Today's Christian Doctor - Spring 2012 by Christian Medical & Dental Associations

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editor

letter from the

by Mandi Mooney

The History of Today

Use your smartphone to read the historical articles or visit www.cmda.org/reflections

I was an immature and naïve high school student when I asked my grandfather if he wanted to go see Pearl Harbor with me at the theatre. History had always been my favorite subject in school, and I thought he would be interested in seeing the movie since he had served in the U.S. Navy during World War II. I knew immediately that he wasn’t happy with me when he started his response with “Chuckeye,” an anonymous term that my sisters and I well-knew as the precursor to being in big, big trouble. And I don’t think I’ll ever be able to forget the look on his face as he flatly turned me down, “That is not real war. If you want to know what it was really like, then listen up.” He began to talk about the war with a sense of great urgency in his voice, as if this was his one chance to get me to understand. He told me about sailing through the South Pacific, he showed me pictures of his war buddies and he brought out the U.S. flag given to him by his captain that flew on their ship throughout the war. It was the only time that I can recall my grandfather ever talking about his experiences in the war. Those pieces of memorabilia are still some of our family’s most treasured keepsakes. But it was that one conversation that stuck with me the most, and it created within me a deep desire, a fascination, a yearning to discover as much as possible about the events that make us who we are today. I started soaking up as much information as possible. My college friends thought I was crazy when I took extra history courses—and even read the textbooks—just for the fun of it. I watched specials on the History Channel, read biographies of important historical figures and visited museums and exhibits. That same intrigue with the chronicles of history continues to motivate me in my work at CMDA. It started out as a simple idea for a quarterly theme for the magazine. What can we learn from the history of Today’s Christian Doctor? How has a particular topic that was examined decades ago changed? Has the passage of time affected that topic or has culture affected it? But as I sat in the CMDA Library reading through archived editions of the journal, it developed into something much larger. I realized that the issues and topics writers discussed in 1950 are the same topics we find ourselves discussing in today’s arena. And the possibilities became endless. Bioethics, abortion, family, medicine as ministry, medical marriage, dentistry, medical missions, today’s medical student, homosexuality, divorce. The list could go on and on. So the idea rapidly expanded into a year-long series, “Reflections of the Past in Today’s Spotlight.” Throughout the series, authors will be taking a side-by-side look at previously published articles as they reflect upon the topics from today’s perspective. Due to space restrictions, the historical articles that serve as inspiration aren’t published in their entireties, but you can view those articles at www.cmda.org/reflections or scan the included smart tag with your smartphone. Aristotle once said, “If you would understand anything, observe its beginning and its development.” The pages of our history have defined the course of the magazine for this year. So join us as we journey into the past to gain a fuller understanding of issues facing the healthcare professions today. It’s an understanding that we must develop in order to better face the future.

C HRISTIAN M EDICAL & D ENTAL A SSOCIATIONS

www.cmda.org

contents Today’s Christian Doctor

VOLUME 43, NO. 1

Spring 2012

The Christian Medical & Dental Associations® Changing Hearts in Healthcare – since 1931.

How Do Today’s Medical Ethic 13 Compare with Christian Ethics? by Robert D. Orr, MD, CM The growth of medical ethics in the past 60 years

Remember to Remember: 17 The Modern Implications of Abortion by John Patrick, MD Examining the cultural changes of abortion

Strategy to 23 CMDA’S Transform Doctors to Transform the World by David Stevens, MD, MA (Ethics) Measuring the success of the ministries of CMDA

30 A Biblical Foundation for Medicine Part 3: Overview of Scripture

by John Dunlop, MD, MA (Bioethics) The final installment in a three-part series

Post-Roe v. Wade: 20 Overt War on Conscience Rages by Jonathan Imbody The impact of Roe v. Wade on doctors’ rights

5 34

Transformations Advertising Section

egional Ministries Northeast Region Scott Boyles, MDiv P.O. Box 7500 Bristol, TN 37621 Office: 423-844-1092 scott.boyles@cmda.org

Connecting you with other Christ-followers to help better motivate, equip, disciple and serve within your community Midwest Region Allan J. Harmer, ThM 9595 Whitley Dr. Suite 200 Indianapolis, IN 46240-1308 Office: 317-556-9040 cmdamw@cmda.org

Western Region Michael J. McLaughlin, MDiv P.O. Box 2169 Clackamas, OR 97015-2169 Office: 503-552-1950 west@cmda.org

Southern Region William D. Gunnels, MDiv 106 Fern Dr. Covington, LA 70433 Office: 985-502-7490 south@cmda.org

Interested in getting involved? Contact your regional director today!

TODAY’S CHRISTIAN DOCTOR®

transformations Transformations Come to Life

EDITOR Mandi Mooney EDITORIAL COMMITTEE Gregg Albers, MD John Crouch, MD William C. Forbes, DDS Autumn Dawn Galbreath, MD Curtis E. Harris, MD, JD Van Haywood, DMD Rebecca Klint-Townsend, MD Robert D. Orr, MD Debby Read, RN VP FOR COMMUNICATIONS Margie Shealy AD SALES Margie Shealy – 423-844-1000 DESIGN Judy Johnson PRINTING Pulp CMDA is a member of the Evangelical Council for Financial Accountability (ECFA). TODAY’S CHRISTIAN DOCTOR®, registered with the U.S. Patent and Trademark Office. ISSN 0009-546X, Spring 2012 Volume XLIII, No. 1. 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 © 2012, 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, Tenn. Postmaster: Send address changes to: Christian Medical & Dental Associations, P.O. Box 7500, Bristol, TN 37621-7500. Undesignated Scripture references are taken from the Holy Bible, New International Version®, Copyright© 1973, 1978, 1984, Biblica. Used by permission of Zondervan. All rights reserved. Scripture references marked (KJV) are taken from the King James Version. Scripture references marked (MSG) are taken from The Message. Copyright© 1993, 1994, 1995, 1996, 2000, 2001, 2002. Used by permission of NavPress Publishing Group. Scripture references marked (NASB) are taken from the New American Standard Bible®, Copyright© 1960, 1962, 1963, 1968, 1971, 1972, 1973, 1975, 1977, 1995 by The Lockman Foundation. Used by permission. Scripture references marked (NIV 2011) 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. Scripture references marked (NKJV) are taken from the New King James Version. Copyright© 1982 by Thomas Nelson, Inc. Used by permission. All rights reserved. Other versions are noted in the text.

“Transformed Doctors, Transforming the World.” CMDA’s vision statement may be a simple sentence, but it’s an unwavering phrase that guides the direction of our various ministries. Each new service we provide bears the goal of working to transform our members as it opens avenues for those same members to transform others. And how do you as members see that transformation? Going forward, we’ll be measuring and showcasing those results through your words, through your comments, through your experiences. Welcome to Transformations, the newly revamped Progress Notes section. This new section will focus on highlighting the inspirational and personal stories and testimonies from our members and ministries. Each story will truly show the impact that CMDA is having on healthcare and on the world. It is our hope that you will read these transformations and be inspired to be transformed yourself. So join us as we make CMDA’s vision statement come to life within the pages of Today’s Christian Doctor.

Spiritual Refreshment in the Northeast During the recent Northeast Winter Conference in Chesapeake Bay, about 180 healthcare professionals and their families, students and residents gathered to explore how followers of Christ are called to pursue soul-satisfying joy. CMDA members in the Northeast region have come to early anticipate this event, knowing that they will meet God and His people throughout the weekend. The conference included small group discussions, campus leadership training, a WIMD session and main sessions with speakers Drs. Paul and Susan Lim. One of the main goals of the weekend was spiritual refreshment, and many conference attendees reported that their relationships with God had been affected and they found themselves changed as a result.

For membership information, contact the Christian Medical & Dental Associations at: P.O. Box 7500, Bristol, TN 37621-7500; Telephone: 423-844-1000, or toll-free, 1-888-230-2637; Fax: 423-844-1005; E-mail: memberservices@cmda.org; Website: http://www.joincmda.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.

• “I no longer pursue my own joy, my freedom, my own growth. I now pursue God with great hope and joy.” • “I’m even more in love with the Lord, and am more excited to serve in the place He has me now.” • “I didn’t realize how far I had distanced myself from God for a while. I have a renewed passion to glorify Him.” • “Like in Jesus’ parable, weeds are growing in my soil. This has been a weekend of spiritual weeding.” • “[I am] motivated to serve God with joy and to seek Him more because He is the source of joy.” C HRISTIAN M EDICAL & D ENTAL A SSOCIATIONS

www.cmda.org

transformations Expansion of Dental Ministries sional and personal lives. Dr. Amstutz will be focusing on greatly expanding our ministry, services and resources for our dental members, as well as intensifying our outreach in dental schools across the country. This new ministry will have an outreach focus as we seek to transform the hearts of dentists so they can transform dentistry. Visit www.cmda.org/dentist and stay tuned for more information about plans to increase dental membership and enhance services to dentists and dental students. Jeff can be reached via email at jeff.amstutz@ cmda.org or via phone at 423-844-1000.

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Jeff will be speaking at the CDA Prayer Breakfast held during the 100th Thomas P. Hinman Dental Meeting on March 23 from 7 a.m. to 8:30 a.m. in Atlanta, Georgia. The breakfast will be held at the Omni Hotel at the CNN Center, and registration is $25 per person. For more information or to register, visit www.cmda.org.

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We are pleased to announce that Jeff Amstutz, DDS, MBA, joined CMDA in January as the Vice President for Dental Ministries, Peter E. Dawson Chair of Dentistry. Jeff brings a passion for ministry, proven entrepreneurial abilities, years of successful work in ministry, U.S. practice knowledge and a wealth of experience to this role. Dr. Amstutz is a graduate of Case Western Reserve and its School of Dental Medicine. While running an active practice in Warren, Ohio, he completed a master of business administration at Kent State University. After 10 years of family dentistry, Jeff and his wife Carrie were called to the mission field in 1999, where they opened a dental clinic in Gabon, established a program to train Gabonese dental technicians, and launched a mobile ministry to treat and evangelize to people in remote villages. In 2004, the Amstutzes moved north, where Jeff was responsible for building and directing a women’s and children’s hospital in Mali. In 2007, Dr. Amstutz joined Compassion and Mercy Associates (CAMA), a Christian relief and development agency, where he was responsible for managing and expanding CAMA services in Senegal and throughout Africa. With the growth of the Dental Ministries, CMDA has a great opportunity to influence many more dentists across the country to better integrate their faith into their profes-

Known as one of the premier dental events in the country, the Hinman Dental Meeting will be held March 22-24, 2012, and features continuing education for dental professionals, exhibits and entertainment. For more information about the conference, visit www.hinman.org.

CMDA is expanding its Dental Ministries in partnership with Dr. Pete Dawson, and the chair position was renamed the Peter E. Dawson Chair of Dentistry in his honor. A well-known dentist, Dr. Dawson is the founder of Dawson Academy, a renowned training center that has provided continuing dental education courses for practicing dental professionals for more than 30 years. Dr. Dawson recently accepted a position as a CMDA board member, and he is working with Dr. Amstutz and other CMDA staff members to develop and increase the dental aspect of CMDA’s ministry.

CMDA Members Recognized for Their Work and Service Dr. Louis Carter was honored with the award of Humanitarian of the Year at the annual Clinical Congress of the American College of Surgeons. He received this award in recognition of his 37 years of service with his wife Anne as missionaries to the needy people in the developing world.

Dr. Jimmy Lin was announced as a new member of the TED Fellows program which honors individuals who have shown unusual accomplishment, exceptional courage and moral imagination. Dr. Lin is a geneticist and the founder of the Rare Genomics Institute, an organization that allows patients to crowdsource funds and genomes to accelerate research of their rare genetic diseases.

T ODAY ’S C HRISTIAN D OCTOR

S PRING 12

.. . e oic V Making ur Yo

a Difference in Washington, D.C.

FOR MORE INFORMATION

“Our office has been getting communications from constituents regarding the Respect for Rights of Conscience Act, which means that groups like yours are doing a good job getting the word out.” – U.S. Senator “Thank you very sincerely for your email. I was happy to reach out to my senators and will be following-up with Senator Mikulski. I appreciate also your specifics and inclusion of Dave Stevens’ letter. I will try to make good use of them both. Glad to be in the trenches with you.” – CMA member who wrote to his senator about conscience legislation, using CMA’s CapWiz tools These statements are just two of the many positive comments received in CMA’s Washington Office as a result of the CapWiz Legislative Action Center, available through Freedom2Care. The results of this new tool are easy to see as we work with you to directly impact legislation. • The number of emails sent by users regarding the Respect for Rights of Conscience Act (S. 1467) now

AND

UPDATES, VISIT

WWW. FREEDOM 2 CARE . ORG

totals 2,373. A total of 24 senators now cosponsor this bill. This proposal has been referred to the Committee on Health, Education, Labor and Pensions. • The Protect Life Act (H.R. 358) was passed in 2011, thanks in part to the 1,016 messages that were sent to legislators urging their support of the bill. A total of 145 representatives helped to cosponsor this bill. • Dr. David Stevens gave testimony on right of conscience before the House of Representative’s Subcommittee on Health in November 2011. More than 1,300 people submitted their responses in a survey for Dr. Stevens to include in his testimony. • New users are being added to the mailing list on a regular basis. There’s still time for you to get involved, and this easy-to-use tool makes it simple for you as a busy healthcare professional. Through CapWiz, you have the ability to send pre-written, customizable emails specifically targeted to your own legislators. These emails can also include a variety of personalized information, such as your legislator’s contact information. Visit www.capwiz.com/f2c or www.freedom2care.org to get involved today.

Website Directory Transformation

Equipping

Campus Ministries cmda.org/student Chapel & Prayer Ministries cmda.org/chapel Community Ministries cmda.org/ccm Dental Ministries cmda.org/dentist Medical Malpractice cmda.org/mmm Side By Side cmda.org/sidebyside Singles cmda.org/singles Specialty Sections cmda.org/specialtysections Women in Medicine & Dentistry cmda.org/wimd

Christian Doctor’s Digest cmda.org/cdd Conferences cmda.org/meetings Doing the Right Thing cmda.org/rightthing Donations cmda.org/donate Human Trafficking cmda.org/trafficking LifeSkills Institute cmda.org/lifeskills Today’s Christian Doctor cmda.org/tcd Weekly Devotions cmda.org/devotions

Voice Service Center for Medical Missions cmda.org/cmm Global Health Outreach cmda.org/gho Global Health Relief cmda.org/ghr Medical Education International cmda.org/mei Membership joincmda.org Pan-African Academy of Christian Surgeons cmda.org/paacs Placement cmda.org/placement Scholarships cmda.org/scholarships

American Academy of Medical Ethics ethicalhealthcare.org Washington Office cmda.org/washington Freedom2Care freedom2care.org

Social Media Blogs cmda.org/blogs Facebook facebook.com/cmdanational Twitter twitter.com/cmdanational YouTube youtube.com/cmdavideos

transformations . . . in Public Policy “Through our membership we know that the Christian voice is not silenced.” – A married CMDA couple “I’m not a Christian, and I generally have a dim view of organized religion, so I was initially skeptical about Dr. Stevens. But his depth of knowledge about the ethical and scientific rhetoric makes him an excellent spokesman despite his affiliation with Christianity.” – A listener during a radio interview conducted with Dr. David Stevens “I have always enjoyed Dr. Patrick’s discussions on [Christian Doctor’s Digest]. After hearing the recent discussion of Hippocratic medicine, I opened the newspaper and read Leonard Pitts—a Pulitzer Prize winning columnist who often says disparaging things about faith. In his (10/10/10) column, “This Citizen Journalism fad is not genuine Journalism,” he says, ”Journalism—like any profession worthy of the name—has standards and ethics, and if you don’t sign on to those, I can no more trust you than I can a doctor who refused the Hippocratic Oath.” Wow, it is just like Dr. Patrick said! Just wanted to thank whoever is involved for this phenomenal resource that is so well and faithfully done. You are making a difference.” – A CMDA member

. . . on Campus

Seen

& Heard

“Having a community of believers within the medical community has been such a blessing. We are going through the same struggles, temptations and stresses; we can pray for and with each other through these issues. Also, I have learned so much from having physicians who are wonderful examples of Christian leaders within the medical profession come and speak to us about what it means and what it looks like to be a Christian physician.” – An M3 student

the CMDA voice

“I feel I have grown tremendously in my spiritual life since coming to medical school and CMDA is the reason for that. Being involved in a strong community of believers within my own class has motivated me to reconnect with my faith and to work to grow it stronger than I feel it has ever been.” – An M1 student “When we see Christ healing in the New Testament, He makes a specific point to address their spiritual needs as well as their physical ones. As physicians, we’ll always need to remember that it’s a trivial thing to heal the body while the soul is dying. We need to maintain an eternal mindset, and CMDA helps us keep that focus.” – A CMDA Student Leader

. . . in Missions “Through the use of ultrasound, women were able to see God’s creation of life, and hearts were turned to Him. One young woman gave her heart to Jesus after she had the opportunity to watch her 12-week-old unborn baby dance for Jesus on the ultrasound. Another woman chose life over abortion as she witnessed God’s knitting together of life in her womb.” – An OB/Gyn on a GHO trip to Haiti “I have been on over 15 missions trips and I have to say this was one of the most rewarding! Not only from the standpoint of helping the indigent, meeting new people from all over the U.S., working with awesome professionals, but from the wonderful opportunity of our surgeons sharing their knowledge with a residency program! I felt honored to be a small part of teaching even though it was not in my field of expertise. I plan to go again as often as I can.” – A nurse anesthetist on a GHO trip to Honduras “I gave a workshop on Asperger’s in the classroom and was surprised at the overwhelming response to it. Many children with special needs have not been educated in the past in Kenya, but that is beginning to change. I realized there is a great need for more teachers and therapist education in this area.” – A special education teacher on an MEI trip to Kenya “As I thought about available mission service trips, I was frustrated to consider how little primary care doctors like me could really do with short-term exposure. While ophthalmologists could go and pull some cataracts, what was I going to do—hand out some aspirin? That’s when it occurred to me how it would be great to do some teaching at overseas med schools . . . and in the matter of a few weeks I pretty much caught fire with the idea. And then I found MEI—it was already being done!” – A recent MEI applicant “[I’m a] longtime follower of Christ, but until now . . . had never prayed with a U.S.A. patient. Transformation happens at any age, at any stage!” – A retiring subspecialist hematologist on a GHO trip to Nicaragua “After reading your most recent e-pistle, I felt I ought to let you know how much you are appreciated. Thank you for the encouragement you give us and the experience and all the wisdom and encouragement of the Word. You are a great vessel through which Jesus flows to many.” – A subscriber to the Center for Medical Missions’ e-newsletter, The e-pistle “I very much enjoy coming alongside students on trips and teaching about patients seen as well as encouraging them to pray with patients and develop a vision for putting their faith in action in their practices.” A GHO team leader

Have you been

transformed? Are you

transforming others? We want to hear from you Send your transformation story, letter or photos to communications@cmda.org or to P.O. Box 7500, Bristol, TN 37621. Please include an email address for us to contact you.

We want to hear your story It can be a simple comment about a CMDA ministry; it can be an account of your experiences on a missions trip; it can be a profile of a member who has had a huge impact upon you; it can be photos from a campus meeting; it can be statistics showing how your trip served the needy; it can truly be anything— we want to see how your work is making a difference.

We want to hear your ideas Do you have a great idea for Today’s Christian Doctor? Send your ideas to communications@cmda.org.

Transformations showcasing the impact of CMDA one story at a time

THE CENTER FOR BIOETHICS & HUMAN DIGNIT Y presents the 19 th Annual Summer Conference

G N I M I A Y L T C I RE GN

Join us as we explore important ethical considerations surrounding developments in reproductive practices and global women’s health through the lens of reclaiming dignity in a culture of commodifica tion. Human dignity, once a cornerstone for bioethics, is increasingly obscured by a contemporary culture of commodiﬁcation. Without neglecting the ongoing emphases on beginning- and end-of-life issues, our task must include attention to prenatal discrimination, the neglect of the girl child, worldwide disparities in women’s healthcare and maternal mortality, and the objectiﬁcation and exploitation of the female body. Responsible Christian bioethics embraces her dignity as essential to her community and foundational to our common humanity.

CONFIRMED SPEAKERS Monique Chireau, MD, MPH, Assistant Professor of Obstetrics and Gynecology, Duke University School of Medicine Paige C. Cunningham, JD, Executive Director, C. Ben Mitchell, PhD, Graves Chair of Moral Philosophy, Union University Pia de Solenni, SThD, Owner Diatoma Consulting

PARTNERS

JULY 12-14, 2012 Register by visiting cbhd.org/conf2012 Receive a $10 discount by entering the code TCD121 *Discount code does not apply to student or one-day rates

president from the CMDA

John R. Crouch, Jr., MD

How Things Have Changed

As the medical director of a nursing home, I enjoy talking with our senior citizens and will often hear about “how it was back in (year),” and how radically changed life is now. It’s not always just about our cars and methods of traveling, our homes and the conveniences, TV and the media, or the impact information technology has on our lives with its myriads of modalities. Senior citizens also pointedly talk about changes in attitudes, morals and community. It’s these latter changes that they don’t necessarily see as positive changes. Just this morning, I visited with A.C. who is proud to be a veteran of World War II and a survivor of Pearl Harbor. During my prayer with him, I thanked God for his service in the cause of freedom; he beamed and, though he is a bit reserved, gave me a hug. What am I saying? Change is inevitable; both large changes and small changes. Sometimes change is for the good, sometimes it’s not so good, sometimes it’s even bad. That is true for organizations, whether it is the In His Image Family Medicine residency program and its outreach ministries (on which I spend much of my time) or a great organization like CMDA. The challenge lies in attempting to manage to some degree the change that is a part of every organization so it is change for the good. From my perspective of being on the CMDA Board the last several years and now serving as president, I can honestly say that our current leaders (Dr. David Stevens, Dr. Gene Rudd and all the other physicians and staff) seem to represent positive change. Thank God for providing these individuals. At the CMDA National Convention, we hold a reception for past presidents where I visit with the preceding men and women of God who created a powerful sense of consistency within the organization, and I prayerfully hope to do my part. There have been some changes in the House of Representatives (formerly House of Delegates). There is now a written strategic plan which is updated regularly. There have been changes in commissions and committees. There have also been changes in strategies for medical missions. And there have certainly been changes in our media and communications departments with Christian Doctor’s Digest on CD and all the ways to get information electronically. And now I am excited about how Today’s Christian Doctor will change. But my heart compels me to point out that there is one thing that must not change. That is the absolute commitment of our organization and its members to the centrality of the gospel. In every part of the organization, we can, should and even must change methods; but please, and I write this literally on my knees, “Please Father, never let us stray from the cross.” 1 Corinthians 1:18 says, “For the word of the cross is foolishness to those who are perishing, but to us who are being saved it is the power [dunamis: the active, life-changing power] of God” (NASB). When it comes to my personal life and my work commitments, I find myself getting frustrated and allowing things to become chaotic when I drift from the cross. But when I constantly remind myself that GOD IS MY SOURCE, and when I remind myself moment by moment that the word of the cross is the power of God, that is when I find that answers and blessings come to me and to the organizations with which I am involved. CMDA is a professional organization that strives to help us grow in our walk as we serve in the power of the gospel. Will you join me with a renewed commitment to the gospel, that one thing that must never change? ✝

C HRISTIAN M EDICAL & D ENTAL A SSOCIATIONS

www.cmda.org

1940s

1950s

1960s

1970s

1980s

1990s

2000s

2010s

1951

In This Year . . . Around the World - “I Love Lucy” and “The Search for Tomorrow” debuted on CBS-TV. - Both the U.S. and USSR were performing nuclear tests, and Stalin claimed that Russia had an atomic bomb. - U.S. and UN forces recaptured Seoul during the Korean War. - The 22nd Amendment that limited a president to two terms of office was ratified to the U.S. Constitution. - All About Eve won the Oscar for Best Picture. - The Yankees beat the Giants to win the World Series.

In This Year . . . at CMDA - The name was Christian Medical Society, the headquarters were based in Chicago, Illinois, Howard Hamlin, MD, served as President and J. Raymond Knighton, Jr., was the Executive Secretary. - The fifth annual CMS Convention was held in Philadelphia, Pennsylvania. One of the keynote speakers was Stanley Anderson, MD, FACS, who led a discussion on birth control. - A subscription to the bimonthly published Christian Medical Society Journal was $1 per year. - Campus chapters were being established at several campuses including the University of California Medical School, the New York Medical College and the University of Louisville Medical School. - Membership dues took effect for the first time, producing an income of $4,597.50.

How Do Today’s Medical Ethics by Robert D. Orr, MD, CM Compare Wit h Christian Ethics? An update of an article with the same title by Robert D. Carpenter published by the Christian Medical Society in 1951 Use your smartphone to read the historical article or visit www.cmda.org/reflections

obert Carpenter, then a senior medical student and president of the Philadelphia chapter of the Christian Medical Society, penned an article in 1951 for the CMS journal comparing medical ethics and Christian ethics. Have things changed in 60 years? Medical Ethics

Medical ethics has changed a great deal in 60 years, especially regarding what issues come under the umbrella of medical ethics. Carpenter assumed that medical ethics primarily involved the relationships physicians had with patients and other physicians, not unlike Percival who wrote the first book on medical ethics in 1803, focusing on physician etiquette. Today we call this professional ethics, one division of medical ethics. But medical ethics has expanded into many other subdivisions as well.

Professional Ethics The physician-patient relationship has been, even since the time of Hippocrates, a fiduciary relationship, i.e., a relationship of trust. The physician has more knowledge, authority and power than the patient. This places a moral responsibility on the physician to always seek the best interests of the patient rather than to serve him- or herself. This responsibility has also been characterized as a covenant, a mission or even a ministry. This remains unchanged. What has changed is that the duty-based relationship has evolved into a rights-based relationship. Prior to the last generation, most physicians interpreted this unequal relationship to mean that they were in charge. Physicians were paternalistic and patients were expected to be subservient. In the social upheaval of the 1960s and ’70s,

C HRISTIAN M EDICAL & D ENTAL A SSOCIATIONS

www.cmda.org

Medical Ethics

individual rights came to the foreground with a focus on minority rights, women’s rights, consumer rights and patient rights. This leveling of the playing field has been a major improvement, preventing the unethical imposition of unwanted treatments on vulnerable patients. The down side, however, is that the professional relationship has taken on a contractual patina, even sometimes with an adversarial tone. Physicians have become “providers.” In addition, social and financial changes have made the long-term trusting relationship between a patient and physician much less common than in the past. Also, internet access to medical information (good and bad) has raised the level and intensity of discourse. Another consequence of the changed relationship is increasing claims of malpractice when patients are dissatisfied. Health Policy Carpenter alludes to what we would now recognize as a second division of medical ethics—health policy— when he asserts that euthanasia is wrong based on an understanding of the sovereignty of God. However, the arguments for and against physician-assisted suicide and euthanasia have been refined over the ensuing 60 years. Opposition on religious grounds alone is not always persuasive in our pluralistic society. We must also raise the specter of bad consequences if such a sea of change were to be adopted.1

The health policy perspective of medical ethics has exploded in the past 60 years to include such issues as mandatory immunizations, contraception, abortion, assisted reproductive technology, definition of death, transplantation, mind-altering drugs, cloning, use of embryonic stem cells, physicians’ participation in capital punishment, care of the poor and uninsured and so many more. “Medical ethics” is much broader and deeper than it used to be. In addition, discussions and decisions in health policy involve advocates, legislators and the courts. Research Ethics It is of historical interest that major failures in the professional ethics of some physicians led to the development of an entirely new subdivision of medical ethics. Physician-researchers in the Nazi death camps undertook experiments using prisoners as subjects, often resulting in pain, disability or death. They forsook their primary goal (seeking the best interest of individual patients) and replaced it with a secondary goal (enhancing the German war effort). Post-war discovery of these atrocities led to the Nuremberg Code and subsequent documents to prescribe the boundaries of ethical research. Tragically, North American researchers felt those ethical guidelines applied only to the “evil” German researchers. When the Tuskegee Study was exposed in 1972, we recognized that forsaking professional ethical standards could also lead to home-grown evils.2 This failure was repeated in studies of hepatitis in mentally disabled children, radiation experiments during the cold war, research on U.S. prisoners and many more. These revelations led to the establishment of Institutional Review Boards and federal oversight of research involving human subjects beginning in the 1970s and continuing with increased intensity and more stringent rules. Clinical Ethics In the past 60 years, advances in medical technology have led to extensive discussion of how and when that technology should be applied. The old maxim, “the ability to act does

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not justify the action,” has never been truer than in modern medicine. Just because we can do dialysis for renal failure does not mean that everyone in renal failure should receive dialysis. Thus, we now face many decisions that were not even contemplated a generation or two ago. Many times these tough decisions lead to disagreement, even conflict. And these conflicts occasionally lead to court battles and public discussion via the media. Beginning with Karen Quinlan in 1976, many such “media cases” have been discussed in the classroom and the living room.3 Soon thereafter, hospitals began to establish ethics committees to encourage education on issues of bedside ethics, to review hospital policies that raised ethical issues and eventually to consult on individual cases. Gradually in the 1980s and ’90s, the field of clinical ethics emerged. This discipline dealt less with policy and focused instead on bedside dilemmas. What are the ethically permissible options for a specific patient? Consultations in clinical ethics were originally done by a full ethics committee; more recently using a subcommittee model or individual ethics consultants. Organizational Ethics Even more recently, healthcare institutions have developed committees in organizational ethics to help the institution examine its role and responsibilities in relation to its mission and its obligations to the local community and to society in general.

“Medicine is inherently a moral enterprise.”4 Ethics is about right versus wrong; good versus bad; or even disciplined reflection on ambiguity. Thus it is not surprising that people of faith would be involved in discussions of ethics as it applies to medicine. The Christian Medical & Dental Associations was one of the leaders in such endeavors. Our first iteration, the Christian Medical Society, established an Ethics Commission in 1973. Over the ensuing 39 years, this body has proposed position statements on 45 issues involving professional ethics, health policy, research ethics and clinical ethics. These statements have been reviewed and modified by the Board of Trustees and the House of Representatives.5 This process continues. Several other Protestant and Catholic professional health organizations and many individual denominations have similarly developed position statements.6 In addition, countless books have been written from a Christian perspective on various issues and on medical ethics in general. Carpenter, in his original comparison of medical ethics and Christian ethics, said, “. . . the Christian physician has a different system of evaluation than that used by non-Christian physicians” and the Christian position “is based on the authoritative Word of God.” He did not, however, articulate how the Word could be applied in Christian medical ethics. In addition to the standard four principles of secular medical ethics (nonmaleficence, beneficence, autonomy and justice), believers have additional help from a number of scriptural principles:7

Medical Ethics

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Sanctity of Human Life – Since we are made in the image of God, each person is of inestimable value, regardless of his or her level of function. The Finitude of Life – Because Adam and Eve sought to be like God, everything changed. Because of the Fall, we are now subject to the human frailties of illness, suffering and death. Unless Jesus returns first, we will all die. God is Sovereign – God very often allows us to make decisions that are not compatible with His will. However, He has final authority. Miracles – God is all-powerful, and He can overrule the laws of nature that He established. The biblical accounts of miraculous intervention in illness are amazing. Believers often pray for His miraculous intervention in the illness of a loved one, but all such prayers should end with, “Thy will be done.”

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Stewardship – God has entrusted to us the earth, its resources and even our lives. We are responsible to Him for how we care for ourselves and our environment. The Quality of Life – Since the Fall, individuals have lives of varying quality. Some have limited functional or intellectual capacity; some have chronic pain or suffering. Sometimes the burdens of illness or disability exceed our ability to carry out our personal mission. In some circumstances, we may decide to use less than maximal efforts to preserve life.8 Justice – Based on the command for human justice, we should treat all people equally, without discrimination. Hope – We often cling to a hope that a loved one will survive and thrive in spite of dire medical predictions. However, our true hope is not in this life, but in eternal life, forever praising God. Part of our hope is that we have a Comforter who can help us as we confront difficult decisions. Our prayer might take the form of, “Thank you God for this person’s life. As we struggle with difficult decisions, we seek your wisdom, your guidance and your peace that passes all understanding. Amen.”

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Medical ethics has changed a great deal in 60 years. The Word of God has not. ✝

Bibliography Orr, Robert D. “What are the Arguments Against Legalization of Physician-Assisted Suicide?” Today’s Christian Doctor 2011; 42(2):30-2 The U.S. Public Health Service observed and investigated 400 poor black men with early syphilis for 40 years (1932-72) to learn more about the natural progression of the disease, but did not give them curative penicillin when it was discovered in the early 1940s. 3 Karen was in a persistent vegetative state and ventilator dependent. Her parents asked that her ventilator be stopped, expecting that she would die. Her physicians felt they couldn’t do that because they would then be the agents of death. The Supreme Court of New Jersey eventually said it is permissible to stop life-sustaining treatment in some circumstances. She was subsequently weaned from the ventilator and she lived for another 10 years. 4 Often stated by Leon Kass and Eric Cassell in the 1970s. I have been unable to determine who said it first. 5 The position statements and countless resources on ethical issues are available at http://www.cmda.org. 6 The Center for Bioethics and Human Dignity is currently working on a compilation of such statements. 7 See chapter two in Medical Ethics and the Faith Factor by the author for an expanded discussion of biblical principles that can be applied in medical ethics. 8 Two cautions regarding quality of life: (a) it is very subjective; it is very difficult to assess someone else’s perception of their own quality of life; (b) non-believers often misconstrue the concept of quality of life, deciding that some lives are worth less than others, leading to horrific results (e.g., slavery, the Holocaust, ethnic violence). 1

Robert D. Orr, MD, CM, is a family physician and ethics consultant who currently teaches clinical ethics to graduate students at Loma Linda University (Loma Linda, California), The Graduate College of Union University (Schenectady, New York) and Trinity International University (Deerfield, Illinois). He has been a member of CMDA for more than 40 years, has chaired its ethics committee and currently serves on the editorial committee of Today’s Christian Doctor.

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In This Year . . . Around the World - Richard Nixon became the 37th President of the United States. - The last issue of the Saturday Evening Post was published. - The Beatles gave their last public performance. - The first temporary artificial heart was transplanted. - A patient became the first American reported to die of HIV/AIDS. - Norma L. McCorvey began her attempts to obtain an illegal abortion in Texas, a struggle that led to the landmark Roe v. Wade decision in 1973. The original court case was filed in 1970 on behalf of McCorvey under the alias Jane Roe. - The U.S. began withdrawing troops from Vietnam. - Apollo 11 landed on the moon and 500 million people watched worldwide as Neil Armstrong became the first man to walk on the moon.

In This Year . . . at CMDA - The name was Christian Medical Society, the headquarters were based in Oak Park, Illinois, Walter O. Spitzer, MD, resigned as General Director and Christopher Reilly, MD, served as both the interim director and President for the next two years. - The first Student Leadership Conference was held in Philadelphia, Pennsylvania. - John W. Shannon served as the director of Medical Group Missions which added project trips to Honduras and Haiti. - A subscription to the bimonthly published Christian Medical Society Journal was $3 per year. - Birth Control and the Christian, a resource published by CMS and Christianity Today, was released.

Remember to Remember: by John Patrick, MD The Modern Implications of Abortion An in-depth look at abortion and how the issue has been affected by today’s culture

Use your smartphone to read the historical 1969 article

Use your smartphone to read the historical 1971 article

Use your smartphone to read the historical 1976 article

or visit www.cmda.org/reflections

emember to remember is a recurrent divine command. God wants us to remember the past in order to celebrate the good and learn to avoid evil. Equally recurrently, the children of Israel forgot to remember and the consequences were usually severe, including exile and slavery. Even with the Israelites serving as a warning, we have also forgotten to remember our history and we have been enslaved at home and in our minds! Who would have thought that pastors could be fined for quoting Scripture and that university students would be so biblically illiterate as to be unaware of who Cain was and what he did? But this is where we are in today’s culture. The modern demonic process is more subtle; we are being enslaved by a ruling elite who have no respect for their own history, as illustrated by Secretary of State Hilary

Rodham Clinton’s rant against religious objections to special rights for homosexuals. We are appalled by such cultural insensitivity, but we remain unable to respond effectively because the “enemy” has an outpost in our heads. To give two examples, we routinely put individual choice above community responsibility, physical facts above moral ones. The mantra of choice ought to have rung warning bells if we had remembered what happened to Israel when everyone did what was right in their own eyes. When CMDA asked me to write this essay, I received three articles on abortion law written 40 years ago by three scholars who had influenced my intellectual development: Professor Duncan Vere of the London Hospital Medical School in the United Kingdon, Carl Henry who was the driving force behind Christianity Today in its early C HRISTIAN M EDICAL & D ENTAL A SSOCIATIONS

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years and Paul Ramsey from Princeton who was the doyen of Protestant thinkers on ethics. I am deeply in debt to all three, but especially to Paul Ramsey. In all three papers, the shear gruesome horror of abortion is not a major feature; instead, they are coolly rational in their recognition and discussion of the huge implications of the legalization of abortion. Paul Ramsey was pessimistic about any real recovery. Old moral certainties were washed away in the 1960s and 1970s on a tide of ill-defined individual rights and an acceptance of values language with its incoherent subtext of moral relativism. Moral certitudes were considered nonsense during the heyday of logical positivism and those who did not go along were viewed as naïve or even bigoted. The intellectual elite enjoyed their libertine world, especially in its sexual expression which, thanks to “the pill,” no longer entailed the risk of children. The proponents of moral uncertainty seemed blind to their own certainty which they set out to impose on the rest of us. The good news is that after 50 years of unopposed triumph, moral relativism is in retreat. (Read Why Believe by John Cottingham for more information.)

The link between the pill and abortion was not understood except by Pope Paul VI1 who said that the problem with an effective contraceptive was that it would do three things: first, it would lead to a contraceptive mentality; secondly, it would lead to a general lowering of morality; and thirdly, it would lead to increased disrespect for women. Inevitably, he was ridiculed for obscurantism, male chauvinism, etc., but who can deny today that he was right and the progressive elite was wrong? So blind are our intellectual elite to their own errors that they march against violence on women without any sense of irony let alone guilt. The Roe v. Wade decision underlined the pope’s point. American women, said the court, have become used to an effective contraceptive but no contraceptive is always effective so there must be a backup. There is no need to labor the point that many abortions are second and third abortions and that abortion has gone from very rare to millions per year since the 1960s. 18

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None of these scholars expected the rampant increase of abortions, but it was early in the sexual revolution and they thought old moral norms would survive. Post-World War II moral relativism is the swamp out of which it was inevitable that abortion rights would emerge. If everyone’s views of good and evil are equally valid, then who has the right to tell me I can’t do what I want as long as no one else is immediately injured? Sadly, most of the students I meet who come from good Bible-believing homes are utterly unable to begin demonstrating what is wrong with this concept. All three writers tacitly, rather than definitively, acknowledge the problem. Professor Vere, being a physician, sees the problem most practically as he struggles with the clash between public or institutional secular utilitarian ethics and traditional Christian ethics. He comforts himself by saying that the abortion law should rarely be needed! Nevertheless, he is worried by what he terms “the scant regard” for conscience rights in the new abortion legislation. Within a few short years, administrative directives regarding hiring effectively removed all senior prolife Christian influences from obstetrics and gynecology in the U.K. Some softening of this barrier is just now beginning to emerge. President Obama intended to go down this path with his Freedom of Choice Act which providentially has been effectively rebuffed by the Catholic bishops, but as in the U.K., lower level administrative directives are having the same effect. Julie Cantor’s infamous editorial in the New England Journal is another example of pro-choice hubris. Her solution is that those who are opposed to abortion ought not to go into OB/Gyn. So only those who see nothing wrong with killing babies are appropriate. Maybe it would be easier if abortion were made a separate entity and those doing abortions could be separated from those caring for babies and their mothers. William Butler Yeats was prescient when he wrote; “The best lack all conviction and the worst are full of passionate intensity.”2 In his article from 1971, Carl Henry writes about the logical progression from abortion on demand in the first trimester to infanticide and geriatricide. He implicitly picks up what has become a commonplace pro-choice argument. The problem is that everyone knows that it is wrong to do gratuitous harm to an innocent person, but that is exactly what abortion is! The solution has been to separate a human being, genetically described and beginning at fertilization, from a human person who is functionally described most commonly as someone who is capable of relationship. The problem of guilt over abortion is assuaged but it has logical progression entailed; it allows not only abortion but logically also infanticide (cf the Groningen Protocol) and geriatricide

“In short, professional judgment or conscience contrary to abortion will be squeezed out. The medical and nursing profession will be reshaped to conformity.” Ramsey was doubtful that individual conscience rights would survive the institutional ethos it opposed. His fears have been justified. None of these writers make the helpful distinction between conscience as moral thought and conscience as moral feeling. Our moral feelings are unreliable, but when we sit down and think problems through, the results are usually solid. Professor J. Budziszewski has discussed this point very effectively in his book, What We Can’t Not Know. This book is a “must read” for serious Christian physicians and anyone who wants to make the church more effective in the public square. The history of the havoc wrought by abortion since these papers were written is well known, but we still need to mull over what we do. Ramsey is, in my mind, right when he questions the capacity of a minority opinion to survive in an antagonistic environment. It is for this reason that we need to adopt the Catholic position known as subsidiarity. We are now in a situation where the bureaucracy is firmly secular without any admission that secularism is a belief system. Its ethics are not compatible with orthodox Christian ethics. They are purely utilitarian and rationalist in the post enlightenment sense. Traditional ethics are treated as solely personal positions without standing in the public square. As Christians, we have not been teaching our own history properly for a long while and hence we don’t ask the right questions. Here are some of the key questions: Is transcendence necessary for moral activity? If someone

Remember to Remember

for the demented. I am waiting for this argument to be used to defend the murder of a drunken abusive husband! Paul Ramsey makes the most cogent case for the imminent threat to rights of conscience. In his 1974 article, he prophesied correctly thus;

has no fear of judgment after death, does that rationally make him more or less trustworthy? Is medicine primarily a technical profession or a moral one? Patients do not have to take your advice; thus, your duty is to help them to do what they ought to do. Ought is a moral act, not a scientific word. Do you wish to be cared for by a physician with or without moral integrity? Everyone answers “yes” to this question, but we differ on what moral integrity actually is. As a matter of justice and democracy, do we not then need institutions that represent the dominant ethical positions of the population? Does it not also follow that funding must be distributed to all institutions in proportion to their population distributions? This is the essence of subsidiarity, finding the level of organization where ethical coherence is possible. This would dramatically reduce the power of central government and allow the different systems to compete as they did in the time of Hippocrates. ✝ For further reading: – Why Believe by John Cottingham (Continuum Press, 2009) – What We Can’t Not Know by J. Budziszewski (Ignatius Press, 2011) – The Hand of God by Bernard Nathanson (Regnery, 1996) – www.hippocraticregistry.com Bibliography 1 2

Paul VI, Humanae Vitae, 1968. “The Second Coming.” William Butler Yeats, 1919.

John Patrick, MD, retired from the University of Ottawa in June 2002. He had been Associate Professor in Clinical Nutrition in the Department of Biochemistry and Pediatrics for 20 years. Dr. Patrick’s medical training was in London, England. He has done extensive research into the treatment of childhood nutritional deficiency and related diseases, holding appointments in Britain, the West Indies and Canada. He has worked in Central Africa assisting in the development of training programs that deal with childhood protein-energy malnutrition. Dr. Patrick now lectures throughout the world working for the Christian Medical and Dental Society in Canada and the Christian Medical & Dental Associations in the U.S. He speaks frequently to Christian and secular groups and is able to communicate effectively on moral issues in medicine and culture, as well as the integration of faith and science.

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In This Year . . . Around the World - The Apple Computer Company was formed by Steve Jobs and Steve Wozniak. - The United States celebrated its bicentennial. - Jimmy Carter defeated Gerald Ford to win the elections to become the 39th President of the United States. - In Gregg v. Georgia, the U.S. Supreme Court ruled that the death penalty is constitutional. - The first commercial flight of the Concorde was completed. - The New Jersey Supreme Court ruled that Karen Quinlan could be disconnected from a ventilator after living in a semi-vegetative state. She lived for another 10 years. In This Year . . . at CMDA - The name was Christian Medical Society, the headquarters were based in Oak Park, Illinois, Marvin R. Jewell, Jr., MD, served as President and Haddon Robinson, DTh, PhD, was the General Director. - CMS was outgrowing its headquarters, and a committee began searching for a new location. - A subscription to the bimonthly published Christian Medical Society Journal was $4 per year. The CMS Journal began publishing thematic editions that focused on important topics for their readers. The topics in 1976 were marriage, missions, abortion and finances.

Post-Roe v. Wade: by Jonathan Imbody Overt war on Conscience Rages The battle for healthcare right of conscience continues in today’s landscape Use your smartphone to read the historical article or visit www.cmda.org/reflections

“The first time ever I saw your face, I thought the sun rose in your eyes.”

s Roberta Flack softly coos her 1973 Grammy-winning song in the background, the 2011 TV commercial slowly unveils a stunning, color image of a developing, gently moving baby in utero. The baby’s tiny arm curls upward, framing her glorious face. The video shifts to the faces of a beaming young woman and a wide-eyed young man. A wider shot reveals a physician applying an ultrasound device to the woman’s pregnant belly. The parents watch with wonder as the monitor shows their newest family member opening and closing her mouth. “When you see your baby for the first time on the new GE 4D ultrasound system, it really is . . . a miracle.” The final, madonna-like shot shows mother cradling her newborn baby as father looks on with wonder. Fade with music: “The first time ever I saw your face.” If only the U.S. Supreme Court 38 years ago had been able to view that ultrasound, and apprehend its profound insight into human development, millions more Americans could be

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alive today, thanks to the eye-opening medical technology that is awakening our culture to the reality of early life. The medical community might be advancing universal healthcare rather than facing a shortage of professionals fueled in part by discrimination on the basis of conscience. For decades and with increasing aggressiveness, medical schools have been drumming out pro-life medical school candidates; training programs have been coercing residents to bow to abortion ideology; and medical institutions have been demoting and dismissing physicians who dare to profess life-honoring medical ethics. In 1973, the Supreme Court handed down a landmark decision that deemed an early developing baby a virtually faceless non-person. In Roe v. Wade, the Court revisited its 1857 Dred Scott v. Sandford decision. The Scott ruling, which essentially valued a slave as just three-fifths of a person, divided the nation over the issue of federalism (the division of powers between the states and the national government) and spawned a bloody fratricide. After the war in 1868, Americans attempted to reconstruct the constitutional protection of persons by enacting the

“The appellee and certain amici argue that the fetus is a ‘person’ within the language and meaning of the Fourteenth Amendment. In support of this, they outline at length and in detail the well-known facts of fetal development. If this suggestion of personhood is established, the appellant’s case, of course, collapses, for the fetus’ right to life would then be guaranteed specifically by the Amendment . . . [But we are persuaded that] the word ‘person,’ as used in the Fourteenth Amendment, does not include the unborn.”1

Christian OB/Gyn relates immediate impact of Roe By returning to the ancient Greek’s rationalization of killing, the Court undermined more than 2,000 years of medical ethics and the objective bases for training physicians’ consciences. The ruling immediately impacted conscientious Christian physicians, as related in an article published in the Christian Medical Society Journal in 1976. In an essay entitled “Abortion and the Law,” Princeton Professor of Religion Paul Ramsey highlighted the reaction of a young Christian physician: “The Supreme Court decision in 1973 came at a point in my residency training in obstetrics and gynecology . . . I decided that I could not work in a hospital that did abortions. “I was assured by the faculty that I would not have to participate or assist in abortions . . . my conscientious objection went much deeper than that. . . . Since the Clinic did not comply with my request to finish the residency at [another] Hospital, I felt forced to resign my position there.”

Post-Roe v. Wade

Fourteenth Amendment: “. . . nor shall any State deprive any person of life, liberty, or property, without due process of law. . . .” Yet just over a century later, the Supreme Court once again reignited the fight over federalism by creating a whole new class of non-persons deemed ineligible for constitutional protection. The Court unilaterally declared that an unborn human being is not a person. Writing for the majority, Justice Harry Blackmun asserted,

Court reverts to pre-Christian ancient Greece Congress passes conscience-protecting laws In Roe, the Court casted aside not only federalism but also more than two millennia of medical ethics, under which physicians who followed the Hippocratic oath had determined to adhere to this ethical commitment: “I will use treatment to help the sick, according to my ability and judgment, but I will never use it to injure or wrong them. I will not help a patient commit suicide, even though asked to do so, nor will I suggest such a plan. Similarly, I will not perform abortions.” Christian healthcare professionals then and now have staked their consciences and careers on the unambiguous biblical commandment, “You shall not murder” (Exodus 20:13). Christians see God’s sacred hand on early human life, reflected in passages such as David’s psalm, “For you created my inmost being; you knit me together in my mother’s womb” (Psalm 139:13) and the prophecy concerning John the Baptist that “he will be filled with the Holy Spirit while yet in his mother’s womb” (Luke 1:15, NASB). Yet in Roe, the Court asserted the indifference of the modern secular state to these venerable foundations of medical ethics and personal conscience. In analyzing medical ethics, Justice Blackmun acknowledged the later confluence of the Hippocratic oath with Christian biblical principles, but he chose to cast his lot with ancient Greeks who rationalized killing. Blackmun observed, “Most Greek thinkers . . . commended abortion, at least prior to viability.” He agreed with an analysis that characterized the Hippocratic oath as merely “a Pythagorean manifesto and not the expression of an absolute standard of medical conduct.”2

Thankfully, the United States Congress grasped the importance of life-affirming physicians’ moral dilemma. By constitutional design more responsive to the values and sentiments of the American public than the often isolated and imperial Supreme Court, Congress recognized Roe’s potential for trampling conscience convictions and passed legislation to protect the conscience rights of life-affirming healthcare professionals from judicial fiat. The 1973 Public Health Service Act (the “Church Amendment”) provided that no individual could be required, at least under specified federal funding programs, “to perform or assist in the performance of any sterilization procedure or abortion if his performance or assistance in the performance of such procedure or abortion would be contrary to his religious beliefs or moral convictions.”3 The law also banned discrimination, promotion or termination for such reasons. While applauding legal protections for the healthcare workplace, Professor Ramsey presciently warned, “The medical or nursing student, still in training, is in a more profound dilemma of conscience. In order to graduate, student doctors and nurses may be forced into learning procedures which they regard as violations of their professional and moral integrity. They may have to participate in abortions for which they believe there is no medical or moral justification.”

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Congress would not adequately address the concern regarding training programs until 1996, when it passed a law (the Public Health Service Act, Section 245) providing that,

ACOG-ABOG positions launch overt war on conscience “the Federal Government, and any State or local government that receives Federal financial assistance, may not subject any health care entity to discrimination on the basis that the entity refuses to undergo training in the performance of induced abortions, to require or provide such training, to perform such abortions, or to provide referrals for such training or such abortions . . .”4 Finally, in 2004, Congress passed the Hyde-Weldon Conscience Protection Amendment to ensure that specified federal funds would not be available to any agency that discriminated against healthcare institutions that don't provide abortions. Medical culture lags behind laws However, the law is one thing, and the culture of medical institutions is yet another. Professor Ramsey provided a crucial insight into this truth: “Without effective institutional conscience clauses, individual conscience clauses will be worthless. Without effective enforcement, the conscience clauses are nugatory—much like laws against discrimination without a watchdog to insure equal opportunity. “Without a sea-change of opinion in our nation, the wave of the future seems clear to me. . . . A campaign has begun to require hospitals, doctors and nurses to perform abortions as a duty.” That prediction turned to reality in November 2007, when the radically politicized, pro-abortion American College of Obstetricians and Gynecologists (ACOG) issued Committee Opinion Number 385, “The Limits of Conscientious Refusal in Reproductive Medicine.” The new ACOG policy stated, “Physicians and other health care providers have the duty to refer patients in a timely manner to other providers if they do not feel that they can in conscience provide the standard reproductive services that patients request. Providers with moral or religious objections should either practice in proximity to individuals who do not share their views or ensure that referral processes are in place.” To make matters worse for life-affirming OB/Gyns, in December 2007, the American Board of Obstetrics and Gynecology’s (ABOG’s) “Bulletin for 2008 Maintenance of Certification” stated that certification may be denied due to

a “violation of ABOG or ACOG rules and/or ethics principles” [emphasis added].

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The conjoining of ACOG’s political abortion advocacy with ABOG’s credentialing authority signaled a new phase of the long-simmering covert war in the medical community against pro-life healthcare professionals. The assault on conscience rights triggered an investigation by the Bush administration's U.S. Dept. of Health and Human Services (HHS), which led to a federal regulation to implement more than three decades of federal conscience laws. The battle also elevated the Christian Medical Association to a position of national leadership in the campaign to protect conscience rights in healthcare, sparking the formation of the CMA-led, 50-organization coalition, Freedom2Care. Despite the Obama administration’s 2011 gutting of the HHS conscience-protecting federal regulation, the federal conscience-protecting laws on which the regulation rests remain on the books. Whether or not those federal laws will actually serve to protect conscience rights in healthcare depends in part on ongoing legislative efforts to strengthen the laws. Real-life protection, however, depends on cultural attitudes and policies in what Professor Ramsey insightfully identified as the make-or-break battleground of conscience rights: the medical community. ✝ Bibliography Blackmun, Harry, majority opinion in Roe v. Wade, decided by the Supreme Court on January 22, 1973; section IX.A. Blackmun, Harry, majority opinion in Roe v. Wade, decided by the Supreme Court on January 22, 1973; section VI.2. 3 42 U.S.C. Section 300A-7. 4 42 U.S.C. § 238(n). 1

Jonathan Imbody is VP for Government Relations for the Christian Medical Association, and also serves as director of the Freedom2Care coalition on conscience rights. He liaisons with the White House, Congress and federal agencies. He focuses on issues including conscience protections for healthcare professionals, human trafficking, abortion, assisted suicide, bioethics, the role of faith in health, international health, abstinence and HIV/AIDS. Jonathan received his bachelor's degree in communications from the Pennsylvania State University, a certificate in theological studies from the Alliance Theological Seminary in New York and a master's degree from Penn State in counseling and education. He and his wife Amy have four grown children. To contact Jonathan, email washington@cmda.org.

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In This Year . . . Around the World - Ronald Reagan began his second term in office as the U.S. President. - Back to the Future opened in theatres and became the highest grossing film of the year. - The wreck of the Titanic was discovered by Dr. Robert Ballard. - DNA was first used in a criminal court case. - The Nintendo Entertainment System was released. - The first artificial heart patient left the hospital.

In This Year . . . at CMDA - The name was Christian Medical Society, the national headquarters were based in Texas, Robert Schindler, MD, served as President and Edwin Blum, DTh, PhD, was the General Director. - A taskforce on Healthcare for the Needy was formed to bring attention to the needs of our nation. - The Dermatology Specialty Section was established to support members within that specialty. - The first Winter Singles Conference was held as an “experiment” at Deer Valley Ranch in Colorado.

CMDA’s Strategy to by David Stevens, MD, MA (Ethics) Transform Doctors to Transform the World How has the CMDA strategic plan changed since it was published in 1985?

t is humorous in some ways. When I became the CEO in 1994, I didn’t know CMDA ever had a strategic plan, but as Solomon said, “there is nothing new under the sun” (Ecclesiastes 1:9). Now 18 years later, while looking at back issues of CMDA’s journal, one of my staff found a published strategic plan from 1985. It was a good plan—visionary, comprehensive and measurable. It was titled, “To 1990 and Beyond.” The “beyond” 1990 was a wise plan because most of the goals were not accomplished for more than a decade due to staffing and financial issues. The humorous part to me was that I incorporated many of these same ideas into the strategic plan I wrote in 1995, and I thought I had come with some great original ideas! The same God who inspired Ed Blum, Dr. Bob Schindler and Dr. Curt Drevets in the 1980s inspired me. More than that, He provided the wisdom and resources to accomplish His purpose! CMDA has grown tremendously. It is so multifaceted now that it is hard for you as a member to know all that

Use your smartphone to read the historical article or visit www.cmda.org/reflections

CMDA does or its plans for the future. Nonetheless, in these days of great challenge and change, it is more important than ever for you to know the services and resources CMDA provides. If you know about our outreaches, you can access them when you need resources or services. More importantly, these outreaches need your prayers! Let me give you an overview. Let’s start with CMDA’s governance. Without that strong foundation, an organization cannot grow strong. CMDA’s 16,000+ members are represented by the 75 members of the House of Representatives, one from each state and one from major local ministries, at the annual meeting of that body during the National Convention in April. This group endorses proposed changes to CMDA’s bylaws and approves the organization’s official ethics statements. They provide a majority of the members to the trustee nominating committee and are the key channel for members to speak to the organization and hear from it at the local level.

C HRISTIAN M EDICAL & D ENTAL A SSOCIATIONS

www.cmda.org

CMDA’s Strategy to Transform Doctors 24

The CMDA Board is made up of 16-20 trustees and meets three times per year. Any member can nominate him- or herself or another member to the board. Candidates are screened by the trustee nominating committee based on their experience, testimony and the skill sets needed on the board. This nominating committee is made up of three trustees and four members of the House. Three trustees are elected annually to serve for four years. A student and resident trustee are also elected annually to serve for a year with full vote and voice. Every two years, the CMDA President (board chair) is elected by the membership from a slate nominated by the board. The person elected serves two years as President-Elect, two years as President and one year as Past President. The board may elect up to three nonCMDA members to serve on the board due to their knowledge in areas such as law, finance or other areas of needed expertise. All board members receive initial orientation and then board training at every meeting so they can function well. CMDA has a great board! The members operate within a self-maintained policy manual that defines operating parameters, major policy fences, financial parameters and their relationship with their sole employee, the CEO, who they hire, annually evaluate, compensate and, if necessary, fire. The CEO is a nonvoting trustee with full voice. The board’s overarching duty is to accomplish CMDA’s mission to motivate, train and equip Christian doctors to glorify God. To facilitate its function, the board has four internal committees—Executive, Finance, Strategic Planning and Governance—and three external committees— Continuing Medical Education (approves CE), Ethics (develops official ethics statements) and Public Policy (approves non-ethical organizational positions). Internal committees are made up of board members and meet at each board meeting. External committees report to the board and are largely made up of non-trustee members. CMDA has a long tradition of volunteer commissions comprised of members who help the organization accomplish a specific outreach the administration may not have the staff or finances to complete. There is a Singles Commission that serves single members through resources, retreats and mission teams. The Women in Medicine and Dentistry Commission focuses on the unique needs of female physicians and dentists through resources, networks, meetings and mission trips. The Continuing Medical and Dental Education Commission designs and runs a large ten-day, four stream and 200+ CE hours conference for healthcare missionaries and their families in either Kenya or Thailand each year. The Malpractice Commission provides prayer, counsel and resources to members dealing with malpractice suits. The Marriage Commission holds marriage renewal weekends. The Pan-African Academy of Christian Surgeons

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initiates, supervises and networks surgical residency programs at mission hospitals to develop a cadre of national missionary surgeons to serve their own people. Presently, there are 39 residents in training. CMDA’s CEO hires and supervises all paid and volunteer staff, works with the board to develop the strategic plan and budget for approval, develops the strategies to accomplish the organization’s goals and is the chief voice to the government, media and the public. The administration is made up of more than 100 full and part time staff, of which about 50 are based in Bristol, Tenn., at CMDA’s beautiful 52,000 square foot headquarters/conference center, and the rest are based around the country. Dr. Gene Rudd, an OB/Gyn, serves as Senior Vice President and then there are ten senior staff members who oversee major areas of ministry. Each area of ministry is categorized into one of CMDA’s five key result areas—Transformation, Service, Equipping, Voice and Organizational Development. These result areas help our ministries to remain focused on the goals set forth in the strategic plan. Transformation – ministries that transform medical professionals’ lives through evangelism and discipleship Dr. Scott Ries, a Family Practice doctor, serves as the Vice President of Campus & Community Ministries,

Equipping – resources and services that give medical professionals and the church the knowledge and tools they need to effectively serve the Lord This result area contains Meeting Planning which plans and facilitates more than 25 meetings each year; Digital Media which produces audio and video resources such as Christian Doctor’s Digest, Just Add Water DVDs, etc. and runs CMDA’s radio and TV studios; Communications which produces Today’s Christian Doctor, the CMDA website and social media sites and more than a dozen electronic resources in addition to conducting annual media training; the Continuing Medical Education department; the Placement service to match Christian doctors for practice; and the Stewardship department which assists members to become good stewards and overseas our fundraising activities. And that’s not all. Life and Health Resources provides tools for doctors and their patients including an entire series of “medically reliable, biblically sound” resources published by CMDA. Is your head spinning yet? You have a lot to be proud of in CMDA!

Service – ministries that provide opportunities for doctors and others to use their God-given skills to meet the needs of others and to share the gospel with them Dr. Don Thompson, a Family Practice physician, directs Global Health Outreach which conducts 40 to 50 shortterm medical and dental trips with national partners around the world. The primary purpose of GHO is to radically impact the lives of its 1,000+ annual participants while doing evangelization, strengthening the local church and providing superb healthcare. A former flight surgeon leads Medical Education International, an outreach that uses medical and dental education to build relationships with national doctors in difficult to access countries to influence them to Christ. Susan Carter, BSN, MPH, and Dr. Daniel Tolan bring their rich experience overseas to lead the Center for Medical Missions that works with more than 700 members who are missionary doctors. CMM works closely with the Global Missions Health Conference which attracts more than 2,500 attendees each November in Louisville, provides consultation to mission organizations and brings together their leaders for a medical mission executive summit each year to plan the future of medical missions. CMM also completes annual new medical missionary orientation, provides scholarships for student and residents to do rotations in mission hospitals and publishes “The e-Pistle,” a monthly resource for missionaries.

CMDA’s Strategy to Transform Doctors

our largest outreach area. Scott is responsible for student ministries on 225 professional campuses and for services to our graduate members. Each student chapter has a local student leadership team and a representative on the National Student Council. Scott’s job includes supervising four Regional Directors who provide supervision to Area Directors and full time staff members working with a local council of members to help fund and set goals for area outreaches. These are usually focused in major urban areas with training schools. In locations where the workload or funding needs are less, an associate staffer is hired to work one or two days each week. Scott also provides oversight to Side By Side, a ministry to female spouses of students and residents; numerous regional and area conferences; Life Support, an audio resource for students and residents published eight times per year; webinars and staff training; and much more. In addition, Scott overseas the Specialty Sections, groups of members who come together for fellowship and voice in their specialty (Family Practice, Psychiatry, Military, etc.). His newest area of responsibility is to assist in facilitating our Christian Dental Association outreach to minister to the needs of our dental members.

Voice – outreaches that speak for our members to the government, media, church and public on bioethical and public policy issues while also training Christians to be effective advocates themselves The fourth key result area is “Voice.” Though you often hear about what CMDA is doing to represent you on important issues in public policy, it actually consumes less than 5 percent of our staff and finances. Vice C HRISTIAN M EDICAL & D ENTAL A SSOCIATIONS

www.cmda.org

CMDA’s Strategy to Transform Doctors

President for Government Relations Jonathan Imbody is based in Washington, D.C., and he makes more than 200 personal contacts each year with legislators, their staff and government officials. He is continually attending meetings to stay abreast of the legislation and regulations. He writes op-ed pieces for newspapers and magazines that reach more than five million people annually. He works behind the scenes with many organizations that share our views to link them with our professional expertise. For example, he brought more than 50 organizations together under the Freedom2Care coalition to fight for healthcare right of conscience. Vice President for Communications Margie Shealy sends out news releases, schedules approximately 200 to 300 media interviews each year and coordinates state campaigns to defeat initiatives to legalize physician-assisted suicide and embryonic stem cell research funding, among other issues.

Organizational Development – ensuring good governance, administration, policies, resources and services are in place to ensure all CMDA’s ministries will flourish The fifth key result area, Organizational Development, helps everyone serving at CMDA accomplish their goals. It includes the finance, information technology, membership services, maintenance, housekeeping and mail services departments. In total, CMDA has more than 45 outreaches. Believe it or not, I have not named them all! God has given us a broad and deep ministry to healthcare, to our culture and to the world. For example, CMDA is the main financial supporter of the International Christian & Medical Association that starts and coordinates national CMDAtype groups in more than 70 countries. We work closely with Nurses Christian Fellowship, Christian Pharmacy Fellowship, The Fellowship of Christian Physician Assistants and Christian Community Health Fellowship in joint ventures. What’s ahead? Well, each of the outreaches I’ve mentioned has its own goals and measurable objectives to enhance the quality and scope of the ministries. These 26

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all roll up into CMDA’s Five-Year Strategic Plan. That plan is reported on, updated and revised three times each year at our board meetings. I’m excited about two new major programs. First, Dr. Jeff Amstutz, a former missionary dentist with an MBA, joined CMDA in January this year to provide leadership for many new dental initiatives including a conference this summer for the top two Christian dental students plus a faculty member from every dental school in the country. We hope to triple our dental membership in the next five years. Secondly, Global Health Relief will provide medical and dental services in major crisis situations around the world in partnership with the Salvation Army. It will hit the ground this year with training and resourcing already underway. I hope you are proud to be a CMDA member. I know I am. I want to be part of an organization that is making a difference in our profession and our culture. I want to disciple the next generation of Christian doctors, support our missionary colleagues, serve alongside likeminded professionals and be a righteous voice into our culture on important issues. With all that’s going on in healthcare, if we didn’t have CMDA, we would have to create it! I challenge you to pray for it daily, support it regularly and get involved if you are not already. There are many connection points. Find one where God can use you at the local and national level. The success of our strategic plan depends on you. Working together, we can transform doctors to transform the world! ✝

David Stevens, MD, MA (Ethics), serves as the Chief Executive Officer for the Christian Medical & Dental Associations. From 1981 to 1991, Dr. Stevens served as a missionary doctor in Kenya helping to transform Tenwek Hospital into one of the premier mission healthcare facilities in the world. Subsequently, he served as the Director of World Medical Mission, the medical arm of Samaritan’s Purse, assisting mission hospitals and leading medical relief teams into war and disaster zones. As a leading spokesman for Christian doctors in America, Dr. Stevens has conducted hundreds of television, radio and print media interviews. Dr. Stevens holds degrees from Asbury University, is an AOA graduate from the University of Louisville School of Medicine and is board certified in family practice. He earned a master’s degree in bioethics from Trinity International University in 2002.

Ministries of the Christian Medical & Dental Associations

The Christian Medical & Dental Associations (CMDA) exists to glorify God by motivating, educating and equipping Christian healthcare professionals and students. As it seeks to change hearts in healthcare, CMDA currently serves more than 16,000 members while providing resources, networking opportunities, education and a public voice through its numerous outreach ministries. This easy reference tool provides a list of CMDA’s resources, services and ministry opportunities. Visit www.cmda.org for more information and to get involved.

Transformation – ministries that transform

medical professionals’ lives through evangelism and discipleship

New Life. Designed to disciple participants, grow national churches, share the gospel and provide care to the poor and needy on the edge of survival.

1. Campus Ministries [J. Scott Ries, MD - ccm@cmda.org] A team of more than 70 regional and area staff who organize campus Bible and ethics studies, mission teams, leadership training and outreach functions on 225 medical and dental campuses in the U.S.

10. Global Health Relief (GHR) [www.cmda.org/ghr] An outreach ministry focused on bringing health and hope to people affected by disasters around the world through medical, dental, spiritual and psychological care.

2. Chapel and Prayer Ministries [Debra Deyton - debra.deyton@cmda. org] Mobilization of staff and members to pray, as well as chapel services held in Bristol with recordings available at www.cmda.org/ chapel.

11. Healthcare for the Poor [www.cmda.org] Our domestic health outreach, in partnership with Christian Community Health Fellowship, encourages Christians in medicine and dentistry to provide healthcare for the poor and marginalized, and offers speakers to student chapters to help them discover their missional call.

3. Christian Dental Association [Jeff Amstutz, DDS - dental@cmda.org] Encouraging and supporting dentists in living out their Christian faith in their professional and personal lives. 4. Commissions [www.cmda.org] Singles (networking, conferences, mission trips and resources to meet the unique needs of single members) and Women in Medicine and Dentistry (conferences, resources and networking to meet the distinctive needs of women in healthcare). 5. Community Ministries [J. Scott Ries, MD - ccm@cmda.org] Our local graduate ministries present an opportunity for members to connect with fellow members in local area ministries to provide mentoring and ministry resources to assist them in living out the character of Christ in their practices and lives. 6. Side By Side [Robin Morgenthaler - sidebyside@cmda.org] A Bible study-based outreach ministry to female medical/dental spouses. 7. Specialty Sections [sections@cmda.org] Academic Medicine, Academic Surgery, Dentistry, Dermatology, Emergency Medicine, Family Medicine, Pediatrics, Psychiatry and Uniformed Services. These sections equip, network and provide a voice for CMDA members to their areas of specialty or service.

12. Medical Education International (MEI) [mei.director@cmda.org] Short-term teams teaching healthcare professionals in academic or clinical settings to bring transformation by advancing medical, dental, bioethical and educational knowledge while modeling and sharing Christ with them. 13. Mission Management Consultation [Susan Carter, BSN, MPH – cmm@cmda.org] Consultation service offered to international mission ministries. 14. Scholarships and Grants [www.cmda.org/scholarships] Dental Student Scholarships (provides $25,000 annually to students), Johnson Short-Term Mission (provides scholarships of up to $1,000 to residents doing rotations in medical mission ministries), Owen Grants (for short-term missions for students at Southwestern Medical School), Risser Fund (training and ministry to Third World national orthopaedic doctors), Steury Scholarship Fund ($100,000 awarded annually to a medical student going into career missions), Tami Fisk Mission (for medical personnel desiring mission service in East Asia) and Westra Mission (up to $500 to medical students doing shortterm mission trips or medical mission rotations).

Service – ministries that provide opportunities for doctors and Equipping – resources and services that give medical others to use their God-given skills to meet the needs of others and to share the gospel with them 8. Center for Medical Missions [Susan Carter, BSN, MPH - cmm@ cmda.org] A CMDA department aiding in the recruitment, training and retention of career medical missionaries, including pre-field orientation training for new medical missionaries. 9. Global Health Outreach (GHO) [Donald Thompson, MD, MPH&TM - gho@cmda.org] One of CMDA's short-term mission programs that sends 40 to 50 medical/dental/surgical mission outreach teams annually. Also includes short-term surgical trips to the university hospital in Tegucigalpa, Honduras, through a partnership with Operation

professionals and the church the knowledge and tools they need to effectively serve the Lord 15. Affinity Program [www.cmda.org/creditcard] CMDA Credit Card, a rewards program that supports the ministries of CMDA. 16. Audio/Video/Print Resources [www.cmda.org] Just Add Water (a DVD resource of outstanding speakers for home or other group meetings), Life & Health Resources (a distribution service for CMDA-produced and recommended resources) and Life Support (podcast audio magazine covering topics of interest for students and residents).

17. Christian Doctor’s Digest [Rusty Sluder - digitalmedia@cmda.org and Margie Shealy - communications@cmda.org] Bimonthly audio magazine resource containing interviews on timely topics of interest to doctors and their families. 18. Commissions [www.cmda.org] Continuing Medical & Dental Education (annual two-week CMDA conference in Kenya or Thailand), Marriage Enrichment (provides weekend retreats each year to help doctors strengthen their marriages), Medical Malpractice Ministry (prayer, resources and encouragement to doctors experiencing malpractice suits), Pan-African Academy of Christian Surgeons (PAACS) (surgical residencies in African mission hospitals). 19. Conferences [Melinda Mitchell - meetings@cmda.org] Includes CMDA’s annual National Convention, the Global Missions Health Conference, Media Training and numerous topical, regional and local conferences listed at www.cmda.org/meetings. 20. Continuing Medical/Dental Education [Barbara Snapp - ce@cmda. org] Accredited by the ACCME to provide AMA PRA Category 1 Credit™ and an Academy of General Dentistry Approved PACE Provider which enables CMDA to offer continuing medical and dental education courses alone or in partnership with other organizations. 21. Development/Stewardship Ministries [Jim Link - stewardship@ cmda.org] An educational service, teaching members to be good stewards of the resources God had given them. 22. Ethics Hotline [423-844-1000] An on-call program to assist members who face difficult patient care decisions, provided by the volunteers members of the Ethics Committee that formulates CMDA’s ethical position statements for Board and House of Representative approval. 23. Internet Resources www.cmda.org [Margie Shealy – communications@ cmda.org] A website with more than 4,000 pages of resources (position papers, magazine articles, meeting calendars, audio and video files and other information), as well as social media sites such as blogs (www.cmda.org/blogs), Facebook (www.facebook.com/ cmdanational), Twitter (www.twitter.com/cmdanational) and YouTube (www.youtube.com/cmdavideos). 24. Membership Services [Raquel McLamb – memberservices@cmda. org] Assists members with information regarding the services and resources available through CMDA, as well as membership recruitment, renewals and retention. 25. National Student Council [nsc@cmda.org] A national organization of student leaders from CMDA Campus Chapters across the U.S., designed to empower Christian medical and dental student leaders to live out their faith authentically, influence the culture of healthcare, unite with other Christian leaders for enduring fellowship and shape the future of CMDA. 26. Newsletters [www.cmda.org] Dental Impact (an informational newsletter for dental members), e-Pistle (monthly training/news for career missionaries), GHO Dispatch (monthly updates for GHO participants), Gift Legacy (monthly stewardship information), Heartchangers (monthly updates for regular financial sponsors), Infusion (quarterly orientation for new members), Intensive Care (quarterly newsletter dedicated to the reporting of changed lives as a result of the generous investment of our members and friends), Medical Connections (a quarterly newsletter for Placement Services), MEI Messenger (a monthly resource for MEI participants), On the Side (monthly resource for Side By Side participants), SCAN (a summary of major medical journals for medical missionaries), the point (biweekly

public policy education on bioethical issues), WIMD Pulse (monthly updates and devotions for WIMD participants) and Your Call (produced to encourage and equip those preparing for a career in missions). 27. Placement Services [Allen Vicars - placement@cmda.org] Recruiting service that brings together Christian physicians, mid-level providers and practices throughout the U.S. to enhance their ministry and advance the kingdom of God. 28. Prescribe-A-Resource [www.cmda.org/par] A catalog of CMDAapproved resources indexed by topic designed to meet the needs of both healthcare professionals and patients. 29. Saline Solution [Melinda Mitchell – meetings@cmda.org] Training for healthcare providers via conferences or small group video series on how to appropriately and effectively help their patients with spiritual issues. 30. Speaker Referral Bureau [Margie Shealy - communications@cmda. org] An online self-referral speaker’s bureau of CMDA members. 31. Today’s Christian Doctor [Mandi Mooney - mandi.mooney@cmda. org] A quarterly magazine with the goal of helping doctors become all that God has designed them to be.

Voice – outreaches that speak for our members to the government, media, church and public on bioethical and public policy issues while also training Christians to be effective advocates themselves

32. American Academy of Medical Ethics® [www.ethicalhealthcare.org] A forum to help train and equip healthcare professionals to adopt the ethical tents defined by the Hippocratic tradition. 33. Amicus Curiae Briefs [Jonathan Imbody - washington@cmda.org] A cooperative endeavor with Christian lawyers to develop legal briefs advocating for life and human dignity in important court cases. 34. Freedom2Care [www.freedom2care.org] Coalition advancing conscience rights in healthcare and providing legislative updates and action tools. 35. News Releases [Margie Shealy - communications@cmda.org] CMDA’s response to breaking news on vital healthcare issues resulting in hundreds of media interviews each year. 36. Public Service Announcements (PSAs) [Margie Shealy communications@cmda.org] Library of PSAs on ethical and healthcare topics available to radio stations each year. 37. Standards4Life [www.standards4life.org] Free web-based resource for the church or personal education that deals with the scientific and biblical issues surrounding tough bioethical issues in simple, easy-to-understand language. 38. State Public Policy Campaigns [Margie Shealy - communications@ cmda.org] Grassroots campaigns to promote life-honoring legislation/ referendums at the state level on physician-assisted suicide, embryonic stem cell research and other issues. 39. Washington Office [Jonathan Imbody - washington@cmda.org] Serving as a liaison with Congress, the White House, federal agencies and nongovernmental organizations in Washington, D.C. Providing opportunities for federal employment, Congressional testimony and committee service. Coordinating legal initiatives to gain justice in the courts.

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A Biblical Foundation for Medicine Part 3: Overview of Scripture by John Dunlop, MD, MA (Bioethics)

This is the final article in a three-part series discussing the ways that the Bible should be impacting your practice. In this issue, we will be presenting an overview of the role of medicine in the Scriptures as we reflect on where the healing professions fit into God’s plan for redemption. If you missed the first two articles in the series, visit www.cmda.org/tcd.

he Scriptures provide key insights into the way true Christian doctors should practice medicine and dentistry. Exploring the major sections of the Bible can enable us to discover them. While some of these lessons refer to what we do medically (substance), most will relate to how we do it (style). Pentateuch Genesis, the book of beginnings, teaches that humans are not the product of time and

chance, but were purposefully created by God. This implies that God understands our anatomy and physiology as well as our psychology and spirituality. He placed within us deep longings that can only be fulfilled by Him. Genesis shows that we were made in God’s image (Genesis 1:26-27), which distinguishes humans from the remainder of creation; an ontological distinction that imputes intrinsic value to individuals independent of their ability or function. Humankind alone has the capability of relating to and finding meaning in God. Bearing the imago dei also bestows a protection that God uniquely gives to human life: “Whoever sheds the blood of man, by man shall his blood be shed, for God made man in his own image” (Genesis 9:6, ESV). The distinction of being created in God’s image requires our respect of all human beings independent of their station in life. Human life begins at the moment of conception when the chromosomes from the father line up with those of the mother at the first mitosis and a unique genetic individual is formed. God’s image persists in us from then until the time of natural death. In the Pentateuch, we are introduced to two key concepts: shalom and checed. Shalom is the blessed state of holistic health. Checed is the faithful loving kindness we see in God typically directed to His people. It is by means

of checed that shalom can be experienced. But we also learn of Adam’s sin. This provides an intellectual understanding for the present human condition—made in God’s image, but fallen into sin. With this in mind, we approach human need while recognizing that individuals are fundamentally broken on the inside. Many of the problems and diseases humans face are the result of wrong moral choices. It is not adequate to simply change the external environment, change must happen from the inside out. A biblical approach to medicine is incomplete until there is inner transformation and shalom. In addition, there are some details in the Torah that teach substance. An emphasis is placed more on prevention than on cure (something distressingly lacking on the contemporary scene). Moses writes, “If you will diligently listen to the voice of the Lord your God, and do that which is right in his eyes, and give ear to his commandments and keep all his statutes, I will put none of the diseases on you that I put on the Egyptians, for I am the Lord, your healer” (Exodus 15:26, ESV). Here we see that disease is under God’s sovereign control in that He can prevent, produce or heal it. Though the primary intent of the ceremonial law was to demonstrate a people set apart to their Holy God, some of the provisions in the law of Moses were good public health principles. Contagious diseases were quarantined (Leviticus 13:46). Some of the dietary distinctions between clean and unclean animals promoted healthier eating. The Israelites were told as a general rule not to eat the fat (Leviticus 3:17) and were punished for gluttony (Numbers 11:31-33). Personal cleanliness was promoted (Leviticus 17:15-16) and sanitation was maintained in the camp by the requirement that the people bury their excrement (Deuteronomy 23:12) and not touch dead bodies (Leviticus 5:2). The Sabbath itself assured that God’s people had appropriate periods of rest to maintain their psychological and spiritual shalom. It is of great significance that in this introduction to the Scriptures, God laid out the principle of respect for infants and the unborn (Exodus 1:17, 21:22-23). History The books of history in the Old Testament largely recount the tragic effects of sin while celebrating God’s love and patience (checed) with His wayward people. When diseases struck, the afflicted were typically encouraged to seek help from God directly rather than from medical practitioners: “. . . Asa was diseased in his feet, and his disease became severe. Yet even in his disease he did not seek the Lord, but sought help from physicians” (2 Chronicles 16:12, ESV). The fact that he consulted a physician was not the point of contention but rather that

he did so without seeking the Lord at the same time. However, we do begin to see some use of God-ordained technology for healing. When Hezekiah was dying, he sought healing through the prophet Isaiah and was instructed to use a poultice (a cake of figs) on his boil and was thereby healed (2 Kings 20:7). Poetry/Wisdom The wisdom books of the Old Testament have a great deal to teach about a biblical foundation for medicine. Job in particular gives valuable perspectives. First we see that disease, though it may be mediated by Satan and it is a mystery to us, is ultimately in God’s control. There is such a thing as suffering productively. Job moved through his suffering to experience God in a far greater and more fulfilling way. Contemporary caregivers would do well to reflect on what God may be accomplishing in their patients’ spirits to ensure that they are working together with God and not against Him as much as possible.i In addition to these issues of style, we see some of the substance of medicine as Job pitifully sat in the ashes scraping his ulcerated skin with pieces of broken pottery; perhaps he is demonstrating the value of debridement and drainage of abscesses. The Psalms teach us to remember that He has some purpose in our affliction even while we are crying out to God in our distress, “I cry out to God Most High, to God who fulfills his purpose for me” (Psalm 57:2, ESV). The book of Proverbs likewise gives helpful perspectives on both the style and substance of medicine. First it teaches the value of wise living and of making good moral choices. The book also urges that this wisdom be shared with others. Teaching the value of living wisely should be part of any practice. In Proverbs, we repeatedly see warnings against promiscuous sex and the abuse of alcohol. Notwithstanding, Proverbs encourages the use of pain control in end-of-life care, “Give strong drink to the one who is perishing, and wine to those in bitter distress” (Proverbs 31:6, ESV). The writer also expresses a holistic view of healing, “A joyful heart is good medicine, but a crushed spirit dries up the bones” (Proverbs 17:22, ESV). In the book of Ecclesiastes, Qoheleth reminds us that there is a time to be born and a time to die (Ecclesiastes 3:2). The principle is therefore established that death is a natural part of life. As we seek to eke a few more days out of life with the plethora of technologic options available to us today, we would do well to remind ourselves that there is a time to die. Prophets The writings of the prophets repeatedly emphasize God’s

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love and care for the poor, including orphans, widows and aliens, and also warn of His judgment upon those who would take advantage of those segments of society. In these books of the prophets, it is instructive to see the increased use of medical technology including oils (Isaiah 1:6), balms (Jeremiah 51:8), medicines (Jeremiah 30:13, 46:11) and leaves for healing (Ezekiel 47:12). These medicinal agents are condoned and not viewed as contrary to God’s will. Gospels One cannot read the accounts of Jesus in the Gospels without being impressed by how committed He was to healing disease. His three years of public ministry were largely spent either in teaching or in healing the sick. In considering the healing ministry of Jesus, we can learn several lessons to follow: 1. Both disease and ultimately death were in the power of God working through Jesus. Jesus frequently made His dependence on God explicit by praying before He healed or raised someone from the dead (John 11:41). 2. Whereas in various circumstances Jesus used healing as a means to the end of authenticating His authority (Matthew 11:5) or to display the works of God (John 9:3), many of His healings appear to have been ends in themselves. 3. Jesus healed those from all races and socioeconomic strata. He healed lepers (Matthew 8:2), the son of a Roman centurion (Matthew 8:5-13), a Gentile Syrophoenician (Mark 7:29) and one of those who came to arrest Him (Luke 22:51).

4. He healed completely. Recall the blind man who initially was able to see men as trees walking but whose vision was fully restored after the second touch (Mark 8:22-25). Jesus was committed to His “patient” until full healing was accomplished. After He healed a blind man, Jesus sought him out and led him to faith in Himself (John 9:35). 5. He recognized that some afflictions were caused by demonization, correctly identified these situations and handled them appropriately. In other words, He recognized the spiritual roots of some afflictions (Matthew 8:28ff, 9:32-34, etc.). 6. He became emotionally involved with and had compassion for the needs of people around Him (Matthew 9:36, 14:14). 7. At times Jesus would use physical means and human involvement in His healing. He applied mud to a blind man’s eyes and had him wash it off (John 9:6-7). He commended the Samaritan who tended the wounds of the victimized traveler by applying dressings using oil and wine (Luke 10:34). 8. Jesus was never obsessed with His power to heal. He did not try to heal everyone in Palestine. He daily did what God called Him to do, took time to commune with His Father and spent time with His disciples. 9. In His own death, Jesus demonstrated that death itself was a lesser wrong than being disobedient to the will of the Father (Luke 22:42). 10. Jesus taught His disciples so they could continue His healing ministry and empowered them to do so (Luke 9:2). In listing the practices that should uniquely characterize His followers, Jesus mentions visiting the sick (Matthew 25:36). This could legitimately be translated as “took care” of the

sick (NET). After telling the story of the Good Samaritan, Jesus asked which of the passersby had been the neighbor to the man beaten and robbed. The answer was the one who showed mercy. The response of Jesus was classic: “You go, and do likewise” (Luke 10:37, ESV). That one statement is enough to authorize the entire enterprise of medicine.

series of biochemically mediated processes but an eternal relationship with the God who made us for Himself and for His own glory. There is therefore an appropriate time to cease fighting death and simply rest in Jesus.ii The Epistles repeatedly urge us to express our dependence on God through prayer. 3 John 1:2 speaks of praying for good health. James exhorts the sick to request prayer and anointing with oil.

Acts

Revelation

The book of Acts chronicles the work of the Holy Spirit to equip and empower the early believers to further the work of Jesus. Part of this was healing and even raising the dead. It is of note that the recorded healings in Acts resulted in people marveling at God’s power and turning in faith to Christ. Acts introduces us to Luke whom Paul referred to as the beloved physician and affirmed him in that role (Colossians 4:14).

John’s revelation of Jesus Christ sets the enterprise of medicine in an eschatological context. “He will wipe away every tear from their eyes, and death shall be no more, neither shall there be mourning, nor crying, nor pain anymore, for the former things have passed away” (Revelation 21:4, ESV). The need for medicine will be past. Believers will have resurrected bodies akin to that which the Lord Jesus had in His post-resurrection appearances—no longer limited by some of the physical and temporal constraints our present bodies are now under, we will be equipped as never before to experience the glory of God.

Epistles The Epistles explicitly teach many of the principles Jesus exemplified. The importance of love is stressed (Romans 12:10, Galatians 5:13, 1 Thessalonians 4:9, etc.). This is not simply love in word but a full and sacrificial giving of one’s self. The apostle said “So, being affectionately desirous of you, we were ready to share with you not only the gospel of God but also our own selves, because you had become very dear to us” (1 Thessalonians 2:8, ESV). The actions that demonstrate this love are the result of our faith (James 2:20) and the fruit of the Holy Spirit who indwells believers (Galatians 5:22). A second key area to emphasize from the Epistles is the importance of the body and the care we give it. We are to glorify God not only in our spirits but with our bodies (1 Corinthians 6:19-20). As human beings we are intrinsically both material and immaterial; body and soul. That is true of our earthly existence but also of our heavenly future. The hope we have of a bodily resurrection underscores the value of the material body. This emphasis on the value of the body raises a tension towards the end of life. Death is presented as an enemy (1 Corinthians 15:26), it came in consequence to the fall. Therefore, we should employ the technology God has allowed us to preserve and honor life as much as we are able. However, death is not ultimately an enemy for by the death and resurrection of Jesus it has been defeated (1 Corinthians 15:53-57, Hebrews 2:15). Rather than simply honoring life, our end-of-life decisions must honor the gospel. Life is after all not fundamentally a

Conclusion This series of articlesiii has demonstrated how understanding a Christian worldview, the character of God and the role of medicine in the Bible can transform our daily practice and allow God to be honored increasingly in our daily service to our patients. “To him be glory forever. Amen” (Romans 11:36b, ESV). ✝ Bibliography Four excellent resources that help us understand how God can use the difficulties of life are: D. A. Carson, How Long O Lord? Reflections on Suffering and Evil (Grand Rapids, MI., Baker Book House, 1990), Larry Crabb, Moving Through Your Problems Toward Finding God, (Grand Rapids, MI., Zondervan, 1993), John Piper and Justin Taylor eds. Suffering and the Sovereignty of God (Wheaton, IL., Crossway, 2006) and Joni Eareckson Tada and Steven Estes When God Weeps: Why Our Sufferings Matter to the Almighty, (Grand Rapids, MI., Zondervan, 1997). ii John Dunlop, Finishing Well to the Glory of God: Strategies from a Christian Physician, (Wheaton IL., Crossway Books, 2011) iii To access all three articles in this series, visit www.cmda.org/tcd. i

John Dunlop, MD, MA (Bioethics) practices internal medicine and geriatrics at the Aurora Health Clinic in Zion, Illinois. He received his MD from Johns Hopkins where he did residencies in Internal Medicine and an MA in Bioethics from Trinity International University where he serves on the adjunct faculty. He is the author of Finishing Well to the Glory of God: Strategies from a Christian Physician (Crossway 2011). He can be reached at JDunlopMD@gmail.com.

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Clinical Tropical Medicine and Traveler's Health – ASTMH accredited. June 12-August 3, 2012. Sponsored by West Virginia University School of Medicine Office of CE and the Global Health Program. Contact Nancy Sanders at 304-293-5916 or email nsanders@hsc.wvu.edu.

Dental Experienced Christian Dentist – seeking P/T position in Southern New Hampshire or North of Boston in Massachusetts. Bread and Butter dentistry as well as cosmetic procedures such as conservative laminate veneers. Contact Dr. Joseph at 603-893-3670 or email drjosephdds@aol.com. Associate Dentist – Christian-minded group practice in Stony Plain, Alberta, Canada requires associate dentist. We work in a fantastic town with great staff and coworkers, and onsite childcare. Successful candidate likes “small town by big city” living, loves children, enjoys learning and is concerned primarily with patients’ well-being. No “get rich quick” scheme, but if you treat your patients well, they will take good care of you. Please send resume to turnerhm@yahoo.com. Oral Surgeon – Illinois – Established 26-yearold practice looking for associate to become a partner. Great place to raise a family, close to Chicago, Milwaukee and Madison. Full scope, Implants, light trauma, laser, I-CAT, mostly fee for service. Guaranteed salary and

Medical Family Medicine – Mad River Family Practice is a progressive community-based family practice in west-central Ohio. Currently seeking a full-time family physician to join a practice founded on lifelong learners and forwardthinking clinicians. Enjoy the rewards of a full scope of practice in a supportive group environment. Our family physicians place strong emphasis on addressing spiritual needs, as well as physical and mental needs. Practice offerings include: a vibrant and long-standing practice with varied demographics, flexibility in style and range of family practice, opportunities to foster medical education among students in healthcare, a welcoming community in west-central Ohio, with easy commuting to Columbus and Dayton, Ohio and a competitive salary and benefits package. Contact Tara Wagner at twagner@madriverfamilypractice. org or call 937-465-0080. Family Practice – Physician needed for a busy Christ-centered private practice in Michigan’s Upper Peninsula. Beautiful rural setting with inland lakes and woods promotes a balanced, active life. Stable, highlyrespected practice with two physicians and two mid-level providers. New office located adjacent to the hospital. OB and inpatient preferred, rural health certified, missions orientation. Offering either employee or partner option. Contact Dan Mitchell, MD, at dmitchell@chartermi.net or 906-282-3559.

Family Practice (outpatient only) – Board certified family practice physician needed for a thriving Christian-based private practice in southern Central Valley, California. Must be comfortable with EMRs and have leadership potential. Send your CV to sjfm@bak.rr.com. Orthopedic – “Do right, love mercy, walk humbly.” —Micah 6:8. Do you share this intent? Ours is a 35+ year old practice in Nebraska devoted to these guiding principles. We aim to help people through our professional and compassionate care as well as our outreach to the community and beyond. Find your niche in an environment that is familyfriendly, community-focused and patientcentric. Low malpractice and cost of living, onsite surgery center, mission minded, vibrant community with a university, new physicianmanaged surgical hospital opening in late 2012, great schools, low crime rate and lots of ways to make a difference. We want to add at least one other general orthopedist as well as a sub-specialist. Won’t you contact us? Kearney Orthopedic & Sports Medicine, Kearney, NE; Medical Director, Dr. Chris Wilkinson at 308-627-4664 or cwilkinson@ kearneyortho.com. Administrator Vicki Aten at 308-865-2512 or vaten@kearneyortho.com.

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