CMDA TODAY
Volume 52 • Number 4 • Winter 2021
My
CMDA
Story
“When I opened my dental speaking/consulting business in 1997, I began searching for professional associations with uniquely Christian foundations. Joining CMDA was a natural response to my desire to integrate my faith with my business. One way I have been able to promote CMDA is by having my membership spotlighted on my biographical page in my attendee handout when I’m lecturing. Many hygienists and dentists have asked me privately about CMDA, and I have been happy to steer dental professionals toward the organization. I am not ashamed of my Lord or my Christianity, and membership is one way of letting my attendees know I am a Christian. In this time of increasing attacks on Christianity, I feel it is more important than ever to band together with Christian professionals. The bigger we are, the more voice we have to stand against evil and protect the Christian heritage and freedoms that we cherish. It is an honor to be a part of an association of Christians who feel as I do, that faith is at our core and naturally influences how we interact with patients, coworkers and business associates. —Dianne Glasscoe Watterson, MDA, RDH, GC-C P.O. Box 7500 Bristol, TN 37621 888-230-2637 www.cmda.org/join memberservices@cmda.org
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From the CMDA President T. Lisle Whitman, MD
“W
e need 750 words,” they said. That is a lot of words. I dictate a knee replacement with less than 300 words. I have decided to go with the “short vignette” approach to filling my quota for this edition’s letter. Describing the last two years as a rollercoaster would do disservice to the fun of riding a rollercoaster. I was discussing this with a sweet 86-year-old patient recently. I have known her for several maladies over the last 15 years. She is articulate and her family loves her, but she has reached the point that she resides in a local assisted living facility. As we discussed the impact of the pandemic, she remarked on the challenges of the lockdown on residents of her facility. Last year’s holiday was dreadfully isolated. Recently, the facility confronted another surge and was locking down again. This time, her daughter drove her to Florida. There her sister joined her for three weeks. I could tell by her description that it was a special time, likely something that would not have occurred under “normal” circumstances. She left the office telling me they were already making plans to get together again. Her comments helped me reflect on the good that has occurred over the last two years. While I think a regular two years would have been calmer, God has brought blessings among the challenges. At the urging of a Bible teacher I respect, I am reading A.W. Tozer’s The Knowledge of the Holy. In this book, Tozer discusses various attributes of God. In the chapter titled “God’s Infinitude,” a sentence jumped off the page:
“How freeing it is to turn from our own limitations to a God who has none.” Wow. Isn’t that so true and so powerful? I continue to learn that truth. This strange rollercoaster has brought me closer to trusting Him as I should. Let me encourage you to consider attending the 2022 CMDA National Convention. This year’s convention is April 21-24, 2022 in Indianapolis, Indiana. Our administration has put together a great lineup of speakers. Our deans have worked hard to make the workshops relevant, to specifically meet you where you are today. There will be food and fellowship opportunities. If you have been to a pre-pandemic convention, come back. If you have never been, give it a try. I think you will be glad you did. One of our speakers will be Carl Trueman, PhD. Consider reading his book The Rise and Triumph of the Modern Self. Dr. Trueman traces how the modern psyche came to perceive itself
as the supreme judge and implementer of truth. His argument is persuasive. Beyond understanding our current environment, the insight into the history behind the current social narrative is powerful and will equip you for many important discussions. As you read this, hunting season will have recently ended. Where I live in Northeast Tennessee, this is a major pastime. Discussions of hunting help me bond with my patients. I hunt; well, I really go out in the woods to lean up against my favorite tree, read God’s Word and watch majestic sunrises. Hunting gives me an excuse to get up early and sit quietly by myself. I rarely see something worth attempting a shot. One year a really big dear walked out and stood in a perfect position. I lined up and pulled the trigger. There was a click instead of a bang, and the monster slowly walked off. I quickly realized I had neglected to put a bullet in the chamber. I chuckled as I asked myself, was I really hunting that morning? How many other situations in my life do I think I know what I am doing but I am merely deceived? James describes this situation in James 1:23-25: “For if anyone is a hearer of the word and not a doer, he is like a man who looks at his natural face in mirror; for once he has looked at himself and gone away, he has immediately forgotten what kind of person he was. But one who has looked intently at the perfect law, the law of freedom, and has continued in it, not having become a forgetful hearer but an active doer, this person will be blessed in what he does” (NASB). My favorite definition of deceived is, “You do not know it.” I often pray that He will remove my deception, those lies I tell myself to feel good about myself, and replace it with His truth in me and for me. O Lord, help me abide in your perfect law and make me an “active doer.” I hope you enjoy this edition of CMDA Today. Your staff works very hard to put together a magazine of insightful and informative articles. I only hope next time they do not ask for quite so many words.
T. Lisle Whitman, MD, is the 2021-2023 CMDA President. He is an orthopedic surgeon in Bristol, Tennessee, and he has practiced with Appalachian Orthopedic Associates since 2000. Lisle and his wife Lauren have three children, one daughter-in-law and three grandchildren. He loves the practice of general orthopedics. He has participated in several overseas mission trips, and he enjoys family trips, the lake and learning new things.
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VOLUME 52 | NUMBER 4 | WINTER 2021
EDITOR Mandi Morrin
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
CMDA TODAY
The Journal of the Christian Medical & Dental Associations
INCLUDES OPPORTUNITIES TO EARN CONTINUING EDUCATION CREDITS See page 30
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DESIGN
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CMDA is a member of the Evangelical Council for Financial Accountability (ECFA). CMDA Today™, registered with the U.S. Patent and Trademark Office. Winter 2021, Volume LII, No. 4. 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© 2021, 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.
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treet Medicine in the Era of S COVID
26
CMDA Ethics Statement on Homosexuality
Jennifer Zamora, DHSc, MPAP, PA-C; with Zahid Mustafa, BS How a free clinic turned to drive-thru
services to continue serving the underserved
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Answering the Call: Launching a CMDA Specialty Section
One hour of continuing education credit available
32
The Dr. John Patrick Bioethics Column Imposed Order John Patrick, MD
Kim-Lien Nguyen, MD; David L. Bolender, PhD; and David L. Larson, MD
Finding fellowship and support in the academic world
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Christ with Us: Practicing Christlike Presence in an Age of Burnout
Finding a framework for order within the image of God
See PAGE 34 for CLASSIFIED LISTINGS
Danielle Ellis, MD
A physician shares how to come alongside patients in their suffering to offer hope
REGIONAL MINISTRIES
Connecting you with other Christ-followers to help better motivate, equip, disciple and serve within your community Western Region: Michael J. McLaughlin, MDiv • P.O. Box 2169 • Clackamas, OR 97015-2169 • Office: 503-522-1950 • west@cmda.org Midwest Region: Allan J. Harmer, ThM, DMin • 951 East 86th Street, Suite 200A • Indianapolis, IN 46240 • 317-407-0753 • cmdamw@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
THE CHRISTIAN MEDICAL & DENTAL ASSOCIATIONS ® Changing Hearts in Healthcare . . . since 1931. 4 | CMDA TODAY | WINTER 2021
Ministry News RESOURCES
CMDA Matters
CMDA Go App Have you downloaded CMDA Go yet? Our mobile app, CMDA Go, is now available to download on Apple and Android mobile devices. Visit your device’s app store to download it today. In the CMDA Go app, you can set up your personal CMDA profile, check out the latest news from CMDA, listen to CMDA Matters and other podcasts, renew your membership and make your dues payments, access a variety of downloadable resources, interact with other members through the discussion forms and join group chats. For more information, visit www.cmda.org/app.
Bridging the Gap As Christians, we are called to speak truth into ethical issues and courageously stand up for what’s morally right according to our beliefs. But in order to engage others in these discussions with grace and kindness, first we need to arm ourselves with knowledge and understanding of each of these topics. Bridging the Gap: Where Medical Science and Church Meet is a new small group study developed by expert healthcare professionals on CMDA’s Church Commission. The curriculum is designed to ask difficult, thought-provoking questions as we seek the truth found in God’s Word about the ethical issues facing Christians today. Topics include addictions, beginning of life, end of life, gender identity, right of conscience and sexuality. For more information and to download this free curriculum, visit www.cmda.org/bridgingthegap.
Are you listening to CMDA’s podcast with CEO Dr. Mike Chupp? CMDA Matters is our popular weekly podcast with the latest news from CMDA and healthcare. A new episode is released each Thursday, and interview topics include bioethics, healthcare missions, financial stewardship, marriage, family, public policy updates and much more. Plus, you’ll get recommendations for new books, conferences and other resources designed to help you as a Christian in healthcare. Listen to CMDA Matters on your smartphone, your computer, your tablet…wherever you are and whenever you want. For more information, visit www.cmda. org/cmdamatters.
Upcoming Events Dates and locations are subject to change. For a full list of upcoming CMDA events, visit www.cmda.org/ events. Northeast Winter Conference January 14-16, 2022 • North East, Maryland
West Coast Winter Conference January 21-23, 2022 • Cannon Beach, Oregon Marriage Enrichment Weekend January 21-23, 2022 • Galveston, Texas Israel Tour February 8-20, 2022 • Israel
Critical Conversations on Identify and Gender with Dallas Theological Seminary February 18-19, 2022 • Dallas, Texas Remedy22 February 26-27, 2022 • Riverside, California Pre-field Orientation for New Healthcare Missionaries March 1-5, 2022 • Abingdon, Virginia 2022 CMDA National Convention April 21-24, 2022 • Indianapolis, Indiana
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Ministry News
CMDA Learning Center The CMDA Learning Center offers complimentary continuing education courses for CMDA members. This online resource is continuing to grow with new courses to help you in your practice as a Christian healthcare professional. More than 100 hours of continuing education are now available at NO COST to CMDA members. For more information and to access the CMDA Learning Center, visit www.cmda.org/learning.
Faith Prescriptions New to the resources provided by CMDA is a new video series called Faith Prescriptions. This 25-part video series (featuring 10 core sessions) provides training on everything from LGBTQ issues in the healthcare arena, to praying with your patients and sharing your faith in ethical and appropriate ways with colleagues and patients. Faith Prescriptions is a revision of the program Grace Prescriptions, which has been in circulation for several years on DVD. But this new, updated and improved series will be video-ondemand. It is free to CMDA members and simply requires your member login and password to access all sessions, as well as all video training sessions, within the CMDA Learning Center. Get started today by visiting www.cmda.org/learning.
COMMUNITY
New Specialty Section The newest addition to CMDA’s growing list of specialty sections is the Addiction Medicine Section. This new section exists to prevent and treat addiction and transform lives by God’s grace, love and power. We strive to provide compassionate excellence in all aspects of addiction care, including whole-person prevention and treatment, education, advocacy, empowerment of others, research, church and community partnerships, and interprofessional collaboration and support. While the impact of substance abuse and addiction feels overwhelming, the Addiction Medicine Section believes that together we have an unprecedented opportunity to impact our local communities and nation by strengthening church and healthcare partnerships among the body of Christ to intercede for and intervene in the lives of those affected by addiction and substance use.
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For more information about this new specialty section, visit www.cmda.org/ams. You can also listen to an interview with Drs. Warren Yamashita and Dr. Kurt Bravata about the section and its goals on the CMDA Matters podcast at www.cmda.org/ cmdamatters. This new Addiction Medicine Section joins a growing list of specialty sections that give members just like you the unique opportunity to equip, network and fellowship with colleagues in your specific specialty. Organized by CMDA members, these sections provide a wealth of resources for those wishing to connect with their colleagues. We now have 14 specialty sections, including psychiatry, dermatology, physician assistants and more. You can find a list of all these specialty sections at www.cmda.org/specialtysections. If your specialty isn’t on the list, we encourage you to contact CMDA’s Campus & Community Ministries at ccm@cmda.org for more information about how to start a new section for your specialty.
New Director of Healthcare Leadership Gregory L. Neal, DHA, MSHA, MBA, recently joined CMDA as Director of Healthcare Leadership. Dr. Neal brings to CMDA 30 years of distinguished executive leadership experience in multiple facets of the healthcare professional delivery system, including acute care hospitals, ambulatory care, post-acute care, supply chain and coaching/consulting. He completed a doctorate in healthcare administration from the Medical University of South Carolina with first honors. He earned his MSHA and MBA from the University of Alabama at Birmingham. His professional passions include the integration of faith and leadership practice, physician collaboration, value-based care and accelerating positive change through cultural transformation, and he is committed to leading community initiatives aimed to improve the quality of life for vulnerable populations. He is co-founder and Director of CMDA’s Christian Healthcare Executive Collaborative (CHEC) with an aim to connect and engage administrative healthcare leaders with opportunities to serve one another and the kingdom of God through a not-for-profit consulting service for missional healthcare professional organizations worldwide. Dr. Neal is also currently serving as Executive Vice President of Kanad Hospital in the United Arab Emirates. He and his wife Beth have been married for 33 years and have two adult daughters. For more information about CHEC, visit www.cmda.org/ chec. To contact Dr. Neal, email greg.neal@cmda.org.
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Ministry News ADVOCACY
MEMBER NEWS
CMDA Welcomes New Director of Federal Public Policy
In Memoriam
CMDA is excited to welcome Anna Pilato as Director of Federal Public Policy. Anna has spent much of her career in public service at the federal, state and local levels, along with time in the non-profit sector. She has worked on various policy issues ranging from foster care/adoption, human trafficking, fatherlessness, religious freedom and emergency preparedness/disaster relief. She most recently served as Senior Advisor, External Affairs to the Assistant Secretary at the Administration for Children and Families (ACF). She previously joined President Donald Trump’s Administration in 2017 as a member of the “beachhead team” in the Office of the Secretary at the United States Department of Health and Human Services (HHS). She also previously served on Governor Sam Brownback’s Administration as Deputy Secretary for the Kansas Department for Children and Families. She was also a presidential appointee in the George W. Bush Administration and served as the Director at the Center for Faith-Based and Community Initiatives at HHS. Prior to that position, she served more than three years in Presidential Correspondence as the Director of Administration in the Executive Office of the President at the White House. Additionally, Anna has several years of experience in the non-profit sector at Operation Blessing and The Christian Broadcasting Network. Anna Pilato earned her bachelor of arts in political science from Nazareth College and a master of arts in counseling from Regent University. Anna will be joining CMDA’s advocacy efforts and serve as CMDA’s liaison with the federal government in Washington, D.C. To contact Anna, email anna.pilato@cmda.org.
Get Involved with Advocacy CMDA’s Advocacy and Communications Team is looking for healthcare professionals who are willing to assist us in advocating against the transgender ideology that is becoming so prevalent in healthcare today. We need expert assistance from healthcare professionals just like you in researching and developing resources, speaking in webinars, etc. If you are interested learning more about this and other advocacy efforts on both the federal and state levels, please contact communications@cmda.org.
Our hearts are with the family members of the following CMDA members who have passed in recent months. We thank them for their support of CMDA and their service to Christ. • William S. Anderson, MD • Anderson, Indiana Member since 1996 • Charles Gregory Alty, MD • Lynchburg, Virginia Member since 1999 • Gerald A. Close, MD • Glencoe, Minnesota Lifetime member since 1984 • Hugh M. Frazer, MD • Plantation, Florida Lifetime member since 1954 • Wilbur H. Gearhart, MD • Ballwin, Missouri Member since 1952 • Robert J. Kingsbury, MD • Roseville, Minnesota Lifetime member since 1958 • Kathryn H. Lewis, MD • Tyrone, Pennsylvania Lifetime member since 1960 • Clarence Rutt, MD • Lititz, Pennsylvania Member since 1954 • Jonathan R. Steinhart, MD • Spokane, Washington Member since 1990 • James Horace Greeley, DDS • Catonsville, Maryland Lifetime member since 1980
Memoriam and Honorarium Gifts Gifts received July through September 2021 Rodney and Sheila Hunt in memory of Ellen Turner Mr. Mark and Dr. Patti L. Palmer in memory of Dr. William Heath Dr. and Mrs. Marvin R. Jewell in honor of Dr. Gene Rudd Ms. Pauline Verbrugge in honor of Berniece Verbrugge’s 80th birthday
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Ministry News MISSIONS
First Dietz Scholarship Awarded Dr. Elicilia Shao is the first recipient of the Margaret J. Dietz Scholarship, which funds the Christian and professional leadership development of physicians and dentists in low and low-middle income countries. Established by Inis Jane Bardella, MD, and her spouse Robert R. McConnell, the scholarship honors the life and legacy of Dr. Bardella’s grandmother, a faithful disciple of Christ who was used by God to call Dr. Bardella to missions. Dr. Shao is as a Tanzanian physician who teaches at Kilimanjaro Christian University Medical College (KCUMC) and uses radio, internet and written publications to educate lay people. He visits different churches where he speaks on health issues. He believes “when [the] public is knowledgeable about health determinants they will be able to take…preventive measures, follow instructions from doctors and teach their children.” His commitment to his calling is shown by his deci-
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sion to decline a position at Harvard School of Public Health to continue as a Tanzanian physician-educator at 10 percent of the salary Harvard offered, saying, “Many people…were shocked with my decision but I am very happy…The lives I have touched, the medical professionals I have mentored and souls I have brought to Christ is a living testimony. My faith and promise to save Tanzanians was stronger than the dollars.” Dr. Shao came to faith in secondary school. His degrees include a master of medicine in internal medicine, an MS in medical microbiology, immunology with molecular biology and a diploma in tropical medicine and hygiene. He is working on a PhD and aspires to higher leadership at KCUMC, the vision of which is “to be a center of excellence in teaching, research and development of health professionals who influence society through dignified health care delivery to promote the love and compassion of Christ.” Dr. Shao is married, has three biological children, has adopted four orphans and cares for an eight child. For more information about this and other scholarships offered through CMDA, visit www.cmda.org/scholarships.
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Jennifer Zamora, DHSc, MPAP, PA-C; with Zahid Mustafa, BS
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hen I contracted COVID-19 on March 18, 2020, it was so early in the outbreak of the pandemic that my illness sent shock waves of fear through Inland Vineyard Medical Mission and Free Clinic where I serve as director. Everyone on our team was worried, including our student workers. How would we keep our team safe? And how would we still treat our patients? For most of our patients, we are their main source for both food and medical care. Where would they go if we suddenly shut our doors? Almost immediately, we knew we couldn’t continue practicing “street medicine” the same way we had been before COVID arrived at our doors. What were we going to do?
STREET MEDICINE BEFORE COVID
Inland Vineyard Medical Mission and Free Clinic is in Riverside County, California, which is also called the Inland Empire, a sprawling collection of cities 50 miles east of Los Angeles. As a team, we provide primary care services and food assistance services to underserved, low-income patients. With a focus on serving the underserved in their local neighborhood and community, volunteer healthcare professionals and students in training take vital signs and provide basic procedures or offer resources for further care. Because of the work we do, our team is an incredibly closeknit group. As the director of the clinic, I do my best to foster a spirit of unity and teamwork. We usually pray before and after events, and some of the volunteers who are from vari-
ous backgrounds, religions and cultures are always respectful during this time. Much of our team consists of undergraduate pre-health professional students, physician assistant students from the University of La Verne and medical students from University of California, Riverside (UCR), School of Medicine. The undergraduate students all rotate leadership roles every three months, which consists of inventory, administration, equipment maintenance, making sure each outreach event has stocked bags ready to go, working with the church pantry to get food donations out to the streets and training other new students to take vital signs, scribe, maintain our electronic medical records and more. Zahid Mustafa, a graduate from UCR, is the first of any of our volunteers to secure a grant, which helped expand the church pantry and obtain iPads for scribing while we expanded our telemedicine services. He also helped develop more patient education materials and secured a generator when we would work into the darkness helping the migrant farm workers who needed medical attention after laboring hard in the fields in East Coachella Valley.
STREET MEDICINE DURING COVID
In early March 2020, COVID-19 had just been recently reported in the state of Washington, plus some cases in northern California. It had not been widely reported throughout the United States at the time, but I knew it was likely circulating in southern California already. Masks had not yet been mandated, nor were there any social distancing protocols implemented yet. We had been going through our normal routines when my symptoms started on March 18, 2020, with the aches and pains
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associated with a fever, plus a loss of taste and smell. The loss of taste and smell was not yet a widely reported symptom of the virus, but I knew this was a unique symptom beyond any other viruses I had studied. It turns out I had contracted the infectious virus while at a Kaiser Hospital in Los Angeles for 12 hours while waiting for my grandmother’s heart surgery two days prior. After communicating with the public health department in my area, I was finally able to schedule a test after informing them that I was scheduled to see patients in the next few days. When my husband started developing symptoms too, I was also able to get him scheduled for a test since he is a public school teacher and was supposed to be at the elementary school handing out lunches and homework, as all California schools had closed just five days prior. Everything came crashing down with the call from a public health doctor when my test results arrived. I was positive for COVID-19. By then, my mild symptoms had quickly turned into crushing fatigue, horrible myalgias making it difficult to move, bone-breaking chills and violent coughing causing my ribs to be sore while alternating and max dosing on ibuprofen and acetaminophen. When battling with a 104-degree temperature with a pre-existing heart condition, my heart began to re-flare: pre-ventricular contractions and severe palpitations. At that point I faced my own mortality and thought, “If there is any time that I am going to die from this virus, tonight is the night,” especially as my breathing became more difficult. It seemed there was no way out of the darkness closing in. However, I simply could not accept death without a fight, as I have young children who needed a mother. Having lost our own mother to breast cancer at a young age, my sisters and I know the tremendous toll that type of loss can take on young children.
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“Is Mommy going to die tonight?” In the midst of my own suffering, these haunting, whispered words of one of my daughters to my husband made me realize what surrendering to COVID-19 truly meant. I placed a defibrillator near me on the bed, purchased years prior due to an existing heart condition. I hoped my husband or oldest daughter could operate it properly by following the prompts if I had a sudden cardiac arrest, yet it brought little comfort as it could not shield me from the onslaught of terrifying thoughts in my delirious state. While I was at home battling the virus and my fear, Zahid and the other student leaders at the clinic were also facing their fears about COVID, now that it had hit so close to home. One of our student volunteers expressed that hearing about my infection “was the point at which it felt like the walls [of COVID-19] were starting to close in.” It “struck like a bolt of lightning,” and he “was scared about getting COVID-19 as well and potentially spreading it to other people, particularly his parents and grandmother that he lived with.” Everyone on the team was worried. Over the course of multiple virtual conversations, an important insight began to crystalize:
If we were fearful, the vulnerable members of the community we serve must be even more so. Our team at the clinic needed to display the same determination and fortitude I was showing in my resolve to beat the virus. One of our student volunteers asserted that we needed to be models for the community because, “If we cannot control our fear and respond appropriately, how can we ever expect our patients to?”
As a clinic, it was scary to cease operations and leave at-risk patients without care. But how could we continue to serve those who rely on us without contributing to the further spread of the virus? With COVID-19 cases rising, telemedicine seemed like a logical solution. However, as we reflected on the situation, we realized that not all of our underserved patients have access to high-speed internet. Furthermore, many of our patients also depend on us for their nutritional needs. We still needed a way for our patients to pick up food for themselves and their families from our clinic. After more thinking and conversation, the team decided to convert the clinic to a drive-thru model. Our drive-thru free clinic uses telemedicine to supplement our services, allowing for both in-person and virtual visits. We run the drive-thru free clinic in the parking lot of the church building we previously worked out of, which was forced to close at the onset of the pandemic due to statewide lockdown orders in California. Having the clinic in the same location makes it easy for former patients and members of the community to find us. Bright orange traffic cones replaced hallways to indicate where patients are to go. When patients first enter the drive-thru, they are able to pick up boxes of food for themselves and their families. At the next stop in the drive-thru, patients can get medical care. The drive-thru model allows patients to remain in their cars throughout their stay at the clinic, reducing the risk that they may infect others. Holding the clinic outdoors also reduces the risk that an infected patient will transmit the virus, while we also wear extra protection such as face masks, shields and gloves. Alternatively, patients can virtually schedule a telemedicine appointment through Zoom and receive medical care from the comfort of their own homes. All of these modifications have brought us tre-
mendous joy since they allowed us to continue providing care to vulnerable members of our community during the pandemic. Many of the patients we have seen since the pandemic started are still very worried. We have noticed that fear manifests most strongly in those who think they will lose a loved one to the virus. One of the most memorable interactions we have had was with a frantic man who believed his wife would die when she contracted COVID-19. Providing him information about the disease in a manner he could understand provided reassurance. Also useful were the personal insights his care team offered based on my experience as someone who had been infected with COVID-19. Everyone involved agreed it was quite
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LEARN MORE Are you interested in learning more about how you can serve the underserved in your local community? Join us at Remedy22, a healthcare missions conference designed to help you listen for and follow God’s call on your life to serve and practice right here in your own backyard in the U.S. For more information, visit www.cmda. org/remedy.
rewarding to help calm the patient, and we continue to check in on this patient, whose wife is doing well. Implementing the drive-thru model has been a success, giving both our staff and our patients comfort while dealing with the fear caused by the pandemic. For all of us—both patients and healthcare professionals— COVID-19 was a learning experience. For our clinic, there’s no question we were all learning together as we faced our fears, faced what seemed to be a losing situation and faced the virus head on with resilience and determination. A year later, we loved being able to move back into the church building—but with some changes. We now have chairs outside
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for patients who prefer to visit us outside due to concerns about the virus, plus we continue to offer the drive-thru and telemedicine models for patients who like to utilize those options as we still battle the ongoing pandemic. This experience showed us that we cannot wait for perfect circumstances to care for the vulnerable. Street medicine is an absolutely crucial part of helping the underserved in our community, and we weren’t going to let the virus stop us from serving our community. And because of that, we had to be willing to adapt, to create new processes and methods, so that we can continue to treat the patients in front of us. If you’re waiting for the perfect circumstances to present themselves before getting involved in caring for the vulnerable in your local community, don’t wait any longer. COVID-19 has proven that we are part of the human tapestry, and it’s shown us more than ever that we have a responsibility to care for and nurture each other in this incredibly stressful time. It is normal to be afraid, but what really counts is how we respond to it. We should not let the weight of fear deter us from doing the right thing.
Jennifer Zamora, DHSc, MPAP, PA-C, is Professor of Practice and Director of Didactic Education University of La Verne, Master of Science, Physician Assistant Practice Program, where she is restructuring and modifying the current curriculum, assessment and appeal to ARC-PA regarding accreditation standards, interviewing all guest lecturers and mentoring and training new faculty. She personally teaches the pediatric and infectious disease series and assist in clinical skills. She also designed and executes the live model and standardized patient program, OSCE exams, simulations and hands-on workshops. She is working to incorporate interprofessional education (IPE) and inter-professional practice with the PA students. She was a founding faculty member of California Baptist University (CBU MSPAS) PA Program and guest lecturer at University of Southern California (USC), Keck School of Medicine. She was also a founding faculty member with a team from six other schools and disciplines for SoCal HEAL IPE (https:// socalheal.org/) and serves as the co-director and clinical faculty at UCR School of Medicine (UCR SOM). As a previous clinical preceptor, she trained numerous physician assistant, nurse practitioner and medical students in the field from various programs including USC, Western University, Azusa Pacific, University of Kentucky, University of Maine and UCR SOM. Currently, the family medicine clinic and street medicine outreaches is a place where UCR MD students rotate at as well as ULV PA students, and she teaches during live patient encounters while at the clinic.
Jennifer would like to thank all the volunteers who have helped keep the free clinic running during the pandemic, especially Zahid who helped with this piece and the grant they recently received to serve the underserved. Most importantly, Jennifer is honored to be a mother of two daughters and a wife of 20 years to her husband. God is good! Zahid Mustafa, BS, is a Magna Cum Laude graduate in biology from UC Riverside. After graduating from UC Riverside, he started volunteering at Vineyard Free Clinic, where he is currently on the leadership team as a clinic coordinator. When the pandemic started, he helped launch a drive-thru model of the free clinic, which was featured in U.S. News & World Report. He also helps write grants for the clinic. Grants he has obtained from the National Association of Free and Charitable Clinics, CPPS Heritage Mission Fund and Google have kept the clinic’s medical and food distribution programs running through the pandemic. He is also a reviewer for the Journal of Student-Run Clinics. Outside of his work with free clinics, Zahid works as a medical researcher, where he has published nine peer-reviewed articles, including one in the Proceedings of the National Academy of Sciences.
WHAT IS REMEDY? Less than 5 percent of Christian healthcare students and residents will leave the U.S. to do career medical missions. This means more than 95 percent of Christians preparing for careers in healthcare will practice some form of medicine inside the U.S. Is God’s call on your life any less vital than His call on others who will do career missions overseas? And are you listening for God’s call? REMEDY22 will challenge you to listen for God’s call on your life to serve and practice right here in your own backyard, surround you with a community of people following a similar calling and provide resources to help make it all happen.
February 26-27, 2022 California Baptist University Riverside, California
Register at www.cmda.org/remedy
ANSWERING THE CALL Launching a CMDA Specialty Section Kim-Lien Nguyen, MD; David L. Bolender, PhD; and David L. Larson, MD
How the spiritual needs of an academic-based group of physicians and scientists inspired the founding of the Christian Academic Physicians and Scientists (CAPS), a specialty section of CMDA.
GET INVOLVED CAPS is a community of Christian academic physicians and scientists who are committed to helping one another discern and live up to our faith-based calling. We endeavor to transform our academic communities through faith, fellowship and scholarship. For more information and to get involved, visit caps.cmda.org.
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T
he desire to put Christian principles into practice led to the founding of countless universities and hospitals across the United States and Europe until the early 20th century. However, most of us see few remnants of this Christian legacy at academic medical institutions today. Increasingly, the professional life of faculty members is conducted in environments that appear disconnected from Christian values. Academic medical centers often expect Christian physicians and scientists to acknowledge and also to embrace and celebrate aspects of society’s rapidly evolving social norms that are in tension with their Christian beliefs. Part of the problem is the absence of a Christian voice within much of academic medicine. Christian faculty exist, but they have become all but invisible, even to the point of Christians not knowing of the Christian presence at their own institutions. That is a tremendous loss both for Christians and the medical centers they serve. The result is that Christian healthcare professionals and scientists are missing opportunities to be witnesses through their example and to encourage one another to realize their potential both in their faith and callings.
CMDA’s historic strength has been its student-focused chapters on healthcare training campuses, which meet students’ needs at a crucial period in their lives. But there is often little continuity in CMDA involvement as students progress into residencies and fellowships and become academic faculty. Interactions among Christian faculty members are even more rare as faculty juggle research, teaching, clinical work and administrative work. The Christian Academic Physicians and Scientists (CAPS) was founded to help fill this gap in academic medicine by seeking to nurture and equip Christian faculty members in leadership ministry (Luke 4:18), so their hearts can remain steadfast on fulfilling God’s purposes. Through fellowship, we hope to equip faculty members to be wise like serpents and gentle as doves (Matthew 10:16), so they may continue to be light and salt in their local and national academic medical communities. Through gatherings and conversations, we hope a natural network of like-minded Christians within academic medicine will develop. By doing our utmost for the glory of His name (Ephesians 2:10), we are called to greatness. As it says in Scripture, “Whatever you do, work at it with all your heart, as working for the Lord, not for human masters” (Colossians 3:23). As a specialty section of CMDA, CAPS may also facilitate bridge-building by helping to establish discipling relationships among peer Christian faculty as well as between faculty and medical trainees on campuses with existing CMDA chapters. These interactions may support the well-being of Christian faculty members, strengthen the Christian voice within academic medicine and provide Christian role models as trainees take the next steps into their medical careers. CAPS has four main purposes: 1) encourage Christian academic physicians and scientists; 2) develop effective pathways of Christian ministry for academic physicians and scientists; 3) provide a supportive network and resources to help faculty successfully manage the difficulties of their profession in a Christ-like manner; and 4) offer guidance in making bioethical decisions in medicine and science based on Christian principles.
To date, the section has more than 165 faculty members and scientists from 92 unique institutions. Ironically, our efforts to establish CAPS in early 2020 were facilitated by the pandemic. A desire for fellowship and access to technology enabled formation through alternative teleconferencing platforms. Thus far, CAPS has adopted several approaches to addressing our proposed goals. These include: (1) monthly webinars by well-known authors or figures in academic medicine or an associated ministry to encourage discourse on topics that may be of interest to our members; (2) formation of small groups consisting of three to five academic believers to share their faith and issues unique to their academic setting; and (3) inaugural funding of a research fellowship to study the relationship between healthcare and faith and to further develop the research career of the awardee through mentorship by scientists in the field. General themes for the webinars have focused on discipleship, the Christian voice in academia, faculty wellness, research and clinical applications at the intersection of faith and healthcare and effective Christian cultural engagement. Speakers have included Greg Ogden, DMin; Mark A. Noll, PhD; Fabrice Jotterand, PhD; Harold Koenig, MD; Farr A. Curlin, MD; Traci Balboni, MD, MPH; Michael Balboni, PhD; Tyler J. VanderWeele, PhD; John Patrick, MD; and Darrell Bock, ThM, PhD. For 2021, we piloted a new series titled “A Christian’s Walk in Academic Medicine,” which enables faculty members and other nationally recognized Christians in healthcare to share their Christian journey (1 Corinthians 10:31) and provide examples of Christian excellence in academic medicine. To promote fellowship, the CAPS Quad Squad program was formed based on discussions about Pastor Greg Ogden’s work
With the above goals in mind, five founding faculty members across the U.S. came together and formed the CAPS section, with the support of CMDA. The members of CAPS consist of faculty from medicine, dentistry, basic sciences or other healthcare disciplines, and they adhere to CMDA’s Statement of Faith. www.cmda.org | 17
LEARN MORE ABOUT CMDA’S SPECIALTY SECTIONS Among all our various ministries, CMDA’s Specialty Sections give you the unique opportunity to equip, network and fellowship with colleagues in your specific healthcare specialty. Organized by CMDA members, the sections listed below provide a wealth of resources for those who wish to connect with their colleagues. 1. Addiction Medicine Section 2. Christian Academic Physicians and Scientists (CAPS) 3. Christian Healthcare Executive Collaborative (CHEC) 4. Christian Physical Rehab Professionals (CPRP) 5. Christian Surgeons Fellowship 6. Coalition of Christian Nurse Practitioners (CCNP) 7. Dermatology 8. Family Medicine Section (FMS) 9. Fellowship of Christian Optometrists (FCO) 10. Fellowship of Christian Physician Assistants (FCPA) 11. Fellowship of Christian Plastic & Reconstructive Surgeons (FCPRS) 12. Neurology 13. Psychiatry 14. Ultrasound Education (UES) Don’t see a section for your specialty? New sections are currently under development with CMDA’s Campus & Community Ministries. As we grow our resources for our members to find connection within their specialties, we are also adding to our staff in order to better support and serve these growing outreach ministries. Contact ccm@cmda.org for more information about getting involved or starting a section.
on discipleship. Its goals were to encourage intentional discussions on faith and fellowship in healthcare, as well as to provide a framework for peer discipleship. The 12 inaugural small groups, termed Quad Squads, participated in a four-week, Zoom-based discipleship program. Each group had three to five CAPS members, one of whom acted as the facilitator. Weekly Zoom meetings centered on discussions about the integration of Christian faith into the four pillars of academic life: research, education, clinical medicine and administration. To equip faculty members with the ability to share the grace of Christ more joyfully and effectively within today’s academic environment, each group member identified opportunities, blessings and challenges within their daily interpersonal relationships with patients and/or their family members, trainees, professional colleagues and superiors. Version 2.0 of Quad Squad lasted four months and focused on effective formation of discipleship. Building on the successes of Quad Squad 1.0 and 2.0, version 3.0 will help like-minded believers establish an identity that can handle both success and failure, as well as provide biblical principles to encourage Christian excellence (Colossians 2:23). At the same time the national Quad Squads formed, efforts to pilot the formation of local CAPS chapters was championed by Clinical Professor of Medicine at George Washington University Dr. Richard Allman. Dr. Allman developed and established the Washington, D.C., Maryland and Virginia (CAPS-DMV) regional group in October 2020. The CAPS-DMV chapter currently holds webinars on the fourth Tuesdays of each month and has 20 members. Looking forward to 2022, the CAPS leadership will be working on development of a research fellowship, formation of a scientific speaker’s bureau, growth of Quad Squad and local chapters and development of committees to champion other CAPS initiatives. The CAPS-funded research fellowship on faith and healthcare will enable collaborations with physicians and scientists, such as Drs. Harold Koenig and Farr Curlin at Duke University. The selected faculty member will attend a research fellowship workshop at Duke and will conduct a focused hypothesis-driven project mentored by a group of scientists in the field. The research fellow will present his or her work at one of the monthly CAPS webinars and will submit a manuscript to a peer-reviewed journal. As the CAPS section grows in number and range of specialty and research areas, we will establish a scientific speaker’s bureau and invite faculty members who wish to serve on the speaker’s bureau to summarize their specific areas of scholarly work on the CAPS website. We encourage like-minded Christian faculty members in healthcare to apply for membership, to participate in our activities and to take an active role in building the CAPS section. Members of CMDA are welcome to participate in CAPS webinars. We encourage faculty members interested in shaping CAPS to contact the executive committee through the CAPS website. We pray CAPS will continue to grow and nurture fac-
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ulty members serving Christ at academic medical centers in the United States and abroad. EDITOR’S NOTE The opinions conveyed in this article reflect the personal views of the authors and not those of their employers.
Kim-Lien Nguyen, MD, is co-chair of CAPS and Associate Professor of Medicine, Radiology and Biomedical Physics at UCLA. She is a cardiovascular imaging scientist and a practicing non-invasive cardiologist. Her funded research focuses on the use of iron-oxide enhanced magnetic resonance imaging in congenital, vascular and ischemic heart disease. Her work has been published in leading imaging journals and her lab receives grant support from the American Heart Association, the National Institutes of Health and the Veterans Health Administration. She attends Pacific Crossroads Church and has a cat.
David L. Bolender, PhD, is vice chair of CAPS and Professor in the Department of Cell Biology, Neurobiology and Anatomy at the Medical College of Wisconsin. Dr. Bolender teaches clinical anatomy, embryology and cell and tissue biology. He has served on the Curriculum and Evaluation Committee. With Elsevier Publishing, he has created a series of animations for teaching embryology. He helped design a modern anatomy dissection lab as well as an advanced anatomy lab for fresh tissue use by senior medical students, residents and clinical faculty. He also serves as an advisor for the student CMDA chapter at Medical College of Wisconsin. David L. Larson, MD, is co-chair of CAPS, chair of the Medical Education International (MEI) Advisory Council and Professor Emeritus in the Department of Plastic Surgery at Medical College of Wisconsin. Dr. Larson is the former Professor and Chairman of the Department of Plastic Surgery at the Medical College of Wisconsin and Program Director of that training program for 20 years. He has authored more than 140 peer-reviewed articles, book chapters and books. He has a professional life committed to the education of medical students, residents, fellows and peers in head and neck cancer, wound care and reconstruction of all areas of the body.
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CHRIST WITH US
Practicing Christ-like Presence in an Age of Burnout Danielle Ellis, MD
O
ne week into a rotation in the Surgical Intensive Care Unit (SICU), I found myself dreaming about the hospital. I was not dreaming about saying the wrong thing on rounds, but I was dreaming about our patients: Mr. Brown’s wife when she’d been told he may not survive his third surgery this admission; Mr. Thomas’ mom crying because she felt responsible for how he’d “turned out.” I told an attending I trusted that I was distressed by how much I was carrying patients’ stories with me, and she graciously admitted to me she’d struggled with the same thing early on in training. The solution, she said, is to not get so attached. “That’s how you burn out,” she said. I wanted to readily accept her words of wisdom, but the thought unsettled me. It was not until finishing that rotation and starting seminary two days later that I put words to this unresolved conflict. As a Christian, I felt called to be present to suffering; as a trainee, I could not reconcile whether keeping my distance was actually a way of avoiding burnout or a symptom if it; and as a Christian trainee, it was unclear whether the kind of presence that felt faithful to my calling was really possible in the practice of modern healthcare.
What is Physician Presence and Why Does it Matter?
Physician presence has been on the minds of theologians and physicians alike in the recent past. Theologian Stanley Hauerwas wrote that presence is the essence of the practice of medicine: the physician’s ultimate commitment is not to cure, but to care by way of being present.1 Coming from a completely secular perspective, a recent study in The Journal of the American Medical Association ( JAMA) set out to describe practices that help cultivate greater presence in the clinical encounter. They defined physician presence as the “purposeful practice of awareness, focus, and attention with the intent to understand
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GET INVOLVED Healthcare professionals pour themselves out for others every day, and CMDA’s Center for Well-being is the place to be refilled! We want to help you align with God, optimize your well-being and maximize your influence. We want to help you find the “sweet spot” of life again, to help you find or regain what the Bible calls “Shalom.” For more information, visit www.cmda.org/wellbeing.
and connect with patients,” and they also observed that presence fosters connection and gives meaning to the vocation of medicine.2,3 The disconnection between the desire to be present and the realities of modern healthcare that make it challenging to do so (i.e. administrative tasks, electronic health records, shortened clinic appointment times) has been associated with physician burnout.3 Experienced by about 50 percent of the physician workforce in the U.S.,4 burnout is a syndrome characterized by emotional exhaustion, depersonalization and a reduced sense of personal accomplishment.5 Christian healthcare professionals desiring greater connection and meaning in healthcare and seeking to answer the call to be present in a Christ-like way have the gift of looking to the ways in which Christ practiced presence in Scripture. Unfortunately, Christians are no less affected by burnout than their less religious or spiritual counterparts.6
Christ-like Presence: Burning Out at the Extremes
The Great Physician (Luke 5:31-32, Mark 5:25-34) models presence in a number of ways, but the pressures of modern healthcare can cause us to distort Christ’s examples and lead to extremes of presence not sustainable for merely human healers. When we internalize modern healthcare’s “hidden curriculum”—that the patient should always come first; that weakness is to be despised; that efficiency is paramount—even in our well-intentioned attempts to emulate Jesus, we may paradoxically find ourselves more burdened and burned out than refueled and restored. Let us look at two salient pictures of Christ’s presence that are easily distorted in today’s healthcare culture. First, “Christ on the cross”—those among us who take on all the suffering around them. Second, “Christ on the throne”—those among us who, seeking to eliminate suffering
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“attempts to emulate Jesus, we
Even in our well-intentioned
may paradoxically find ourselves more burdened and
burned out than refueled and restored.
”
and orchestrate outcomes, maintain a distant objectivity that prevents them from ever truly becoming invested. Presence as a distortion of “Christ on the cross” drags a clinician fully into a patient’s world and crushes her under burdens much too heavy to bear. In God’s greatest display of love for the world, Jesus takes on our burdens (Matthew 11:28-30), is obedient to the point of death (Philippians 2:8) and gives fully of Himself on the cross that we might be healed. A healthcare professional modeling presence after Christ in this way takes on suffering in its totality, even perceiving this “dying to oneself ” kind of investment as the pinnacle of presence. The physician who desires to be fully present for each patient’s highs and lows, both medical and otherwise, may be lauded for being self-sacrificial or deeply invested. But when she, for example, forsakes true sabbath on her days off to go check on patients instead, or thinks herself obligated to stay late to see one more patient, or to sit with a grieving family member because there is “no one else who can,” she has perhaps invested and sacrificed too much. It is not hard to imagine how attempting to be present to suffering as Christ was when “He himself bore our sins in his body on the tree” could lead to a human healer’s emotional exhaustion and eventual burnout (1 Peter 2:24, ESV). The best of intentions aside, carrying another’s suffering over the course of a day, and over a lifetime, becomes insufferable. 22 | CMDA TODAY | WINTER 2021
By contrast, presence as a distortion of “Christ on the throne” allows a healthcare professional to remain above and in proximity to, but never fully a part of, a patient’s suffering narrative. In His omnipotence, omniscience and total sovereignty, God’s purposes are always accomplished, and He need not entangle Himself in human affairs to ensure that His will prevails. Although Christ comes in human form and can empathize with us (Hebrews 4:15), He is ultimately exalted by God to the highest place (Philippians 2:9) and is seated “at the right hand of the throne of the Majesty in heaven” (Hebrews 8:1). As seen when Jesus calms the storm, He is able to be present to challenging circumstances and deliver people from them without experiencing the fear and worry that often accompany suffering (see Mark 4:35-41). A physician embodying this type of presence to suffering enters the stories of his patients as an other-worldly, superhuman savior— empathetic, but ultimately immune to the goings-on of the mortals around him. He may deliver crushing news with little emotion or encourage his trainees to “not get too involved.” Presence as “Christ on the throne” may appear to keep the healthcare professional a safe distance from suffering and prevent him from being pulled into the fray, but this disconnection from his patients (and, ultimately, himself ) is a recipe for the depersonalization that makes burnout so devastating for the physician-patient connection.
I have witnessed both of these kinds of presence practiced with grace, but I have also experienced and seen them distorted by a healthcare system that, at times, tells a story of healthcare professionals as providers of services rather than as practitioners of healthcare. Despite being modeled after Christ, extreme versions of these ways Jesus is present to our suffering may actually compound the pressures that have allowed burnout to become so prevalent. So let us consider a third model of presence— ”Christ with us,” modeled as Jesus weeps alongside Mary and Martha after the death of Lazarus. This kind of presence is marked by the practice of lament and a coming alongside of our patients in their suffering. Though not immune to distortion, we will see that it may bring us closer to the restoring fount of Living Water that we seek and offer hope for a way forward.
Christ With Us: Presence as Lament
“Christ with us” uses the practice of lament to bring healthcare professionals alongside their patients. Lament invites us into the story of the sufferer, and in being present in that moment in a story that is not our own, we are inwardly changed and moved to outward action. When Jesus weeps at the death of Lazarus alongside Mary and Martha, He neither bears the full weight of their grief and suffering nor sits on the throne of high priesthood disconnected from it. In this display, we see a model of presence with both inward and outward postures toward suffering that transform those experiencing it and those present to it as well.
with a fleeting sympathy. Yet, the collective grief of Mary and her community moves Jesus inwardly to enter Mary’s narrative, becoming troubled as she was. And in lamenting alongside of her, He offers the sort of presence that patients crave in the pain and isolation of suffering. The outward expression of this “Christ with us” lamenting presence is codified in one of the Bible’s shortest verses: “Jesus wept” ( John 11:35). Jesus’ weeping prompts the Jewish community surrounding Mary and Martha to begin grieving aloud, asking the sorts of questions that must be posed when interpreting suffering as a new part of one’s story (see John 11:36-37). Why Lazarus? Was there no other way? How can this be? As Jesus’ inwardly troubled soul drives Him to weep, He makes space for those suffering to start making sense of the senseless. The second outward expression of Christ’s lament is equally significant: it is what theological ethicist Allen Verhey describes as “looking heavenward.”8 Jesus’ literal heavenward glance—“Then Jesus looked up and said ‘Father, I thank you that you have heard
Inwardly, Jesus’ posture in this encounter demonstrates how lament can allow us to inhabit another person’s story. Theologian Rebekah Eklund notes an astonishing parallel: the Greek word used to describe Jesus’ “troubled” soul at seeing Mary weep (see John 11:33) is the same one used when He predicts his own death (see John 12:27).7 For Jesus to be the same sort of “troubled” in response to Mary’s grief and the death of her brother as He would be just days later at the realization of His own death is profound. After all, how many physicians feel the same degree of distress at the prospect of terminally extubating a nameless “86-year-old woman with a history of COPD admitted for hypoxic respiratory failure” as they would at terminally extubating a loved one? If anyone could have pushed aside feeling “troubled” at Mary’s grief, it would be Jesus—He knew not only that Lazarus would be resurrected, but He also knew that He Himself would be the one to accomplish this feat. With the knowledge of the joyful and awe-inspiring resurrection to come, Jesus could have responded to Mary www.cmda.org | 23
Perhaps more importantly, the outward response it invites prompts patients and their communities to seek meaning in suffering and reorients the practitioner to the ultimate origin of all healing—Christ Himself. It would be overly triumphalistic to suggest that presence as “Christ with us” has alleviated the tensions between being present as a Christian and training as a clinician, or that this alone could insulate you or I from the sting of burnout. But if it is after Emmanuel—God with us who is indeed ever present and doing immeasurably more than we ask or imagine—that we model our practice of presence, I am hopeful we are on our way. me’” ( John 11:41b)—demonstrates a humility in understanding where all restoration originates. As God Incarnate, Jesus could have raised Lazarus without making this gesture. And yet, He looks to the Father for power and wisdom. In responding outwardly to suffering, it is Mary’s grief that moves Jesus to first weep and acknowledge the suffering in front of Him. It is the grace and power allotted to Him by the Father that moves Him to then heal and restore. Among no other group of healthcare professionals than Christians should there be a greater awareness of and submission to God’s sovereignty. The act of looking heavenward serves as a reminder that if there it is to be any reparation or renewal, our role is only participatory. That reality, however humbling, should also offer Christian healthcare workers immense peace and hope— in every moment we have the opportunity to participate in the healing God is doing, and we never bear the burden of executing it ourselves. As healthcare training and the modern healthcare system interact with our desire to be the hands and feet of Jesus, we may find ourselves pushed to extremes of presence, either fully bearing patients’ burdens and suffering, as Christ did for us on the cross, or maintaining a sense of control over sickness and suffering, as Christ does from His throne. Although they are Christlike in principle, presence in those forms is not fully faithful to what we believe as Christians. At each extreme, we think too highly of ourselves and our power to heal. Though not immune to distortion, presence as “Christ with us” creates a space in each encounter for healthcare professionals to assume an inward posture that sees and inhabits the suffering in front of them.
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References 1 Hauerwas S. Salvation and Health: Why Medicine Needs the Church. In: ; 1985. doi:10.1007/978-94-015-7723-6_13 2 Brown-Johnson C, Schwartz R, Maitra A, et al. What is clinician presence? A qualitative interview study comparing physician and non-physician insights about practices of human connection. BMJ Open. 2019;9(11). doi:10.1136/bmjopen-2019-030831 3 Zulman DM, Haverfield MC, Shaw JG, et al. Practices to Foster Physician Presence and Connection with Patients in the Clinical Encounter. JAMA - J Am Med Assoc. 2020;323(1):70-81. doi:10.1001/ jama.2019.19003 4 West CP, Dyrbye LN, Shanafelt TD. Physician burnout: contributors, consequences and solutions. J Intern Med. 2018;283(6):516-529. doi:10.1111/joim.12752 5 Maslach C, Jackson SE. The Measurement of Experienced Burnout. J Organ Behav. 1981;2:99-113. 6 Salmoriago-Blotcher E, Fitchett G, Leung K, et al. An exploration of the role of religion/spirituality in the promotion of physicians’ wellbeing in Emergency Medicine. Prev Med Reports. 2016;3:189-195. doi:10.1016/j.pmedr.2016.01.009 7 Eklund R. Jesus Wept: The Significance of Jesus’ Laments in the New Testament. London: Bloomsbury T&T Clark; 2016. doi:10.1111/rsr.12690 8 Verhey A. Reading the Bible in the Strange World of Medicine. Grand Rapids, MI: Wm. B. Eerdmans Publishing Co.; 2003.
Danielle Ellis, MD, is a general surgery resident at the Massachusetts General Hospital and an alumna of the Theology, Medicine and Culture fellowship at Duke Divinity School. She is deeply committed to cultivating kingdom principles for both patients and healthcare professionals, a commitment which was nurtured by her CMDA chapter in medical school and formation in seminary. She plans to pursue pediatric surgery and palliative care, with interests in health parity, surgical pedagogy and practical theology.
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HOMOSEXUALITY CMDA affirms that all human beings are created in the image of, and beloved by, God. All human beings are our neighbors and are to be loved by us as we love ourselves. As such, every human being possesses intrinsic dignity and is worthy of equal respect and concern from healthcare professionals. CMDA affirms the biblical teaching that the appropriate context for sexual relations is within marriage, defined as a consensual, exclusive and lifelong commitment between one man and one woman. This teaching exists for the benefit of individuals, of families, and of all society. This teaching is about more than just what one does with one’s own body because sexuality has moral and spiritual dimensions in addition to the physical dimensions. CMDA also recognizes that many individuals struggle with or accept same-sex attraction and that there are voices in our culture that celebrate this and seek to make it conventional and to force participation in educational programs promoting it. Thus, Christian healthcare professionals find themselves in the position where some sexual choices and behaviors that have broad social approval are contrary to an orthodox Christian worldview. Christianity teaches human equality, not behavioral equality. CMDA affirms the obligation of Christian healthcare professionals caring for patients who identify as gay or lesbian to do so with sensitivity and compassion, even when we cannot validate their choices. CMDA views homosexuality within the following frameworks:
A. BIBLICAL 1. All people are loved by God ( John 3:16-17). 2. We are to love our neighbors as ourselves (Matt 22:39). 3. God, in his holiness and wisdom, is the creator of the world and the definer of moral reality. Christians are called to obey God and his commandments. When we engage in any sexual sin, we are failing to love God with our whole heart and soul and mind and strength. When we condone another person’s embrace of sexual sin, we are not truly loving our neighbor (1 Cor 6:1820. 4. Everyone struggles with moral failure and falls short of God s standards (Rom 12) and, therefore, needs the forgiveness that God provides through Christ alone 26 | CMDA TODAY | WINTER 2021
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( John 3:36; Rom 3:22-24; Col 1:15-21; 1 Tim 2:5-6). 5. The moral authority of the Bible in matters of sexuality rests in God, who inspired and reliably guided its human authors ( Josh 1:8; Matt 5:18, 24:35; Luke 16:17; 1 Thes 2:13; 2 Tim 3:16; Heb 4:12; 2 Pet 1:21). The moral teachings of the Scriptures are trustworthy (Psa 119:86; John 17:17b), beneficial (Deu 30:19; Psa 119:105, 133; Luke 11:28), and true for all times (Psa 119:89; Isa 40:8; Heb 13:8). 6. We live in a fallen world (Gen 3), and we are all fallen creatures with a sinful nature (Rom 3:9-12). The fall is expressed in nature and in humanity in many ways, including sexuality. Same-sex attraction is but one example of our fallenness, as are marital breakdown and fornication (Rom 1:24-32; Eph 5:3). 7. To experience temptation alone is not to sin. Jesus was tempted yet did not sin (Matt 4:1-11, Mark 1:12-13, Luke 4:1-13). We are commanded to pray for relief from and to flee temptation (Matt 6:13, 1 Cor 6:18, 1 Thess 4:3, James 1:13-15). Scripture clearly teaches that yielding to the temptation to engage in homosexual behavior, or even to indulge in homosexual fantasy, is sinful (Matt 5:28). 8. A lifestyle that is directed by sexual desires or personal sexual fulfillment misses the divinely ordained purpose of sex, which is for procreation, mutual mar-
ital enjoyment, and for facilitating unity in the lifelong commitment of marriage between one man and one woman. This unity fosters a secure and nurturing environment for children, reflects the unity that exists between Christ and the church (Exod 20:1-18; Lev 20:10-21; Rom 1; Eph 5:23-33), and is the human image of God (Gen. 1:26-28). 9. The Scriptures promise God’s blessing on lifelong heterosexual union in marriage, and they prescribe chastity in all other circumstances. 10. The Scriptures consistently forbid the practice of homosexuality, calling it sin (Lev 18:22, 20:13; 1 Kings 14:24; Rom 1:24-27; 1 Cor 6:9; Jude 1:7). Same-sex attraction cannot be consummated within God’s design for human sexuality and procreation (Gen 2:24; Mark 10:6-8; Eph 5:1-17). The Scriptures affirm, however, the value of same-sex friendships that are not erotic in nature. 11. It is possible by God’s grace for those with same-sex attraction to live a chaste life (Psa 51:10, 119:9-10; Rom 6:11-14, 12:1-2; 1 Cor 6:18, 10:13; 2 Cor 7:1; 1 Thes 4:3-5, 5:23-24; Gal 2:20, 5:16, 22-25; Col 3:5). 12. Homosexual behavior is not a victimless activity even among consenting adults. Modeling homosexual behavior to young children contributes to normalizing same-sex attraction, that may also entice them to imitate that behavior, and is a grievous sin (Mark 9:42).
B. SOCIAL
1. God has designed us for, and with a desire for, intimacy. Most everyone has a sex drive and is responsible for managing it. This is true regardless of one’s type of sexual attractions or desires. Intimacy is distorted by sin. Ultimate intimacy is to be found in a relationship with God. 2. In our current culture, which is saturated with sexual references, there is a prevailing view that personal fulfillment is to be found through abolishing traditional sexual boundaries and following desires and passions that cross those boundaries. One outcome of this trend is a view that same-sex relationships should be regarded as equivalent to opposite-sex relationships.1 In our current culture there is also a view that to embrace diversity means to enforce acceptance and affirmation of same-sex relationships, while suppressing other viewpoints.2 3. CMDA believes that, in contrast to the current culture, living out one’s biological sexuality (as standardly defined by X and Y chromosomes and observed in genital anatomy) within God’s design will result in a healthy and fulfilled life. CMDA recognizes that this traditionally affirmed view has become countercultural; however, CMDA affirms that God’s design transcends culture.
4. CMDA recognizes that the causes of same-sex attraction are multifactorial and may include biological, developmental, psychosocial, environmental, and cultural factors that are not of the individual’s choosing.3 However, deciding on a same-sex lifestyle and pursuing same-sex fantasies and encounters are voluntary and therefore involve moral responsibility. 5. CMDA recognizes that, for individuals who struggle with same-sex attraction, choosing not to act on their same-sex erotic desires may be difficult. Similarly, many individuals who are sexually attracted to the opposite sex also struggle with erotic desires that are contrary to the teachings of Scripture. 6. Endorsement of same-sex marriage harms the stability of society, the raising of children, the institution of marriage,4 the revelation of Christ’s relationship to His Church, and the revelation of God through those who bear His image. If the only criterion for marriage were love, mutual consent, or commitment, then there would be no logical grounds to prohibit polygamy, polyamory, incestuous unions, adultery, or pedophilia.5-10 7. Adoption into homosexual environments puts children at risk.10,11 Children need both primary male and female attachments in their social development and the modeling of a male-female relationship. Children should not be exposed to the promiscuity that the gay culture often promotes (nor to heterosexual promiscuity). Children raised by same-sex couples are at increased risk of later engaging in homosexual activity.12,13,14
C. MEDICAL
1. Among individuals who engage in homosexual acts, there is an increased incidence of drug15 or alcohol16 dependence, compulsive sexual behavior,17 anxiety,18 depression,19 and suicide.20 These are harmful to the health of same-sex patients21,22 and are associated with increased medical costs to society.23 2. Some sexual acts, common to, but not unique among, homosexuals, are physically harmful because they disregard normal human anatomy and function. These acts are associated with increased risks of tissue injuries, anal cancers, HPV-induced head and neck cancers, and transmission of infectious diseases, including HIV/AIDS, Hepatitis C, parasitic infections, and bacterial infections due to exposure to, or ingestion of, fecal material.24 3. Data demonstrate that life expectancy is significantly shortened in male homosexuals compared to their heterosexual peers.25,26 4. Individuals who act on their same-sex attractions can change their behavior even when desire persists. There www.cmda.org | 27
is valid evidence that many individuals who chose to abstain from homosexual acts have been able to continue to abstain.27-32 Such change often will be difficult, and individuals seeking assistance to change their behavior need an empathetic, loving, and mutually consenting approach.
CMDA Recommendations for the Christian Community 1. A person struggling with same-sex attraction should evoke neither scorn nor enmity, but rather a Christian’s loving concern, compassion, help, and understanding. Christians must respond to the complex issues surrounding same-sex attraction with grace, civility, and love. 2. Christians should welcome inclusion of gay- and lesbianidentified individuals into friendship and community, affirming them as equal with all other human beings before God, yet without condoning sexual choices and behaviors that are contrary to Scriptural teaching. 3. The Christian community, beginning with the Christian family, must resist labeling and rejecting individuals who do not fit the stereotypes of masculinity and femininity. At the same time, parents should guide their young children and adolescents in appropriate gender identity development. For children and adolescents who are experiencing gender identity confusion, the Christian community should provide appropriate role models and, if needed, counseling. 4. The Christian community, in its biblical calling to be salt and light to the world, has a key role to help society understand that traditional marriage is good and is a part of the natural order. CMDA believes that redefining marriage, so as to include same-sex relationships, for the aforementioned reasons, would have detrimental spiritual, emotional, cultural, and medical repercussions. Even if the legal definition of marriage within a society changes, the Christian’s definition remains the same see A. Biblical, point #8 above). 5. The Christian community must condemn hatred and violence directed against homosexuals. Love for the person does not equate with support of the decision to engage in a gay or lesbian lifestyle. 6. The Christian community must encourage and strongly support those who wish to abandon homosexual behavior. 7. Chastity should be encouraged for those with same-sex attraction and for those not in a marriage between a man and a woman. 8. The Christian community should strenuously oppose pornography, which is a source of temptation to sexual sin of all types, including homosexual behavior (See CMDA Statement on Pornography). 9. The Christian community should oppose the adoption of children into homosexual households. 10. Sexual education for children should be determined by their parents. Curricula that promote or normalize sexual 28 | CMDA TODAY | WINTER 2021
behaviors outside of God’s design should be avoided. 11. The Christian community is one body with Christ as the head. As such, Christians should support those who suffer for upholding biblical values and truth regarding sexuality. 12. The Christian community is to be a refuge of love for all who are broken, including the sexually broken. We should not affirm their sin, or condemn them, but should shepherd them to Jesus, who alone can forgive, heal, restore, and redirect them to a godly, honorable, and virtuous way of life. God provides the remedy for all moral failure through faith in Jesus Christ and the life-changing power of the Holy Spirit.
CMDA Recommendations for Christian Healthcare Professionals 1. CMDA advocates competent and compassionate medical care of patients who identify as gay or lesbian. Such care requires our love, an open and trusting dialogue, and acceptance of the person without agreeing with the person’s sexual ideology. When responding to a patient’s psychological distress over sexual matters, Christian healthcare professionals should make a genuine effort to understand and respond to the patient’s perspective. 2. CMDA believes that the appropriate medical response to patients who identify as gay or lesbian should be to affirm their value as human beings and their longing for meaning and worth in life, even when their lifestyle choices or sexual behaviors cannot be condoned. 3. A patient’s wishes regarding hospital visitation rights and surrogate medical decision-making by a committed samesex partner should be respected.
CMDA Recommendations Regarding Nondiscrimination 1. Christian healthcare professionals, in particular, must care for their gay- and lesbian-identified patients in a non-judgmental and compassionate manner, consistent with the love Jesus has commanded us to show all people. 2. Christian healthcare professionals who hold to a biblical view of human sexuality and marriage should be tolerated in a diverse society and permitted to express their views in civil discourse free from exclusion, oppression, or discrimination. Healthcare professionals who hold the position that homosexual behaviors are harmful and inconsistent with the will of God should not be stigmatized or accused of being bigoted, phobic, unprofessional, or discriminatory because of this sincerely held belief. The label “homophobic” implies a prejudice against and overwhelming fear of homosexual persons; such prejudice does not apply to the vast majority of healthcare professionals, including Christian healthcare professionals. CMDA rejects the homophobic label as inaccurate and a prejudicial attempt to disparage individuals without a willingness to engage in respectful discussion or
to seek mutual understanding. Healthcare professionals are not afraid of individuals practicing homosexual acts, but rather are concerned about the physical, psychological, and spiritual health risks inherent in homosexual behavior. Bigotry in any form from any party is unacceptable.
REFERENCES
1. Joyner K, Manning W, Prince B. The Qualities of Same-Sex and Different-Sex Couples in Young Adulthood. J Marriage Fam 2019; 81(2): 487-505. doi:10.1111/jomf.12535 2. Pereira A, Pereira C, Monteiro M. Normative pressure to reduce prejudice against homosexuals: The buffering role of beliefs about the nature of homosexuality. Personality and Individual Differences 2016; 96: 88-99. 3. Thebigdealaboutmarriage.com.au. 2020 [online]. <http://www. thebigdealaboutmarriage.com.au/wp-content/uploads/2016/11/Understanding-thecauses-of-same-sex.php_.pdf> [Accessed 23 August 2020]. 4. Council, Family, 2020. Ten Arguments From Social Science Against Same-Sex Marriage. [online] FRC. Available at: <https://www.frc.org/issuebrief/ten-arguments-fromsocial-science-againstsame-sex-marriage> [Accessed 23 August 2020]. 5. D e Block A, Adriaens PR. Pathologizing sexual deviance: a history. J Sex Res 2013; 50(3-4): 276-298. doi:10.1080/00224499.2012.738259 6. North American Man/Boy Love Association 2020. [online] Available at: <https:// nambla.org/welcome.html> [Accessed 23 August 2020]. 7. Blumberg A. More Americans than ever say polygamy is morally acceptable. Huffington Post, July 31, 2017. Accessed September 8, 2020 at: https://www.huffpost.com/entry/ polygamy-moralacceptance_n_597f6976e4b02a8434b83e4f 8. Strauss G. Is polygamy inherently unequal? Ethics 2012; 122(3): 516-544. 9. German Ethics Council in favor of lifting ban on incest with siblings. DW, September 24, 2014. Accessed September 8, 2020 at: https://www.dw.com/en/german-ethicscouncil-in-favor-of-lifting-ban-on-incestwith-siblings/a-17950246 10. Sullins D. Emotional Problems among Children with Same-Sex Parents: Difference by Definition. Br J Educ Society Behaviour Science 2015; 7(2): 99-120. 11. A llen D. “High school graduation rates among children of same-sex households,” Review of Economics of the Household, Springer, December 2013; vol. 11(4): 635-658. 12. Schumm W., Children of Homosexuals More Apt to Be Homosexuals? A Reply to Morrison and to Cameron Based on an Examination of Multiple Sources of Data. J Biosoc. Sci. 2010; 42:721-742. 13. Regnerus M., How Different are the Adult Children of Parents who Have Same-Sex Relationships? Findings from the New Family Structures Study. Soc Sci Res. (2012); 41:752-770. 14. Marks L., Same-sex Parenting and Children’s Outcomes: A Closer Examination of the American Psychological Association’s Brief of Lesbian and Gay Perenting. Soc Sci Res. (2012):41(4):735-751. 15. Drug Use and Dependence: Giraudon I, Schmidt AJ, Mohammed H. Surveillance of sexualised drug use - the challenges and the opportunities. Int J Drug Policy 2018; 55: 149-154. doi:10.1016/j. drugpo.2018.03.017 Guadamuz TE, Cheung DH, Boonmongkon P, et al. Illicit Drug Use and Social Victimization among Thai Sexual and Gender Minority Adolescents. Subst Use Misuse 2019; 54(13): 2198-2206. doi:10.1080/10826084.2019.1638936 Heinsbroek E, Glass R, Edmundson C, Hope V, Desai M. Patterns of injecting and noninjecting drug use by sexual behaviour in people who inject drugs attending services in England, Wales and Northern Ireland, 2013-2016. Int J Drug Policy 2018; 55: 215-221. doi:10.1016/j.drugpo.2018.02.017 Hibbert MP, Porcellato LA, Brett CE, Hope VD. Associations with drug use and sexualised drug use among women who have sex with women (WSW) in the UK: Findings from the LGBT Sex and Lifestyles Survey. Int J Drug Policy 2019; 74: 292-298. doi:10.1016/j.drugpo.2019.07.034 Hibbert MP, Brett CE, Porcellato LA, Hope VD. Psychosocial and sexual characteristics associated with sexualised drug use and chemsex among men who have sex with men (MSM) in the UK. Sex Transm Infect 2019; 95(5): 342-350. Doi:10.1136/ sextrans-2018053933
3. Healthcare professionals should not be prevented from providing support and counseling to patients or to parents of children who request assistance with abstaining from homosexual behavior (change-allowing therapy).
Kann L, Olsen EOM, McManus T, et. al. Sexual Identity, Sex of Sexual Contacts, and Health-Risk Behaviors Among Students in Grades 9-12: Youth Risk Behavior Surveillance, Selected Sites, United States, 2001-2009. MMWR (2011). June 10; 60:133. Lea T, Hammoud M, Bourne A, et al. Attitudes and Perceived Social Norms toward Drug Use among Gay and Bisexual Men in Australia. Subst Use Misuse 2019; 54(6): 944-954. doi:10.1080/10826084.2018.1552302 Moore CL, Gidding HF, Jin F, et al. Patterns of Drug Use and Drug-related Hospital Admissions in HIV-Positive and -Negative Gay and Bisexual Men. AIDS Behav 2016; 20(10): 2372-2386. doi:10.1007/s10461-016-1303-3 Parsons JT, Millar BM, Moody RL, Starks TJ, Rendina HJ, Grov C. Syndemic conditions and HIV transmission risk behavior among HIV-negative gay and bisexual men in a U.S. national sample. Health Psychol 2017 Jul; 36(7): 695-703. doi: 10.1037/ hea0000509. Epub 2017 May 25. PubMed PMID: 28541070; PubMed Central PMCID: PMC5532533. Prestage G, Hammoud M, Jin F, Degenhardt L, Bourne A, Maher L. Mental health, drug use and sexual risk behavior among gay and bisexual men. Int J Drug Policy 2018; 55: 169-179. doi:10.1016/j.drugpo.2018.01.020 Saxton P, Newcombe D, Ahmed A, Dickson N, Hughes A. Illicit drug use among New Zealand gay and bisexual men: Prevalence and association with sexual health behaviours. Drug Alcohol Rev 2018; 37(2): 180-187. doi:10.1111/dar.12536 Starks TJ, Robles G, Bosco SC, Doyle KM, Dellucci TV. Relationship functioning and substance use in same-sex male couples. Drug Alcohol Depend 2019; 201: 101-108. doi:10.1016/j.drugalcdep.2019.04.009 Stevens O, Forrest JI. Thinking upstream: the roles of international health and drug policies in public health responses to chemsex. Sex Health 2018; 15(2): 108-115. doi:10.1071/SH17153 Theo GM Sandfort, deGraff R, Ten Have M, Ransome Y, Schnabel P. Same-sex Sexuality and Psychiatric Disorders in the Second Netherlands Mental Health Survey and Incidence Study (NEMESIS-2). LGBT Health. (2014); 1(4):292-301. 16. Alcohol Dependence: Pakula B, Shoveller J, Ratner PA, Carpiano R. Prevalence and Co-Occurrence of Heavy Drinking and Anxiety and Mood Disorders Among Gay, Lesbian, Bisexual, and Heterosexual Canadians. Am J Public Health 2016 Jun; 106(6): 1042-8. doi: 10.2105/ AJPH.2016.303083. Epub 2016 Mar 17. PubMed PMID: 26985615; PubMed Central PMCID: PMC4880251. Peralta RL, Victory E, Thompson CL. Alcohol use disorder in sexual minority adults: Age- and sex- specific prevalence estimates from a national survey, 2015-2017. Drug Alcohol Depend 2019; 205: 107673. doi:10.1016/j.drugalcdep.2019.107673 Ogbuagu O, Marshall BDL, Tiberio P, et al. Prevalence and Correlates of Unhealthy Alcohol and Drug Use Among Men Who Have Sex with Men Prescribed HIV Preexposure Prophylaxis in Real-World Clinical Settings. AIDS Behav 2019; 23(1): 190-200. doi:10.1007/s10461-018-2260-9 17. Compulsive Sexual Behavior: Starks TJ, Grov C, Parsons JT. Sexual compulsivity and interpersonal functioning: sexual relationship quality and sexual health in gay relationships. Health Psychol 2013 Oct; 32(10): 1047-56. doi: 10.1037/a0030648. Epub 2013 Jan 21. PubMed PMID: 23339646. Blain LM, Muench F, Morgenstern J, Parsons JT. Exploring the role of child sexual abuse and posttraumatic stress disorder symptoms in gay and bisexual men reporting compulsive sexual behavior. Child Abuse Negl 2012 May; 36(5): 413-22. doi: 10.1016/j.chiabu.2012.03.003. Epub 2012 May 21. PubMed PMID: 22622224. Brown MJ, Serovich JM, Kimberly JA. Outcome Expectancy and Sexual Compulsivity Among Men Who Have Sex with Men Living with HIV. AIDS Behav 2016 Aug; 20(8):
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EDUCATIONAL OBJECTIVES
· Discuss the medical basis for recommending sex be confined to marriage between a man and a woman. · Describe the importance of competent and compassionate care of individuals who identify as gay or lesbian. · Identify the importance of delivering healthcare for individuals struggling with same-sex attraction in a nondiscriminatory manner.
ACCREDITATION
The Christian Medical & Dental Associations is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
PHYSICIAN CREDIT
The Christian Medical & Dental Associations designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
NURSE PRACTITIONER
The American Academy of Nurse Practitioners Certification Program (AANPCP) accepts AMA PRA Category 1 Credit™ from organizations accredited by the ACCME. Individuals are responsible for checking with the AANPCP for further guidelines. Nurse practitioners may receive up to 1.0 credits for completing this activity.
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DENTAL CREDIT
CMDA is an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing education programs of this program provider are accepted by AGD for Fellowship, Mastership and membership maintenance credit. Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. The current term of approval extends from 1/1/2019 to 12/31/2022. Provider ID#218742. 1.0 Hours Self Instruction Available. No prior level of skill, knowledge, or experience is required (or suggested).
DISCLOSURE
None of these authors, planners or faculty have relevant financial relationships. Jeffrey J. Barrows, DO, MA (Ethics); Mandi Morrin; Barbara Snapp, CE Administrator; Sharon Whitmer, EdD, MFT; CE Committee Members; and CE Committee Dental Members. CMDA CE Review Committee John Pierce, MD, Chair; Jeff Amstutz, DDS; Trish Burgess, MD; Stan Cobb, DDS; Jon R. Ewig, DDS; Gary Goforth, MD; Elizabeth Heredia, MD; Curtis High, DDS; Bruce MacFadyen, MD; Dale Michels, MD; Shawn Morehead, MD; Michael O’Callaghan, DDS; and Richard Voet, MD THERE IS NO IN-KIND OR COMMERCIAL SUPPORT FOR THIS ACTIVITY.
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166774. doi: 10.1007/s10461-016-1361-6. PubMed PMID: 26979416; PubMed Central PMCID: PMC4945400. Coleman E, Horvath KJ, Miner M, Ross MW, Oakes M, Rosser BR. Compulsive sexual behavior and risk for unsafe sex among internet using men who have sex with men. Arch Sex Behav 2010 Oct; 39(5): 1045-53. doi: 10.1007/s10508-009-9507-5. Epub 2009 Jul 9. PubMed PMID: 19588239; PubMed Central PMCID: PMC3719393. Grabski B, Kasparek K. Sexual dysfunctions in non-heterosexual men - literature review. Psychiatr Pol 2017 Feb 26; 51(1): 85-94. doi: 10.12740/PP/63768. Epub 2017 Feb 26. PubMed PMID: 28455897. Klein V, Briken P, Schröder J, Fuss J. Mental health professionals’ pathologization of compulsive sexual behavior: Does clients’ gender and sexual orientation matter? J Abnorm Psychol 2019 Jul; 128(5): 465-472. doi: 10.1037/abn0000437. PubMed PMID: 31282729. Laier C, Pekal J, Brand M. Sexual Excitability and Dysfunctional Coping Determine Cybersex Addiction in Homosexual Males. Cyberpsychol Behav Soc Netw 2015 Oct; 18(10): 575-80. doi: 10.1089/cyber.2015.0152. Epub 2015 Sep 16. PubMed PMID: 26374928. Miner MH, Raymond N, Coleman E, Swinburne Romine R. Investigating Clinically and Scientifically Useful Cut Points on the Compulsive Sexual Behavior Inventory. J Sex Med 2017 May; 14(5): 715-720. doi: 10.1016/j.jsxm.2017.03.255. PubMed PMID: 28499521; PubMed Central PMCID: PMC5472451. Miner MH, Romine RS, Raymond N, Janssen E, MacDonald A 3rd, Coleman E. Understanding the Personality and Behavioral Mechanisms Defining Hypersexuality in Men Who Have Sex with Men. J Sex Med 2016 Sep; 13(9): 1323-1331. doi: 10.1016/j. jsxm.2016.06.015. Epub 2016 Jul 30. PubMed PMID: 27486137; PubMed Central PMCID: PMC4996734. Pachankis JE, Rendina HJ, Restar A, Ventuneac A, Grov C, Parsons JT. A minority stress-emotion regulation model of sexual compulsivity among highly sexually active gay and bisexual men. Health Psychol 2015 Aug; 34(8): 829-40. doi: 10.1037/ hea0000180. Epub 2014 Dec 22. PubMed PMID: 25528179; PubMed Central PMCID: PMC4476950. Parsons JT, Rendina HJ, Ventuneac A, Moody RL, Grov C. Hypersexual, Sexually Compulsive, or Just Highly Sexually Active? Investigating Three Distinct Groups of Gay and Bisexual Men and Their Profiles of HIV-Related Sexual Risk. AIDS Behav 2016 Feb; 20(2): 262-72. doi: 10.1007/s10461-015-1029-7. PubMed PMID: 25750052; PubMed Central PMCID: PMC4561607. Rendina HJ, López-Matos J, Wang K, Pachankis JE, Parsons JT. The Role of SelfConscious Emotions in the Sexual Health of Gay and Bisexual Men: Psychometric Properties and Theoretical Validation of the Sexual Shame and Pride Scale. J Sex Res 2019 MayJun; 56(4-5): 620-631. doi: 10.1080/00224499.2018.1453042. Epub 2018 Apr 10. PubMed PMID: 29634377; PubMed Central PMCID: PMC6179944. Rendina HJ, Gamarel KE, Pachankis JE, Ventuneac A, Grov C, Parsons JT. Extending the Minority Stress Model to Incorporate HIV-Positive Gay and Bisexual Men’s Experiences: A Longitudinal Examination of Mental Health and Sexual Risk Behavior. Ann Behav Med 2017 Apr; 51(2): 147-158. doi: 10.1007/s12160-016-9822-8. PubMed PMID: 27502073; PubMed Central PMCID: PMC5299076. Storholm ED, Satre DD, Kapadia F, Halkitis PN. Depression, Compulsive Sexual Behavior, and Sexual Risk-Taking Among Urban Young Gay and Bisexual Men: The P18 Cohort Study. Arch Sex Behav 2016 Aug; 45(6): 1431-41. doi: 10.1007/s10508015-0566-5. Epub 2015 Aug 27. PubMed PMID: 26310878; PubMed Central PMCID: PMC4769690. Studer J, Marmet S, Wicki M, Gmel G. Cybersex use and problematic cybersex use among young Swiss men: Associations with sociodemographic, sexual, and psychological factors. J Behav Addict 2019 Dec 1; 8(4): 794-803. doi: 10.1556/2006.8.2019.69. Epub 2019 Dec 23. PubMed PMID: 31868514; PubMed Central PMCID: PMC7044587. Wang X, Wang Z, Jiang X, Li R, Wang Y, Xu G, Zou H, Cai Y. A cross-sectional study of the relationship between sexual compulsivity and unprotected anal intercourse among men who have sex with men in Shanghai, China. BMC Infect Dis 2018 Sep 15; 18(1): 465. doi: 10.1186/s12879-018-3360-x. PubMed PMID: 30219033; PubMed Central PMCID: PMC6139151. Weinberger AH, Esan H, Hunt MG, Hoff RA. A review of research on smoking behavior
in three demographic groups of veterans: women, racial/ethnic minorities, and sexual orientation minorities. Am J Drug Alcohol Abuse 2016 May; 42(3): 254-68. doi: 10.3109/00952990.2015.1045978. Epub 2015 Jul 7. Review. PubMed PMID: 26151807. Weinstein A, Katz L, Eberhardt H, Cohen K, Lejoyeux M. Sexual compulsion-relationship with sex, attachment and sexual orientation. J Behav Addict 2015 Mar; 4(1): 22-6. doi: 10.1556/JBA.4.2015.1.6. PubMed PMID: 25786496; PubMed Central PMCID: PMC4394850. 18. Anxiety: Björkenstam C, Björkenstam E, Andersson G, Cochran S, Kosidou K. Anxiety and Depression Among Sexual Minority Women and Men in Sweden: Is the Risk Equally Spread Within the Sexual Minority Population? J Sex Med 2017 Mar; 14(3): 396-403. doi: 10.1016/j.jsxm.2017.01.012. Epub 2017 Feb 12. PubMed PMID: 28202321; PubMed Central PMCID: PMC6909248. Moore CL, Grulich AE, Prestage G, Gidding HF, Jin F, Petoumenos K, Zablotska IB, Poynten IM, Mao L, Law MG, Amin J. Hospitalization for Anxiety and Mood Disorders in HIV-Infected and -Uninfected Gay and Bisexual Men. J Acquir Immune Defic Syndr 2016 Dec 15; 73(5): 589-597. doi: 10.1097/QAI.0000000000001147. PubMed PMID: 27846072; PubMed Central PMCID: PMC5141611. Muñoz-Laboy M, Ripkin A, Garcia J, Severson N. Family and Work Influences on Stress, Anxiety and Depression Among Bisexual Latino Men in the New York City Metropolitan Area. J Immigr Minor Health 2015 Dec; 17(6): 1615-26. doi: 10.1007/ s10903-015-0220-2. PubMed PMID: 25957046. Reitzel LR, Smith NG, Obasi EM, Forney M, Leventhal AM. Perceived distress tolerance accounts for the covariance between discrimination experiences and anxiety symptoms among sexual minority adults. J Anxiety Disord 2017 May; 48: 22-27. doi: 10.1016/j.janxdis.2016.07.006. Epub 2016 Jul 21. PubMed PMID: 27475254; PubMed Central PMCID: PMC5253127. Remy LS, Scherer J, Guimarães L, Surratt HL, Kurtz SP, Pechansky F, Kessler F. Anxiety and depression symptoms in Brazilian sexual minority ecstasy and LSD users. Trends Psychiatry Psychother 2017 Oct-Dec; 39(4): 239-246. doi: 10.1590/2237-608920160081. Epub 2017 Nov 13. PubMed PMID: 29160330. Sandfort TGM, deGraff R, Ten Have M, Ransome Y, Schnabel P. Same-sex Sexuality and Psychiatric Disorders in the Second Netherlands Mental Health Survey and Incidence Study (NEMESIS-2). LGBT Health. (2014); 1(4):292-301. Semlyen J, King M, Varney J, Hagger-Johnson G. Sexual Orientation and Symptoms of Common Mental Disorder or Low Wellbeing: Combined Meta-analysus of 12 UK Population Health Surveys. BMC Psychiatry. (2016); 16(67):1-9. Tao J, Qian HZ, Kipp AM, Ruan Y, Shepherd BE, Amico KR, Shao Y, Lu H, Vermund SH. Effects of depression and anxiety on antiretroviral therapy adherence among newly diagnosed HIV-infected Chinese MSM. AIDS 2017 Jan 28; 31(3): 401-406. doi: 10.1097/QAD.0000000000001287. PubMed PMID: 27677168; PubMed Central PMCID: PMC5233466. Tao J, Vermund SH, Lu H, Ruan Y, Shepherd BE, Kipp AM, Amico KR, Zhang X, Shao Y, Qian HZ. Impact of Depression and Anxiety on Initiation of Antiretroviral Therapy Among Men Who Have Sex with Men with Newly Diagnosed HIV Infections in China. AIDS Patient Care STDS 2017 Feb; 31(2): 96-104. doi: 10.1089/apc.2016.0214. PubMed PMID: 28170305; PubMed Central PMCID: PMC5312604. 19. Depression: Chodzen G, Hidalgo MA, Chen D, Garofalo R. Minority Stress Factors Associated with Depression and Anxiety Among Transgender and Gender-Nonconforming Youth. J Adolesc Health 2019 Apr; 64(4): 467-471. doi: 10.1016/j.jadohealth.2018.07.006. Epub 2018 Sep 18. PubMed PMID: 30241721; PubMed Central PMCID: PMC6528476. Hu Y, Zhong XN, Peng B, Zhang Y, Liang H, Dai JH, Zhang J, Zhong XH, Huang AL. Comparison of depression and anxiety between HIV-negative men who have sex with men and women (MSMW) and men who have sex with men only (MSMO): a cross sectional study in Western China. BMJ Open 2019 Jan 3; 9(1): e023498. doi: 10.1136/bmjopen-2018-023498. PubMed PMID: 30610021; PubMed Central PMCID: PMC6326305. Lee C, Oliffe JL, Kelly MT, Ferlatte O. Depression and Suicidality in Gay Men: Implications for Health Care Providers. Am J Mens Health 2017; 11(4): 910-919. doi:10.1177/1557988316685492 Sandfort TGM, deGraff R, Ten Have M, Ransome Y, Schnabel P. Same-sex Sexuality
and Psychiatric Disorders in the Second Netherlands Mental Health Survey and Incidence Study (NEMESIS-2). LGBT Health. (2014); 1(4):292-301. Semlyen J, King M, Varney J, Hagger-Johnson G. Sexual Orientation and Symptoms of Common Mental Disorder or Low Wellbeing: Combined Meta-analysus of 12 UK Population Health Surveys. BMC Psychiatry. (2016); 16(67):1-9. 20. Suicide: De Graaf R, Sandfort TGM, ten Have M. Suicidality and Sexual Orientation: Differences Between Men and Women in a General Population-based Sample from the Netherlands. Arch Sex Behav. (2006); 35(3):253-262. Kann L, Olsen EOM, McManus T, et. al. Sexual Identity, Sex of Sexual Contacts, and Health-Risk Behaviors Among Students in Grades 9-12: Youth Risk Behavior Surveillance, Selected Sites, United States, 2001-2009. MMWR (2011). June 10; 60:133. Kunzweiler CP, Bailey RC, Okall DO, Graham SM, Mehta SD, Otieno FO. Depressive Symptoms, Alcohol and Drug Use, and Physical and Sexual Abuse Among Men Who Have Sex with Men in Kisumu, Kenya: The Anza Mapema Study. AIDS Behav 2018; 22(5): 1517-1529. doi:10.1007/s10461-017-1941-0 Mathy RM, Cochran SD, Olsen J., et.al. The Association between Relationship Markers of Sexual Orientation and Suicide: Denmark, 1990-2001. Soc Psychiatry Psychiatr Epidemiol. (2011); 46(2):111-117. Parker RD, Lõhmus L, Valk A, Mangine C, Rüütel K. Outcomes associated with anxiety and depression among men who have sex with men in Estonia. J Affect Disord 2015 Sep 1; 183: 205-9. doi: 10.1016/j.jad.2015.05.014. Epub 2015 May 15. PubMed PMID: 26025366. 21. D ai H, Meyer IH. A Population Study of Health Status Among Sexual Minority Older Adults in Select U.S. Geographic Regions. Health Educ Behav 2019; 46(3): 426-435. doi:10.1177/1090198118818240 22. Kann L, Olsen EOM, McManus T, et. al. Sexual Identity, Sex of Sexual Contacts, and Health-Risk Behaviors Among Students in Grades 9-12: Youth Risk Behavior Surveillance, Selected Sites, United States, 2001-2009. MMWR (2011). June 10; 60:1-33. 23. O ’Cleirigh C, Pantalone DW, Batchelder AW, et al. Co-occurring psychosocial problems predict HIV status and increased health care costs and utilization among sexual minority men. J Behav Med 2018; 41(4): 450-457. doi:10.1007/s10865-018-9913-z 24. Camenker, B., 2017 Feb 3. The Health Hazards of Homosexuality. CreateSpace Independent Publishing Platform. February 3, 2017. ISBN 9781539983811 25. Frisch M, Brønnum-Hansen H. Mortality among men and women in same-sex marriage: a national cohort study of 8333 Danes. Am J Public Health 2009; 99(1): 133-137. doi:10.2105/AJPH.2008.133801 26. C ochran SD, Mays VM. Sexual orientation and mortality among US men aged 17 to 59 years: results from the National Health and Nutrition Examination Survey III. Am J Public Health 2011; 101(6): 1133-1138. doi:10.2105/AJPH.2010.300013 27. Jones SL, Yarhouse MA. A Longitudinal Study of Attempted Religiously Mediated Sexual Orientation Change. J Sex Marital Ther. (2011); 37(5):404-427. 28. Nyamathi A, Reback DJ, Shoptaw S, Salem BE, et. al. Impact of Tailored Interventions to Reduce Drug Use and Sexual Risk Behaviors Among Homeless Gay and Bisexual Men. Am J Mens Health (2017); 11(2):208-220. 29. Reback CJ, Shoptaw S. Development of an Evidence-based, Gay-specific Cognitive Behavioral Therapy Intervention for Methamphetamine-abusing Gay and Bisexual Men. Addict Behav. (2014); 39(8):1286-1291. 30. Shoptaw S, Reback CJ, Peck JA, et. al. Behavioral Treatment Approaches for Methamphetamine Dependence and HIV-related Sexual Risk Behaviors Among Urban Gay and Bisexual Men. Drug Alcohol Depend. (2005); 78(2):125-134. 31. Shoptaw S, Reback CJ, Larkins S, et.al. Outcomes Using Two Tailored Behavioral Treatments for Substance Abuse in Urban Gay and Bisexual Men. J Subst Abuse Treat. (2008); 35(3):285-293. 32. Vice.com. 2020. The Openly Gay Christians Swearing Off Sex For Jesus. [online] Available at: <https://www.vice.com/en_ca/article/bj379a/the-openly-gay-christiansswearing-off-sex-forjesus> [Accessed 23 August 2020]. Revised from 2016 CMDA Statement Approved by Board on January 30, 2021 Approved by the House of Representatives Passed with 42 approvals, 0 opposed, 0 abstention May 2, 2021, virtual
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Bioethics The Dr. John Patrick Bioethics Column
John Patrick, MD
“Go and clean your room!”
N
ow, is that likely to get immediate and rueful compliance? Probably not, yet we cannot live without a modicum of order. But order divorced from a richer framework can become a devastating obsession. As is inevitable, if we are made in the image of God, our bristling response to anyone telling us what to do meets an inner reality that we know when the command is justified. We are not mere animals responding to innate instincts. We do not even arrive as an empty slate but as rational beings with moral knowledge, but so often we are unable to respond appropriately 32 | CMDA TODAY | WINTER 2021
and very, very unlikely to be grateful that we are made with moral knowledge. Blessed are the wounds of a friend, but he’s no friend of mine at the moment of conviction. Ah, the human condition is not compatible with Utopian dreams. As a morally fractured culture, we are so solipsistic (navel gazing) that we all want it my way and don’t tolerate anyone asking the question, “Why?” Anyway, who is going to adjudicate? The ever-enlarging bureaucracy wants to, but its continuous power grabs are not going unnoticed. Some sort of agreed ethical framework, one that is realistic about who we are, is desperately needed. The courts should go back to interpreting the law not making it. But on what foundation do ethics stand?
If I ask medical students to rank the four moral principles in patient care—beneficence, non-maleficence, autonomy and justice—they most frequently put autonomy at the top. If I state them differently as, “Do not do harm, do good, be just, honor autonomy,” they will be more thoughtful but still lost. These are your future colleagues—brainwashed into reductionism not understood by either their role models or themselves. In The Abolition of Man, C.S. Lewis summarized it with an earthy metaphor: “We castrate and bid the gelding be fruitful.” Of the many contradictions that the ruling elite face, the meaning of fact is the most ambiguous. If only scientific facts are publicly true and that includes radical Darwinism, then there is no universal good. “What’s in it for me” is the only real Darwinian question, and getting caught is the only restraint. Yet the leaders of our profession waffle on about the need for empathy with patients who are suffering and dying. Science has nothing to offer at this point, so we are providing euthanasia. How did all this come about? Jews and Greeks and all the great religions believed in transcendence. There must be something beyond us, materialism is not enough. They could see that some lives were well lived, and they were ordered toward honesty, integrity and justice—they had genuine purposes in life, labeled as telos in Greek. Living well meant finding one’s place in the natural created order. The children of Israel believed God gave them the law so they would flourish. He did not give reasons for the laws, but He said, “Keep this law and you will flourish, go against it and you will not.”
and order so we could get on with producing more things. We, as individuals, are free, but we willingly trade in some of our freedom for security and order. This is the consent of the governed. Obey the law and do what you want. Hobbes followed with the recognition that such individual freedom will spread onto all areas of life not controlled by law. He acknowledged that the origin of parental authority was God’s law delivered to Moses, but he said it was self interest that made it work and individuals should be free, including wives and children, but they would face trade-offs. He did not engage with the idea that when we cease to honor God, we will soon cease to honor His laws. Autonomy was nevertheless king. Patrick Deneen wrote, “Ironically, the more complete the securing of a sphere of autonomy, the more encompassing and comprehensive the state must become. [Modern views of ] liberty require in the first instance liberation from all forms of associations and relationships—from the family, church, and schools to the village neighbourhood and community broadly defined—that exerted strong control over behavior largely through informal and habituated expectations and norms.”1 Now we have reached a cancel culture where local loves and norms are dismissed, while unscrupulous traders in victimhood without thought of consequence have effectively destroyed the lives of many whom they claim to represent with the inner-city riots and accompanying vandalism of small businesses.
There is a real fact/value divide. Clever academics confuse students with trickery by saying I can get a value from a physical fact: “If you want to catch the train you ought to leave now.” However, that is only a prudential ought, not a moral one. Read and re-read C.S. Lewis’ The Abolition of Man until you can make the argument. It is only just over 100 pages.
Freedom must be preserved, but to quote English philosopher Lord Acton, it must be the freedom to do what you ought, not what you wish. Sadly, without a revival of genuine religion, that is unlikely. “Out of the crooked timber of humanity, no straight thing can be made” (which is Isaiah Berlin quoting Kant).
Before the Scientific Revolution beginning in the late 13th century, moral facts were dominant because they gave us a telos, a purpose for living well. They were qualitative and described good and bad character, but the new science started measuring things and experimenting, hypothesizing and testing again. The power of reductive science was utterly astonishing. Within a couple of centuries, Francis Bacon purloined the word “fact” for things which can be measured. That is how we almost all think today. Of course, all the cultural norms derived from the Greeks and Judeo-Christian theology were assumed to be untouched, but they were not. COVID managers had only the physical facts in their field of vision. They were blind to all our metaphysics, love, loyalty and promise keeping, and they forced us to break our marriage vows (until death do us part) by putting a glass screen between people who had lived together for decades.
1 https://www.firstthings.com/article/2012/08/unsustainableliberalism
References
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.
English philosopher Thomas Hobbes, he of nasty, brutish and short fame, taught that we needed rulers to provide law www.cmda.org | 33
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