary part is that many authorities in the medical community, which used to lead the way in promoting and following objective ethical standards, have all but abandoned the Hippocratic oath and increasingly promote autonomy as the ethic that trumps all else.

As appealing as autonomy may sound and even though it has its place in some cases, it is not the kind of standard that protects others well at all, like the Bible and the Hippocratic oath do. That's because one person's autonomy in one direction inevitably runs smack into another person's autonomy headed in the opposite direction. What happens then? Whoever is strongest wins.

If a patient gains the power in the name of autonomy to demand and receive whatever he or she wants, the healthcare professional becomes a mere "provider" and loses the essence of professionalism--professing to follow an objective standard. Similarly, if a mother insists on fulfilling her autonomy through an abortion, the baby loses her life.

Autonomy brooks no competition. So autonomy is less a reliable ethic and more a prescription for conflict, an enemy of tolerance and diversity.

In the First Amendment's establishment clause ("Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof"), America's founders carefully balanced conscience freedoms with community interests, minority rights with majority rule, individual liberty with governmental function. We must shore up that understanding of freedom every chance we get--in the culture, in Congress and in the courts--or we will lose the ability to live out our faith in our professions and in the public square.

  1. Urge your U.S. senators to support (or thank your senator for already co-sponsoring) the Health Care Conscience Rights Act - S. 1204 , to protect religious liberty and preserve patient access by providing conscience protections for health care professionals. (Note: You will be provided with editable text based on your senator's sponsorship or non-sponsorship of this bill.)
  2. Urge your U.S. Representative to support (or thank your Rep. for already co-sponsoring) the Health Care Conscience Rights Act - H.R. 940.

CMDA's Freedom2Care website: Freedom of faith, conscience and speech
CMDA's Freedom2Care commentaries in national newspapers
CMDA Freedom of Faith and Conscience resources
"U.S. Senate Democrats launch push for “the most radical pro-abortion bill ever" - National Right to Life

Religious freedom law is essential

Excerpted from "A Perpetual Haven: Why the Religious Freedom Restoration Act Matters," commentary by Kim Colby, Public Discourse, June 30th, 2014 - Religious liberty is America’s most distinctive contribution to humankind. The genius of American religious liberty is that we protect every American’s religious beliefs and practices, no matter how unpopular or unfashionable they may be. By protecting all religious beliefs and practices regardless of their popularity or political power, religious liberty makes it possible for citizens who hold very different worldviews to live peaceably together. Robust religious liberty avoids a political community riven along religious lines.

But religious liberty is fragile, too easily taken for granted, and too often neglected. A leading religious liberty scholar, Professor Douglas Laycock of the University of Virginia, recently warned: "For the first time in nearly 300 years, important forces in American society are questioning the free exercise of religion in principle—suggesting that free exercise of religion may be a bad idea, or at least, a right to be minimized."

Congress’s passage of the Religious Freedom Restoration Act of 1993 (RFRA) was a singular achievement. For two decades, RFRA has stood as the preeminent federal protection of all Americans’ religious liberty. RFRA ensures a level playing field for Americans of all faiths. It puts "minority" faiths on an equal footing with any "majority" faith.

Yet RFRA has recently become a prime target for those who would deny robust protection to religious liberty. Congress may soon come under pressure to amend RFRA and diminish its protection, if the Supreme Court upholds RFRA’s protection of Americans whose religious consciences will not allow them to comply with the HHS mandate. Congress must withstand such pressure in order to protect religious liberty in America.

RFRA creates a level playing field for Americans of all faiths, putting "minority" faiths on an equal footing with "majority" faiths. Essentially, RFRA makes religious liberty the default position in any conflict between religious conscience and federal regulation.

The oft-heard argument that America must limit religious freedom because it has become more religiously diverse has it precisely backwards. Robust religious liberty is the reason for America’s dramatic diversity and remains essential to maintaining that diversity. RFRA ensures religious diversity by protecting all religions, including the hundreds of numerically disadvantaged faiths, by increasing the likelihood that those faiths will obtain sensible exemptions from well-intentioned laws that unknowingly restrict their religious practices.

In the long term, RFRA maximizes social stability in a religiously diverse society and minimizes the likelihood of political divisions along religious lines. The reason is simple. As Laycock puts it, "religious liberty reduces social conflict; there is much less reason to fight about religion if everyone is guaranteed the right to practice his religion." In other words, RFRA implements the Golden Rule in the context of religious liberty: in protecting others’ religious liberty, we protect our own religious liberty.


Jonathan ImbodyThe author of this piece, colleague Kim Colby of the Christian Legal Society, is one of a cadre of smart and savvy attorneys forming a bulwark of religious freedom through landmark litigation. CMDA has participated with Christian Legal Society, Alliance Defending Freedom, Americans United for Life and others in over 40 court cases. We meet regularly in Washington, DC to discuss legal strategy, messaging and culture-changing strategies to preserve the religious freedoms ensconced in the First Amendment, the Religious Freedom Protection Act and three federal laws protecting conscience in healthcare.

Such freedoms are never free, and we remember that "eternal vigilance is the price of liberty." So I hope you will take a moment now to use the quick and easy form at our Freedom2Care legislative action website to tell your legislators to protect your conscience freedoms:

Protect conscience rights - HR.940
End discrimination in health care - S.1204

  1. Urge your U.S. senators to support (or thank your senator for already co-sponsoring) the Health Care Conscience Rights Act - S. 1204 , to protect religious liberty and preserve patient access by providing conscience protections for health care professionals. (Note: You will be provided with editable text based on your senator's sponsorship or non-sponsorship of this bill.)
  2. Urge your U.S. Representative to support (or thank your Rep. for already co-sponsoring) the Health Care Conscience Rights Act - H.R. 940.

CMDA's Freedom2Care website: Freedom of faith, conscience and speech
CMDA's Freedom2Care commentaries in national newspapers
CMDA Freedom of Faith and Conscience resources

Thursday, July 10, 2014

The difference between right and wrong in medicine

Excerpted from "Doing What Might Be ‘Wrong’: Understanding Internists’ Responses to Professional Challenges," Academic Medicine. April, 2014 — To develop a deeper understanding of the complexity of physicians’ decision making when faced with professional challenges, Dr. Shiphra Ginsburg and a team conducted a secondary analysis of transcripts from focus groups with 40 internists in 2011. Participants responded to scripted professional challenge scenarios, and the authors then analyzed the transcripts for instances in which participants discussed “doing what might be wrong” (i.e., something that goes against their values or others’ expectations). They used the theory of planned behavior (TPB), which posits that intention to act is predicted by attitudes, subjective norms and perceived behavioral control, to understand the findings in a broader context.

The results showed that the theme of “doing what might be wrong” was pervasive, particularly in response to scenarios involving stewardship, non-patients’ requests for advice or care or requests for email access. Participants’ rationales for suggested behaviors included a desire to keep patients happy and be (or appear) helpful.

The study’s authors concluded that physicians often do what might be wrong when they are asked to do something that goes against their values and beliefs, by patients, others or as perceived by their organizations. Actions are often rationalized as being done for the right reasons. The study reported that these findings should inform the development of educational initiatives to support physicians in acting in accordance with their ideals.


Dr. Gene RuddCMDA Executive Vice President Gene Rudd, MD: “These findings are troubling. Medicine has always had some ‘bad apples,’ physicians who failed to live up to the values of the profession. But now we hear that physicians ‘often’ choose to violate their conscience and do what is wrong when someone else expects them to. Such wholesale capitulation with cultural expectations will undermine all medical ethics.

“I recall a patient asking that I change the due date of her pregnancy on an insurance form to make it more likely she would qualify for coverage. While I wanted to please her, I recall my conscience warning me that it would be wrong. I told her that if I ever lied for her, she could never be sure that I wouldn’t lie to her. I expected her to leave my practice, but in this case, she didn’t. She found the demonstration of integrity more valuable than the potential loss of insurance coverage.

“Maintaining ethics begins with personal integrity. Whatever the ethical value, to be operative, the individual must have the moral courage to adopt it. This study reveals the widespread lack of moral courage required to adhere to convictions. No wonder standards of professionalism promoted over the last decade have failed to change professional behavior.1 Values, morals or ethics mean nothing and accomplish nothing without disciplined commitment to them. Convictions are nothing more than casual opinions unless acted on.”

1Kinghorn WA, McEvoy MD, Michel A, Balboni M., Professionalism in modern medicine: does the emperor have any clothes?, Acad Med. 2007 Jan;82(1):40-5.


Professionalism in Peril – Character Counts by Gene Rudd, MD
Grace Prescriptions – Learning How to Share Your Faith in Practice

Response to the Hobby Lobby ruling

Excerpted from CMA doctors hail Supreme Court mandate ruling, decry ongoing targeting of faith community,” CMDA News Release. June 30, 2014 — The 15,000-member Christian Medical Association, the nation's largest and oldest faith-based doctors' organization, today praised the Supreme Court's ruling in two Health and Human Services (HHS) Obamacare mandate cases but noted "increasing attempts by the government to coerce the faith community." CMA had outlined the medical aspects underlying religious objections to the HHS Obamacare mandate in its friend of the court brief in Burwell v. Hobby Lobby and Conestoga Wood v. Burwell.

CMA CEO Dr. David Stevens said in a statement, "We are very thankful that the Supreme Court acted to protect family businesses from government coercion and fines for simply honoring the tenets of their faith.

"This is a much-needed victory for faith freedoms, because this administration continues its assault on the values of the faith community. We are witnessing increasing attempts by the government to coerce the faith community to adopt the government's viewpoint in matters of conscience," noted Stevens.

CMA also filed a friend-of-the-court brief in another Supreme Court case this term, McCullen v. Coakley, to defend First Amendment free speech and assembly rights of pro-life advocates against a Massachusetts law that prohibited many citizens from entering a public street or sidewalk within 35 feet of an abortion facility.

"There seems to be growing intolerance of the faith community by some government officials who appear to want to extinguish the First Amendment freedoms that allow for a diversity of values," Stevens observed, "We are seeing this antagonism expressed in coercive government mandates enforced with harsh penalties and discriminatory practices that threaten to eliminate the faith community from the public square."


Dr. David StevensCMDA CEO David Stevens, MD, MA (Ethics): “I’m appalled that the ruling was five to four. One vote and we would have lost religious freedom, perhaps forever, in this country. It would have impacted us as healthcare professionals most of all, as Judge Alito noted in his majority opinion. He wrote, ‘Under HHS’s view, RFRA (the Religious Freedom Restoration Act) would permit the Government to require all employers to provide coverage for any medical procedure allowed by law in the jurisdiction in question—for instance, third-trimester abortions or assisted suicide.’

“We are already seeing the co-opting of the unwilling as a result of court rulings in the same-sex marriage issue. The courts are requiring participation by family-owned businesses in wedding ceremonies, despite their religious objections. The government is also forcing recognition of same-sex marriages as a condition for federal grants in this country and abroad.

CMDA’s amicus brief, representing you, affected the decision. It scientifically established the potentially deadly effect of two ‘morning after pills’ and two types of IUDs on nascent life before implantation. That fact was accepted in the majority opinion.

“We won the battle, but the war is not over. We must continue to fight relentlessly locally and nationally to protect healthcare right of conscience. The stakes are just too great to do otherwise.”


Learn more about CMDA’s efforts to protect the right of conscience
CMDA’s amicus curiae brief

Divorce rates in the church

Excerpted from “Church Divorce Rate Way Lower Than Anyone Thought,” Charisma News. June 23, 2014 — It's long been believed that half of America's marriages end in divorce and the problem is just as bad in the Church as the rest of the country. But when Harvard-trained researcher Shaunti Feldhahn tried to find the actual research to prove those points, she couldn't. It started her on an eight-year odyssey to find the actual facts.

The Atlanta-based researcher and author realized the widespread belief that marriage failure is as bad in the Church as the rest of the world demoralizes Christians and can even cause them to question their faith. In her book, The Good News About Marriage, Feldhahn lays out what she found during her eight years of investigating the complicated, complex divorce statistics. First, the divorce rate is way below 50 percent and much lower for those who attend church. Feldhahn estimates the overall divorce rate for the country is around 31 percent. The studies of people who regularly go to church all show a much lower divorce rate for them.

Feldhahn hopes these facts she's uncovered become widespread. "Pastors need to know this," she said. "People need to be able to look around the average congregation and say, 'You know what, most of these people will have strong and happy marriages for a lifetime. Doing what God says matters. This is a big deal to know."

So where do things go from here? For one, pastors and counselors can now say with assurance, marriage makes sense and is likely to last a lifetime. For religious believers, if they'll be attentive to practice their faith with their spouse, they can almost double their odds of avoiding divorce.


Dr. Richard JohnsonCMDA President Richard E. Johnson, MD: “As I think about the issue of divorce, I would be hesitant to simply say that ‘being a Christian’ will divorce-proof or significantly reduce the risk of divorce. It is possible to generate statistics to prove any position. The reality is that many dysfunctional people attend church and call themselves ‘Christian.’ I know some, and you know some. Indeed I have had my own dysfunctional symptoms pointed out to me! Being a Christian redeems our soul. It does not per se (although it should) make me a better physician or dentist, a more diligent student, a fairer person or more honest. It does not automatically make me a kind and good spouse. We must address the underlying issues that have made us who we are and work on allowing God to be the Lord of every aspect of who we are.

“In order to understand any survey, we need to know the definition of the denominator. If, for instance, we define the word ‘Christian’ as someone who would not divorce because they are showing the fruits of the spirit and are hence a ‘real Christian,’ then our sample might yield a low divorce rate. If, on the other hand, we say our ‘Christian’ sample is anyone who calls himself or herself a Christian, then our divorce rate will be higher....probably similar to the general population.

“CMDA’s vision statement speaks of ‘transformed doctors.’ We should be encouraging ourselves as well as others to engage in the work of understanding ourselves and our spouse, understanding where our expectations come from and how they impact our marriage, practicing repentance and forgiveness and having a pure, exciting and exclusive view of sex. These are issues that need to be preached from the pulpit, and we need to address then with our patients and in the public square. When we do this, I believe we will truly see a change in the divorce statistics.”


CMDA’s Marriage Enrichment Ministry
Restoring Health to Medical Marriages