Thursday, January 29, 2015

Assisted suicide activists ramp up national campaign

Excerpted from "Assisted suicide movement gaining traction across U.S.," Washington Times, January 21, 2015 - The highly publicized physician-assisted suicide of 29-year-old brain cancer patient Brittany Maynard has given the ailing right-to-die movement a new lease on life. A national campaign advocating state right-to-die legislation kicked off Wednesday in Sacramento with the introduction of the California End of Life Option Act, modeled after Oregon's 1994 law allowing doctors to aid terminally ill adults who want to end their lives.

Another dozen states are expected to follow with similar legislation, including Colorado, Connecticut, Delaware and Missouri. The D.C. Council is considering a "death with dignity" proposal introduced last week by council member Mary M. Cheh, Ward 3 Democrat, and the New Jersey Assembly passed an Oregon-style bill in November.

"We have a goal of 10 in 10. In the next 10 years, we're anticipating having 10 more states," said George Eighmey, a former Oregon state legislator who serves as vice president of the Death with Dignity National Center in Portland, Oregon. "It's sort of like the other social movements that are out there — the gay rights movement, the legalizing marijuana movement. All those things get to a critical mass and once they get to that critical mass, you start seeing other states get on board very quickly," said Mr. Eighmey, who advised on the California bill.

Plugging Maynard's story behind the scenes was Compassion & Choices, a right-to-die group funded by liberal billionaire George Soros that emerged from the ashes of the now-defunct Hemlock Society.

After Oregon voters approved the Death with Dignity Act, the movement stalled. It took until 2008 for voters in a second state, Washington, to enact a similar law. In 2013, Vermont Gov. Peter Shumlin signed into law the Patient Choice and Control at End of Life Act.

The Montana and New Mexico high courts have ruled that physicians may prescribe lethal drugs to the competent terminally ill. At the same time, state legislatures have snuffed dozens of right-to-die bills over the years, and Massachusetts voters defeated in November 2012 a "death with dignity" initiative by 51 percent to 49 percent. One big reason: The disabled community, led by groups such as Not Dead Yet, has mobilized against assisted-suicide measures, including the California bill, arguing that they are ripe for abuse.

"If this bill passes, some people's lives will be ended without their consent, through mistakes and abuse," Marilyn Golden, senior policy analyst for the Disabled Rights Education & Defense Fund, said in a Wednesday statement. "No safeguards have ever been enacted or proposed that can prevent this outcome, which can never be undone."


Dr. David StevensCMDA CEO David Stevens, MD, MA (Ethics): “A tidal wave of physician-assisted suicide (PAS) legislation is hitting the shores of state capitals across the country. CMDA is tracking efforts in 23 states, not a dozen as this article reports. Last fall, I completed statewide speaking tours in Montana and New Jersey to train church leaders, healthcare professionals and community leaders for this battle. I’m representing you in radio, TV and print interviews as well responding to op-ed pieces. In New Jersey, I met with individual legislators and was invited to address the minority party caucus in the state assembly. I stood with disability rights and other activists to speak your concerns at a news conference in the state capital.

“In Montana, where there is no law legalizing it, Compassion & Choices (C&C) representatives showed up at four of the five cities where I spoke to challenge my points during the question and answer period. During the first night’s session, a physician heading a hospice organization proudly and publically announced that she was already prescribing lethal drugs to her patients.

“The poignant Brittany Maynard story received enormous positive media coverage, and C&C is now using Brittany’s husband to lobby legislators. Billionaire activist George Soros’ money is funding an enormous effort and I’m extremely concerned that a half dozen more states will legalize PAS this year.

“CMDA staff members cannot stem this tide alone. As Christian healthcare professionals, we must link arms to halt this flood. I’m asking you to step up and be part of a leadership team in your state if it is targeted. My staff and I will come alongside each team to train and give you the tools and direction needed for this battle. We will guide you each step of the way.

“Once PAS is legalized, I doubt it will ever be reversed. Now is the time to halt this evil tide that will affect you and your patients.

“All that is required for evil to win is for good men and women to be too busy to fight it. This is a battle we dare not lose.”


If you would like to help, contact Margie Shealy, who leads our state initiatives, at or call 423-844-1000.

State Legislative Issues
Kara Tippets Interview
CMDA Resources on physician-assisted suicide

CMA recognized at March for Life

Excerpted from "March for Life reflects abortion awareness among young generation," Washington Times, January 23, 2015 - The 42nd March for Life again lived up to its reputation, drawing hundreds of thousands of mostly young marchers who oppose abortion.

Sara Silander, a 21-year-old senior from Jacksonville, Florida, who is president of Georgia Tech Students for Life, said, “I have always been taught that we should respect the dignity of everyone, including the unborn. We’ve always been told to protect the minorities, the impoverished and everyone, and that is so important, but we have also include the unborn.”

“I drove all the way from Michigan with my friends to be here. And I wanted to be here to walk for the unborn. I believe that little babies are just as precious inside of the womb as they are outside of it,” said Stephanie Mestizy, 25.

Several speakers talked about choosing life even when the unborn child is found to be imperfect. Eight or more of every 10 unborn children with disabilities are aborted. “That’s just wrong, isn’t it?” said Jeanne Monahan-Mancini, president of the March for Life Education and Defense Fund.

Rep. Cathy McMorris Rodgers, Washington Republican and a leader of the Congressional Down Syndrome Caucus, said her son, who was born with that distinctive chromosomal anomaly, has strengthened her convictions that every life matters. “That extra chromosome has brought my family a whole bunch of joy,” she said.

Mrs. McMorris Rogers and other speakers addressed the legislative drama on Capitol Hill: Instead of voting as promised Thursday for a bill that would ban most abortions after 20 weeks because of the ability of a fetus to feel pain at that stage of life, the House took up — and passed — a bill to block federal funding of abortions, especially in the new health care insurance plans.

Rep. Christopher Smith, New Jersey Republican, said the No Taxpayer Funding for Abortion Act, which he introduced, is necessary to end people’s “complicity” in paying for abortions, especially when they oppose the procedures. The House will soon take up the pain-capable bill, Mr. Smith added. “We will bring it to the floor and we will pass it.”

“The Senate will stand with the House” as it passes pro-life legislation, said Sen. Tim Scott, South Carolina Republican.

The now-massive March for Life is held on the Jan. 22 anniversary of the Roe v. Wade and Doe v. Bolton Supreme Court rulings that made abortion a federal constitutional right.


Jonathan ImbodyCMA VP for Government Relations Jonathan Imbody: “I enjoyed the privilege of representing you on stage just moments before the massive crowd of half a million pro-life marchers took to the streets to peacefully and impressively mark the Supreme Court's tragic 1973 decision opening the door to abortion on demand. Besides demonstrating the visible strength of the swelling pro-life movement, the March for Life also aims to influence public policy by having marchers visit their lawmakers after the march.

“This year a few otherwise pro-life GOP lawmakers managed to delay a planned vote on a bill to ban abortions after 20 weeks. That is the stage of fetal development at which when our own members and others have testified that babies have all the architecture needed to feel pain yet lack the pain inhibitors that protect fully developed individuals. A few GOP representatives questioned a rape exception requirement that simply ensured reasonable compliance by stipulating that the rape must have been reported to authorities. The bill does not affect abortions sought during the first five months of pregnancy.

“As an alternative, the House of Representatives passed another CMA-backed bill, the No Taxpayers Funds for Abortions Act. That's good, and we expect in this new, more pro-life Congress to pass more bills backed by popular opinion, which disfavors government abortion funding, favors a ban on late-term abortions and favors parental involvement when minor girls are considering an abortion.

  1. Maybe marching in the streets hasn't been on your bucket list, but you might consider joining next year's March for Life simply to join hands with hundreds of thousands of other committed believers to demonstrate your support for the notion that every life is a sacred gift from God. Perhaps you could organize a passel of students or fellow church members to join you. You will be standing alongside many people just like you--normal, church-going believers who may not be politically inclined but sense a call to put some kind of action to their life-honoring values.
  2. Voice your values by urging your lawmakers to support the Pain-Capable Unborn Child Protection Act. This bill will ban abortions after 20 weeks, when our own members and others have testified that developing babies have all the architecture needed to feel pain at intense levels. Click here to use our Freedom2Care pre-written, customizable form.

March for Life
CMDA resources on abortion
Fetal pain testimony
President Obama's statement

President proclaims "National Slavery and Human Trafficking Prevention Month"

Excerpted from "January is National Slavery and Human Trafficking Prevention Month," U.S. Department of Health and Human Services blog, January 6, 2014, by George L. Askew, MD, FAAP, Chief Medical Officer: Human trafficking is a form of modern-day slavery. Victims of human trafficking are subjected to force, fraud or coercion for the purpose of commercial sex, debt bondage or forced labor. It is estimated that more than 20 million women, men and children around the world are victims of human trafficking. Among the diverse populations affected, children are at particular risk for sex trafficking and labor trafficking.

The Department of Health and Human Services (HHS) is the federal agency responsible for providing victims and survivors of human trafficking access to benefits and services needed to help them restore their lives and achieve self-sufficiency. The Federal Strategic Action Plan on Services to Victims of Human Trafficking in the United States calls for coordinated, effective, culturally appropriate and trauma-informed care for victims and survivors.

Trafficking victims and survivors may suffer from an array of physical and psychological health issues stemming from inhumane living conditions, poor sanitation, inadequate nutrition, poor personal hygiene, brutal physical and emotional attacks at the hands of their traffickers, dangerous workplace conditions, occupational hazards and general lack of quality health care.

Preventive health care is virtually non-existent for these individuals. Health issues are typically not treated in their early stages, but tend to worsen until they become critical, even life-endangering situations. In many cases, health care is administered at least initially by an unqualified individual hired by the trafficker with little if any regard for the well-being of their “patients” — and even less regard for disease, infection or contamination control.

A few months ago in response to the Federal Strategic Action Plan on Services to Victims of Human Trafficking in the United States, our office collaborated with the HHS Office of Women's Health to develop a pilot project that will create a national technical working group to strengthen coordination of medical and health system responses to human trafficking. Specific actions include:
  • Supporting the development of protocols to manage and provide services to victims of human trafficking
  • Training and educating health care providers to recognize signs of human trafficking, identify potential cases, and respond effectively
  • Creating a referral mechanism for healthcare professionals to inform and connect with law enforcement agencies, social service providers, and community-based organizations
  • Promoting effective, culturally relevant, and trauma-informed care to improve the short-term and long-term health of victims.


Jeff BarrowsCMDA Health Consultant on Human Trafficking and Direct of U.S. Training for Hope for Justice Jeff Barrows, DO, MA: “I was honored to serve on the technical working group mentioned by Dr. Askew that was established by the Department of Health and Human Services in response to the Federal Strategic Action Plan on Human Trafficking. This past year, that technical working group developed a two-hour training for healthcare professionals on human trafficking and piloted that training in five different locations across the country.

“There is need for standardized training curriculum on human trafficking that is evidence-based and shown to be effective in helping identify victims of human trafficking within the healthcare setting. A study published last year found that almost 88 percent of victims of domestic sex trafficking encountered a healthcare professional while being trafficked.1

“The CMDA Commission on Human Trafficking is about to undertake a randomized survey of a portion of the membership of CMDA regarding their knowledge of human trafficking. This survey is being conducted in association with Liberty University and is an effort to add to the limited existing data regarding healthcare professional knowledge of human trafficking. A survey of emergency room personnel in 2012 found that less than 6% were confident in their ability to identify a victim of human trafficking, while only 2% had received any formal training on human trafficking.2

  1. If you think you have come in contact with a victim of human trafficking, call the National Human Trafficking Resource Center at 888-373-7888. For more information on human trafficking, visit
  2. If you are chosen to participate in this survey, please help us gather this critical data by taking the few minutes necessary to complete the survey. It will help us develop evidence-based training curricula that will eventually lead to victims being identified and freed.
  3. Equip yourself to recognize and respond to victims of human trafficking by taking CMDA's CME-credit online course at

1 Lederer, L. and Wetzel, C.A. “The Health Consequences of Sex Trafficking and Their Implications for Identifying Victims in Healthcare Facilities.” (2014) The Annals of Health Law 23:1. 61-91.
2 Chisholm-Straker, M., Richardson, LD., and Cossio, T. “Combating Slavery in the 21st century: The role of emergency medicine.” (2012) J Healthcare for Poor and Underserved 23:980-987.

CMDA resources on human trafficking

Thursday, January 15, 2015

Survey on today’s dilemmas in healthcare

Excerpted from "Life-and-Death Decisions That Keep Doctors Up at Night," Medscape. December 15, 2014 — Few professions invoke such a sweeping array of ethical questions as medicine. Although ethics may factor into life-and-death decisions, they can also play a role in everyday decision-making, such as whether or not to accept a lunch invitation from a pharmaceutical representative or ask a former patient on a date. On many of these issues, physicians are sharply divided.

Although six U.S. states have laws permitting physician-assisted suicide, doctors—like much of the general public—are deeply divided over the issue. A slim majority of doctors (54%) say they favor allowing physician-assisted suicide. Still, a passionate minority (31%) protest that assisted suicide violates the Hippocratic Oath.

When it comes to owning a harmful error that would affect a patient, 9 out of 10 (91%) of doctors say honesty is the only policy. Despite this near unanimous consensus, 6% of respondents say there are or could be situations in which it would be acceptable to cover up or fail to disclose a mistake. Others acknowledge that in a perfect world, they would step forward, but are less inclined to do so in light of the danger of malpractice suits.

When it comes to accepting perks, most doctors are adamant that they cannot be "bought." Nearly 6 out of 10 (59%) say that perks, such as meals and speaking fees, won't sway their decisions. Many regard restrictions on interactions with pharmaceutical representatives as "puritanical." Still others (30%) say that although they like to believe they couldn't be swayed, they recognize that data indicate otherwise and therefore oppose such interaction.


Dr. Robert OrrClinical Ethicist and CMDA Trustee Robert D. Orr, MD, CM: Medscape recently distributed a survey to more than 21,500 physicians from the U.S. and Europe asking their opinions or practices on several dilemmas in clinical and professional ethics. The results are interesting and varied, but we must be cautious in interpreting these results. Decisions about right and wrong are not a matter of a majority vote. Perhaps your mother, like mine, taught me that, ‘Just because everybody is doing it doesn’t make it right.’

“There have been numerous reports of physician surveys on the legalization of physician-assisted suicide (PAS), and we know results vary depending on the wording of the question. Recent surveys in the U.S. show that 35 to 55 percent of physicians support legalization of PAS; physician support has consistently been higher in Europe. The most recent comparable international survey found 65 percent opposed legalization. Importantly, when some surveys asked about personal beliefs rather than public policy, a large majority (about 75 percent) of physicians have said that they would be unwilling to participate even if it were legal. In addition, in at least one survey a large majority said they believed it would be impossible to ensure protection from abuse.

“Physician opinions about honesty in reporting harmful errors not surprisingly show the great divide between the moral ideal versus the reality of human psychology. It reminds me of the ongoing struggle Paul describes in Romans 7. The survey results suggest that the moral ideal persists in regard to conflicts of interest (i.e., most physicians believe their practices cannot be altered by accepting ‘perks’ from vendors). However, empiric research consistently shows the opposite. One fascinating study showed that only 2 percent of respondents felt gifts from pharmaceutical reps influenced their prescribing practice, though 30 percent of the same sample believed those same gifts influenced their colleagues. It’s the Pharisee (‘God, I thank you that I am not like other people…’) versus the tax collector (‘God, have mercy on me, a sinner’) (Luke 18:9-13, NIV 2011).

“Whether you rely on Paul, Luke or my mother, don’t take the Medscape survey results too seriously.”


Physician-Assisted Suicide Fact Sheet
CDD STAT Interview with Kara Tippetts
CMDA Ethics Statement on Industry Relationships

New anti-abortion bills in Congress

Excerpted from Republicans Introduce Five Anti-Abortion Bills In First Days Of New Congress,” Huffington Post. January 8, 2015 — Emboldened by a new Senate majority, Republicans in Congress introduced five abortion restrictions in the first three days of the new legislative session that would severely limit women's access to the procedure.

Reps. Trent Franks (R-Ariz.) and Marsha Blackburn (R-Tenn.) on Monday reintroduced a ban on abortions after 20 weeks of pregnancy, which the GOP-controlled House already passed once in 2013. And Sen. David Vitter (R-La.) introduced four bills on Wednesday that would bar Planned Parenthood from receiving federal family planning funds, require all abortion providers to have admitting privileges at a local hospital, ban abortions performed on the basis of gender, and allow hospitals, doctors and nurses to refuse to provide or participate in abortion care for women, even in cases of emergency.

Planned Parenthood Action Fund President Cecile Richards condemned the onslaught of anti-abortion bills on Thursday and the attack on her own organization. “The public wants Congress to protect women’s health, not interfere in women’s personal medical decisions," she said in a statement, "which means making sure all forms of birth control are affordable, women can get preventive care at Planned Parenthood and other trusted providers, and abortion remains safe and legal."

Abortion rights advocates expressed frustration that Republicans are launching new attacks on abortion at a federal level after running as moderates on the issue in the 2014 midterm elections. "The Republican Congress is like Groundhog's Day," said Ilyse Hogue, president of NARAL Pro-Choice America. "Just as they did in 2010, anti-choice Republicans hid their agenda on the campaign trail by promising to work to address the economy or the numerous other issues.”


Dr. Gene RuddCMDA Senior Vice President Gene Rudd, MD: “Reporters need things to say and write about, so they ask lots of questions. Just today a reporter asked if I thought there would be a wave of abortion legislation in 2015. My response, ‘Of course; and in 2016 and onward.’ Sadly, I do not see this critical social issue resolved in 2015.

“The main thrust of the interview (and I assume the article being written) was to challenge the right of Congress to interfere with the patient-doctor relationship. Here are some of the thoughts I shared:
  • Patients and doctors already have a myriad of laws and regulations governing the relationship.
  • We might argue there are too many and some are not needed or inappropriate.
  • But we cannot rationally argue that the patient-doctor relationship is outside the law.
  • When a patient has an inflamed appendix, we have laws and regulations that say who may perform surgery and what standards must be met.
  • Laws and regulations are even more important when a third life is involved.
  • We don’t allow mothers to abuse or kill their born children, even if she and her doctor thought that would be best for her mental health.
  • Laws that restrict abortion are simply society’s effort to decide how early in life we will bestow protection.
  • While I favor protection from life’s beginning, for 2015, I will be pleased to see our society begin protecting life from 20 weeks gestation.
“Just as I was writing these comments, the American Congress of Obstetricians and Gynecologists (formally American College) announced they would hold a press conference to decry Congress’ intrusion into the patient-doctor relationship. The battle continues.”


CMDA’s Abortion Ethics Statement
The Modern Implications of Abortion by John Patrick, MD
Visit our Freedom2Care legislative action website for easy-to-use forms to voice your values to your legislators.

URGENT ACTION: The US House of Representatives will vote on the Pain-Capable Unborn Child Protection Act during the March for Life this Thursday, Jan. 22. This bill will ban abortions after 20 weeks, when our own members and others have testified that developing babies have all the architecture needed to feel pain at intense levels. Click here to use our Freedom2Care pre-written, customizable form to urge your Representative to support this important bill.

To attend the March for Life, click here. Our VP for Govt. Relations will represent CMA on stage at this annual event that marks the Supreme Court’s 1973 Roe v. Wade abortion decision.

Connecticut court rules against teen who didn’t want chemo

Excerpted from Girl says she knows she'll die without chemo,” The Associated Press. January 8, 2015 — A 17-year-old girl being forced by state officials to undergo chemotherapy for her cancer said Thursday she understands she'll die if she stops treatment but it should be her decision. The state Supreme Court ruled earlier in the day state officials aren’t violating the rights of the girl, Cassandra C., who has Hodgkin lymphoma.

Cassandra told The Associated Press in an exclusive interview from her hospital it disgusts her to have "such toxic harmful drugs" in her body and she'd like to explore alternative treatments. She said by text she understands "death is the outcome of refusing chemo" but believes in "the quality of my life, not the quantity." Cassandra will be free to make her own medical decisions when she turns 18 in September. She, with her mother, had fought against the six-month course of chemotherapy. The case centered on whether the girl is mature enough to determine how to treat her Hodgkin lymphoma, with which she was diagnosed in September. Several other states recognize the mature minor doctrine.

Cassandra is confined in a room at Connecticut Children's Medical Center in Hartford, where she's being forced to undergo chemotherapy, which doctors said would give her an 85 percent chance of survival. Without it, they said, there was a near certainty of death within two years.

The teen's mother, Jackie Fortin, of Windsor Locks, said after the arguments Thursday that as a single mom for the last 15 years she wouldn't allow her daughter to die. She said they just want to seek alternative treatments that don't include putting the "poison" of chemotherapy into her body. After Cassandra was diagnosed with high-risk Hodgkin lymphoma, she and her mother missed several appointments, prompting doctors to notify the state Department of Children and Families, court documents say. Child welfare agency officials defended their treatment of Cassandra, saying they have a responsibility to protect her.


Dr. Nick YatesCMDA Member and former member and chair of the CMDA Ethics Committee Nick Yates, MD, MA (Bioethics): “Adolescent decision-making has troubled parents for eons, and there is – likely – no relief in sight. The American Academy of Pediatrics has much to say on this topic. Many experts in adolescents feel that teenage decision-making is informed by 1) a teen’s feeling that ‘rules’ don’t directly apply; 2) that peer relationships guide decision-making; and 3) that a teen’s reasoning often disregards germane information.

“Recognizing these potential limitations in forethought, a teenager attempting to engage in life or death decision-making must demonstrate decision-making capacity. Typically this is acknowledged through ‘informed consent’ – which is acknowledged when an individual has full medical information and decision-making capacity and can make a decision that is free from coercion. Decision-making capacity, while being more complicated (to acknowledge), does not necessarily require a legal determination, but it does require demonstration that the teen knows and understands the medical information, is able to weigh the ‘pros and cons’ and is willing to make a decision between medical options. Decision-making capacity is demonstrated when one is complicit with routine medical evaluations and demonstrates mature behavior. ‘Standard and routine’ life-saving medical therapies may be declined under the proper setting if informed consent is recognized.

“When attempting to obtain court approval for end-of-life decision making, the teen must demonstrate maturity, dignity and decorum. Age is not necessarily a disqualifying factor, but immature or improper behavior certainly might be. Decision-making capacity may not be granted if medical appointments are missed and if a patient is missing for a week.

“End-of-life decision making is difficult under the best of circumstances, and it certainly must not be a platform for pontification.”


CMDA’s Patient Refusal of Therapy Ethics Statement
American Academy of Pediatrics Statement on Informed Consent
Bioethics Series: Informed Consent