German mom expecting quadruplets at 65

Excerpted from “German Mom Expecting Quads at 65 Is 'Irresponsible': Bioethicist,” NBC News. April 14, 2015 — Berlin school teacher Annegret Raunigk is proudly prolific and, at age 65, not done making babies — pregnant with quadruplets that would enlarge her family from 13 to 17 children. Raunigk said she became pregnant again because her 9-year-old daughter asked for a younger sibling. (Her first 12 children — by five men — are ages 22 to 44). She told German tabloid Bild that donated eggs were fertilized and implanted at a clinic in Ukraine. Multiple attempts were required to get the eggs to fertilize. She did not say whose sperm was used or if the egg donor was paid.

What she is doing is unethical. She doesn't think so. But she left her country to receive an infertility treatment that's illegal in Germany due to her age. And she sought that help on the sole grounds that her youngest daughter wants a sibling. Of course, given that logic, future requests by any of her newest kids apparently guarantee no end to her pregnancies.

The number of reasons why this very-late-in-life pregnancy is morally wrong nearly equates to the number of children Raunigk has conceived. But let's stick to the main issues. First, she likely will not live long enough to raise her current children, much less any new kids. It is not fair to children, as adoption agencies know when they limit adoption to those under 55, to intentionally create a family where mom and dad will enter a nursing home as the kids enter junior high.

Making four kids in a 65-year-old body also is irresponsible. The quadruplets are likely to be premature and, if they survive, may pay a steep price for this decision in terms of their health. Her older body makes the pregnancy extremely high risk all the way around. There will be a C-section, which is dangerous for her. And there certainly will be no breast-feeding by mom.

And what clinic would agree to accept as a patient a woman with 13 children — simply because her daughter wants a sibling? What clinic would not insist on a surrogate mom? What clinic would not demand she stay nearby during the pregnancy? What clinic would even let her try to deliver four fetuses?

The answer: One looking to gain fame and clients by engaging in a publicity stunt with nascent lives. Then again, this theoretically could have happened as well in the U.S. where there are no restrictions about who can use technology to have a baby — grandparents, mentally ill, very old single parents, even child molesters. Despite the headlines babbling about "miracles" and "gifts," and despite Annegret Raunigk's insistence that she should be free to reproduce however and whenever she wants, what's needed is a far more thoughtful, moral stance to govern reproductive technology.

Commentary

CMDA Member John Pierce, MD: “The case of Annegret Raunigk is another clear example of doing what is ‘…wise in your own eyes’ (Proverbs 3:7a, NIV 2011). In the world, there are arguments for age limits on IVF including the multiple health risks for the older mother and her infant, as well as arguments against age limits purporting reproductive freedom, equality for women (as older men can father a child) and social factors ‘to help fulfill lifelong dreams.’ Moral arguments might ask questions such as, ‘Is it right to have a child when the average life expectancy (about 80 years old for women in the developed world) means the child would be without a mother before driving a car?’ or ‘On what grounds do you deny the patient her rights?’

“Clear thinking using the principles of autonomy, beneficence, non-maleficence and justice has been supplanted with situational ethics incorporating intense emotions and cultural relativism. Why would we not have these struggles when there is no standard and a crumbling foundation? The law is silent on age in reproductive rights and most medical organizations provide weak recommendations,ⁱ leaving the decision up to individual clinics,ⁱⁱ or refute the need for practitioners to use their conscience.ⁱⁱⁱ

“Solomon sincerely asked the Lord, ‘So give your servant a discerning heart to govern your people and to distinguish between right and wrong...’ (1 Kings 3:9, NIV 2011). While we may argue vehemently, the loudest voice will be undeniable examples of healthy relationships, thriving marriages, happy families and renewed minds.”

ⁱEthics Committee of the ASRM. Oocyte or Embryo Donation to Women of Advanced Age: A Committee Opinion. Fertil Steril, 2013;100:337-40.
ⁱⁱ Fisseha S and NA Clark. Assisted Reproduction for Postmenopausal Women, AMA Journal of Ethics, Jan 2014, Vol 16, No 1:5-9.
ⁱⁱⁱCommittee on Ethics. ACOG Committee Opinion: The Limits of Conscientious Refusal in Reproductive Medicine. Obstet Gynecol, 2007 (reaffirmed 2013);110:1203-8.

Resources

CMDA’s Assisted Reproductive Technology Ethics Statement
Standards4Life – Infertility and Reproductive Technology

How assisted suicide corrupts medicine

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

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

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

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

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

Commentary

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

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

Action

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

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

Survey on today’s dilemmas in healthcare

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

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

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

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

Commentary

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

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

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

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

Resources

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

Connecticut court rules against teen who didn’t want chemo

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

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

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

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

Commentary

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

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

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

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

Resources

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

Woman gives birth from a transplanted womb

Excerpted from “World first: baby born after womb transplantation,” Medical News Today. October 6, 2014 — In September, a 36-year-old Swedish woman became the first ever to give birth from a transplanted womb. A new paper published in The Lancet provides a "proof of concept" report on the case. The woman received her womb from a 61-year-old family friend. As the recipient had intact ovaries, she was able to produce eggs, which were then fertilized using IVF prior to the transplant.

"Absolute uterine factor infertility" is the only type of female infertility still considered to be untreatable. Adoption and surrogacy have so far been the only options for women with absolute uterine factor infertility to acquire motherhood. However, the news of the first baby to be born from a woman who received a womb transplant brings hope to women with forms of absolute uterine factor infertility.

The researchers who performed the transplant - from the University of Gothenburg, Sweden - have been investigating the viability of womb transplantation for over 10 years. In 2013, the researchers initiated transplants in nine women with absolute uterine factor infertility who had received wombs from live donors. The Swedish woman who recently gave birth was one of these women. Although two of the women in the trial had to have hysterectomies during the initial months - because of severe infections and thrombosis - the team reported success in the other seven women.

According to Prof. Brännström, who led the team of researchers, "Our success is based on more than 10 years of intensive animal research and surgical training by our team and opens up the possibility of treating many young females worldwide that suffer from uterine infertility. What is more, we have demonstrated the feasibility of live-donor uterus transplantation, even from a postmenopausal donor."

Commentary

CMDA National Director of Campus & Community Ministries J. Scott Ries, MD: “At first glance, it seems like a heartwarming tale of the newest medical ‘miracle’ and a triumph of life. But one doesn’t need to squeeze hard to deliver a very sour and sobering insight of what lies ahead. Though it is at its surface a sweet story of an otherwise impossible birth, deeply thinking and conscientious physicians must pause and ask, ‘At what cost?’

“Three things should deeply concern us in the pushing of these ethical boundaries:

1. How many developing babies will we immolate on the altar of innovation? This patient on three separate occasions nearly rejected her uterine transplant. How many babies will be sacrificed in future trials of uterine transplantation?
2. At what age do we stop? If it works for a 36-year-old woman, why not a 56-year-old woman? Or perhaps a 76-year-old woman? Where does the ‘right’ to bear a child end?
3. Why limit a uterine transplantation to only women? In this day of gay and transgender rights, why not allow a male partner to receive a uterine transplantation? If the barrier is simply vascular anastomosis and hormone infusion, why not permit gestation within the abdomen of a man?

“The story is both a wonder and a worry. That a uterus dormant for years can suddenly spring to life with mere influx of blood and hormone is wondrous testimony to its divine design.

“Yet if we abandon moral standards given by that same Designer, on what basis shall we then make these decisions? We have so quickly progressed from challenging the boundaries of moral standards to repudiating their existence altogether. As followers of the Way, we must infuse in our culture the distinction between what could be and what should be.”

Resources

CMDA Resources on Reproductive Technology
CMDA Ethics Statement – Assisted Reproductive Technology

Drug firms release payment information

Excerpted from “Drug and device firms paid $3.5B to care providers,” Associated Press. September 30, 2014 — Drug and medical device companies paid doctors and leading hospitals billions of dollars last year, the government disclosed Tuesday in a new effort to spotlight potential ethical conflicts in medicine. The value of industry payments and other financial benefits totaled nearly $3.5 billion in the five-month period from August through December 2013, according to the Centers for Medicare and Medicaid Services, which released the data.

It's part of a new initiative called Open Payments, required by President Barack Obama's healthcare law. It was intended to allow patients to easily look up their own doctors online, but that functionality isn't fully developed. In future years, the information will cover a full 12 months and will be easier to search, officials said.

Consumer groups said it's a step toward much-needed transparency. But doctors and industry said the government rushed to release the data, and they raised questions about accuracy and lack of context.

The American Medical Association said it remains "very concerned" about release of the payments file, adding that the data may contain inaccuracies and lacks context to help the average person evaluate the information. Consumer groups say disclosure is overdue. "Research has shown over and over that these financial relationships influence doctors, even a meal," said John Santa, medical director for health projects with Consumers Union. "Studies also show that doctors believe it does not affect them, but strongly believe it affects other doctors."

Commentary

CMDA Member John Dunlop, MD: “Wow! $3.58 billion spent by pharmaceutical and device manufactures to directly influence physician choice is an impressive amount. I naively thought that these payments and gifts went out with the free lunches and logos on pens several years ago. It appears that those restrictions do not have much substance and thus the potential for ethical abuse persists as a real threat. The number comes from the website “Open Payments,” a project of Obamacare intended to bring accountability to the heretofore undisclosed inducements given by industry to practicing physicians. It should be noted, however, that just two days after this article was released, another article pointed out many potential flaws in this data.

“As Christians, when faced with the possibility of receiving incentives from industry, we must remind ourselves that our primary responsibility is not to make money but to provide the best, compassionate and cost effective care to our patients. In Proverbs 19:6, Scripture warns that receiving gifts influences our behavior, and this may be true even when those gifts do not obligate the recipient to prescribe the products involved.

“The CMDA Ethics Statement on Doctor & Pharmaceutical/Medical Device Industry Relationships states the ethical principle: ‘Doctors should consider carefully the basis of their therapeutic decisions to assure that they are made in accordance with best possible evidence applied to the welfare of the patient. Personal gain must never be the compelling reason for our decisions. Incentives from industry, intended to influence therapeutic choices, can compromise doctor integrity and behavior.’”

Resources

Christian Physician’s Oath
Doctor & Pharmaceutical/Medical Device Industry Relationships Ethics Statement
Professionalism in Peril - Part 3: Professional Adultery

Ice bucket challenge raises ethical concerns

Excerpted from "Send Your Ice Bucket Challenge Donation to Ethical, Successful Adult Stem Cell Research," LifeNews. August 21, 2014 — You’ve probably heard of it by now, the Ice Bucket Challenge. Those challenged are supposed either to dump an ice bucket of cold water over their head, or donate to ALS research. Most people do both, posting a video of their icy bath. It’s a stunt, but has successfully raised awareness of ALS as well as donations for research. But people should consider where their donations go and how the money is used.

ALS (Amyotrophic Lateral Sclerosis, a.k.a. “Lou Gehrig’s Disease”) is a fatal, progressive neurological disease. It attacks the nerves that control voluntary muscles, so it is sometimes termed “motor neuron disease”. As the nerves die, muscles weaken and atrophy, including the muscles for breathing; most people suffering from ALS die of respiratory failure. The cause is unknown and at this point there is no cure, and very little that can even slow disease progression.

So, raising awareness about ALS and increasing support for ALS research is a good thing. But whether you participate in a challenge or just donate to important research, where should your donation go? So far, most of the attention and millions of dollars in donation have gone to the ALS Association. However, the ALSA has admitted that it gives some of its money to embryonic stem cell research and has no qualms about doing so in the future.

But there are alternatives for donations that use only ethical stem cell sources! Here are a few of my favorites: The Midwest Stem Cell Therapy Center (MSCTC) at the University of Kansas Medical Center is only a year old, but is starting an increasing number of clinical trials and educational efforts. The MSCTC does not do any embryonic or aborted fetal stem cell research. The John Paul II Medical Research Institute in Iowa City is doing research in several areas including ALS, and does not support embryonic stem cell research.

Commentary

CMDA Member and Senior Fellow for Family Research Council David Prentice, PhD: “As healthcare professionals, it’s heartening to see excitement for support of research into treatments for disease, and to raise empathy and awareness for people who suffer with life-threatening conditions. Let’s make sure that excitement is channeled in ways that maintain bedrock principles of medicine—to preserve and protect life.

“Research in particular runs the risk of venturing into paths of ‘progress by any means,’ so it’s important to keep principle first. The ALS ice bucket challenge fired the imagination and support of many and provided a fun way to get more people involved, but questions about where the donations were going and for what uses showed that some organizations were not committed to life-preserving principles in their supported research, but rather to that ‘progress by an means’ ethic.

“Research using embryonic stem cells or aborted fetal tissue relies on the willful destruction of young human lives. Let’s keep our eyes on the real prize and promote only life-affirming research, such as adult stem cells. We don’t have to sacrifice lives or ethics for medical progress.”

Resources

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

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

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

Governor seeks to thwart abortion clinic law

Excerpted from "Gov. McAuliffe calls for review of abortion clinic regulations in Virginia," Washington Post, May 12, 2014 - Gov. Terry McAuliffe moved to free Virginia’s abortion clinics from strict hospital-style building codes on Monday, loading up the state health board with abortion rights supporters and ordering it to review rules that clinic operators say threaten to put them out of business.

The Democratic governor is also looking for ways to soften or suspend the rules to keep clinics open during the health board’s review, which could take more than two years. The General Assembly approved the regulations in 2011; they are set to take effect as early as June.

“I am concerned that the extreme and punitive regulations adopted last year jeopardize the ability of most women’s health centers to keep their doors open and place in jeopardy the health and reproductive rights of Virginia women,” McAuliffe said.

“This was an overtly political move,” said House Speaker William J. Howell (R-Stafford). “The General Assembly, by law, directed the Board of Health to establish regulations to protect the health and safety of women who seek an abortion. This seems like another attempt by the McAuliffe administration to undermine a law they don’t like, and that is very troubling.”

On Monday, McAuliffe appointed five people to the 15-member health board, filling one vacancy and nudging four other members to wrap up their terms about a month early.

McAuliffe, elected with help from abortion rights groups, made no pretense of ignoring the litmus test, stating flatly that his appointees reflected his views not only on abortion but also on the need to review the clinic regulations. The five appointees “share his commitment to women’s health and support his plan to review the health center regulations,” the governor’s office announced in a written statement.

Yet there could be a political downside for McAuliffe, who takes the step as he seeks to get conservative Republicans on board with Medicaid expansion. Abortion opponents characterized McAuliffe’s move as yet another end run around the legislature.

“Whether the governor and the abortion industry like it or not, the law of Virginia requires that abortion centers have health and safety standards,” said Victoria Cobb, president of the Family Foundation of Virginia.

“The governor is not a king, but he’s doing everything within his power,” Coy said.

Commentary

CMA VP for Govt. Relations Jonathan Imbody: “Trying to clarify that ‘the governor is not a king,’ the spokesman for Virginia Governor Terry McAuliffe unwittingly highlights the autocratic nature of the governor's scheme to skirt state law on abortion clinic health and safety.

“Virginia's legislature is one of dozens of state legislatures that in recent years have aimed to curb abuses and bring abortion clinics in line with reasonable health and safety requirements of similar facilities. Abortion clinic abuses uncovered in Texas, for example, included the illegal disposal of hazardous bio-medical and infectious waste, including tissue that appeared to be the partial remains of aborted babies; dirty and poorly maintained conditions inside and outside the abortion clinics; drug violations, including the illegal dumping of drug vials containing controlled substances and the availability and use of blank prescription slips; and widespread abuses of Texas’s informed consent law and the mandated 24-hour reflection period.

“Governor McAuliffe, however, is ignoring such abuses and plotting to put abortion ideology over the rule of law, seeking end-runs around the people's representatives and meanwhile stacking the state health board with abortion partisans.

“A year ago May 13, Philadelphia abortion clinic doctor Kermit Gosnell was convicted of murder. Gosnell had openly operated a squalid abortion clinic, let a patient die and butchered babies born alive. The Grand Jury report cited testimony revealing that when pro-abortion governor Tom Ridge took office, ‘high-level government officials’ decided to discontinue abortion clinic inspections. ‘There was a concern that if they did routine inspections, that they may find a lot of these facilities didn’t meet [health and safety standards] and then there would be less abortion facilities...’

“When abortion politics trumps health and safety, ‘back alley abortion clinics’ and their accompanying horrors thrive. As a healthcare professional, your support of abortion clinic health and safety regulation--through testimony before legislatures, behind-the-scenes expert advice and the use of electronic, print and social media--can prove very effective.

Action
Order model state legislation that your state can adopt to protect health and safety.
Use our easy Freedom2Care form to urge your legislators to support S. 369 - Child Interstate Abortion Notification Act.

Resources
CMA-led U.S. Senate taskforce report on abortion clinic regulation (access restricted to CMDA members)
After Gosnell's ''House of Horrors'': Women's Health and Abortion in America - webcast
Model clinic health and safety legislation

Researchers harvest stem cells from cloned human embryos

Excerpted from "Cloning advance using stem cells from human adult reopens ethical questions,"Washington Post, April 17, 2014 - Scientists have grown stem cells from adults using cloning techniques for the first time — bringing them closer to developing patient-specific lines of cells that can be used to treat a whole host of ailments, from heart disease to blindness. The research, described in Thursday’s online edition of the journal Cell Stem Cell, is a controversial advance likely to reopen the debate over the ethics of human cloning.

The scientists’ technique was similar to the one used in the first clone of a mammal, Dolly the sheep, which was created in 1996. They “reprogrammed” an egg cell by removing its DNA and replaced it with that of an adult donor. Scientists then zapped the cell with electricity, which made it divide and multiply. The resulting cells were identical in DNA to the donor.

Paul Knoepfler, an associate professor at the University of California at Davis who studies stem cells, called the new research “exciting, important and technically convincing.”

“In theory you could use those stem cells to produce almost any kind of cell and give it back to a person as a therapy,” he said.

While the research published Thursday involves cells that are technically an early stage embryo, the intention is not to try to grow them into a fully formed human. However, the techniques in theory could be a first step toward creating a baby with the same genetic makeup as a donor.

Shoukhrat Mitalipov, director of the Center for Embryonic Cell and Gene Therapy at Oregon Health & Science University, developed the method that Chung’s group built upon. He emphasized that the work involves eggs that have not been fertilized.

“There will always be opposition to embryonic research, but the potential benefits are huge,” Mitalipov said.

Seventeen years ago, news about Dolly’s birth led to impassioned calls for a ban on human cloning for the purpose of producing a baby who is a genetic copy of someone else. Several countries took measures to limit or outlaw such work. But in the United States, the issue became entangled in the politics of abortion, and Congress became deadlocked. Some lawmakers called for a ban on reproductive human cloning, but others refused to support such legislation unless it included a ban on human cloning whether it was for the purposes of reproduction or for the development of new therapies. At least 15 states have laws addressing human cloning.

Commentary

CMDA Member and Senior Fellow for Life Sciences at Family Research Council David Prentice, PhD: – “The language continues to be deceptive. Growing ‘stem cells from adults using cloning techniques’ sounds innocent, as if they had taken one heart cell and multiplied it in a dish. Making a ‘reprogrammed’ egg cell, getting it to divide, producing cells ‘identical in DNA to the donor.’ And the requisite ‘exciting’ and ‘new therapies.’

“But the reality is that a new human being was produced by the cloning technique (somatic cell nuclear transfer.) This news story notes that it is ‘technically an early stage embryo,’ but goes on to minimize the humanity of this young being, created asexually in the lab, and instead point toward the theoretical possibilities if the embryo is instead used as raw materials, destroyed for embryonic stem cells that have in reality produced not a single therapy.

“But there is no technicality--this is really an embryo, the youngest stage of human life, just as Dolly the sheep started as a cloned sheep embryo. And while any therapies are conjectural, the reality is the increased likelihood of cloned human children from this scientific advance. In other stories, the cloners themselves admit that the clones they created could develop and be born if implanted in surrogate wombs. It all starts with creation of the new, cloned embryo, an embryo that could then be used for cell stock or transferred to a womb.

“Further, left unsaid is an additional scientific abuse inherent in cloning technology—exploitation of women. Cloning relies on eggs to make the new, living clones, no matter their intended final use. Lots and lots of eggs. The current experiment used seven young women as egg donors (a procedure known to risk their health), collecting a total of 126 eggs for experiments, but resulting in only two cell lines. Egg donors were ‘financially reimbursed,’ an economic incentive that can prey especially on poor young women. An industry that induces women to exchange their eggs and risk their health is exploitive and should not be countenanced.

“It’s time there was an outcry to prohibit manufacture and trafficking of any cloned humans.”

Resources

Understanding the Ethics and Opportunity of Scientific Research - Dr. David Prentice

CMDA Resources on Stem Cell Research

Action

Use our Freedom2Care quick and easy message system to alert your Representative about human cloning and the need to support a legislative ban, HR 2164.

Assisted suicide advocates make their case in JAMA

Editor's note: Under JAMA's Conflict of Interest Disclosures, each of the authors of this excerpted article "report consulting for Compassion and Choices," an assisted suicide advocacy organization formerly known as the Hemlock Society.

Excerpted from "The Changing Legal Climate for Physician Aid in Dying," JAMA, April 14, 2014 - Voters in Oregon and Washington have legalized aid in dying by public referendum, legislators in Vermont have done so by statutory enactment, and courts in Montana and New Mexico have done so by judicial rulings. Support for aid in dying is increasing, and it would not be surprising to see voters, legislators, or courts in other states approve the practice.

At one time, it was not clear whether patients could hasten death by refusing life-sustaining medical treatment. Recognition of the right to refuse life-sustaining care reflected a societal consensus that people should be able to decline treatment when they are suffering greatly from irreversible and severe illness. Although a right to refuse treatment did not go too far in allowing death-causing actions, many people felt it did not go far enough. For instance, some patients are seriously ill and suffering greatly from widely metastatic cancer or other advanced diseases, but are not dependent on life-sustaining treatment. For those patients, aid in dying can be an important option.

However, there are real risks if patients are allowed to receive a prescription for a lethal dose of medication. Not all patients who would ask for a prescription would be suffering from an irreversible and severe illness. Some might have become tired of life, depressed, or feel that that their life has insufficient meaning. Accordingly, a right to aid in dying could be recognized only with assurances that access would be limited to patients who are truly seriously ill. In addition, as with the withdrawal of treatment, the government could not impose limits by making quality-of-life judgments.

The terminal illness requirement provides the right kind of limit for aid in dying. It does not empower the government to make quality-of-life judgments, and it restricts the practice to patients who are suffering from irreversible and severe disease.

This is not just a matter of theory. Oregon has had more than 15 years of experience with aid in dying limited to the terminally ill, and the state’s experience has been reassuring. Vulnerable patients are not succumbing to aid in dying. It is not surprising that once Oregon’s experience with aid in dying was reassuring, other states were willing to consider authorizing aid in dying.

By restricting aid in dying to competent and terminally ill adults, the law can ease the dying process for patients, and their families, and avoid the potential for the mistreatment of patients.

Commentary

CMA VP for Government Relations Jonathan Imbody – “These assisted suicide advocates cleverly employ several techniques to break down barriers to their radical position, which is that we should obviate over two millennia of Hippocratic medicine and empower doctors to help their patients kill themselves.

• Employing euphemisms: The authors insist that the euphemistic term ‘aid in dying’ replace the clear and accurate term ‘assisted suicide.’ The group they support changed its name from the Hemlock Society to Compassion and Choices.
• Linking a radical idea to an accepted idea: We're supposed to think that just as our society once hesitated to allow patients to refuse life support but now accepts that notion, we likewise should see the light and embrace assisted suicide. As if there is no difference between letting someone die naturally and killing them with secobarbital.
• Stressing meaningless safeguards: The authors try to position themselves as the concerned, conservative protectors of patients and ethics, emphasizing that ‘a right to aid in dying could be recognized only with assurances that access would be limited to patients who are truly seriously ill.’ But since ‘the government could not impose limits by making quality-of-life judgments,’ who determines what ‘seriously ill’ means? You guessed it--physicians like the authors, whose bias toward assisted suicide will doubtless expand the definition beyond meaning.
• Citing misleading statistics: ‘Figures don't lie, but liars figure.’ Crafty assisted suicide advocates wrote into Oregon's assisted suicide measure the following secrecy clause: ‘...the information collected shall not be a public record and may not be made available for inspection by the public.’ That clause prohibits anyone-- relatives, media, watchdog groups, medical associations--from investigating the details of any of the reported assisted suicide cases. State bureaucrats, who, of course, maintain a vested interest in covering up any problems or abuses that might reflect negatively on the state, annually trot out their own bland, general statistics without detail or the possibility of review. Year after year, assisted suicide advocates point to these meaningless, whitewashed, non-verifiable numbers as proof that the system is working wonderfully.

“For secular audiences, some effective arguments against assisted suicide include:

• highlighting the lack of safeguards in most assisted suicide measures, including inadequate diagnosis and treatment of depression, the absence of requirements to notify family members and the dangers of storing lethal medications at home;
• explaining how assisted suicide perverts the safe nature of the patient-physician relationship, removing the vital assurance that the physician will always ‘do no harm;’ and
• emphasizing that healthcare payers including insurers, the government and even heirs have a tempting financial incentive that leans heavily toward your premature death.”

Resources

CMDA Resources on Assisted Suicide

Action

Write a response to JAMA

Advocate in your own specialty college for hospice and palliative care and against assisted suicide and euthanasia.

SCOTUS hears case on free speech re: abortion in Obamacare

Excerpted from "Campaign speech case is regulatory overkill," commentary by George F. Will, Washington Post, April 18, 2014 - Former U.S. representative Steve Driehaus, a Cincinnati Democrat who considers himself antiabortion, says he lost his 2010 reelection bid because the antiabortion Susan B. Anthony List violated Ohio’s law with ads saying that when he voted for the Affordable Care Act (ACA), he voted for taxpayer funding of abortion. When he learned that the SBA List planned to erect billboards proclaiming “Shame on Steve Driehaus! Driehaus voted FOR taxpayer-funded abortion,” he filed a complaint with the Ohio Elections Commission, the truth arbiter and speech regulator. So the billboard company refused the SBA List’s business.

Driehaus says the ACA does not specifically appropriate money for abortions. The SBA List counters that the ACA can subsidize abortion-inclusive insurance coverage.

Driehaus says insurance companies must collect a “separate payment” from enrollees and segregate this money from federal funds. The SBA List says money is fungible, so this accounting sleight of hand changes nothing.

Driehaus says an executive order issued after passage of the ACA, which was promised to get him and a few other pro-life Democrats to vote for the act, prohibits ACA funds from being used for abortions. The SBA List says the executive order proved that the ACA itself allowed taxpayer-funded abortions.

Ohio’s law, which obviously is designed to encourage self-censorship, certainly chilled the SBA List’s political speech. The SBA List’s brief to the Supreme Court notes that “a law requiring citizens to pay $1 before they could publicly comment on electoral issues or candidates for office would be immediately justiciable (and promptly invalidated).” Yet Ohio’s law makes it easy for literally millions of Ohioans to subject participants in the political process to much more expensive costs — not to mention the threat of incarceration.

This case, which comes from Cincinnati, where the regional IRS office was especially active in suppressing the political speech of conservative groups, involves the intersection of two ominous developments. One is the inevitable, and inevitably abrasive, government intrusions into sensitive moral issues that come with government’s comprehensive and minute regulation of health care with taxes, mandates and other coercions. The Supreme Court will soon rule on one such controversy, the ACA requirement that employer-provided health-care plans must cover the cost of abortifacients. The other development is government’s growing attempts to regulate political speech, as illustrated by the Obama administration’s unapologetic politicization of the IRS to target conservative groups.

These developments are not coincidental. Government’s increasing reach and pretensions necessarily become increasingly indiscriminate.

Commentary

CMA VP for Govt. Relations Jonathan Imbody: – “Government actions hostile to religious freedom have triggered a raft of cases that now are reaching the Supreme Court. They're worth tracking because (a) they involve our faith-based and pro-life colleagues and (b) the principles impact virtually every believer, and especially those who own or work for businesses--including medical and dental practices. These cases include, but are not limited to:

1. the recently heard religious freedom cases of faith-motivated for-profit employers forced to violate their conscience convictions by participating in providing HHS-mandated contraceptives that the FDA notes can end the life of a human embryo;
2. the free speech case analyzed above, of a pro-life organization censored for political speech that sought to educate voters on abortion-related provisions in the Affordable Care Act (Obamacare);
3. the upcoming religious freedom cases (of a total of nearly 100 cases in all) of non-profit organizations also opposed to participating in the HHS contraceptives mandate.

“With the number of Americans who hold no religious affiliation increasing (read my analysis of that trend here), the faith community is losing natural supporters of religious freedom. That means we have to step up our efforts to protect ourselves in law and also to educate our countrymen.


“Some basic points to emphasize about religious freedom:

1. Faith-based groups help the poor and needy. (Polling shows that even the non-religious still appreciate the charitable services of the faith community.)
2. Religious liberty protects against discrimination and promotes tolerance and diversity. (Why should religious views be censored in the public arena? Religious tolerance is a hallmark of our democratic republic designed to aid the coexistence of disparate groups and viewpoints.)
3. A threat to one group’s First Amendment freedoms is a threat to all. As Protestant Pastor Martin Niemoller lamented after serving in a concentration camp during the Nazi holocaust, ‘First they came for the Jews. I was silent. I was not a Jew. Then they came for the Communists. I was silent. I was not a Communist. Then they came for the trade unionists. I was silent. I was not a trade unionist. Then they came for me. There was no one left to speak for me.’”

Resources

CMA SCOTUS brief in Hobby Lobby religious freedom case

CMA’s Freedom2Care website on freedom of faith, conscience and speech

CMA commentaries

Action

Use our easy pre-written customizable message to support H.R. 940 - Healthcare Conscience Rights Act (House bill) and S. 1204 - Health Care Conscience Rights Act (Senate bill)

New method for growing stem cells

Excerpted from “Acid bath offers easy path to stem cells,” Nature. January 29, 2014 — In 2006, Japanese researchers reported¹ a technique for creating cells that have the embryonic ability to turn into almost any cell type in the mammalian body — the now-famous induced pluripotent stem (iPS) cells. In papers published this week in Nature², ³, another Japanese team says that it has come up with a surprisingly simple method — exposure to stress, including a low pH — that can make cells that are even more malleable than iPS cells, and do it faster and more efficiently.

“It’s amazing. I would have never thought external stress could have this effect,” says Yoshiki Sasai, a stem-cell researcher at the RIKEN Center for Developmental Biology in Kobe, Japan, and a co-author of the latest studies. It took Haruko Obokata, a young stem-cell biologist at the same centre, five years to develop the method and persuade Sasai and others that it works.

Obokata says that the idea that stressing cells might make them pluripotent came to her when she was culturing cells and noticed that some, after being squeezed through a capillary tube, would shrink to a size similar to that of stem cells. She decided to try applying different kinds of stress, including heat, starvation and a high-calcium environment. Three stressors — a bacterial toxin that perforates the cell membrane, exposure to low pH and physical squeezing — were each able to coax the cells to show markers of pluripotency.

Obokata has already reprogrammed a dozen cell types, including those from the brain, skin, lung and liver, hinting that the method will work with most, if not all, cell types. She now wants to use these results to examine how reprogramming in the body is related to the activity of stem cells. Obokata is also trying to make the method work with cells from adult mice and humans. “The findings are important to understand nuclear reprogramming,” says Shinya Yamanaka, who pioneered iPS cell research. “From a practical point of view toward clinical applications, I see this as a new approach to generate iPS-like cells.”

Commentary

CMDA Member and Senior Fellow for Family Research Council David Prentice, PhD: “Stress a Cell, Get a Stem Cell. It seems every time one turns around there’s a new non-embryonic stem cell discovery, each more amazing than the last. The latest in the journal Nature is no exception: simply stressing normal adult cells can transform them into embryonic-like stem cells, similar to the Nobel prize-winning induced pluripotent stem (iPS) cells made by Dr. Yamanaka. But unlike Yamanaka’s technique, these ‘STAP’ cells transform from mature mouse cells into stem cells under the influence of stressors such as acid or stretching, without genetic manipulation and in a much shorter time period. And don’t be confused by some of the stories, including the Nature news report. These are not adult stem cells as found in body tissues, nor are these new stem cells inherently embryos or able to form embryos, despite the fact that these mouse STAP stem cells can form placental as well as body tissue types. It takes more than haphazard production of all tissues to form an organism, as has already been seen with human embryonic stem cells. Dr. Maureen Condic has produced an in-depth review of the range of stem cell potency.

This new technique shows once again that there are many acceptable, ethical routes to stem cells, and absolutely no necessity for life destroying embryo research. Adult stem cells from tissues, which are the gold standard for patient treatment, as well as iPS cells and STAP cells, emphasize that ethical, life preserving science is also the best science.

Resources
CMDA Ethics Statement on Stem Cell Research
Scientific Demagoguery in the Stem Cell Wars by David Stevens, MD, MA (Ethics)

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

Pro-life movement unites in march on Washington

Excerpted from "Annual 'March for Life' to go on despite ice and cold," USA Today, Jan. 22, 2014 - "We march because 56 million Americans never had a chance to experience snow," the March for Life's Twitter account posted Tuesday, referring to the estimated number of abortions since the 1973 Supreme Court decision that made abortion legal nationwide.

Veronika Johannsen, 22, of College Station, Texas, beat the weather and arrived safely for her second time at the march.

"The face is changing. It's not just white male politicians like the pro-choice people like to say," Johannsen said. "All kinds of people come. Religious groups of all different denominations, former abortion workers, women who have been raped or have been conceived in rape."

This is the 40th year that protesters will march from the National Mall to the Supreme Court, and 2014 is bringing changes like social media and a March For Life app. There is a "virtual march" on Facebook where users who can't make it can post a past March for Life photo as their cover photo to show support.

The theme this year is adoption. Speakers will include Republican House Majority Leader Eric Cantor of Virginia and Democratic Rep. Dan Lipinski of Illinois.

"We want to encourage women facing the option of abortion to choose adoption," said Jeanne Monahan, president of the March for Life Education & Defense Fund. "Adoption is at the center of motherhood. Motherhood is all about sacrifices. This is an ultimate sacrifice for the good of the baby."

Commentary

CMA VP for Govt. Relations Jonathan Imbody– “Respect for life need not be a partisan proposition, and thankfully some politicians challenge the notion that a party cannot simultaneously advance the interests of women and babies. That's crucial, because decades ago, a specious argument of radical feminists began to prevail in the courts and with many politicians and women--namely, that a woman cannot advance professionally apart from the ability to terminate the life of her unborn child. Thankfully, many pro-life professional women, including members of organizations like CMDA's Women in Medicine and Dentistry, are demonstrating the fallacy of that assertion.

“I enjoyed the privilege of joining my good friend Jeanne Monahan, president of the March for Life, on stage Wednesday. I felt heartened as I looked out on the enormous crowd on the National Mall in Washington, D.C.—women, children and men who had braved 18-degree cold to join our march to the Supreme Court to solemnly protest the Roe v. Wade 1973 abortion decision. Especially encouraging are the vast numbers of young men and women who have seen through the deception that separates women from their babies and have determined to see the horror of abortion on demand abolished in their lifetime.

“If you can make it to next year's March for Life, please do so and bring family and friends. I hope you will also winsomely engage others in personal conversations, social media networks and professional opportunities to help them unpack the deception of abortion rights and recognize the gift of life.

“You can also help build a culture of life by encouraging and supporting options for women in challenging pregnancies--including by serving as a medical advisor in your community's pregnancy center.”

"We are destroying speculations and every lofty thing raised up against the knowledge of God…" (2 Corinthians 10:5, NASB).

Action

1. Join the March for Life next year
2. Serve in a local pregnancy center (see Action under article below)

Resources

• Read Freedom2Care blog and view March for Life photos
• CMDA Abortion Resources

Why a feminist changed her mind on abortion

Excerpted from "How I Changed My Mind about Abortion," by Julia Herrington, Patheos, accessed on January 20, 2014 - Abortion was not an issue that I had ever imagined I’d become remotely passionate about. I am a bona-fide feminist with extreme ideas and boisterous opinions. Secretly, I’ve always felt that abortion wasn’t ideal and maybe not even right. But it’s complicated to believe that when you’re a feminist, and it’s certainly not something you profess publicly.

Working at a Pregnancy Resource Center changed all of this. This organization exists to offer women alternatives to abortion. I was pleasantly surprised to find that my co-workers were kind, compassionate and thoughtful.

My perspective changed dramatically because I determined that abortion does not actually benefit women. In so much as this is a women’s issue, it seems that abortion actually oppresses women. Procedurally what abortion requires is the silencing of a woman’s body and the unmitigated dismissing of her gender. What’s more, the reason a woman finds herself seeking out an abortion is that society holds her solely liable for pregnancy. Why are we letting men off the hook?

Abortion has a lot more to do with sex than we might have thought. Pornography, sexual crimes and abuses against women cannot be disconnected from the issue of abortion. Sexual liberation has made slaves out of women; it has only perpetuated and glorified their objectification. Sex that is void of relationship, honor and respect is why we’re here, be it the woman who is raped or the teenager who gets pregnant.

Just because a child is born into tragedy does not mean that his or her life is destined for a tragic ending. Regardless of circumstance, we as Christ followers must possess hope that any situation is redeemable. That’s what Jesus does, He redeems things. To be honest, I’m a fledgling where this conversation is concerned. I have really only just opened the door on this issue.

We cannot disregard this issue. We can no longer allow for the continued unquestioned oppression of women to persist. We need to reclaim healthy sexuality for ourselves, our children, our communities and our culture. And we must defend the weak, the defenseless; the children who might not be born.

Commentary

CMDA Member and Care Net Medical Advisor Sandy Christiansen, MD, FACOG– As an ‘older’ pro-life woman, it does my heart much good to see the next generation taking the standard and running with it. Kudos to Julia Herrington! Right you are that pregnancy centers are all about dispensing the compassion of Jesus to women—and men—at their point of need. Women facing an unplanned pregnancy come to our centers with a jumble of emotions and find a safe place to be heard, to gain valuable information about their bodies and their baby and to explore life-affirming alternatives to abortion.

“Abortion is not healthy for women. In fact, there are no scientific studies demonstrating how abortion improves women's mental health.¹ On the contrary, there is a lot data supporting induced abortion's harmful effect on women's wellbeing and mounting evidence of its negative impact on men.

“Not to burst Miss Herrington's feminist bubble, but pregnancy centers actually are responding to this new research and are customizing services for both women and men. Women are more likely to choose abortion because of lack of support and because they don't want to become single mothers.² Men who have experienced a partner's abortion can struggle with anger, anxiety and depression.³ No matter how you cut it, men are involved and need support, too. To find a pregnancy center near you or to talk to someone who cares, visit www.pregnancydecisionline.org.”

¹Fergusson DM, Horwood LJ, Boden JM. Does abortion reduce the mental health risks of unwanted or unintended pregnancy? A re-appraisal of the evidence. Aust N Z J Psychiatry. 2013 Sep;47(9):819-27. doi: 10.1177/0004867413484597. Epub 2013 Apr 3
²Finer, L. (2005). Reasons U.S. women have abortions: Quantitative and qualitative perspectives. Perspectives on Sexual and Reproductive Health, 37(3), 110–18.
Coleman, P.K., Maxey, C., Spence, M., Nixon, C. (2009). Predictors and correlates of abortion in the fragile families and well-being study: Paternal behavior, substance use, and partner violence. Int J Ment Health Addict., 7(3), 405–22.
³Rue, V. (1996). His abortion experience: The effects of abortion on men. Ethics and Medics, 21(4), 3–4.
Coyle, C. (2007). Men and abortion: A review of empirical reports. Internet J of Mental Health, 3(2).

President of Heartbeat International Dr. Peggy Hartshorn– “What a breath of fresh air it was to read this clear and articulate, first-hand account of a woman whose eyes were opened to the fact that abortion, far from advancing women's rights—or human rights for that matter—instead contributes to the increased and continued oppression of women.

“How fitting to come to grips with this truth in a Pregnancy Help Center, which for over 40 years have offered women in the United States and around the world the type of emotional support and practical resources needed in the midst of an unexpected or difficult pregnancy. Out of a sea of statistics showing that the pro-life movement is gaining ground in recent years, stories like Ms. Herrington's burst forth in vivid light and color, screaming, ‘Pregnancy Help Centers are good for America!’

“Today more than ever, physicians and everyone in the medical field have a critical role to play in the protection and cherishing of all life—born and preborn. Pregnancy Help Centers across the nation are adding and enhancing existing medical services, and they are in need of life-minded professionals from all corners of the medical field to lend their expertise to everything from medical advisory boards to staff physicians. What a joy it would be for the director of a local Pregnancy Help Center to receive a call from a pro-life medical professional in its community, asking what he or she can do to help save lives from the violence of abortion.”

Action

Medical pregnancy centers need physicians willing to volunteer as little as an hour per week to write orders, read ultrasounds and provide oversight to the nurse administering the medical services. To find a pregnancy center near you through a national pro-life organization:

• Care-Net centers: Go HERE to see centers in your region or call 703-554-8753 or email.
• Heartbeat International centers: email Heartbeat's Medical Specialist - SDammann@HeartbeatInternational.org

Resources

• Women’s Protection Project - state legislation
• CMDA Abortion Resources

New public attitudes about access to medical information, bio tissue for research

Excerpted from “New public attitudes about access to medical information, bio tissue for research,” MedicalXpress. December 13, 2013 -- In this age of surveillance cameras, computer algorithms for tracking website visits and GPS-imbedded cell phones, many people feel their right to privacy is slipping away. This perception extends into the medical realm as well where information gleaned from Electronic Health Records and clinical tissues are being used for medical research purposes with and without patient consent in some situations, though compliant with federal regulations.

With the continued development and importance of the University of Utah's biobank of tissues acquired through research projects and through residual clinical specimens, lead investigator Jeff Botkin, MD, MPH, and his colleagues initiated a study to better understand public attitudes regarding these practices. "There are many technical and financial challenges to establishing a biobank, but we think the largest risk to the enterprise is a loss of public trust if the public is surprised and alarmed by how research is conducted at institutions like ours," says Botkin, associate vice president for research integrity at the University.

The results of the study, published this month in the Journal of Community Genetics, reveal that when the general public is educated about the intricacies involved in collecting and using this information in population-based research—particularly the safeguards and confidentiality measures in place to maintain anonymity—that they support it. "What was surprising is the public is generally not aware of the safeguards in place to assure that research is done in an ethically appropriate fashion," points out Botkin.

"The most important finding from this study was that people, when educated about the safeguards, were fine with their information or tissue being used for research without their signed consent. They were okay with it as long as they had the option to opt out if they wanted," explains co-investigator Erin Rothwell, PhD. The study indicates that once the general public is educated and understands that the risk to their privacy is low, and the option to say "no" (an opt-out) is available, then they are onboard with contributing to the research.

Commentary

Gastroenterologist Jeff Fenyves, MD: -- “While most of practicing clinicians would agree with Dr. Botkin in regard to the importance of public trust, there are many viewpoints as to the best path to take in the case of Biobanks and research. Educating the public, especially given the diversity of types of biobanks, would be impractical. Prior studies already show that the public generally supports the broad goals of genetic research.¹

“Boiled down, the real issue is a widely accepted consent process: opt-in or opt-out, and how much info to go with this? Most agree that formal opt-in, fully explained consent is probably overkill and cumbersome for de-identified specimens. But the public may be rightfully dubious of the assumption of participation, unless they sign an ‘opt-out’ section of a larger document, such as a hospital admission doc or blood draw consent. Or should we find some middle ground, with separate opt-out, or opt-in consent, along with a pamphlet or other informative material?”

¹Kaufman D, Murphy J, Scott J, Hudson K. Subjects matter: a survey of public opinions about a large genetic cohort study. Genet Med. 2008;10:831–839. doi: 10.1097/GIM.0b013e31818bb3ab.

Resources

1. Simon CM, L'Heureux J, Murray JC, Winokur P, Weiner G, Newbury E, et al. Active choice but not too active: Public perspectives on biobank consent models. Genetics in Medicine. 2011;13(9):821–831.
   
2. Project Mkultra: One of the Most Shocking CIA Programs of All Time
   
3. A Biobank for Genomics Research: Do we need Patient Consent?
   
4. Informed Consent for Biobanking
   
5. CMDA Ethics Statement – Human Research Ethics