Thursday, May 7, 2015

The Point Blog is Moving!

You can now read and comment on The Point blog on CMDA's website!

Senate passes human trafficking bill

Excerpted from "Senate Passes Human Trafficking Bill With Abortion Restrictions On Victims," Huffington Post. April 22, 2015 — The Senate passed a sex trafficking bill on Wednesday after a bitter, weeks-long fight over an anti-abortion provision tucked into it. The Justice for Victims of Trafficking Act passed 99-0.

At its core, the bill has had broad support. It provides resources to law enforcement officials and collects fees from sex traffickers that go into a new fund for victims. But Republicans included language subjecting the victim fund to the Hyde Amendment, the federal provision that bars the use of taxpayer funds for abortions except in cases of rape and incest. Democrats refused to let the bill advance over the Hyde language, particularly because, for the first time, it would have applied to non-taxpayer funds.

It took a month of back-and-forth between Sen. John Cornyn (R-Texas), the bill's author, and Sen. Patty Murray (D-Wash.) to find a compromise. They settled on creating two funding streams in the bill. One collects fines from traffickers and uses them for survivor services, excluding health care. That stream doesn't include Hyde restrictions. The second one comes from community health center funds already subject to the abortion limits.

The deal lets both parties walk away with a solid talking point: Democrats can say they prevented an expansion of Hyde, and Republicans can say they prevented victims of sex trafficking from using federal funds for abortions.

Commentary


Dr. Jeffrey BarrowsCMDA Health Consultant on Human Trafficking Jeffrey J. Barrows, DO, MA (Bioethics): “This legislation passed unanimously by the Senate focuses on the trafficking of children under age 18 and will provide many resources should it become law. There are provisions that apply to the healthcare profession, especially those who are “first responders” and healthcare officials. The bill provides grants to train professionals who commonly encounter victims of trafficking on how to identify victims of human trafficking, address their unique needs and facilitate their rescue. Emergency department personnel are a prime example.

“One study has shown that almost 88 percent of victims of domestic sex trafficking regularly encounter healthcare professionals while being trafficked, especially those working within emergency departments.1 Unfortunately, fewer than three percent of emergency department personnel have been trained on human trafficking and so these victims are rarely identified.2

CMDA’s Commission on Human Trafficking has addressed the issue of training by developing a series of online educational modules on human trafficking specifically designed for the healthcare profession which can be found at www.cmda.org/tip. In addition, the commission is planning an in-depth training seminar later this year in Atlanta on November 13-14. More information will be forthcoming and registration will be open to anyone who desires to learn more about the interface between healthcare and human trafficking. Any questions about CMDA’s work against human trafficking can be addressed to humantrafficking@cmda.org.

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


Resources

CMDA’s Human Trafficking Ethics Statement
Commission on Human Trafficking
Human Trafficking Continuing Education

The key to a thriving practice

Excerpted from Majority of ETSU’s Quillen graduates heading into primary care,” Johnson City Press. April 25, 2015 — As the world of health care dramatically changes around East Tennessee State University’s Quillen College of Medicine, Dr. Kenneth Olive, a professor and associate dean for academic and faculty affairs, is still seeing medical students follow specialties about which they’re most passionate. The majority of the time, ETSU’s statistics show that this passion is involved with primary care, which includes family medicine, internal medicine, pediatrics and general obstetrics and gynecology. For the May 8 graduating class, 52 percent of the students are going into the primary care field.

Olive meets with each and every one of the 59 graduates, getting a sense of their time at the Quillen College of Medicine and what path they’re currently on. They discuss job options and how to be competitive as well, citing the changes in health care. Changing reimbursement models, electronic health records, the effects of the Affordable Care Act and the use of team collaboration among health care professionals are some of the topic issues in the field.

Dr. Brian Cross, an associate professor and vice-chair of the Department of Pharmacy at ETSU’s Bill Gatton College of Pharmacy, and Dr. Reid Blackwelder, a medical professor in the Quillen College of Medicine, recently delivered the keynote address at the American Pharmacists Association annual conference in San Diego in late March, centering their talk on the ongoing transformation of the health care system and the need for collaboration to meet the needs of a community and the outcomes a patient meets.

Citing egos and the established hierarchy among health care providers, the pair have made it their mission to start a collaborative mentality early on in a student’s education. “That’s something that we’ve been doing at ETSU,” Blackwelder said. “There’s no question that this is a very powerful and readily available way to improve outcomes.”

Through team collaboration, ETSU’s involvement is leading the charge in the way a patient receives health care in this area, which is getting noticed across the country. In his opinion, the use of team collaboration is huge for community-based medical schools and health care systems.

Commentary


Dr. Peter AndersonFamily Practice Physician Peter Anderson, MD: “As a family physician of 30 years, I was negatively impacted by the changes that came from an aging population, health information technology and declining reimbursement. But teamwork became my practice’s salvation. As much as ‘collaboration’ is needed between the larger entities of healthcare like pharmacy, nursing, behavioral medicine and community resources, it would not have fixed the difficulties I faced daily in the exam room.

“Two main responsibilities are associated with the primary care exam room. The first is the compilation of a complete medical picture and decisions for the patient’s care. The second is the documentation of data and explanation of decisions to the patient with the necessary education and implementation of actionable steps. The first part is physician work; the second is non-physician work. The first part is effective today because it evolved as medicine advanced. The second is broken and archaic because the process has not changed for the last century.

“We have accepted the notion that only the physician belongs in the primary care exam room. This belief has led to a delivery process that absolutely fails to make primary care physicians accessible. And this failure of the delivery process is the only reason primary care practices are not thriving.

“The problem is the delivery process, not primary care itself. Primary care is incredibly valuable and desperately needed. But the lack of teamwork in the exam room has kept our product from our culture.

“Build a team inside your exam room and your practice will thrive.”

Resources

June 2015 Christian Doctor's Digest Interview with Peter Anderson, MD - Joyful and Efficient Patient Care (CMDA member only content)

The summer edition of Today’s Christian Doctor includes an article by Dr. Anderson with more information about team care medicine. Visit www.cmda.org/tcd for more information when this article becomes available.

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


Dr. John PierceCMDA 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

Thursday, April 23, 2015

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


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

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

Action

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

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

A new national religion?

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

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

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

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

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

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

Commentary


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

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

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

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

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

Action

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

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

Silence on religious persecution and killings

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

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

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

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

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

Commentary


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

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

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

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

Though our own political leaders may shrink back from responsibly responding to the worldwide persecution of Christians, our persecuted brethren are standing tall as a shining example of courage and faithfulness.
  • The Christian Post reports, "A number of the 21 Coptic Christians who were recently shown being beheaded in a horrific video by Islamic State militants in Libya were reportedly whispering the name of Jesus as their heads were being hacked off their bodies."
  • Christianity Today reports, "The Archbishop of Canterbury, Justin Welby, arrived in Cairo to offer condolences for the previous martyrs in Libya: 20 Coptic Orthodox Christians and a sub-Saharan African. 'Why has Libya spoken so powerfully to the world?' asked Welby during a public sermon. 'The way these brothers lived and died testified that their faith was trustworthy.'"
As we move on our government to stand up to persecution, may we also personally imitate the trustworthy faithfulness of this great cloud of witnesses.

Action

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

Resources
USCIRF 2014 Annual Report