CMDA
Protecting the Vulnerable NO MATTER WHAT
Entrusted with the Gospel
“My
Masters in Bioethics from TEDS gave me critical knowledge that enabled me to do hundreds of media interviews each year, train healthcare professionals, write for publications, and affect public policy decisions at the state and federal levels.”
DR. DAVID STEVENS
’02
The Master of Arts in Bioethics
How should we think about moral and ethical issues related to healthcare, scientific research, and emerging technology? The Master of Arts in Bioethics from Trinity Evangelical Divinity School (TEDS) will provide you with the ethical and theological understanding you need to approach these questions with skill and care. Our program will equip you to work in healthcare, science, law, advocacy, clergy, and more.
• We offer the MA in Bioethics in several delivery formats and it is designed to be flexible with busy professionals in mind.
• Complete the program in person or online (with one or two weeklong summer courses).
Why Earn a Master of Arts in Bioethics at TEDS?
At TEDS, you’ll not only study bioethics from a rigorous academic perspective but also explore how Christian faith informs and influences the field. We’ll give you the framework and tools to understand and navigate these issues with clarity and compassion.
Get access to The Center for Bioethics & Human Dignity (CBHD), Trinity’s world-class Christian bioethics center
The Center engages in research and cultural-engagement initiatives, and is the only center focused on Bioethics among Evangelical academic institutions. As a student, you’ll be able to attend CBHD events, including their annual conference.
TEDS HAS NEW SCHOLARSHIPS AVAILABLE! Go to www.teds.edu/CMDA to apply today
Grasping The Sword
This edition of CMDA Today includes our newest CMDA position statement, “Medical Futility and The Good of The Patient,” which was reviewed by our Board of Trustees in its January 2024 meeting. The timing for this review was providential for me and my family as my father, Ray Chupp, was being treated in a neurocritical care unit of a large teaching hospital in Greenville, South Carolina at that time. My dad developed a tumor of his pineal gland and subsequent cerebrospinal fluid obstruction and hydrocephalus. On January 3, 2024, his mental status suddenly deteriorated, and my mom called 911. His course was complicated by pseudomonas aeruginosa ventriculitis, after a decompression catheter was placed by a neurosurgeon. Unfortunately, Dad’s level of consciousness never returned to normal during his 58-day NICU stay. As the only physician in my family, my mother and siblings looked to me as the mediator between the NICU team and our family as we considered medical and surgical options to relieve hydrocephalus. On a number of occasions, the highly competent and experienced intensivists talked with me about what they felt constituted appropriate care for an 82-year-old like my dad (who was still working part-time as a consultant engineer). While my family and I didn’t always agree with the recommendations coming from his care team, this CMDA statement provided relevant talking points for me with that team right up until his death on March 11. I know you also will find it a useful guide for conversations with family and colleagues as you care for patients facing end-of-life care decisions.
My father played a major role in my own walk with Christ and spiritual growth during my formative years, even as I experienced medical school and residency training. He constantly encouraged me to incorporate the spiritual disciplines of Scripture memory and meditation in my life.
Dr. Jake Morris, an emergency medicine physician, missionary in Papua New Guinea and former resident trustee for CMDA, has written an excellent article on the why and how of Scripture memorization. Over the last eight years that I have served in leadership at CMDA, I have met dozens of godly men and women in healthcare, just like Dr. Morris, who are champions for bringing the hope and healing of Christ to the world through their professional lives. A unifying theme for many of them is their dedication to hiding God’s Word in their hearts. Proverbs 22:17-19 is an ongoing admonition for me to not only know about God’s Word but to have it ready to share from my lips at a moment’s notice: “Listen to the words of the wise; apply your heart to my instruction. For it is good to keep these sayings in your heart and always ready on your lips. I am teaching you today—yes, YOU—so you will trust in the Lord” (NLT, emphasis added). Applying our hearts to the Word with a readiness to share it verbally with others is a necessary part of trusting God, according to Solomon. Dr. Morris’ testimony is that over the last 10 years, “I have seen a gradual but profound change in my thinking as God’s Word more and more permeates my thought life.”
As Christian healthcare professionals, we have already invested so much time and mental energy in memorizing a plethora of principles and clinical pearls, as well as facts and stats to share with our peers and patients. We do this to make us better physicians, dentists, nurse practitioners, physician assistants, physical therapists, healthcare executives, etc. This knowledge will all pass away eventually, but the living and active Word of God is eternal! One of the most sobering admonitions of Christ for me is his foretelling of what the end times will be like in Matthew 24:10,12 “At that time many will turn away from the faith and will betray and hate each other…Because of the increase of wickedness, the love of most will grow cold” (emphasis added). I am sure when most of us read “most” in this passage, we don’t see ourselves in that company but most equals most! I believe you will find the Dallas Willard quote shared by Dr. Morris to be a powerful admonition to intentionally commit more of God’s Word to memory. Four years ago, the Holy Spirit reminded me I had hidden a large part of the New Testament in my heart during high school, college and medical school but then life got busy, including 20 years as a medical missionary. God gave me a new 10-year plan of Scripture memory that has been transformational. Thank you, Dr. Jake Morris, for challenging us to grasp God’s Word as never before!
Mike Chupp, MD, FACS, is the CEO of CMDA. He graduated with his medical degree from Indiana University in 1988 and completed a general surgery residency at Methodist Hospital in 1993. From 1993 to 2016, he was a missionary member of Southwestern Medical Clinic in St. Joseph, Michigan, while also serving as a career missionary at Tenwek Mission Hospital in Kenya.
Mike Chupp, MD, FACS
EDITOR
Rebeka Honeycutt
EDITORIAL COMMITTEE
Gregg Albers, MD
John Crouch, MD
Autumn Dawn Galbreath, MD
Curtis E. Harris, MD, JD
Van Haywood, DMD
Rebecca Klint-Townsend, MD
Debby Read, RN AD SALES
423-844-1000 DESIGN
Ahaa! Design + Production PRINTING Pulp
CMDA is a member of the Evangelical Council for Financial Accountability (ECFA).
CMDA Today™, registered with the U.S. Patent and Trademark Office. Fall 2024, Volume LV, No. 3. Printed in the United States of America. Published four times each year by the Christian Medical & Dental Associations® at 2604 Highway 421, Bristol, TN 37620. Copyright© 2024, Christian Medical & Dental Associations®. All Rights Reserved. Distributed free to CMDA members. Non-doctors (US) are welcome to subscribe at a rate of $35 per year ($40 per year, international). Standard presort postage paid at Bristol, Tennessee.
Undesignated Scripture references are taken from THE HOLY BIBLE, NEW INTERNATIONAL VERSION®, NIV® Copyright © 1973, 1978, 1984, 2011 by Biblica, Inc.® Used by permission. All rights reserved worldwide. Other versions are noted in the text.
CHRISTIAN MEDICAL & DENTAL ASSOCIATIONS
P.O. Box 7500, Bristol, TN 37621 888-230-2637
main@cmda.org•www.cmda.org
If you are interested in submitting articles to be considered for publication, visit www.cmda.org/publications for submission guidelines and details. Articles and letters published represent the opinions of the authors and do not necessarily reflect the official policy of the Christian Medical & Dental Associations. Acceptance of paid advertising from any source does not necessarily imply the endorsement of a particular program, product or service by CMDA. Any technical information, advice or instruction provided in this publication is for the benefit of our readers, without any guarantee with respect to results they may experience with regard to the same. Implementation of the same is the decision of the reader and at his or her own risk. CMDA cannot be responsible for any untoward results experienced as a result of following or attempting to follow said information, advice or instruction. Organizational financial records, Board of Trustees meeting minutes and House of Representatives meeting minutes are available upon request.
CMDA
JeffreyJ.Barrows,DO,MA(Ethics), andMandiL.Morrin
A deeper look at this historic event for CMDA
JacobMorris,MD
importance of Scripture and a practical tool to accomplish memorization
JoelCho,MD
Utilizing practical wisdom to serve the well-being of patients Healthcare as it is shaped by post-modern ethics
REGIONAL MINISTRIES
Connecting you with other Christ-followers to help better motivate, equip, disciple and serve within your community
Western Region: Wes Ehrhart, MA • 6204 Green Top Way • Orangevale, CA 95662 • 916-716-7826 • wes.ehrhart@cmda.org
Midwest Region: Connor Ham, MA • 2435 Lincoln Avenue • Cincinnati, OH 45231 • 419-789-3933 • connor.ham@cmda.org
Northeast Region: Tom Grosh, DMin • 1844 Cloverleaf Road • Mount Joy, PA 17552 • 609-502-2078 • northeast@cmda.org
Southern Region: Grant Hewitt, MDiv • P.O. Box 7500 • Bristol, TN 37621 • 402-677-3252 • south@cmda.org
MEMBER NEWS
CMDA Members Win Awards
VIE Poster Session
Andre M. Cipta, MD, FAAHPM, was recently awarded the prestigious Hastings Center Cunniff Dixon Physician Award for exemplary end-of-life care. He was one of three physicians nationwide selected for the early-career award. Dr. Cipta is the Assistant Professor of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, program director of the Hospice and Palliative Medicine Fellowship and site director of the innovative mid-career fellowship track at the Kaiser Permanente Los Angeles Medical Center. He also serves as associate medical director of the Kaiser Permanente Los Angeles Hospice Agency and palliative medicine clerkship director at the Tyson School of Medicine. Board certified in hospice and palliative medicine, Dr. Cipta is a recipient of the American Academy of Hospice and Palliative Medicine Leadership Scholar Award. In his multifaceted roles as a leader, educator and researcher, he strives to enhance the quality of care across the continuum of serious illnesses. His interests lie in exploring novel approaches to medical education, studying the relationship between spirituality and health and advocating for compassionate, evidence-informed, whole-person-centered care.
Andre K. Mickel, DDS, MSD, MDiv, DMin (DEN '91, DEN '94), was honored with the Case Western Reserve University (CWRU) School of Dental Medicine (SODM) 2024 Distinguished Alumnus Award. In 1995, Dr. Mickel was selected as the program director of the CWRU School of Dental Medicine postdoctoral residency program in endodontics, and he successfully led the program to regain its full accreditation status from the Commission on Dental Accreditation (CODA). Dr. Mickel has been the Chair of the CWRU School of Dental Medicine Department of Endodontics since 2008 and established and currently directs the International Fellowship in Endodontics program. He was the first African American to earn a postdoctoral specialty MSD degree at CWRU SODM and the first African American chief resident of a postdoctoral residency program at CWRU SODM. Additionally, he was the first boardcertified endodontist in the history of the CWRU Endodontic program and the world’s first African American Endodontic Residency program director. A sought-after speaker, Dr. Mickel has presented hundreds of lectures locally, nationally and internationally at professional societies. Dr. Mickel has authored or co-authored well over 100 papers, abstracts and publications. Dr. Mickel and his wife Estomarys have four children.
Please encourage students, residents and fellows to submit an abstract for CMDA’s eighth annual VIE Poster Session, which will take place during the 2025 CMDA National Convention. Presentations in areas of spirituality, ethics, education, computational biology, mathematical modeling, biophysics, biotechnology, biomedical science, medicine, surgery, dentistry, nursing and medical humanities are all welcome! Visit cmda.org/vie to submit an abstract by January 31, 2025. Cash prizes are awarded!
ICMDA Appoints New North American Regional Secretary
Sharon A. “Shari” Falkenheimer, MD, MPH, MA, PhD, was recently appointed North American Regional Secretary of International Christian Medical and Dental Association (ICMDA). ICMDA exists to start and strengthen Christian national medical and dental movements. In this role, Dr. Falkenheimer will promote the mission and vision of ICMDA in the U.S. and Canada by working with national fellowship leaders to strengthen and encourage their movements and participation in ICMDA. To find daily devotionals, weekly webinars and international conferences, and to learn more about ICMDA’s mission, visit icmda.net Additionally, volunteers are welcome to make an impact through ICMDA by giving webinars that are translated into several languages to reach Christian healthcare professionals in numerous countries. For more information, contact Dr. Falkenheimer at shari.falkenheimer@icmda.org.
Ministry News
WPDC Celebrates Anniversary
Women Physicians & Dentists in Christ (WPDC), a ministry of CMDA, is celebrating their 30th anniversary in 2024. WPDC first began in 1994, and since has grown exponentially to the glory of God. WPDC provides support for Christian women physicians and dentists, as well as equipping them to handle the unique challenges faced by Christian women in healthcare. To learn more or get involved, visit wpdc.cmda.org
Inspired By Your Generosity
In May 2024, CMDA announced $1.1 million was needed in donations to meet our annual general fund giving goal of $2.9 million. It has been nothing short of a miracle to see how the Lord has provided so faithfully, as He always does, to overcome our concerns and provide what was needed. The outpouring of generosity started in late April, with 12 CMDA supporters providing $154,000 in matching gifts to help inspire others to support the ministry. In early May, this generosity continued when nearly 1,000 2024 CMDA National Convention attendees responded
following Dr. Chupp’s annual CEO report highlighting the ministry impact of CMDA, with an incredible offering of $106,215. While we were surprised by a special estate gift of $279,694, CMDA staff realized the Lord was piecing together the financial resources needed to sustain His ministry here on earth through Christian healthcare professionals. In May and June, an additional $378,201 was given by 374 CMDA supporters who responded to the fiscal year-end giving campaign. Combined, this provided $918,110! We are incredibly blessed by the generosity of those who invest their time and resources to help achieve the vision of CMDA, which is to bring the hope and healing of Christ to the world through Christian healthcare professionals. Here is just one of the many testimonies CMDA receives expressing gratitude for you, the generous supporters and volunteers of CMDA:
“The CMDA Campus Ministry at my medical school helped strengthen my relationship with God during one of the most intense years of school I’ll likely experience. The leadership and members helped to keep me spiritually and emotionally fed during that time.” – Second-year medical student
SHARING THE GOSPEL THROUGH HEALTHCARE MISSIONS
CMDA’s Global Health Outreach sends short-term healthcare mission teams around the world to places like Central America, Africa, Western Europe, Middle East and Asia. We serve the poor and needy who have no access to healthcare by offering medical, dental and surgical care.
Our trips are open to anyone interested in serving others through missions, whether you have experience in healthcare or not. Joining a team is easy, so visit cmda.org/gho to find a trip that fits your schedule. Join us today as we bring the HOPE and HEALING of CHRIST to the world through HEALTHCARE .
“This ministry is truly impacting lives, not only of the patients but also of the ones who serve on the trips. It was the experience of a lifetime.”
—Trip Participant
Upcoming Events
Dates and locations are subject to change. For a full list of upcoming CMDA events, visit cmda.org/events.
2024 CMDA THRIVE Tour
September - October, 2024 • Multiple Locations
The Convergence Conference
September 19-21, 2024 • Virtual
CMDA Group Mentor Coaching
September 23-November 18, 2024 • Virtual
501 Foundations in Coaching
September 24 - October 29, 2024 • Virtual
2024 Midwest Fall Conference
September 27-29, 2024 • Norton Shores, Michigan
Mentoring With A Coach Approach
October 3-31, 2024 • Virtual
Marriage Enrichment Weekend Conference
October 4-6, 2024 • Grand Rapids, Michigan
Great Commission Dental Conference
October 4-5, 2024 • Dallas-Fort Worth, Texas
CMDA Northeast Regional Retreat
October 25-27, 2024 • North East, Maryland
Saline Process Witness Training
November 6-7, 2024 • Louisville, Kentucky
Global Missions Health Conference
November 7-9, 2024 • Louisville, Kentucky
Perkins Justice Pilgrimage
November 13-17, 2024 • Mississippi and Alabama
2025 National Convention
May 1-4, 2025 • St. Charles, Missouri
RESOURCES
The Voice of
Advocacy
As Christians in healthcare, we glorify God by serving as a voice for the vulnerable. CMDA Advocacy is pleased to introduce The Voice of Advocacy. This monthly podcast is hosted by Senior Vice President of Bioethics and Public Policy Jeff Barrows, DO, MA (Ethics), and it features members of the Advocacy team as well as special guests. Listen to learn more about Advocacy’s grassroots efforts at the state and federal level, legal and legislative victories and how CMDA members can be involved in achieving justice for the vulnerable. To listen to the latest episode, visit cmda.org/advocacy.
Legal Assistance for CMDA Members
As a result of a partnership between CMDA and Alliance Defending Freedom (ADF), we are now offering free legal consultations for CMDA members who may be experiencing conscience freedom issues in the workplace. Exclusively available to CMDA members, this program is designed to serve members who feel they are being discriminated against in the workplace due to their firmly held moral and religious beliefs.
We believe conscience freedoms have profound ethical and religious importance within the healthcare profession, and we encourage colleagues, institutions and governments to respect these freedoms. If you feel your conscience freedoms are at risk, please visit cmda.org/ legal.
Standing Strong in Training
As the latest addition to CMDA’s long list of resources for our members, Standing Strong in Training is a new on-demand video series that helps healthcare students and residents stand up against the cultural pressures facing Christians within healthcare today.
The curriculum’s seven modules are designed for group settings, allowing attendees to solidify their foundational worldview beliefs regarding important issues, such as the beginning of life, end of life and biblical sexuality. Each module also offers ideas of how to winsomely defend biblical values and positively interact with others in developing their worldview beliefs.
For more information and to access this new study, visit cmda.org/ standingstrong
Protecting the Vulnerable NO MATTER WHAT
JeffreyJ.Barrows,DO,MA(Ethics),andMandiL.Morrin
GET INVOLVED
You can learn more about this case and CMDA’s advocacy efforts by listening to TheVoiceofAdvocacy, a new monthly podcast from CMDA Advocacy. Hosted by Senior Vice President of Bioethics and Public Policy Dr. Jeff Barrows, each episode features special guests that can help you dive deeper into ethical issues and learn about our grassroots efforts at the state and federal level, our legal work and how you can be involved in achieving justice for the vulnerable. To listen to the latest episode, visit cmda.org/advocacy
On Tuesday, March 26, 2024, the U.S. Supreme Court heard oral argument in U.S. Food & Drug Administration v. Alliance for Hippocratic Medicine. This was the first time CMDA was a named party in a U.S. Supreme Court case, a monumental and historic moment in CMDA’s ongoing advocacy work to protect the vulnerable and protect the conscience freedoms of our members— no matter what.
ABOUT THE CASE
In 2000, the U.S. Food and Drug Administration (FDA) approved Mifeprex (mifepristone), a new drug with unique progesterone-blocking properties for use to induce a chemical abortion along with a previously approved uterine contractile agent, misoprostol. This chemical abortion regimen was approved with specific safety standards in place. Those safety standards included three in-person evaluations of the patient to estimate the dates of the pregnancy, rule out ectopic pregnancy and follow up after administering the drugs to check for excessive blood loss and severe infection. Since its initial approval, the FDA has removed the requirement for in-person visits, markedly increasing the risk of mistaking the age of the pregnancy, missing ectopic pregnancies, severe infection and excessive hemorrhage. In 2016, the FDA also removed the requirement for prescribers to report serious complications from the drugs, with the exception of death. By eliminating the requirement that doctors provide in-person care, the FDA has endangered the girls and women who take these high-risk drugs all alone at home or in their dorm rooms.
In 2022, represented by Alliance Defending Freedom (ADF), CMDA, together with other national medical associations and individual doctors, sued the FDA to hold it accountable for endangering the health and safety of women and girls. In 2023, the U.S. Court of Appeals for the Fifth Circuit ruled that the FDA acted unlawfully in removing these important safety standards. The U.S. Supreme Court agreed to review the case and heard oral argument on March 26, 2024.
VIEWS FROM INSIDE THE COURT
CMDA CEO Dr. Mike Chupp and CMDA Senior Vice President of Bioethics and Public Policy Dr. Jeff Barrows were privileged to be inside the U.S. Supreme Court listening to the oral argument in this case.
“Both Jeff and I want you to know how grateful we are for you and your commitment to pray for us, our lawyers with Alliance Defending Freedom and much more. About an hour before she argued before the court, I was able to share with Alliance Defending Freedom attorney Erin Hawley that more than 500 CMDA members were actively praying for her. That was an encouragement to her, so you can know your prayers made a difference! The specific point that stands out to me is how the solicitor general and the justices engaged in a discussion about the absolute necessity of protecting conscience freedoms of doctors of faith. That was a great encouragement to us and our litigation team. According to our lawyers, the solicitor general made a monumental concession when she proclaimed that federal law protects the conscience rights of doctors, including those who work in emergency rooms and hospitals.”
—Dr. Mike Chupp
“This hearing was about the preliminary injunction and establishing that our members will experience harms, such
as conscience violations, when they end up being forced into treating patients suffering from complications of chemical abortion. Erin Hawley did a great job of reinforcing the fact that, by the FDA’s own statistics, one in 25 women who take the abortion drug regimen will end up in the emergency room for our members to take care of them.”
—Dr. Jeff Barrows
VIEWS FROM OUTSIDE THE COURT
During oral argument, dozens of healthcare professionals and students from CMDA, the American Association of Pro-life Obstetricians and Gynecologists (AAPLOG) and other like-minded organizations joined together to hold a rally outside on the steps of the court. What an incredible display of camaraderie as we stood together to make our voices heard and protect women’s health. We’ve included two personal testimonies from CMDA members who participated in this rally.
The call to serve at the March 2024 rally held at the U.S. Supreme Court was received loud and clear from the CMDA email inviting interested healthcare professionals to join this
momentous effort. I was a new physician assistant graduate in between jobs, and I couldn’t think of a better way to kickstart my healthcare career than standing alongside veteran heroes who have dedicated their lives to protecting and speaking up for the youngest of humanity and their mothers.
Above all, I am a Christian physician assistant, and I wholeheartedly desire to speak truth and to serve Jesus and His kingdom. After all, that’s who I am really working for while on earth. As Jesus loves each of us, that is what I imagined we would be doing through our efforts at this rally—expressing our love and desire to protect mothers and their children who have been placed at risk for loss of life and/or critical injury.
I had no idea God would pair me with a former abortion doctor turned Christian OB/Gyn when I expressed interest in sharing hotel accommodations. It was a miracle the cost would be more affordable (especially with rates in Washington, D.C.), but after confirming the hotel reservations, I later learned the person I would be sharing hotel accommodations with was Dr. Patti Giebink, as in, THE Patti Giebink who I had heard sharing her testimony on “The 700 Club.” I was in shock and wondered what in the world God was up to.
I still had two long white coats hanging in my closet that I had not put on since graduating physician assistant school, although I had been volunteering and was employed as a new graduate. However, now felt like the right time to finally wear my long white coat, advocating for something as noble as protecting the lives of unborn humans and their mothers. Wearing my long white coat on the steps of the Supreme Court felt to be a declaration in spirit and to the world that, by the grace of God, I will always stand for truth, righteousness and life. As a social worker, I had always advocated for the rights and welfare of my patients and clients. Being a physician assistant will allow me to go places I had never or could never go previously. I couldn’t think of a better time or way to advocate than rallying alongside such heroes in my eyes.
What I didn’t expect was there to be hundreds of heroes at that rally who shared the same heart and concern as me, Dr. Giebink and countless others at CMDA. My eyes were opened, and I realized the profundity of the collective voice of each of us from all walks of life and professions who sing the song of hope and victory. Thank you, CMDA, Dr. Giebink and every person and organization represented at that rally for caring deeply for your spiritual neighbors, brothers and sisters who are made in the image of God and by the hand of the Almighty. It was a true honor to participate in this event, and I pray our efforts made and will continue to make a positive difference in the lives of mothers and their unborn children.
—Melody Moore, PA-C
It was a privilege to be invited to Washington, D.C. in March when this case was heard. Even though the Supreme Court
justices declined to address the FDA’s reckless actions, it should have brought attention to the fact that lax FDA policies concerning Mifepristone put women in danger. However, media spun the story to sound like this was an access to abortion case, not safe practices.
The highlight of my trip was meeting and spending time with Melody Moore, a physician assistant from North Carolina. We walked to the meetings and toured that area of D.C., putting in miles. The cherry blossoms were in full bloom and their perfume perfused the air.
On Tuesday morning, we met and walked to the front of the U.S. Supreme Court, where a large crowd of demonstrators gathered with big signs and loud voices, spouting pro-abortion slogans and slamming us as liars and worse. We were prepared in our white coats and carrying signs that read: “FDA do your job,” “Women’s Health Matters” and “FDA put women first.” It was cold as we stood there for four hours praying for our people inside.
As we stood there with our signs, we listened to heartbreaking testimonies from women who took the abortion pills, one even unknowingly. One woman told of her husband spiking her smoothies with the drugs, but he was caught and prosecuted. Several women recounted being alone at home passing unbelievable amounts of blood and clots with no one to call, uncertain what to do with the products/the baby.
GET LEGAL HELP
As a result of a partnership between CMDA and Alliance Defending Freedom, we are now offering free legal consultations for CMDA members who may be experiencing conscience freedom issues in the workplace. Exclusively available to CMDA members, this program is designed to serve members who feel they are being discriminated against in the workplace due to their firmly held moral and religious beliefs. If you feel your conscience freedoms are at risk, please visit cmda.org/legal to learn more about how we can help.
Back in my home state of South Dakota, the fight continues. Following the Dobbs v. Jackson Women’s Health Organization decision in 2022, South Dakota’s trigger ban took effect, which prohibits induced abortion except to save the life of the mother. During this time, countless lies and mistruths have been spread about the practice of obstetrics, leaving some physicians wondering whether they can care for their pregnant patients. Don’t be deceived by fearmongering. Unless you want to perform an induced abortion for no other reason than [to] terminate the life of the unborn fetus, you are covered. The law is clear and is based on intent. My intent as an obstetrics physician is a healthy mother and a healthy baby. Some complications require early delivery in which the baby may not survive. The child’s death is a tragedy, but it was never the intended outcome.
However, a group of political activists with a radical proposal seeks to enshrine induced abortion into our state constitution in November 2024. At first blush, it doesn’t appear too bad, even to pro-life healthcare professionals. However, the wording is intentionally vague and misleading, and it uses the unscientific language of “trimesters.” This group uses the phrase “restore Roe” as one of its battle cries. Why would we want to go back 50 years? Think about the amazing progress we’ve made in science and healthcare during this time and the numerous other options available now. This measure will make induced abortion legal throughout all nine months, and in the first “trimester,” there can be no regulations! No criteria for informed consent, no waiting period, no parental rights, no clinic standards, no screening for coercion, none. This measure is actually worse than Roe.
What can you do? This is not the time to sit back and let someone else worry about it. If we do nothing, this measure will pass, like a similar amendment in Ohio. It will permanently affect the practice of healthcare. Encourage likeminded co-workers to join in CMDA’s advocacy efforts. Arm yourself with reliable information and please help us fight and win this battle.
—Patricia Giebink, MD
▲ Melody Moore, PA-C
THE RESULT
Sadly, when the U.S. Supreme Court released its decision on June 13, 2024, it did not address the FDA’s reckless removal of its longstanding protections for women. The FDA managed to escape accountability based on a legal technicality, but nothing in this decision changes the fact that the FDA’s own label for these drugs says that roughly one in 25 women who use them will end up in the emergency room. In other words, the FDA’s actions are as wrong now as they were previously, and we are grateful for the three states (Missouri, Kansas and Idaho) who have already intervened in the lower court and stand ready to hold the FDA accountable and protect women’s health.
The bottom line is that women should have the ongoing care of a doctor when taking high-risk drugs. The FDA betrayed women and girls when it removed the in-person doctor visits that protected women’s health and well-being. As healthcare professionals, we witness women suffering harms caused by the FDA’s reckless actions. Data cited by the FDA shows that hospitalizations increased more than 300 percent with no in-person doctor visit, and yet still the FDA removed all three of them. We’ve seen these harmful results firsthand. Women deserve real healthcare.
Please pray alongside us that the FDA will ultimately be held accountable and women’s health will be protected. Pray as well for CMDA members around the country, as they increasingly care for women who suffer from complications caused by chemical abortion drugs. In spite of this disappointing result, we at CMDA will continue to advocate for women’s health and seek to restore commonsense safeguards for abortion drugs— no matter what.
THE NEXT STEPS
Though the decision was disappointing, we were pleased that both the Supreme Court and the FDA affirmed broad conscience protections for healthcare professionals. That is a major victory, which will protect CMDA members from being required to provide abortions or other medical treatment against their conscience. We will continue to fight for our members as we seek to protect their conscience freedoms— no matter what.
Through this case and our ongoing advocacy efforts, we are on the frontlines as we work to protect the vulnerable. In fact, this case was only part of our work in advocacy here at CMDA. Will you prayerfully consider getting involved in CMDA’s advocacy efforts in your individual state? To get involved, visit cmda.org/ advocacy.
Thank you for your prayers throughout this legal initiative. May God give each of us renewed courage and confidence as we speak His truth—no matter what!
Jeffrey Barrows, DO, MA (Ethics), is Senior Vice President of Bioethics and Public Policy for CMDA. Dr. Barrows is an obstetrician/gynecologist, author, educator, medical ethicist and speaker. He completed his medical degree at the Des Moines College of Osteopathic Medicine and Surgery in 1978 and his residency training in obstetrics and gynecology at Doctors Hospital in Columbus, Ohio. In 2006, he completed a master’s in bioethics from Trinity International University in Chicago, Illinois. Dr. Barrows served as the director of CMDA’s Medical Education International (MEI) from 2002 to 2005 before transitioning into the fight against human trafficking. He dedicated 15 years of his career to fighting against human trafficking within the intersection of trafficking and healthcare, as well as the rehabilitation of survivors of child sex trafficking. In 2008, Dr. Barrows founded Gracehaven, an organization assisting victims of domestic minor sex trafficking in Ohio. In 2020, Dr. Barrows published a novel entitled Finding Freedom that realistically portrays child sex trafficking in the U.S.
Mandi L. Morrin serves as CMDA’s Vice President of Communications and Events, where she leads the ministry’s communications initiatives and oversees the development and execution of the CMDA National Convention each year. She is instrumental in the publication of CMDA Today and CMDA Matters, as well as the design and production of a variety of other resources produced by CMDA. She manages and implements the ministry’s communication initiatives including media relations, news releases and media interviews, and she oversees a media training conference each year. She received her bachelor’s degree in communications with an emphasis in journalism from Milligan University in Johnson City, Tennessee in 2006. Despite having lived in Tennessee for more than 20 years, Mandi is an avid Kentucky Wildcats basketball fan. Mandi, her husband Chad and their dog Clyde reside in Bristol, Tennessee.
▲ Patricia Giebink, MD
A SIMPLE WAY TO Memorize Scripture
Scripture and Oxaloacetate
“Citrate Is Kreb’s Starting Substrate For Making Oxaloacetate.” Seven years after completing medical school, my grasp on the Kreb’s Cycle is only slightly better than my recall of what I ate for breakfast on the third Tuesday of November of 2016 (i.e. I am clueless, but probably Raisin Bran). And while my synapses that used to make sense of the Kreb’s Cycle have long-since abandoned their fraternal linkage, I can still recall the first letter of each esteemed molecule thanks to the nifty mnemonic. Please don’t ask me about the Urea Cycle, though, or the stages of embryogenesis. The word “neural tube” conjures up an image in my mind somewhere between The Matrix and a Rorschach Test.
JacobMorris,MD
If your blood pressure escalated 10 points by reading the last paragraph (as mine did by writing it), I assure you I will attempt to eschew much more medical school or biochemistry jargon. My point, however, is this: You, dear reader, whether radiologist, pediatric nurse or orthodontist, have devoted a significant portion of your life to memorization. Even more so, you have proven yourself to be no mere show pony when it comes to fact retention and recall. You have traversed the jungle of board exams, step exams and organic chemistry finals, and while the forest may have left you battered and tattered, you have emerged through the tangle, or, for those still in training, have at least covered ample ground.
Have you and I applied our precious, God-given mental abilities to memorizing God’s Word and hiding it in our hearts? These days, Hebrews 13:5 is far more valuable to me
than recalling the branches of the Brachial Plexus. Psalm 1 is of infinite more succor than Ohm’s Law. I think for several of us, though, we must admit we devoted far more energy to memorizing facts that helped us pass tests than memorizing Scripture that helps us pass life. I am guilty. What I want to do is share with you a tool and a method for Scripture memory that has blessed me immensely. Perhaps you already have a way to hide God’s Word in your heart that is fruitful; I applaud you! The method I would like to share is easy, incredibly effective, accessible and utilizes the life-changing principle of spaced repetition. The remainder of this essay is divided around three questions:
1. Why memorize Scripture?
2. Why spaced repetition?
3. How do I practically do it?
Why Memorize Scripture?
A thousand pens, a thousand books and an ocean of ink would not suffice to exhaust all the reasons to memorize Scripture. Author Dallas Willard wrote, “Bible memorization is absolutely fundamental to spiritual formation. If I had to choose between all the disciplines of the spiritual life, I would choose Bible memorization, because it is a fundamental way of filling our minds with what it needs.” 1
Memorization is roadwork for the mind. Imagine a group of Minnesota children standing at the precipice of a hill laden with deep and fresh snow. As the first child careens down on their sled, brisk air whipping back their hair, they create track. If that path is used repeatedly, it becomes packed and durable. Soon, sleds coursing anywhere nearby will be sucked into the robust route. Those who memorize Scripture and meditate on it repeatedly find that fleeting daily thoughts and circumstances will be pulled into God’s Word like a sled going across a hill and encountering a hardy trail.
When Paul urges us to renew our minds in Romans 12, it is not just a metaphor. In the mysterious interface between mind, body and soul, a physical change occurs through the act of Scripture meditation. Neuropsychologist Donald Hebb famously said, “Neurons that fire together, wire together.” Research demonstrates that when we use neuronal connections repeatedly, the myelin coating around those axons thickens, and dendrites between those connected neurons become more robustly interlinked. The meat of our brain changes alongside our mind and soul.
Practically, having Scripture in my brain influences the trajectory of my entire day. C.S. Lewis once wrote, “The real problem of the Christian life comes where people do not usually look for it. It comes the very moment you wake up each morning. All your wishes and hopes for the day rush at you like wild animals.” 2 For a while now, I have been trying to tame the wild animals. I don’t do this flawlessly, but when my alarm goes off, I aspire to reach over and silence my phone without opening it. The wild animals of email and my iPhone growl and try to leap out of their cage, but I kick them back, forsake my phone and lay back in bed. I then take a few minutes to let my mind wake up to God’s Word. I recite Psalm 1, Psalm 23 and Philippians 4:4-9. I greet my companions: a blessed fruitful tree, a gentle and powerful Shepherd and the joy of the Lord. The wild animals stay in their cage, and I don’t look at my phone until an hour later after I have spent time with God. Take that, beasts.
Why Spaced Repetition?
Perhaps you are convinced of the importance of Scripture memorization. We are then led to ask, “How do I effectively memorize Scripture?” This is where the concept of spaced
repetition comes in. Imagine learning a new fact: perhaps that the earth is 93 million miles from the sun. Desiring to impress your 6-year-old son (I speak hypothetically) you decide to commit that fact to memory. Now, what do you need to do to remember that fact 10 years from now?
To memorize this astronomical statistic, you may need to review it in one hour, then tomorrow, then in a week, then in a month, then in a year and then in three years. This is the beautiful truth of “spaced repetition.” When we learn something new, we need to review it frequently. However, over time, that neural pathway becomes robust, and we need to review that fact less and less frequently to keep it in our memory. Spaced repetition aims to help us review facts right before we are about to forget them, thereby keeping our hard-earned learning alive in our long-term memory.
When it comes to Scripture memorization, the initial act of memorization is not complicated. I can open my Bible and read 2 Timothy 3:16-17 until it is committed to memory. I can actively test myself to see if I know it. I can remind
"Bible memorization is absolutely fundamental to spiritual formation."
myself of the verse tomorrow and next Tuesday. What about three years from now, though? What about when I have 100 verses written on the tablet of my mind? I put in hard and fruitful labor to learn these verses; how do I ensure I will review them at the right time to keep them in my memory? How do I sled that path on the hill before the winds of time erase all traces of my former route?
Make It Stick: The Science of Successful Learning by Peter Brown et. al., is an interesting book I read earlier this year. A group of scientists set out to scour the field of research on learning and try to elucidate principles on what works and what doesn’t. One of the key effective principles was spaced repetition: “Deliberately spacing the repetitions of to-belearned information over time has been shown to be a highly effective practice…The technique is called spaced retrieval practice, and it’s one of the most powerful methods for promoting long-term retention and transfer to new contexts.” 3 If we want to effectively memorize Scripture, we must utilize the principle of spaced repetition. We can work hard to memorize 50 verses this year, but most of them will be gone
with the wind five years from now if we don’t have a systematic method for actively retrieving and practicing those verses at appropriate intervals.
How Do I Practically Do It?
I hope your Christian formation has persuaded you of the vital importance of Scripture memorization. Further, I hope you recognize the value of spaced repetition. In the battle for Scripture memorization, there is synergistic power in heart motivation combined with effective strategy. Countless people are willing to memorize Scripture, but they never experience lasting success because of the lack of a systematic means to review the Scriptures they have learned.
This leads to the final question, assuming I am motivated to memorize Scripture, and I embrace the theory of spaced repetition, how do I practically pair these ambitions in my quest for memory? A number of ways are available to do this, but let me share what has worked for me. I would like to introduce you to a software thousands of medical students have used for memorizing the cranial nerves and 10 million other facts: a program called Anki. Anki is an open-source program built around the principle of spaced repetition. You, the user, can create simple flashcards, in our case, of Scripture verses. Anki will then show these cards to you at specific intervals determined by a built-in spaced repetition algorithm. At first, you will review a new card frequently, and if you remember the verse, the interval for review will be spaced further and further out. If, however, it is a tricky verse, and you forget it, Anki will automatically take care of making you review the card more frequently until that track is built into your long-term memory. Easy verses you will review less frequently and difficult ones more frequently, helping you capitalize on your memory efficiency.
You can start by inputting tens of verses into Anki, eventually this will grow into hundreds or even thousands of verses, and you never have to remember to review those verses again: Anki will automatically display a verse to you as soon as it thinks you are about to forget it, thereby helping you keep an enormous library of Scripture in your long-term memory. This will aid you in the real battle: continually meditating on and applying Scripture to all the circumstances you face in your day-to-day life. Knowledge is not the goal; love shaped by God’s Word is the goal.
Anki Introduction
I will now walk you through the simple process of creating Scripture flashcards in Anki. If I have persuaded you of the importance of memorizing and meditating on Scripture, and of the value of spaced repetition, this is where the rubber meets the road. This is the practical portion of the article, and you will want a device in front of you. To get started, pull out your electronic device of choice: PC, Mac, iPad, Android, iPhone, etc.
If you download Anki on multiple devices, Anki will sync your cards, allowing you to review your verses from your phone, your laptop or whatever you have handy. I love having Anki on my iPhone because it helps me redeem idle time. If I am waiting for a meeting to start, instead of scrolling through emails, I pull out Anki and review my cards for the day.
First things first: Download Anki from apps.ankiweb.net. Navigate to “Download Anki” at the bottom of the screen and choose the version for your device. Be aware if you download through the App Store, there are competitor “Anki” programs developed from the original, so look for the app with a logo of a blue star on a gray background. One other disclaimer: Anki is free on every device except the iPhone/iPad, where it costs a single payment of $25. I started using Anki 10 years ago and have used it for thousands of hours—the $25 was worth every penny! However, if you want to “test things out” before committing $25, you can start by using Anki on your PC, Mac or web browser for free.
Once you have downloaded Anki, open the program. You should see a deck called “Default.” You can rename this deck,
“Scripture” (swipe left on the deck in the iOS App to rename the deck). Then open the deck and click “Add” to start adding your first flash cards. You should now have a “Basic” flash card with open fields that say, “Front, Back and Tags.” Click the “Type” field on the card in the upper left. This allows you to select different types of flash cards. Change this from “Basic” to “Basic (and reversed card).”
Now, in the “Front” field, you can input your verse reference. For example, “2 Timothy 3:16-17.” On the “Back” field, you can write the Scripture in your desired translation, “All Scripture is breathed out by God and profitable for teaching, for reproof, for correction, and for training in righteousness, that the man of God may be complete, equipped for every good work” (ESV). Imagine these fields like the front and back of an actual, physical flash card. Because you have made a “Basic and reversed card,” Anki will sometimes give you the Scripture reference and you will need to know the verse, and sometimes it will show you the verse and you will need to recall the reference. Click “Save.” You have now made your first flash card!
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When you go back to your deck, you will now see two notes to review for the day. When you review the card, you will mark it, “Again, Hard, Good or Easy,” and Anki will automatically schedule your reviewing of that verse for the rest of your life, helping you transition it into long-term memory. Now, go and add another five verses you know, plus one you want to learn. Once you have added and reviewed all your cards, go to ankiweb.net and click “Sign Up” to make an account. When you have made an account, you can go back to your Anki app, click “Synchronize” and input your account information, and now those flash cards will be accessible from any Anki app on any device. Anki has other helpful and powerful features, which I cannot explain in this brief article. If you want to learn more, please reach out to me or watch one of the available YouTube videos that explain additional features of this powerful program.
Now that you have made your first cards, commit to reviewing your due cards daily, being honest to mark it “Again” when you forget it, and gradually add more cards over time. Days, weeks, months and years from now, your memory library of Scripture will expand, and, more importantly, your life will change as meditating on God’s Word literally alters the neuronal connections in your brain and influences the choices you make. You, dear reader, have memorized numerous facts that have helped you pass tests. Now, apply that
“I have stored up your word in my heart, that I might not sin against you”
(Psalm 119:11, ESV)
same industry and zeal to memorize God’s Word, which will help you pass life!
*Disclaimer: Neither the author nor CMDA have any financial connection or conflict of interest with Anki.
Endnotes
1 Willard, Dallas. 2001. Spiritual Formation in Christ for The Whole Life and Whole Person . Vocatio.
2 Lewis, C.S. 1996. Mere Christianity . HarperOne.
3 Brown, Peter. Roediger III, Henry L. McDaniel, Mark A. Make It Stick: The Science of Successful Learning . 2014. Belknap Press: An Imprint of Harvard University Press.
Jake Morris, MD, is an emergency physician who previously practiced in Eau Claire, Wisconsin. He completed his medical school at the Mayo Clinic College of Medicine and his chief residency in emergency medicine at the University of Alabama at Birmingham. He has been actively involved in CMDA since 2012. He was a Resident Trustee on the CMDA Board of Trustees from 2018 to 2019. He previously served as the Wisconsin Assistant State Director for the American Academy of Medical Ethics. The Morris family moved to Papua New Guinea in early 2023 to serve as healthcare missionaries.
When Caring for The Unbelieving Terminally Ill Patient
JoelCho,MD
Over my 20 years as a hospital medicine physician in one of the least churched areas in the country in San Francisco, California, I have cared for several patients who are terminally ill. Though such duty is never a happy one, spiritually I found it hardest to know how a Christian physician can best care for the terminally ill unbelievers. For example, I remember an elderly man (I will call him Mr. Jones) who was dying of multi-organ failure. As his body was failing him, even dialysis eventually stopped working. Everyone knew it was only a matter of days before he would fall asleep and not wake up. Mr. Jones was a kind and courteous gentleman, and he always held my hand when I was in his room. Even in his state, I was grateful for the respect he had shown me as his physician.
As I watched his health slowly downward spiral in front of my eyes, as I often ask terminally ill patients, I asked him if he attended church or had a religion. His answer was a firm “no.” Typically I don’t push the spiritual issue more when my patients are not interested. But, the next day, as he was holding my hand as usual, for some reason I felt compelled to ask him again, “Are you sure you don’t want to see a pastor or chaplain? I just want to make sure we can provide the best care for you wholistically…Did you grow up attending a church?”
“Oh, yes, I did. I grew up Christian.”
“I could get you a chaplain if you’d like….”
Shaking his head slowly, “No.”
I could then tell he was getting fatigued and didn’t want to converse much more. So, I performed the rest of my medical exams, informed him of the plan for the rest of the day and left his room, uttering quiet prayers for him under my breath. That was the last time I saw him.
As I look back, I wonder if I had done all that I could for Mr. Jones. I was at his bedside every day that week. As his physician, I had the privilege to have his undivided attention when I was in his room. Should I have probed a bit more about his relationship with Jesus? Was that too much for someone who could barely stay awake as toxins built up in his body?
I often have struggled with such situations throughout my career. Over the past few years, through the miracle of the internet God has opened doors for me to receive a formal theological education at Reformed Theological Seminary (RTS) while working full-time as a physician. This theological training helped me to reflect on this all-too-common dilemma for all physicians a bit more thoughtfully and prayerfully. That’s what I would like to share here. Though my reflections here are neither comprehensive nor authoritative, I hope this will be beneficial to anyone whom God has called to be in healthcare—or, as you are now caring for an unbelieving loved one.
Physicians are Not in Control
In Western societies, healthcare professionals are often praised as healers and are highly regarded. While I appreciate such warm sentiments, when being honest, any physician worth his/her salt would tell you that such praise is highly exaggerated. Modern surgeons can fix the plumbing in our human body with elegance but cannot make dead tissue live again. With the advancement of HIV medications, HIV positive patients now have the same life expectancy as the rest of the population; however, in the end, the eventual physical demise comes to us. As my oncology colleague once commented, “Human mortality rate is still 100 percent.” At the microscopic level, the ultimate repair of human tissues happens because God has designed our bodies with the ability to repair themselves. If our human bodies were not so wonderfully made by God (Psalm 139:14) with a built-in mechanism to heal, no amount of medicine would have a prayer in healing anything. As much as I would hate to admit, physicians are not all that powerful. Sure, we are called to care for our patients to the best of our abilities. At the same time, the truth is that healthcare professionals are but stewards of the tools that He has graciously allowed humanity to discover through science.
God Alone is Sovereign
When bad news comes to me, my natural reaction is, “How could this have happened?” in bewilderment. However, it is important to remember that nothing—absolutely nothing— surprises our God. As I approach the twilight of my healthcare career, I think of one lesson I wish I could tell my young self. As a Christian healthcare professional, in my profession, I am called by God to do all I can to care for my patient, but at the same time, fully acknowledge that He alone is in control. As Elisabeth Elliot famously put it, the best posture of a healthcare professional ought to be, “No, never lazy, sluggish, or slothful, but He knew when to take action and when to leave things up to His Father. He taught us to work and watch but never to worry, to do gladly whatever we are given to do, and to leave all else with God.”
God is Not Just Sovereign but is Good.
A recent book by Dr. Guy Prentiss Waters has been a tremendous help in thinking about this issue. When speaking with an unbeliever with a terminal disease, rather than being overwhelmed about the gravity of the situation or focusing so much on what I can do, it is much more helpful to reflect on just how good our God is. Dr. Waters elaborated, “We must also remember the Bible’s teaching that God is perfectly just and righteous. God never does any human being wrong or does injustice. No one—ourselves included—deserves the least bit of mercy from Him. We must never let our confidence in the integrity of God’s character waver.” 1
Rather than being overly focused on what I can do at such moments, “the best thing to do is to steer the conversation towards Jesus Christ and the gospel” (Waters, p. 64) After all, does not salvation belong to Him alone (Revelation 7:10)?
Perhaps Mr. Jones cried out to Jesus, whom he had learned about in his childhood with his dying breath, though no one else heard it. I previously wrote that deathbed confessions are rare, and I never had the privilege to be a witness to one. By far, it is much better to make it a priority to be reconciled to God today. At the same time, I have also come to realize that God’s grace in His Word is greater than anyone’s personal experiences. His Word alone is authoritative, and His goodness is far beyond my feeble mind and experiences. Just look at Jesus! He said He would not lose anyone who should cry out to Him (John 6:39).
That still does not mean I don’t look back and wonder if I should have spent more time sharing the gospel with Mr. Jones—as well as many other Mr. Joneses I have cared for over my 20 years. On this side of heaven, I doubt I will ever know if I have done all I could. May God have mercy on me for all my failings! But I do know that my God is good and gracious far beyond what I can do or imagine (Ephesians 3:20). One day, by His mercy when I am up in glory, perhaps I will be pleasantly surprised to run into Mr. Jones and maybe others whom I had the privilege to care for during their last days.
I sure hope so.
Endnotes
1 Facing the Last Enemy: Death and The Christian, Guy Prentiss Waters, PhD. P. 63. Ligonier Ministries, 2023.
Joel Cho, MD, is senior physician of Kaiser Permanente San Francisco. He is a candidate for master of arts in theological studies at Reformed Theological Seminary.
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CMDA Position Statement
MEDICAL FUTILITY AND THE GOOD OF THE PATIENT
As Christian medical professionals, we recognize the limitations of the art and science of medicine. We realize that not all medical interventions offer a reasonable expectation of recovery or of achieving the therapeutic goals sought by both the medical professional and the patient or the patient’s surrogate decision makers. We believe it is the obligation of the medical professional to inform patients or their surrogates when interventions are ineffective and do not serve the good of the patient. In fact, when presenting the range of options to their patients, medical professionals have a duty to counsel against interventions that do not offer a realistic expectation of benefit. To do otherwise is to mislead and risk undermining both the good of the patient and the trust between medical professional and patient.
The standard term for these situations is “medical futility,” and it may be used in circumstances when interventions are believed to be ineffective. However, “medical futility” should not be used when the real underlying issue is cost, convenience, or allocation of medical resources. Nor should futility be based on an interpretation of a patient’s “quality of life.” Rather, the medical professional’s best clinical judgment should be used to assess whether an intervention is likely to help the patient achieve his or her goals for therapy.
The compassionate and prudent medical professional serves as a shepherd and guide to the suffering patient and distraught family. Medical professionals should bear with humility the authority and experience of professional expertise, demonstrating practical wisdom by coming alongside patient and family in shared decision making, to comfort, collaborate, and counsel.
BACKGROUND
The Biblical Understanding of the Patient as Person
1. The Scriptures of both the Old and New Testament speak with clarity on the sanctity of every human life as made in the image of God (Genesis 1:27; Genesis 9:6ff; Acts 17: 24-29; Col 3:10).
2. Jesus of Nazareth, the second person of the Trinity, made human embodiment sacred by being made incarnate as a man. (John 1:1-18).
3. Mortality entered human history through willful disobedience to God such that all men and women now live under the sentence of illness and death (morbidity and mortality). (Genesis 2:16-17; 3:19; Psalm 49:9-10; Psalm 89:48, Romans 6:23.).
4. Embodiment entails certain limits, and in a fallen world this includes limits to natural life. (Psalm 90:10, Hebrews 9:27)
5. The inevitability of death should lead us to live soberly, but not to ignore, deny, or fear our mortality. Human flourishing must be understood under the limitations of fallen human nature, the human condition, the finitude of life, and the promise of resurrection and life everlasting. (1 Cor 15; Hebrews 2:15; 13:14)
6. Although hastening death is prohibited, indefinite prolongation of natural life is neither possible nor desirable. (Psalm 90:12; Psalm 139:15-16; Psalm 31:15; Genesis 9:1-6).
7. In mercy, Jesus Christ, the God-Man, identified with our humanity and suffered death so that through his sacrifice those who trust him may have the hope of a glorious resurrection body delivered from pain and suffering. (2 Corinthians 5:1-5; Revelation 21:4).
The Medical Professional-Patient Relationship
1. The relationship between a medical professional and patient is a covenantal relationship wherein the medical professional pledges to use his or her best clinical judgment to serve the well-being of the patient.
2. This relationship is not a consumerist relationship between a so-called provider and client, but between a medical professional and a patient (literally, a sufferer).
3. The medical professional - patient relationship requires trust that the medical professional is a virtuous care giver, will use his or her competence and compassion to serve the patient’s well-being (beneficence), and will do no harm to the patient (non-maleficence).
4. Goal-based planning with the patient or the patient’s family or surrogate should acknowledge the realities of the clinical situation, and should focus primarily on shared, realistic goals rather than on specific interventions.
The Medical Professional-Patient Relationship and Medical Futility
1. Because patients are persons made in God’s image, medicine and those who administer it should aim to aid human flourishing within the limits of life, from fertilization to natural death, in a fallen world which entails morbidity and mortality.
2. Because human life and medicine have their limits, medical interventions which ignore these limits do not serve human flourishing, and in some cases may impede or diminish flourishing or even be abusive.
3. The word “doctor” derives from the Latin docere , which means “to teach.” With this in mind, all medical professionals have a moral duty to educate patients, surrogates, and the healthcare team. Medical professionals must help patients understand the diagnosis (what is wrong), possible interventions (what can be done), what may be the best course of treatment (what should be done), and interventions that are possible but ineffective (what should not be done). We can always do things to patients; however, some interventions may not do anything for their benefit. Medical professionals have a particularly weighty moral responsibility to use their knowledge, experience, practical wisdom, and therapeutic interventions to help patients achieve realistic treatment plans. Because of the limitations of human life and medicine, some therapeutic interventions may only increase suffering, and may actually inhibit human health and flourishing at the end of life, when interventions such as advanced life support may only prolong or complicate the dying process.
4. A frank and realistic prognosis should be provided, with updates as needed, and uncertainties acknowledged. In many clinical situations, an initial prognosis may give way to one that is more favorable or unfavorable as time goes by. There are times when we are asked to “do everything” when it is predictable that certain interventions will not benefit and will cause harm to the patient. Because of the limitations of human life and of medicine, there will be times when more can be done than should be done. When medical interventions offer no benefit to the patient, are harmful to the patient, or cause harm out of proportion to benefit, they should not be administered. In those cases, these interventions are inappropriate and properly termed futile
5. Medical professionals, as compassionate moral agents, are not obligated to provide interventions that are requested by patients or surrogates but which, in the medical professional’s clinical judg -
ment, do not contribute to the patient’s care and are therefore deemed futile.
6. Because of the potential for harm from treatments, medical professionals have a moral duty to inform patients or their surrogates when an intervention will cause harm rather than achieve the patient’s good.
7. Medical professionals should reject any interventions that intend to hasten death. CMDA rejects any and all programs of physician-assisted suicide or euthanasia (PAS/E). Please see the CMDA Position Statement on PAS/E.
8. Because a medical professional’s best clinical judgment and a patient’s or surrogate’s wishes may differ about a potential course of action, wisdom and patience should shape dialogue that strives for as much consensus as possible. Communication should be compassionate, frank, clear, and honest, avoiding euphemisms that obscure reality.
9. When it is clear a patient is dying, some interventions may need to be discontinued. In discussions about such decisions, it should be made clear to patients and surrogates that medical care will always be continued. Indeed, palliative aspects of that care may be intensified toward the goal of comfort. When the scientific capacity of medicine to deliver beneficial or curative results is exceeded, the therapeutic relationship continues by rendering compassionate care to every patient. In patients who are dying, there are times when a decision of “no escalation” of life-sustaining interventions is appropriate.
10. Because the medical professional’s clinical judgment may sometimes reach an impasse with the patient’s or surrogate’s preferences, reasonable efforts should be undertaken to resolve disagreements. In some cases, consultation from a hospital ethics committee or clinical ethics service may be helpful. Obtaining a second opinion may also be helpful and should be facilitated by the attending medical professional of record. In rare cases referral to another medical professional or transfer to another facility may be appropriate. In situations of persistent disagreement, legal counsel should be considered. In no case should a patient be abandoned. Medical professionals should be compassionate, patient, and respectful as they do their best to work through serious disagreements.
ANNOTATED BIBLIOGRAPHY
Hook, C. Christopher, “Medical Futility,” in J. Kilner, A. Miller, and E. Pellegrino, Dignity and Dying: A Christian Appraisal. Grand Rapids, Eerdmans, 1996.
Dr. Hook’s essay provides the backdrop of clinical and legal cases that have brought the question of medical futility to the fore. He provides helpful definitions and offers a history of the contemporary futility “debate,” the reasons that physicians have felt the need for and articulation of such a concept, and the reasons that such a concept has been opposed or rejected by detractors. Hook engages the necessary dimensions of the problem of reaching a clear definition of futility. Whereas this essay is somewhat dated, it provides essential background to the matter and serves as a bridge from the era of CMDA’s prior statement on medical futility (1994) to more recently published polemic.
Bosslet, Gabriel, et al, An Official ATS/AACN/ACCP/ESICM/ SCCM Policy Statement: Responding to Requests of Potentially Inappropriate Treatments in Intensive Care Units.
American Journal of Respiratory and Critical Care Medicine, 191(11): 1318-1330, 2015.
The discussion of medical futility in the past decade has settled broadly into definition-based or process-oriented approaches. In this paper, Dr. Bosslet and colleagues present a seven-step process for conflict resolution in situations wherein patients or their surrogates request treatments that the health care team considers to be inappropriate – in other words, medically futile.
We offer this reference as resource, as this or similar processes (such as the Texas Advance Directive Act) are well established in the literature, albeit less so in clinical practice. Whereas the processes delineated by these authors and their respective professional organizations may be useful at times, the entire approach is other-than-desirable, as it presupposes conflict rather than covenant as the starting point for engagement. As one might surmise, and as experience has taught those who have been involved with such programs, the entire process is cumbersome, time consuming, and confrontational. The time involved in navigating the processes renders them largely impractical in decision-making in the acute care setting.
Pellegrino, Edmund, “Decisions at the End of Life: The Use and Abuse of the Concept of Futility,” The Dignity of the Dying Person (Proceedings of the 5th Assembly of the Pontifical Academy for Life, 24-27 February 1999) Juan De Dios Vial Correa and Elio Sgreccia, editors, Libreria Editrice Vaticano, 00120 Citta del Vaticano, 2000, pp. 219-241.
In this paper, Dr. Pellegrino offers a deeply Christian philosophical approach to the concept of futility and provides an in-depth philosophical history of how the concept has evolved in contemporary culture and thought. He contends that futility is not itself a principle, but rather a prudential guide to applying principles in making clinical decisions. The paper, like so much of his writing, is thoughtfully pastoral, always advocating compassionate shared decision-making with patients and families, but eschewing conflict resolution-oriented process approaches, such as those of Bosslet et al (vide supra). Pellegrino frames a definitional approach in terms of treatments or interventions that are proportional or disproportional to a given clinical scenario; this framing will resonate with anyone engaged in the clinical care of patients who are at life’s end.
Pellegrino, Edmund, Futility in Medical Decisions: The Word and the Concept, HEC Forum Springer) 2005; 17(4): 308-318. This essay expands on Pellegrino’s discussion of medical futility in the previous paper. Germane to the issue is his acknowledgement of the
difficulty of both the word and the concept in medicine; nevertheless, he contends that futility is a fundamentally necessary concept because it is, many times, the inevitable state of affairs for a given patient. In fact, we do disservice to our patients if we cannot acknowledge when a proposed, or demanded, intervention is medically futile. Pellegrino recommends a “functional definition of that time when medical interventions are no longer serving the good of the patient.” He re-states his argument against procedural approaches. Finally, Pellegrino warns us against the pitfalls of the application of the process, including the abrogation of our duty to provide care even when certain interventions are futile, the misinterpretation of futility to mean that a patient is somehow “less worthy,” or the misuse of the concept to justify physician-assisted suicide.
Kaldjian, Lauris C. Practicing Medicine & Ethics: Integrating Wisdom, Conscience, and Goals of Care, New York, Cambridge University Press, 2014. (Primarily Chapters 1 and 3)
Chapters 1 and 3 of this text offer the rationale for a goal-directed, rather than an intervention-focused, approach to shared clinical decision making. Goal-directed decision making is grounded in and limited by the realistic constraints of the patient’s medical condition, and practical wisdom invokes the wholeness and finitude of the patient as a person, not merely as a biological being. Dr. Kaldjian understands practical wisdom to be a virtue and explores “the close connection between practical wisdom in medicine and clinical judgment: both involve perceiving the reality of a patient’s situation and responding to that reality in a health-promoting fashion” (p 61).
Curlin, Farr, and Tollefsen, Christopher, The Way of Medicine: Ethics and the Healing Profession, University of Notre Dame Press, Notre Dame, Indiana, 2020.
Whereas Curlin and Tollefsen do not specifically address biomedical futility in this text, their identification of the “Provider of Services Model” embraces any intervention that a patient or surrogate decision maker demands, the doing of which is either morally wrong, or would constitute “bad medicine.” The construct is germane to the consideration of futility in critically ill patients, given the prevalence of families’ insistence on treatments or interventions that have no benefit and carry the risk of harm. Additionally, Curlin and Tollefsen embrace the concept of a physician’s possession of the “authority of expertise,” which is a beneficent authority, and serves the good of the patient in a non-paternalistic way.
Approved by the House of Representatives Passed with 61 approvals, 0 opposed, 0 abstention May 2, 2024, Ridgecrest, North Carolina
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The Dr. John Patrick Bioethics Column
ETHICS AS A CONDITION OF A FUNCTIONAL
There can be no ethics in a rigorous Darwinian world; instead, it comes down to a struggle with your neighbor to pass on your genes, rather than those of your neighbor, to the next generation. Therefore, there is no rational basis for patriotism, nor for noble acts of self-sacrifice, despite the desperate attempts of true believers to produce a theory of group altruism. This leaves us with only utilitarian, temporary trade-offs as the best we can expect, with suspicion being the only basis for decisions. This is the miserable and depressing world our students are brainwashed into tacitly believing to be true. The girls are chronically anxious, and the boys are wasting their lives on video games; both with no hope for a better future. Meanwhile, the wealthy elite fly private jets around the world and lecture the blue-collar world on their profligate production of carbon dioxide! Yet, all “normal” people are still challenged by the tragedy of terrible disease in childhood, rather than proposing we should eliminate such “terrible genes” as thorough-going evolutionists would rationally do. In an evolutionary world, we should have evolved to simply accept the inevitable. The two most sophisticated religions, Hinduism and Christianity, defer the problem of justice via reincarnation or justice in heaven. It is ironic that the problem of suffering cannot be solved here, but Christianity teaches us that suffering plays an important role in character formation (Romans 5:1-5).
Patrick, MD
“Ethics cannot be put into words.”
—Ludwig Wittgenstein
In a world so devoid of justifiable hope of a better life, it is hardly surprising that popular entertainment, which brings to life memories of a different romanticized past or narcissistic fantasies of the future, is so commercially successful. What in the world is going on? From the Christian perspective, it is explained by the fall and the image of God within. As G.K. Chesterton puts it, we all know we are the survivors of a colossal wreck that went down at the beginning of our world.1 The good news is that vestiges remain, and we know this is not a total account of what life should be. We still love babies, cute animals, beautiful gardens and acts of heroism. Best of all, those who seek a better way to understand the world are promised they will not be disappointed. Sadly, in our churches we skirt round difficult problems and put on the Band-Aids of soft empathy. The church should be a place where the realities of suffering, death, injustice and broken promises are the regular subjects of vigorous argument, leading to deeper and satisfying theological answers.
Healthcare is not immune to the poisonous effects of post-modern incoherences, where only the affirmation of personal desires is acceptable. We lack the fortitude to even insist on clear definitions. For example, the physicians affirming the gender desires of children by turning boys and girls into a simulacrum of the opposite gender do not insist that these children must understand they will be infertile, incapable of an orgasm and socially handicapped if they proceed all the way. To think a child can make a reasonable decision at a point in their lives when they cannot possibly understand what all this means is utterly farcical. The perpetrators know what they are doing is wrong. Those who did careful, long-term observation of children with gender dysphoria, like Dr. Paul McHugh, are cancelled because their conclusions do not fit with the desires of a small group of activists.
For two millennia, physicians worked within stable moral rules, within which they hardly had to think about how to behave. The transcendent source of morality expressed by the church was accepted by all. The breakdown occurred at the end of the Middle Ages when the invention of the printing press put intellectual and theological material into the hands of everyone. Then inductive analysis of the world via experiments forced a new approach to the physical world, which was stunningly successful, and the church was marginalized. Questioning of church dogma was rampant because only physical, measurable facts mattered. It took a few centuries for the limitations of this view to become apparent, with disasters like the French Revolution exposing the results of our fallen nature. Utopian visions abounded, and prizes were given to visionaries
John
whose own lives were far from appropriate as models for their utopian worlds. Even the almost unmitigated horrors of Communist states have not quenched our susceptibility to Utopian ideas.
When physicians had little real power over disease, large scale corruption was minimal. (It was not until the 1860s that going to the doctor actually extended your likelihood of living longer.) Once there were procedures with real outcomes, however, corruption increased, but it was not until the 1970s that an ethics component was formally introduced into medical curriculum. There was little recognition of how a changing and deteriorating intellectual environment would influence healthcare. For example, no one foresaw the level of data fabrication and manipulation we have now. The academic world arrogantly assumes all problems can be solved by them because problems are essentially caused by ignorance. So, we expanded the universities, but we could not expand the number of people capable of teaching rigorously. The “studies” programs have a deservedly bad reputation.
The social sciences were flooded with naïve utopians whose intellectual base was minimal. It promoted the new ordering of behavior based on “identity politics” and the prioritization of minority ideals. This approach has already failed, as the recent debacle of the Claudine Gay fiasco at Harvard University dramatically illustrated. A long while ago, C.S. Lewis pointed out that our most common error is to disorder the virtues.2 Who could be against diversity and inclusion? Equity of outcome can only be achieved by lowering standards. Equal access is viable, but these requirements must include some measure of demonstrated competence. Only where candidates have equal competence can the lesser requirements kick in.
Healthcare has been traditionally understood as going back to the Hippocratic physicians of the fourth century B.C. who were responding to the unscrupulous behavior of “traditional healers,” those who exploited the anxieties of the sick with herbal and largely ineffective remedies. However, these traditional healers also had a knowledge of toxic herbs. They could and did kill. Now, as physicians take to killing patients again through assisted suicide and euthanasia, corruption is inevitable because money and goods change hands at death. Already, multiple chilling accounts of cynical and utterly insensitive behavior toward seriously ill patients are circulating. Why now? The Hippocratic physicians realized that trust was therapeutic and a complete commitment to all life at all times was a way to establish a good reputation. Margaret Mead understood this and expressed it beautifully:
“For the first time in our tradition there was a complete separation between killing and curing. Throughout the primitive world, the doctor and the sorcerer tended to be the same person. He who had power to kill had power to cure, including specially the undoing of his own killing activities… With the Greeks the distinction was made clear. One profession, the followers of Asclepius, were to be dedicated completely to life under all circumstances, regardless of rank, or intellect – the life of a slave, the life of the emperor, the life of a foreign man, the life a defective child… This is a priceless possession which we cannot afford to tarnish, but society always is attempting to make the physician into a killer—to kill the defective child at birth, to leave the sleeping pills beside the bed of a cancer patient…It is the duty of society to protect the physician from such requests.”3
Hippocratic physicians went further and insisted they would only train those who took their oath, which invoked transcendence and recognized judgment to come. These remarkable men also understood that medicine is not just application of physically known facts but is a moral transaction at heart. When a patient visits their physician, he or she is not required to take the physician’s advice but may do as they please. It follows that a physician’s duty is to help the patient decide what they ought to do. “Ought” is a moral word. Physical facts cannot generate an ought. “Oughts” come from consideration of issues of truth, justice and faith. These we cannot see or measure, but they are the foundation of our culture. Allowing this reality to be displaced by mere personal subjectivity is catastrophic. We must learn to talk about them again and to discuss their objectivity and how they are generated. These remarkable polytheistic pagans realized that foreswearing any form of killing would increase patient trust, and that is very therapeutic. Trustworthiness is not part of the assessment of medical students because it is considered too subjective; yet, knowledge, measured by grade scores with rampant cheating, is part of the assessment. At the least, skills assessed by a practicing physician are reasonable, but to allow attitudes to displace character is foolish, as is the whole of the present accreditation process which is not predictive of long-term clinical careers.
For more than 30 years I have been asking students in multiple medical schools what proportion of their class they trust. During my training I met a few “bad apples” but only a few. When I came out of my ivory tower and started to engage with students, the decline in trust was apparent, with 20 percent of students judged untrustworthy by their peers. Soon I had emails from students saying 50 percent was nearer the truth, and twice I have had second-year students say they had no one in their class whom they trusted. Over 50 years ago, law professor Arthur Leff wrote about this problem among law students, and Nobel Laureate economist Robert Fogel wrote about it among his economics students. Fogel concluded that finding trustworthy colleagues will be a major problem in this century. Data of this sort spurred the growth of bioethics, but it presumed that all that was needed was information. Yet, everyone knows we all know the difference between right and wrong. Our problem is not ignorance but weak character and a weak will to do what is right. Regular readers of this column know what I and others, from Tom Sowell to Denzel Washington, think the solution is, but that must wait for another column.
Endnotes
1 Chesterton, G.K. Orthodoxy. 1908.
2 Lewis, C.S. 1996. Mere Christianity. HarperOne.
3 Mead, M. cited in Levine, M. Psychiatry and Ethics. 1972. G. Braziller.
John Patrick, MD, studied medicine at Kings College, London and St. George’s Hospital, London in the United Kingdom. He has held appointments in Britain, the West Indies and Canada. At the University of Ottawa, Dr. Patrick was Associate Professor in Clinical Nutrition in the Department of Biochemistry and Pediatrics for 20 years. Today he is President and Professor at Augustine College and speaks to Christian and secular groups around the world, communicating effectively on medical ethics, culture, public policy and the integration of faith and science. Connect with Dr. Patrick at johnpatrick.ca. You can also learn more about his work with Augustine College at augustinecollege.org
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