CMDA Today - Fall 2021

CMDA TODAY

Volume 52 • Number 3 • Fall 2021

A STRATEGIC PL AN

TO SUCCEED

My

CMDA

Story

Bill Sasser, DMD, while serving on a Global Health Outreach trip to Nicaragua.

“It’s a privilege to share my life with the CMDA family.

In a secular society such as ours, it’s a privilege to walk alongside men and women who seek to follow the great commandment of Christ, to love God and love our neighbors.

Scripture calls us to live examined lives before the Lord. Who’s really on the throne of my life? How am I using my time? Dental disease is a great need throughout the world, and I’ve learned how dentistry can be portable up to a point. As such, it’s a great vehicle for loving, serving and sharing the good news of the gospel. The call to serve is ongoing. We just have to respond to the call and say ‘yes’ to participation in a Christian organization like CMDA. Then get ready to mentor young people, donate your time and services at home and follow Christ’s order to support the Great Commission efforts around the world.”

—Bill Sasser, DMD, CMDA member since 1994 P.O. Box 7500 Bristol, TN 37621 888-230-2637 www.cmda.org/join memberservices@cmda.org

JOIN CMDA TODAY Join Dr. Sasser and more than 19,000 healthcare professionals across the country who are part of this growing movement of “bringing the hope and healing of Christ to the world through healthcare professionals.”

Visit www.cmda.org/join or call 888-230-2637 to join today.

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CEO Editorial Mike Chupp, MD, FACS

Bragging about Baba “Therefore, as it is written: ‘Let the one who boasts boast in the Lord.’”

I

—1 Corinthians 1:31

f you are a parent, I am guessing you pray a lot for your kids, even if they are now all grown up (and if so, then even more so). A couple of months ago, at dawn on a Sunday morning, as I was reading in the Word, a heaviness came over my heart and spirit related to Melody, my oldest daughter who is 26 years old. It was such a heaviness that I felt compelled to get on my knees right then and pray for her ardently through my tears on our couch. Just a few minutes later, she came through our front door and surprised me as she had driven two hours from Knoxville, Tennessee to Bristol, Tennessee that morning before sunrise, unable to sleep due to stress and worry. She rarely sees me cry, so when I explained why I was on my knees and had tears in my eyes, she was touched and gave me a big hug and with a sigh said, “It is so good to be home, Dad.” A couple of months later she handed me a Father’s Day card with this message: “Dad, my favorite memory this year was when I walked in the house one early Sunday morning from Knoxville and found you kneeling at the couch; you told me you had just been praying for me. I was going through a hard emotional time and that made me feel so loved and cared for. I’ve told multiple of my clients that story and that made a few of them cry as I bragged on my dad. ” One of the Swahili words that became part of my prayer vocabulary over a couple of decades in Kenya is “Baba,” the word for father. Kenyan children used to call me “Baba Melody” or “Baba Steven” (Dad of Melody or Steven). It is also a great prayer starter. Even now I can cry out, with the help of the Holy Spirit, “Abba, Baba!” (Romans 8:15).

Throughout CMDA’s 2021 fiscal year that concluded June 30, our national leadership team and Board of Trustees have earnestly asked Baba God to direct and supply CMDA’s ministry in the midst of the COVID-19 crisis, as well as the political and racial turmoil experienced across our nation. Baba God responded, full of mercy and grace and abundant supply of help in countless forms. Even Global Health Outreach (GHO) and Medical Education International (MEI), which are two CMDA ministries that focus on international mission outreaches, remained intact through extra funds from caring champions, and they are now back out on the mission field as

they bring the hope and healing of Christ to the world. We ended this fiscal year with such a surplus and favorable position that we are prepared to fund a new three-year strategic plan, which I write about in this issue of CMDA Today. Our 2021 surplus did not come about because of our ingenuity or innovative fundraising prowess (though our Stewardship team rocks!), but because we serve Baba God, who is able to supply all our needs according to His glorious riches in Christ Jesus (Philippians 4:19).

Baba God is also incredibly merciful and filled with unfailing love for the lost among our co-workers and colleagues. In this issue of CMDA Today, you will also read Dr. Patti Giebink’s incredible story of redemption as a former Planned Parenthood abortion doctor who made an Unexpected Choice to follow Christ in South Dakota more than 15 years ago. She is now a CMDA member and pro-life advocate who has much to teach us about the loving ways Christians in healthcare can winsomely challenge our pro-abortion colleagues. You can listen to my interview with Patti and other great guests this year on the weekly CMDA Matters podcast at www.cmda.org/cmdamatters.

I can’t think of any better way for Christian healthcare professionals to “brag about Baba” than to share our confidence in the gospel of Jesus Christ. Our brand-new video training series called Faith Prescriptions is now available online in the CMDA Learning Center to help healthcare professionals learn how to share their faith in their practice. And in his article in this edition, CMDA’s Vice President of Dental Ministries Dr. Bill Griffin gives us an inside look at this vital CMDA program that he produced with the help of 20 faculty members who gladly donated their time and shared their experiences with CMDA in these modules.

Jesus’ brother, Jude, concludes his short epistle with a big brag on Baba God in verse 25, “All glory, majesty, power, and authority are his before all time, and in the present, and beyond all time! Amen” ( Jude 1:25, NLT).

Mike Chupp, MD, FACS, is the CEO of CMDA. He graduated with his medical degree from Indiana University in 1988 and completed a general surgery residency at Methodist Hospital in 1993. From 1993 to 2016, he was a missionary member of Southwestern Medical Clinic in St. Joseph, Michigan, while also serving as a career missionary at Tenwek Mission Hospital in Kenya.

www.cmda.org | 3

VOLUME 52 | NUMBER 3 | FALL 2021

EDITOR Mandi Morrin

EDITORIAL COMMITTEE Gregg Albers, MD John Crouch, MD Autumn Dawn Galbreath, MD Curtis E. Harris, MD, JD Van Haywood, DMD Rebecca Klint-Townsend, MD Robert D. Orr, MD Debby Read, RN

CMDA TODAY

The Journal of the Christian Medical & Dental Associations

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CMDA is a member of the Evangelical Council for Financial Accountability (ECFA).

CMDA Today™, registered with the U.S. Patent and Trademark Office. Fall 2021, Volume LII, No. 3. Printed in the United States of America. Published four times each year by the Christian Medical & Dental Associations® at 2604 Highway 421, Bristol, TN 37620. Copyright© 2021, Christian Medical & Dental Associations®. All Rights Reserved. Distributed free to CMDA members. Non-doctors (US) are welcome to subscribe at a rate of $35 per year ($40 per year, international). Standard presort postage paid at Bristol, Tennessee.

Undesignated Scripture references are taken from THE HOLY BIBLE, NEW INTERNATIONAL VERSION®, NIV® Copyright © 1973, 1978, 1984, 2011

by Biblica, Inc.® Used by permission.

All rights reserved worldwide. Other versions are noted in the text.

CHRISTIAN MEDICAL & DENTAL ASSOCIATIONS P.O. Box 7500, Bristol, TN 37621 888-230-2637 main@cmda.org • www.cmda.org If you are interested in submitting articles to be considered for publication, visit www.cmda.org/publications for submission guidelines and details. Articles and letters published represent the opinions of the authors and do not necessarily reflect the official policy of the Christian Medical & Dental Associations. Acceptance of paid advertising from any source does not necessarily imply the endorsement of a particular program, product or service by CMDA. Any technical information, advice or instruction provided in this publication is for the benefit of our readers, without any guarantee with respect to results they may experience with regard to the same. Implementation of the same is the decision of the reader and at his or her own risk. CMDA cannot be responsible for any untoward results experienced as a result of following or attempting to follow said information, advice or instruction.

(See pages 26 & 30)

In This Issue

Brianna Snyder 423-844-1000

PRINTING

INCLUDES OPPORTUNITIES TO EARN CONTINUING EDUCATION CREDITS!

10 ON THE COVER

A Strategic Plan to Succeed

Mike Chupp, MD, FACS

24

CMDA Ethics Statement on Abortion

An inside look at CMDA’s strategic plan for

future ministry One hour of continuing education credit available

16

Faith Prescriptions: Just What the Doctor Ordered William T. Griffin, DDS

29

Introducing a new video-based program on how to bring faith into patient care

CMDA Ethics Statement on Persons with Acquired Cognitive Impairment

One hour of continuing education credit available

20

If I Had Known Then…

Patti Giebink, MD

32

The Dr. John Patrick Bioethics Column

Country Fences

by Aaron Hensley, MD

A former abortion doctor shares her journey to advocating for life

Exploring the fences traditionally observed in healthcare

See PAGE 34 for CLASSIFIED LISTINGS

REGIONAL MINISTRIES

Connecting you with other Christ-followers to help better motivate, equip, disciple and serve within your community Western Region: Michael J. McLaughlin, MDiv • P.O. Box 2169 • Clackamas, OR 97015-2169 • Office: 503-522-1950 • west@cmda.org Midwest Region: Allan J. Harmer, ThM, DMin • 951 East 86th Street, Suite 200A • Indianapolis, IN 46240 • 317-407-0753 • cmdamw@cmda.org Northeast Region: Tom Grosh, DMin • 1844 Cloverleaf Road • Mount Joy, PA 17552 • 609-502-2078 • northeast@cmda.org Southern Region: Grant Hewitt, MDiv • P.O. Box 7500 • Bristol, TN 37621 • 402-677-3252 • south@cmda.org

THE CHRISTIAN MEDICAL & DENTAL ASSOCIATIONS ® Changing Hearts in Healthcare . . . since 1931.

4 | CMDA TODAY | FALL 2021

Ministry News COMMUNITY

RESOURCES

Specialty Sections

CMDA Matters

Among all of our various ministries, CMDA’s Specialty Sections give you the unique opportunity to equip, network and fellowship with colleagues in your specific healthcare specialty. Organized by CMDA members, the sections listed below provide a wealth of resources for those who wish to connect with their colleagues.

Are you listening to CMDA’s weekly podcast with CEO Dr. Mike Chupp? Start listening now to learn more about our new Book of the Month program.

CMDA Matters is our popular weekly podcast with the latest news from CMDA and healthcare. A new episode is released each Thursday, and interview topics include bioethics, healthcare missions, financial stewardship, marriage, family, public policy updates and much more. Plus, you’ll get recommendations for new books, conferences and other resources designed to help you as a Christian in healthcare.

Listen to CMDA Matters on your smartphone, your computer, your tablet…wherever you are and whenever you want. For more information, visit www. cmda.org/cmdamatters.

1. Christian Academic Physicians and Scientists (CAPS) 2. Christian Healthcare Executive Collaborative (CHEC) 3. Christian Physical Rehab Professionals (CPRP) 4. Christian Surgeons Fellowship 5. Coalition of Christian Nurse Practitioners (CCNP) 6. Dermatology 7. Family Medicine Section (FMS) 8. Fellowship of Christian Optometrists (FCO) 9. Fellowship of Christian Physician Assistants (FCPA) 10. Fellowship of Christian Plastic & Reconstructive Surgeons (FCPRS) 11. Neurology 12. Psychiatry 13. Ultrasound Education (UES) Don’t see a section for your specialty? New sections are currently under development with CMDA’s Campus & Community Ministries.

As we grow our resources for our members to find connection within their specialties, we are also adding to our staff in order to better support and serve these growing outreach ministries. Contact ccm@cmda. org for more information about getting involved or starting a section.

Christian Academy Physicians and Scientists (CAPS) As one of CMDA’s specialty sections, the Christian Academic Physicians and Scientists (CAPS) is focused on meeting the spiritual needs of academic-based physicians and scientists, developing pathways of ministry, providing a supportive network and offering guidance in making bioethical decisions. The section has grown in the last year, as they focused on offering small discipleship small groups for their members. Currently, CAPS is hosting monthly webinars to encourage discourse on topics that may be of interest to faculty members and scientists.

As CAPS continues to grow and nurture faculty members who are serving Christ at academic medical centers around the U.S. and abroad, we encourage like-minded Christian faculty members in medicine to join the CAPS section.

For more information, visit www.cmda.org/caps.

Upcoming Events Dates and locations are subject to change. For a full list of upcoming CMDA events, visit www.cmda.org/ events.

Women Physicians and Dentists in Christ Annual Conference September 30 – October 3, 2021 • Grand Rapids, Michigan Greece Tour October 1-10, 2021 • Greece

New Zealand Tour October 12-26, 2021 • New Zealand

501 Foundations in Christian Coaching October 12 – November 16, 2021 • Virtual

Midwest Fall Conference October 15-17, 2021 • Norton Shores, Michigan CMDA and DTS Dialogues: Healthcare and Theology Learning Together November 6, 2021 • Virtual Marriage Enrichment Weekend November 12-24, 2021 • Palm Coast, Florida Israel Tour November 12-14, 2021 • Israel

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Ministry News MEMBER NEWS

Robert Orr, MD, CM Dr. Robert Orr passed away on May 20, 2021, after a five-year battle with cancer. A lifetime member of CMDA, Dr. Orr was an active volunteer with CMDA’s various ministries, and he was well known for his leadership and service.

After receiving his medical degree from McGill University in 1966, he joined the U.S. Navy. After his military service, Dr. Orr, his wife Joyce and their three children moved to Vermont where he practiced family medicine for 18 years. A growing interest in medical ethics led him to pursue a post-doctoral fellowship at the University of Chicago. After completing his postdoctoral studies, he served for 25 years in various professional roles. He greatly enjoyed assisting patients and families as they worked through difficult choices, teaching ethics to students at all levels and subsequently offering counsel as they pursued their chosen career pathways.

“Bob Orr taught me so many things, more than just about ethics,” said Gene Rudd, MD. “In the wake of moral failures by some of his colleagues, I remember Bob saying that being an ethicist does not make you ethical. But he stood apart from that. His life was a demonstration of a godly man, full of grace.”

He authored, co-authored or edited six books, 15 book chapters and scores of articles in journals and magazines. He was a vital leader in CMDA’s advocacy efforts, and he was a respected voice while serving on CMDA’s Board of Trustees from 2010 to 2018, as well as serving as chair of the Ethics Committee.

“Bob taught me much since I was a bioethical neophyte when I took up the mantle of leading CMDA’s public policy efforts in the mid-1990s,” said CEO Emeritus David Stevens, MD, MA (Ethics). “Later we did a speaking tour together fighting the legalization of physician-assisted suicide in South Africa and became close friends. As a writer, chair of the Ethics Committee, trustee and frequent speaker, he had a profound impact on our membership, the church and government policy.”

We are thankful for the impact he had in bringing the hope and healing of Christ to the world, and he will be missed by the entire CMDA family.

Now Accepting Referrals for Telehealth Sessions Online with CMDA Member Dr. Thomas Maple Dr. Maple is a psychologist providing faith-based psychotherapy online in: • • • • • • • •

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Dr. Maple has been treating patients via telehealth since 2017 and accepts private insurances and Medicare. For more information, visit www.crosswalknow.com or call 334-432-8372.

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Ministry News

Memoriam and Honorarium Gifts Gifts received April through June 2021 r. Lawrence and Mrs. Marissa Frick in memory of Dr. David Randall D Gary L. Veenstra in memory of Mrs. Ann Fisk Norman and Skaidrite Sparks in memory of Mrs. Ann Fisk Naomi E. Michie in memory of Mrs. Ann Fisk Susan J. Joseph in memory of Mrs. Ann Fisk Thomas and Marcia Greiner in memory of Mrs. Ann Fisk Robert and Jackie Swedberg in memory of Mrs. Ann Fisk John and Cornelia Wesley in memory of Mrs. Ann Fisk Dexter and Pamela Speck in memory of Dr. David C. Randall Elaine Hoffman in memory of Mrs. Ann Fisk Mark and Nicolette Dumke in memory of Mrs. Ann Fisk Dona D. Gustafson in memory of Mrs. Ann Fisk LeRoy and Catherine Dekeyzer in memory of Mrs. Ann Fisk Barbara K. Schwartz in memory of Mrs. Ann Fisk Dr. and Mrs. Samuel Molind in memory of Dr. Robert Orr Dr. and Mrs. Donald Wood in memory of Dr. Robert Orr Mr. and Mrs. Thomas Titkemeier in memory of Carol Sue Davis Dr & Mrs. Marvin R. Jewell, Jr. in honor of Dr. Gloria Halverson Hallie H. Herring in honor of Dr. Lee Herring For more information about honorarium and memoriam gifts, please contact stewardship@cmda.org.

Robert J. Lerer, MD CMDA member Dr. Robert Lerer was awarded the 2021 Samuel P. Asper Award for Achievement in Advancing International Medical Education by the Johns Hopkins Medical & Surgical Association and Dean of the School of Medicine and CEO of Johns Hopkins Medicine Paul B. Rothman, MD. Dr. Asper believed that the Hopkins-trained physicians who are dedicated to fostering excellent medical care and education in a foreign country are continuing the outreach effort of Dr. William Osler, who traveled to China to assist in establishing Peking Medical Union College. In his desire to find a way to recognize the work of such individuals, Dr. Asper created an endowed fund for this award.

Dr. Lerer was recognized for positively influencing countless lives during his career as a pediatrician. His commitment to providing medical care and sharing his medical knowledge to benefit those patients most in need, both in his local community and also in his native Cuba, is inspiring.

Since 2015, Dr. Lerer has been a leader in CMDA’s Medical Education International in helping to send teaching teams that offer valuable medical information and techniques.

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In Memoriam Our hearts are with the family members of the following CMDA members who have passed in recent months. We thank them for their support of CMDA and their service to Christ.

• Juliette Anderson • Moscow, Idaho Member since 1997 • David R. Breitkreuz, MD • Waterloo, Iowa Member since 1987 • Richard E. Brown, MD • Tempe, Arizona Member since 2001 • Marshall Burke, MD • Beaver Falls, Pennsylvania Member since 1973 • Brian Counts, MD, BMed • Lakewood, Colorado • Member since 1978 • Earl Crouch, MD • Virginia Beach, Virginia Member since 1973 • Lee Herring, MD • Flowood, Mississippi Member since 1988 • Lawrence P. Keegan, DDS • Dearing, Georgia Member since 2009 • Stuart R. Kortebein, MD • Grand Rapids, Michigan • Member since 1954 • Robert D. Orr, MD, CM • Burlington, Vermont Member since 1970 • David C. Randall, PhD • Versailles, Kentucky Member since 1984 • Tom Wilson, MD • Sioux Falls, South Dakota Member since 1997

CORRECTION

From CEO Dr. Mike Chupp “In my editorial for the spring edition of CMDA Today, I referenced Dr. Jeff Barrows’ and Jonathan Imbody’s article on ‘Ethical Vaccines.’ I referred to the Pfizer and Moderna COVID-19 mRNA vaccines as ‘FDA or other international authority approved vaccines.’ A few of our members respectfully pointed out that these vaccines (as stated in the article) were not approved but issued an ‘Emergency Use Authorization.’ Formal approval of the Pfizer and Moderna vaccines by the FDA is pending for these vaccines and, therefore, my word choice was not accurate.”

Dallas Jenkins

Lila Rose

Daisey Dowell, MD

Carl Trueman, PhD

Lila Rose

Dennis Rouse

Stephanie Seefeldt

Charity Gayle & Ryan Kennedy

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A STRATEGIC PL AN

TO SUCCEED Mike Chupp, MD, FACS 10 | CMDA TODAY | FALL 2021

I

had spent more than four years wishing and praying for a CT scanner at Tenwek Hospital, a 300-bed referral center in rural southwest Kenya where I was serving as a missionary surgeon in Africa. For years, every patient who came to us with a closed head injury, abdominal mass or recurrent abdominal pain had to be referred to a larger hospital in Nairobi, the capital city of Kenya. But more often than not, patients wouldn’t or couldn’t go to Nairobi, regularly due to the high cost of travel and treatment.

Then, out of nowhere, it was like my wish came true when a technology corporation offered a used CT scanner to the hospital. We were thrilled!

So began months of work of getting the machine and the equipment shipped to Kenya, finding spare parts and then searching for a company to install it. We successfully crossed every hurdle to get it set up and running.

Before we knew it, we were preparing to host a commissioning ceremony with the Kenyan Ministry of Health and scores of local and regional dignitaries in just a few months.

Rev. Kilel simply smiled back at me and stated, almost as a matter of fact, “God gave us this machine, and we are going to use it to bring Him glory. God will make this plan work, if you do your part, Dr. Chupp.” He then asked God to bless our plan to dedicate the CT scanner and, in the process, provide us a technician.

But behind the scenes, a larger, more real, more pressing problem was brewing. All of our plans were coming together perfectly, except for one—we had no formally or informally trained technicians on staff to complete the scans. In fact, CT technicians were nowhere to be found in rural Kenya. All of the qualified technicians were in the capital city, and the salary we were offering certainly wasn’t at the top of the bell curve.

These words by Solomon have always seemed a bit presumptuous to me. Yes, his father, King David, gave Solomon and us a stellar example of actions or campaigns committed to Jehovah with startling success. David so faithfully credited his victorious plans to His heavenly Father. Nevertheless, what does the authentic commitment of a serious plan to the Lord by a group of Christ-followers look like?

Month after month passed, and the commissioning ceremony loomed large. To say I was worried was an understatement. So when I heard our highly respected staff pastor and chaplaincy school director Rev. David Kilel share how excited he was that God had finally given the hospital a CT scanner, I felt compelled to speak up.

For the last couple of years, CMDA’s leadership has been focused on that one single factor—authentic commitment to the Lord’s plans for the strategic future of CMDA.

“COMMIT YOUR ACTIONS TO THE LORD, AND YOUR PLANS WILL SUCCEED.” PROVERBS 16:3, NLT

“Rev. Kilel, I agree that this scanner is an amazing gift that God has provided, but I don’t think you understand. We don’t have anyone to run the machine! It’s not an ordinary x-ray machine, and I have no idea where to find such a technician in Kenya who knows how to use it.”

In January 2021, CMDA’s Board of Trustees gathered at the CMDA national headquarters in Bristol, Tennessee, some virtually and some in person, to determine the key strategic objectives CMDA will pursue over the next three years to accomplish our mission of educating, encouraging and equipping Christian healthcare professionals to glorify God. www.cmda.org | 11

This two-day retreat was the culmination of nearly 18 months of preparation with analysis of the state of CMDA as a membership association AND as a faith-based ministry in a changing healthcare and cultural landscape. The board was guided in this process by Dr. Dale Lefever, a strategic planning consultant from the University of Michigan’s family medicine department who has led thousands of clients, including healthcare entities, through strategic plan development over the last 40 years. Dr. Lefever’s challenge to the board was to determine the key strategic issues facing CMDA, issues the ministry cannot afford to fail to address definitively over the next three years.

During that retreat, CMDA’s administrative leadership team presented white papers on many critical topics to the trustees, combined with a presentation from a stakeholder analysis, including focus group input and a survey of nearly 1,400 Christians in healthcare, members and non-members alike. As a result, the board voted on the following nine strategic objectives to guide and direct the ministry for the next three years, each falling under four Key Result Areas to facilitate the focus of our next strategic objectives: • Community • Advocacy • Service • Equipping Over the next several weeks, CMDA’s leadership developed a variety of goals to address the strategic objectives, and the Board of Trustees approved the new strategic plan at its board meeting in April 2021. Below you will find these strategic objectives presented as questions, followed by a summary of the goals.

COMMUNITY MENTORING THROUGH TRANSITIONS

How can CMDA leverage mentoring relationships in order to keep members engaged through their professional transitions?

CMDA’s Campus & Community Ministries (CCM), led by Bill Reichart, MDiv, and CMDA’s Dental Ministries, led by William “Griff ” Griffin, DDS, serve students and residents on approximately 330 healthcare campuses, as well as graduates in more than 90 communities across the country. The desire for effective and engaged mentors at the graduate and post-graduate levels is greater than ever, especially as students prepare for residency and residents prepare for professional practice. The CCM leadership team is setting its sights on developing a mentoring toolbox and platform, establishing at least 250 mentoring relationships on campuses and within residencies and identifying a national mentoring champion, all by the end of 2022. Dr. Griffin has set a goal of connecting at least 50 percent of graduating 12 | CMDA TODAY | FALL 2021

Christian dental student members with a mentor by graduation before mid-2024. The Center for Well-being plans to develop a mentoring course, taught by our coaching staff, while Global Health Outreach (GHO) plans on linking mission team participants with a seasoned, short-term missions mentor after every GHO mission team experience.

STRENGTHEN COMMUNITY AND NETWORKS

How can we draw Christian healthcare professionals into community as well as strengthen existing relationships through formation of vibrant small groups?

With greater challenges on healthcare campuses for graduate students to conform to new sexual mores that conflict with biblical teaching, the strengthening of supportive student, resident and graduate groups is more vital than ever. The acceptance of virtual meetings as the new normal will facilitate the efforts of our field staff in contacting Christian campus advisors/faculty, thereby expanding their access to undergraduate, Christian preprofessional groups. Having CMDA better known by students before they arrive on campus for their healthcare training should strengthen and grow our various communities. CCM is planning a virtual event for undergraduate chapters by 2024, after expanding the network discussed above. Under the leadership of Doug Lindberg, MD, the Center for Advancing Healthcare Missions (CAHM) is also targeting undergraduate groups for healthcare missions awareness and mobilization with a virtual event planned during the next three years.

rows and his team will be developing a teaching curriculum for all levels of healthcare professional involvement by CMDA on the “how to” of balancing biblical truth and Christ-like compassion in communicating our well-developed position statements. In the second half of the three-year period, Dr. Barrows plans on developing a video training series to accompany the curriculum, possibly in partnership with a respected Christian, non-healthcare advocacy organization to focus on an excellent equipping series for Christians in healthcare, including members in training at all levels.

PROMOTE DIVERSITY

How can we promote more representation of our current missing demographics (especially ethnicity) in our internal and external stakeholders?

ADVOCACY ADVOCATE FOR CHRIST’S PRIORITIES

How should CMDA align its advocacy in more areas where Jesus had the greatest concern?

This is a paradigm shift, but it is not an abandonment of our long-held public policy efforts to promote life from conception to natural death and to advocate for biblically consistent policies dealing with marriage and sexuality, substance abuse, pornography, right of conscience, etc. The CMDA Ethics Committee is already at work to produce white papers for our board that will address biblical principles impacting our healthcare advocacy, especially as demonstrated by Christ in the Gospels. Senior Vice President of Bioethics and Public Policy Jeff Barrows, DO, MA (Ethics), will then realign our advocacy staff priorities in their public policy pursuits and energy investment at both the federal and state levels.

Since 2018, CMDA has prioritized addressing the relatively low percentages of our members, volunteers and leaders who represent minority communities. This includes staff in our national and field leadership positions as well as various ministry councils and commissions. Our national ministry has developed several goals in this strategic plan to promote diversity within our leadership and membership. Assisting the Board of Trustees and CMDA’s staff members on this critical issue is the newly established R2ED Committee (Racism, Reconciliation, Equality and Diversity), which was appointed by the board to give recommendations on how to practically address our missing demographics. Our three mission outreaches (CAHM, GHO and Medical Education International [MEI]) will be recruiting minority team participants with a new but well-funded scholarship program. CCM will be developing a four-part curriculum for campus groups that presents a biblical understanding of racism and pursuit of reconciliation. Both CCM and CMDA’s Dental Ministries are making a greater presence on historically black colleges and universities a top priority. Staff in the communications department will be actively seeking out minority authors and guests for our various resources, and the CMDA National Convention planning team will be actively seeking input and speaker/music recommendations from the R2ED Committee.

SERVICE DOMESTIC OUTREACH FOCUS

EQUIP LOVING MESSENGERS OF TRUTH

How can we increase organizational focus domestically on service to the poor and marginalized while bringing the hope and healing of Christ to the world?

Addressing this strategic issue will require a collaborative effort between our advocacy team and our CCM team. Dr. Bar-

As an organization that desires to emulate Christ and serve the poor and marginalized wherever our members live and work, CMDA will place a greater emphasis on domestic healthcare ministry in Christ’s name to urban and rural poor communities of our nation. We will pursue strategic partnerships with

How can CMDA equip and train Christians in healthcare to communicate truth in love regarding controversial social issues for which we have developed position statements based upon a biblical ethic?

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make our team outreaches even more impactful through expanded patient safety, public health and pastoral training programs. MEI’s leadership team plans to take medical education in Christ’s name and with the gospel to 10 new countries. Dental Ministries intends to grow involvement in missions through scholarship fund development and greater recruitment of dental school faculty and their students to GHO teams.

EQUIPPING INCREASE MEMBER RETENTION

How can CMDA engage, educate and encourage first year members (and inquirers) in such a way that they become long-term members?

“

YOU CAN MAKE MANY PLANS, BUT THE LORD’S PURPOSE WILL PREVAIL….

”

other Christian organizations that are doing excellent work to support and strengthen their ministries. We will promote short-term and long-term service opportunities among our students and residents through the development of a handbook of domestic mission opportunities, and we will avail scholarship funds to students and residents who desire to complete elective rotations in such settings. Emulating the success of the Dental Residency [+] program in Memphis, Tennessee, a second site is being developed in Detroit, Michigan, including a Fellowship [+] training program that reaches cross-culturally to both healthcare and gospel needy urban communities. GHO will promote short-term service opportunities to the Navajo Nation through partnerships with other non-profit organizations and non-governmental organizations.

Advancing our membership numbers in every category is a prime objective in the new strategic plan. We will continue to offer greater value for membership with the growth of free continuing education for members in the CMDA Learning Center.

We are launching a dues-sharing program with local ministries that have part-time or full-time staff with a gradual increase in the percentage of annual dues shared to 50 percent between our national ministry and the local ministry. Our digital media team will be leveraging technology and the virtual space to increase member engagement, especially in the first two years of a new member’s experience.

BUILD MEMBER RESILIENCE

How can CMDA equip members to be faithful, effective and resilient ambassadors for Christ and the gospel in a healthcare culture that is increasingly intolerant of Christian perspectives?

As members, you are keenly aware of the opposition Christians are facing in the public square, especially in healthcare. We have hired a full-time Director of Leadership and Church Relations who will also oversee the Center for Well-being, including the coaching ministry. We will be promoting the new Faith Prescriptions video training series across all levels of training and practice and hope to reach 300 or more small groups with this training in the next three years. We will increase training and support of our students and resident groups who are facing greater pressure from school and hospital administrations to disavow CMDA’s position statements dealing with marriage and sexuality.

INTERNATIONAL OUTREACH FOCUS

How can we improve upon the success and organizational structure of existing overseas mission activities?

CAHM will launch new programs called “First Fruits” and “Capstone” to mobilize early and late career members to engage in intermediate and long-term international service. GHO will 14 | CMDA TODAY | FALL 2021

Though extensive, this is not a comprehensive list of our strategic goals over the next three years, but it should give you insight into our future priorities for serving our members, the church and other constituents over the next three years. As I look ahead to CMDA’s future, I am encouraged by Solomon’s matter-of-fact perspective on strategic planning in Proverbs

A NOTE FROM THE PRESIDENT Lisle Whitman, MD

The CMDA Board of Trustees and administration capped an engaged threeyear season with the approval of a new strategic plan at the April 2021 meeting. This season began with the selection of our new CEO and continued through the development of a new strategic plan. We believe both these actions will set CMDA’s direction for years to come. I would like to thank both the trustees and CMDA administration for the diligent sacrifices of time and prayer to prepare for these exciting opportunities. As the trustees have walked through this time, we have seen time and again God’s provision of wisdom. Especially with the need for clarity and consensus during the strategic planning process, virtual meetings can create significant impediments. As you read Dr. Chupp’s overview of the outcomes of these deliberations, I think we can all be excited about CMDA’s ability to bring the hope and healing of Christ to the world through healthcare professionals.

19:21, “You can make many plans, but the Lord’s purpose will prevail” (NLT).

It’s the same verse Rev. Kilel reminded me of back at Tenwek when we were installing the new CT scanner. There I was, worried that we didn’t have a technician to run the scanner, despite all the plans we had made, while Rev. Kilel was confident that God would provide.

And that’s exactly what happened. Unbeknownst to me, the hospital’s chief radiography technician had reached out to the dean of the Kenya Medical Training College in Nairobi, School of Radiography, and she had arranged for me to have a conference call with him. During the call, the dean kindly invited me to come and talk with the graduating class of technicians. So I paid my first visit to the school, where I made a presentation to a class of 30 to 40 graduating x-ray technicians. Few students in the class had ever even heard of Tenwek, but after the presentation, four students asked to apply. Just two weeks before the long-awaited commissioning of our scanner, two installation technicians worked around the clock to install the scanner. And joining them were not just one, not just two, but THREE fully trained Kenyan CT technicians. Nearly 24 hours before the commissioning, the power was switched on and the first scans were produced, all within God’s timing and His plans.

Rev. Kilel was fully committed to this “Big Holy Audacious Goal” at Tenwek, and he had complete confidence and trust in

the Lord. I will admit that I had doubts along the way, but in the end, I had a front row seat as God blessed the plans we had made, all for the glory of God. Today, I have a front row seat yet again to watch God work in and through CMDA’s new strategic plan. I invite you to join me!

We believe these “Big Holy Audacious Goals” will move CMDA toward our vision of bringing the hope and healing of Christ to the world through healthcare professionals. And just like that CT scanner continues to do for patients in Kenya, we believe this plan will make a difference for years to come, all for the glory of God! Mike Chupp, MD, FACS, is the Chief Executive Officer of CMDA, the nation’s largest faith-based organization of healthcare professionals. He grew up in the suburbs of Indianapolis, Indiana, graduated with a pre-medical degree in chemistry from Taylor University in 1984 and then graduated with his medical degree from Indiana University in 1988. He completed a five-year general surgery residency at Methodist Hospital in 1993. From 1993 to 2016, Mike fit in nearly seven years of private general surgery practice as a missionary member of the Surgical Department of Southwestern Medical Clinic (a large Christian multi-specialty group) and Lakeland Regional Health System in St. Joseph, Michigan. Prior to his service with CMDA, he was a career missionary with World Gospel Mission, serving at Tenwek Mission Hospital in Kenya. Mike and his wife Pam have four children: Steven, Melody, Kayla and Ashley.

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FAITH

PRESCRIPTIONS JUST WHAT THE DOCTOR ORDERED

Introducing a new video-based teaching program from CMDA to equip healthcare professionals to share the love of Christ with their patients and colleagues William T. Griffin, DDS

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H

ow many Christian healthcare professionals entered into their training with the goal of utilizing healthcare as a means of communicating the love of Christ to their patients? I have only met a select few whose desire to become healthcare professionals was integrally tied to their desire to proclaim Christ through their treatment by seeking to preach and heal as Jesus did (Matthew 9:35)—either on the mission field or on the home front.

2013. Developed by Drs. Walt Larimore, Bill Peel and Gene Rudd, this material was eagerly consumed and applied by thousands of Christian healthcare professionals across the country. The benefits of this program extended to both patients and clinicians, as patients received care that transcended their physical needs, while doctors discovered that their efforts to treat the whole person made their profession more fulfilling as they stepped into a fuller understanding of how the Lord could use them in their chosen profession.

The more common scenario is that Christians go into healthcare because they want to “help people,” a desire that is somewhat vague and incompletely defined, with the assumption that the content of this desire will take shape somewhere along the journey. What a delight it can be to discover that our treatment of patients’ physical ailments can be such a powerful entrance into addressing their spiritual needs!

Faith Prescriptions is CMDA’s latest effort to equip and inspire Christian healthcare professionals, and this video-based version of the curriculum builds upon the solid foundation of the prior programs, with some significant differences. First, the videos in this series are 15 minutes, a perfect length for discussion groups.

Also, 20 healthcare professionals from 12 states and various ethnicities bring their expertise to the series. They treat patients in a variety of settings—private practices, hospitals, low-income clinics and the international mission field. Additionally, the series covers a broad spectrum of healthcare topics: addiction treatment, end-of-life care, ministering to the LGBTQ community, treating refugees

In keeping with its mission to educate, encourage and equip Christian healthcare professionals to glorify God, CMDA launched two tremendous training programs known as Saline Solution in 1995 and Grace Prescriptions in

and immigrants, dental treatment, academic medicine and more. The net result is a powerful launching pad for CMDA members to enjoy mutual inspiration and encouragement in applying the love of Christ to everyday patient care.

Faith Prescriptions is now available in the CMDA Learning Center, which CMDA members can access for free.

The first 10 videos were made available in conjunction with the 2021 CMDA National Convention. These initial episodes include a number of topics of interest to all healthcare professionals, including taking a spiritual history, praying with patients, staying on schedule, keeping it natural, spiritual interventions, sharing the good news, etc. More videos are being added each month, with a total of 25 videos planned and currently in various stages of completion. Also available with the videos are a Participant’s Guide and Leader’s Guide, which include episode summaries, discussion questions and additional resources.

A Short Preview of the Series

To whet your appetite for the inspiring content of this video series, consider the following excerpts from five episodes.

“ADDICTION AND THE GOOD NEWS”

with Timothy Allen, MD, from Milwaukee, Wisconsin

“T

he Bible really gets people, and that’s one of the things I like to emphasize. When I talk to my patients who struggle with addiction, I’ll take them to Romans chapter 7, starting with verse 14, where Paul talks about, ‘Why is it that I do the things that I don’t want to do, and I don’t do the things that I do want to do, who will save me from this body of death?’ And when I bring that up to patients, they’re like, “Whoa, the Bible gets me, it understands addiction.” And it’s like, ‘Yeah, you’re in the Bible, so am I….’” www.cmda.org | 17

“GOOD NEWS FOR THE LGBTQ COMMUNITY”

with Jennifer Kang, MD, from Redding, California

“M

y goal in interacting with my LGBTQ patients is to allow them to feel the truth of my heart toward them, which is that I don’t reject their pain experience. I see their pain experience, I validate it… I have not experienced the same pain, but I do know I have experienced rejection, I have experienced many of these things that are human, and I know what they feel like.”

“When we affirm a person’s pain, we are affirming that person, and not their beliefs or their conduct or their behavior. If those things we judge so strongly that we cannot connect with somebody and see their value, then we’re always going to struggle, because we all fail, and we all are on a journey.”

“COMMUNICATING THE GOSPEL INTERNATIONALLY”

with Dr. Scott, a missionary serving in the Middle East

“I

found that in relationships in general, I as a foreigner who didn’t have the same rules of honor and shame in terms of how I related to people, became a safer person for people to reveal their struggles—struggles within the family, struggles within work, emotional struggles, spiritual struggles. I think it was in part because I opened up first and sort of revealed that even though I’m a doctor and a foreigner— and there was a certain degree of honor that was automatically given to me because of my position—I was also a human being in need of the grace of God, a person of weakness.”

“NOT FOR DENTISTS ONLY”

“RACE RELATIONS: CROSSING THE DIVIDE”

with Omari Hodge, MD, from Braselton, Georgia

“D

iversity will bring different groups of people around you who may not look like you and think like you and talk like you, but cross-cultural dependency will add another layer, a layer that says that I give authority to other people who don’t think and look like me, to speak into my life and I am relying on them, understanding that I have blind spots, that I am limited in the way I can see and do life.”

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with Kevin Aduddell, DDS, from Richardson, Texas

“I

n financial circles we are told to invest for the longterm, and that’s a wise thing. We know from our walk with Christ that we also need to invest for eternity. When we take small investments of time over the course of our careers, we will be able to look back at the end and know that those seeds of faithfulness have grown into a harvest that’s great. And we will be able to look at our career, and one day, God-willing, we will hear, ‘Well done, good and faithful servant.’”

Invite colleagues. There are great potential advantages to having other healthcare professionals in your area exposed to this series. First, it will increase the spiritual IQ of your healthcare community, opening the doors for additional ministry opportunities, in which healthcare professionals can act synergistically to move a shared patient toward Christ. Secondly, having other local clinicians join together for training experience will serve as a visible reminder that we are not alone in our efforts to proclaim Christ through our patient interactions. Thirdly, studying this material with local colleagues will create the mutual encouragement that can inspire us to be more regularly involved in spiritual interventions.

Get Started Sharing Your Faith in Your Practice

So how can this series best be utilized to gain the most benefit for our members and their patients?

Form a group. “As iron sharpens iron, so one person sharpens another” (Proverbs 27:17). The greatest benefit for viewers will be gained through participation with others. With each video being concise, the quantity of material presented is limited, but the potential applications to real-life patient situations is virtually unlimited. Group discussion, with the sample questions as a starting point, will move the topics from the theoretical to the practical, and the regularity of meetings will create built-in accountability to exercise what is learned and discussed.

Limit discussion group size. If your group includes more than five or six members, consider watching the video together, then splitting into smaller groups for the discussion. This will facilitate greater involvement and ideally greater application of what is discussed.

Watch the videos in advance. Each video, though limited in length, is jam-packed with thought-provoking applicable content. If participants view the videos prior to the group meetings, the subsequent group discussion will be more profound and beneficial.

To easily access this series in the CMDA Learning Center, visit www.cmda.org/learning. All episodes are free to CMDA members. The first episode is even available at no charge for nonCMDA members as a special preview. Our hope is that many CMDA members will spread the word, so that study groups will spring up across the nation. In this way, even the potentially devastating effects of disease can serve God’s purposes to grow faith in our patients and colleagues. May our great God receive the glory He alone deserves as we seek to be the hands and feet of Jesus in healthcare.

William T. Griffin, DDS, serves as the director of the Faith Prescriptions project. He has been a member of CMDA since dental school, and he now serves as CMDA’s Vice President of Dental Ministries. He also has served on the CMDA Dental Advisory Council since 2013. He is a 1983 graduate of Virginia Commonwealth University School of Dentistry, and he has been practicing in Newport News, Virginia for 35 years. Dr. Griffin formerly served as Board Chairman and Dental Director at the Lackey Clinic, a Christian medical-dental clinic in Yorktown, Virginia. He averages four international dental mission trips each year, and he is passionate about opportunities to communicate the love of Christ to others, both domestically and internationally. He and his wife Linda have been married since 1983, and they have been blessed with two married children and two grandchildren.

www.cmda.org | 19

Then…

If I Had Known Patti Giebink, MD

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W

hen I started medical school nearly 40 years ago, Roe v. Wade was only a decade old. At that time, there was little if any talk of abortion, but prevailing medical thought accepted legal abortion as a procedure that saved women’s lives.

Then came the years of the Clinton Administration, when the mantra was “safe, legal and rare.” Did we ever imagine that abortion would grow into the industry it has become, in which abortion on demand would eliminate generation after generation—perhaps 50 million lives lost and counting? How do we reconcile that?

Is it tragedy, genocide, holocaust, “a woman’s right to choose” or simply reproductive freedom?

I was once asked why I did abortions. My answer: “If I had known then what I know now, I never would have done them.” Even after studying embryology and stages of development in medical school, I

In childhood and well into adulthood, I didn’t know the Lord.

I was the fourth child of seven (the invisible middle) and routinely the peacemaker attempting to balance the scales of fairness within turbulent sibling rivalry. And though I attended Sunday school and was baptized at age 12, I had no relationship with Jesus. My family leaned toward the liberal side of social issues, and we often discussed politics. I think it paved the way for my freethinking tolerance and broadmindedness.

My dad served as a combat surgeon in World War II. After his tour, he returned to Minneapolis, Minnesota and dedicated his skills to orthopedic surgery. His stories of internship at Hennepin County Hospital made a lasting impression. Interns rode in the ambulance to retrieve and treat women in septic shock due to illegal abortions, and of the countless horrible things he saw in his career, these experiences were the most memorable.

Initially, I thought I would follow in his footsteps and go into ortho/sports medicine. Instead, I became interested in women’s healthcare. At the time, OB/Gyn was dominated by men, but more and more women were entering the field, and it seemed to fit my growing independent streak.

was told, “It’s just tissue,” making it easier to settle my conscience. Initially, when early ultrasound pictures were more like a snowstorm than the detailed images we see today, fetuses seemed less human. But it’s still no excuse. I pray that my story of reconciliation and transformation, chronicled in Unexpected Choice: An Abortion Doctor’s Journey to Pro-life, might help anyone who is struggling with the pain of abortion, contemplating abortion or curious to know how the other side thinks.

Throughout my OB/Gyn residency at Indiana University Medical Center, I never thought I would be doing abortions as a career, let alone eventually become the sole abortion provider at Planned Parenthood in Sioux Falls, the only abortion clinic in the state of South Dakota. At first, they had another fulltime abortion doctor, and I only worked one day a week while mostly focusing on my busy private OB/Gyn practice in Sioux Falls. At the time, the dichotomy never hit me: working hard one day to save the lives of my patients, both mothers and babies; then going to Planned Parenthood the next day to termi-

Kudos to the American Association of Pro-life Obstetricians and Gynecologists (AAPLOG)1 for recognizing and rejecting the pro-choice/proabortion stance of the venerable American College of Obstetricians and Gynecologists (ACOG).

Around 1972, just prior to Roe v. Wade ( January 22, 1973), a fledgling group of pro-life doctors formed their own organization. AAPLOG has since become an established source of evidence-based information countering the biased professional resources produced by ACOG. www.cmda.org | 21

▼ Dr. Patti Giebink (second from left) prays with team members before seeing patients during a Global Health Outreach mission trip to the Middle East.

ery. Serendipitously, a friend invited me to a small church where—after a long, painful and reluctant process—God captivated my heart and transformed my life. And eventually He led me to speak out about this topic that is so fraught and contentious.

My years working in the abortion industry taught me that most women don’t choose abortion because they are bad mothers. They are desperate and feel they are unable to be good mothers given their circumstances.

nate pregnancies. Perhaps my medical education blinded me to the obvious. Or was I refusing to allow myself to see the truth?

After nearly two years of working part-time, Planned Parenthood offered me a full-time position. Their abortion doctor wanted to fully retire after decades of being the primary abortion provider in the state. Hiring me was his exit strategy.

Sometimes in life, we arrive at a junction where we could go one of two ways, and years later we might even wish we had a do-over. This was one of those times.

A turbulent year of working full-time at Planned Parenthood ended suddenly. My growing dissatisfaction with the conveyor belt mentality had drawn attention, prompting the regional manager to travel from Minneapolis to ask—in person—for my resignation, though I was the only abortion doctor in the state.

When I stood up to him and said I had done nothing wrong, he handed me my termination letter. I immediately felt a sense of relief. How could I regret it when my conscience compelled me to consider the many ways I could help my patients? Women need choices!

Looking back, I can see the hand of God even then, protecting me, leading me on a path to Him. But it would take more than a loss of a stable job before my stubborn human will would bend and eventually submit.

God’s plan soon had me filling in for physicians in the scenic little town of Chamberlain in central South Dakota on the Missouri River, serving a rural community and two Indian reservations. For me, it’s been a place of peace and spiritual discov22 | CMDA TODAY | FALL 2021

Too often it is not even a voluntary choice. Young women are coerced into this decision more often than we recognize or want to admit. The teenager whose parents insist she either get an abortion or find a new place to live. The husband who puts a gun to his wife’s head and says, “Choose: your life or the abortion.” The boyfriend who pays for the abortion, threatening to leave if she doesn’t follow through…and then leaves anyway.

God commands us to care for widows and orphans. I like to think these women fit His definition. Have we as churches shirked that responsibility? How can we make our churches and our neighborhoods safe places for everyone no matter what they’ve done? A place where we can share burdens and spread kindness?

Words can hurt or heal, curse or bless, show kindness or cruelty. To judge is not a Christian’s responsibility, but that of God who knows all, sees all, hears all. As believers in Christ—the one who sacrificed His life for everyone, when we were but sinners—it is our job to love, period!

Imagine a woman who has been hurt by abortion sitting in your local congregation. (Believe me, it’s more than likely you’ve encountered one or more people suffering in silence.)

When the topic of abortion comes up at your church, what is the tone? Are the words that ring out compassionate and forgiving? Do they invite a loving response? Or are they loud vitriol, adding to that woman’s anxiety and humiliation?

Before my previous life was revealed as an abortion doctor, I sat silently in church, cringing every time the topic of abortion came up. I felt firsthand the guilt, shame and regret of my actions, as well as the fear of being discovered. But God helped me overcome those feelings by healing me of my past. I was an

unbeliever in the throes of a battle, and only by His grace did I find the light.

That same grace is extended daily in pregnancy help centers throughout the world. These centers provide emotional support and encouragement, as well as parenting classes, mentoring programs, baby clothes and necessities.

They need our help—not only our finances, but also our time and talent. Volunteering offers several opportunities in all kinds of activities: gardening, painting, decorating, doing mailings for newsletters, etc. Many of these centers need medical directors.

Find out what’s in your community and see how you can serve.

My concern for the underserved was honed working with Indian Health Service on the two nearest Indian reservations, Crow Creek and Lower Brule, both Lakota. Eventually I became interested in missions and have worked with several Christian organizations, taking me to Asia and the Arabian Peninsula. The first time I gave my testimony to a CMDA Global Health Outreach (GHO) team was in the guesthouse in the Middle East. I was “outed” by a team member who heard an interview I had done with Janet Parshall on Moody Radio the month before the trip. Fast and enduring friendships form on these intense GHO travels.

In our highly polarized society, it is difficult to communicate with those who do not share our beliefs, but it is more critical than ever that we make the effort. Moshe Dayan, a famous Israeli freedom fighter and minister of defense, said, “If you want to make peace, you don’t talk to your friends. You talk to your

enemies.” We cannot guarantee how our listeners may respond, but we can always communicate with patience and gentle instruction.

How can we become sensitive about what we say and how we say it? The answer comes from my own life experiences, detailed in Unexpected Choice. I have walked out on pro-life meetings because they were too brutal, hurtful, inflammatory. Ironically, they were filled with well-meaning people, many who were and are my friends. But as a dear friend once told me, “Patti, not everyone has been to the foot of the cross.” She was wise enough to see that the lack of compassion usually comes from the lack of common life experience.

That’s what I tell myself when I hear people with their own stories of abortion—whether unapologetic or repentant. In both cases, I extend grace and then more grace while remembering that “Mercy triumphs over judgement” ( James 2:13). After all, I was complicit too, and God’s grace saved me.

In order for us to preserve the sanctity of life, we must safeguard our capacity to feel. John Newton said it best: “The awareness of our own depravity is the root of perpetual tenderness.”

To change minds, we must first change hearts. That is the message God shared with us 2,000 years ago. Jesus appealed to our need for love, not our ability to understand. Our desire for Him to care for us. To bear our faults, endure our mistakes and reveal to us the way we’re to go.

Endnotes 1 APPLOG’s website at www.aaplog.org is a wealth of user-friendly and reliable information.

Patti Giebink, MD, is an OB/Gyn physician who has more than 30 years of experience delivering babies in the U.S. and in hospitals overseas. While working in her private practice in Sioux Falls, South Dakota, she began working part-time performing abortions at Planned Parenthood, the only abortion clinic in South Dakota. Eventually she closed her practice to work full-time at Planned Parenthood but left one year later in September 1997. She has not performed any abortions since. Her book, Unexpected Choice, chronicles her career, her journey and her transformation and gives readers insight into both sides of this divisive issue. Dr. Patti now spends her time helping people find compassion and sensitivity to those affected by abortion. Dr. Patti lives in South Dakota along the Missouri River with her cat. Her hobbies include bicycling, reading and prairie gardening. Unexpected Choice is her first book.

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CMDA Ethics Statement EARN CONTINUING EDUCATION CREDITS! (See page 26)

ABORTION The active termination of pregnancy has existed since 1550 BCE, with the first documented abortion occurring in Egypt.1 The School of Hippocrates included the following prohibition against abortion in the oath named for him in approximately 400 BCE: “I will not give to a woman a pessary to cause abortion.”2 The attitude toward abortion throughout its 3500-year history has varied from general acceptance to criminalization of the act, including the death penalty in certain circumstances.3 That range of perspective, except for the death penalty, remains today with the overall trend worldwide toward increasing cultural acceptance of abortion.

The Christian Church from its earliest recorded Patristic writings outside of the New Testament condemned abortion as murder.3,4 CMDA affirms the historical prohibition against abortion, as supported by the following:

A. BIBLICAL

1. After God released the ancient Israelites from slavery in Egypt, one of the rules He instituted acknowledged the ability to cause harm to an unborn child. Harm to an unborn child resulted in a significant additional penalty above the harm to the mother (Exodus 21:22-25).

2. God knew each of us as persons before conception ( Jeremiah 1:5, Ephesians 1:4).

3. G od begins formation of us in utero (Isaiah 44:2, 24).

4. King David’s record of his in utero development recognizes that God “wonderfully” created him (Psalm 139:13-16).

5. The Lord’s calling and naming of Isaiah began in utero (Isaiah 49:1, 5).

6. God acknowledged and set apart the prophet Jeremiah while he was still in utero, treating him as a person ( Jerimiah 1:5).

7. John the Baptist in utero leapt for joy when he heard Mary’s greeting, revealing his ability to perceive and respond (Luke 1:41-45).

8. S cripture prohibits murder (Genesis 9:6, Exodus 20:13).

B. BIOLOGICAL

1. W hen a sperm fertilizes an ovum, two haploid sets of chromosomes are combined, resulting in a unique compilation of chromosomes.

2. Except in the phenomenon of identical twinning, no other individual will possess this unique collection of chromosomes.

3. The genetic encoding contained within these chromosomes determines and regulates the ongoing development of the embryo.

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4.

After fertilization, this ongoing development and growth consist solely of cell division and specialization. Normally, no further alteration of the chromosomal composition occurs.

5. Therefore, at fertilization there is the creation of a unique collection of chromosomes capable of directing growth and development represents the event in which the life of a new individual begins.

6. Science defines the creation at fertilization of a new human being. 5,6,7 7. The concept of a pre-embryo (fertilization to the formation of primitive streak about day 14) is an illegitimate attempt to lessen the moral status of the earliest forms of a human being.8 8. Any effort to stop the normal growth and development of this unique individual after fertilization is equivalent to taking the life of this human being.

9. The active effort to end a pregnancy is known as “elective abortion” to differentiate it from spontaneous abortion or miscarriage. Throughout the remainder of this document, the word abortion will refer to elective termination of a pregnancy.

C. SOCIAL

1. Statistics a. In the US alone, an estimated 63 million abortions9 have been performed since the nationwide legalization of abortion in 1973 following the Supreme Court’s Roe v. Wade ruling. The total estimates of elective abortions worldwide is over 1.5 billion since 1980.10

b.

In the US, abortion advocates emphasize that the number of reported abortions per 1,000 women 15 to 44 years old has declined in recent years. However, states are not required to report abortion data to the Centers for Disease Control and Prevention (CDC)11 and accurate data are not available.

2. Roe v. Wade a. W hile science makes clear that a developing baby is a human being, the law has not always followed science.

Abortion in the US hinges on the flawed legal rationale developed by the Supreme Court in the 1973 Roe v. Wade and Doe v. Bolton decisions, ruling abortion a Constitutional right, without legitimate Constitutional justification.12 b. The Supreme Court ruling also tore governance and decision-making power away from the citizens and their duly elected representatives in the states, and opened the door to nationwide abortion on demand. c. In analyzing medical ethics, Supreme Court Justice Blackmun acknowledged the later confluence of the Hippocratic oath with Christian biblical principles.

Yet, he chose to cast his lot with non-Hippocratic ancient Greeks who rationalized killing.

3. Abortion as a business a. To abortion providers such as Planned Parenthood, terminating the lives of developing babies is not only an ideology; it is also a lucrative business. As a “nonprofit” enterprise, Planned Parenthood in one year made well over a billion dollars with a profit approaching onequarter of a billion dollars. Taxpayer money provided a third of funding to Planned Parenthood for many years.13 Planned Parenthood performs roughly a million abortions every three years.14 4. Abortion clinic conditions and regulations a. Since Roe v. Wade, the regulation of abortion clinics has repeatedly been removed by the court system, such that now abortion clinics are not required to meet routine standards required of heath care facilities. Without regulation and standards, there is no ability to audit or prevent the “back-alley” abortion. b. Without proper oversight, the risk of harm to women increases dramatically (e.g. Gosnell)15 5. Pro-abortion advocacy a. The American College of Obstetricians and Gynecologists (ACOG) aggressively promotes abortions and access to abortions.16 Other leading medical specialty organizations cannot be relied upon to provide objective scientific evidence supporting a pro-life position. b. A prominent pro-abortion argument is that abortion allows a woman to control the most intimate aspect of her life.17 This argument ignores that the majority of unwanted pregnancies occurs as a result of poor sexual choices by both men and women. Women and their unborn children bear the disproportionate consequences of those choices.

6. Pro-life advocacy provides alternatives to the perceived need for abortion a. Thanks to the compassionate work of thousands of pregnancy centers around the country, women who

face financial and personal challenges during pregnancy and after giving birth are receiving financial, medical, and practical help plus emotional and spiritual support. Young fathers are learning, through pregnancy centers’ education, counseling, and mentoring, to share in the responsibility and fulfillment of bringing a new life into the world. b. Multiple national organizations help shepherd thousands of community-based pregnancy centers offering counseling, testing, education, and provisions to pregnant women. c. Pro-life clinics often provide services such as childbirth classes, parenting classes, ongoing pregnancy support, as well as maternity and baby clothing at no cost to the client. d. Many organizations continue supportive services after the birth of the child. There are organizations that will help with adoptions, if needed. For the protection of the child, baby safe haven laws exist in all states.

D. MEDICAL (see Appendix)

1. Abortion can be induced through medications or performed through surgical methods.

2. The option of FDA-approved medication abortion began in 2000 using mifepristone with the prostaglandin misoprostol for termination of a pregnancy less than 49 days duration.18 These chemical agents are hazardous and have resulted in significant morbidity and the loss of many lives.19 3. If after taking mifepristone (progesterone blocker), the woman changes her mind, then reversal of the effects of mifepristone with progesterone has been evaluated with small anecdotal reports and one large case series.

Successful reversal rates between 64 and 68% have been achieved.20 4. Short-term complications of surgical abortion include infection, perforation, hemorrhage, incomplete abortion, anesthesia-related complications, and death of the mother.21,22 5. Long-term complications may surface several years after the abortion and include pre-term birth, infertility, breast cancer, and increased long term mortality.23,24 6. Mental health complications are not being systematically reported, and we recognize that there are many anecdotal reports of mental health harm, but overall these harms are difficult to assess.23 Documentaries such as Silent No More have recorded the personal testimonies of women who were traumatized by having an abortion.25

E. ETHICAL

1. Two ethical questions usually form the basis for the arguments for or against abortion:17 a. The moral status of the embryo/fetus. b. The woman’s right to control her body to the exclusion of any interests from the embryonic/fetal human being, her child.

2. The status of the embryo/fetus a. Some pro-abortion advocates argue that the embryo/

www.cmda.org | 25

EARN CONTINUING EDUCATION 1.0 HOUR NOW AVAILABLE

e are now offering continuing education W credits through CMDA Today. 1.0 hour of selfinstruction is available.

To obtain continuing education credit, you must complete the online test at https://www.pathlms.com/cmda/courses/33730. Continuing education for this article is FREE to CMDA members and $60 for non-members.

If you have any questions, please contact CMDA’s Department of Continuing Education Office at ce@cmda.org.

Review Date: June 24, 2021 Original Release Date: September 1, 2021 Termination Date: September 1, 2024

EDUCATIONAL OBJECTIVES

• Discuss the biological evidence of when life begins.

• Cite the ethical reasons for opposition to abortion.

• List recommendations regarding care of women with unwanted pregnancy.

ACCREDITATION

The Christian Medical & Dental Associations is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

PHYSICIAN CREDIT

The Christian Medical & Dental Associations designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

NURSE PRACTITIONER

The American Academy of Nurse Practitioners Certification Program (AANPCP) accepts AMA PRA Category 1 Credit™ from organizations accredited by the ACCME. Individuals are responsible for checking with the AANPCP for further guidelines. Nurse practitioners may receive up to 1.0 credits for completing this activity.

PHYSICIAN ASSISTANT

AAPA accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit(s)™ by an organization accredited by the ACCME or a recognized state medical society. Physician assistants may receive up to 1.0 credits for completing this activity.

DENTAL CREDIT

CMDA is an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing education programs of this program provider are accepted by AGD for Fellowship, Mastership and membership maintenance credit.

Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. The current term of approval extends from 1/1/2018 to 12/31/2022. Provider ID#218742. 1.0 Hours Self Instruction Available. No prior level of skill, knowledge, or experience is required (or suggested).

DISCLOSURE

None of these authors, planners or faculty have relevant financial relationships.

Jeffrey J. Barrows, DO, MA (Ethics); Barbara Snapp, CE Administrator; Sharon Whitmer, EdD, MFT; CE Committee Members; and CE Committee Dental Members.

CMDA CE Review Committee John Pierce, MD, Chair; Jeff Amstutz, DDS; Trish Burgess, MD; Stan Cobb, DDS; Jon R. Ewig, DDS; Gary Goforth, MD; Elizabeth Heredia, MD; Curtis High, DDS; Bruce MacFadyen, MD; Dale Michels, MD; Shawn Morehead, MD; Michael O’Callaghan, DDS; and Richard Voet, MD THERE IS NO IN-KIND OR COMMERCIAL SUPPORT FOR THIS ACTIVITY.

26 | CMDA TODAY | FALL 2021

fetus, because of their absolute dependence upon the mother for survival, does not constitute a separate being worthy of the status of personhood. i. Some who hold this view will argue that the fetus does not become a separate being of worth until birth. ii. Others will go further to include the requirement that the baby must be wanted and valued even after birth. This view justifies infanticide for babies born alive during an abortion. iii. Some will argue that the fetus becomes a person with dignity only when the threshold for viability outside the uterus is achieved. The proponents of this view will support early abortion but will oppose late-term abortion. b. CMDA holds that fertilization creates at least one new individual with inherent dignity worthy of all the protections, rights, and respect granted to any human being. Therefore, the embryo/fetus has the moral status of a human being from the time of conception.

3. The right of the woman to control her body a. Some pro-abortion advocates emphasize the autonomy of the woman over her pregnancy, and may characterize the pregnancy as an invasion of her body. i. This position invalidates the independent moral status of the embryo/fetus and relegates it to the will of the woman. ii. In this view, if the woman decides to terminate her pregnancy, she is within her rights, independent of the status of the embryo/fetus. b. CMDA respects, honors, and cherishes the unique abilities of a woman to bear children. CMDA respects the autonomy of women. CMDA holds that the embryo/fetus has inherent value as a unique human being. The mother has responsibility for her child that is not lessened by her autonomy. She should not end the life of her unborn child, regardless of her non-life threatening medical circumstances. c. In the rare instance that the continuation of a pregnancy threatens a woman’s life, decision-making should proceed on the basis that two lives are at stake, that of the mother and the baby. CMDA recognizes these situations are rare, complex, and difficult. In extremely rare circumstances with a medical condition that will result in the death of both the mother and the fetus, therapeutic abortion may be indicated. (See CMDA Statement on Double Effect)

CMDA Recommendations for the Christian Community

1. CMDA recommends that Christian communities develop and support local organizations providing loving care and resources in the name of Christ to assist women with unwanted pregnancies.

2. CMDA recommends the Christian community minister to the couple’s physical, spiritual, emotional, and psychological needs.

3. CMDA recommends the local Christian community give those struggling with an unwanted pregnancy love, understanding, and compassion. In providing support to these persons, we must be careful not to be self-righteous, but to act with humil-

ity. We are all capable of sin and all are dependent on the mercy of God (Rom 3:23).

4. CMDA holds that the Christian community should advocate against laws and regulations promoting abortion at the local, state, and federal levels.

5. CMDA condemns any violence perpetrated against abortion centers and abortionists. Prayer vigils and demonstrations at abortion centers need to follow local regulations.

6. CMDA recognizes the struggle over abortion is an issue of spiritual warfare. Prayer is the primary weapon against the spiritual evil of culture of death and the lie that unborn lives don’t matter.

Psalm 139:13-16 For you formed my inward parts; you knitted me together in my mother’s womb. 14 I praise you, for I am fearfully and wonderfully made. Wonderful are your works; my soul knows it very well. 15 My frame was not hidden from you, when I was being made in secret, intricately woven in the depths of the earth. 16 Your eyes saw my unformed substance; in your book were written, every one of them, the days that were formed for me, when as yet there was none of them.

CMDA Recommendations for Christian Health Care Professionals

Isaiah 44:24 Thus says the LORD, your Redeemer, who formed you from the womb: “I am the LORD, who made all things, who alone stretched out the heavens, who spread out the earth by myself.

1. CMDA recommends that HCPs counsel patients with unwanted pregnancy against abortion, while helping them access resources that are available. HCPs should be a voice of healing without condemning, shaming, or being judgmental.

2. CMDA believes that HCPs caring for women with a history of abortion should maintain a loving and compassionate attitude, especially if she is suffering from a complication.

3. CMDA believes that if the HCP refers for a medication or surgical abortion, the HCP is complicit in the act of abortion.

(See CMDA Statement on Moral Complicity with Evil) 4. CMDA recommends that Christian HCP’s consider offering their expertise and support to local crisis pregnancy centers on a complimentary basis.

Bible Verses (ESV)

Genesis 9:6 Whoever sheds the blood of man, by man shall his blood be shed, for God made man in his own image.

Exodus 20:13 You shall not murder.

Exodus 21:22-25 When men strive together and hit a pregnant woman, so that her children come out, but there is no harm, the one who hit her shall surely be fined, as the woman’s husband shall impose on him, and he shall pay as the judges determine. 23 But if there is harm, then you shall pay life for life, 24 eye for eye, tooth for tooth, hand for hand, foot for foot, 25 burn for burn, wound for wound, stripe for stripe.

APPENDIX TO CMDA STATEMENT ON ABORTION MEDICATION ABORTION:

1. Due to reports of severe bacterial infection, excessive bleeding, ruptured ectopic pregnancies, and death, the FDA revised the black box labeling for Mifepristone on November 15, 2004, to include those complications.26 2. After multiple reports of additional significant adverse effects associated with mifepristone use, the FDA issued a public health advisory in 2005 highlighting the risk of sepsis with Mifepristone and Misoprostol when used in a manner not consistent with approved labeling.27 3. In 2006 an additional public health advisory was issued by the FDA following reports of multiple deaths associated with the use of Mifepristone and Misoprostol.28 4.

A report summarizing adverse events from Mifepristone and misoprostol use by approximately 1.52 million women up through 4/30/2011 found the following:29 a. 2207 cases with adverse events b. 14 deaths c. 612 hospitalizations

Isaiah 44:2 Thus says the LORD who made you, who formed you from the womb and will help you: Fear not, O Jacob my servant, Jeshurun whom I have chosen.

Isaiah 49:1 Listen to me, O coastlands, and give attention, you peoples from afar. The LORD called me from the womb, from the body of my mother he named my name Isaiah 49:5 And now the LORD says, he who formed me from the womb to be his servant, to bring Jacob back to him; and that Israel might be gathered to him— for I am honored in the eyes of the LORD, and my God has become my strength— Jeremiah 1:5 “Before I formed you in the womb I knew you, and before you were born I consecrated you; I appointed you a prophet to the nations.”

Luke 1:41-45 And when Elizabeth heard the greeting of Mary, the baby leaped in her womb. And Elizabeth was filled with the Holy Spirit, 42 and she exclaimed with a loud cry, “Blessed are you among women, and blessed is the fruit of your womb! 43 And why is this granted to me that the mother of my Lord should come to me? 44 For behold, when the sound of your greeting came to my ears, the baby in my womb leaped for joy. 45 And blessed is she who believed that there would be[g] a fulfillment of what was spoken to her from the Lord.”

Ephesians 1:4 Even as he chose us in him before the foundation of the world, that we should be holy and blameless before him. In love

d. 58 ectopic pregnancies e. 339 patients requiring blood transfusion f. 256 infections with 48 classified as severe 5. Because of the accumulating evidence of serious adverse effects of Mifepristone and Misoprostol, including death, the FDA determined that a REMS (Risk Evaluation and Mitigation Strategy) was necessary for Mifepristone.30 6. As part of this REMS, physicians who prescribed Mifepristone had to meet the following qualifications:31 a. Ability to assess the duration of pregnancy accurately b. Ability to diagnose ectopic pregnancies c. Ability to provide surgical intervention in cases of incomplete abortion or severe bleeding or to have made plans to provide such care through others d. Can assure patient access to medical facilities equipped to provide blood transfusions and resuscitation, if necessary. e.

Have read and understood the prescribing information of Mifeprex (Mifepristone).

7. In 2016, the FDA extended the gestational age during which

Mifepristone and Misoprostol could be used to up to ten weeks gestation.32 8. This extension included the continued use of the previous REMS. The REMS was updated to include the following: a. Mifepristone must be ordered, prescribed and dispensed by or under the supervision of a healthcare provider who prescribes and who meets specific qualifications b. Healthcare providers who wish to prescribe Mifepristone must complete a Prescriber Agreement Form prior to ordering and dispensing Mifepristone c. Mifepristone may only be dispensed in clinics, medical offices, and hospitals by or under the supervision of a certified healthcare provider d. The healthcare provider must obtain a signed Patient Agreement Form before dispensing Mifepristone 9. In April of 2019, the FDA modified the REMS for Mifepristone to a single, shared system (SSS) REMS. This update included an assessment plan that detailed various metrics to be collected from 4/11/2019 over the next year and every three years after that.

www.cmda.org | 27

These metrics included the number of prescribers, the number of women exposed to Mifepristone, any program deviations, and an analysis of whether the REMS was meeting its goals.33 10.

The COVID-19 pandemic of 2020 prevented the FDA from reviewing the REMS data from the manufacturer of Mifepristone in April of 2020.

11. On July 13, 2020, the United States District Court of the District of Maryland ruled that the FDA REMS “ In-Person Requirements impose a substantial obstacle to abortion patients seeking medication abortion care.”34 The Court then imposed a nationwide injunction on the FDA REMS requirements until 30 days after the Department of Health and Human Services declares that the COVID-19 pandemic has passed.

12.

According to the Guttmacher Institute, by 2017, chemical abortions made up 39% of all abortions within the United States.35

REVERSAL OF MEDICATION ABORTION:

1. Small case series using high dose progesterone before ingestion of Misoprostol have resulted in healthy live births in 4 of 6 women36 and 2 out of 3 women37 2. A significant case series of 754 patients using progesterone to reverse the effects of Mifepristone found 20 successful reversal rates between 64-68% depending on the route of administration without an increase in congenital anomalies.

3. A randomized prospective study comparing observation alone with progesterone supplementation in women who took a single dose of Mifepristone was stopped prematurely due to severe bleeding in the group receiving only Mifepristone.38 a. Four of the five women who received progesterone rescue had living fetuses at the 2-week follow-up. b. 40% of the women in the Mifepristone alone arm had a viable fetus at follow-up.

4. A 2013 study evaluating the risk of congenital malformations in 105 pregnancies exposed to Mifepristone found the overall rate of major malformations at 4.2%, slightly increased over the baseline rate.39

COMPLICATIONS OF ABORTION:

1. Short-term complications of surgical abortion a. Inherent bias within the medical literature compromises the

REFERENCES

1. Drife JO. Historical perspective on induced abortion through the ages and its links with maternal mortality. Best Pract Res Clin Obstet Gynaecol. 2010;24(4):431-441. doi:10.1016/j.bpobgyn.2010.02.012 2. Markel H. “I swear by Apollo”--on taking the Hippocratic oath. N Engl J Med. 2004;350(20):2026-2029. doi:10.1056/NEJMp048092 3. Didache, The Teaching of the Twelve Apostles (120 CE), The Epistle of Barnabas (125 CE), St Athenagoras’ Legatio (177 CE), Tertullian’s Apology (197 CE), Clement of Alexandria (150-215 CE) Paedagogas, St. John Chrysostom (347-407 CE), Homily 24 on Romans, St. Augustine (354-430 CE), Sermon 126, and Basil the Great, Letter (374 CE).

4.

Noonan Jt J. Abortion and the Catholic church: a summary history. Nat Law Forum. 1967;12:85-131. doi:10.1093/ajj/12.1.85 5. Keith L. Moore & T.V.N. Persaud. The Developing Human: Clinically Oriented Embryology. 6th Edition, 1998 6. Condic ML. Life: defining the beginning by the end. First Things.

2003;(133):50-54.

7. Ventura-Juncá P, Santos MJ. The beginning of life of a new human being from the scientific biological perspective and its bioethical implications. Biol Res. 2011;44(2):201-207.

8. Flamigni C. The embryo question. Ann N Y Acad Sci. 2001;943:352359. doi:10.1111/j.1749-6632.2001.tb03815.x 9. NRL News Today. 2020. Abortion Statistics: United States Data And Trends - NRL News Today. [online] Available at: <https://www. nationalrighttolifenews.org/2020/08/abortion-statistics-unitedstates-data-and-trends-4/> [Accessed 23 August 2020].

10. Numberofabortions.com. 2020. Number Of Abortions In US & Worldwide - Number Of Abortions Since 1973. [online] Available at: <http://www.numberofabortions.com/> [Accessed 23 August 2020].

28 | CMDA TODAY | FALL 2021

data regarding complications of both medical and surgical abortion. b. The risk of surgical complications from abortion escalates as the pregnancy progresses. c. A recent study of complications following surgical abortion found:40 i. A total complication rate of 1.3% for first-trimester abortion. ii. A total complication rate of 1.5% for second-trimester abortion. iii. Complications included: 1. Incomplete abortion 2. Uterine perforation 3. Anesthesia-related complications iv. However, 57% of the complications were classified as “other or undetermined,” undermining the study. d. A Swedish study observed an overall surgical complication rate of 5.2%.41 e. While some favorably compare the mortality from abortion as less than that following childbirth,42 the veracity of this conclusion has been challenged because of the following methodological problems:43 i. Incomplete reporting ii. Definitional incompatibilities iii. Voluntary data collection iv. Research bias v. Reliance upon estimations vi. Inaccurate and incomplete death certificate completion vii. Failure to include indirect causes of death such as suicide 2. Long-term complications a. Increased long-term mortality i. A study using Danish population-based records revealed44 long-term mortality rates were increased by 45%, 114%, and 191% for 1, 2, and 3 abortions, respectively, compared to women with no abortions. ii. A review of abortion mortality in Denmark found45 women whose first pregnancy ended with either a first or secondtrimester abortion had significantly higher mortality 1-10 years later compared to women whose first pregnancy ended in the birth of a child. b. Preterm birth i. A Practice Bulletin of the American Association of Prolife Obstetricians and Gynecologists (AAPLOG) concluded the

11. Cdc.gov. 2020. CDCs Abortion Surveillance System Faqs | CDC. [online] Available at: <https://www.cdc.gov/reproductivehealth/ data_stats/abortion.htm> [Accessed 23 August 2020].

12. Krason, Stephen M. (1984). _Abortion: Politics, Morality, and the Constitution: A Critical Study of Roe V. Wade and Doe V. Bolton and a Basis for Choice. Upa. 13. Nytimes.com. 2020. Planned Parenthood Refuses Federal Funds Over Abortion Restrictions. [online] Available at: <https://www. nytimes.com/2019/08/19/health/planned-parenthood-title-x. html> [Accessed 23 August 2020].

14. Plannedparenthood.org. 2020. [online] Available at: <https://www. plannedparenthood.org/uploads/filer_public/2e/da/2eda3f5082aa-4ddb-acce-c2854c4ea80b/2018-2019_annual_report.pdf> [Accessed 23 August 2020].

15. Friedersdorf, C., 2020. Why Dr. Kermit Gosnell’s Trial Should Be A Front-Page Story. [online] The Atlantic. Available at: <https:// www.theatlantic.com/national/archive/2013/04/why-dr-kermitgosnells-trial-should-be-a-front-page-story/274944/> [Accessed 23 August 2020].

16. Acog.org. 2020. Abortion Policy. [online] Available at: <https:// www.acog.org/clinical-information/policy-and-positionstatements/statements-of-policy/2017/abor tion-policy> [Accessed 23 August 2020].

17.

Mathison E, Davis J. Is There a Right to the Death of the Foetus?. Bioethics. 2017;31(4):313-320. doi:10.1111/bioe.12331 18.

U.S. Food and Drug Administration. 2020. Approval Letter MIFEPREX™ (Mifepristone) Tablets. [online] Available at: <https://www.accessdata.fda.gov/drugsatfda_docs/ appletter/2000/20687appltr.htm> [Accessed 23 August 2020].

19. Soon JA, Costescu D, Guilbert E. Medications Used in Evidence-

following regarding abortion and preterm birth:46 1. Women with a history of a single abortion are at 30% increased risk over baseline of preterm birth 2. Women with a history of two or more abortions have a 200% increased risk of preterm birth c. Breast Cancer i. A meta-analysis of published reports on abortion and breast cancer found47 patients with any history of elective abortion had an odds ratio of 1.3 for developing breast cancer. ii. A follow-up meta-analysis and systematic review of studies on the association between abortion and breast cancer documented:48 1. The odds ratio of developing breast cancer in women with a history of abortion was 2.51.

2. Five studies demonstrated increasing odds as the number of abortions increased. d. Infertility I. A recent review of the data concluded:49 1. There is sufficient evidence to suggest a link between abortion and infertility that warrants investigation.

2. Infertility from abortion may not be a rare phenomenon.

3. Possible mediating factors include but are not limited to: 1) Cervical or endometrial damage 2) PID 3) Intrauterine adhesions e. Mental Health Complications I. AAPLOG has issued a Practice Bulletin detailing the controversial history of efforts to scientifically evaluate the association between abortion and subsequent mental health problems.50 They make the following conclusions: 1. Women who have an abortion after the first trimester may be at higher risk of experiencing trauma symptoms than women who have an abortion during the first trimester.

2. All women who present for elective abortion should be screened for risk factors for adverse mental health outcomes.

3. Women experiencing adverse mental health outcomes may benefit from mental health interventions.

4. More research on the association between abortion and mental health complications is needed.

Based Regimens for Medical Abortion: An Overview. J Obstet Gynaecol Can. 2016;38(7):636-645. doi:10.1016/j.jogc.2016.04.005 20. Delgado G, Condly SJ, Davenport M, et al. A case series detailing the successful reversal of the effects of mifepristone using progesterone. Issues Law Med. 2018;33(1):21-31.

21. Harris LH, Grossman D. Complications of Unsafe and Self-Managed Abortion. N Engl J Med. 2020;382(11):1029-1040. doi:10.1056/ NEJMra1908412 22. Zane S, Creanga AA, Berg CJ, et al. Abortion-Related Mortality in the United States: 1998-2010. Obstet Gynecol. 2015;126(2):258-265. doi:10.1097/AOG.0000000000000945 23. Thorp JM, Hartmann KE, Shadigan E. Long-term physical and psychological health consequences of induced abortion: a review of the evidence. Linacre Q. 2005;72(1):44-69. doi:10.1080/2050854 9.2005.11877742 24. Studnicki, J. et al. (2020) ‘Pregnancy Outcome Patterns of MedicaidEligible Women, 1999-2014: A National Prospective Longitudinal Study’, Health Services Research and Managerial Epidemiology. doi: 10.1177/2333392820941348.

25. Silentnomoreawareness.org. 2020. Silent No More Awareness Campaign. [online] Available at: <https://www. silentnomoreawareness.org/Index.aspx> [Accessed 23 August 2020].

26. U.S. Food and Drug Administration. 2004. FDA To Announce Important Labeling Changes for Mifepristone. [online] Available at: <http://wayback.archive-it.org/7993/20170111185918/ h tt p : / w w w.f da . g o v / N e w sE ve n t s / N e w sro o m / PressAnnouncements/2004/ucm108373.htm> [Accessed 12 March 2021].

27. U.S. Food and Drug Administration. 2005. FDA Issues Public

Health Advisory for Mifepristone. [online] Available at: <http://

wayback.archive-it.org/7993/20170113112728/http:/www.fda.gov/ NewsEvents/Newsroom/PressAnnouncements/2005/ucm108462. htm> [Accessed 12 March 2021].

28.

U.S. Food and Drug Administration. 2006. Public Health

Advisory: Sepsis and medical abortion with mifepristone (Mifeprex). [online] Available at: <http://wayback.archive-it.

org/7993/20170114041910/http:/www.fda.gov/Drugs/DrugSafety/ PostmarketDrugSafetyInformationforPatientsandProviders/ ucm051298.htm> [Accessed 12 March 2021].

29.

U.S. Food and Drug Administration. 2011. Mifepristone

U.S. Postmarketing Adverse Events Summary through 04/30/2011 [online] Available at: <http://wayback.archive-it.

org/7993/20170113112718/http:/www.fda.gov/downloads/Drugs/ DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/UCM263353.pdf> [Accessed 12 March 2021].

30. U.S. Food and Drug Administration. 2011. FDA Letter to Danco Laboratories. [online] Available at: <https://www.accessdata. fda.gov/drugsatfda_docs/appletter/2011/020687s014ltr.pdf> [Accessed 12 March 2021].

31.

U.S. Food and Drug Administration. 2011. Medication Guide Mifeprex Danco Laboratories. [online] Available at: <https://www. accessdata.fda.gov/drugsatfda_docs/label/2011/020687s014lbl. pdf> [Accessed 12 March 2021].

32. U.S. Food and Drug Administration. 2016. Mifeprex (mifepristone) Information. [online] Available at: <https://www.fda.gov/drugs/ postmarket-drug-safety-information-patients-and-providers/ mifeprex-mifepristone-information> [Accessed 12 March 2021].

33. U.S. Food and Drug Administration. 2019. FDA Letter to Danco Laboratories. [online] Available at: <https://www.accessdata. fda.gov/drugsatfda_docs/appletter/2019/020687Orig1s022ltr.pdf> [Accessed 12 March 2021].

34. Courthousenews.com. 2020. American College of Obstetricians and Gynecologists v. United States Food and Drug Administration.

[online] Available at: <https://www.courthousenews.com/wpcontent/uploads/2020/07/093111166803.pdf> [Accessed 12 March 2021].

35.

Guttmacher Institute. 2019. Medication Abortion. [online] Available at: <https://www.guttmacher.org/evidence-you-canuse/medication-abortion> [Accessed 12 March 2021].

36. Delgado, G. and Davenport, M., 2012. Progesterone Use to Reverse the Effects of Mifepristone. Annals of Pharmacotherapy, 46(12), pp.1723-1723.

37.

Garratt, D. and Turner, J., 2017. Progesterone for preventing pregnancy termination after initiation of medical abortion with mifepristone. The European Journal of Contraception & Reproductive Health Care, 22(6), pp.472-475.[published correction appears in Eur J Contracept Reprod Health Care. 2017 Dec;22(6):I. Dosage error in article text].

38. Creinin, M., Hou, M., Dalton, L., Steward, R. and Chen, M., 2019.

Mifepristone Antagonization With Progesterone to Prevent Medical Abortion. Obstetrics & Gynecology, 135(1), pp.158-165.

39. Bernard, N., Elefant, E., Carlier, P., Tebacher, M., Barjhoux, C., BosThompson, M., Amar, E., Descotes, J. and Vial, T., 2013. Continuation of pregnancy after first-trimester exposure to mifepristone: an observational prospective study. BJOG: An International Journal of Obstetrics & Gynaecology, 120(5), pp.568-575.

40. Upadhyay, U., Desai, S., Zlidar, V., Weitz, T., Grossman, D., Anderson, P. and Taylor, D., 2015. Incidence of Emergency Department Visits and Complications After Abortion. Obstetrical & Gynecological Survey, 70(6), pp.384-385.

41. Carlsson, I., Breding, K. and Larsson, P., 2018. Complications related to induced abortion: a combined retrospective and longitudinal follow-up study. BMC Women’s Health, 18(1).

42. Cree, D. and Jelsema, R., 2012. The Comparative Safety of Legal Induced Abortion and Childbirth in the United States. Obstetrics & Gynecology, 119(6), p.1271.

43. Calhoun, B., 2013. The Maternal Mortality Myth in the Context of

Legalized Abortion. The Linacre Quarterly, 80(3), pp.264-276.

44. Coleman, P., Reardon, D. and Calhoun, B., 2012. Reproductive history patterns and long-term mortality rates: a Danish, population-based record linkage study. The European Journal of Public Health, 23(4), pp.569-574.

45. Reardon, D. and Coleman, P., 2012. Short and long term mortality rates associated with first pregnancy outcome: Population register based study for Denmark 1980–2004. Medical Science Monitor, 18(9), pp.PH71-PH76.

46. American Association of Prolife Obstetricians & Gynecologists.

2019. Practice Bulletin: Abortion and risks of preterm birth. [online] Available at: <https://aaplog.org/wp-content/ uploads/2019/12/FINAL-PRACTICE-BULLETIN-5-Abortion-PretermBirth.pdf> [Accessed 12 March 2021].

47. Brind, J., Chinchilli, V., Severs, W. and Summy-Long, J., 1996.

Induced abortion as an independent risk factor for breast cancer: a comprehensive review and meta-analysis. Journal of Epidemiology & Community Health, 50(5), pp.481-496.

48. Brind, J., Condly, S. J., Lanfranchi, A., & Rooney, B. (2018). Induced abortion as an independent risk factor for breast cancer: a systematic review and meta-analysis of studies on south asian women. Issues in Law & Medicine, 33(1), 32–54.

49.

Pike, G.K. (2020). Abortion and Infertility. Issues in Law & Medicine, 35(1&2):173-195.

50. American Association of Prolife Obstetricians & Gynecologists.

2019. Practice Bulletin: Abortion and mental health. [online] Available at: <https://aaplog.org/wp-content/uploads/2019/12/ FINAL-Abortion-Mental-Health-PB7.pdf> [Accessed 12 March 2021].

Approved by the House of Representatives Passed with 41 approvals, 2 opposed, 0 abstention May 2, 2021, virtual

CMDA Ethics Statement

PERSONS WITH ACQUIRED COGNITIVE IMPAIRMENT CMDA affirms the value of all persons with cognitive impairment and recognizes their inherent dignity. Within a Christian worldview, all people have worth and meaning regardless of their cognitive abilities and deserve our utmost respect.

Principles to consider:

EARN CONTINUING EDUCATION CREDITS! (See page 30)

A. BIBLICAL

1. All deterioration, disease, and death are the result of the fall (Gen 3:16-22).

2. God is sovereign over all things including cognitive impairment (Ps 115:3). His ways are perfect and just (Deut 32:4, Job 37:23).

3. His ultimate purpose, in all things, is His own glory (Rom 11:36).

4. Cognitive impairment is not meaningless, as God’s ways are often beyond our comprehension (Rom 11:33, Is 55:8-9, Deut 29:29) yet wonderful ( Job 42:3).

5. He exists in eternity (Ps 90:2) and His purposes may not be understood during our earthly lives (Heb 11:35-40).

www.cmda.org | 29

EARN CONTINUING EDUCATION 1.0 HOUR NOW AVAILABLE

e are now offering continuing education W credits through CMDA Today. 1.0 hour of selfinstruction is available.

To obtain continuing education credit, you must complete the online test at https://www.pathlms.com/cmda/courses/33723. Continuing education for this article is FREE to CMDA members and $60 for non-members.

If you have any questions, please contact CMDA’s Department of Continuing Education Office at ce@cmda.org.

Review Date: June 24, 2021 Original Release Date: September 1, 2021 Termination Date: September 1, 2024

EDUCATIONAL OBJECTIVES

• Cite the biblical evidence supporting the inherent dignity of every person, regardless of their cognitive ability or the presence of cognitive impairment.

• Discuss how to defend the ethical position of inherent value of individuals with cognitive impairment.

• Describe the clinical implications of cognitive impairment as it relates to both caregivers and healthcare professionals.

ACCREDITATION

The Christian Medical & Dental Associations is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

PHYSICIAN CREDIT

The Christian Medical & Dental Associations designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

NURSE PRACTITIONER

The American Academy of Nurse Practitioners Certification Program (AANPCP) accepts AMA PRA Category 1 Credit™ from organizations accredited by the ACCME. Individuals are responsible for checking with the AANPCP for further guidelines. Nurse practitioners may receive up to 1.0 credits for completing this activity.

PHYSICIAN ASSISTANT

AAPA accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit(s)™ by an organization accredited by the ACCME or a recognized state medical society. Physician assistants may receive up to 1.0 credits for completing this activity.

DENTAL CREDIT

CMDA is an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing education programs of this program provider are accepted by AGD for Fellowship, Mastership and membership maintenance credit.

Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. The current term of approval extends from 1/1/2018 to 12/31/2022. Provider ID#218742. 1.0 Hours Self Instruction Available. No prior level of skill, knowledge, or experience is required (or suggested).

DISCLOSURE

None of these authors, planners or faculty have relevant financial relationships.

Jeffrey J. Barrows, DO, MA (Ethics); Barbara Snapp, CE Administrator; Sharon Whitmer, EdD, MFT; CE Committee Members; and CE Committee Dental Members.

CMDA CE Review Committee John Pierce, MD, Chair; Jeff Amstutz, DDS; Trish Burgess, MD; Stan Cobb, DDS; Jon R. Ewig, DDS; Gary Goforth, MD; Elizabeth Heredia, MD; Curtis High, DDS; Bruce MacFadyen, MD; Dale Michels, MD; Shawn Morehead, MD; Michael O’Callaghan, DDS; and Richard Voet, MD THERE IS NO IN-KIND OR COMMERCIAL SUPPORT FOR THIS ACTIVITY.

30 | CMDA TODAY | FALL 2021

6. All humans are made in God’s image (Gen 1:26-27) and receive life from God himself (Gen 2:7), thus imparting inherent dignity to all persons independent of their functional or intellectual capacities. Whereas humans tend to attribute their worth to their capacities, God loves every person, independent of their abilities, because love is his nature (Rom 5:8, 1 John 4:16) (See CMDA Ethics Statement Human Life: Its Moral Worth).

7. Serving the needy and disabled is part of serving Christ (Matt 25:40).

8. Human beings are living mysteries, fearfully and wonderfully made (Ps 139:14), whole persons, and embodied souls; we are not merely minds (Matt 10:28-29). A person’s fundamental identity is grounded in God’s relationship to him or her (Acts 17:28).

9. God is with us, even when our minds are dysfunctional.

We can trust that the Holy Spirit is active on behalf of those who are cognitively impaired (Rom 8:20-27), and we give thanks that no impairment can separate us from the love of Christ (Rom 8:35-39).

10. God may use cognitive impairment to instruct us as to the true foundation of human value ( Jer. 9:23-24).

11. Jesus showed care and compassion to those with cognitive impairment (Luke 4:33-35, 8:27-33, 38-39 and 9:37-43a).

B. MEDICAL

1. Cognitive impairment encompasses a spectrum of clinical conditions ranging from mild memory impairment to dementia; these may occur transiently or permanently, and they may be static or progressive. Its causes include birth anoxia, encephalitis, head trauma, stroke, epilepsy, malnutrition, alcohol and other toxins, prescription drug adverse effects, illicit drug effects, and neurodegenerative disorders such as Alzheimer disease, among others.

2. All potentially correctable causes of cognitive impairment should be diligently sought before the patient is labeled as having an untreatable condition.1 3. W hereas the medical profession currently has no curative means to treat most of the causes of cognitive impairment, we should show respect for the patients’ dignity through loving interactions that engage them to the greatest degree possible.1-6 4. There is currently no cure for degenerative dementias.

There are pharmacologic interventions, such as memantine, that may slow the progression of cognitive deterioration in a subset of patients with dementia.2,4-6 There are also some non-FDA-approved interventions and nutritional supplements that are claimed to improve declining memory, but such claims are not supported by valid scientific evidence.

5. It is imperative for the medical profession to attempt to relieve distress experienced by the cognitively impaired even when they are unable to express them verbally.

CMDA cannot support physician-assisted death as a means to relieve this distress. (see CMDA statements on Physician-Assisted Suicide and Euthanasia).

6.

Life-prolonging interventions may not be indi-

cated in patients with profound dementia and may need to be carefully assessed by a shared decisionmaking model (see CMDA Statement on Artificially Administered Nutrition and Hydration).

respected. Their current ability to make decisions will determine the appropriateness of involving the person in making choices.1,12 3. Patients with cognitive impairment should be encouraged to engage in activities meaningful to them.4-6 4. Patients with cognitive impairment may enjoy being reminded of memories and participating in activities enjoyed in the past.1 5. Persons with cognitive impairment may have delusions.

Depending upon their medical condition or status of their disease, it may or may not be appropriate to address the delusions. At all times, it is important to respect the person and guard their dignity regardless of the delusions.13 6. Correction or criticism can be devastating to the dignity of one with dementia. Redirection or distraction may be more effective in addressing inappropriate behavior.8,9 7. Caregivers and HCPs should avoid referring to the patient in the third person, but rather to engage the patient the conversation as much as possible. Ideally, the person with dementia should be spoken to directly, maintaining eye contact.1,4-6 8. Emotional memories are more resilient than other memories. Persons with impaired cognition may not remember what they did, but may remember how they felt.

9.

HCPs are encouraged to recommend only FDA-approved interventions that may slow the progression of cognitive deterioration.

10. Followers of Jesus should be reminded of the basic tenets and practices of their faith. Engaging patients in familiar activities such as prayers, liturgy, reading of Scripture, hymns, or worship music may encourage them powerfully in the exercise of their faith.14

C. ETHICAL

1. A person’s inherent value is not diminished by physical or mental disability.

2. The person with cognitive impairment who displays inappropriate and/or abusive behavior may or may not be ethically culpable. HCPs should take appropriate precautions and protections in cases of violent or aggressive patients.

3. Despite the stress of caring for a person with cognitive impairment, it is always wrong to respond with any form of abuse.

D. SOCIAL

1. Caring for a person with dementia is demanding. The HCP should recognize the toll exacted on caregivers, particularly in the later stages of the disease, when the patient often becomes increasingly dependent, agitated, aggressive, or confused.

2. Caregiver strain is felt physically, emotionally, mentally, financially, and spiritually.

3. Caregivers should be encouraged to seek and utilize available resources to help in areas of need. The HCP should be familiar with locally available resources, including people who can be of assistance (e.g. social workers).7 4. The local church and its members may be of assistance to patients and their caregivers. Caregivers should be encouraged to reach out to their faith communities.

E. CLINICAL IMPLICATIONS

1. Persons with cognitive impairment may have no sense of time or memory. They may still be able to engage socially and may enjoy spending time in the presence of others.

Time spent with loved ones, even if soon forgotten, is nevertheless of value.1,8-11 2.

Individuals with cognitive impairment should be involved in decision-making to the extent of their current capacity. They may have preferences regarding items such as food or clothing, and these should be solicited and

REFERENCES

1. Atri, A., 2019. The Alzheimer’s Disease Clinical Spectrum. Medical Clinics of North America, 103(2), pp.263-293. 10.1016/j. mcna.2018.10.009.

2. Bourgeois, Michelle and Ellen Hickey, Dementia from Diagnosis to Management A Functional Approach,(Psychology Press, Taylor and Francis Group, New York, 2009), pg. 189-203.

3. Kitwood, Tom, Dementia Reconsidered the Person Comes First, (Open University Press, McGraw -Hill Education, Berkshire, UK, 1997), Chapter 4.

4. Scales, K., Zimmerman, S. and Miller, S., 2018. Evidence-Based Nonpharmacological Practices to Address Behavioral and Psychological Symptoms of Dementia. The Gerontologist, 58(suppl_1), pp.S88-S102. DOI: 10.1093/geront/gnx167.

5. Travers, C., Brooks, D., Hines, S., O’Reilly, M., McMaster, M., He, W., MacAndrew, M., Fielding, E., Karlsson, L. and Beattie, E., 2016.

Effectiveness of meaningful occupation interventions for people living with dementia in residential aged care. JBI Database of

Conclusion

All people with cognitive impairment have God-given worth and can lead meaningful lives. Their caregivers, too, deserve our help, support, and prayers.

In these cases the individuals’ cognition was impaired by demons but Jesus went out of his way to exorcise them and restore him to his right mind. a

Systematic Reviews and Implementation Reports, 14(12), pp.163-

225. DOI: 10.11124/JBISRIR-2016-003230.

6. Tisher, A. and Salardini, A., 2019. A Comprehensive Update on Treatment of Dementia. Seminars in Neurology, 39(02), pp.167-178.

DOI: 10.1055/s-0039-1683408.

7. Riffin, C., Van Ness, P., Wolff, J. and Fried, T., 2017. Family and Other Unpaid Caregivers and Older Adults with and without Dementia and Disability. Journal of the American Geriatrics Society, 65(8), pp.1821-1828. DOI: 10.1111/jgs.14910.

8. Dunlop, John, Finding Grace in the Face of Dementia, (Crossway, Wheaton, IL 2017), pg.113-127.

9. Harris, M., 2017. Cognitive Issues. Nursing Clinics of North America, 52(3), pp.363-374. DOI: 10.1016/j.cnur.2017.05.001 10. Regier, N., Hodgson, N. and Gitlin, L., 2016. Characteristics of Activities for Persons With Dementia at the Mild, Moderate, and Severe Stages. The Gerontologist, p.gnw133. DOI: 10.1093/geront/ gnw133.

11.

Walmsly, B. and McCormack, L., 2013. The dance of communication: Retaining family membership despite severe non-speech dementia. Dementia, 13(5), pp.626-641. DOI: 10.1177/1471301213480359.

12. Darby, R. and Dickerson, B., 2017. Dementia, Decision Making, and Capacity. Harvard Review of Psychiatry, 25(6), pp.270-278. DOI: 10.1097/HRP.0000000000000163.

13. Gallagher, D., Fischer, C. and Iaboni, A., 2017. Neuropsychiatric Symptoms in Mild Cognitive Impairment. The Canadian Journal of Psychiatry, 62(3), pp.161-169. DOI: 10.1177/0706743716648296.

14. Mast, Benjamin, Second Forgetting Remembering the Power of the Gospel During Alzheimer’s Disease, (Zondervan, Grand Rapids, 2014), pg.15-28.

Approved by the House of Representatives Passed with 40 approvals, 0 opposed, 0 abstention May 2, 2021, virtual

www.cmda.org | 31

Bioethics The Dr. John Patrick Bioethics Column

COUNTRY

fences Aaron Hensley, MD

I

am blessed to live in central Kentucky. Driving through the picturesque countryside, horse farms are seen throughout the region. Many are ornate and extensive. Others are more modest. Others still have a few horses for personal pleasure and a barn. No matter, they all share this one specific feature in common: fences. These fences require regular upkeep, including replacement of broken boards, staining, etc. Why do horses require fences? The obvious reason is that someone has decided they have a value that is worthy of protection.

Although noble animals (at least by some estimations), they are wont to run wild and endanger themselves in a world of high-speed automobiles.

32 | CMDA TODAY | FALL 2021

In like fashion, it is worthwhile to spend time reflecting upon the reasons for cultural “fences.” You may call them acceptable behaviors, norms or morals or another descriptor, but they are the “shalt nots.” In the case of country fences, this is to “say” to the horses: “this far and not beyond.” What are the fences that have been traditionally observed in the practice of medicine?

Perhaps the most obvious is the Hippocratic injunction essentially stating that we as healthcare professionals shall not kill. Why did Hippocrates construct this fence? Here it would be useful to reflect upon the practice of medicine prior to Hippocrates when the physician was also a killer. Margaret Mead,

the anthropologist and not known as an orthodox Christian, famously commented about this in writing: “For the first time in our tradition there was a complete separation between killing and curing.

Throughout the primitive world, the doctor and the sorcerer tended to be the same person. “[Doctor and sorcerer] with power to kill had power to cure….

“With the Greeks, the distinction was made clear. One profession, the followers of Asclepius, were to be dedicated completely to life under all circumstances, regardless of rank, age, or intellect—the life of a slave, the life of the Emperor, the life of a foreign man, the life of a defective child….

“This is a priceless possession which we cannot afford to tarnish, but society always is attempting to make the physician into a killer—to kill the defective child at birth, to leave the sleeping pills beside the bed of the cancer patient….

“It is the duty of society to protect the physician from such requests.”

Prior to the time of Hippocrates and continuing after that time in some traditions (shamanic and otherwise), the physician with the power to heal also had the power to kill. Which was to be practiced upon the patient? Was there a conscious weighing of the interests of the patient along with other concerned parties (relatives, city, state, physician, et. al.)? What if the desire of the patient conflicted with the desires of the other parties? If these all figured into the heal/kill calculation, the patient presenting for treatment certainly had reason to regard that physician with caution. Trust, therefore, was impossible.

Conversely, if the physician was bound by an oath that prohibited killing his patient, he could be trusted to act in said manner.

Even though the patient may have asked for death, the doctor was bound not to comply. Thereby trust was established in the doctor/patient relationship.

Yet, as Mead writes, society is always attempting to make the physician into a killer. This has occurred numerous times in history. Perhaps the most well-known occasion in the last century was in Germany under the Nazi regime. In the time leading up to World War II, German physicians were asked to assist in helping the state by decreasing the demand for resources by those who didn’t merit them. “Lebenunwertes Leben,” lives unworthy of life, was the term applied to such persons. “Mouths unworthy of food” was another way unto which they were referred. Initially, it was largely the physically and mentally handicapped to whom this was applied. Practices learned during this

time would later be utilized in Hitler’s solution to the problem of the Jews. Should you wish to delve into this disturbing era in the history of medicine, I recommend reading Jay Lifton’s The Nazi Doctors.

More recently, we may look to the evolution of the practice of euthanasia by the Dutch. What was initially proposed as a practice to “help” those in the later stages of a terminal illness was extended to those who deemed their own lives not worth living. Eventually it “progressed” to include killing those who desired life but were deemed unworthy of life by that physician.

Understand, this means they were killed against their wishes.

The “slippery slope” argument is not given much weight in the practice of formal logic. But when a hurdle is cleared, it is reasonable to think the next hurdle will be more easily cleared.

There is a saying in the country: “Before you tear down a fence think about why there was a fence in the first place.” We face increasing pressure from cultural and governmental forces to do away with the injunction of “physicians do not kill.” Perhaps, it is time to more thoughtfully consider this Hippocratic fence that has been a pillar of modern medicine. When the fence is torn down, how far will the horses run?

Aaron Hensley, MD, is an anesthesiologist practicing in Lexington, Kentucky. He and his wife Marsha are the parents of three adult children. When not practicing medicine, he enjoys reading, cycling and beekeeping among other interests.

www.cmda.org | 33

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Resources CMDA members have access to a variety of resources developed specifically for Christians in healthcare.

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• Bridging the Gap - www.cmda.org/bridgingthegap A small group study designed to ask thought-provoking questions about ethical issues facing Christians today.

• CMDA Learning Center - www.cmda.org/learning Higher learning for healthcare professionals that features original courses on a wide range of topics to help educate and advance your healthcare knowledge.

• CMDA Go - www.cmda.org/app Access the latest news, podcasts and resources while also interacting with other CMDA members.

CMDA PLACEMENT SERVICES Bringing together healthcare professionals to further God’s kingdom

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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 healthcare professionals and practices. We have an established network consisting of hundreds of opportunities in various specialties.

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