Measles outbreak raising national concerns

Excerpted from "CDC ‘very concerned’ about potential for large measles outbreak," Face the Nation. February 1, 2015 — Tom Frieden, the director of the Centers for Disease Control and Prevention (CDC), said his agency is "very concerned" about the possibility of a large measles outbreak in the U.S. because of the growing number of people who have not been vaccinated against the disease.

"What we've seen is, as over the last few years, a small but growing number of people have not been vaccinated. That number is building up among young adults in society, and that makes us vulnerable," Frieden said in an interview on CBS' "Face the Nation" Sunday. "We have to make sure that measles doesn't get a foothold in the U.S. It's been actually eliminated from this country for 15 years. All of our cases result, ultimately, from individuals who have traveled and brought it back here."

There are at least 102 reported cases of measles in 14 states, according to CDC statistics. Frieden said there will likely be more cases going forward, and the CDC is taking "aggressive public health action" to identify contacts and isolate those infected in order to stop the spread.

But, he said, the disease is preventable and the best way to do that is with the vaccine, which he said is "safe and effective." There is a 92 percent vaccination rate in the United States, but the number of unvaccinated children is higher in certain states. In California, where an outbreak of the disease has been linked to Disney theme parks in the southern part of the state, 8 percent of kindergarteners fail to get the required immunizations against measles, mumps and rubella. In Pennsylvania, that number rises to 15 percent of kindergarteners.

Commentary

CMDA CEO David Stevens, MD, MA (Ethics): “I didn’t see a single case of measles during my training. You probably didn’t either. Parents didn’t need to be convinced to immunize their children in those days because they probably had measles as a child or knew of children in their community who had complications or died before the vaccine was available. As a young missionary in Kenya, I took care of a entire isolation ward full of children with severe measles complications. (We had a total of 427 admissions in 1984). Children had pneumonia, encephalitis and died because the immunization rates in our service area were under 20 percent. The problem was so severe that despite working long days and every third night, I started a community health program that, among many other initiatives, sent staff on motorcycles to vaccinate children under trees, in school rooms, churches and in the marketplace. Volunteers were trained to teach and motivate their neighbors on this issue. Five years later, we had dropped our measles admissions by 95 percent, and measles was almost completely wiped out in seven years. My passion for immunization is not academic. I saw it save many lives.

“But how do we balance parental rights and the need to have children immunized? CMDA has an eloquent and practical ethics statement available on this topic. Read it and add it to your files. You will be better equipped to educate others about this issue in the news.”

Resources
CMDA Ethics Statement on Immunization
Vaccinations Information and Recommendations
Is Vaccination Complicit with Abortion?

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."

Commentary

CMDA 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.”

Action

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

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

Terminally ill patient ends her life

Excerpted from “Brittany Maynard, right-to-die advocate, ends her life,” USA Today. November 3, 2014 — Brittany Maynard, the 29-year-old face of the controversial right-to-death movement, has died. She captivated millions via social media with her public decision to end her life.

Sean Crowley, spokesman for the non-profit organization Compassion & Choices, confirmed Maynard's death Sunday evening. "She died peacefully on Saturday, Nov. 1 in her Portland home, surrounded by family and friends," according to a statement from Compassion & Choices. The statement said Maynard suffered "increasingly frequent and longer seizures, severe head and neck pain, and stroke-like symptoms." She chose to take the "aid-in-dying medication she received months ago."

Her death brings a new element to the movement in the age of social media because the conversation has included younger people. "She's changed the debate by changing the audience of the debate," Abraham Schwab, an associate professor of philosophy at Indiana University-Purdue University Fort Wayne, told the Associated Press earlier.

Maynard was diagnosed with a stage 4 malignant brain tumor. She moved with her family from California to Oregon, where she could legally die with medication prescribed under the Oregon Death With Dignity Act.

"I understand she may be in great pain, and her treatment options are limited and have their own devastating side effects, but I believe Brittany is missing a critical factor in her formula for death: God," said Joni Eareckson Tada last month in an article for Religion News Service.

Commentary

CMDA CEO David Stevens, MD, MA (Ethics): “I’m deeply saddened by Brittany Maynard’s suicide. As far as we know, she had no hope—despite Joni Erickson Tada, Kara Tippets (who is dying with Stage 4 breast cancer) and others pointing her toward God, our real source of hope. I’m saddened because Compassion and Choices used and possibly abused her as their ‘poster child’ for legalizing physician-assisted suicide in a slick media campaign that drew millions of Facebook and YouTube hits, as well as enormous favorable media attention. I can’t help but wonder why she announced she was going to postpone her suicide, only to take her life two days later? Did she feel pressured or obligated to do it?

“I’m even more saddened that many more patients are likely to die because Ms. Maynard glorified suicide as the answer to suffering, and it won’t just be highly controlling, terminally ill patients like her. In the short term, it will be vulnerable teens and the depressed. In the long run, it will be handicapped newborns, Alzheimer’s patients, the chronically sick and the mentally ill, as we have already seen in Europe. It’s inevitable, despite all the so-called safeguards. Who can deny ‘this right to death with dignity’ to anyone who is suffering or is even afraid they may suffer in the future? And if the patient is incompetent, should the physician, exhausted caregiver or the son or daughter set to inherit the estate decide ‘on their behalf?’ Ultimately, it will kill the ethos of healthcare as doctor-patient trust is destroyed.

“It is too late for Brittany, but not for you and me to speak the truth in love to alter the predictable future. I’m heading to New Jersey next week to meet with legislators to urge them to say ‘No’ on an expected physician-assisted suicide vote scheduled for Thursday, November 13. I’m then traveling from one end of Montana to the other, speaking out against physician-assisted suicide in every major city and doing media interviews along the way to hopefully halt their march off the physician-assisted suicide cliff.

“What are you going to do to alter the future—before it is too late?”

Resources

CDD STAT Interview with Kara Tippetts, a stage-four cancer patient
Euthanizing Medicine, a presentation on the implications of legalizing physician-assisted suicide
Top Reasons Why Physician-Assisted Suicide Should Not Be Legal

Action

Physician-assisted suicide legislation is now being attempted in California, Connecticut, Massachusetts, Nevada, New Jersey, New Mexico and Pennsylvania. If you’d like to get involved in the fight against this dangerous legislation, please contact communications@cmda.org.

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

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."

Commentary

CMDA 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.”

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 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

Resources
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

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."

Commentary

CMDA 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.”

Resources

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

FDA examines genetic tinkering

(Excerpted from "FDA raises concerns about three-parent embryo procedure," USA Today, February 26, 2014) - In two days of hearings ending Wednesday, a federal committee proved quite skeptical about research that might help some patients birth healthy children — but might also open the door to human gene manipulation. The procedure being considered, called mitochondrial transfer, would mix the genes of two women in hopes of creating a healthy baby.

Although the panel, which advises the federal Food and Drug Administration, did not take a vote, many members questioned the ethics of the procedure, and whether the research into it is as far advanced as some supporters claim.

All people carry two sets of genes in every cell: the 20,000 genes in the cell's nucleus, which determine traits like height, eye color and intelligence; and the 37 genes in the mitochondria, which provide energy for each cell. The mitochondrial transfer procedure would combine the nuclear genes from the mother with the mitochondrial genes of a donor woman. When fertilized, it would lead to babies with genetic material from three "parents."

The procedure promises to help women who carry defective genes that can lead to devastating mitochondrial problems in children, including blindness, organ failure and stroke. It might eventually also help resolve some types of infertility.

The committee considered what scientists would need to do before they could try the technique in people, and whether it would be possible to design a clinical trial to answer the many outstanding questions about the procedure. David Prentice, a cell biologist and senior fellow for life sciences at the Family Research Council, a conservative advocacy group, told the panel he strongly objects to any mixing of genetic material.

"The individuals created are experiments," he said by phone after the meeting ended. "You're actually creating and destroying young human life which we object to. It just seems a very wrongheaded way to proceed."

Commentary

Breaking News...

CMDA CEO Dr. David Stevens debated this issue with Ethicist Arthur Caplan on the Fox and Friends national news program, cohosted with Elisabeth Hasselbeck this morning. Dr. Stevens noted the destruction of human embryos in the proposed procedure and non-destructive alternatives to pursuing the cure. He also highlighted the ethical issue of foisting genetic changes, with unknown consequences, on successive generations.

"Germ line manipulation is something that has been prohibited in science all over the world up until the present time," Dr. Stevens noted.

Dr. Caplan replied, "I understand the concern about where we might go. I'm going to worry about that when I get there."

Watch the video here

CMDA CEO David Stevens, MD, MA (Ethics): “Dr. Caplan is not a scientist so maybe he doesn’t understand the grave dangers that germ line manipulation can cause. In some mice studies using ‘mitochondrial replacement therapy,’ there were decreased survival rates, developmental delays, fertility problems and behavioral changes in progeny. No one knows what will happen if it is tried in humans, but we do know that if problems occur, they will continue through every generation. We should be worrying about that now, not when ‘we get there.’ By then, it will be too late.

“As an Ethicist, Dr. Caplan should be concerned that the scientists experimenting on the unborn can’t get informed consent from that child’s granddaughter before doing experiments that will affect her life. He should be concerned that two of the methods of replacing ooplasm require cannibalizing another human embryo causing their death.

“Forty-one years ago, the Supreme Court decided a child could be destroyed if a woman didn’t want it. The FDA is now deciding whether a woman has the right to construct the child she wants. That decision is based on a genetic mutation problem that only causes serious disease in 400 to 600 of the four million babies born each year. If women get this new right, how can society deny them exercising it to correct more serious problems like obesity, diabetes or heart disease, if this ability becomes available through germ line manipulation? Look at all the money society would save on healthcare! Wouldn’t people be happier?

“While the scientist is tinkering, why stop at just making members of that family tree skinny? Why not add making them all six-foot tall, blue eyed and athletic? Welcome to the brave new world of designer babies and two classes of humans, the enhanced and unenhanced.

“As a society, we should not cross the clear line in the sand prohibiting germ line manipulation. It’s science too dangerous to use.”

Executive Director of The Tennessee Center for Bioethics & Culture D. Joy Riley, MD, MA: (from her testimony before the FDA, Feb. 25, 2014) – “It is remarkable to note that while more than 40 nations have prohibited germ line modification, we are contemplating stepping over that bright line. It is imperative that we reflect upon the words of philosopher George Santayana, who presciently wrote, ‘Those who cannot remember the past are condemned to repeat it.’ This applies in several ways.

“First of all, consider that this change is being evaluated by the ‘Cellular, Tissue and Gene Therapies’ Advisory Committee of the FDA. While this is your purview, it is not merely cells, tissues or genes which are being affected by this decision. No, it is human beings – human beings at their earliest stages – who are the subjects of this research. These are your and my children, grandchildren, nieces, nephews and cousins being considered here today. Their Petri dish appearance should not confuse us. They are very much human.

“Secondly, consider codes of international standing:

“The Declaration of Geneva proclaimed for physicians worldwide, ‘The health of my patient will be my first consideration.’

“The Declaration of Helsinki stated, ‘In medical research involving human subjects, the well-being of the individual research subject must take precedence over all other interests.’

“In the Council of Europe’s Convention on Biomedicine and Human Rights, intervention on the human genome is countenanced ‘only if its aim is not to introduce any modification in the genome of any descendants.’

Finally, a major requirement of research on human subjects is that of fully informed consent by the human being whose life, health and posterity will be impacted by the proposed human experiment. This is not therapy for the ones undergoing experimentation. Their very formation is the experiment under consideration here. They are not able to give consent; neither are all their descendants who come after them able to give consent, yet the proposal is to experiment on all of them by virtue of altering their germ line for all time.

Resources:
CMA Letter to FDA on Oocyte Modification in Assisted Reproduction
CMDA Genetics Resources

Brain-dead patient taken off life-support

Excerpted from “Brain-dead Texas woman taken off ventilator,” CNN Health. January 27, 2014 — A wrenching court fight—about who is alive, who is dead and how the presence of a fetus changes the equation—came to an end Sunday, January 26 when a brain-dead, pregnant Texas woman was taken off a ventilator. The devices that had kept Marlise Munoz's heart and lungs working for two months were switched off about 11:30 a.m. Sunday, her family's attorneys announced.

Munoz was 14 weeks pregnant with the couple's second child when her husband found her unconscious on their kitchen floor November 26. Though doctors had pronounced her brain dead and her family had said she did not want to have machines keep her body alive, officials at John Peter Smith Hospital in Fort Worth had said state law required them to maintain life-sustaining treatment for a pregnant patient.

Sunday's announcement came two days after a judge in Fort Worth ordered the hospital to remove any artificial means of life support from Munoz by 5 p.m. Monday. The hospital acknowledged Friday that Munoz, 33, had been brain dead since November 28 and that the fetus she carried was not viable. Her husband, Erick Munoz, had argued that sustaining her body artificially amounted to "the cruel and obscene mutilation of a deceased body" against her wishes and those of her family. Marlise Munoz didn't leave any written directives regarding end-of-life care, but her husband and other family members said she had told them she didn't want machines to keep her blood pumping.

Commentary

Since there are a variety of opinions on this difficult ethical issue, we have included 2 commentaries.

CMDA CEO David Stevens, MD, MA (Ethics):"While the medical technology being applied to Mrs. Munoz’s body might be considered “organ support” for her, it was “life support” for her unborn child. At the time of her death the baby was a few days from reaching 24-weeks gestation when survival rates approach 50%. Every day of continued life support improved the odds of the baby’s survival.

"A few days ago, on February 9th, Robyn Benson had a premature baby boy. Just after Christmas she suffered a cerebral hemorrhage resulting in her own brain death. She was maintained on life support until her baby was delivered. The ventilator was disconnected the day after her child was born. According to reports, the baby is doing well in the NICU.

"I don’t have access to the medical records in either of these cases, but a CNN article on the Benson case makes an inadequate effort to ethically differentiate between her baby’s situation and Mrs. Munoz’s. First, they let you know that one child was wanted by its father but the other was not. The worth of a human being does not depend on whether it is wanted or not. Secondly, the Munoz lawyer’s reported that an incomplete ultrasound had shown the baby had hydrocephalus and possibly other malformations. We should recognize that disposing of the disabled is unethical and simply eugenics. Who decides when a person is disabled enough for elimination?

"CMDA does not have an official ethics statement dealing with this complex issue. Maybe we should. You can contribute to the discussion of what it should say by clicking on the comment link below."

Clinical Ethicist and CMDA Trustee Robert D. Orr, MD, CM:“Marlise Munoz was dead, but her 14-week old fetus was alive. If Mom’s organs could be successfully perfused for another 12-14 weeks, her unborn baby could survive and be delivered by C-section. It is possible, though clinically very challenging. But should it be done?

“Marlise’s family did not want artificial support continued, and they were convinced she would not want it. The hospital believed Texas law prohibited removing life support from a pregnant woman. The legal issue was straightforward: Marlise was dead, therefore the support was not ‘life support’ for her, but ‘organ support’ for the benefit of the fetus. Continued support was legally optional.

“But what about the ethical dilemma? Who should decide? What factors should be considered? Some believe it is morally obligatory to do everything possible to prevent fetal death. Others believe that ‘doing everything’ is not always obligatory, making this comparable to high risk, high burden prenatal fetal surgery, i.e., optional, decided by her family based on their understanding of her wishes and values.

“Not all believers will agree. We will agree that we are stewards of our lives, our bodies and our resources. And we will likely agree it is immoral to intentionally end prenatal life for trivial reasons. The intention in continuation was to possibly benefit a second life. The intention in stopping was to discontinue ineffective and unwanted treatment. I personally believe continued support in this case was discretionary. And I believe we should not harshly judge the Munoz family’s decision.”

Resources

CMDA Ethics Statement on Vegetative State
Resources on End of Life Care

Obamacare rollout highlights views of government

Excerpted from "An opening for the right," The Washington Post, commentary by Jennifer Rubin, October 27 - The Obamacare debacle challenges a number of liberal mantras that undergird a whole set of policies and campaign appeals. Here are the top 10 liberal tenets threatened by Obamacare:

1. If there is a problem, the federal government should attack it.
2. Government can compel people to act against economic self-interest by passing laws.
3. There is no downside to big government.
4. The welfare state is the best mechanism to help the poor.
5. Those opposed to big government hate the poor.
6. Government is capable of running highly complex systems effectively.
7. When addressing big problems it is best to centralize and standardize.
8. Unintended consequences of government programs are a small price to pay.
9. People will trust the government with private decisions and personal information.
10. Spending more and taxing more are evidence of concern for the poor.

All of these precepts have been challenged by conservatives, but there is nothing like a real example and personal experience to drive home a message. We don’t have just a few “glitches” or even a time crunch for putting up the exchanges, we have in Obamacare a fundamental misunderstanding of the limits of the government and citizens’ aversion to big, complicated entities. The effort to construct one big system with a highly regulated product (Obamacare-standard insurance) may in fact be the entire effort’s undoing.

Commentary

CMDA CEO David Stevens, MD, MA (Ethics):
“Our healthcare system is broken and badly in need of a fix. The root problem is that healthcare costs too much, so individuals and businesses can’t afford insurance. The Affordable Care Act, unfortunately, is built on the premise that most people’s health insurance programs are not adequate and all perceived inequities must be solved. So the law says preventative services and contraceptives must be free. It doesn’t allow surcharges for age or preexisting conditions. Children can stay on their parents’ plans until age 26. There are no lifetime cost ceilings. Plans must contain psychiatric, eye and other coverages that most insurance plans have not provided.

“I like all those things, just like I like all the bells and whistles on a Mercedes Benz 500 with its great ride and exquisite comfort. But I’ve never owned a Mercedes because I can’t afford one, just like most people in our country. I drive a Honda Civic and, you know what, it gets me there. We can’t afford the Affordable Care Act either. It will add a whopping $2.8 trillion to our healthcare costs over the next 10 years. Already, self-insured individuals are experiencing the reality of that sticker shock but they are no longer in a market-driven healthcare economy. They can’t buy a well-used insurance vehicle at an economical price. Only a Mercedes is adequate.

“We very well may be headed for a debacle. The ‘cure’ may be worse than the disease. If so, everyone may be so traumatized that they refuse to even give a hearing to a real solution.”

Proposed treatment to fix genetic diseases raises ethical issues

Excerpted from “Proposed treatment to fix genetic diseases raises ethical issues,” Shots: Health News from NPR. August 14, 2013 -- The federal government is considering whether to allow scientists to take a controversial step: make changes in some of the genetic material in a woman's egg that would be passed down through generations. Mark Sauer of the Columbia University Medical Center, a member of one of two teams of U.S. scientists pursuing the research, calls the effort to prevent infants from getting devastating genetic diseases "noble." Sauer says the groups are hoping "to cure disease and to help women deliver healthy, normal children."

But the research raises a variety of concerns, including worries it could open the door to creating "designer babies." Specifically, the research would create an egg with healthy mitochondrial DNA (mtDNA). Unlike the DNA that most people are familiar with—the 23 pairs of human chromosomes that program most of our body processes—mtDNA is the bit of genetic material inside mitochondria, living structures inside a cell that provide its energy.

Scientists estimate that 1 in every 200 women carries defects in her mtDNA. Between 1 in 2,000 and 1 in 4,000 babies may be born each year with syndromes caused by these genetic glitches; the syndromes range from mild to severe. In many cases, there is no treatment, and the affected child dies early in life. "We have developed a technique that would allow a woman to have a child that is not affected by this disease, and yet the child would be related to her genetically," says Dieter Egli of the New York Stem Cell Foundation.

But this is all still very controversial. First of all, the baby would be born with genes from three different people: from the father, from the woman trying to have a healthy baby, and from the woman who donated the healthy egg. There are even bigger concerns, which start with whether the technique is safe for the resulting infant, and whether by trying to fix one problem, scientists may inadvertently introduce mistakes into the human genetic code. That's why this sort of thing has always been off-limits — even banned in many countries, according to Marcy Darnovsky of the Center for Genetics and Society.

Commentary

CMDA CEO David Stevens, MD, MA (Ethics): “Germline genetic engineering, where a portion of the egg or sperm’s genome replaced, changed or supplemented, is unethical, unnecessary and unsafe. It crosses a bright line in the bioethical sand labeled, ‘That shalt not!’


“It is unethical because it permanently changes the child’s genes and any unforeseen consequences that occur are passed on to every generation that follows. Thus, it violates the ethical principle of autonomy. How does the doctor get informed consent from their grandchild yet to be conceived? Some of the techniques proposed involve destroying human embryos, not just manipulating women’s eggs. For example, some propose discarding female embryos created and only implanting male embryos to avoid the risk of passing on an inheritable defect.

“It is unnecessary. Women who have an identified high risk with a high mutation load, (under 18 percent mutations of mtDNA, there is 95 percent certainty of no risk) already have the option of not having children, adopting, utilizing a donated egg, preimplantation genetic diagnosis and prenatal diagnosis with abortion. Some of these options are unethical because they destroy life, but they are legal. Scientists are trying to justify germline manipulation so that women with this genetic liability might have the option of having a child with their genes. While this ambition is understandable, because there are alternatives, and because there are significant risks to generations of offspring, we should prohibit this option.

“It is unsafe. This type of genetic manipulation is not human cloning but uses similar techniques that have been associated with serious problems when used in animals—large organ syndrome, malformations and miscarriages.

“The ‘hard cases’ have been historically used to justify crossing the ‘bright lines’ in bioethics. We saw this in abortion, but once society agreed that abortion was justified because the mother didn’t want a child because of rape, incest or a genetic defect, it soon became justified for a woman not wanting a child for any reason. In other countries, physician-assisted suicide was justified for patients who had lives ‘not worthy to be lived’ because they were terminally ill and suffering. Now it is allowed for any reason the patient conceives that their life is unworthy to live. It is not unreasonable to predict if society says germ line manipulation is okay to avoid having a child with an imperfect genome that society will soon open the door for germline genetic engineering in the quest for perfect children.”

Resources
Novel techniques for the prevention of mitochondrial DNA disorders
Position Paper on Human Germline Manipulation
CMDA Resources on Reproductive Technology and Health

Physicians prepare to deal with increased demand, strain on practices under ObamaCare

Excerpted from “Physicians prepare to deal with increased demand, strain on practices under ObamaCare,” Fox News. October 1, 2013 -- As enrollment in ObamaCare begins, physicians throughout the country are preparing to deal with an influx of newly insured patients – as well as the increased financial demands this will place on their practices. While it will take a few years for doctors to fully determine how they will be affected by ObamaCare, some physicians are already anticipating the need to make major changes to the way they run their practices.

One of the most immediate changes that physicians in these areas expect to see is an increase in patients seeking preventive health care – something many avoided when uninsured. However, scheduling more routine check-ups and screenings may place a strain on already short-staffed practices in rural areas. As a result, some doctors are considering handing over some basic aspects of patient care and education to nurses, nurse practitioners, or physicians assistants in order to treat patients more efficiently. Dr. Jason Marker, of Wyatt, Indiana, is already looking to hire additional staff members in order to meet the increased needs in his community.

Rural areas throughout the country already face a shortage of primary care physicians and doctors like Marker fear that this problem might become exacerbated in coming years, as more patients have the means to seek regular care.

“We know definitively that health insurance coverage and access to a physician are what improve health care outcomes.” Marker said. “We’re about to get changes in coverage, but we don’t have a ready way to say, ‘Here’s another million family doctors.’ So there’s a pipeline problem where it will be another five to 10 years where we are able to get the volume of doctors to take all these patients.”

Marker said Congress will need to step up in order to help fix this problem. “The big weak link is whether or not Congress is willing to put additional dollars into family medicine residential training,” Marker said. “That’s the current bottleneck in the training pipeline, is having residency slots. It doesn’t do good to have residents interested if there aren’t slots to do training.”

Commentary

CMDA CEO David Stevens, MD, MA (Ethics): -- “When we went as missionaries to Africa, Jody knew we would be far from the grocery store yet entertaining many guests, so she bought a cookbook called More With Less. That phrase succinctly describes the focus that every healthcare professional will need as we move forward. There are going to be more patients to see than ever before but not enough physicians to see them. Though more medical schools are opening, including two Christian ones, there are not enough residencies being funded. Physician assistant and nurse practitioner schools are expanding to help fill in the gap, but the problem is bigger than that.

According to leading economic John Maudlin, reimbursement rates are going to plunge by 25 percent in the next five years. (I encourage you to read the eye-opening article.) The Cleveland Clinic now collects $6 billion a year and expends $5.5 billion. They are projecting their income to plunge to $4.4 billion by 2018, despite a significant increase in their patient load, as commercial insurance companies on average go from paying $.38 on the dollar billed to $.26. (Medicare now pays $.23 and Medicaid $.18.) Since 60 to 80 percent of their cost is for personnel, that is where cost savings will have to be realized. That is why you are already hearing of hospitals and practice groups laying off staff and if those staff are rehired elsewhere, they probably will be paid less.

CMDA’s Executive Vice President Gene Rudd, MD, told those attending the CMDA Midwest Regional Conference a few weeks ago that they would all need to become missionary doctors…but not necessarily by going overseas. They will have to have a missionary's mentality of working very hard and not getting paid as much, but doing it because God has called them to minister through medicine.

Though we will all being doing "more with less" I believe that the opportunities to minister through healthcare are going to be greater than ever! God does His best work in the midst of crisis and change if we simply rest and trust in Him!

Resources
From My Viewpoint: Healthcare Reform by David Stevens, MD, MA (Ethics)
Why HR 3200 is No Healthcare “Reform” by Gene Rudd, MD
Affordable Care Act Impact on Doctors and Patients

ObamaCare rollout faces physician shortage

Excerpted from "Get ObamaCare, while supplies last," USA Today, column by Paul Howard, July 11, 2013 - On Oct. 1, the uninsured can start signing up for coverage under ObamaCare. But should every policy be sold with an asterisk: Guaranteed access to care ... while supplies last?
Maybe. The unpleasant truth is that we don't have enough doctors to offer quality care to a growing number of Americans, never mind the nearly 30 million uninsured who'll begin to gain coverage under ObamaCare starting in 2014.

Changing demographics and perverse reimbursements are the main culprits. But ObamaCare didn't do much to address the underlying problems. Estimates vary, but the Association of American Medical Colleges predicts the U.S. will be short 130,000 doctors across all specialties by 2025. In fact, about one-third of all doctors plan to retire in the next decade.

Today, nearly 20 percent of Americans lack adequate access to primary care because there aren't enough physicians. About 30 percent of doctors won't accept new Medicaid patients. About one-third of ObamaCare's insurance expansion will come through expanding Medicaid.

ObamaCare relies on primary care providers to coordinate care in the hopes of lowering costs and improving outcomes. After adjusting for population growth, aging and demand for care created by the newly insured, we estimate that by 2025, the U.S. will face a shortage of 30,000 primary care physicians, nearly 5,000 of which are attributable to the expansion of insurance under ObamaCare.

Medicare grossly underpays primary care doctors compared with specialists and pays nurse practitioners 85 percent of what it pays doctors for the same services. And medical students are leaving school with crushing debt.

ObamaCare's focus on expanding health insurance left many of our biggest access-to-care challenges untouched. Get ready for Health Care Reform 2.0, starting next year, when many of America's newly insured realize that they have to get in line to see a doctor when they need one.

Commentary

CMDA CEO David Stevens, MD, MA (Ethics):"Why go to school for seven or eight years to become a primary physician when you can make 85 percent of a physicians salary as a nurse practitioner by adding just a couple more years of schooling to your undergraduate degree? You also will come out with a lot less debt. The median debt for a public medical school in 2012 was $160,000 and for a private $190,000.¹ It is no surprise that only 25 percent of allopathic school graduates are going into primary care, but even that statistic may be misleading since 75 percent of students matching to internal medicine programs go into specialties.² That is one of the reasons that osteopathic schools are prospering. Their number has grown from 19 campuses in 2000 to 37 in 2013.³ More than half their graduates go into primary care.⁴ Unfortunately, their debt load average on graduation is higher than allopathic schools by almost 25 percent.

"Economic disincentives have seriously damaged primary care and, if surveys are right, it will be worsened by the large number of physicians planning to retire early due to their concerns about Obamacare.⁵ Ultimately, patients will pay the price with decreased accessibility and poorer health.

"The ranks of mid-level professionals are increasing dramatically to fill in the gaps, but we should be concerned that a significant drop in primary care physicians will leave a dangerous knowledge and experience void between what mid-levels can provide and what specialists should handle.

"This cloud does have a silver lining! With the need for more physicians, it has opened the door for two Christian osteopathic schools to be up and running by this fall and two more are in the planning stages. I’ve also noted that there seems to be a higher percentage of Christian students on secular osteopathic campuses than allopathic ones and they seem to maintain a more balanced life."

1.https://www.aamc.org/download/152968/data
2.http://sphhs.gwu.edu/abouttheschool/news/?d=12544
3.http://www.aacom.org/about/colleges/Pages/default.aspx
4.http://www.princetonreview.com/medical/osteopathic-medicine.aspx
5.NewsMax “Sixty percent of the doctors responding to the Deloitte Center for Health Solutions survey are likely to will retire sooner than planned in the next one to three years, irrespective of age, gender or medical specialty.”

Kindergarten lessons on health care

COMMENTARY

Excerpted from July 5, 2012 commentary published in The Washington Examiner

by CMA VP for Government Relations Jonathan Imbody:

Reforming health care is unquestionably challenging, but it's not brain surgery and works best when following basic principles most kindergartners learn. Help others up when they've fallen, keep your hands off other people's stuff and save your lunch money for when it's needed.

[For example]:

• Provide a targeted and sustainable safety net to assist the poor and patients with catastrophic health care costs.
• Preserve patient access to health care professionals through conscience rights and malpractice reform.
• Cut government bureaucracy and paper work and return decision making to patients and their physicians.
• Empower consumers with insurance competition between states and portability between jobs.
• Encourage health savings accounts that protect against unaffordable expenses and let consumers choose care and medicines through transparent pricing.

ARTICLE

CMA submits Congressional testimony on health care law

Excerpted from written testimony by the Christian Medical Association submitted to the United States House of Representatives, House Oversight and Government Reform Committee, Subcommittee on Health Care, District of Columbia, Census and the National Archives. The Subcommittee held a hearing July 10, 2012, "The Affordable Care Act (ACA): Impact on Doctors and Patients."
The ACA's weakening of conscience rights threatens to accelerate looming physician shortages and result in loss of access for millions of patients:

• Currently, 65 million people lack adequate access to primary care physicians.ⁱ
• Fifty medical studies have projected critical shortages of physicians.ⁱⁱ
• The American Association of Medical Colleges concludes, “If physician supply and use patterns stay the same, the United States will experience a shortage of 124,000 full-time physicians by 2025.” ⁱⁱⁱ
• Millions of patients, notably the poor and those in medically underserved regions, depend for care on religious health care institutions and professionals whose faith and conscience compel their service. Faith-based health care depends on protections against discrimination for upholding life-affirming ethical standards. Absent conscience protection, nine of ten faith-based physicians say they would be forced to leave medicine.^iv Yet the Obama administration eviscerated the only federal regulation that protected the exercise of conscience in health care, and partisans in the last Congress shot down amendments to protect conscience in the ACA.
• The HHS contraceptive mandate illustrates how an administration can use the ACA to weaken conscience rights and ignore First Amendment freedoms. Besides mandating a massive expenditure without a cost analysis, the mandate also tramples the conscience rights of virtually every patient, physician, employer and insurer who ethically objects to any of the contraceptives included in the mandate, including those which the FDA notes can end the life of a human embryo.
• Funding for abortion training is not excluded from the Teaching Health Graduate Medical Education (THCGME) program. Without strong conscience protections, such training can become essentially mandatory in practice and can effectively exclude life-affirming OB/Gyn residents from medicine.

REFERENCES:
ⁱ“Shortage Designation: HPSAs, MUAs & MUPs,” HRSA web site http://bhpr.hrsa.gov/shortage/
ⁱⁱ“Recent Studies and Reports on Physician Shortages in the U.S.,” Association of American Medical Colleges, April 2009. http://www.aamc.org/workforce/stateandspecialty/recentworkforcestudies.pdf
ⁱⁱⁱ“The Complexities of Physician Supply and Demand: Projections Through 2025,” AAMC report, October 2008.https://services.aamc.org/publications/index.cfm?fuseaction=Product.displayForm&prd_id=244
^ivhttp://www.freedom2care.org/docLib/200905011_Pollingsummaryhandout.pdf

---

COMMENTARY

CMDA CEO David Stevens, MD, MA (Ethics):
"This past week I did a Christian Doctor's Digest STAT interview with Stewart Harris, who teaches constitutional law at a nearby law school. The interview will be released next month. He is Princeton-trained, articulate and media savvy, since he does a regular regional NPR program on constitutional law. Since the contraceptive mandate has generated more than 20 lawsuits that will likely end up at the Supreme Court, I asked him how he thought the Court might rule.

"He thought since the contraceptive mandate is "generally applicable" in that it applies to everyone except churches that this will likely be the argument made by the government, and it could succeed.
"I commented that the religious exemption clause in the contraceptive mandate is the narrowest one ever written into federal law. If it is not overturned, this could have a profound effect on religious freedom, essentially narrowing our right of freedom of religion to simply a freedom of worship. In other words, we could worship whatever and however we desired but would no longer have the right to exercise our religious beliefs in the public square.

"I then stated as an example, 'So if the government required all doctors in OB/Gyn or family practice to have abortion training or to provide abortions in their practice and thus the law was generally applicable to all physicians in those specialties, that would be constitutional?' He responded, 'I hadn’t thought of it in that way, but the answer could be, 'Yes.'

I’m not a constitutional lawyer, but I know there are other factors to consider. CMDA partners with a number of legal organizations that are involved in these suits. These attorneys will also argue that the government does not have a compelling interest to force religious groups to effectively subsidize, against their convictions, all contraceptives. They will also argue that the mandate is not the least religiously restrictive way to pursue its goals. There are also laws on the books prohibiting requiring abortion training or other participation in abortion.

"Stewart went on to comment that the interpretation of the Constitution is unfortunately often based on the 'rule of five' – whatever you can get five Justices of the court to agree on is considered constitutional. He then commented that this is why it is so important to elect people to office who represent your views on important issues. Not only will they pass laws that don’t abuse religious liberty; they are also some of the ones who will decide who the next Supreme Court Justices will be--and whether those justices will follow the original intent of the Constitution or bend it to suit their own preferences. He expects three Justices to be replaced in the next four years.

"It may seem obvious to us that the First Amendment free exercise of religion clause makes the contraceptive mandate unconstitutional, but others see it in a totally different light. We dare not let ourselves think we are too busy to be involved in this crucial time in the history of our country. This fall we must vote and urge as many others as possible to register to do the same."