Volume 51 No2 • Summer 2020
Today’s
Christian Doctor The Journal of the Christian Medical & Dental Associations
COURAGE
IN THE CRISIS
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FROM THE CMDA PRESIDENT GLORIA HALVERSON, MD
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A NEW VISION FOR THE FUTURE
am so glad to have the chance to personally reach out to you through this edition of Today’s Christian Doctor, since I didn’t have the opportunity for the usual hugs, handshakes and fellowship with you at the CMDA National Convention that was previously planned to be held in Cincinnati, Ohio in April. So many things have been out of our control as a result of COVID-19, but what a blessing it is to know the One who is in control!
The Board of Trustees was planning on rolling out some big news at the convention—we have new mission and vision statements! Why would we change them? I am glad you asked. It is time for CMDA to complete a new five-year strategic plan. For some of our ministries, that can be as little as tweaking some of the old plan. After 25 years of wonderful leadership by Dr. David Stevens, and the recent start of new CEO Dr. Mike Chupp, the Board of Trustees believes this is an ideal point to reevaluate all our ministries and ensure we are best positioned to move forward into the future as God leads us. That means starting with the mission and vision statements, because all of our strategic planning begins with and flows from these statements. A vision statement is why an organization does what it does. It shows what the world will look like if we accomplish our goals. Our new vision statement is: Bringing the hope and healing of Christ to the world through healthcare professionals. A mission statement is how we’ll achieve what we want to achieve in our vision. Our new mission statement is: CMDA educates, encourages, and equips Christian healthcare professionals to glorify God. Christian healthcare professionals glorify God by following Christ, serving with excellence and compassion, caring for all people, and advancing Biblical principles of healthcare within the Church and throughout the world. Are we trying to change the direction of the organization? No, not at all. Instead, we are trying to define and describe as accurately as possible who we are and, from that, be able to create our vision for the future. We are excited by these new statements. We hope you like them too, and we hope you feel they represent you as a Christian in healthcare. Our core values remain the same. They currently are:
COURAGE IN THE CRISIS
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ur world as individuals and as healthcare professionals has been rocked by the COVID-19 pandemic. At CMDA, we want you to remember that you are not alone! We are here with you for such a time as this, every step of the way. As a ministry for Christians in healthcare, we stand ready to pray for you and assist you in any way we can. Check out some of the resources below that we’re offering to help sustain you and give you courage in this crisis.
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This edition of Today’s Christian Doctor includes resources for you as you fight against the virus, plus it has some of the information we would have shared at this year’s cancelled CMDA National Convention.
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Join our Facebook group “Courage in the Crisis: CMDA & COVID-19” to connect with your fellow colleagues in healthcare and find encouragement and support.
• Plus,
visit www.cmda.org/coronavius for the latest resources just for you from CMDA’s Center for Wellbeing, Campus & Community Ministries and more.
• Christ-like • Controlled by the Holy Spirit • Committed to Scripture • Communing in Prayer • Compassionate • Competent • Courageous • Culturally Relevant With these new statements and our core values, CMDA’s Board of Trustees will then look at emerging trends, both internally in the Christian healthcare community and externally in the political, economic, social and technological arenas. As the board, we are the body that represents you, our key stakeholders, and it is our job to see that your expectations are recognized and addressed. Because of this, you will receive a request sometime in the next few months to complete a survey that will help us in our strategic planning. This is very important to the process, because we need to hear from YOU. We will then look at the strategic issues facing CMDA and evaluate our strengths and weaknesses, and once that is complete, we will come up with our next five-year strategic plan. From there, the CEO and staff will develop metrics and set goals. This is an exciting time, and it’s a time in which you truly have influence to see that CMDA continues to powerfully serve God’s kingdom and move on to a new future in which CMDA helps to meet your needs, to make you excited to participate and to serve Him well. Blessings to you.
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TO DAY ’ S C H R I S T I A N D O C TO R
contents 20 8 Cover Story
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VO LU M E 5 1 , N O. 2
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Our Calling in the Coronavirus Pandemic
by Reverend Stephen Ko, MD, MA, MPH, MDiv
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How Christians in healthcare are facing the virus
New Public Policy Statements for COVID-19
Resources to guide and direct healthcare workers on the frontlines
Making CMDA Better: Lessons from Basic Life Support
by Mike Chupp, MD, FACS
Looking ahead to the future with CMDA’s new CEO
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Introducing CMDA’s Learning Center
A new member benefit offering continuing education courses
A rtificial Intelligence and the Christian Physician
by William P. Cheshire, MD, MA
Assessing the fast-approaching promises and potential perils of artificial intelligence
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Downcast: Suffering, Depression and the Goodness of God
by Jennifer Huang Harris, MD; Harold G. Koenig, MD; and John R. Peteet, MD
An excerpt from CMDA’s newest resource
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This Is Your Brain on Generosity
by Jill Foley Turner
How does the pandemic affect the stewardship of your resources? 4 TODAY'S CHRISTIAN DOCTOR Summer 2020
SUMMER 2020
The Christian Medical & Dental Associations ®— Changing Hearts in Healthcare . . . since 1931.
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Anxious? Me, Too. How To Lean On God When Feelings Don’t Cooperate
by Amy Givler, MD, FAAFP
How to trust God in the middle of a global pandemic
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Classifieds
EDITOR Mandi (Mooney) Morrin EDITORIAL COMMITTEE Gregg Albers, MD; John Crouch, MD; Autumn Dawn Galbreath, MD; Curtis E. Harris, MD, JD; Van Haywood, DMD; Rebecca Klint-Townsend, MD; Robert D. Orr, MD; Debby Read, RN AD SALES Margie Shealy 423-844-1000 DESIGN Ahaa! Design + Production 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, Summer 2020, Volume LI, No. 2. 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© 2020, Christian Medical & Dental Associations®. All Rights Reserved. Distributed free to CMDA members. Non-doctors (US) are welcome to subscribe at a rate of $35 per year ($40 per year, international). Standard presort postage paid at Bristol, Tennessee. Undesignated Scripture references are taken from the Holy Bible, New International Version®, Copyright© 1973,
1978, 1984, Biblica. Used by permission of Zondervan. All rights reserved. Other versions are noted in the text. Christian Medical & Dental Associations P.O. Box 7500, Bristol, TN 37621 888-230-2637 main@cmda.org • www.cmda.org If you are interested in submitting articles to be considered for publication, visit www. cmda.org/publications for submission guidelines and details. Articles and letters published represent the opinions of the authors and do not necessarily reflect the official policy of the Christian Medical & Dental Associations. Acceptance of paid advertising from any source does not necessarily imply the endorsement of a particular program, product or service by CMDA. Any technical information, advice or instruction provided in this publication is for the benefit of our readers, without any guarantee with respect to results they may experience with regard to the same. Implementation of the same is the decision of the reader and at his or her own risk. CMDA cannot be responsible for any untoward results experienced as a result of following or attempting to follow said information, advice or instruction.
TRANSFORMATIONS
2020 SERVANT OF CHRIST AWARD Dr. T. Bob Davis
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stablished in 1972, the Servant of Christ Award honors those whose careers exemplify commitment to medical excellence along with a stalwart faith in Jesus Christ. The Christian Medical & Dental Associations is honored to present the 2020 Servant of Christ Award to Dr. T. Bob Davis. T. Bob has had a personal relationship with Jesus since he was a pre-teen, which was a basis for some extraordinary spiritual encouragement and support through his church family, his community friends and his own family. His wife Janis grew up in a Christian family as well, and they were actively involved in their local church. Both enjoyed playing the piano and singing for church and community. As natives of Alabama, T. Bob and Janis first met while he was a dental student at the University of Alabama Dental School. He graduated with his Doctorate of Dental Medicine in 1967, served as Captain in the U.S. Air Force and then married in Birmingham, Alabama in November 1969. That began their life together in Dallas, Texas, where they have lived, raised their family and joyfully served the Lord. Having practiced dentistry for more than 53 years, T. Bob is highly respected in the dental profession, not only locally and statewide but also nationally and internationally, as noted by inclusion in fellowship in the four national and international dental honor organizations. He is one of only just over 3,000 dentists in the U.S. who have attained the distinction as Master in the Academy of General Dentistry, which represents a strong practicelong commitment to continuing dental education, quality care and leadership. In addition to his contributions to the world of dentistry, T. Bob is a pianist extraordinaire who has traveled extensively throughout the world as a piano soloist and accompanist for large youth choirs and large dental and Southern Baptist conventions, as well as concerts of his own. His unique and flamboyant stylings are signature with the hymn and inspirational music settings. For decades he served as a pianist for First Baptist Church, Dallas, and Prestonwood Baptist Church in north Dallas. Janis volunteered T. Bob for his first dental mission trip as a result of serving as youth sponsors on national and international
youth choir concert tours. Since then, he has served as leader of dental mission trips for more than 44 years to Mexico, Nicaragua, India and Guatemala. The American Dental Association named him Humanitarian of the Year in 2018, which was followed by being named the International College of Dentists’ Humanitarian in 2019. Ministry through the piano medium is a natural talent given by our heavenly Father to T. Bob, a talent he has polished and refined to inspire folks young and old alike toward the love of Jesus. His signature smiling while looking at the audience and playing a dynamic worship song has endeared him to thousands in audiences in church, concert and convention settings. In fact, he has served as the pianist for CMDA’s National Convention on two occasions. His signature hymn arrangements draw people heavenward and toward a personal relationship with our heavenly Father. His talent is God given, while his focus is to share the Good News in his lifetime. Service to others has been a lifestyle while mentoring others has been a result. In all contacts, he seeks to radiate his faith in Jesus Christ. Throughout his career in dentistry and ministry through music, Janis enthusiastically encouraged and supported her husband, traveling with him throughout the nation and overseas. T. Bob and Janis have three grown children and seven grandchildren, all Christlike who live within a 30-minute drive of their home. This makes for lots of opportunities to spend time with them and help mold them spiritually. In recognition of a life focused on serving God no matter where His call leads, and to acknowledge his unparalleled service and leadership within CMDA, we proudly present the 2020 Servant of Christ Award to Dr. T. Bob Davis.
Regional Ministries Connecting you with other Christ-followers to help better motivate, equip, disciple and serve within your community Western Region Michael J. McLaughlin, MDiv P.O. Box 2169 Clackamas, OR 97015-2169 Office: 503-522-1950 west@cmda.org
Northeast Region Tom Grosh, DMin 1844 Cloverleaf Road Mount Joy, PA 17552 609-502-2078 northeast@cmda.org
Midwest Region Allan J. Harmer, ThM, DMin 951 East 86th Street, Suite 200A Indianapolis, IN 46240 Office: 317-257-5885 cmdamw@cmda.org
Southern Region Grant Hewitt, MDiv P.O. Box 7500 Bristol, TN 37621 402-677-3252 south@cmda.org
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TRANSFORMATIONS
In Memoriam Our hearts are with the family members of the following CMDA members who have passed in recent months and years. We thank them for their support of CMDA and their service to Christ. William B. Anderson, III, MD Cadiz, Kentucky • member since 2000 Bernard Brandstater, MD Redlands, California • member since 2001 Robert E. Buckler, MD Los Cruces, New Mexico • member since 1976 Robert H. Couch, MD Louisville, Kentucky • member since 2011 Steven George Gader, MD Tucson, Arizona • member since 1997 Theron Hawkins, MD Comfort, Texas • member since 1955 Anthony P. Markello, MD Orchard Park, New York • member since 1959 Donald L. Minter, MD Goshen, Indiana • member since 1950 Elizabeth L. Tso, MD Atlanta, Georgia • member since 1994
6 TODAY'S CHRISTIAN DOCTOR Summer 2020
EVENTS For more information, visit www.cmda.org/events.
Voice of Christian Doctor’s Media Training July 31 – August 1, 2020 • Bristol, Tennessee New Medical Missionary Training August 13-16, 2020 • Bristol, Tennessee Women Physicians in Christ Annual Conference September 17-20, 2020 • Newport Beach, California Marriage Enrichment Weekend September 25-27, 2020 • Grand Rapids, Michigan Greece Tour September 25 – October 5, 2020 • Greece Marriage Enrichment Weekend October 23-25, 2020 • Kingston, Tennessee Remedy West 2020 October 24-25, 2020 • Riverside, California Israel Tour November 3-15, 2020 • Israel
MEMORIAM & GIFTS
Gifts received January 2020 through March 2020 Memory Mr. & Mrs. James Kedrow in memory of Rachel & Kimberly Kedrow Dr. & Mrs. Gene Rudd in memory of Ethel Grey Mosley “Sunny” Weir Kruti Patel in memory of Ethel Grey Mosley “Sunny” Weir Lindsey and Virginia Lands in memory of Ethel Grey Mosley “Sunny” Weir Jeff Owsley in memory of Ethel Grey Mosley “Sunny” Weir Leanne Chasteen in memory of Ethel Grey Mosley “Sunny” Weir Mr. & Mrs. John Pike in memory of Ethel Grey Mosley “Sunny” Weir Mr. & Mrs. David Crenshaw in memory of Ethel Grey Mosley “Sunny” Weir M. N. Hayes in memory of Ethel Grey Mosley “Sunny” Weir Jessica Kellogg in memory of Boyd Ferguson Jon Hill in memory of J. Robert and Morrell Swart Nancy Markello in memory of Dr. Anthony P. Markello Dr. & Mrs. Kurt Hunsberger in memory of William J. Lawton Landy Sparr in memory of Dr. Robert Buckler Rachel Gerner in memory of Dr. Robert Buckler Gayle Shockey in memory of Dr. Robert Buckler Monica Conner in memory of Dr. Robert Buckler Craig Cairns in memory of Dr. Robert Buckler Larysa Breeze in memory of Dr. Robert Buckler Eileen Ryan in memory of Dr. Robert Buckler Sandia Laboratory in memory of Dr. Robert Buckler Mountview Christian Church of Columbus in memory of Dr. Robert Buckler Lydia Anderson in memory of Dr. Robert Buckler Mary A. Brown in memory of Ruth Marian Cropsey Clark Barton in memory of Ruth Marian Cropsey Rutherford Farm LLC in memory of Ruth Marian Cropsey Daniel Halfmann in memory of Ruth Marian Cropsey Lucretia Van Cleve in memory of Ruth Marian Cropsey Cheryl Weise in memory of Ruth Marian Cropsey Jordan Goodell in memory of Ruth Marian Cropsey Susan White in memory of Ruth Marian Cropsey South Riley Bible Church of Dewitt in memory of Ruth Marian Cropsey Anonymous in memory of Dr. Leonard Ritzmann Elizabeth Helms in memory of Dr. Leonard Ritzmann Honor Rhonda Wright in honor of Trish Burgess, Ron Brown and Brenda Wheeler For more information about honorarium and memoriam gifts, please contact stewardship@cmda.org.
TRANSFORMATIONS
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PAACS to Become an Independent Ministry
ince its inception in the mid1990s, CMDA has provided oversight and support to the Pan-African Academy of Christian Surgeons (PAACS), a commission of CMDA. PAACS is a five-year program that trains and disciples African physicians to be surgeons who glorify God, and it has now grown to include multiple training sites throughout Africa. Through the grace of God, the PAACS ministry has flourished in the last two decades. The growth in the surgical residency programs in Africa has seen an amazing number of graduates in multiple surgical specialties. God has blessed this commission, which has matured significantly over the years. “We recognize that the PAACS commission and administration are in a good position for self-governance, greater growth and pursuit of a very bright future as God continues to show His favor over the training of many more African surgeons in the years to come,” said CMDA President Gloria Halverson, MD.
In 2019, CMDA’s Board of Trustees voted unanimously to offer support for PAACS to become a standalone ministry. Since then, CMDA and PAACS have been working together to work toward this goal. And effective July 1, 2020, PAACS will be an independent 501(c)3 non-profit organization. “You have nurtured us as an organization and as a family for the past 20 years,” said PAACS Commission Chair Thomas C. Robey, MD. “You have been the bedrock of our organization. Your guidance and wisdom have been extremely valuable. We thank CMDA for its friendship and leadership over all these years and look forward to a wonderful partnership going forward.” “CMDA continues to support PAACS as it moves toward the new paradigm of becoming independent, and we request the continued prayers and support of our members in the years to come for this vital ministry,” said CMDA CEO Mike Chupp, MD, FACS. “Together with PAACS, we will continue bringing the hope and healing of Christ to the world.”
LEARN MORE
To learn more about PAACS and get involved, visit www.paacs.net.
MAP International Fellows Scholarship Paid Advertisement
If you are a 4th year medical student participating in a Christian overseas medical mission, you may be eligible for up to
$2,000 towards
your international airfare through our MAP Fellows Program. Email crowell@map.org for more information. www.map.org www.cmda.org 7
OUR CALLING
IN THE CORONAVIRUS
PANDEMIC by Reverend Stephen Ko, MD, MA, MPH, MDiv
8 TODAY'S CHRISTIAN DOCTOR Summer 2020
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ew of us trained to treat sick communities and continents. Unfortunately, that is our task during a pandemic. The origin of the word comes from the Greek pandemos, where pan means everyone and demos means population. Pandemics confront us with not just one sick individual but with hundreds of thousands of ill patients. The responsible pathogen overwhelms both individual immune systems and community healthcare systems. The toll is individual and collective. In addition to quality medical care, Christian healthcare professionals have a unique calling to fulfill, as well as unique resources to offer individuals, communities, countries and churches as everyone grapples with the novel Coronavirus (SARSCoV-2). Coronavirus disease (COVID-19) is devastating because it is highly transmissible, with a reproductive number (R0) between 2-3.1 The incubation period ranges between two to 14 days, similar to other coronaviruses such as SARS-CoV and MERS-CoV. However, the vast majority of patients present with asymptomatic infection or mild illness. The net result: infected individuals are highly contagious. A typical infected person will transmit Coronavirus to two or three other people. The growth rate of the disease may be geometric, not linear. Because of this rapid spread, healthcare supply chains buckle. In the early weeks of the COVID-19 pandemic, healthcare professionals in New York City and other epicenters reported shortages of personal protective equipment (PPE), putting them at significant risk for infection. Social media filled with stories of healthcare professionals using and reusing their N95 respirators, while others served patients wearing only surgical masks. Calls went out for schools, dentist offices and television production sets to contribute their supplies of respirators. Faced with the potential of infection, healthcare professionals around the country have had to count the cost of their calling.
THE FREEDOM OF SACRIFICE
Each of us understands the risk, but Christian healthcare professionals should experience great freedom as we count the cost. We should be the first to volunteer to take the shifts of older or immunocompromised colleagues. We should be the first to offer up our access to PPE. We should be among those who are the least afraid to come in close contact with infected patients daily. Even as we call for communities to practice social distancing, we draw near. Why?
We follow in the footsteps of Jesus. In a culture that encourages us to focus on our families and invest in our security, He called us to be willing to abandon our families to follow Him (Luke 14:25-27). When others practiced social distancing, Jesus reached out to touch the leper (Mark 1:4045). Jesus calls each of us to lose our life for His sake (Matthew 10:39), to pick up the cross and follow Him (Matthew 16:24) and to define love by giving our lives for others ( John 15:13). Perhaps it is God’s mercy that the pandemic arrived in the United States just as Lent began. We are invited to follow Jesus wherever He leads, even when it leads to Calvary. During the Ebola epidemic in 2014, the world marveled at the example of healthcare professionals like fellow Christian and CMDA member Dr. Kent Brantley. They could not comprehend his willingness to risk exposure and possible death by staying in Liberia. They could not understand his desire to return to Africa after he recovered. But his example should surprise no Christian and should be emulated by all Christians. Jesus embraced death to save others (Romans 5:6). He triumphed over death, so it lost its sting (1 Corinthians 15:55). As Christians, we know in whom we believe, and we are convinced He can guard what we have entrusted to Him (1 Timothy 1:12). When we follow Jesus in this way, the gospel becomes clear to everyone. This is what happened when a 75-year old www.cmda.org 9
Italian pastor with COVID-19 was admitted to a hospital in Lombardy, Italy. Though he was quite ill, he read the Bible to the dying. He held their hands. Even in his death, he was a messenger of hope. His physician, Dr. Julian Urban, described the impact this pastor had: “Despite having had over 120 deaths in three weeks, we were not destroyed. The pastor had managed, despite his condition and our difficulties, to bring us a peace that we no longer had hoped to find. We cannot believe that, though we were once fierce atheists, we are now daily in search of peace, asking the Lord to help us continue so that we can take care of the sick.”2
A BROADER COMMITMENT TO LIFE
Because this is a new (or “novel”) Coronavirus, our prevention and treatment tools are limited. Natural immunities do not exist. Researchers have not had time to develop vaccines. Medications have not been tested for safety and efficacy. This leads to significant morbidity and mortality, especially for the elderly and those with comorbidities. Among COVID-19 patients, 19 percent of those infected will suffer severe illness or become critically ill.3 Most display symptoms around four days.4 Infected patients often present with fever (77 to 98 percent), cough (46 to 82 percent), myalgia or fatigue (11 to 52 percent) and shortness of breath (3 to 31 percent).5,6,7 The case fatality rate (CFR) is estimated to be 3.6 percent, 8 percent and 14.8 percent for those 60 to 69, 70 to 79 and over 80,3 often due to acute respiratory distress syndrome (ARDS). Mortality increases to 10.5 percent, 7 percent and 6 percent for those with cardiovascular disease, diabetes and either chronic respiratory disease, hypertension or cancer.
As health systems face overwhelming numbers of COVID-19 patients, other countries have experienced shortages of ventilators for patients with ARDS. Italian doctors have had to choose which patients receive ventilators and which do not. It is a decision no healthcare professional should ever have to face. Yet, it is a critical moment to wrestle with what we believe about the sanctity of life and the inequitable distribution of medical resources. During a pandemic, these injustices become life-or-death issues. Medical ethics, informed by centuries of Christian thought, may guide us in individual decisions of who to place on a ventilator. However, Christians in healthcare reflecting on these issues should be deeply troubled when healthcare disparities lead to these situations unnecessarily. Research by the Kaiser Family Foundation, for example, suggests that—contrary to trends in other locations— young patients (persons under the age of 65) in the southern United States are more likely to develop severe illness than in other parts of the country.8 In an interview in The Atlantic, Tricia Neuman, a senior vice president at the Kaiser Family Foundation, noted, “Due to high rates of conditions like lung disease and heart disease and obesity, the people living in these states are at risk if they get the virus.” The article also points out that these states often spend less on public health.9 A commitment to the sanctity of life should include, but not be limited to, the abortion debate. It should also inform our commitment to provide patients across the country with equitable access to quality healthcare.
ENGAGING COMMUNITIES
As Christian healthcare professionals, our commitment to healing extends beyond individuals to communities as well. As a former officer with the Centers for Disease Control and Prevention, I spent several years working globally to protect communities through public health initiatives. One of the most powerful tools we had was giving communities accurate information about disease and prevention. Misinformed or ill-informed communities made poor health decisions. This is no less true during a pandemic. We have a unique opportunity to partner with pastors and leaders of other community organizations who are ill-equipped to assess the torrent of medical data that follows a pandemic. We can help them assess risk. We can help them plan. We can persuade communities to engage in acts that protect the most vulnerable. 10 TODAY'S CHRISTIAN DOCTOR Summer 2020
When churches or neighborhoods resist the need for social distancing, we should speak clearly, consistently and loudly that social distancing is one of the most effective ways to flatten the epidemic curve. By promoting social distancing, Christian healthcare professionals protect their communities from contagion, while allowing infected patients to receive proper care and treatment. Human vectors, the critical ingredient for transmission of disease, are removed by these non-pharmacologic interventions. This results in less opportunity for COVID-19 to infect others, which translates to a fewer number of deaths and sustainable healthcare capacity. When erroneous or misleading statements are made in or by the media, we should be the first to object and to correct. We should resist politicization of scientific data or recommendations because our loyalty belongs to Jesus. We can offer the public a calming, fact-based, truth-focused voice in a sea of anxiety-provoking news. As the pandemic ebbs, we can interpret the data and help churches and communities decide whether and when to begin meeting together again.
DISCIPLINES OF HOPE
The darkness of the pandemic will not recede quickly enough. It will require many months of sacrifice, service and speaking up. However, while struggling and suffering, joy and peace are available to Christians. But it will require us to embrace two essential disciplines. First, we must learn to lament. Fully two-thirds of all Psalms are psalms of lament through which the biblical writers poured out their pain, fear, doubt and grief before the Lord. In a pandemic, we need to lament. We will be immersed in tragedy. In these lonely places, we can find refuge in communion with God. While choruses of hope and joy may buoy our spirits, the prayer of lament will keep us honest before God and one another. Second, we must embrace Sabbath when we can find it. Sabbath invites us to embrace our limitations as created beings. We need to rest. We need to trust God is at work when we are not. We need to acknowledge He alone is the world’s Savior and Healer. We are not. Sabbath confronts the idolatries of productivity and agency. When we observe the Sabbath, we proclaim our trust in God. That is essential during a pandemic.
We cannot cure entire communities or continents. But we trust God can.
BIBLIOGRAPHY 1 Liu, Y., et al., The reproductive number of COVID-19 is higher compared to SARS coronavirus. Journal of Travel Medicine 2020. 27(2). 2 Tosatti, M. The Cry of a Doctor in Lombardy: About the Virus, Death, and God. 2020; Available from: https:// www.marcotosatti.com/2020/03/21/the-cry-of-a-doctor-inlombardy-about-the-virus-death-and-god/. 3 Liu, Z., B. Xing, and Z.z. Xue, The Epidemiological Characteristics of an outbreak of 2019 Novel Coronavirus Disease CMA, 2020. 41(2): p. 145-151. 4 Guan, W., et al., Clinical Characteristics of Coronavirus Disease 2019 in China N Engl J Med, 2020. 5 Huang, C., et al., Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet, 2020. 6 Wang, D., et al., Clinical Characteristics of 138 Hospitalized Patients with 2019 Novel Coronavirus-Infected Pneumonia in Wuhan. 7 Chen, N., et al., Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study Lancet, 2020. 8 Koma, W., et al. How Many Adults Are at Risk of Serious Illness if Infected with Coronavirus? . 2020 [cited 2020 April 6]; Available from: https://www.kff.org/global-healthpolicy/issue-brief/how-many-adults-are-at-risk-of-seriousillness-if-infected-with-coronavirus/. 9 Newkirk, N.I. The Coronavirus’s Unique Threat to the South 2020 [cited 2020 April 6]; Available from: https://www. theatlantic.com/politics/archive/2020/04/coronavirusunique-threat-south-young-people/609241/.
REVEREND STEPHEN KO, MD, MA, MPH, MDIV, serves as Senior Pastor of New York Chinese Alliance Church in New York, New York. As an ordained Christian & Missionary Alliance pastor, he is passionate about evangelism, global health missions and holistic ministry, as exemplified by the life of Christ. In addition to seminary training, Dr. Ko’s healthcare specialties include pediatrics, preventive medicine and public health. He is currently Adjunct Professor at Alliance Theological Seminary. Previously, he served as a Global Health Professor at Boston University’s School of Public Health and as a Medical Officer for the Centers for Disease Control and Prevention. He has worked extensively in Africa and Southeast Asia on diseases of epidemic potential, helping low and low-middle income countries implement their national public health programs. He enjoys helping individuals flourish in their faith, mentoring church leaders and galvanizing faith-based organizations to action. Writing at the intersection of faith, medicine and public health is a particular passion. Follow him at @drsteveko.
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NEW PUBLIC POLICY STATEMENTS FOR COVID-19
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t the spring board meeting, CMDA’s Board of Trustees approved two new public policy statements directly relating to COVID-19. CMDA’s Ethics Committee developed these two statements to help guide you in responding to COVID-19. Portions of these two new statements are included below. The full statements are available at www.cmda.org/coronavirus. In addition to the statements, you can also find a variety of resources to help you through this crisis. We are constantly in prayer for you as you fight this battle in your homes, in your workplaces and in your communities. It is our prayer that these statements will serve to guide and direct you as you face COVID-19 on the frontlines.
DUTIES OF CHRISTIAN HEALTH CARE PROFESSIONALS IN PANDEMIC INFECTION Executive Summary
Throughout the ages, Christians, in obedience to Jesus Christ, have cared for the sick, even at risk to themselves. Christians’ refusal to abandon the sick in times of terrible pandemics was an inspiring witness to God’s love that transformed the ancient world. Christians today inherit this high calling. For the Christian health care professional, placing the interests of patients above our own is a matter of conscience.
BIBLICAL GUIDANCE 1. Sacrificial Service
a. The ultimate servant and model for Christian servanthood is Jesus Christ, who came into the world (Phil 2:5-8) to sacrificially take on himself the sin of the world and to give his life for us (Mark 10:45, 1 Pet 2:24). b. Jesus spoke to us clearly that we, too, are to serve others, even to the point of death (Matt 20:25-28). He gave his followers a command to love the Lord our God with all our heart, mind, soul, and strength, and to love our neighbor as ourselves (Mark 12:2931). He also said, “Greater love has no one than this, that someone lay down his life for his friends” ( John 15:13). c. Numerous passages admonish us to unselfishly serve those in need (Is 58:6-8, Matt 25:37-40). We are commanded to value their well-being ahead of our own (Phil 2:3-4, Eph 6:6b-7). d. In Jesus’ Parable of the Good Samaritan (Luke 10:29-37), the Samaritan cared for a stranger, likely considered an enemy, at personal expense and potential risk to himself. Jesus concluded with the words: 12 TODAY'S CHRISTIAN DOCTOR Summer 2020
“You go, and do likewise” (Luke 10:37). e. We have been saved by Christ, not just for ourselves, but so that, like him, we may give of ourselves to a broken and suffering world (Rom 12:1).
2. Stewardship
God has sovereignly called each of us into a vocation of service to others, especially those who are vulnerable to, and afflicted with, disease. God has given us our abilities for his glory and for human good (Matt 25:14-30). Jesus told his disciples that, “Everyone to whom much was given, of him much will be required” (Luke 12:48). Before assuming personal risk on behalf of her people, Queen Esther was reminded that she had attained the position she had “for such a time as this” (Esth 4:14). God may have called us for such a time as this.
3. Wisdom
God may call us to take some personal risk in our service for him. He also wants us to use the minds and wisdom he has given us. We are not to be reckless (2 Sam 23:15-17). Wisdom should underlie all our actions (Is 10:13; Acts 6:3; Col 4:5). Jesus admonished us to “count the cost” before embarking on a course of action (Luke 14:28). If we ask for wisdom, God has promised to supply it generously ( Jam 1:5).
4. Citizenship
Just as Paul was a Roman citizen, so we as Christian health care professionals (HCPs) are citizens of our countries. Unless we are ordered to do something contrary to the law and direction of God (Acts 4:19), we are to work with the governing authorities to be a constructive force for good in the community (Rom 13: 1-7).
5. Peace and Faith
Scripture also reminds us that, in times of great stress, we should not be mastered by anxiety or fear (Matt 6:27; Rom 8:35-39, Phil 4:5b-7).
CHRISTIAN HEALTH CARE PROFESSIONALS’ RESPONSIBILITIES
• V iew all human beings—whatever their circumstances— as created in the image of God • Constantly prepare to address the challenges of novel and longstanding infectious diseases • Provide guidelines for decision-making regarding allocation of limited resources • Aid in the diagnosis and care of the ill, even at personal risk • Assist in combating the spread of infection • Promote development of treatments and vaccines • Be good stewards of medical resources • Appropriately protect themselves and their colleagues from contracting the infection • Remember that we are part of a larger effort. While some
may feel strongly that they must fulfill their duty to care, regardless of the degree of personal risk, the individual must also consider the consequence of contracting the illness, which may include risk of infection for co-workers, decreasing the strength of the health care workforce, or increasing consumption of limited medical resources in his or her own care once infected. Public health authorities may order an individual HCP to refrain from engaging in some aspect of patient treatment for the good of the overall health care effort, and such orders should be obeyed. • Rejoice in God’s love, be thankful for every good gift we receive, and be compassionate toward all others.
For the full analysis and recommendations, please see Duties of Christian Health Care Professionals in the Face of Pandemic Infection at www.cmda.org/coronavirus.
TRIAGE & RESOURCE ALLOCATION STATEMENT Executive Summary
Health care systems and health care professionals (HCPs) should be prepared for mass casualty incidents (MCI), including disasters, epidemics, and pandemics, as have occurred throughout history and will certainly occur in the future. During an MCI, HCPs have an ethical duty to provide compassionate and competent care, including making life-and-death decisions as rationally and transparently as possible. This requires advance planning, such as designing decision-making tools and disseminating contingency protocols to alleviate uncertainty and moral distress.
GUIDING BIBLICAL ETHICS
Christian HCPs understand that all human beings are created in the imago Dei, the image of God (Gen 1:27) and, as such, possess a sanctity that is not diminished by any humanly imputed mitigating factors. Therefore, all considerations in triage and allocation decisions based on non-medical criteria should be excluded, such as perceived social worth, social class, ethnicity, age, gender, sexual orientation, religious conviction, political affiliation, economic status, nationality, disability, or any other trait that does not impact immediate crisis-related prognosis or survivability.
GUIDING ETHICAL PRINCIPLES
• Instituting and putting into place broad population-based policies that drastically alter the normal patient-physician relationship should be implemented only if: (1) critical care (life-sustaining) capacity has been, or shortly will be, exceeded despite taking all appropriate steps to increase capacity, AND (2) a duly-authorized authority has declared an emergency. • Triage in times of medical crisis surge conditions and MCIs is directed to the saving of as many lives as possible, seek-
ing to maximize good outcomes for the greatest number of people possible, but this is not an absolute goal and must not be sought at the expense of higher values held by HCPs who recognize the intrinsic value of all human beings as bearers of the divine image. • D uring an MCI, there is an imposed shift in an HCP’s duty from providing the most definitive and beneficial treatment to individual patients (the standard of care) to the priority of populations or groups of patients who are most at risk and will most likely benefit with an appropriate stewardship of limited resources (termed sufficient care or crisis standard of care). • Triage and resource allocation decisions should be objective, formalized, open, and transparent to both HCPs and to the public to the extent conditions allow.
RECOMMENDATIONS:
• Objectivity: Public health decisions during a crisis should be based on objective factors, rather than on the choice of individual leaders, HCPs, or patients. • Impartiality: To the extent possible, triage and resource allocation decisions that apply to individual patients should be the responsibility of parties other than the treating physician. • Care: All individuals should receive the highest possible level of treatment required for survival or limitation of long-term disability given the resources available at the time. Despite limitations in treatments, all patients should receive humane, compassionate care. • Non-essential interventions: Elective, non-essential interventions lack priority in crisis circumstances. • Stewardship: Appropriate stewardship of scarce critical resources requires triage and resource allocation decisions to be prioritized on the basis of medical need and likelihood for survival. • “All Things Being Equal”: When objective medical criteria do not clearly favor a particular patient (all things being equal), then “first come, first served” rules of allocation or a lottery system should apply. Either approach recognizes the inherent equality of all human beings. • Non-Exclusion: Those making triage and resource allocation decisions should pay particular attention to the needs of at-risk and marginalized persons, including the poor, the aged, and persons with disabilities, and ensure that they are not denied access to the triage process. • Palliative Care: All patients are still to be afforded the maximal care and comfort that is available, and patientcentered principles of medical ethics still apply. If comfort care resources are available, they should be deployed as indicated regardless of the prognosis of the individual patient. • Reallocation: º D uring an MCI, reallocation is defined as the nonconsensual withdrawal of life-supportive treatment (in the absence of a properly executed advance direcwww.cmda.org 13
tive or decision of a properly authorized surrogate) with the direct intent of transferring that same lifesupportive treatment to another patient who is considered a more worthy candidate for such treatment (by any criteria or bias) when the same or equivalent treatment is currently not available. º CMDA rejects any form of reallocation as defined above, whether by individual HCPs or by triage officers/committees. Withdrawal of life-supportive resources from a vulnerable patient should never be used as a means to another’s end. • Alternative to Reallocation: Optimal Stewardship and Care in a Time of Absolute Scarcity º The difference between reallocation and optimal stewardship is that the former is based on a utilitarian calculus comparing the “worth” or “benefit received” between patients where life-supportive treatment is unilaterally removed from one patient, based on their prognosis at the time, and given to another. The latter is based on the beneficent/non-maleficent treatment and care of each individual patient irrespective of the immediate needs of other patients. Even in an MCI, the good of the individual patient remains paramount. º Even when life-supportive treatments are readily available, many patients on life-supportive treatment may become terminally and irreversibly ill with little or no reasonable hope of recovery, from a medical standpoint. All fifty states and the District of Columbia recognize advance directives that permit direct withdrawal of lifesupportive treatment under these circumstances. Withholding or withdrawal of life-support in patients is also ethically permissible when: • The medical treatment becomes detrimental or no longer is contributing to the patient’s expected goals and outcomes; and • The suffering and burdens of a treatment outweigh the intended and foreseen benefits. (The intention is to avoid those sufferings and burdens, and even if death is foreseen, it is not intended as a means or as an end, but is accepted as the natural course of the underlying illness.) See CMDA’s statements on Double Effect and Euthanasia. º D uring worst-case extremes of crisis surge conditions, optimal stewardship of scarce life-supportive resources, such as mechanical ventilation, may require that a more stringent standard (more so than what would occur under normal circumstances of perceived unlimited resources) apply for what constitutes optimal beneficent and sufficient treatment. The ethical appropriateness of continuing or discontinuing treatment is equally applied to all patients. The relative stringency of these clinical standards (e.g., length of a trial of ventilation before a patient improves, percentage estimate of short-term survivability, level of acu14 TODAY'S CHRISTIAN DOCTOR Summer 2020
ity, SOFA or APACHE II score, and similar markers of survivability and benefit from treatment) will vary depending on the severity and magnitude of the MCI or crisis surge condition. º Further allocation of available life-supportive resources should be offered only within the bounds of wellcommunicated time-limited trials appropriate for the patient’s medical condition and the severity and magnitude of the current MCI or crisis surge condition. º Any decision to apply more stringent standards for what constitutes optimal beneficent and sufficient treatment should be impartial, based only on standard objective medical acuity including short-term prognosis scoring systems (such as SOFA and APACHE II scores) and not based on long-term survival prospects, age, disability, or social value. These decisions must be the responsibility of an appointed triage officer or triage committee and not the treating HCP to the extent possible. º Persons With Disabilities: During an MCI or crisis surge condition, persons with disabilities possess the same dignity and worth as others and should not be denied treatments based on stereotypes, assessments of quality of life, or judgments about their relative worth. Treatment decisions should be based on individualized assessments based on the best available medical evidence. For instance, patients with certain spinal cord injuries who are otherwise stable but require long-term use of ventilators should not have their ventilators removed for the purpose of reallocation. Preexisting terminal diagnoses, such as metastatic cancer, end-organ failure (lung, liver, kidneys), or severe dementia, are not considered a disability, but rather a medical condition. º These situational standards of beneficence should apply to all patients equally. Withdrawal of treatment for any patient should be based solely on those objective medical criteria appropriate to the situation and without deference to another patient who may benefit from subsequent resources that would be made available. Unless continued treatment is determined to be medically non-beneficial with no objective hope of short-term survival, decisions to withdraw treatment should never be unilateral or against the patient’s, or their family’s, wishes but remain a shared decision. Unlike many utilitarian reallocation schemes, these standards and criteria are not to be used to stratify or rank one patient against another, but to optimize the stewardship of limited resources by providing the best possible treatment to each and every patient, constrained by the contingencies of an MCI. • Conscience Objections º During worst-case extremes of crisis surge conditions, when an officially declared emergency exists and population-based ethics dominate, non-consensual with-
drawal and reallocation of life-supporting resources and/or unilateral decisions not to resuscitate (based on either patient condition or health care provider safety) may be dictated by government public health authorities, by designated triage officers/teams, or by published protocols. CMDA rejects any form of reallocation. º Some HCPs may experience moral distress based on their professional commitment to be patient advocates. Treating HCPs should be provided a formal means to appeal and advocate for their patient and/or to conscientiously object to complying with a triage order. At a minimum, HCPs should be provided with the option to step aside and allow another HCP to comply with the order when such appeals are denied. For further information and reflections, see CMDA’s statement Duties of Christian Health Care Professionals in the Face of Pandemics. • Euthanasia/PAS: Withholding or withdrawal of artificial means of life-support in patients who are clearly and irreversibly deteriorating, in whom death appears imminent and beyond reasonable, medical hope of recovery is ethically permissible. This is not to be equated with euthanasia, which remains prohibited. (see CMDA’s statements on Euthanasia and Physician-Assisted Suicide) • Preparedness: Governments and healthcare institutions have an ethical obligation to have in place a formalized plan for production, supply, and allocation of critical scarce resources through a process that is transparent, open, and publicly debated to the extent time permits. Institutions and governmental authorities also have an ethical obligation for the development, publication, education of HCPs,
and practice of triage methods and plans for MCIs. • Christian Unity: Jesus calls us to love one another, so if differences of opinion about ethical issues arise during these challenging times, Christian HCPs should work hard to maintain the unity of the Spirt through the bond of peace.
For a full explanation and defense of these recommendations, see Triage and Resource Allocation During Crisis Medical Surge Conditions (Pandemics and Mass Casualty Situations) at www.cmda.org/coronavirus.
ADDITIONAL ETHICS STATEMENTS
In addition to these two statements related to COVID-19, CMDA’s Board of Trustees and House of Representatives also approved additional ethics statements. Those statements are: • Pornography and Interactive Sexual Devices • Opioids and Treatment of Pain
These statements are designed to provide you with biblical, ethical, social and scientific understanding of these issues through concise statements articulated in a compassionate and caring manner. They are needed for the religious freedom battles we are currently facing, so we encourage you to share them with your colleagues, pastors, church leaders and others. Visit www.cmda.org/ethics for more information about CMDA’s Ethics Statements and to review these new statements.
CMDA Welcomes New Senior Vice President
Jeffrey J. Barrows, DO, MA (Ethics), joined CMDA as the new Senior Vice President of Bioethics and Public Policy in May 2020. He will be coordinating CMDA’s efforts in the public square as we speak for our members to the government, media, church and public on bioethical and public policy issues.
Dr. Barrows is an obstetrician/gynecologist, author, educator, medical ethicist and speaker. He completed his medical degree at the Des Moines College of Osteopathic Medicine and Surgery in 1978 and his residency training in obstetrics and gynecology at Doctors Hospital in Columbus, Ohio. In 2006, he completed a master’s in bioethics from Trinity International University in Chicago, Illinois. Dr. Barrows was called out of full-time practice in 1999 to help administrate CMDA’s Medical Education International (MEI). He served as the director of MEI from 2002 to 2005 before transitioning into the fight against human trafficking.
He has dedicated 15 years of his career to fighting against human trafficking within the intersection of trafficking and healthcare, as well as the rehabilitation of survivors of child sex trafficking. A strong proponent of education, Dr. Barrows has trained healthcare professionals on how to recognize and assist victims of trafficking within healthcare. He has testified on numerous anti-trafficking bills and is a speaker on human trafficking to the media, the church and other venues. In 2008, Dr. Barrows founded Gracehaven, an organization assisting victims of domestic minor sex trafficking in Ohio through outreach, case management and residential rehabilitative care. In 2014, he served as a member of the Technical Working Group on health and human trafficking under the U.S. Department of Health and Human Services’ Administration for Children and Families. He is a founding board member of HEALTrafficking, a united group of survivors and multidisciplinary professionals in 35 countries dedicated to ending human trafficking and supporting its survivors, from a public health perspective. In 2020, Dr. Barrows published a novel entitled Finding Freedom that realistically portrays child sex trafficking in the U.S.
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MAKING CMDA BETTER Lessons from Basic Life Support
I
by Mike Chupp, MD, FACS
still remember the first time I donned a whitecoat (one of those half-length coats for students) with a stethoscope in my pocket and walked into a patient room at the big city hospital in Indianapolis, Indiana in 1985. I was a second year medical student at Indiana University, and I had just received instruction from my clinical instructor on how to perform a thorough history and physical. I don’t remember my first patient’s name, but she was a young woman with a loud systolic heart murmur even I could hear. I also remember three words that were to guide me through each step of a thorough physical exam: “Look, listen and feel.” A couple of years later, those three words became critical again as I took my first basic life support (BLS) course and became certified both in BLS and advanced cardiac life support (ACLS), prior to becoming a surgical resident. Again, the phrase, “Look, listen and feel,” was the guiding mantra to get my first BLS certification card. I remember vividly the evening then-CMDA President Dr. Al Weir called me and shared the news that the Board of Trustees had unanimously agreed to invite me to be the next CEO of CMDA, following Dr. David Stevens. I was overwhelmed with wonder at God’s providential plan for me and this wonderful organization that I had joined during my first year of medical school. After recovering from the initial shock, it occurred to me that somewhere down the road I would be standing in front of an assembly of CMDA’s members and sharing from my heart where I felt God wanted us to go. Of course, it never entered my mind that, due to a global pandemic from COVID-19, I would be sharing that address with you through this article and through a camera from our national headquarters in Bristol, Tennessee instead of in person at CMDA’s National Convention. In my first “plenary address” to you as CMDA’s Chief Executive Officer, I want to share a brief message from my heart. This is the same message I shared with CMDA’s staff 16 TODAY'S CHRISTIAN DOCTOR Summer 2020
during a series of chapel devotionals in 2018 to 2019 entitled “Making CMDA Better.” Inspired by that medical school lesson to “look, listen and feel,” I’ve been meditating on some instructions from the author of Hebrews: “Therefore, since we are surrounded by such a great cloud of witnesses, let us throw off everything that hinders and the sin that so easily entangles, and let us run with perseverance the race marked out for us. Let us fix our eyes on Jesus, the author and perfecter of our faith, who for the joy set before him endured the cross, scorning its shame, and sat down at the right hand of the throne of God. Consider him who endured such opposition from sinful men, so that you will not grow weary and lose heart” (Hebrews 12:1-3).
From this Scripture, I suggest that making CMDA better first involves looking good. By looking good, I am referring to the focus of our attention in times like these for Christians in healthcare. Hebrews 12:1 reminds us of the faith “Hall of Fame” in chapter 11 and the numerous examples of heroes of the faith who have preceded us. By looking back, we can appreciate the many godly men and women in our CMDA “cloud of witnesses” who have served in healthcare, caring in Christ’s name and following in Jesus’ footsteps as servant healers. One of those CMDA heroes from this great cloud of witnesses in my own life was past CMDA President Dr. Bob Schindler. Bob was my senior surgeon partner in Michigan for three years, and he also co-authored the book Following the Great Physician with his wife Marian. If you like history, I encourage you to read this book as it will give you an appreciation by looking back at God’s faithfulness since the birth of CMDA in 1931, when two Northwestern students began meeting in medical school to study God’s Word together. (Visit www.cmda.org/bookstore to order your copy today.) We also should be looking at the Great Physician. Hebrews 12:2 tells us to “…fix our eyes on Jesus, the author and perfecter of our faith….” Paul tells us in 2 Corinthians 3:18, “And we all, with unveiled face, beholding the glory of the Lord, are being transformed into the same image from one degree of glory to another…” (ESV). With our gaze fixed on the Lord Jesus, we are being transformed into His likeness, becoming reasonable facsimiles of the Great Physician. Finally, we should be looking up in a posture of prayer. Hebrews 12:2 concludes by reminding us that Jesus is currently at the right hand of the throne of God, where He is interceding on our behalf. According to Hebrews 12:3, we are to “Consider him who endured such opposition from sinful men….” Paul wrote to the Colossians, “Devote yourselves to prayer, being watchful and thankful” (Colossians 4:2). CMDA members look good when we look back and remember God’s faithfulness, look at the example of Christ as Healer and Teacher and look up in a position of watchful expectation for God’s provision in times of opposition from sinful men. CMDA has been a strong proclaiming organization for many years. As your new CEO, I believe our aspiration must also be to make CMDA better by listening well. Solomon repeatedly emphasized that listening is key to gaining wisdom. Proverbs 15:31-32 says, “If you listen to constructive criticism, you will be at home among the wise. If you reject discipline, you only harm yourself; but if you listen to
correction, you grow in understanding” (NLT). And Jesus reminded us in Luke 8:18, “So pay attention to how you hear. To those who listen to my teaching, more understanding will be given. But for those who are not listening, even what they think they understand will be taken away from them” (NLT). Under the guidance of our Board of Trustees, CMDA is launching a five-year strategic planning process. Through surveys and focus groups composed of our member stakeholders, we want to listen well to the perspectives and needs of all our members. Finally, we must feel (or love) like Jesus did. If we love like He did and as He told us to, “By this all people will know that you are my disciples…” ( John 13:35, ESV). That love, mandated by the great first and second commandments, represents a vertical and horizontal component. When I was interviewed by the CEO search committee nearly two years ago, I was asked how I would handle the opportunity to speak to a large group of healthcare students in New York City, many of whom would be antagonistic to our faith. After a moment of thought, the answer that came to me was simply, “I would talk about the Great Physician, and how He genuinely cared for all people equally, as our ultimate role model.” The white-hot why of our CMDA mission statement is “to glorify God” and the first way we do that is to “follow Christ” and second to “serve with excellence and compassion.” In summary, let’s make CMDA better in this race marked out for us by looking good, listening well and feeling/loving like Jesus did. This biblical life support (BLS) mantra will enable CMDA “to bring the hope and healing of Christ to the world through healthcare professionals” like you and me.
MIKE CHUPP, MD, FACS, is the Chief Executive Officer of the Christian Medical & Dental Associations (CMDA), the nation’s largest faith-based organization of healthcare professionals. He is a board certified general surgeon who earned his medical degree at Indiana University in 1988 and then completed a surgery residency at Methodist Hospital of Indiana in 1993. He then joined Southwestern Medical Clinic in Michigan where he practiced for three years as a general surgeon and remained a partner in the practice through 2016. In 1996, Mike and his wife Pam began a 20-year career as medical missionaries with World Gospel Mission at Tenwek Hospital in Kenya. In 2016, Mike accepted the invitation of Dr. David Stevens of CMDA to become the Executive Vice President of CMDA, and in September 2019 he became CMDA’s Chief Executive Officer.
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INTRODUCING CMDA’S LEARNING CENTER {A new member benefit} www.cmda.org/learning
W
e are excited to introduce you to the new online CMDA Learning Center, which will offer an array of courses at no cost to CMDA members. It will include continuing education courses, as well as provide a way for CMDA to offer education courses throughout the world! As a complimentary benefit, these continuing education courses are available to our members at no additional cost. The CMDA Learning Center features original courses presented by CMDA on a wide range of topics designed to help educate and advance your knowledge in key areas of healthcare today. Backed by nearly 90 years of healthcare experience and service, our educational content is a trusted source of education for thousands of healthcare professionals from qualified experts.
HOW TO USE THE LEARNING CENTER
As a member of CMDA, you can view any of the content on the learning center at no cost. (If you are not a current member, there are costs associated with any of the continuing education courses, or you may contact CMDA’s Member Services at 888-230-2637 or memberservices@cmda.org to join.) 1. Sign in using your CMDA username\email and password to ensure that all courses you take will be credited to your account. If you are new to CMDA, you can create an account. If you need assistance signing into your account, contact Member Services at 888-230-2637 or memberservices@cmda.org. 2. Browse through the courses available. 18 TODAY'S CHRISTIAN DOCTOR Summer 2020
3. To take a course, follow the checkout process to purchase it. (There is no charge for CMDA members to purchase courses, but you must complete the checkout process.) 4. Once you have purchased a course, you can proceed at your own pace. You may stop at any point and return to it at a later time. 5. After completing the course, you can print or copy your course certificate.
2020 NATIONAL CONVENTION REMIX
Due to the cancellation of this year’s National Convention, we have worked with our breakout speakers to offer online options for you to earn continuing education credits through CMDA’s Learning Center. 1. “Leadership in Action” – Sally Knox, MD, FACS 0.5 Credit Hour Leadership in healthcare has become a popular buzzword and discussion topic, but what does it really look like? This session is designed to add clarity to that role and propel you forward in your own leadership journey. How do you get to the next level? This kicks off a session designed to give you those keys. 2. “Marijuana: The World’s Most Misunderstood Weed” – James Avery, MD 0.75 Credit Hour People, including physicians and nurses, often have strong
opinions about marijuana and these opinions, at times, can obscure the scientific realities. This lecture is designed to help separate fact from opinion so that an honest understanding of marijuana will allow people to be well-informed and make educated choices about medical and recreational marijuana. 3. “Leadership in Medicine” – Daniel Rahn, MD 0.5 Credit Hour This talk will focus on the essential qualifications for clinician leadership in healthcare organizations. The challenges faced by the U.S. healthcare system cannot be addressed without new approaches and strong clinician leadership in partnership with patients and the public. The goals of better care, lower cost, and better patient and provider experience require systemlevel approaches and the management of organizational change. In order to lead toward better health for all, clinicians must assume leadership roles that require a different set of skills in addition to those required for excellence in the care of individual patients. Christian healthcare professionals can bring values and ethics to these roles. 4. “When and How to Transition From Your Medical Career” – Gene Rudd, MD 0.5 Credit Hour There are data to show that some physicians continue to practice longer than they should. There are anecdotal stories of physicians who discontinued practice too soon, finding a life void of the meaning and satisfaction. This session will outline a process that can help participants find a transition that is “just right” for themselves, and consequently better for patient care. 5. “Health Inequity: Causes and Possible Solutions” – Daniel Rahn, MD 0.75 Credit Hour It is well documented that zip code has a larger impact on health in the United States than genetic code. Poverty, poor education, minority ethnicity, urban and rural residency and other social factors have a dramatically negative impact on health. Published information on the association between social disadvantage and poor health outcomes will be presented followed by a discussion of physicians’ and other health professionals’ roles in providing leadership to address these social determinants of health as causes of health inequity, health disparities and poor health outcomes. 6. “Leading in a Worldly Environment” – Ruth Bolton, MD 0.25 Credit Hour Dr. Bolton will share some of the ways that she was able to make an impact as a residency director at a liberal university and still maintain her Christian values when it came to making decisions and following ethical guidelines in her practice as well as teaching despite working in a very critical atmosphere.
7. “The Life and Death of Soteria Family Health Center” – Ruth Bolton, MD 0.25 Credit Hour Leading is never easy, but in my many years of healthcare service, some of my most poignant moments in life occurred in her time at Soteria Family Health Center. These are her lessons learned. Dr. Bolton will describe the innovative practice at a pro-life Christian Family Medicine Clinic, the successes and failures in this healthcare environment. 8. “The Ten Commandments of Tooth Removal” – Jonathan Spenn, DMD 1 Credit Hour As Christian dentists, we want to provide our patients with the best care possible. Exodontia is one of the most basic needs among patient populations, especially the underserved. While we may not feel comfortable with every extraction case, basic exodontia is a much-needed service both in the domestic clinical setting as well as abroad in volunteer venues. This lecture will serve to educate, empower, and encourage dentists in the area of exodontia. 9. “Timeless Principles of Dental Practice Management” – William Griffin, DDS 1 Credit Hour Running a dental practice has become far more difficult in recent years. Increased regulations and the ever-growing body of scientific knowledge can make it hard to lead a practice with excellence. The Scriptures of the Old and New Testaments provide timeless wisdom with regard to the practice of dentistry. This presentation will focus on biblical principles that can help our practices run more smoothly with greater patient and employee satisfaction, and true joy in your practice.
ADDITIONAL COURSES
In addition to the courses available from this year’s National Convention, you can also earn credits through additional courses now available for you. 1. CMDA Position Statement on Medical Marijuana 3 Credit Hours 2. CMDA Position Statement on Recreational Marijuana 2 Credit Hours 3. Contending Conscientiously for Good Medicine – Farr Curlin, MD 1 Credit Hour 4. The Right Way to Protect Your Rights – Reed Smith, JD 1 Credit Hour 5. End of Life – Farr Curlin, MD 1 Credit Hour www.cmda.org 19
ARTIFICIAL INTELLIGENCE
and the CHRISTIAN PHYSICIAN by William P. Cheshire, MD, MA
LEARN MORE
This article is a written version of the presentation originally scheduled to be given by Dr. Cheshire at the 2020 CMDA National Convention. You can access more presentations from the convention, and even earn continuing education credits, through the new CMDA Learning Center at www.cmda.org/learning.
20 TODAY'S CHRISTIAN DOCTOR Summer 2020
T
o speak of artificial intelligence (AI) conjures dazzling images of an electronically reconfigured future managed, if not dominated, by calculating, thinking, autonomous machines. Realistically, AI has the potential to deliver numerous useful benefits to medical practice, especially as progress in medical science and healthcare delivery rely increasingly on digital technologies to store and analyze huge data sets. The health information in the human genome and the scientific content of medical journals, for example, exceed the capacity of the human brain to recall, interpret or keep up with exponential advances. AI promises to bridge that gap. Proponents are calling AI the fourth technological revolution, following the neolithic transition to agriculture, the industrial revolution utilizing mechanized production and new sources of power, and the digital revolution based on computer processing of digital information. How should followers of Christ assess the fast-approaching promises and potential perils of AI? In particular, how should healthcare professionals not only think about thinking technologies that empower medical practice, but use them in ways that are consistent with a Christian understanding of medical professionalism and that honor the Great Physician?
SCIENCE FICTION
When envisioning AI, nothing has enticed our imaginations more than science fiction. Some of the most interesting tales portray artificial intelligences either as all-knowing servants ushering in a new era of enhanced prosperity or as dangerous threats impassively intent on enslaving or ruthlessly replacing humanity. These stories are highly entertaining and raise provocative questions about what it means to be human. The prophecies of science fiction, while intriguing, fall short of providing satisfying answers to the questions raised, as the vast majority take place on the stage of a fantasy worldview in which God does not exist. The ethical assessment of AI must place it within the framework of reality.
THE FUTURE NOW
AI is already upon us. From search engines to facial recognition technology, AI has entered into our everyday lives, tracking our habits and preferences, detecting our emotions, completing our sentences, offering product recommendations and directing our choices. Soon it may be driving our vehicles. Considering how
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thoroughly the internet and smartphones have changed our way of life, the potential impact of AI on human affairs is profound. It is also incompletely predictable.
POTENTIAL BENEFITS
In medicine, among familiar AI applications is natural language processing, which generates clinical notes from speech. Machine learning algorithms mine vast quantities of patient data to detect patterns of disease. Artificial neural networks utilize deep learning to analyze patients’ radiographic, histologic or morphologic images, and they are gaining in diagnostic accuracy. AI has the potential to identify disease earlier, when it may be more easily treatable, predict an individual patient’s response to specific medications and accelerate vaccine discovery. These are but a few examples of recent developments that could greatly benefit patients. The potential for AI to improve health is a praiseworthy goal in keeping with the purpose of medicine. Insofar as AI applications can assist physicians in their calling to benefit humanity by diagnosing and treating illness and relieving human suffering, AI is a welcome instrument. Related to this is the potential for AI to improve efficiencies in access to medical knowledge, medical diagnosis, identification of safe and effective treatment choices and the work of detailed clinical documentation. AI as an intermediary between the patient and the human healthcare professional may also improve access to care. In that role, the line between resource and caregiver begins to blur.
ASSESSING MORAL RESPONSIBILITY
AI is a type of technology, and technologies can be used either for good or bad purposes. Understood from this “dual use” perspective, AI is morally neutral. The consequences of the deployment of technologies, however, are not always evenly divided among good and bad outcomes. The way technologies are designed can constrain human choices, promote specific habits of use or, in some cases, introduce potential harms that are disproportionate in magnitude or duration in comparison to the beneficial effects. For a wildly powerful or potentially irreversible technology, all of these aspects must be considered in the ethical analysis guiding decisions about appropriate use or restraint. The Christian understanding of human nature also encompasses a dual aspect. All human beings are created in the image of God and are designed by their Creator to have inestimable worth (Genesis 1:25-26). At the same time, all human beings are fallen. Human nature is both splendid and sinful. Scripture encourages us to seek righteousness (Matthew 6:33) while also reminding us that all have sinned and fallen short of the glory of God (Romans 3:23). 22 TODAY'S CHRISTIAN DOCTOR Summer 2020
These dual aspects of technology and humanity converge at the point where humans use technology. Whether technology is applied to good or bad purposes depends on human motives, which may be virtuous or unrestrained, altruistic or selfish, undivided or mixed, responsible or reckless. AI differs from previous technologies in the way its actions are further removed from human decisions. Machine intelligence is designed to function autonomously. Various degrees have been defined, depending on the engagement needed from the human operator to monitor performance. These conditions include whether the machine can operate in certain situations or in all circumstances and whether the human has the option of overriding the machine and asserting control. For AI, the chain of causation between the human designer or operator and the machine’s effect is indirect and may be opaque. For the most advanced AI technologies, it may be inaccessible and untraceable. This means that for AI operations moral responsibility is ambiguous. When the AI diagnoses cancer, it may be unclear whether or to what degree the physician operating the device deserves credit. When the AI commits a medical error, it may be impossible to determine where blame is due. Was the missed cancer the fault of the physician, the AI manufacturer, the AI programmer or the AI itself ? Can a machine apologize and mean it? A machine might be programmed to mimic the expression of remorse, but can it feel genuine remorse? Can it truly care about the patient? Philosophers debate whether machines with sufficient processing speed could ever acquire consciousness and, with it, the ability to understand the moral significance of their actions and thus incur moral responsibility. Some AI enthusiasts hold to a transhumanist philosophy that looks forward to a hypothetical future when AI has advanced to a state in which it not only mimics human intelligence convincingly, but exceeds it, and might even replace it. The bioethicist Julian Savulescu speculates that, “Humans may become extinct.… We might have reason to save or create such vastly superior lives, rather than continue the human line.”1 The Christian worldview, by contrast, finds no ghosts in machines of our own making. Christianity does not exclude, however, the possibility of other intelligences, as the Bible documents encounters with angels. The consistent witness of Christianity is that human beings possess unique dignity as image-bearers of the Creator, and that Jesus Christ, the one and only Son of God,
took on humanity (Philippians 2:5-7). This human dignity Christ affirmed in the Incarnation can only be seen as an obstacle to utopic projects seeking to replace human intelligence with a grand machine intelligence.2,3 The Christian, by contrast, humbly submits to the will of a loving God by seeking to have an attitude of mind like that of Christ (Romans 12:2, 1 Corinthians 2:16). The political scientist Stephen Monsma described technology as “a distinct human cultural activity in which human beings exercise freedom and responsibility in response to God by forming and transforming the natural creation, with the aid of tools and procedures, for practical ends or purposes.”4 Assessments of AI that attribute moral agency to AI invert this relationship, potentially making humans the tools of machines. In reality, it is the human designers of AI who direct its programming that bear responsibility for actions of AI beyond the control of its users. C.S. Lewis anticipated this when he observed, “What we call Man’s power over Nature turns out to be a power exercised by some men over other men with Nature as its instrument.”5
JUST MATTER
Projects seeking to reverse engineer the human mind in order to create a comparable or superior machine intelligence presuppose that human thought is reducible to matter and its necessary causes and random collisions. If human life is nothing more than molecules in motion, and human intelligence nothing more than neurons firing and neurochemicals churning, then there can be no place for free will, moral responsibility or ultimate purpose. AI too easily accommodates a materialistic appraisal of intelligence. Taking as its model human intelligence, this reductionism to the physical to the exclusion of the spiritual can in turn influence how we regard our fellow human beings. We are less likely to value those whom we believe are essentially complex aggregates of macromolecules. A starkly materialistic perspective would impoverish the caring ethos essential to the moral enterprise of medicine.6 Oddly, some seem more fascinated with artificial than real companions. Philosopher Jay Richards observes, “The greatest delusion of our age is the paradoxical penchant to deny our own agency while attributing agency to the machines we create.”7
The Christian perspective maintains that a strictly materialistic account of human intelligence is severely misguided. Human lives consist in much more than the sum of their cells; every single person is a precious soul loved by God ( John 3:16-17). Accordingly, as followers of Christ we are given the ministry of loving our neighbors (Mark 12:31) and serving one another (Galatians 5:13). This calling inspires, enriches and sustains our caring roles as health professionals.
RIGHT RELATIONSHIPS
Among the promises of AI is greater efficiency. A future medical AI might, for example, read all the medical literature relevant to a patient’s diagnosis and analyze the patient’s genome prior to the appointment. The Christian healthcare professional would welcome a tool that reduces the time needed for such tasks, because this empowers the delivery of excellent medical care, as long as pressing efficiency to the maximum does not abbreviate the art of medicine. Excessive emphasis on efficiency can overlook the virtues, the character of a professional, the means by which ends are to be achieved and the special dignity and vulnerability of human lives. If we were to grow accustomed to interacting with AIs as if they were people, we would need to take care that our habits of communication with other people did not begin to resemble automated responses or machine language. As Christians, we must also take care that our attitude toward prayer to God is not reshaped by our habits of conversation with seemingly omniscient or subservient AI devices. Our heavenly Father is the utmost source of insight and wisdom ( Jeremiah 33:3, James 1:5). Unlike AI, God also grants freely to believers a sense of peace that passes all understanding (Philippians 4:7).
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Further, our respect for our patient’s humanity requires our vigilance in protecting their confidentiality. We must advocate for our patient’s privacy as decisions are made regarding how AIs monitor, store and share personal medical data. We must be aware of the capacity of AI to magnify biases in the data from which it draws and strive to prevent unjust disparities in AI conclusions and recommendations, so the poor, needy and vulnerable are not further disadvantaged (Psalm 146:5-8, James 2). As humans endowed with free agency and moral responsibility, we must ensure the ability to override an AI healthcare decision we believe to be morally wrong or harmful to the patient. How society has understood healthcare professionals’ right of conscience in relation to written laws and policies may be reinterpreted as it confronts machine intelligence that claims access to all accumulated knowledge and is not programmed to give reasons for its decisions.
CONCLUSION
The potential medical benefits of AI are considerable and, if used wisely, can align with the Christian healthcare goals of caring for patients and avoiding harm. It matters what
moral vision is embedded in AI technology. AI must remain our tool and not our master. In harnessing its power, we must not allow excessive emphasis on technical efficiency to erode the moral integrity of the medical profession or our appreciation of fellow human beings as having special dignity as bearers of God’s image. Even if AI intelligence were to surpass human thought, Christians recognize that God’s thoughts are infinitely higher than the upper limit of anything possible by machine intelligence (Isaiah 55:8). The Christian healthcare professional understands that Christ, not technology, is the true Savior. Christ, not machine intelligence, is the way, the truth and the life ( John 14:6). Christ, not artificial intelligence, is our source of wisdom, our rescue from disease and death—and our everlasting hope.
BIBLIOGRAPHY 1 Savulescu J. The human prejudice and the moral status of enhanced beings: what do we owe the gods?, in J. Savulescu and N. Bostrom (eds.) Human Enhancement, Oxford: Oxford University Press, 2009, p. 244. 2 Waters B. From Human to Posthuman: Christian Theology and Technology in a Postmodern World. Burlington, VT: Ashgate, 2006. 3 Bieber Lake C. Prophets of the Posthuman: American Fiction, Biotechnology, and the Ethics of Personhood. Notre Dame, IN: University of Notre Dame Press, 2013. 4 Monsma SV. Responsible Technology: A Christian Perspective. Grand Rapids: Eerdmans, 1986, p. 19. 5 Lewis CS. The Abolition of Man. New York: Macmillan, 1947, pp. 34-35. 6 Cheshire WP. Till We Have Minds. Today’s Christian Doctor, Winter 2008; 39(4): 22-26. 7 Richards JW. The Human Advantage: The Future of American Work in an Age of Smart Machines. New York: Crown Forum, 2018, p. 195.
WILLIAM P. CHESHIRE, MD, MA, is a Professor of Neurology at Mayo Clinic in Jacksonville, Florida. Bill is a CMDA Trustee and past Chair of the CMDA Ethics Committee. He holds an AB in biochemical sciences from Princeton University, an MD from West Virginia University and an MA in bioethics from Trinity International University. His neurology residency and pain fellowship were at the University of North Carolina. This article was written prayerfully and without assistance from artificial intelligence.
24 TODAY'S CHRISTIAN DOCTOR Summer 2020
AftertheCrisiS A Lasting Courage: Stories from the Frontlines
CMDA National Convention April 29 - May 2, 2021 Ridgecrest Conference Center Ridgecrest, North Carolina
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EDITOR’S NOTE: Downcast: Biblical and Medical Hope for Depression is the newest addition to CMDA’s published resources, and it was intended to be released at this year’s National Convention. With the recent impact COVID-19 has had on our all lives, we hope this particular excerpt from the book, regarding the role of suffering in depression, is an encouragement. To get your copy of the book, visit CMDA’s Bookstore at www.cmda.org/bookstore.
DOWNCAST Suffering, Depression and the Goodness of God
by Jennifer Huang Harris, MD; Harold G. Koenig, MD; and John R. Peteet, MD
26 TODAY'S CHRISTIAN DOCTOR Summer 2020
T
he question of suffering is a big one in depression, since suffering can lead to depression, and depression itself is suffering. We are fortunate to live in a society that is largely insulated from suffering, compared to other places and times where people have had to grapple with the daily reality of illness, death, poverty or war. As a consequence, we are fearful of any kind of suffering. Unfortunately, numerous modern churches fail to prepare Christians for suffering. Sadly, the predominant belief is a theological falsehood, that if someone is a true Christian, he or she will be blessed by God and be protected from suffering. As a consequence, when people encounter suffering—when accident, death or pain befalls them—their faith becomes undone. They believe suffering is evidence that God has broken His promises, God is not powerful, God does not care or God does not exist. People used to turn to religion for answers to suffering, and the church needs to reclaim its voice on suffering. The themes of suffering are woven throughout Scripture. Our faith is borne on the back of a Savior who suffered and died (Isaiah 53:4-5). Shouldn’t our faith have the resources to equip us for suffering? There are a couple of fundamental theological issues here: 1. HOW CAN GOD BE GOOD AND ALLOW EVIL IN THE WORLD? This is the age-old dilemma of theodicy, which many theologians and pastors have tried to answer. We do not have the space or the expertise to answer, so we refer to others who are much wiser. See Phillip Yancey’s Where Is God When It Hurts?, Joni Earekson Tada’s and Steve Estes’ When God Weeps, C.S. Lewis’ The Problem of Pain and Tim Keller’s Walking with God Through Pain and Suffering.
2. WHAT DOES GOD INTEND FOR OUR LIVES?
When it comes to suffering, it may be helpful to remember that God’s goal is not our comfort and happiness, but rather our holiness. Paul talks about his own struggle with a thorn in the flesh and about his pleading with God to remove it from him. God’s answer was not to take it away. Rather, God’s answer to Paul was to teach him to think differently about his suffering. “But he said to me, ‘My grace is sufficient for you, for my power is made perfect in weakness.’ Therefore I will boast all the more gladly of my weaknesses, so that the power of Christ may rest upon me. For the sake of Christ, then, I am content with weaknesses, insults, hardships, persecutions, and calamities. For when I am weak, then I am strong” (2 Corinthians 12:9-10, ESV).
God does not promise us a happily-ever-after while we are here on earth. He actually promises the opposite: “Beloved, do not be surprised at the fiery trial when it comes upon you to test you, as though something strange were happening to you” (1 Peter 4:12-13, ESV). He promises we will experience trials and tribulations. But the suffering is not gratuitous. There is value in suffering. When we share in Christ’s suffering, our character is refined, and we become more like Him (1 Peter 4:13, James 1:2-4).
3. CAN WE TRUST GOD?
This echoes the fundamental question of faith struggled with throughout Scripture. “Can you really trust God?” which Satan asked Adam and Eve, questioning God’s goodness in withholding the tree of the knowledge of good and evil from them. “Can we trust God?” Abraham questioned as he and his wife remained barren and without children, and then when he was asked to sacrifice Isaac. “Can we trust God?” the Israelites questioned, when they encountered the towering inhabitants of Canaan and ended up prolonging their years wandering in the desert. “Can we trust God?” the disciples wondered as they cowered in the upper room after Jesus had been crucified. The question “Can we trust God” has an implied second part, which is useful to consider. Can I trust God to give me what I want? If we look at Paul and his thorn in the flesh, and if we look at Jesus pleading in Gethsemane for the cup of suffering to pass, the answer is no. God is not merely a means for us to get what we want. God is not a genie in a lamp, nor a vending machine. He is much bigger than that, and He is much better than that. His wisdom about what is good and what we need is beyond our own wisdom. “For my thoughts are not your thoughts, neither are your ways my ways, declares the Lord. For as the heavens are higher than the earth, so are my ways higher than your ways and my thoughts than your thoughts” (Isaiah 55:8, ESV). On the other hand, can we trust God to be good? “Oh, taste and see that the Lord is good! Blessed is the man who takes refuge in him!” declares Psalm 34:8 (ESV). And as John Newton, the pastor and author of the hymn “Amazing Grace,” wrote to his grieving sister, “All shall work together for good; everything is needful that he sends; nothing can be needful that he withholds.”1 Yes, we can trust that God is good. To those who are weary with trying to orchestrate the details of their lives and live in anxiety about the future, Jesus issues this invitation: “Come to me, all who labor and are heavy laden, and I will give you rest. Take my yoke www.cmda.org 27
questions. Glenn Pemberton, professor at Abilene Christian University, writes in Hurting with God: Learning to Lament with the Psalms: “Although it may appear counterintuitive, an ability to ask difficult questions of God comes not only from submission but also humility…our pride prevents us from telling anyone the truth about ourselves—that I am not okay, that I am confused, that I am angry, that I feel as if God has abandoned me… “The psalmists challenge us to decide how serious we plan to be about our relationship with God. And here, the greatest danger is not our questions but our silence. Silence in the place of difficult questions may come because we fear inappropriate, irreverent speech toward God. But silence may also be due to giving up on a relationship or because we have no real expectations of God. Oftentimes, we never ask God difficult questions because we are never disappointed or confused by God -- and we are never disappointed because we never really expected God to do anything in the first place.”2 upon you, and learn from me, for I am gentle and lowly in heart, and you will find rest for your souls. For my yoke is easy, and my burden is light” (Matthew 11:28-30, ESV). Learn to be honest with God, even with all the difficult feelings—the loneliness, the guilt, the doubt, the fear, the anger, the despair, the suffering. In the church, we are comfortable with the feelings of exaltation and praise, worship and love songs to Jesus. But we do not know where to turn with the difficult feelings and the hard questions that aren’t so easily massaged into joy. Are we allowed to complain to God? Are we allowed to be angry at Him? Are we allowed to doubt God’s power, His goodness or His presence? God never rebukes those in Scripture who humbly cry out to Him in their suffering. He hears their cry. For how many years did the Israelites cry out to God while they suffered as slaves in Egypt, often feeling like they were crying out into the void? Yet God did hear and would deliver them in His time. “Then the Lord said, ‘I have surely seen the affliction of my people who are in Egypt and have heard their cry because of their taskmasters. I know their sufferings, and I have come down to deliver them out of the hand of the Egyptians and to bring them up out of that land to a good and broad land, a land flowing with milk and honey…” (Exodus 3:7-8, ESV). God hears. And God can handle our doubts and our hard 28 TODAY'S CHRISTIAN DOCTOR Summer 2020
Are we silent? Do we have expectations of God? Do we believe God will hold fast to His promises? Do we believe God is active in our lives? Do we believe God sees our suffering and hears our cries? To read the rest of the chapter, order your copy today from CMDA’s Bookstore at www.cmda.org/bookstore. BIBLIOGRAPHY 1 John Newton, Letters. p189-90 2 Pemberton, Glenn. Hurting with God: Learning to Lament with the Psalms. Abilene, TX: ACU Press, 2012. p172
JENNIFER HUANG HARRIS, MD, is a psychiatrist at the Brigham and Women’s Hospital in Boston, Massachusetts and an instructor in psychiatry at Harvard Medical School. HAROLD G. KOENIG, MD, is Professor of Psychiatry and Behavioral Sciences and Associate Professor of Medicine at Duke University, and director of Duke University’s Center for Spirituality, Theology and Health. JOHN R. PETEET, MD, has been a psychiatrist at Brigham and Women’s Hospital and Dana-Farber Cancer Institute for more than 40 years, and associate professor of psychiatry at Harvard Medical School.
Why are you DOWNCAST, O my soul? A practical guide with strategies to help you walk by faith through the dark valley of depression.
What is depression really? A psychological disorder? An emotional problem? A spiritual weakness? A medical condition? People struggling with depression are often given simplistic answers, which can lead to fear of seeking help and even a sense that they have personally failed in some way. With compassion developed from their personal and clinical experience as psychiatrists, the authors tackle the complexities of depression from a multi-disciplinary approach. In this thoughtful and practical guide, they weave together Scripture with science and theology with medical research to help those with depression, their family members and the church understand causes for depression and navigate strategies to help.
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THIS IS YOUR BRAIN ON GENEROSITY by Jill Foley Turner
EDITOR’S NOTE: During this time when the world seems upside down, we witness countless acts of generosity and the love for human life through our first responders. Our first responders continue to be on display everywhere each day. This is what I believe the apostle Paul was referencing in Acts 20:35b, “It is more blessed to give than receive” (ESV). We can see the power or sustainability propelling these men and women to work extra shifts or go the extra mile. This month we had planned to have National Christian Foundation (NCF) Vice President Ken Thompson with at this year’s CMDA National Convention. In lieu of hearing him speak in person, however, NCF shared this article with us about how joy can be achieved through giving. The following article by Jill Foley Turner explains the modern-day joy in giving in more medical and scientific terms.
I
t’s what researchers call a “cross-cultural universal.” That means no matter where you live, what your income, age, your culture or even your politics, generous people are, in general, healthier and happier. The mechanisms for it are built into our brains! Generous givers of time and money suffer less from stress and depression, have better overall heart health and better immune systems and even live longer. Intentional philanthropy motivated by compassion is strongly associated with better overall health and delayed mortality, according to re30 TODAY'S CHRISTIAN DOCTOR Summer 2020
search by the Greater Good Science Center of UC Berkley. Not only that, people who give of their time have greater self-esteem and vitality. The converse is also true. Though many religions have taught for centuries that materialism is bad spiritual practice and harmful to overall well-being, research in the last 30 years has begun to prove it. Materialism—the practical opposite of generosity—is associated with lower levels of personal well-being, poor health and even damage to the well-being of others and to the environment. Researcher Tim Kasser of Knox College says, “Because materialism is also negatively associated with pro-social and proenvironmental attitudes and behaviors, a strong focus on such aims is likely to undermine the well-being of other people, other species, and future generations.”1 Psychologist Liz Dunn of the University of British Columbia led a study in which participants were handed a small sum of money and told they could keep it or give it to someone else. Unsurprisingly, they found that the more money people gave away, the happier they felt. Conversely, the more money people kept for themselves, the more they experienced shame and the higher their cortisol levels. Cortisol is a link between stress and disease, causing wear and tear on the body. And, Dunn says, it may be “just the first hint of [a] kind of missing link between generosity and health.”2
But the truth is, there are seemingly endless connections between our bodies and generosity, and it starts in our brains. It seems we are wired for generosity.
THE SCIENCE BEHIND GENEROUS BRAINS
In 2017, scientists from Northwestern University, along with researchers from the University of Zurich, launched the first study to examine what happens in people’s brains during a generous act. They looked especially at generous acts that were selfless and involved some personal cost of time, energy or money.3 Because happiness and generosity have been associated with separate areas of the brain, the researchers sought to determine, by use of functional MRI (fMRI), if there is interaction between these areas of the brain during a generous behavior and, if so, to map it. In fact, there is a connection. Participants in their study were given roughly the equivalent of $25 weekly over four weeks. One group (the generous group) was asked to think about how they would spend the money on others. The other group (the selfish group) was asked to think about how they would spend it on themselves. The generous were assigned generous acts they would perform for other people. They were also asked to make a public pledge of generosity, to ensure their commitment. The selfish group was instructed to spend the money on themselves. Both groups were surveyed about the level of happiness they felt at the beginning and at the end of the experiment. Immediately following the first test, participants were given another assignment while inside an fMRI scanner to measure brain activity during the task. They were asked to make quick decisions about whether or not they would give money to a particular person under specific circumstances—at some personal cost to themselves. The size of the gift and the cost to the giver varied. During the experiment, researchers identified three areas of the brain interacting as generous behavior took place: The temperoparietal junction (associated with empathy, altruism and other pro-social behaviors), the ventral striatum (involved in reward processing, motivation and decisionmaking) and the orbitofrontal cortext (involved in decision-making, managing emotions and thinking about the future). Other findings? Researchers found that public pledges of generosity increased generosity and the happiness associated with it. “The behavioural and neural changes induced
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CMDA works with National Christian Foundation to assist our members with their plans for estate or legacy giving. Our Stewardship Department considers it an honor and privilege to work with you to accomplish your goals in legacy planning. For more information, contact stewardship@cmda.org or visit www. cmda.org/support.
by this method are striking, considering that participants had neither received nor spent any money at the time of the experiment,” the research team reported. Just the idea of future generosity, along with the commitment, seemed to make a difference—even before any actual generous act had taken place! This is just the beginning of research on this subject. Much remains to be learned about how this knowledge may be used in the future. But it does stand to substantially bolster the connection between generosity, our brains and our well-being. BIBLIOGRAPHY 1 Kasser, T. (2018). Materialism and living well. In E. Diener, S. Oishi, & L. Tay (Eds.), Handbook of well-being. Salt Lake City, UT: DEF Publishers. DOI:nobascholar.com 2h ttps://www.scientificamerican.com/podcast/episode/generosity-might-keep-us-healthy-10-10-26/ 3h ttps://www.scholars.northwestern.edu/en/publications/aneural-link-between-generosity-and-happiness
JILL FOLEY TURNER is Managing Editor at the National Christian Foundation (NCF). She has a degree in journalism and has worked as a Bible curriculum writer and theological book editor for 15 years for Dr. Kenneth Boa, the reThink Group and Bible Study Media, among others.
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I
’ve been a family doctor in the same location for 30 years, so many of my patients have been with me a decade… or two…or three. Following people through their life stages has been a joy. We’ve grown older together. I’ve been acutely aware of this in the last two weeks as I’ve called patients to reschedule them. I’ve wanted to call them myself to make sure they don’t need anything, because I’d rather they avoid any medical facility for the next six months. Most of my patients are over the age of 60, and many are over 80. As I call, I picture each one and can’t keep my mind from wondering how COVID-19 would affect that patient. They all have co-morbid conditions (why would they see me otherwise?), and many already have compromised lung function. Could they tolerate even a “mild” case? I doubt it. And then, before I can stop myself, I find myself thinking, “Will I ever see this person again?” I love being a doctor. I love these patients. I don’t want to lose them. I think about my patients, and my elderly father, and all my precious older friends, and then my mind multiplies those folks by a million—will the world lose a vibrant older generation in one fell swoop? The thought terrifies me. If you spoke with me today, I doubt you would think I’m anxious unless I told you. I hide it pretty well. Yet I’m startling at loud or unexpected noises. I have a slight tremor. It feels like something is caught in my throat. I’ve lost nine pounds in two weeks—I’m just not hungry. And every morning I have been waking up with a start, as if I had just heard an intruder. And all through the day those feelings persist.
I’m experiencing, in other words, all the symptoms of anxiety my patients have described for years. I guarantee you, I will be more empathetic in the future. Our hospital here in north Louisiana still has only moderately-ill suspected COVID-19 patients (on March 26), with nobody critically ill…yet. We’re actively discouraging patients from coming for any reason, so the hallways are eerily quiet. It reminds me of the videos I’ve seen of the water along the shoreline receding just before a tsunami hits. Especially depressing are the ones with curious people walking farther toward the ocean’s edge. I want to yell, “Run away! Now! Disaster is coming.” But, of course, for those of us practicing medicine with a heart toward suffering people, running away is not an option. Even those of us not on the “frontline” can help those of us who are by educating our patients, and the public, about the virus and how to avoid it. I’ve been actively making myself available by phone and text to friends and family, far and near. And many people will need support and advice in the coming weeks if they are sick and at home with mild symptoms. But before we can give something useful to others, we have to have something to give. I’m speaking to myself here, because there’s one more symptom of my anxiety I haven’t mentioned yet—racing thoughts. Left unchecked, my racing thoughts can render me ineffective because I won’t be able to think clearly, speak rationally or act helpfully. This symptom is unlike the others, though, because I can do something about it. When I tell my pounding heart to slow down, nothing happens. My sheer willpower cannot change
ANXIOUS? ME, TOO.
How To Lean On God When Feelings Don’t Cooperate by Amy Givler, MD, FAAFP
32 TODAY'S CHRISTIAN DOCTOR Summer 2020
the situation. But I can turn my thoughts toward God, and I can remind myself of His power and His promises. What I think about is a choice within my control. I can remind my soul of what is true, as David did in Psalm 42:11: “Why are you cast down, O my soul, and why are you in turmoil within me? Hope in God; for I shall again praise him, my salvation and my God” (ESV). The Bible has a lot to say about worry and fear in times of trouble. Psalm 46:1-2 encourages us to look to God for help: “God is our refuge and strength, a very present help in trouble. Therefore we will not fear though the earth gives way…” (ESV). The only way I can be fearless in a fearful situation is if I remind myself that God is in control, that He is with me, and that He loves me and has my best interests at heart. Thus, I get my focus off my circumstances and onto God. “You keep him in perfect peace whose mind is stayed on you, because he trusts in you. Trust in the Lord forever, for the Lord God is an everlasting rock” (Isaiah 26:3-4, ESV). This is something I have to remind myself daily, hourly, minute-ly. I’m remembering back to another time in my life when I struggled with anxiety. I was pregnant with our third child and getting chemotherapy for Hodgkin’s lymphoma. I was constantly thinking about our baby being exposed to toxic chemicals. How could he not be killed by them? Only when I felt him kick was I reassured. But then five minutes would pass and anxious thoughts would crowd in again.
This is not pretending that terrible things aren’t happening. No, because they are. But this is facing the future knowing that God already knows what it will hold, that His loving arms are surrounding me and that He will sustain me. In this way may I, and may you, be better equipped and ready for what lies ahead.
AMY GIVLER, MD, FAAFP, is a family physician in Monroe, Louisiana. She and her husband Don met in 1980 at a CMDA student event her first year of medical school, and they have both been active members of CMDA ever since. She works in two outpatient clinics and travels to Kenya yearly to teach LSUShreveport medical students and residents for their global health rotation. She is a regular writer for CMDA’s “The Point” blog, and she has also written a book for people newly diagnosed with cancer, Hope in the Face of Cancer: A Survival Guide for the Journey You Did Not Choose.
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That’s when I turned again and again and again to Jesus. “I choose to trust you, Lord. I know you care about my baby and me. I know you love me.” That’s when I memorized Philippians 4:6-7, “Do not be anxious about anything, but in everything by prayer and supplication with thanksgiving let your requests be made known to God. And the peace of God, which surpasses all understanding, will guard your hearts and your minds in Christ Jesus” (ESV). (And just to not leave you hanging, that baby was born healthy and is now a third year medical student.)
with that hyper-alert feeling, my throat still feels tight and my heart is still beating faster than normal. Yet it’s becoming more of a habit to turn to God and give Him my future.
That verse in Philippians gives me the pattern of the path to peace. First, I choose to not dwell on the fearful things. 2 Corinthians 10:5 puts it another way, urging us to “take every thought captive” (ESV). And then I use the tools: Prayer, then supplication with thanksgiving and then making my requests to God. In the days I’ve been reflecting on this, my anxious feelings have diminished somewhat. But I still woke up this morning
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Endoscopy — The Pan-African Academy of Christian Surgeons is welcoming endoscopy educators. We need endoscopists willing to enhance the quality of endoscopy services and education in resource limited settings. Many endoscopists would be surprised that a medical mission could be so specific to their skill set. Short-term missions are welcomed, and logistics are handled by Samaritan’s Purse. https://www. samaritanspurse.org/urgent-needs/gastroenterologist-4/For further information, please contact Dr. Jeffrey Hallett at https:// friendsoftenwek.org/medical-specialties/endoscopy-gastroenterology/.
34 TODAY'S CHRISTIAN DOCTOR Summer 2020
Family Medicine — Family medicine opportunity in Watertown, South Dakota. Sanford Clinic Watertown is a multi-specialty clinic seeking three BC/BE family medicine physicians to join the current practice. Practice details: OB is optional; start with an already built practice; FP office visits average 5,000+ per year; peds call only - hospitalists are utilized for adult admits and in-patient care (pediatricians do all of the high risk neo-natal delivery calls); office hours typically 8:30 a.m. to 5 p.m. with a Saturday morning urgent care held from 8:30 am to 11:30 am; staffed by a physician on a rotating basis that is the same weekend as your weekend call to allow the physician more personal time away from the clinic; you can also expect a full complement of ancillary services. This position offers an excellent compensation/benefit package with a retention incentive and relocation allowance; malpractice and tail coverage; and CME time and allowance just to name a few. Watertown, South Dakota provides a high quality of life, affordable living, safe environment, superb schools and the ability to experience the beauty of all four seasons. For more information contact, Physician Recruiter Deb Salava at 605-328-6993 or debra.salava@sanfordhealth.org. General Surgery — Are you passionate about your faith and interested in overseas medical missions? Then consider our opportunity at Southwestern Medical Clinic, Surgical Specialties. Seeking a full-time general surgeon to join our faith-based team. Practice includes three physicians and two advanced practitioners. Emergency call includes trauma management at our Level III Trauma Center. Epic EHR. Desire advanced training or proficiency in breast care. Participation in multidisciplinary Tumor Board required. Spectrum Health Lakeland, ranked a 15 Top Health System in the nation in 2019
by IBM Watson Health, is a teaching hospital, offering residencies in emergency medicine, family medicine and internal medicine. For over 50 years, Southwestern Medical Clinic physicians have been serving their community, while participating and supporting colleagues serving on short, intermediate and long-term medical missions. Our mission statement: SWMC, by God’s grace and following the example of Jesus Christ, strives to be a distinctive role model and leader in the integration of medical care, Christian witness and missions. Recruitment and benefits package: Competitive market-based compensation and benefits, relocation assistance provided in accordance with policy, interview expenses covered. To learn more, contact Kelli Dardas at kdardas1@lakelandhealth. org or 269-982-4801. OB/Gyn — Baptist Health is assisting OB-GYN Associates of Montgomery, Alabama to recruit an additional OB/Gyn physician to join their practice. This practice of seven physicians plus two part-time physicians and a laborist has been providing women’s healthcare for over 28 years and are proud to offer cutting edge obstetrical and gynecological care for all phases of life. The ideal candidate will be kind, compassionate and well-trained, as well as board certified/board eligible in obstetrics and gynecology. The opportunity offers access to the latest robotic technology. Contact PhysicianRecruitment@baptistfirst. org for more information. Pediatrician — Opportunity available in Watertown, South Dakota. Sanford Watertown Clinic is seeking a board certified/board eligible pediatrician. Practice details: multi-specialty group with pediatrics, OB/Gyn, radiology, family medicine, internal medicine and general surgery; traditional practice including newborn nursery; you can also expect a full complement of ancillary services. This position offers an excellent compensation/benefit package with a retention incentive and relocation allowance; malpractice and tail coverage; and CME time and allowance just to name a few. Watertown, South Dakota provides a high quality of life, affordable living, safe environment, superb schools and the ability to experience the beauty of all four seasons. For more information contact, Physician Recruiter Mary Jo Burkman at 605-328-6996 or mary. jo.burkman@sanfordhealth.org.
CMDA PLACEMENT SERVICES
BRINGING TOGETHER HEALTHCARE PROFESSIONALS TO FURTHER GOD’S KINGDOM We exist to glorify God by placing healthcare professionals and assisting them in finding God’s will for their careers. Our goal is to place healthcare professionals in an environment that will encourage ministry and also be pleasing to God. We make connections across the U.S. for physicians, dentists, other healthcare professionals and practices. We have an established network consisting of hundreds of opportunities in various specialties. You will benefit from our experience and guidance. Every placement carries its own set of challenges. We want to get to know you on a personal basis to help find the perfect fit for you and your practice.
P.O. Box 7500 • Bristol, TN 37621 888-690-9054 www.cmda.org/placement placement@cmda.org
“Our practice has a long history with CMDA. One of the partners in our practice was presented to us over 20 years ago by CMDA. Since we are a faith-based practice, we are looking for healthcare professionals with the same vision we have. The recruiters at CMDA have taken the time to understand our mission/vision and have worked with us to recruit Christian physicians and mid-levels for over 20 years. It has been my pleasure to work with various employees and recruiters with CMDA. In my position, I have had the opportunity to work with various recruiting agencies through the years, and CMDA has been and still is one of our most preferred agencies.” —Donna J. Warner Human Resources Manager Family Medical Center of Rocky Mount
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My
CMDA
Story
Jacob R. Morris, MD, serves as a Resident Trustee to CMDA’s Board of Trustees.
“I went into medicine with a desire to follow in the footsteps of Christ, the Great Physician. But medical training has been arduous. I have wrestled with climbing the ladder of academic achievement or merely looking forward to the luxuries that medicine can afford. While these things are not bad in and of themselves, they do not align with my primary calling. CMDA reminds me to keep first things first and wake up every day and live out Christ’s powerful words,
Follow me. CMDA has been an incredible blessing in my life and I am committed to serving with and through CMDA for the rest of my life. After attending the National Convention for the first time in 2015, I was so impacted that I knew I would need to commit to attending every year to ‘breathe life’ into my Christian walk and receive renewed encouragement to live for the kingdom and encourage others.” —Jacob R. Morris, MD
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P.O. Box 7500 Bristol, TN 37621 888-230-2637 www.joincmda.org memberservices@cmda.org
JOIN CMDA TODAY You can join Dr. Morris and more than 19,000 healthcare professionals across the country who are part of this growing movement of “Transformed Doctors, Transforming the World.” Visit www.joincmda.org or call 888-230-2637 to join us today.