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Thursday, January 18, 2018

Reforming the federal grants process to ensure the best help to the most people

I recently enjoyed the privilege of meeting with USAID chief Mark Green (center) to discuss how the US govt. can work better with faith-based organizations, to partner with to reach the needy overseas. What's needed IMHO is wholesale reformation of a byzantine grants process that favors huge companies that have extensive financial resources--not necessarily to do the best work or to reach the most in need--but resources to hire staff who write slick grant proposals and schmooze with bureaucrats. By contrast, many faith-based ministries operate on shoestring budgets devoted to direct care rather than to financial development.
USAID under Administrator Green is addressing this challenge, and their dedication promises improvements that will extend more effective aid to more individuals. For example, a Broad Agency Announcement now allows interested organizations to submit a two-page expression of interest for grant projects.
Other practical suggestions for reform include:
  1. Provide training for faith-based organizations by government officials and faith-based grantees on how to navigate the grants process, similar to the New Partners Initiative program.
  2. Use the USAID faith-based office to review all relevant grants for faith-friendliness, and provide the office with legal expertise on religious freedom issues.
  3. Include members of the faith community on grant review panels, which injects a faith perspective into the process and also educates reviewers about the process.
  4. Take a look at the current contractors under the Indefinite Delivery Indefinite Quantity (IDIQ) system, which as far as I can tell has no explicitly faith-friendly contractors, and see how a large faith-based organization might participate and then be in a position to sub-grant to smaller faith-based organizations. 
The goal is not to get money to any particular organization based on size or ideology but simply to keep the doors open to those organizations capable of doing the best work for the most people.

Wednesday, January 3, 2018

"Patient autonomy" – The Trojan Horse assault on conscience freedom in healthcare

Note: This excerpt is the fourth 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

Just as the Declaration of Geneva's original commitment in 1948 to honor pre-born life fell to new ideology, so did the original commitment to healthcare professionals' conscience freedom.
The relevant clause in the original Declaration of Geneva read simply,
"I will practise my profession with conscience and dignity."[i] 

The Declaration recognized that as a professional, a physician professes to ethical standards and then exercises professional judgment in the application of those standards. So the 1948 Declaration did not dictate what specific conscience convictions were allowed or disallowed. Prescribing specific clarifiers would have undermined the main point, which is that a medical professional exercises ethical judgment.
All that changed, however, within a few decades and with the insertion of a few seemingly innocuous phrases.
The U.S. Supreme Court's 1973 Roe v. Wade decision that legalized abortion on demand followed transformational cultural shifts that helped make abortion socially acceptable. Having won acceptance and legalization, many abortion advocates have shifted sights to the next goal: eradicating opposition and mandating submission.
Unsatisfied with the mere acceptance and legalization of their position, they now aim at forcing others to submit to and carry out their ideological agenda. A prime target for forcing abortion rights doctrine on everyone: conscientious objectors in the medical community.
Not content with acceptance and legalization, abortion
advocates moved to force everyone--even nuns--
to submit to their ideological agenda.
In 2017, Declaration of Geneva revisionists followed this playbook by adding an innocuously phrased but politically charged limitation to freedom of conscience. The revision reads (changes in italics),
"I will practise my profession with conscience and dignity and in accordance with good medical practice." [ii]
Everyone would have understood the original Declaration statement, "I will practise my profession with conscience and dignity," to presume good medical practice. No one would have countenanced a medical ethics oath that provided cover for bad medical practice. By keeping the statement simple without adding unneeded qualifiers, the original statement provided for maximal latitude for medical professionals to exercise conscience, practiced within the bounds of the high dignity of the profession and calling.
So in the seven decades after the original 1948 Declaration, did new evidence of medical abuses in the name of conscience require qualifying the original statement? Certainly if physicians exercising conscience judgment had been causing deaths and harm to patients, abortion advocates would have shouted it from the rooftops.
So why then, in the absence of such evidence, would Declaration of Geneva committee members go to all the trouble to add onto a complete and satisfactory statement?

When "good medical practice" actually means ideological conformity

The most obvious answer is that ideologues, most notably abortion activists, wanted to lay the groundwork for narrowly defining "good medical practice" to fit their own radical ideology. If one can assert the claim that abortion is an essential part of "good medical practice," then a physician can be denied any claim of conscience as grounds for declining to participate in abortion.
Obamacare architect and
conscience freedom critic
Dr. Ezekiel Emanuel
That is precisely the path that Obamacare architect Dr. Ezekiel Emanuel and University of Pennsylvania professor Ronit Stahl take in their New England Journal of Medicine opinion piece, "Physicians, Not Conscripts — Conscientious Objection in Health Care."[iii]
  • First, they contend that "although abortion is politically and culturally contested, it is not medically controversial."[iv] They cite American Medical Association documents to assert that abortion "is a standard obstetrical practice."
  • Therefore, they reason, objectors "cannot completely absent themselves from providing these services." [v] (The authors, at least for now, stop short of demanding that objecting physicians perform abortions but still would require all physicians to refer for abortions. Many pro-life physicians view referring for an abortion as an act of complicity in the morally impermissible act of abortion. So requiring a pro-life physician to refer for abortions is like requiring an abolitionist to refer slave buyers to slave traders.
  • Finally, to invalidate conscience claims, Emanuel and Stahl invoke patient autonomy, which they consider the trump card against conscience and the highest principle of "good medical practice":

"To invoke conscientious objection is to reject the fundamental obligation of health care — the primary duty to ensure patients’ continued well-being."[vi]
Authors Emanuel and Stahl, like the Geneva Declaration revisionists, will hardly come right out and say, "Oh, and by the way, by 'good medical practice,' we mean participating in abortion." That tie-in task is left to others, and unfortunately, too many in the medical community are eager to take on the role of conscience limiters.

Conscience limiters assert "patient's well-being" to leverage agenda

ACOG: Conscientious objectors must submit.
In fact, the American College of Obstetrics and Gynecology (ACOG), in 2007 actually published an ethics committee opinion declaration entitled, "The Limits of Conscientious Refusal in Reproductive Medicine."[vii] ACOG's document (which subsequently was tied to the career-determining ethics requirements of ABOG, the American Board of Obstetrics and Gynecology), asserted,
"When conscientious refusals conflict with moral obligations that are central to the ethical practice of medicine, ethical care requires either that the physician provide care despite reservations or that there be resources in place to allow the patient to gain access to care in the presence of conscientious refusal." [viii]
Like authors Emanuel and Stahl, ACOG also cleverly conflated patient well-being with abortion in order to undermine physicians' conscience freedom:
"In the provision of reproductive services, the patient's well-being must be paramount. Any conscientious refusal that conflicts with a patient's well-being should be accommodated only if the primary duty to the patient can be fulfilled." [ix]
Therefore, ACOG concluded, even physicians conscientiously opposed to abortion are obligated to refer patients for abortions, and in some cases, even to perform abortions.
Somehow ACOG obstetricians, in all their deliberations over "a patient's well-being," never considered that the unborn baby is also a patient, a patient whose well-being ends abruptly in an abortion.
The ACOG strategy of undermining physicians' conscience freedoms by trumping those freedoms with "patient rights" is not an isolated opinion but a worldwide ideological assault. The framework for coercion and discrimination against pro-life physicians has been laid down in many arenas, using the clean-sounding language of patient autonomy, medical consensus/good medical practice, duty, human rights and civil liberties.

Activists focus first on acceptance, then legalization and finally coercion

"Patient autonomy" is the handsome Trojan Horse
that has infiltrated medicine.
Abortion activists are redeploying these positive concepts to build their case for coercing all health professionals and institutions to participate in morally controversial practices.
1.      The strategy begins with using cultural influencers to promote acceptance of a radical agenda.
2.      The resulting shift in public acceptance helps activists leverage laws to permit the agenda.
3.      The final stage is eradicating all opposition and mandating participation.
This same process—acceptance, legalization, coercion--has been followed by LGBT activists and will be followed by assisted suicide activists as well.
"Patient autonomy" is the cornerstone of the radical new ethic. Patient autonomy is the strategic nuclear weapon deployed to eradicate all competing notions of morality and all appeals to conscience.
This is why Declaration of Geneva revisionists insisted on literally "shifting all new and existing paragraphs focused on patients’ rights to the beginning of the document, followed by clauses relating to other professional obligations."[x]
"Patient autonomy" is the handsome Trojan Horse that has infiltrated medicine and opened the door for the enemies of conscience to coerce, discriminate against and force pro-life professionals, clinics, care centers and institutions into submission.

[i] Declaration of Geneva, World Medical Association, adopted October, 1949.
[ii] Declaration of Geneva, World Medical Association, October 2017.
[iii] "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.
[iv] Ibid, p. 1383.
[v] Ibid.
[vi] Ibid, p. 1384.
[vii] "The Limits of Conscientious Refusal in Reproductive Medicine," ACOG Committee Opinion Number 385, November 2007Reaffirmed 2016, Committee on Ethics. Available online at, accessed 1/3/2018.
[viii] Ibid.
[ix] Ibid.
[x] Ramin Walter Parsa-Parsi, MD, MPH, "The Revised Declaration of GenevaA Modern-Day Physician’s Pledge," Journal of the American Medical Association, Viewpoint October 14, 2017. Available online at accessed 1/3/18.

Wednesday, December 20, 2017

Why the US Should Strategically Invest in Foreign Aid and Engage with Faith-based Organizations

W.H.O.: faith-based organizations provide
up to 70% of healthcare in Africa.

Faith-based organizations (FBO's)

·        The World Health Organization released a report revealing that between 30% and 70% of the health infrastructure in Africa is currently owned by faith-based organizations.[1]
·        The Gallup World Poll asked sub-Saharan Africans in 19 countries about their confidence in eight social and political institutions. Overall across the continent, they were most likely to say they were confident in the religious organizations (76%) in their countries. [2] 
(FBO's) typically are:
1.      Efficient - know how to operate on limited budgets and tap vast resources of volunteers.
2.      Accountable - answerable to governing boards and donors who expect a high yield on their donations.
3.      Transparent - overseen by charitable organization watchdogs and use well-established networks in local communities to reach the people most in need.
4.      Sustainable - typically long-established in communities and dedicated to remaining to serve communities long after grant projects are completed.

Gallup: Africans most likely to say they were
confident in the religious organizations (76%)
in their countries

5.      Apolitical - motivated by faith tenets, not by political ideology.

U.S. Funding Goals:

Our government should carefully target foreign aid to reflect the values of the American people, who expect aid to be:
1.      Efficient: Programs meet quantifiable goals and demonstrate a high return on investment.
2.      Accountable: Programs produce measurable results.
3.      Transparent: Open accounting proves that U.S. funds actually reach the needy.
4.      Sustainable: Programs will continue yielding benefits long after U.S. funds are expended.
5.      Apolitical: Aid reflects universal values of compassion and not partisan ideology.
Besides meeting these criteria, aid can also serve pragmatic American interests by prioritizing aid that will keep Americans safe. Death and disease lead to economic instability, making a country vulnerable to radical political movements. For example, when mothers in Africa die from AIDS, their sons become the recruiting targets of terrorist groups. Foreign aid can help prevent country disintegration that ultimately threatens American security.
Additional worthy goals can include aiding countries that: advance democracy by practicing or moving toward American values and strengthen alliances with countries that provide economic, energy, military and political advantages to the United States.

[1] "Faith-based organizations play a major role in HIV/AIDS care and treatment in sub-Saharan Africa," February 8, 2007:
[2] Gallup Poll, "Africans' Confidence in Institutions -- Which Country Stands Out?" January 18, 2007:

Monday, December 4, 2017

Medical ethics: Bedrock oaths versus zeitgeist barometers

Note: This excerpt is the third 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

On the heels of World War II, with medical ethics in the spotlight following unconscionable Nazi atrocities, the World Medical Association (WMA) decided that the Hippocratic oath, which had guided medicine since around 500 BC, needed to be replaced. So the Association developed a new oath that contained some of the principles of the ancient oath but opened the door to continual modernizing.
The World Medical Association responded to Nazi
medical atrocities not by reasserting the time-tested
Hippocratic oath, but by asserting a new modern
oath, subject to change every 10 years.

The WMA's Declaration of Geneva, introduced in 1948, followed the general pattern of the Hippocratic oath, which promotes patient protections by highlighting the physician's discretion in the use of power.
The Declaration of Geneva followed the Hippocratic oath's assumption that the physician is not a pawn of the patient but a professional who exercises ethical judgment. The Declaration stated conscience freedom in healthcare simply: "I will practice my profession with conscience and dignity."[i]

Shifting ideology is replacing timeless oaths and bedrock principles

By contrast to the fixed bedrock principles enshrined in the millennia-old Hippocratic oath, however, the World Medical Association's Declaration of Geneva undergoes revision every decade. After half a dozen windward revisions in the direction of liberal social positions, the evidence of the Declaration's ever-shifting form belies its claim to "safeguard the ethical principles of the medical profession, relatively uninfluenced by zeitgeist and modernism."[ii]
The WMA's ever-changing Declaration of Geneva
is a virtual zeitgeist barometer.
In fact, the Declaration serves as a veritable zeitgeist barometer, tracking with the current era's cultural climate.
Exhibit A: Physicians using the original Declaration of Geneva promised, "I will not permit consideration of religion, nationality, race, party politics or social standing to intervene between my duty and my patient." Five considerations.
By 2017, the list had expanded with over a dozen new items or phrasings to read, "I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing, or any other factor to intervene between my duty and my patient"[iii] (changes noted in added italics). Apparently exhausted by compiling the extra items, the Declaration editing committee decided to cover their bases for all time: "or any other factor."
The Declaration of Geneva has quickly become a "fill-in-the-blank" blackboard of social and political agendas.
Exhibit B: The original Declaration unequivocally asserted, "I will maintain the utmost respect for human life from the time of conception."[iv]
With every revision, "life" keeps getting vaguer.
That apparent pro-life commitment survived just one revision.
By 1983, activist editors had watered it down to, "I will maintain the utmost respect for human life from its beginning" (emphasis added).[v] Divorced from science and subjected to the ideological whim of the interpreter, "beginning" could mean any time from conception to birth to verbal ability to, what the heck,  graduation with an advanced degree.
Fill in the blank with your own whim.
Apparently by 1983, practitioners of modern medicine had lost the ability to acknowledge what biological science right up until that point had clearly demonstrated as an inarguable reality: that human life begins at conception. So the new medical oath reflected the loss of scientific knowledge, resorting to fuzzy, flexible ambiguity.
By the fourth revision, oath editors apparently had lost all interest in when life begins.
The newly revised statement simply said, "I will maintain the utmost respect for human life."
Perhaps the next revision will delete human and simply refer to "life," followed by a subsequent revision that will pledge, "I will maintain the utmost respect." The final revision will be simply, "I," which appears to be the only remaining ethic. Whatever I want, whatever I think, whatever I choose.

Next essay: Abortion activists tie conscience freedom to ideological conformity

[i] Declaration of Geneva, 1948 original version, World Medical Association. Reprinted and analyzed in "Use of the Hippocratic Oath: A Review of Twentieth Century Practice and a Content Analysis of Oaths Administered in Medical Schools in the U.S. and Canada in 1993," by Orr, Robert D., Pang, Norman, Pellegrino, Edmund D., Siegler, Mark
Journal of Clinical Ethics. 1997 Winter; 8(4): 377-388.
[ii] World Medical Association web page, accessed Nov. 16, 2017.
[iii] Declaration of Geneva, World Medical Association, October 2017.
[iv] Declaration of Geneva, World Medical Association, adopted October, 1949.
[v] Declaration of Geneva, World Medical Association, October 1983.

Friday, November 3, 2017

Christian Medical Association doctors and Freedom2Care applaud HHS initiative to connect sex education to science

Washington, DC—November 3, 2017: The 19,000-member Christian Medical Association ( and the 30,000-strong Freedom2Care ( 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."

Thursday, October 26, 2017

Autonomy quickly translates to tyranny

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

  1. 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
cooperation--not domination.
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?

Choosing a healing profession does not mandate killing

Two patients.
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.
But those who breathe the rarefied air of radical ideology have no patience to contemplate real-life consequences. They aggressively, relentlessly, blindly drive toward their goal of ideological conformity--at any price.

[i] Jonathan Imbody, Faith Steps: Moving toward God through personal choice and public policy, Washington, DC: Logion Publishing, Second Edition, 2016, p. 26. Available at
[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.
[iv] Stahl and Emanuel. p. 1380.
[v] Ibid. p. 1383.

Monday, October 23, 2017

Federal Legislation Top Priorities - 2018

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.

Top Priorities: Freedom of faith, conscience and speech

·        Conscience Protection ActS. 301, H.R. 644 - Prevent government coercion related to abortion.
·        Free Speech Fairness ActS. 264, H.R. 781 - Protect free speech on political issues for nonprofit organizations including churches.

Top Priorities: Right to life

·        Pain-Capable Unborn Child Protection ActS. 1922, H.R. 36 (passed) - Protect developing babies from abortions at the stage in which they can feel pain.
·        House Resolution on Dangers of Assisted SuicideH. Con. Res. 80 - Prevent assisted suicide.

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 ActS. 220, H.R. 37 - Save lives of babies born in an abortion.
·        No Taxpayer Funding for Abortion and Abortion Insurance Full Disclosure ActS. 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.