How assisted suicide corrupts medicine

Excerpted from "Physician-Assisted Suicide Corrupts the Practice of Medicine," Heritage Foundation Issue Brief by Ryan T. Anderson, PhD, April 20, 2015 - The heart of medicine is healing. Doctors cannot heal by assisting patients to kill themselves or by killing them. They rightly seek to eliminate disease and alleviate pain and suffering. They may not, however, seek to eliminate the patient. Allowing doctors to assist in killing threatens to fundamentally corrupt the defining goal of the profession of medicine.

Physician-assisted suicide will not only corrupt the professionals who practice medicine, but also affect patients because it threatens to fundamentally distort the doctor–patient relationship, greatly reducing patients’ trust of doctors and doctors’ undivided commitment to the healing of their patients.

Our laws shape our culture, and our culture shapes our beliefs, which in turn shape our behaviors. The laws governing medical treatments will shape the way that doctors behave and thus shape the doctor–patient relationship.

Physician-assisted suicide will create perverse incentives for insurance providers and the financing of health care. Assisting in suicide will often be a more “cost-effective” measure from the perspective of the bottom line than is actually caring for patients. In fact, some advocates of PAS and euthanasia make the case on the basis of saving money.

Instead of helping people to kill themselves, we should offer them appropriate medical care and human presence. We should respond to suffering with true compassion and solidarity. Doctors should help their patients to die a dignified death of natural causes, not assist in killing. Physicians are always to care, never to kill.

Commentary

Video Commentary by Josiah C. Trent Professor of Medical Humanities at Duke University School of Medicine Farr A. Curlin, MD: "The question that arises is, 'Why is [the Hippocratic oath prohibition on physician-assisted suicide] there?' Why is that something that physicians, with tremendous consistency, over 2,000+ years, have continued to affirm and profess? A commitment to never participate in assisted suicide is essential for the possibility of doctors continuing to care well for patients who are dying."

Listen to the rest of Dr. Farr’s commentary from “Living Life to Its Fullest: Supporting the Sick and Elderly in their Most Vulnerable Hours” as part of the Heritage Foundation symposium.

Action

If your state is included on this list of states considering assisted suicide, join with CMDA and others in your state to protect your patients and the medical profession. To learn more, contact communications@cmda.org.

Resources
CMDA Resources on Physician-Assisted Suicide and Euthanasia
Physician-Assisted Suicide Fact Sheet
CMDA Physician-Assisted Suicide Ethics Statement

A new national religion?

Excerpted from "The Shifting Definition of Religious Freedom," Breakpoint commentary by Eric Metaxas, April 13, 2015 - Just this month, we watched a family-owned pizzeria close its doors after its owners received hate mail and death threats from around the country. Their offense? Giving the wrong answer to a question about whether they'd cater a gay wedding.

But gay columnist Frank Bruni recently took it to the next level in the New York Times, writing that it's time Christians get with the program and “take homosexuality off the sin list.” The lived experience of same-sex couples ought to trump what he calls the “scattered passages of ancient texts” condemning his lifestyle. Wow.

As for freedom of religion, Bruni suggests a new definition: “freeing ... religious people from prejudices that they ... can indeed jettison, much as they’ve jettisoned other aspects of their faith’s history, rightly bowing to the enlightenments of modernity.”

Writing at National Review, Yuval Levin says what we're witnessing isn't so much the suppression of free exercise of religion as it is the establishment of a new national religion; the religion of secular liberalism. And dissenters must be forced to worship at its altar and affirm its creed of anything-goes sexuality.

Given the likely outcome of this summer's Supreme Court case on same-sex marriage, Rod Dreher asks what will it be like to be a Christian in our brave, new society—and what will become of orthodox Christianity now that the price of professing it could be our credibility and livelihoods.

Friends, the fight for religious liberty is far from over. And as John Stonestreet and I have been saying again and again, it’s time for the Church to wake up, to pray, and to publicly defend our religious rights and our brothers and sisters under assault for their beliefs.

Commentary

CMA VP for Government Relations Jonathan Imbody, MEd: “Beyond the significant public policy battle over what marriage means, social issues agitators both inside and outside the church are advancing arguments that try to pry Christians off of our moral foundation, the Scriptures. New York Times commentator Frank Bruni suggests that ‘the continued view of gays, lesbians and bisexuals as sinners is a decision. It’s a choice. It prioritizes scattered passages of ancient texts over all that has been learned since — as if time had stood still, as if the advances of science and knowledge meant nothing.’ Clearly Bruni has little understanding or respect for the divine inspiration, authority, unity, integrity and timelessness of the Scriptures that many of us trust with our lives both here and for eternity.

“Even some within the church are making similar arguments. These arguments seem to boil down to the notions that Bible writers injected personal bias and that science had not yet enlightened the early church. Therefore, Scriptures prohibiting and condemning homosexual behavior (and by extension, it would seem, Scriptures prohibiting any sex outside of marriage) can be thrown out like potshards from an ignorant, ancient culture.

“The trouble is that in the pursuit of social activism, these views undermine Scripture in order to reinterpret Scripture, leaving no real Scriptures at all. For if Bible writers did not actually write God-breathed words but instead injected their own personal bias, why would we elevate the Bible over, say, the Aeneid, or the works of Shakespeare, or the New York Times?

“If today's claims of science trump millennia of biblical truths, why would anyone persist in believing in the miracles described in the Bible or in anything supernatural at all? Following this train of thought, Jesus' virgin birth, healings, miracles, resurrection and promised return become a bunch of bunk to be debunked by science and social activists. Jesus Himself becomes suspect, since He unwaveringly treated Scripture as divinely inspired and authoritative. (What can we expect from an unschooled Galilean?)

“Rejecting this Bible-devaluing approach is not to say that nothing in the Bible is culturally based, but that we must discern between superficial cultural symbols and deep and consistent moral teaching in the Bible. Contrary to the assertions of those who would remake in their own image the Bible's teachings on sexuality, the evidence from Genesis through Revelation is far too compelling, deep and consistent that God clearly designed sex for marriage between one man and one woman in a lifelong relationship uniquely geared to raising children.”

Action

Sen. Patrick Leahy (D-Vt.) has introduced legislation that would shrink religious freedom and marginalize faith-based organizations simply because they view boys as boys and girls as girls based on biology. By inserting "gender" issues into federal program requirements and by leaving the definition of gender open to liberal interpretation, while also leaving out any exemptions for those who view gender biologically and according to faith tenets, this legislation holds the potential to unfairly discriminate against and exclude faith-based organizations from funding. Click here to learn more and to send your senators an editable pre-written message to oppose S 262.

Resources
CMDA’s Same-Sex "Marriage" Public Policy Statement
CMDA’s Marriage Public Policy Statement
CMDA’s group letter supporting Marriage and Religious Freedom Act

Silence on religious persecution and killings

Excerpted from "Christians thrown overboard left to drown by Obama," commentary by Kirsten Powers in USA Today - When a throng of Muslims threw a dozen Christians overboard a migrant ship traveling from Libya to Italy, Prime Minister Matteo Renzi missed the opportunity to label it as such. Standing next to President Obama at their joint news conference Friday, Renzi dismissed it as a one-off event and said, "The problem is not a problem of (a) clash of religions."

As Renzi was questioned about the incident, Obama was mute on the killings. He failed to interject any sense of outrage or even tepid concern for the targeting of Christians for their faith. He just can't seem to find any passion for the mass persecution of Middle Eastern Christians or the eradication of Christianity from its birthplace.

Religious persecution of Christians is rampant worldwide, as Pew has noted, but nowhere is it more prevalent than in the Middle East and Northern Africa, where followers of Jesus are the targets of religious cleansing. Pope Francis has repeatedly decried the persecution and begged the world for help, but it has had little impact. Western leaders — including Obama — will be remembered for their near silence as this human rights tragedy unfolded. The president's mumblings about the atrocities visited upon Christians (usually extracted after public outcry over his silence) are few and far between. And it will be hard to forget his lecturing of Christians at the National Prayer Breakfast about the centuries-old Crusades while Middle Eastern Christians were at that moment being harassed, driven from their homes, tortured and murdered for their faith.

A week and a half after Obama's National Prayer Breakfast speech, 21 Coptic Christians were beheaded for being "people of the cross." Seven of the victims were former students of my friend and hero "Mama" Maggie Gobran, known as the "Mother Theresa of Cairo" for her work with the poorest of the poor. She told me these dear men grew up in rural Upper Egypt and had gone to Libya seeking work to support their families. They died with dignity as they called out to their God, while the cowardly murderers masked their faces.

Rather than hectoring Christians about their ancestors' misdeeds, Obama should honor these men and the countless Middle Eastern Christians persecuted before them.

Commentary

CMA VP for Government Relations Jonathan Imbody, MEd: The president's reticence on the international persecution of Christians, coupled with his administration's policies that threaten domestic religious freedom, is puzzling yet alarmingly consistent.

As the Washington Post reported, the Obama administration waited months before appointing a replacement for Rev. Suzan Johnson Cook, a reputedly ineffective ambassador-at-large for international religious freedom, a position that should function as the State Department’s religious freedom watchdog. The administration had taken more than two years to appoint Cook, a failure of action that evidenced an extremely low priority on religious freedom.

The U.S. Commission on International Freedom, by contrast, explains that "As Americans, religious freedom reflects who and what we aspire to be as a nation and people. For the vast majority of people across the globe, religion matters: Fully 84 percent of the world’s population identifies with a specific religious group."

Pro-life colleague and Catholic scholar Dr. Robert P. George serves as vice chairman of the U.S. Commission on International Religious Freedom (USCIRF). He notes, "Abuses against Christians span the globe. A key reason is the confluence of two factors. First, there are more than 2 billion Christians in the world. Second, according to a Pew Research study, in one-third of all nations, containing 75% of the world's people, governments either perpetrate or tolerate serious religious freedom abuses. A six-year Pew study found that over six years, Christians were harassed in 151 countries, the largest of any group surveyed."

Though our own political leaders may shrink back from responsibly responding to the worldwide persecution of Christians, our persecuted brethren are standing tall as a shining example of courage and faithfulness.

• The Christian Post reports, "A number of the 21 Coptic Christians who were recently shown being beheaded in a horrific video by Islamic State militants in Libya were reportedly whispering the name of Jesus as their heads were being hacked off their bodies."
• Christianity Today reports, "The Archbishop of Canterbury, Justin Welby, arrived in Cairo to offer condolences for the previous martyrs in Libya: 20 Coptic Orthodox Christians and a sub-Saharan African. 'Why has Libya spoken so powerfully to the world?' asked Welby during a public sermon. 'The way these brothers lived and died testified that their faith was trustworthy.'"

As we move on our government to stand up to persecution, may we also personally imitate the trustworthy faithfulness of this great cloud of witnesses.

Action

1. Write to your elected officials (simply enter your zip code under "Find your elected officials" on our legislative action website) and urge them to take appropriate and strong legislative, diplomatic and military action to stop the persecution and killings of Christians overseas and to advance religious freedom worldwide and at home.
2. Consider serving our brethren overseas, some of whom experience great hardship under governments hostile to Christians, on a Global Health Outreach or Medical Education International trip.

Resources
USCIRF 2014 Annual Report

Global campaign to protect disabled infants

Excerpted from "Irish group Every Life Counts launches global campaign to end ‘incompatible with life’ label," LifeSiteNews. March 11, 2015 — Irish families have joined with international medical experts and disability advocacy groups to launch the Geneva Declaration on Perinatal Care at the United Nations. The Declaration, which is the centerpiece to a global campaign to end disability discrimination caused by the “incompatible with life” label, has already been signed by more than 200 medical practitioners and researchers and 27 disability and advocacy NGOs. It aims to improve care for mother and baby where a life-limiting condition has been diagnosed before or after birth.

At the event, families from Ireland, Northern Ireland, Canada, Spain and Switzerland said that the label “incompatible with life” was not a medical diagnosis and was causing “lethal discrimination against children diagnosed with severe disabilities, both before and after birth.”

Barbara Farlow, whose ground-breaking research led to a new understanding of the experiences of families where children had a life-limiting condition, said that the label “incompatible with life” had been shown to lead to sub-optimal care after birth and the phrase dehumanised children.

Professor Giuseppe Benegiano, former director of special programmes for the UN, said that the UN should give support for this important initiative against disability discrimination. Professor Bogdan Chazan, an imminent obstetrician from Poland, said that babies with a challenging diagnosis deserved better care than abortion.

Commentary

CMDA Member and Care Net Medical Advisor Sandy Christiansen, MD, FACOG: “The mark of a civilized society is the degree to which it protects its weakest most vulnerable members. Psalm 82:3 admonishes us to ‘Defend the weak and the fatherless; uphold the cause of the poor and the oppressed’ (NIV 2011). The Geneva Declaration is a beautiful example of the fulfillment of this passage.

“Routine prenatal testing seeks to detect fetal abnormalities before birth. With the discovery of a problem, what choices are offered? Data across the globe report that anywhere from 29 percent to 85 percent of fetuses with Down Syndrome are aborted.¹²³ But some families are choosing a different path and finding joy in the journey. Turning away from the offered termination of pregnancy for a fetal anomaly that has been pronounced ‘incompatible with life,’ some couples have instead chosen to embrace every minute of life their child has—both inside and outside the womb. They face pressure from healthcare professionals to abort and experience lack of understanding from family and friends. Yet, 97 percent of respondents in a 2012 study of families with children with trisomy 13 and 18 described their child as happy and parents reported these children enriched their family.⁴ Their experience was incongruent with the dismal picture predicted by their physicians. The most common negative comment made by parents in this study was a sense that healthcare professionals did not see their baby as having value, as being unique and as being a baby.

“A recent study looked at women who aborted and women who carried after learning their babies were diagnosed with a life-limiting diagnosis. The abortion group experienced more grief, depression and emotional stress, and they also had symptoms consistent with post traumatic stress disorder (PTSD) for up to seven years after the abortion as compared to the women who chose to carry group.

“Evidence is mounting to support the benefits of taking a hands-off approach to a life-limiting prenatal diagnosis and simply allowing couples to spend time with their unborn babies for as long as they have them. As Christian healthcare professionals, we should be prepared to offer families a different option to the default termination solution so often given for an adverse prenatal diagnosis. Words need to be chosen carefully, avoiding terms like ‘incompatible with life;’ instead, we should use words that affirm the baby’s life and value as a human being. Couples who choose to carry their child should be connected to resources that provide the support and understanding they desperately need.

“Perinatal hospice⁵ is a unique solution and can be thought of as ‘hospice in the womb.’ It is easily incorporated into routine prenatal care and birth planning. A team approach can include obstetricians, perinatologists, labor and delivery nurses, NICU staff, chaplains/pastors and social workers, as well as genetic counselors and traditional hospice professionals. It enables families to make meaningful plans for the baby's life, birth and death, honoring everyone.”<sup>6

1</sup>Siffel, C., Correa, A., Cragan, J., & Alverson, C. (2004). Prenatal Diagnosis, Pregnancy Terminations And Prevalence Of Down Syndrome In Atlanta. Birth Defects Research Part A: Clinical and Molecular Teratology, 70(9), 565-571.
²Khoshnood B, De Vigan C, Vodovar V, Goujard J, Goffinet F (2004) A population-based evaluation of the impact of antenatal screening for Down's syndrome in France, 1981–2000. BJOG 111: 485–490.
³Leroi, A. (2006). The future of neo-eugenics. Now that many people approve the elimination of certain genetically defective fetuses, is society closer to screening all fetuses for all known mutations? EMBO Reports, 7(12), 1184-87. Retrieved April 2, 2015, from http://embor.embopress.org/content/7/12/1184.
⁴Janvier A. Farlow B. Wilfond B. (2012)The Experience of Families With Children With Trisomy 13 and 18 in Social Networks Pediatrics Vol. 130:293 -298 (doi: 10.1542/peds.2012-0151).
⁵Hoeldtke, N., & Calhoun, B. (2001). Perinatal Hospice. American Journal of Obstetrics & Gynecology, 185(3), 525-29.
⁶Calhoun, B., Napolitano, P., Terry, M., Bussey, C., & Hoeldtke, N. (2003). Perinatal hospice. Comprehensive care for the family of the fetus with a lethal condition. Journal of Reproductive Medicine, 48(5), 343-8.

Resources

Perinatal Hospice Resources in the U.S.
CMDA’s Abortion Ethics Statement
CMDA’s Human Life Ethics Statement

Bringing empathy back into the doctor’s office

Excerpted from “Instilling empathy among doctors pays off for patient care,” CNN. March 26, 2015 — Developed by medical faculty at Duke, the University of Pittsburgh and several other medical schools, "Oncotalk" is part of a burgeoning effort to teach doctors an essential but often overlooked skill: clinical empathy. Unlike sympathy, which is defined as feeling sorry for another person, clinical empathy is the ability to stand in a patient's shoes and to convey an understanding of the patient's situation as well as the desire to help.

Clinical empathy was once dismissively known as "good bedside manner" and traditionally regarded as far less important than technical acumen. But a spate of studies in the past decade has found that it is no mere frill. Increasingly, empathy is considered essential to establishing trust, the foundation of a good doctor-patient relationship.

Studies have linked empathy to greater patient satisfaction, better outcomes, decreased physician burnout and a lower risk of malpractice suits and errors. Patient satisfaction scores are now being used to calculate Medicare reimbursement under the Affordable Care Act. And more than 70 percent of hospitals and health networks are using patient satisfaction scores in physician compensation decisions.

"The pressure is really on," said psychiatrist Helen Riess. The director of the empathy and relational science program at Massachusetts General Hospital, she designed "Empathetics," a series of online courses for physicians. "The ACA and accountability for health improvement is really heightening the importance of a relationship" between patients and their doctors when it comes to boosting adherence to treatment and improving health outcomes.

Commentary

CMDA Past President and Oncologist Al Weir, MD: “Is it possible to ‘instill empathy’ into our healthcare professionals, and is it a good thing to try?

“It is certainly good for us to have and demonstrate real compassion for our patients. Those of us who love Christ should have His compassion flowing naturally from us to those who are suffering. If we do not, there is something wrong with our relationship with the Christ. Perhaps, if we learn to love Him more, we will indeed love our patients more and demonstrate that compassion better.

“This is foremost, and all the training in the world cannot mimic true love for those we serve.

“However, though our character of love is most important, we certainly also need to develop communication skills to best demonstrate that love in a way that best demonstrates the heart of God. Communication skills can indeed be learned and practiced so that we ‘do best’ what we ‘are’ inside. I am familiar with the training instruments listed in this article. They, among others, can be quite valuable tools for Christian healthcare professionals to use in honing our skills, so that our communication actions might match our hearts of compassion.

“Just as a missionary physician must learn new roads to carry his message of Christ into the deserts of northern Sudan, all of us should learn new skills of communication through which we may best carry the message of God’s love to each patient we serve.”

Resources

Grace Prescriptions – Learn how to share your faith in your practice
Spiritual Assessment in Clinical Care – Part 1: The Basics
The Practice of Medicine: More Than Just Science

HIV epidemic hits Indiana

Excerpted from “HIV ‘Epidemic’ Triggered by Needle-Sharing Hits Scott County, Indiana,” NBC News. March 25, 2015 — An HIV "epidemic" fueled by needle-sharing opiate addicts has infected at least 72 people in one southern Indiana county as Gov. Mike Pence plans to declare a public health emergency in that community on Thursday. The outbreak's swift acceleration in Scott County — beginning with seven known HIV-positive patients in late January — has prompted state officials to ask the Centers for Disease Control and Prevention to deploy investigators to test residents and to help control further spread of the virus, Pence said.

The epidemic's true epicenter is the town of Austin, in northwestern Scott County, said Dr. William Cooke, medical director at Foundations Family Medicine. He opened the facility in Austin about 10 years and, since then, he's watched opiate abuse take a far deeper hold.

Used needles litter roadsides, ditches and yards, said Cooke, who has been publicly voicing his concerns about a brewing HIV outbreak. On Wednesday, Cooke also lobbied Indiana lawmakers to launch a clean-needle program — a strategy that, in his vision, would offer safe fresh needles and safe places to dispose of dirty needles while also connecting participating residents to addiction therapists.

Austin's population is about 4,200 people, according to the U.S. Census Bureau, and the majority of the nearly 80 known HIV cases are people who live in that town, Cooke said. Poverty is driving the mass opiate-addiction rate — and, now, the HIV epidemic, Cooke said. “We need help. But that costs money. My clinic serves the poorest people in Indiana, potentially the poorest in the country," Cooke said. "We do a sliding scale here. If they can, they may pay us 10 dollars for care. I'm hopeful this declaration provides the funding we have needed.”

Commentary

CMDA Member and Assistant Professor at Indiana Wesleyan University Reginald Finger, MD, MPH: “The HIV infection outbreak in Scott County, Indiana, straddling I-65 between Indianapolis and Louisville, occurred because at least three unfortunate factors came together at once. Lying astride a heavily traveled north-to-south transportation corridor in the Eastern U.S., it unfortunately acts as a pipeline for illegal drugs. The county struggles with poverty and poor health, ranking last among Indiana counties for health indices by the Robert Wood Johnson Foundation. Many communities nationally, however, are just as much at risk. Any one of them has enough people injecting illegal drugs with shared needles to fuel a lethal epidemic if the right virus were introduced, as it was to Scott County. Even in this age of anti-retroviral medications, HIV still makes a mess of human lives, while piling up millions of dollars in healthcare costs onto a community already struggling to make ends meet.

“What is the lesson for healthcare professionals in similar communities across the country? First: one needs a high index of suspicion not only for HIV infection itself but for any of the associated risk factors and conditions. Hepatitis C infection is often seen first. Not every injecting drug user fits a ‘stereotypical’ profile. I have decided never to be offended when a doctor, pastor or counselor asks me a blunt question about lifestyle choices, even ones that may be far from my experience. My response is ‘No, sir, but thank you for asking.’ By the question, I know that this professional is on the ball, interested not only in whatever may affect my health—as important as that is—but on protecting my community as well. Next, be well connected to social, legal and spiritual resources in your community. You may be the only human services professional that your patient has seen in a long time, especially if the person has low regard for ‘the system’ and came to you only because their need is acute. “Finally, each clinician must remember that better health for our nation depends on community and environmental factors, yes, but also on individual decisions and interventions that can only occur one patient or family at a time. The person whose life you touched in the office today may be the index case of the epidemic that did not happen—because you were there!”

Resources

Professionalism in Peril – Part 5: Our Obligation to the Poor
Healthcare for the Poor