Human trafficking victim: Healthcare professionals can help

Excerpted from "Kidnap Victim Addresses Human Trafficking Forum," ABC News, August 14, 2014, - A woman who was held captive for nine months has underscored the importance of work performed by health care professionals, law enforcement and social workers to rescue and support kidnap victims. Elizabeth Smart-Gilmour told a South Dakota forum on Wednesday that such work "makes a difference" in the fight against human trafficking and sexual abuse.
"People like you brought me back," Smart-Gilmour told the audience.

Smart-Gilmour was taken from her Salt Lake City bedroom in June 2002 at age 14 and held for nine months. Now 26, she described her capture and the repeated sexual assaults she endured. She told how she was moved from Utah to California and constantly threated with death if she tried to escape.

She stressed that authorities must have protocols in place to deal with rescued victims. Smart-Gilmour recalled how she was handcuffed, taken to the police station and left in a "little room with no windows" right after police officers found her. The situation, she said, did not make her feel comfortable. Since her rescue, she has started the Elizabeth Smart Foundation to protect children and educate them about violent and sexual crimes.

Commentary

CMA VP for Govt. Relations Jonathan Imbody: “Last week I attended in Atlanta a roundtable discussion group, led by trafficking expert Dr. Laura Lederer, focused on strategies to help healthcare professionals recognize and respond to victims of human trafficking. I began working with Laura over a decade ago when she was helping to lead the U.S. State Department's fight against trafficking. She was one of the first to recognize the tremendous potential for healthcare professionals to recognize and respond to human trafficking victims, who often visit healthcare facilities during their captivity.

“Along with CMDA Health Consultant on Human Trafficking Dr. Jeff Barrows, we engaged the White House, the Centers for Disease Control, the Department of Homeland Security, the AIDS ambassador and many others in an effort to get the government to implement programs to encourage the healthcare community to respond to opportunities to help human trafficking victims. I remember a frustrating meeting in the White House with CDC Director Dr. Julie Gerberding and the President's advisors, trying to convince her of the need while she questioned the data supplied by the FBI.

“Since then, more research data has proved the point, and most recently a published research project led by Dr. Lederer highlights the tremendous opportunities for healthcare professionals to make a difference. A comprehensive study found that:

• Of victims who answered the questions about their contact with healthcare (N=98), 87.8 percent had contact with a healthcare provider while they were being trafficked.
• By far the most frequently reported treatment site was a hospital/emergency room, with 63.3 percent being treated at such a facility. Survivors also had significant contact with clinical treatment facilities, most commonly Planned Parenthood clinics, which more than a quarter of survivors (29.6 percent) visited. More than half (57.1 percent) of respondents had received treatment at some type of clinic (urgent care, women's health, neighborhood or Planned Parenthood).
• Pregnancy, miscarriage and abortion were all common experiences for survivors in the study. More than half (55.2 percent) of the 67 respondents who answered reported at least one abortion, with 20 respondents (29.9 percent) reporting multiple abortions; survivors in this study similarly reported that they often did not freely choose the abortions they had while being trafficked.

“You can make a difference. Your education on how to recognize and respond to victims of human trafficking can mean the difference between life and death, freedom and slavery for a victim you may encounter. Please consider taking the CME-credit online course below.”

Action
Use CMDA's online modules for human trafficking education to obtain CME credit while equipping yourself to recognize, respond and treat victims of human trafficking.

Resources
"Health consequences of sex trafficking and their implications for identifying victims in healthcare facilities" - published research by Dr. Laura Lederer

CMDA's online modules for human trafficking education

Additional resources on human trafficking from CMDA

To learn more about a new CMDA Commission on Human Trafficking to help prepare healthcare professionals to identify and assist victims of human trafficking contact Dr. Jeffrey Barrows at: jeff@abolitioninternational.org.

Administration again tweaks Obamacare contraception mandate

Excerpted from "Administration offers new tweak to birth control rule," Washington Post, August 22, 2014 - The Obama administration, still facing legal challenges to its requirement that employer health plans provide no-cost birth control to female employees, outlined a new policy Friday to ensure that female workers at religiously-affiliated nonprofits can still receive contraception, even if their employers object. The administration also intends to offer a similar work-around to for-profit businesses after the Supreme Court's bitterly debated 5-4 decision in June that owners of closely held firms could refuse contraception coverage if it conflicts with their religious beliefs.

The new federal guidelines address a set of ongoing legal challenges to the contraceptive requirement raised by dozens of religious nonprofit groups, such as hospitals and charities, that could again put the contraception mandate before the Supreme Court. The religious nonprofits are challenging the administration's already existing opt-out, in which the groups can ask a third party to provide the contraception coverage to their employees. However, the nonprofits say that filling out the form notifying the third party violates their religious beliefs.

The nonprofits can now directly inform the Department of Health and Human Services of their religious objections. HHS and the Labor Department will then coordinate contraception coverage with insurers and third party administrators. The nonprofits still have the option to notify a third party directly.

The Becket Fund, a law firm that represents 126 nonprofit plaintiffs ranging from evangelical Wheaton College to Catholic University of Notre Dame, said Friday afternoon it hadn’t yet seen the full text of the rule and thus couldn’t comment on its specifics. Several of the country’s biggest faith groups on Friday said the revised rule was still problematic because it didn’t fully exempt organizations – for-profit or non-profit – with religious objections.

"Here we go again,” said Russell Moore, president of the policy arm of the Southern Baptist Convention, the largest U.S. Protestant denomination. “What we see here is another revised attempt to settle issues of religious conscience with accounting maneuvers. This new policy doesn't get at the primary problem.”

The U.S. Conference of Catholic Bishops said it's worried that the administration's proposal could limit which for-profit businesses can receive a religious exemption.

"By proposing to extend the 'accommodation' to the closely held for-profit employers that were wholly exempted by the Supreme Court’s recent decision in Hobby Lobby, the proposed regulations would effectively reduce, rather than expand, the scope of religious freedom,” the group's statement read.

Commentary

Senior Counsel for the Becket Fund for Religious Liberty Lori Windham’s Statement: "This is latest step in the administration’s long retreat on the HHS Mandate. It is the eighth time in three years the government has retreated from its original, hardline stance that only 'houses of worship' that hire and serve fellow believers deserve religious freedom.

"The new rule holds implications for the 102 cases, including religious charities like Little Sisters of the Poor (see video), Mother Angelica’s Eternal Word Television Network (see video) and religious colleges like Colorado Christian University. Ninety percent of religious ministries challenging the mandate have received relief from the courts, and we are hopeful the administration’s new rule will reflect the robust protections that have always been given to religious individuals in this country.

"Religious ministries in these cases serve tens of thousands of Americans, helping the poor and homeless and healing the sick. The Little Sisters of the Poor alone serve more than ten thousand of the elderly poor. These charities want to continue following their faith. They want to focus on ministry—such as sharing their faith and serving the poor—without worrying about the threat of massive IRS penalties."

Action

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 healthcare 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.

Resources
Read new HHS rule

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

Court rules that states can define marriage

Excerpted from "Judge Upholds State’s Authority to Define Marriage as Union of Man and Woman," commentary by Ryan T. Anderson in The Daily Signal, August 12, 2014 - Last week a judge in Tennessee upheld that state’s Constitutional authority to define marriage as the union of a man and a woman. The case involved a same-sex couple married in Iowa that sought a divorce in Tennessee. Because Tennessee does not recognize same-sex relationships as marriages, it was unable to divorce the couple. Last week, Judge Russell E. Simmons, Jr., cited the Supreme Court’s decision in the federal Defense of Marriage Act case, U.S. v. Windsor, as support that Tennessee has the right to define marriage for itself.

When the Supreme Court struck down the federal law defining marriage last year, Justice Anthony Kennedy explained that states have “the historical and essential authority to define the marital relation.” Simmons takes Kennedy at his word, recognizing the basic equality of state citizens. Just as the citizens of Iowa are free to adopt same-sex marriage (though it was a state court that redefined marriage there), so too the citizens of Tennessee are free to retain the traditional definition.

What about arguments that claim there is a fundamental right to same-sex marriage? Simmons explains that while “marriage is a fundamental right,” there is no right to redefine marriage. Simmons continued: “neither the Tennessee Supreme Court nor the United States Supreme Court has ever decided that this fundamental right under a state’s laws extends beyond the traditional definition of marriage as a union between (1) one man and (1) one woman.”

What’s really at stake in this debate? Simmons explains: “The battle is not between whether or not marriage is a fundamental right but what unions are included in the definition of marriage.” Yes, the fundamental policy question in this debate is “What Is Marriage?”

Our federal Constitution is silent on what marriage is. Judges should not insert their own policy preferences about marriage and declare them to be required by the Constitution. The courts should uphold the freedom of the American people and their elected representatives to make marriage policy.

Commentary

“As the links to a research controversy below (see Resources) suggest, anyone wading into the marriage debate these days needs a double coat of armor. But that's hardly unexpected or new for Christians whose convictions counter the culture. If we can demonstrate love for those who practice homosexuality while courageously offering a reasonable rationale in defense of marriage as between a man and woman, as my colleague Ryan Anderson does, then perhaps reasonable people will consider our message.

“For millennia, societies have recognized marriage as a consensual, exclusive and lifelong commitment between one man and one woman, expressed in a physical union uniquely designed to produce and nurture children. The universal recognition of conjugal marriage by virtually every civilization throughout history, arrived at from both secular and theistic perspectives, testifies to the natural evidence for marriage, its objective structure and its significant contribution to human flourishing and societal stability.

“But now some would replace marriage with a subjective notion based on emotional relationship, divorced from the natural and objective marital elements of physical union and procreation. The abject subjectivity of this approach offers no rational parameters that would exclude further redefinitions of 'marriage as between multiple partners, related persons or even persons and pets.

“With people of good will on both sides of the marriage debate, we all do well to focus on respecting and listening to each other, presenting a reasonable rationale and letting the democratic process play out to express the will of the people. Courts have a tendency to short-circuit that process by imposing personal views from the bench, and conflicting rulings in lower courts appear bound to return this issue to the Supreme Court in the near future.

“In the meantime, consider reading some of the resources below on this issue. As we commit to remaining true to convictions founded on Scripture, may God give us the courage to live faithfully in the midst of a contrary culture--just as the biblical Daniel, Esther and a "great cloud of witnesses" have done throughout history.

Action
Use the easy, editable form at the CMA Freedom2Care legislative action website to voice your support for:

House bill: Marriage and Religious Freedom Act - HR 3133

Senate bill: Marriage and Religious Freedom Act - S 1808

Resources
What is Marriage? by Ryan T. Anderson, et. al.

Research and controversy:

• "How different are the adult children of parents who have same-sex relationships? Findings from the New Family Structures Study" research publication by Mark Regnerus
• "Homosexual Parent Study: Summary of Findings," article by Peter Sprigg
• "Study of Gay Parenting Draws Criticism" - ABC News
• "Mark Regnerus: Defending my research on same-sex parenting" - Dallas Morning News
• Social Scientists Defend Mark Regnerus' Controversial Study on Same-Sex Parenting - Christianity Today

The ethics behind the Ebola treatment serum

Excerpted from "Ebola outbreak prompts ethical questions," BioEdge. August 9, 2014 — The worst-ever Ebola outbreak has prompted bioethical discussion on two fronts. The viral disease has killed about 1,000 people in West Africa, mostly in Guinea, Sierra Leone and Liberia. A few cases have been diagnosed in Nigeria. The chances of dying in this outbreak are about 50 percent. Newspapers in Western countries like the U.S., the UK and Australia are highlighting the possibility of their own epidemics.

The first issue, as bioethicist Arthur Caplan points out, is that developed countries only worry about exotic diseases like Ebola when it threatens them: “The harsh ethical truth is the Ebola epidemic happened because few people in the wealthy nations of the world cared enough to do anything about it. We do need headlines about Ebola ... A public health policy that ends at our borders is not fair, just or even smart.”

The second is equitable distribution of a vaccine. There is no approved vaccine at the moment. A small American company, Mapp Biopharmaceutical, has been testing a vaccine called ZMapp on animals. But no one knows whether it is safe or effective on humans. Only a handful of doses at the moment and scaling up production to thousands of doses would take months. However, two white American medical missionaries, Kent Brantly and Nancy Writebol, who contracted the disease in Africa have been given two precious doses of ZMapp and seem to be improving. Why were they chosen instead of Africans? Apparently it is regarded as good practice to treat "first responders" first because of a social responsibility to help those who help others.

The WHO has convoked a gathering to discuss the ethics of providing an untested vaccine. “We are in an unusual situation in this outbreak,” says Dr Marie-Paule Kieny, of the WHO. "We need to ask the medical ethicists to give us guidance on what the responsible thing to do is.”

Commentary

CMDA CEO David Stevens, MD, MA (Ethics): “I’ve debated Art Caplan on TV and radio on a wide range of bioethical issues. As I do with his comments in this article, we have agreed on some points and disagreed on others.

“He is absolutely correct when he says, ‘A public health policy that ends at our borders is not fair, just or smart.’ The danger in a country where people worship financial, physical and emotional security is that our claim of ‘compassion’ is merely a slushy sentimentality, a loose veneer barely covering our selfishness. At the first hint that a health crisis killing more than a thousand people could affect us, that thin veneer is quickly ripped to shreds. We’ve already seen that. Ann Coulter publically claimed Dr. Kent Brantley was “idiotic” for going to Liberia and that the U.S. should focus on its own problems. Others, including a few Christian leaders, decried bringing Dr. Kent Brantley and Nancy Writebol back to the U.S. for treatment.

“On the other hand, Dr. Caplan’s comment on providing untested treatment to Ebola sufferers puts us in an artificial binary trap of ‘treatment’ or ‘public health.’ It is obvious that the good public health practice is what is needed to contain and ultimately stop the epidemic. But that begs the question about whether an unproven experimental drug should be used to treat seriously ill Ebola victims. With Ebola’s mortality rate, no other alternatives and a deteriorating condition, I would have taken the drug just as Kent Brantley did. He showed marked improvement in hours. It is not good to take an untried drug, but it is the lesser of two evils when you are about to die and an unproven drug has showed promise in animal trials. What’s more, to prohibit its import to other countries if their medical experts desire to use it is paternalistic.

“Many called Kent and Nancy ‘heroes’ for their self-sacrifice for the good of others. “Greater love has no one than this: to lay down one’s life...”(John 15:13, NIV 2011). We should admire their faithfulness to deny themselves, take up their cross and follow Jesus by doing exactly what He would do, but I think Kent and Nancy would not want to be thought of as heroes. They consider what they did as ‘normal Christian behavior.’ So should we.

“For more than two milleniums, Christians have laid down their lives for others. If we seek security, we will never find it. If we give up our security to follow Christ, that is when we find real security in Him. Then true compassion wells up from our souls.”

Resources

CMDA News Release on Dr. Kent Brantly, with a live interview with Dr. David Stevens
USA Today interviews CMDA on Ebola
CMDA Resources on International Healthcare

Recognizing and relating to a patient’s emotions

Excerpted from “Should Your Doctor Cry With You?,” U.S. News & World Report. July 2, 2014 — Doctors deal with intensely emotional situations every day, in the face of which they are taught to remain objective. But there’s a growing recognition in clinics and medical schools that empathy and emotional intelligence have a prominent place in medicine, too.

If doctors really want to connect with their patients, says Peter Ubel, a physician and behavioral scientist at Duke University, they should model themselves after Starbucks’ employees. Baristas are trained to handle angry customers using the “latte” method of communication, which stands for: listen; acknowledge the problem; take action to solve it; thank them for bringing it to your attention; explain what you’ve done to fix the problem.

Instead, doctors often dismiss a patient’s negative emotions, Ubel continues. Studies have shown that when cancer patients expressed feelings such as ‘I’m in pain’ or ‘I’m scared,’ their doctors – mostly experienced oncologists – said nothing or changed the subject. But simple acknowledgment of the patient’s feelings – with something like "Oh, I can understand why this must be scary for you" – can open up an emotional channel that improves the relationship as well as, potentially, clinical outcomes.

At the same time, the distance that doctors are taught to maintain from patients is important to uphold. “You don’t want your doctor blubbering around the hospital,” Barron Lerner, an internist and professor of medicine at New York University School of Medicine, says. “There’s a professionalism associated with being able to deal with profoundly emotional situations in a dispassionate manner.”

Commentary

Founder, Executive Director and Psychiatrist at Lighthouse Network Karl Benzio, MD: “The Hippocratic Oath is profound in its message as it is a spiritual covenant to hold as the utmost priority the best for the patient and not the best for the healthcare professional or any other third party. ‘The best’ for the patient pertains to the ultimate spiritual and psychological benefits, as Hippocrates said he would not perform an abortion or euthanasia, which would prioritize the physical over the psychological and spiritual.

“Physicians have expertise and healing to impart to patients, but unless a bridge exists to reach patients, healing will be delayed, compromised or not delivered at all. The bridge is relationship, not only doctor-to-patient but also human-to-human. The first step in building this bridge requires communicating understanding, sensitivity, respect, dignity and honor. This is why healthcare professionals ask probing questions, and our demeanor while patients respond allows them to invite us into their pain. Our responses of sympathy and empathy show we are listening and feeling the hurt, fear or uncertainty that can deeply harm them.

Resources

Grace Prescriptions – Learning How to Share Your Faith in Practice
Moving Beyond Physical Healing by Dr. David Levy

News agency blows nosey headline

Excerpted from “Woman Grows A Nose On Her Spine After Stem Cell Experiment,” Popular Science. July 18, 2014 — Eight years ago, doctors took nasal tissue samples and grafted them onto the spines of 20 quadriplegics. The idea was that stem cells within the nasal tissue might turn into neurons that could help repair the damaged spinal cord, and the experiment actually worked a few of the patients, who regained a little bit of sensation. But it didn’t go well for one woman in particular, who not only didn’t experience any abatement in her paralysis, but recently started feeling pain at the site of the implant. When doctors took a closer look, they realized she was growing the beginnings of a nose on her spine, New Scientist reports.

This is hardly the first case of adverse side effects from a stem cell transplant. The New Scientist article points to several cases where people developed tumors after participating in clinical trials—including one 50-year-old man who, after receiving an experimental treatment for Parkinson’s disease, developed a brain tumor with hairs and cartilage embedded within it.

The nasal tissue experiment took place at a mainstream hospital in Portugal, and there are thousands of legitimate stem cell trials taking place all over the world, but so far only a few stem cell therapies have been approved by the FDA. Stem cells have the potential to treat everything from baldness and diabetes to cardiovascular disease and Parkinson’s. But stem cells, some of which can differentiate into almost any cell in the body, also have the potential to cause harm.

Commentary

CMDA Member and Senior Fellow for Family Research Council David Prentice, PhD: “It sounds funny—a woman grows a nose on her back or, as another reporter put it, on her spine. Coupled with the buzz term ‘stem cell,’ it ensures notice for the news outlet and reporter. But it’s neither funny nor true.

“The real story: a patient who received her own stem cells in an attempt to treat spinal cord injury had an adverse reaction eight years after treatment. While the cell mixture used didn’t produce tumors as has been seen with embryonic stem cells or fetal stem cells, some ectopic tissue differentiation occurred that pressed on her spinal cord, causing pain. Sadly, the surgeons who removed her partially-differentiated growth published their findings and went to the news media, rather than showing concern for other patients and contacting the doctors who did the spinal cord clinical trial. The older version of this approved clinical trial, which this patient received, has been the only treatment for chronic, complete spinal cord injury resulting in significant functional improvement, with a very low (less than 1 percent) incidence of complications, with more than 140 patients having received the treatment.

“The news of this one adverse event highlights the power of stem cells even years after transplant, the experimental nature of clinical trials and the risk inherent in such trials. Clinicians should be cognizant of all of these factors. Even approved clinical trials using ethically-sourced stem cells must be monitored carefully. The wise healthcare professional keeps concern for the patient first at all times.”

Resources

CMDA Ethics Statement – Human Stem Cell Research and Use
Scientific Demagoguery in the Stem Cell Wars by Dr. David Stevens