Washington, DC—November 3, 2017: The 19,000-member Christian Medical Association (www.cmda.org) and the 30,000-strong Freedom2Care (www.Freedom2Care.org) today applauded a new initiative by the U.S. Dept. of Health and Human Services to ensure that its investment in sex education is backed by sound and objective scientific research.
"The HHS leadership recognizes how important it is to tie policy and programs to sound research, and this project promises to tie that knot securely," said CMA CEO Dr. David Stevens. "Research not only on what programs work but also what communication with youth works should go a long way toward equipping our youth with sound strategies for sexual health. It's also vitally important to involve parents in any strategies, such as sexual risk avoidance programs, for their children's sex education."
Freedom2Care director Jonathan Imbody added, "The new $10 million research project with HHS's Administration for Children and Families (ACF) and the Office of the Assistant Secretary for Health (OASH) promises to make a reality what too often is just a slogan: evidence-based policy. It's tempting to bend social science research to fit one's ideology, and we trust that this effort will provide a transparent process, scientifically sound methodology and accurate and objective interpretation of results to produce the best strategies for our youth. With so many previous federally funded sex education programs failing to produce positive results, it's imperative to translate this research into policy quickly and effectively for the sake of our youth."
Friday, November 3, 2017
Thursday, October 26, 2017
|Do the rights of patients in healthcare |
trump everyone else's rights?
Note: This excerpt is the second in a series of essays on conscience in healthcare, by Jonathan Imbody, Vice President for Government Relations of the Christian Medical Association and Director of Freedom2Care.
The essays respond to "Physicians, Not Conscripts — Conscientious Objection in Health Care," Ronit Y. Stahl, Ph.D. and Ezekiel J. Emanuel, M.D., Ph.D., New England Journal of Medicine 376;14, April 6, 2017.
- Essay #1: "Choose, you lose" prescription threatens the conscience rights of every professional
The essays respond to "Physicians, Not Conscripts — Conscientious Objection in Health Care," Ronit Y. Stahl, Ph.D. and Ezekiel J. Emanuel, M.D., Ph.D., New England Journal of Medicine 376;14, April 6, 2017.
By contrast to the patient-physician dual protections of Hippocratic medicine, Dr. Emanuel Ezekiel and Ronit Stahl assert that the "rights of patients" in healthcare trump everyone else's rights. But why? On what basis?
It's one thing to expect physicians to do everything possible to advance healing for patients. It's quite another to insist that whatever the patient wants, the patient gets--so the physician must provide it at risk of his or her career.
Whenever one group gets its way regardless of the impact on others, that is not autonomy; that is tyranny.
As I wrote in my book, Faith Steps,
"The trouble with adopting autonomy as the only guiding 'rule' is that while compromise and avoidance may work for a while, conflicting worldviews inevitably produce an irreconcilable conflict. By definition, autonomy is utterly incapable of resolving an irreconcilable conflict. The rule of autonomy can only avoid judgment; it cannot make a judgment."[i]
Autonomy (literally, self-law) is by definition impossible whenever one depends on others. The fact that patients depend on physicians, on payers and a myriad of other health entities by definition means that patients are not and cannot be autonomous. So a medical ethic that insists on pure patient autonomy is at best unworkable and at worst disruptive to the entire healthcare system.
To achieve health goals, no one party can assert autonomy in our complex and interwoven healthcare system. Doctors can't do whatever they want and patients can't get whatever they want. Payers can't exist without premiums or government funds and the accountability and regulation that comes with both.
|Success in our healthcare system requires|
Success in our healthcare system requires cooperation--not domination. And cooperation requires addressing the goals and needs of each party.
In the authors' view, however, in cases of conflict, patients get what they want regardless of the conscience concerns of health professionals or institutions:
"Making the patient paramount means offering and providing accepted medical interventions in accordance with patients’ reasoned decisions."[ii]
Suddenly a patient's "reasoned decision" replaces medical judgment and nullifies longstanding principles of medicine that include conscience protection.
The authors deploy the phrase "reasoned decisions" in an effort to paint any opponents as by definition unreasonable; they argue with a patient's "reasoned decision." The authors never specify, of course, what qualifies as a "reasoned decision." One can only imagine what a patient's "reasoned decision" might sound like in practice:
"Oh don't worry, doctor--I saw a commercial about this drug and researched it on the Internet."
"Well, I'm saying that my back still hurts and I want another prescription of Oxycontin now."
"I know I'm only 14¸but my college boyfriend says I need to start taking the Pill. And don't tell my Mom."
Besides asserting a patient oligarchy, the authors also attempt to conflate asserted rights of patients with the well-being of patients. Yet asserted rights and well-being are not always compatible.
What happens, for example, when a patient asserts a right to a prescription or a medical procedure that medical evidence and/or professional judgment indicates would not advance the patient's well-being? Isn't that exactly the point at which we want qualified medical professionals to intervene, to prevent harm to the patient?
The question of harm to the patient comes into focus in the issue of abortion. Many Ob-Gyn physicians see their task as tending to two patients—the mother and her developing baby. Most women visiting an Ob-Gyn for prenatal care clearly share this view.
Yet Emanuel and Stahl apparently see no contradiction in compelling Ob-Gyn physicians, who chose a profession of healing, to participate in killing an unborn child through abortion. As to the well-being of the patient who is also a mother, the authors mention no consideration of abortion's potential for emotional or physical harm as a legitimate reason for a physician to counsel a patient against abortion.[iii]
Not only do the authors fail to see abortion as antithetical to a healing profession and a blatant violation of the Hippocratic oath; they go so far as to contend that abortion is "medically not controversial."[iv] They frame abortion not as antithetical to but as integral to patient care. Therefore, they reason, ending the life of a pregnant patient's developing baby constitutes "patient care," and abortion on demand thus trumps a physician's conscience freedom.
The patient wants an abortion, the patient gets an abortion, end of story. Any physician who disagrees does not deserve to remain in the profession:
"Health care professionals who are unwilling to accept these limits have two choices: select an area of medicine, such as radiology, that will not put them in situations that conflict with their personal morality or, if there is no such area, leave the profession."[v]
Of course, erecting such barriers to everyone who does not share the ideological persuasions of the authors would eliminate from medicine tens of thousands of physicians at a time of critical shortage of physicians. The result would be a catastrophic loss of healthcare for tens of millions of patients.
|Ejecting conscientious objectors from medicine would cause|
a catastrophic loss of healthcare for tens of millions of patients.
[ii] "Physicians, Not Conscripts — Conscientious Objection in Health Care," Ronit Y. Stahl, Ph.D. and Ezekiel J. Emanuel, M.D., Ph.D., New England Journal of Medicine 376;14, April 6, 2017., p. 1383.
[iii] For a listing of selected abortion sequelae research publications, see http://afterabortion.org/2011/abortion-risks-a-list-of-major-psychological-complications-related-to-abortion/.
[iv] Stahl and Emanuel. p. 1380.
[v] Ibid. p. 1383.
Monday, October 23, 2017
Note: The official positions of the Christian Medical Association and its affiliated Freedom2Care cover many policy areas. To maximize impact with current resources, CMA's Washington office focuses on the foundational right to life and freedoms of faith, conscience and speech—upon which all other rights and freedoms hinge.
Other bills supported
· Child Welfare Provider Inclusion Act – S. 811, H.R. 1881 - Protect religious freedom of faith-based child service providers.
· Title X Abortion Provider Prohibition Act - H.R. 217 - Redirect tax dollars from abortion businesses like Planned Parenthood to federally qualified health centers.
· Born-Alive Abortion Survivors Protection Act – S. 220, H.R. 37 - Save lives of babies born in an abortion.
· No Taxpayer Funding for Abortion and Abortion Insurance Full Disclosure Act – S. 184, H.R. 7 (passed) - Prevent tax dollars from funding abortion.
· Parental Rights Resolution - S J Res 48 - Proposes an amendment to the Constitution of the United States relating to parental rights.
· Federal Disaster Assistance Nonprofit Fairness Act – S. 1823, HR 2405 – Gives community centers, including tax-exempt houses of worship, eligibility for disaster relief and emergency assistance.
· Heartbeat Protection Act - HR 490 – would not allow a physician to perform an abortion: (1) without first determining whether the fetus has a detectable heartbeat, (2) without informing the mother of the results, or (3) after determining that a fetus has a detectable heartbeat.
Friday, October 6, 2017
Christian Medical Association and Freedom2Care Applaud Administration's Actions to Protect Conscience in Healthcare
Washington, DC—October 6, 2017: Today the nation's largest association of Christian health professionals, the 18,000-member Christian Medical Association (CMA, www.cmda.org) applauded the administration's actions to restore conscience freedoms in healthcare. The administration took action concerning the Obamacare contraceptives mandate, insurance premiums used to pay for abortions, and regarding government respect for religious freedom.
"We are thankful to see these vital conscience freedoms restored in healthcare," noted CMA Senior Vice President Gene Rudd, MD, and Ob-Gyn physician. "For millennia, medical ethics have provided for conscientious opposition to abortion by physicians who took up the practice of medicine as a healing art never to be used for the destruction of human life. And until recently, our government reinforced those ethical principles with conscience protections. We are heartened to see our government heading back in the direction of these vital freedoms that protect patients, medicine and freedom in our country."
Jonathan Imbody, director of Freedom2Care (www.Freedom2Care.org), which is affiliated with CMA said, "As Americans who have inherited a nation founded upon freedom of faith, conscience and speech, we can agree that the government must never force individuals to violate their deepest held beliefs on vital and extremely controversial issues such as abortion. When our leaders forget these principles, and take to forcing nuns to participate in matters they consider wholly immoral, the American people realize that our fundamental freedoms are in jeopardy. If the government can take away the rights of one group, then no one is safe from government coercion.
"These actions today by the administration are an important step back in the direction of freedom and respect for one another, and we look forward to more actions in the future, including restoration of the conscience rule for health professionals that President Obama gutted."
Monday, October 2, 2017
Note: This excerpt is the first in a series of essays on conscience in healthcare, by Jonathan Imbody, Vice President for Government Relations of the Christian Medical Association and Director of Freedom2Care.
Essay #1: Weaponizing "the patient comes first" eliminates ethical protections and professional judgment
Obamacare architect Dr. Ezekiel Emanuel and University of Pennsylvania professor Ronit Stahl advocate barring from medicine all physicians who would decline a patient's demand for morally controversial services such as abortion.
In a New England Journal of Medicine opinion piece entitled, "Physicians, Not Conscripts — Conscientious Objection in Health Care,"[i] Emanuel and Stahl make an argument against conscience freedom in healthcare that they summarize as follows:
"The proliferation of conscientious objection legislation in health care violates the central tenet of professional role morality in the field of medicine: the patient comes first." [ii]
|Physicians are caught in the cross-hairs of an aggressive |
agenda aimed at eliminating objections to abortion.
"The patient comes first" sounds good in theory; who would argue that physicians should pursue as their primary goal the patient's best interest? Physicians often make admirable personal sacrifices in order to advance health and healing for their patients, and many enter the medical profession motivated by compassion and a strong desire to help others.
So if "the patient comes first" is taken to mean that a physician should lay aside personal comfort, convenience and selfish ambition in order to focus on a patient's well-being, the phrase will find little argument and much example in the medical community.
But if "the patient comes first" is taken to mean that a physician must lay aside ethical convictions and professional judgment in order to fulfill every patient's preferences and demands, that interpretation will meet with great and justifiable resistance.
Ideologues can wrap a warped version of the noble notion around their political agenda, weaponizing "the patient comes first" to undercut professional judgment and the ethical standards that protect patients and the integrity of medicine. To assert that caring for patients requires doing whatever legal procedure and prescribing every prescription the patient demands is a flawed premise that leads to a flawed conclusion—that all conscientious objectors must be banned from medicine.
Corrupted into a power grab, a "patient comes first" rule turns medicine into a patient dictatorship with no checks and balances. Ezekiel and Stahl's plan illustrates the danger, requiring the unilateral confiscation of conscience rights from all health professionals in order to ensure that patients receive whatever controversial procedure or prescription they demand. Behind the rhetoric of Emanuel and Stahl appears to be an aggressive agenda aimed specifically at eliminating objections to abortion, by eliminating from medicine all professionals objecting to abortion.
What the authors actually require, but of course do not spell out, is that everyone must accept as dogma their view of what is a patient's best interest. While claiming to advance the consensus of the medical community, they actually are asserting the controversial agenda of abortion rights activists.
In doing so, they contravene the objective standards that have guided medicine for millennia.
|The role of the physician is to exercise ability and judgment.|
Although the authors avoid it and abortion advocacy has suppressed its use in recent years, for millennia the well-balanced principles of the Hippocratic oath have served as "the central tenet of professional role morality in the field of medicine." The first principle of Hippocratic medicine, the professional ethic that formed the basis for the oath, is not simply "the patient comes first" but rather "do no harm."
The Hippocratic oath does not pit patients against physicians but instead positions both as worthy of honor and protection, while spelling out objective standards to guide the practice of medicine. Hippocratic medicine recognizes both the vulnerability of the patient and the physician's unique role as a professional entrusted with potentially lifesaving or lethal power.
The Hippocratic oath therefore constrains the physician to abide by objective ethical principles, at the same time emphasizing that a physician's ethics and professional judgment serve as the prime protectors of a patient's best interests:
“I will use treatment to help the sick, according to my ability and judgment, but I will never use it to injure or wrong them.
"I will not help a patient commit suicide, even though asked to do so, nor will I suggest such a plan. Similarly, I will not perform abortions.
"But in purity and in holiness, I will guard the sanctity of life and my role as healer."[iii]
The role of the physician, therefore, is to exercise ability and judgment to help the sick and to guard the sanctity of life, thus preserving medicine as a healing and not a killing profession.
Wednesday, August 23, 2017
In Defense of Healthy Children: Recent Papers Expose the Truths About Dangerous Gender Dysphoria Treatments
Editor’s note: The following commentary reflects the personal views of the author and does not represent the official stance of the Christian Medical and Dental Associations
The most popular therapies to treat gender dysphoria in children are dangerous and biased, according to new research published in, “Growing Pains: Problems with Puberty Suppression in Treating Gender Dysphoria.” by Johns Hopkins physicians Hruz, Mayer, and McHugh.
- The effectiveness and success of gender-affirmation therapy and its use of puberty-blocking hormones is unknown, unproven and unapproved by the FDA.
- Despite the claim that puberty suppressors are “fully reversible,” puberty suppressors have not been proven either reversible or harmless.
- Physicians are advising children to endure experimental treatments to treat a mental disorder that has a 95% chance of disappearing with time.
- Gender-affirmation treatments lead most children toward a transgender adulthood, a lifestyle known for its 41% suicide rate.
- Parents deserve full and unbiased information when making choices concerning their children’s health, and an objective review of the evidence concerning the gender-affirmation approach.
You walk into a doctor’s office with your child who isn’t feeling right. The doctor proposes two treatments: one has a 95 percent chance of success and the other increases the risk of death by 41 percent. Which would you choose?
This scenario depicts the gender dysphoria debate stripped to its bare bones. If the child was being seen for any other condition besides gender dysphoria, the later treatment would never even be considered. It would appear that too often, physicians who propose puberty-blocking hormones may be unduly swayed by cultural pressures and emotional appeals.
Physicians and parents alike should understand that they do not need to sacrifice good medicine and good parenting in order to be loving and caring towards these children. Sometimes we have to wipe our children’s and patient’s tears away and still say “no.”
When our children feel like breaking into the medicine cabinet, our hearts skip a beat as we slam the cabinet door shut. And yet, when our children tell us they feel that they want to be a different gender, why would our default be to accommodate that feeling with experimental drug treatments?
With transgender activism sweeping society, children who identify as “trans” are being welcomed into the spotlight. But should such activism and ideology dictate decisions parents make concerning their children's health?
An objective review of the evidence on “transitioning” into another sex is not as cut and dried as Caitlyn Jenner and other trans activists might make it seem.
Leading Medical Experts Concerned About Children
In a paper entitled, “Growing Pains: Problems with Puberty Suppression in Treating Gender Dysphoria,” published this month in The New Atlantis, three medical experts laid out the groundbreaking results of their research.
Physicians Paul W. Hruz, Lawrence S. Mayer, and Paul R. McHugh conclude that families are not being properly educated about their children’s gender dysphoria.
The Johns Hopkins experts conclude that the research, statistics, studies, and results do not support the methods of treatment and therapy which are currently being presented as the healthiest and most loving option for children with gender dysphoria.
Physicians are telling parents that their sons and daughters are trapped in the wrong body and in order to free them from their mental anguish they need to take medical action. This popular form of consultation is known as gender-affirmation therapy. Rather than strive to help the gender dysphoric child to accept their biological gender, the physician or therapist affirms whatever gender the child prefers.
Assuming children to be fully capable of understanding their gender identity at a very young age, gender-affirmation therapy charges children to make decisions that will affect the rest of their lives. We put age restrictions on driving motor vehicles, the consumption of alcohol, enlisting in combat, even when purchasing a rental car, because we recognize the limits of adolescent maturity both mental and physical. And yet physicians are expecting 9 year olds to decide whether or not they’d like to retain their fertility in adulthood.(1)
Unfortunately, many families will never hear about reputable studies that contradict the gender-affirmation position. For instance, one study found that 80-95% (2) of children with gender dysphoria will grow out of gender dysphoria and will embrace the gender of their biological sex. In his 2016 report, Sexuality and Gender,(3) McHugh discovered that the concept of gender is very fluid among children. He insists that children are not fully capable of grasping the concept of gender identity. But this is exactly what is to be expected of children according to the leading medical and advocacy groups who monopolize this discussion.
The medical community is presenting the gender-affirmation approach as the only compassionate response to gender dysphoric children and usually results in the child eventually transitioning into a transgender adult. They characterize all opposing views, such as the opinion of Hruz, Mayer, and McHugh, as bigoted and anti-LGBTQ. Although the opinions of these qualified medical experts are rooted in sober science and a concern for children, the heated rhetoric of the left-wing gender ideologues will characterize them as superstitious religious zealots whose opinions are a form of hate speech. An example of this can be found in a leftist rebuttal of McHugh’s report, in which a “trigger warning” is shown prior to The New Atlantis’ interview with McHugh and Mayer.(4)
This particular counterargument coveys a common example of discrimination in which the credibility of the report is rejected due to the author and publisher’s Judeo-Christian beliefs.
Physicians and patients alike should be wary of any ideology forming a dictatorship over the medical community. Scientific facts do not always coincide with the fashions and fads of the times. Patients ought to be able to find comfort in their physician's reliance upon unbiased data.
Misguided “Guidelines” and Experimental Treatments
Puberty suppression is a hormone intervention that prevents the normal progression of puberty:
“...The testicles and penis of the boy undergoing puberty suppression will not mature, and the girl undergoing puberty suppression will not menstruate. The boy undergoing puberty suppression will have less muscle mass and narrower shoulders than his twin, while the breasts of the girl undergoing puberty suppression will not develop. The boy and girl undergoing puberty suppression will not have the same adolescent growth spurts.”(5)
Medical experts who endorse puberty suppression have been publishing guidelines for treatment which suggest that children as young as age 9 can begin receiving puberty-blockers and then at age 16 be administered cross-sex hormones. Doctors Hruz, Mayer, and McHugh discovered no well-established consensus about the safety and efficacy of these treatments. Regarding treating any patient, particularly a child, administering drugs is a step which should always be taken with great prudence, especially when the medications have not been tried and tested. Hruz, Mayer, and McHugh insist that experimental treatments for children must always be subject to intense scrutiny since 1) children cannot provide their own legal consent, and 2) they are consenting to become a subject to an unproven therapy.
Since puberty-suppression treatments were originally developed to normalize puberty for children who undergo puberty too early, all clinical trials undergone for these medications focused on delaying precocious puberty. Only in 1990 did physicians begin using these medications for treating otherwise physiologically healthy children who exhibited gender dysphoria.
These medications have never been approved by the FDA for treating children with gender dysphoria.
Hruz, Mayer, and McHugh assert, “Whether blocking puberty is the best way to treat gender dysphoria in children remains far from settled, and it should be considered not a prudent option with demonstrated effectiveness but a drastic and experimental measure.”(6)
False Claims of Reversibility
Medical experts who attest to the provenness of puberty suppression also assure their patients and their families, absent any proof, that these medications are “fully reversible.”
Even LGBTQ advocacy groups such as the Human Rights Campaign have noted how “extremely distressing” the development of secondary sex characteristics can be and that “some of these physical changes, such as breast development, are irreversible or require surgery to undo.”(7)
Hruz, Mayer, and McHugh insist, “It seems difficult to expect that a 12-year-old would have an understanding of the effects of these complex medical interventions and of the ‘social consequences of sex reassignment’ when these are matters that are poorly understood by doctors and scientists themselves.”(8)
Should Encouraging Your Child to Transition Take Priority Over Their Health?
Children want to be happy, to “fit in”, to be loved. These are perfectly natural desires which both physician and parents wish for the child. Yet the means to achieve these goals may not be the most avant-garde approach.
Hruz, Mayer, and McHughs urge families to consider the very real possibility that therapies which involve puberty-suppression and cross-sex hormones will inevitably lead to the child desiring sex-reassignment surgery. In other words, gender-affirmation therapy commonly leads to transgenderism. Transgenderism has not been shown to heal children from their existing mental ailments. No follow up studies ensure that the child’s gender dysphoria and their depression and suicidal thoughts will desist. Reliable studies that even transgender advocates cite convey shocking results:
- The transgender population shows a 41% suicide rate compared to the 4.6 rate (9) of the general population.
- People who have had transition surgery are 19 times(10) more likely than average to die by suicide.
Some argue that the morbidity rates associated with transgenderism are entirely due to the unproven “social stress model,”(11) which attributes the social stress of the individual to discrimination and stigmatization. The medical community simply does not yet know why the transgender population experiences such tragic mental health outcomes.
If the goal of the physician and the parent is to relieve a child of mental anguish, they must look these disconcerting facts straight on and accept that there is a high chance that a transgender lifestyle may not be the best solution.
Protecting Our Children
The health of little boys and little girls must never fall victim to the ideological or political movements of the present age.
Protecting our children’s health requires both sober science and loving hearts.
When a daughter struggling with anorexia comes to her parents for help, we would never expect her parents to affirm their daughter’s belief that she is fat. A physician would never prescribe a weight-reduction diet for the daughter.
The anorexia analogy does not sit well with the transgender community. This is largely due to the widespread belief that gender dysphoria is a biological orientation--something we are born with, fixed and immutable. Children struggling with gender dysphoria are constantly consuming what the media and the most popular youtubers inform them concerning transgenderism. Unfortunately, these outlets do not provide reliable medical facts. Qualified medical experts like Hruz, Mayer, and McHughs conclude that there is no evidence that gender dysphoria among children is fixed. McHugh explains these conclusions in the report he co-authored with Dr. Mayer, Sexuality and Gender. In an interview concerning his report, McHugh claimed that the science is never settled, saying “The claim that it is settled now; that the issues such as born that way or you’re fixed or it’s immutable. There is no evidence from the science that those things are correct.”(12)
McHugh’s results may not parallel the party line, but his approach is unbiased and rooted in genuine concern for a vulnerable population prone to severe mental disorders and a high morbidity rate.
As far as medical research can tell us, the path down which physicians and families are ushering vulnerable children is dangerous and even deadly. Parents must not cease in performing their duty as parents: to love and protect. Any therapy that families pursue should be rooted in the best and safest medicine. Perhaps the best therapy a parent can provide is affirming that a child’s worth, value, and identity is not rooted in gender but in the fact that they are loved and wonderfully made.
Paul R. McHugh, M.D. is University Distinguished Service Professor of Psychiatry and a professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine. He served for twenty-six years as the psychiatrist-in-chief at the Johns Hopkins Hospital.
Lawrence S. Mayer, M.B., M.S., Ph.D. is a scholar in residence in the Department of Psychiatry at the Johns Hopkins University School of Medicine and a professor of statistics and biostatistics at
Arizona State University.
Paul W. Hruz, M.D., Ph.D. is an associate professor of pediatrics, endocrinology, and diabetes and an associate professor of cell biology and physiology at Washington University School of Medicine in St. Louis.