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.”

Commentary

CMDA 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.”

Resources

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.

The difference between right and wrong in medicine

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

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

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

Commentary

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

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

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

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

Resources

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

Contraception's impact on abortion disputed

Excerpted from "Does Contraception Really Reduce the Abortion Rate?," commentary by Michael J. New, National Review Online, June 17, 2014 - Last week, the Guttmacher Institute released an analysis of the recent decline in the incidence of abortion. Overall, the abortion rate declined by an impressive 13 percent between 2008 and 2011 and reached its lowest level since 1973. This Guttmacher analysis joins a chorus of pundits — including Andrew Sullivan — who were quick to credit contraception for this decline in the abortion rate. And like most Guttmacher studies, this analysis is quick to downplay pro-life laws and other pro-life efforts.

The author makes a fair point that the abortion decline was fairly consistent throughout the country and was not concentrated in states that were active in passing pro-life laws. He correctly points out the sharp increase in state-level pro-life laws took place after the abortion decline already happened. However, the study presents a false dichotomy between either crediting legislation or crediting contraceptives for the falling abortion numbers. Indeed, it neglects other factors such as public opinion. In 2009, for the very first time, Gallup reported that a majority of Americans described themselves as “pro-life.”

A longer term analysis of abortion trends reveals insights which weaken Guttmacher’s case. Last month, the Charlotte Lozier Institute released a study by Susan Wills analyzing the U.S. abortion decline from 1990 to 2010. The key finding is that the abortion decline has not been uniform among age groups. The declines have been the greatest in both absolute and percentage terms among teens and women in their early 20s. This is important for two reasons. First, Long Acting Reversible Contraceptives (LARCs), which are touted by Guttmacher, tend to be unpopular with this subset of women. Second, there is a growing body of data showing declines in teen sexual activity since the early 1990s. As such, contraceptive use may be playing less of a role in the long-term abortion decline than the Guttmacher analysis would indicate.

Additional analysis further weakens Guttmacher’s argument. According to its own statistics, the number of abortions has fallen by roughly 34 percent since 1990 and the abortion rate has fallen by 38 percent since that time. It is true that contraception use has increased since the early 1990s, but it’s also true that contraception use has been rising steadily since the early 1960s, and obviously predates the abortion decline by a significant number of years. More importantly, even though contraceptive use has gone up, the fertility rate and unintended pregnancy rate have both actually increased slightly since the mid-1990s. All in all, pro-life efforts to change the hearts and minds of women facing crisis pregnancies might be more effective than commonly realized.

Commentary

CMDA Executive Vice President Gene Rudd, MD – “When I recently asked an accountant for a financial report, her response was, “What do you want the numbers to be?” I had heard this as a joke, but she seemed serious. When I told her I wanted the numbers to be accurate, she explained that she could make a variety of assumptions and chose different methodologies that would produce somewhat different results. If I had a preference for how the numbers should look, she would make decisions that would influence the numbers in that direction. To me it sounded like cooking the books; essentially asking what I wanted 2 + 2 to equal.

“And it is not only in accounting. The medical and scientific literature are replete with similar biases and influences that determine outcome, intentional or not. A survey published in the journal Natureⁱ revealed the magnitude of the problem, from poor record keeping (27 percent) to outright fraud. And these were the researchers themselves admitting wrongdoing! Actual misbehavior may be higher.

“We should be wary that those with social or political agendas will cook the books, reporting data the way that serves their purpose. What do you think the Guttmacher Institute (founded and funded by Planned Parenthood) wants the numbers to be?”

Resources
CMDA Resources on Abortion

ⁱMartinson BC, Anderson MS, de Vries R. Scientists behaving badly, Nature 435/9, June 2005.

Christians no longer comfortable in culture

Excerpted from "The days of acceptable Christianity are over," World Magazine, May 13, 2014 - Robert P. George, chairman of the U.S. Commission on International Religious Freedom, on Tuesday delivered a somber message to Christians: “The days of acceptable Christianity are over.”

George, the McCormick Professor of Jurisprudence at Princeton University, made the remarks at the 10th annual National Catholic Prayer Breakfast in Washington, D.C. George said society calls Christian beliefs bigoted and hateful, and “they despise us if we refuse to call good evil and evil good.” He argued that American Christians no longer have the option to avoid the culture wars, saying “a price must be paid” for holding to traditional church teachings on life, marriage, and sexual ethics.

Former Mozilla CEO Brendan Eich and axed reality show hosts David and Jason Benham are some of the latest to pay that price for their belief in traditional marriage. George said what American Christians are facing is the 21st century version of the question, “Am I ashamed of the gospel?”

“Marriage is inseparable from the gospel,” he said. “These teachings are not the whole gospel, but they are integral to the gospel. They are not optional truths.”

George said even if the current cultural trend is unstoppable, Christians should not stop teaching what the Bible says about human sexuality. “If we deny these truths, we really are like Peter [saying] ‘I do not know the man,’” he said. “If we keep silent, we are like the other disciples, who ran.”

George noted how societal pressures have helped unite Catholics and evangelicals, who he called “our brothers and sisters in Christ.”

Commentary

CMDA Executive Vice President Gene Rudd, MD – “I write this while still jet-lagged from a trip to an East Asian country where persecution of Christians is well known. I return with a heightened appreciation of the struggles facing believers who live under the real threat of reprisal for their faith. With signs and symptoms now manifest here, it is easy to agree with Professor George in predicting that our culture is destined to the same fate.

Growing up, I never imagined overt persecution against Christians in the United States. But our faith is now the one that the “tolerant ones” refuse to tolerate. Is it because of our message, or because of hypocrisy and lack of grace? Likely both. The first we must not abandon; for the second we must seek forgiveness.

On a recent flight, I read Nik Ripken’s (pseudonym), The Insanity of God, his personal research of the persecuted church in many cultures. My seatmate must have thought I was daffy. At one moment I would be laughing and in the next, crying. In one of the book’s poignant conclusions, Ripken reminds us that God uses persecution to grow the Body of Christ. We should not disdain persecution. Rather than pray to be delivered from persecution, we must simply pray that we be found faithful.

“Jesus said, ‘Blessed are you when men hate you, when they exclude you and insult you and reject your name as evil, because of the Son of Man. Rejoice in that day and leap for joy, because great is your reward in heaven. For that is how their fathers treated the prophets’” (Luke 6:22-23, NIV 1984).

Resources
Full Remarks – Robert P. George at the National Catholic Prayer Breakfast
http://www.freedom2care.org/

A new study shows religion helps toughen the brain

Excerpted from “Religion, Spirituality May Build Resilience Against Depression by Toughening the Brain, Study Suggests,”Psychiatric News Alert. January 9, 2014 — The reason that religion or spirituality appears to protect people with a familial risk of depression from developing the illness may be because religion or spirituality thickens the cortices of the brain, Columbia University researchers Lisa Miller, PhD, Myrna Weissman, PhD, and colleagues report in JAMA Psychiatry.

Their study included 103 adults who were either at high familial risk or low familial risk for depression. The importance they placed on religion or spirituality was evaluated at two time points during a five-year period. The thickness of their brain cortices was measured with MRI at the second time point. The researchers found that the brain cortices of subjects who placed a high importance on religion or spirituality were thicker than the brain cortices of those who did not, but that, in addition, the cortices were especially strong in those individuals who placed a high importance on religion or spirituality and who had a high risk of depression.

"This study points to measurable, beneficial effects of presumably healthy spirituality, especially for individuals with biological predispositions to depression," Mary Lynn Dell, MD, told Psychiatric News. The study, she continued, "adds to substantial and growing evidence that psychiatrists should support healthy development in that sphere of patients' lives. Studies such as these may also inform the particular ways and methodologies religious professionals...employ to care for and work with depressed individuals, while at the same time staying true to their particular religious beliefs and traditions."

Commentary

Sr. Vice President, CMDA Gene Rudd, MD: “A single study finding that the cerebral cortex is thicker in people who place a high priority on religion or spirituality obviously requires additional investigation. But it is only one new addition to the large amount of literature linking many positive health outcomes with religion and spirituality. That accumulative data is impressive – more than 1,500 studies and counting.


“So if faith is so good for health, why are we not introducing it more in clinical care? In surveying Christian doctors, we found that the great majority have a desire to engage the spiritual lives of their patients, but the obstacles that prevent them are 1) concerns about time, 2) fear of ethical concerns, and 3) ignorance of how to appropriately do so. Would it surprise you to know that there are excellent answers and solutions to each of these concerns?

“To help Christian doctors overcome the obstacles, effectively engage the spiritual needs of patients and improve overall healthcare delivery, CMDA has developed a curriculum called Grace Prescriptions. Visit www.cmda.org/gracerx to find information as to where and when these seminars will be held in the coming months. While the live seminar experience is the best way to gain this knowledge and skill, we are also developing a video curriculum that can be used by groups in their local communities. The video curriculum is expected to be released by summer 2014.

“As a means of honoring Christ’s command that we be salt and light, and as a means of broadening the scope of healing care for your patients, we hope you will join us in learning how to provide Grace Prescriptions.”

Resources
Grace Prescriptions
Faith and Health

CMA advises Supreme Court on embryo-ending drugs

Excerpted from "U.S. Supreme Court Takes Up Healthcare Law Again," AUL blog, Nov. 26, 2013 - “The U.S. Supreme Court again has the chance to defend the constitutional rights of all Americans, in considering the punishing mandates in a landmark, anti-life law,” commented Americans United for Life President and CEO Dr. Charmaine Yoest, on hearing news that the court decided to review two cases challenging Obamacare’s HHS Mandate, Conestoga Wood Specialties v. Sebelius and Sebelius v. Hobby Lobby Stores. “Punishing Americans for their moral objection to life-ending drugs and devices is abhorrently un-American.”

Conestoga Wood Specialties is owned by Christians and operated according to the owners’ Mennonite Christian beliefs. Hobby Lobby is an Oklahoma-based national arts and crafts retailer founded and run by David Green and his family. The Greens attribute God’s grace for Hobby Lobby’s success and over the course of four decades of expansion the Green family’s Christian faith has remained an integral part of the business. Both Conestoga Woods and Hobby Lobby do not oppose all contraception, but those drugs and devices that have been labeled as “contraception” by the FDA although they are known to have life-ending effects.

In our briefs, AUL demonstrates that the life of a new human being begins at fertilization (conception), that so-called “emergency contraception” has a post-fertilization effect that can prevent a new human being from implanting in the uterus, and that forcing employers to provide coverage for such drugs violates their constitutionally protected freedom of conscience.

The briefs were filed on behalf of the Association of American Physicians and Surgeons, American Association of Pro-Life Obstetricians & Gynecologists, Christian Medical Association, Catholic Medical Association, National Catholic Bioethics Center, Physicians for Life and National Association of Pro Life Nurses.

Commentary

CMDA Executive Vice President Gene Rudd, MD– “Some challenge the rights of these business owners because they do not agree with their understanding of the science—that they are protecting early human life. I remember the debate back in the 1970s among those who foresaw the backlash when the public eventually discovered that developing technologies would abort the development of early human life.

“The strategy since has been to diminish our understanding of the continuum of human life. The strategy includes verbal ploys such as ‘blob of tissue’ and ‘pre-embryo,’ all intended to disguise the truth. Has it worked? Yes, some are either deceived or they failed to value and protect life. But not these business owners. They want their business practices to honor life.

“They want to follow the words of Jesus, who said, “My mother and brothers are those who hear God’s word and put it into practice” (Luke 8:21, NIV 2011).

“But the new warning from the government is that you should not expect to have a conviction and also think you can live by it. Our Administration would rather you live by its social agenda.

“Under the guise of promoting healthcare, the Administration seeks to force individuals and their businesses to provide reproductive services which the owners find morally objectionable. Some seek to refuse the owners’ rights because they do not share the same convictions. They would rather abandon 200 years of Constitutionally-protected ‘free exercise,’ forcing these owners to comply with and pay for their social views.

“Will our Supreme Court uphold the rights of these individuals to run their businesses by their convictions? Freedom of religion, freedom to live out your conviction, is at stake.”

Action

Use our Freedom2Care pre-written letters to urge your legislators to support conscience rights and religious freedom in healthcare:

Urge your senators to support conscience rights - S.1204
Urge your Rep. to protect conscience rights - HR 940

Resources
On Embryo-Killing “Contraceptives” from The National Review Online
Endowment for Human Development

Obamacare May Trigger Exodus of Christian Doctors

Excerpted from “Obamacare May Trigger Exodus of Christian Doctors,” CBN News. October 1, 2013 -- Thousands of Christian doctors across the nation are considering quitting medicine or working overseas because of concerns over the new healthcare law.

Dr. Gene Rudd, senior vice president of the Christian Medical Association, says they're worried they could be forced to facilitate abortions or prescribe drugs that violate their convictions.

Rudd says many of them have avoided hiring and taking on new patients due to uncertainty over Obamacare.

Thousands of the doctors provide care for the poorest areas of the United States and feel called by God to help the sick, but say they need to be able to do so with a clear conscience.

Commentary

CMDA Senior Vice President Gene Rudd, MD: “I rarely view or read media reports after I have been interviewed. (In part, this is because someone else at CMDA does that.) But being asked to comment on this article that was based on what I said to a reporter reminded me of how the media uses their perspectives and agendas to create the news. Too frequently I find a failure to report ‘the truth, the whole truth and nothing but the truth.’

“Timed to coincide with the beginning of the enrollment for Obamacare, my interview with this AP reporter covered many perspectives on healthcare reform, perspectives I classified as ‘the good, the bad and the ugly.’ My limited comments about Christian doctors were almost an afterthought. But only those comments made the news.

“Among the many perspectives I cited, one ‘good’ aspect of reform is that some of our neighbors who previously couldn't obtain health insurance coverage would now have some basic level of protection. A ‘bad’ aspect is that now healthy individuals and families who did not have coverage and had little healthcare costs will now have to pay either a penalty for failure to participate or pay premiums. Even with subsidies, one estimate placed the average family premium at more than $5,000. That will be a substantial burden to most family budgets.

“One of the ‘ugly’ aspects of the current reform bill is the permission assumed by the Administration to usurp individual rights and undermine the First Amendment. Already we have seen HHS interpret and implement legislation in a way that attempts to force employers to provide coverage that includes provisions they find morally objectionable. And under the guise of providing required services, we will be required to fund abortions. Only with the use of smoke and mirrors do they attempt to claim otherwise.

“Will reporters continue to filter the news to suit their agendas? Of course. But we will continue to speak the truth in love. Will Obamacare survive? I don’t know. But we will continue to contest provisions that are morally unacceptable and dangerous to our foundation of freedom."

Resources
Voice of Christian Doctors Media Training
From My Viewpoint: Healthcare Reform by David Stevens, MD, MA (Ethics)
Nationalized Healthcare – Prescription or Problem?

Conscience, liberty and duty

Excerpted from "What ‘Conscience’ Really Means," National Review Online interview, July 12, 2013 - "Respect for the dignity of the human being requires more than formally sound institutions; it also requires a cultural ethos in which people act from conviction to treat one another as human beings should be treated: with respect, civility, justice, compassion," Robert P. George writes in his new book, Conscience and Its Enemies: Confronting the Dogmas of Liberal Secularism.

KATHRYN JEAN LOPEZ: Can conscience have enemies if we don’t even agree on what conscience is?

ROBERT P. GEORGE: Sure. But one’s identification of the enemies of conscience will depend on one’s view of what conscience is. Today, many on the Left and even some on the Right imagine that “conscience” is a matter of sorting through one’s feelings to see whether one would feel badly about doing something — badly enough, that is, that one would prefer the option of not doing it. Where one strongly desires to do something, and especially where one sees some advantage to oneself in doing it, “conscience,” understood in this way, tends to be reliably permissive. If one wants to do something badly enough, “conscience” can pretty much be counted on to produce a “permission slip” — especially if one can manage to conceptualize the conduct in question as purely “self-regarding.”

The distinction between liberty and license — a distinction critical to the thought of the founders of our nation and the architects of our Constitution — loses its intelligibility, and those who defend traditional notions of morality, virtue and the common good come to be perceived and derided as reactionaries, and even “bigots” and “haters.”

Authentic conscience is not a writer of permission slips to act on feelings or desires. It is one’s last best judgment — an unsentimentally self-critical judgment — informed by critical reason and reflective faith of one’s strict duties, one’s feelings or desires to the contrary notwithstanding. Authentic conscience governs — passes judgment on — feelings and desires; it is not reducible to them, and it is not in the business of licensing us to act on them.

Today, the enemies of conscience trample on those sacred rights in a wide variety of ways — everything from the odious Department of Health and Human Services abortion-drug and contraception mandates to the abuse of anti-discrimination laws to drive religiously affiliated adoption services out of business or to harass caterers, florists and others who cannot, in conscience, provide their services for ceremonies they judge to be immoral. Another way that they assault conscience is by stigmatizing as a bigot anyone who dissents from their views on morally divisive issues.

Commentary

CMDA Senior Vice President Gene Rudd, MD: "Notice George’s comment, 'If one wants to do something badly enough, "conscience" can pretty much be counted on to produce a "permission slip."' Of course he is speaking of the dangers of a poorly formed conscience.

"C.S. Lewis addresses this well in The Abolition of Man. Lewis rejects the view that all judgments are subjective. He explains how moral truth and values are supported objectively. He goes on to show how moral values (conscience) must be taught to each generation lest society slip into anarchy. Lewis illustrates using the body. The head provides reasoning. The stomach represents our passions (the carnal man). But something is needed between them for proper stature – the chest. The chest represents the moral values instilled in us by a rightly structured family, church and society. 'Men without chests' are dangerous.

"George is right, 'Authentic conscience is not a writer of permission slips to act on feelings or desires.' An authentic, God-honoring conscience must be formed within each of us. While we can still learn this as adults, it best occurs at the formative time of our lives, in the home. Are we training our families to have such a conscience? We cannot depend on society, or even the church, to do that for us."

Outcry in America over prohibitive cost of birth

Excerpted from “Outcry in America over prohibitive cost of birth,” BioEdge. July 6, 2013 -- A report by data analytics company Truven has revealed that the cost of giving birth in the U.S. is the highest of any industrialized nation. The average total price charged for pregnancy and newborn care was about $30,000 for a vaginal delivery and $50,000 for a C-section, with commercial insurers paying an average of $18,329 and $27,866.


One factor contributing to the high birth cost is the “charge for service” policy of U.S. hospitals, whereby patients are charged for each service they receive during their stay.

There have also been claims of a lack of transparency and regulation in the pricing of services provided by hospitals. Hospitals are able to set prices extremely high with little fear of retribution. Charges for delivery have nearly tripled since 1996 and out of pocket costs are four times higher. Some women have reported that they are very reluctant to have a caesarean due to the hefty price attached.

American commentators have reacted strongly to the report. "It's a truly sad state of affairs," wrote Sasha Brown-Worsham of The Stir. “There is something so damaged about a country that claims to support families and wants people to procreate and then does absolutely nothing to support them once they do.”

Commentary

CMDA Executive Vice President Gene Rudd, MD: “The cost of healthcare has become a plague in and of itself. The burden of paying for healthcare is the leading cause of bankruptcy with childbirth-related costs, resulting in seven percent of those bankruptcies. Too many young families face lifelong economic marginalization due to these excessive costs.


“Why is U.S. healthcare so costly? There are many reasons: overutilization, for example. The threat of malpractice adds many ‘routine’ but unhelpful tests and procedures. There are too many cooks in the kitchen—business entities waiting in line to make profits. And the uninsured are most severely affected. They are expected to pay the chargemaster costs while those with third-party payers pay discounted rates often at one-third of the chargemaster.

“It is further disturbing to know that we are not getting a good return on our healthcare investmentⁱ. Shameful, in fact. We pay a higher amount of our social and family budgets than any other developed country, but rank well below in outcomesⁱⁱ.

“Personally, I oppose the current healthcare reform plan, but not because I oppose reform. Reform must occur. I oppose the current plan because it does not adequately address our economic burden of health care as reflected in the cost of childbirth. Starting with already unacceptably high costs, the planned reforms only exasperate the problem, likely collapsing the system. Was this intended by social engineers as a means of getting what they ultimately want, a single-payer, universal system? I do not know, but I am growing suspicious.”

ⁱHealth care spending, delivery, and outcome in developed countries: a cross-national comparison. American Journal of Medical Quality
ⁱⁱ For Americans Under 50, Stark Findings on HealthThe New York Times

HHS mandate bypasses parents on contraceptives for children

Excerpted from "HHS mandate allows minors free contraception, sterilization," Catholic News Agency, Sep 25, 2012--Minor children on their parents’ health care plans will have free coverage of sterilization and contraception, including abortion-causing drugs, under the controversial HHS mandate – and depending on the state, they can obtain access without parental consent.

Matt Bowman, senior counsel for the religious liberty legal group Alliance Defending Freedom, said the mandate “tramples parental rights” because it requires them to “pay for and sponsor coverage of abortifacients, sterilization, contraception and education in favor of the same for their own children.”

The Department of Health and Human Services ruled in January 2012 that most employers who have 50 or more employees must provide the coverage as “preventive care” for “all women with reproductive capacity.” The mandate also requires the coverage for beneficiaries, including minors, on the affected health plans, Bowman told CNA Sept. 20. That means that a minor on her parents’ plan could be sterilized if she finds a doctor willing to perform the procedure.

“She can be sterilized at no cost,” Bowman stated. “Whether her parents will know and/or consent might differ by state. But the Guttmacher Institute and other abortion advocates explicitly advocated for this mandated coverage of minors so that access without parental involvement might be able to increase.”
The Guttmacher Institute, in a Sept. 1 briefing on state policies, said that an increase in minors’ access to reproductive health care over the last 30 years shows a broader recognition that “while parental involvement in minors’ health care decisions is desirable, many minors will not avail themselves of important services if they are forced to involve their parents.” The institute, the former research arm of abortion provider Planned Parenthood, said that 26 states and the District of Columbia allow all minors 12 years and older to consent to contraceptive services. At least one state, Oregon, allows 15-year-olds to consent to sterilization.

There are presently 30 lawsuits challenging the HHS mandate in federal court on religious freedom grounds.

Commentary

CMDA Executive Vice President Gene Rudd, MD: “'Beware of Greeks bearing gifts.'
"Sadly, in today’s society, we as parents have to warn our children to avoid adults who try to lure them into doing things that might be dangerous, even deadly. Stereotypically, it is the shady character on the street corner who invites your child to pet his dog or enjoy his candy.

"But what do we do when it is the government or an agency operating with government funds doing this? They also have an agenda, and they wish to entreat our children to take part in that agenda even when we as parents do not approve. And worse, our laws have morphed to make it legal! Yes, there are some differences between their agenda and that of a pedophile, but the outcomes can be just as destructive to the wellbeing of the child and the family.

"So now we must warn our children that adults serving in public positions, those with an element of authority over their lives, might also lure them into behavior contrary to their moral training and dangerous to their health. And as a more definitive step, we must take steps to reverse this social engineering.

"I realize there is an argument to be made for providing care for children in exceptional circumstances, but allowance for the exception has become the rule for all. We must now require our government leaders to scrap the onerous rule that allows for this (included in the Affordable Care Act) and replace it with healthcare reforms that do not undermine the family."

Assisted suicide advocates: Bypass physicians for lethal prescriptions

ARTICLE:
Excerpted from "Redefining Physicians' Role in Assisted Dying," by Julian J.Z. Prokopetz, B.A. and Lisa Soleymani Lehmann, M.D., Ph.D. New England Journal of Medicine: N Engl J Med 2012; 367:97-99, July 12, 2012) - Under the Death with Dignity Act (DWDA), the patient's physician prescribes lethal medication after confirming the prognosis and elucidating the alternatives for treatment and palliative care. In theory, however, the prescription need not come from the physician. Prognosis and treatment options are part of standard clinical discussions, so if a physician certifies that information in writing, patients could conceivably go to an independent authority to obtain the prescription. We envision the development of a central state or federal mechanism to confirm the authenticity and eligibility of patients' requests, dispense medication, and monitor demand and use. This process would have to be transparent, with strict oversight. Such a mechanism would not only obviate physician involvement beyond usual care but would also reduce gaps in care coordination: in Oregon and Washington, patients whose doctors don't wish to participate in assisted dying must find another provider to acquire a prescription. Physicians who strongly object to the practice could potentially refuse to provide certification or could even alter their prognosis, but these possibilities yield the same outcome as permitting conscientious objection. Patients could also provide an independent authority with their medical record as proof of their prognosis.

Such a mechanism would make it essential for physicians to offer high-quality palliative care. The availability of assisted suicide in Oregon seems to have galvanized efforts to ensure that it is truly a last resort, and the same should hold true regardless of who writes the prescription. Usual care for terminally ill patients should include a discussion of life-preserving and palliative options so that all patients receive care consistent with their own vision of a good death.

Momentum is building for assisted dying. With an independent dispensation mechanism, terminally ill patients who wished to exercise their autonomy in the dying process would have that option, and physicians would not be required to take actions that aren't already part of their commitment to providing high-quality care.

COMMENTARY:

CMDA Member Mark McQuain, MD: responded to this NEJM article: "Returning to Pre-Hippocratic Medicine - Margaret Mead has been quoted as saying (regarding the Hippocratic Oath), 'For the first time in our tradition there was a complete separation between killing and curing. Throughout the primitive world, the doctor and the sorcerer tended to be the same person. He with the power to kill had power to cure, including specially the undoing of his own killing activities. He who had the power to cure would necessarily also be able to kill...With the Greeks the distinction was made clear. One profession, the followers of Asclepius, were to be dedicated completely to life under all circumstances, regardless of rank, age or intellect - the life of a slave, the life of the Emperor, the life of a foreign man, the life of a defective child...'
"Amongst other things, Margaret Mead was talking about trust between the patient and her physician. Society should not want physicians and other health care providers to be placed in any position where this trust becomes questionable, particularly as other entities insert themselves into the decision-making process. This is particularly the case as physician's conscience protections are being challenged and arguably eroded via federal regulations."

COMMENTARY:

CMDA Senior VP Gene Rudd, MD: "This is 'reasonable' progression of the assisted suicide initiatives. 'Reasonable' in the sense that once you cross the moral boundary of facilitating death, you need only improve the efficiency of the process by removing impediments.

"Some see state laws as the greatest impediments to expanding assisted suicide. Actually, our experience in opposing expansion has shown resistance of the medical community as the most effective impediment. The opposition from individual doctors and state medical societies has been key to thwarting the agenda of death. So proponents of assisted suicide now want to bypass that impediment.

"The article states that the Oregon experience proves there is no slippery slope. However, the author’s proposal for government involvement in order to expand assisted suicide is evidence to the contrary. Since the great majority of physicians refuse to participate or even endorse assisted suicide, the author concludes we simply need the government to step in with a system to assist in dying. That’s all we need, another costly federal program and more bureaucratic control of our health care – or in this case, control of our dying. I used to think it inappropriate to make this comparison, but as I have seen events unfolding, I am compelled by the slogan in the wake of the Holocaust, 'Never again!' We must stop this descent into cultural insanity or the next proposal will be that we establish federal centers where people will be 'referred' for death."