CMDA Today - Spring 2022

CMDA TODAY

Volume 53 • Number 1 • Spring 2022

HOW TO DE-STRESS IN YOUR DISTRESS

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CEO Editorial Mike Chupp, MD, FACS

Above All Else!

T

he CMDA motto “Changing Hearts in Healthcare” has inspired our leaders, volunteers and members for decades, as heart transformation is the prerequisite for abundant life in Christ (2 Corinthians 5:17). Two equal, but different, subjects of this heart change are implied by our motto. The first is that we healthcare professionals, as Christ followers who are called to serve in God’s kingdom, are His ambassadors for heart change and reconciliation in our practices. Christ makes His appeal to our patients, colleagues, staff and families through us: “…

Be reconciled to God” (2 Corinthians 5:20b). The second implication is the application to our own hearts, as we are disciples in healthcare who understand that we belong to the Great Physician. Our hearts are being transformed into Christ’s image “… with ever-increasing glory…” (2 Corinthians 3:18).

For several years now (especially since becoming CEO of CMDA), the poignant instruction of King Solomon in Proverbs 4:23 has served as a command that challenges me to the core. It says, “Guard your heart above all else, for it determines the course of your life” (NLT). Rev. Bert Jones wrote an excellent article in this issue of CMDA Today entitled “How to De-stress in your Distress” that reminded me of the “heart work” required for us to stay on a course that brings glory to our heavenly Father. How many fallen and/or exposed Christian leaders does it take to wake us to the fact that watching over and studying and keeping our hearts in tune with the heavenly Father matters more than anything else in our personal and professional lives?

We live in days and in a cultural moment where we face explosive, divisive and mentally challenging issues that threaten the church of Jesus Christ in every aspect. We know the church (and CMDA members as the hands, feet, eyes, ears and other parts of that body) will prevail against the gates of hell, because our Lord Jesus said so. However, our hearts will need to constantly be examined along the way, “above all else” (Proverbs 4:23, NLT). We only need to consider Old Testament patriarchs (like Moses hitting instead of speaking to the rock) and kings (like Solomon), as well as mature, modern-day saints, who failed in tending their own vineyard. We can be so focused on tending to other vineyards that we fall short in addressing the health and well-being of our own. It is possible for spiritual heart health to suffer during every season of the believer’s life and walk.

Speaking of seasons, I have just finished a 17th century classic in modern English: Keeping the Heart by English Presbyterian

minister and author John Flavel (1627–1691). His book centers on the Proverbs 4:23 command to guard or “Keep your heart with all vigilance, for from it flow the springs of life” (ESV).

Flavel’s work, recently updated by Jason Roth, is one I highly recommend to you in 2022. It serves as a highly practical treatise on guarding our hearts during various seasons of life, including a season of adversity: “When providence frowns on you and blasts your outward comforts, then look to your hearts. Keep them with all diligence from complaining against God or fainting under His hand.

For troubles, though sanctified, are still troubles; even rose bushes and holly thistles have their prickles.”1 I was able to glean so much helpful counsel from Flavel on how to handle various seasons of temptation, persecution, sickness, fear, church troubles and more. For me, this year of ministry and service as your CEO of CMDA will be the year I want us to focus on GUARDING our hearts in healthcare.

Many CMDA members and leaders have written to us about the opposition they are facing as Christ followers who hold the Bible as the divinely inspired and authoritative Word of God. Just for them to acknowledge their CMDA membership on their CV puts them at risk for consequences in position and/or opportunity in medicine, dentistry or other healthcare professional career track.

I trust this spring edition of CMDA Today will serve to educate, encourage and equip you to glorify God with a vision for bringing the hope and healing of Christ to the world through your healthcare practice. In addition, I urge you to take advantage of the continuing education credit available in this edition related to the CMDA Ethics Statement on Transgender Identification, recently approved by CMDA’s Board of Trustees and House of Representatives.

Endnotes 1 Flavel, J., Roth, J. (2020), Keeping the Heart. In Modern English, http:// christianclassicsmodern.com (Kindle version, Loc 717)

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 53 | NUMBER 1 | SPRING 2022

EDITOR Kim Shattell

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

CMDA TODAY

The Journal of the Christian Medical & Dental Associations

INCLUDES OPPORTUNITIES TO EARN CONTINUING EDUCATION CREDITS See page 26

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CMDA Today™, registered with the U.S. Patent and Trademark Office. Spring 2022, Volume LIII, No. 1. Printed in the United States of America. Published four times each year by the Christian Medical & Dental Associations® at 2604 Highway 421, Bristol, TN 37620. Copyright© 2022, 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.

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ON THE COVER ow to De-stress in Your H Distress

24

Pastor Bert L. Jones

E xperiencing peace in the midst of overwhelming burnout

16

Professional, Not Provider—Please!

Margaret Cottle, MD

CMDA Ethics Statement on Transgender Identification

Two hours of continuing education credit available

32

The Dr. John Patrick Bioethics Column

Medicine in Times of Public Crisis John Patrick, MD

One doctor’s opinion that her profession should return to its roots

20

First Fruits and Capstone

Comparing the history of public health and traditional medicine with today’s culture

See PAGE 34 for CLASSIFIED LISTINGS

Doug Lindberg, MD

Two new mission ministries birthed under the CMDA umbrella

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 | SPRING 2022

Ministry News RESOURCES

New CMDA Today Editor CMDA is excited to welcome Kim Shattell as the new Editor of CMDA Today, our quarterly publication. Kim recently came onboard to assume responsibility for producing the magazine, which includes coordinating authors and articles, writing, editing, assisting with graphic design and layout and working with vendors. In addition, she assists with other projects within the Communications department, including editing, media relations and advocacy initiatives.

Previously, Kim held various positions with trade magazines and business and publishing companies to provide writing, editing and design of magazines, marketing materials, press releases and books, as well as marketing/advertising pieces for corporate communications and trade shows. In addition, Kim holds a bachelor’s degree in journalism from Colorado State University. She recently relocated to Johnson City, Tennessee from upstate New York, where she enjoys this beautiful area, as well as reading, baking and entertaining, biking/activity, music and theatre, and spending time with family and friends. And coffee!

To contact Kim, email kim.shattell@cmda.org or call 423-844-1071.

CMDA Go App Have you downloaded CMDA Go yet? Our new mobile app is now available to download on Apple and Android mobile devices. Visit your device’s app store to download it today.

In the new CMDA Go app, you can set up your personal CMDA profile, check out the latest news from CMDA, listen to CMDA Matters and other podcasts, renew your membership and make your dues payments, access a variety of downloadable resources, interact with other members through the discussion forms and join group chats.

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

Do you feel down, depressed or hopeless? Have you lost interest or pleasure in doing things? Do you know someone who might be depressed and want to help?

Are you a Christian healer—healthcare professional, counselor or clergy—and want to expand your knowledge base on depression? If you answer yes to any of these questions, this book may be of help to you.

As a Christian family physician and educator for more than 40 years plus seminary training, Dr. Andrew White has found that treating the whole person with clinical depression is the most likely way to be healed from this dreadful illness. There are now many real helps for those with clinical depression from the medical (including psychiatric), counseling and pastoral care professions, especially from the Bible itself. Dr. White has suffered from seven clinical depressions, so he knows the issues facing those who are depressed. Also included are real-life examples of Christians who have suffered from depression and recovered, plus helpful quotations from Scripture and special prayers for those who are depressed.

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“A powerful testimony and treatise on the power of prayer, counseling and medical therapy for depression. Andy’s personal lifetime experience with depression makes this book a tremendous labor of love and a mustread for healthcare professionals as well as patients, families, pastors and others engaged in mental healthcare inside and outside the church.”

—Mike Chupp, MD, FACS CEO, Christian Medical & Dental Associations www.cmda.org | 5

Ministry News

CMDA Matters

Bridging the Gap

Are you listening to CMDA’s weekly podcast with CEO Dr. Mike Chupp?

We’re welcoming new and exciting guests to the podcast this year, so you don’t want to miss it.

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.

As Christians, we are called to speak truth into ethical issues and courageously stand up for what’s morally right according to our beliefs. But in order to engage others in these discussions with grace and kindness, first we need to arm ourselves with knowledge and understanding of each of these topics.

Bridging the Gap: Where Medical Science and Church Meet is a small group study developed by expert healthcare professionals from CMDA. The curriculum is designed to ask difficult, thought-provoking questions as we seek the truth found in God’s Word about the ethical issues facing Christians today.

Topics include addictions, beginning of life, end of life, gender identity, right of conscience and sexuality.

For more information and to download the curriculum, visit www.cmda.org/bridgingthegap.

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Ministry News

Faith Prescriptions

MEMBER NEWS

New to the resources provided by CMDA is a new video series called Faith Prescriptions. This 25-part video series (featuring 10 core sessions) provides training on everything from LGBTQ issues in the healthcare arena, to praying with your patients and sharing your faith in ethical and appropriate ways with colleagues and patients.

Faith Prescriptions is a revision of the program Grace Prescriptions, which has been in circulation for several years on DVD. This new, updated and improved series is now video-on-demand. It is free to CMDA members and simply requires your member login and password to access all sessions, as well as all video training sessions, within the CMDA Learning Center.

Get started today by visiting www.cmda.org/learning.

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.

• • • •

Upcoming Events

•

Dates and locations are subject to change. For a full list of upcoming CMDA events and further information for each event, visit www.cmda.org/events.

•

Richmond CMDA Annual Banquet March 24, 2022 • Richmond, Virginia Knoxville CMDA Spring Banquet April 7, 2022 • Knoxville, Tennessee CMDA National Convention 2022 April 21-24, 2022 • Indianapolis, Indiana Pre-field Orientation for New Healthcare Missionaries August 1-4, 2022 • Boone, North Carolina Voice of Christian Doctors Media Training August 12-13, 2022 • Bristol, Tennessee Women Physicians & Dentists in Christ Annual Conference September 15-18, 2022 • Newport Beach, California

• • •

George D. Belcher, MD – Independence, Kansas Member since 1958 Jimmie R. Crow, MD – Collinsville, Oklahoma Member since 1988 James H. Greeley, DDS – Catonsville, Maryland Member since 1980 Walter B. Hull, MD – Columbus, Ohio Member since 1959 Fred W. Lathrop Jr, MD – Flemington, New Jersey Member since 1954 David W. McQuoid, MD – Indian Land, South Carolina Member since 1959 James B. Martins, MD – Northbrook, Illinois Member since 1968 Isaac Mooney, Student – Pflugerville, Texas Member since 2021 Thomas M. Robb, DO – Hudson, Ohio Member since 1975

Memoriam and Honorarium Gifts Gifts received October through December 2021 Gregory and Debra Kuhn in memory of Margaret Ann Fisk Edith Korpi and Sandra K. Curran in memory of Dr. Bob J. Kingsbury Angela G. Mitchell in memory of Dr. Bob J. Kingsbury Charles and Patty Criddle in memory of Dr. Bob J. Kingsbury Paul and Donna Mertens in memory of Dr. Bob J. Kingsbury Chuck and Ginny Linsenmeyer in memory of Dr. Bob J. Kingsbury Dr. and Mrs. Donald Wood in memory of Dr. Bob J. Kingsbury Shirley G. Hickman in memory of Dr. Bob J. Kingsbury Dr. and Mrs. Russell B. Dieterich in memory of Dr. Bob J. Kingsbury Dora and Tom Heath in honor of Dr. Albert Kerr, Dawn Kerr and staff Dr. and Mrs. James R. Kistner in honor of Drs. Matthew and Julia Schaffer Mr. and Mrs. Bob R. Sluder in honor of Mr. and Mrs. Rusty Sluder

For more information about honorarium and memoriam gifts, please contact stewardship@cmda.org.

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Ministry News COMMUNITY

New Associate Regional Directors CMDA is pleased to introduce our two Associate Regional Directors, who joined CMDA in 2022.

Connor Ham, MA, is the new Associate Midwest Regional Director who will succeed Allan Harmer as Midwest Regional Director after his retirement on January 1, 2023. Connor attended Moody Bible Institute and graduated with a bachelor’s in biblical languages (i.e. Hebrew and Greek) in 2018. He continued his studies for his master’s in theology and religious studies at KU Leuven in Belgium (a Catholic research university), which he completed in summer 2020. Upon returning to Ohio, Connor began his PhD work in Cincinnati in August 2020 at Hebrew Union College, studying ancient Christian and Jewish literature. Along with his PhD studies, Connor has been involved in young adult ministry at Kenwood Baptist Church and in ministering as CMDA associate staff—both in Cincinnati. To contact Connor, email connor.ham@cmda.org.

Wes Ehrhart, MA, is the new Associate Western Regional Director to succeed Michael McLaughlin as Western Regional Director after his retirement on October 1, 2022.

Between his family experiences and many years in ministry, including his last role as Executive Dean for two regional graduate school locations at Western Seminary in Sacramento and San Jose, California, Wes brings a deep well of experience to this position. Wes and his wife Sherry have an 18-year-old son, twin 15-year-old daughters and twin 5-yearold foster boys who all reside in Sacramento, California. To contact Wes, email wes.ehrhart@cmda.org.

GET INVOLVED Are you looking to find connection with Christians in healthcare on campus or in your local community? Are you interested in starting a local ministry group or a campus chapter? Contact your regional director at regions@cmda.org to learn more about how you get involved in connecting, fellowshipping, discipling and living out your faith in your practice.

CMDA Learning Center

Higher Learning for Healthcare Professionals The CMDA Learning Center features original courses presented on a wide range of topics designed to help educate and advance your knowledge in key areas in healthcare today.

CMDA Learning Center Higher Learning for Healthcare Professionals

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HOW TO DE-STRESS IN YOUR DISTRESS Pastor Bert L. Jones

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“In my distress I prayed to the Lord, and (Psalm 118:5, NLT)

way, that leadeth to destruction, and many there be which go in thereat. Because strait is the gate, and narrow is the way, which leadeth unto life, and few there be that find it” (KJV). We often imagine the wrong word here in thinking the strait place is a straight place. Jesus is not speaking about a road without curves but a path that may rattle your nerves along the way—an unsettling journey that may be full of stress and leave you “in distress.”

picked up the phone to return a call from a message I had received on my office voicemail earlier that day. The call was from a doctor. I called the doctor back and said, “Hello, this is Pastor Bert from CMDA returning your phone call, how can I help you?” After a pause, he responded, “Thank you for calling me back; I don’t know how much longer I can continue to practice in this environment.” As he continued to download the heavy burden he was carrying, I realized the doctor on the other end of the call was in distress. It was a 911 call for spiritual help. Unfortunately, that phone call is becoming all too common and frequent in my office.

Jesus has already faced what we are facing. He prayed in the garden for the cup of sorrow to pass if it was God’s will, but through intense prayer, He understood the path before Him would lead to everlasting life for all who choose it, but it would require Him to follow the strait way. Don’t be discouraged in your distress. Jesus warned us in John 16:33, “‘I have told you these things, so that in Me you may have [perfect] peace. In the world you have tribulation and distress and suffering, but be courageous [be confident, be undaunted, be filled with joy]; I have overcome the world.’ [My conquest is accomplished, My victory abiding]” (AMP).

One of the simultaneous consequences of the pandemic has been the increase of stress and the decrease of well-being. It’s the rise of frustration and the fall of fulfillment in serving. This has been especially true for those serving in the healthcare profession. Under pressure to perform long hours, few have forced themselves to address the personal stress they face as a result of the ongoing crisis. Failure to address the stress in one’s life will often progress into a state of deep distress.

Psalm 118 is the last of the five “Hallel” Psalms. “Hallel” means praise. The Jews used these Psalms as a celebration of Passover, which God instructed them to do just before their exodus from Egypt (Exodus 12:14). They worshiped God while singing these songs and making sacrifices to Him. Israel learned that sacrifice often involves suffering.

the Lord answered me and set me free”

I

The Oxford English Dictionary defines distress as extreme anxiety, sorrow or pain. If that description sounds familiar and you are feeling like your stress level has progressed to a state of distress, you are not alone. Scripture includes multiple examples of strong leaders who served in a state of distress. The phrase, “in my distress,” is repeated multiple times throughout the Bible.

Leaders like Jacob (Genesis 35:3), Moses (Exodus 3:7), David (Psalm 4:1, 55:17, 18:6, 120:1) and Paul (Philippians 4:14) experienced the depths of distress and despair and prevailed.

The word distress is an interesting word. It literally means “from a strait place.” It means being in a tough spot. We often hear of people being in “dire straits” or in an extremely difficult or dangerous situation. The Psalmist describes this situation as “in my distress” (Psalm 18:6). It is an incredibly real and personal place for the writer. It is my distress. It’s interesting how a general pandemic that impacts everyone around the world has deeply personal and unique implications for each of us, implications that can be quite different from others with whom we serve. The meaning of this word strait is significant. It is used in reference to a situation that is characterized by a specific degree of trouble or difficulty.

It reminds me of Jesus’ warning in Matthew 7:13-14, “Enter ye in at the strait gate: for wide is the gate, and broad is the

Notice the verses of thanks and praise that precede the prayer of distress, “Give thanks to the Lord, for he is good! His faithful love endures forever. Let all Israel repeat: ‘His faithful love endures forever.’ Let Aaron’s descendants, the priests, repeat: ‘His faithful love endures forever.’ Let all who fear the Lord repeat: ‘His faithful love endures forever’” (Psalm 118:1-4, NLT).

While the Bible challenges us not to ramble in our prayers (Matthew 6:7), there is plenty of evidence compelling us to repeat portions of our prayers. When it comes to prayers made “in distress,” some things really are worth repeating.

In Psalm 118:2-4, did you notice the Psalmist challenged his readers three times to repeat a portion of the prayer? As I studied this passage, I began to notice six places in the prayer where the Psalmist repeated a portion of this prayer “in distress.” I think it sets the stage for us to begin to de-stress in our state of distress. Take a look at these repeated portions of the prayer from Psalm 118.

1. GIVE THANKS (verses 1, 29). The most powerful prayers

in a season of distress begin and end with a heart of thanksgiving. We need to confess gratitude and remember the word “hallel” means praise. The Lord has taught me through the years to start with praise when I’m facing a problem. Our tendency is to make a todo list for God, but we often forget to praise Him for www.cmda.org | 11

LEARN MORE Healthcare professionals pour themselves out for others every day, and CMDA’s Center for Well-being is the place to be refilled! If you find yourself feeling burned out or in distress, then the Center for Well-being is for you. We want to help you align with God, optimize your well-being and maximize your influence. We want to help you find the “sweet spot” of life again, to help you find or regain what the Bible calls “Shalom.”

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

what He has already done. Paul encourages us to give thanks in everything (1 Thessalonians 5:18). Before you ask God for something, acknowledge what He’s doing for you now, and then thank Him for what He will do for you, as a result of your prayers. Raise your praise and give Him thanks!

2. HIS FAITHFUL LOVE ENDURES FOREVER (verses 1-3).

Four times in just two verses, we are called on to repeat the phrase, “His faithful love endures forever.”

What a great reminder when in distress. In 2 Thessalonians 3:3, Paul said, “But the Lord is faithful; He will strengthen you and guard you from the evil one” (NLT). In 1 Corinthians 1:9, he reminds us that we have been called into fellowship with the Son of our faithful God. As we look with our natural eyes, we often have a tendency to be fearful of what we see, but as we begin to look up and see the Lord, we will be amazed with His faithfulness. We will begin to comprehend, “Great is his faithfulness...” (Lamentations 3:23, NLT).

3. THE LORD IS FOR ME (verses 6-7). One of the schemes

of Satan is to make us think we are alone in our times of distress. We convince ourselves we are flying solo with no one on our team. That is simply a lie. Jesus promised to never leave us or forsake us (Hebrews 13:5). Many years before Romans was written, the

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Psalmist understood the teaching of Romans 8:31b, “If God is for us, who can be against us?” Several times in Paul’s writings he testified to the Lord’s presence through some incredibly difficult and dangerous times (Acts 23:11, 2 Timothy 4:17). He also found that God used those moments of distress to further the gospel (Philippians 1:12-14). The conclusion of the Psalmist is “…so I will have no fear…” (Psalm 118:6, NLT).

4. TAKE REFUGE IN THE LORD (verses 8-9). Notice the

Psalmist points out twice that it is better to take refuge in the Lord than to put our trust in human intervention. Don’t forget, “God is our refuge and strength, an ever-present help in times of trouble” (Psalm 46:1, BSB). In times of despair and distress, we can either retreat backward or look upward to God to be our place of refuge. We should trust Him with all our hearts and lean not on our own understanding (Proverbs 3:5-6).

We need to rest in the One who is our shelter.

5. ALL AUTHORITY IS AVAILABLE TO YOU (verses 10-12).

The writer details the feeling of fear he experienced in his moment of distress. He was surrounded by those who were against him, swarming like group of bees ready to attack. In that moment, he stood not on his own authority but on the Lord’s authority, and he was victorious. I’m reminded of those moments when Jesus sent out His disciples to do the work of minis-

try. When He sent them, He gave them power and authority (Luke 9:1-2). Even though they were being sent out as lambs among wolves (Luke 10:3), they came back rejoicing in what the Lord had done for them (Luke 10:17). In Jesus’ final commission to His disciples, which includes us, He gave us all power and authority to go and fulfill the Great Commission of spreading the gospel (Matthew 28:18). I challenge you to stand against the schemes of the enemy, not on your authority but on His.

6. THE LORD IS MY STRENGTH (verses 14-16). Some

of us have an incorrect view of what it means to be strong. There is a tendency to honor and glorify the physical strength of leaders who hold out and stand firm on their own ability and in their own strength through adversity. As followers of Christ, though, we don’t have to go through those seasons alone. We have One who desires to come along and be our strength in times of weakness (2 Corinthians 12:9-10). He invites us to take His yoke (Matthew 11:29) and find our strength in Him. Remember Paul’s challenge to the Ephesians, “Finally, my brethren, be strong in the Lord and in the power of His might” (Ephesians 6:10, NKJV). The writer in Psalm 118 repeats his reference to the strong right arm of the Lord to show us His strength and power, as well as remind us of what glorious things strength and power can do. I challenge you to rely on His strength and comfort when you struggle in distress.

dently singing in repetition these verses in Psalm 118, while Jesus knew fully what was about to happen. In light of the night ahead—including His betrayal, denial, arrest, pain, suffering and ultimate crucifixion—He continued to sing, “In my distress I prayed to the Lord, and the Lord answered me and set me free” (Psalm 118:5, NLT). What an example for us to follow (1 Peter 2:21). If it was the song Jesus chose to sing, maybe we need to learn the words for our hour of distress.

Billy Graham once said, “Don’t let circumstances distress you.

Rather, look for the will of God for your life to be revealed in and through those circumstances.” It has been helpful for me to understand that doing the will of God does not exempt you from the press of distress (Luke 22:44). We also need to be mindful of the stress we cause ourselves because of bad decisions we make, along with the stress that comes because of uncontrollable circumstances. Remember to keep 1 Peter 3:17 in perspective, “For it is better, if it is the will of God, to suffer for doing good than for doing evil” (NKJV).

Through this prayer of desperation, we discover God is listening and acting on our prayers (verses 5, 21). 1 Peter 3:12 tells us God’s ears are attentive to our prayers, and 1 John 5:14 explains that we can have confidence in God hearing and answering those prayers if we ask according to His will. Jacob discovered that God responded to his prayer in distress, so he went back to Bethel and built an altar to the Lord (Genesis 35:3). We can begin to de-stress our distress by giving our burdens and cares to the Lord (Psalm 120, Psalm 55:22, 1 Peter 5:7).

I believe repeating these portions of the prayer will reduce the defeat and depletion of our souls and lift us above it as we commune in the spirit with the Lord.

They will offer us hope and help us begin to de-stress in our state of distress.

In Matthew 26, we find the last Passover celebration Jesus shared with His disciples in the upper room before going out to the garden and eventually to the cross. We call it the last supper. In verse 30, they sang a hymn and then went out to the Mount of Olives. Have you ever wondered which song in the hymnal they sang that night before they left? Do you have any idea which song may have given them comfort for what they were about to face? Bible scholars believe Jesus and His disciples would have sung the Psalms of Hallel.

Just think about that for a moment.

Picture Jesus and His disciples confiwww.cmda.org | 13

David understood what it was like to overcome the feeling of distress and be victorious. His song appears in 2 Samuel 22:1-7: “David sang this song to the Lord on the day the Lord rescued him from all his enemies and from Saul. He sang: ‘The Lord is my rock, my fortress, and my savior; my God is my rock, in whom I find protection. He is my shield, the power that saves me, and my place of safety. He is my refuge, my savior, the one who saves me from violence. I called on the Lord, who is worthy of praise, and he saved me from my enemies. The waves of death overwhelmed me; floods of destruction swept over me. The grave wrapped its ropes around me; death laid a trap in my path. But in my distress I cried out to the Lord; yes, I cried to my God for help.

He heard me from his sanctuary; my cry reached his ears’” (NLT).

May we learn from the example of the Psalmist and from Christ Himself who prayed in distress. Let Psalm 118:21 be our benediction in the midst of our affliction, “I thank you for answering my prayer and giving me victory!” (NLT). Will you be willing to thank God in advance of a change in your circumstance?

Look what the Lord does when this prayer of distress is prayed—He sets them free (verse 5). Some translations say, “The Lord answered me, and set me in a large place;” literal-

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ly, the Lord answered me on the open plain. The idea is that the Lord gave me enlargement—took me out of my straits—and “...set my feet in a large room” (Psalm 31:8, KJV).

Are you feeling weary and heavy-hearted today (Matthew 11:28-30)? Call on the Lord! Warren Weirsbe said, “Let God enlarge you when you are going through distress. He can do it, you can’t do it, and others can’t do it for you.”

Take a moment, repeat these promises in Scripture and pray them over your situation. God will hear your prayer as He heard the psalmist. He will help you de-stress in your distress.

Pastor Bert L. Jones serves as CMDA’s Director of Leadership & Church Relations. In this role, Bert oversees the Center for Well-being and church ministries. Bert also serves as chaplain of CMDA. Since 1988, Bert has led multiple teams across the street and around the world. Bert has traveled on five different continents and to more than 33 different countries to teach and preach the gospel. He has engaged in leadership development nationally and internationally throughout his ministry. Bert co-authored the book Servant Leadership Proverbs in 2017 with Dr. David Stevens. Prior to this project, Dr. Stevens and Bert co-authored the book Leadership Proverbs. Bert is also the author of Practical Youth Ministry.

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Professional, Not Provider

PLEASE! Margaret Cottle, MD

“You have to prescribe some penicillin for my sore throat.”

“When I feel like this my real doctor always gives me. . .”

P

hrases like these were extremely common in my daily practice when I served as a physician at a university student health center early in my career.

Those words were often a result of simple naivete, but consumer-driven patient attitudes have intensified dramatically through the years. Here in Canada, where euthanasia/assisted suicide is legal, I currently face more serious and sinister demands in my palliative care practice.

“I don’t want to live any more—there’s just no joy left. Please arrange everything so that I can go immediately.”

“I’m ready to die right now! Do what needs to be done to make that happen.”

In the midst of these tragic situations, the diplomatic skills I honed while working with students have helped me to navigate these shoals with my integrity and Christian principles intact.

However, these blunt directives expose our culture’s deepening sense of expectation and entitlement in healthcare matters, and the language we have allowed to infiltrate our profession has played a major role in facilitating and reinforcing this change.

In recent years, the word “provider” has become a common designation for healthcare professionals responsible for patient care. These include physicians, physician assistants, nurse prac16 | CMDA TODAY | SPRING 2022

titioners, nurses, pharmacists and others. Provider used to be an honorable designation reserved for specific contexts—a provider in the home, for example. And, after all, God calls Himself Jehovah Jireh, our Provider. In healthcare, however, the use of the word connotes and enforces a commercial, corporate and passive perspective. The ethical, vocational practitioner is degraded to someone who provides what the consumer desires and what officials will allow.

As healthcare professionals have become “providers,” we have also experienced pressure for patients to become, and to be called, “clients.” Our medical culture was from an era in which trained practitioners told untrained patients what was needed.

Today, at least in some settings, we see untrained patients tell clinicians what they want. If the professional disagrees or hesitates, patients tend to be offended, angered or shocked. The reason for a clinician’s hesitation is irrelevant to them in the face of their demands, even when patients’ demands are based on an internet testimonial or the suggestion of a friend. Well, so what!? Isn’t it their choice?

“Provider” signals a move away from the Hippocratic tradition of a medical covenant, a committed relationship for personal, individual care, and a move toward a commercial, transactional one. By definition, a covenantal relationship involves a binding commitment between patient and practitioner. It implies a stronger bond and duty to care—a bond withstanding hardship, disappointment, tragedy and even misunderstanding—rather than a mere commercial contract.

Medicine is a “moral” profession according to its very nature—dealing with the “shoulds” and “oughts” of our patients’ lives. Our years of training and experience are critical resources when patients seek our advice, asking us what we think they should do or what treatment they ought to pursue. As Dr. Francis Peabody said in a famous address in 1927, “…the secret of the care of the patient is in caring for the patient.”1

Truly caring involves giving what we believe to be the best medical advice possible, even when it is not what patients want to hear and may not be a course they wish to follow. It is much easier for our patients—and their loved ones—to consider our recommendations more seriously if they have a trusting relationship with us and believe we genuinely care for them.

If we create only a consumer-provider relationship, it can be difficult to give the guidance or earn the trust so desperately needed in challenging situations. It can even be an excuse for the healthcare professional to rationalize following the patient’s direction, even where experience and training suggest it is not the best course of care.

pens even if the attending physician’s clinical assessment renders the procedure, such as an abortion or euthanasia/assisted suicide, inappropriate.

This sense of the commercial drives the current move by some bioethicists to insist that anyone admitted to medical school be prepared not only to approve, but also to perform, any legal procedure.2 They continue by declaring that those who are unwilling to do so should find another profession. The Hippo-

Just because a treatment is requested does not mean it is clinically appropriate. Patients’ perspectives are often limited to the pain and fear of a diagnosis or limit.

The practitioner who has seen hundreds of similar cases, and the potential for better outcomes, may have another view. Denying that perspective is a disservice to the person in need. For example, a person rendered paraplegic following an accident may think life is no longer worth living, whereas a physician who has treated hundreds similarly can say, “Give us time to show you that life, while different, will still be worthwhile.”

Today, the dominance of consumer-based, provider-ship permeates most deeply the areas of healthcare that are morally most contentious—especially those involving life and death. In several Canadian jurisdictions, physicians who are opposed to a legal procedure risk losing their licenses to practice if they refuse to provide a formal “effective referral” to another physician who will carry out a patient’s request. This hapwww.cmda.org | 17

use the titles—clinician, doctor, physician, practitioner or professional—that best reflect our role as vocational carers.

As such, and as Oslerian practice once recommended, with our patients we commit to listen to each other and use our collective wisdom and resources to arrive at the best possible treatment. Numerous factors will contribute to that outcome. Arriving at it will not be a quick, short-order menu but a complex dance among participants to arrive at an acceptable, feasible and effective plan.

cratic ideal of vocational practice simply becomes a commercial undertaking with little moral grounding.3 Herein lies the danger hidden in the language but evident in the reality of complex care. In denying the healthcare professional’s conscience,4 they also deny the ideal of conscientious practice grounded in the practitioner’s personal ethics as well as his or her training and experience.

As “providers,” clinicians are answerable to a patient’s wishes and to the dictates of the commercial insurers and government agencies that have deemed a particular procedure legal and thus appropriate. Nevertheless, just because it is legal does not mean it is ethical or moral. Time and again, the sundering of conscientious practice from official dictates has been horrific. That was the message at the Nuremburg Trials, in which Nazi physicians were simply following orders in the concentration camps, and at Tuskegee, where patients became mere objects of experimentation.

A hypocrisy is inherent in the insistence by some who believe that, as “providers,” clinicians must dutifully answer the patients’ demands and adhere to the dictates of supervising organizations. However, it is worth noting and emphasizing that, despite the insistence on patient rights and the physician’s obligations as a “provider,” these often do not extend to the marginalized and fragile communities in need. As published reports have emphasized, members of the First Nations are often denigrated and denied the care they request and, sometimes, the care they need.5 So, too, are those with critical disabilities receiving sub-standard care from the systems responsible for their healthcare and social well-being. The case of Roger Foley in Hamilton, Ontario, in Canada, which is much in the news in Canada and is still being adjudicated in the courts, is only one example.6 As healthcare professionals, we do ourselves a serious disservice by allowing ourselves to be called “providers.” Healthcare is more than a simple service. Let us refuse the label and pledge to

18 | CMDA TODAY | SPRING 2022

As Christian healthcare professionals, we are well acquainted with the tremendous gift of Jesus, Emmanuel (God with us). As a result of His life, death and resurrection—His sacrifice on our behalf—we can experience a close, covenantal relationship with the living God. It is also a gift to be a healthcare professional, to be invited to walk alongside other members of our human family in both darkness and joy. May Jehovah Jireh truly be our Provider—the One who gives us the strength and wisdom to love and care for our patients and each other, as He would desire, and to be the healthcare professionals He has called us to be in partnership with Him. Endnotes 1 Peabody Francis W. The Care of the Patient. JAMA. 1927;88(12):877882. doi:10.1001/jama.1927.02680380001001.

2 Savulescu J., Schucklenk U. Doctors Have no Right to Refuse Medical Assistance in Dying, Abortion or Contraception. Bioethics 2016. https://doi.org/10.1111/bioe.12288.

3 Worthen L.; Potter S. Euthanizing Hippocratic medicine? CMF: Triple Helix, 2021. https://www.cmf.org.uk/resources/publications/content /?content=article&id+27278. Is the journal CMF or Triple Helix?

4 Schucklenk U. Why Medical Professionals Have No Moral Claim to Conscientious Objection Accommodation in Liberal Democracies.

Bioethics 2017); 162-170. https://doi.org/10.1111/bioe.12288 5 Wylie, L., McConkey, S. Insiders’ Insight: Discrimination against Indigenous Peoples through the Eyes of Health Care Professionals. J. Racial and Ethnic Health Disparities 6, 37–45 (2019). https://doi. org/10.1007/s40615-018-0495-9 6 Koch T. The right to a compassionately accepted life, not death.

Toronto Star.

April 2, 2018. https://www.thestar.com/opinion/ contributors/2018/04/02/the-right-to-a-compassionately-assistedlife-not-death.html.

Margaret Cottle, MD, is a palliative care physician in greater Vancouver, British Columbia, and a clinical assistant professor at the University of British Columbia (UBC) Faculty of Medicine. She speaks internationally about end-of-life issues and palliative care, and she addressed members of the Canadian Parliament in 2006 and 2017. Dr. Cottle and her husband, Dr. Robin Cottle who is an ophthalmologist, sponsor the UBC student chapter of CMDA Canada, hosting the students weekly for dinner and discussions. Cara, their black Labrador retriever, accompanies Dr. Cottle on some of her home hospice visits. The Cottles have two grown children and four (wonderful!) grandchildren.

Join The Practice Faith-based Direct Primary Care Established in 2010 by CMDA member Dr. Jan Mensink with the vision of providing concierge medicine for the common man, The Practice in Bakersfield, California is the fourth largest direct primary care practice in America.

The direct pay model we work on is a win-win for doctors and patients; it is very financially beneficial for both sides, and because doctors have time to do quality medical care, patients get healthier and doctors have greater job satisfaction. Direct primary care also provides a wonderful work/life balance because of the longer visits, little to no insurance paperwork, smaller patient panels vs. numerous patients for typical insurance taking primary care doctor.

We are seeking a doctor for immediate employment and the unique opportunity of taking over this thriving functional medicine practice when Dr. Mensink retires in a few years.

During full-time employment now, the candidate will work closely with Dr. Mensink to be well prepared to take over as Dr. Mensink phases out. The Practice is continuing to grow at a phenomenal rate, and Dr. Mensink is seeking to reduce his hours and turn the practice over to an associate in the next two to five years.

For more information, contact CMDA Placement Services at placement@cmda.org or visit www.cmda.org/placement.

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T

First Fruits Capstone Doug Lindberg, MD

GET INVOLVED CMDA’s Center for Advancing Healthcare Missions (CAHM) seeks to mobilize and support physicians, dentists, nurses, therapists and other health personnel to use their professional skills to help people encounter Jesus, both here in the U.S. and around the world. For more information and to get involved, visit www. cmda.org/cahm. To get involved in the new First Fruits and Capstones initiatives, visit www.cmda.org/firstfruits and www.cmda.org/capstone.

20 | CMDA TODAY | SPRING 2022

he healthcare mission field stands at an important crossroads. Around the world, opportunities abound for fruitful ministry through healthcare missions. Healthcare professionals are desperately needed, and they can serve in places non-medical missionaries can’t serve. All too often, needs and opportunities go unmet. The doors will not remain open forever. As health systems around the world modernize, healthcare missions and missionaries become less necessary in the eyes of the host community, and the missionary’s witness and scope of influence are curtailed significantly.

Even so, as these opportunities cry out for workers, we are seeing alarming attrition in our healthcare mission workforce. There are myriad reasons for this. Certainly, the pandemic is a factor, leading some long-term workers to return earlier than planned, while others are deciding not to travel at all. However, understaffing at mission hospitals and unmet opportunities pre-dated the pandemic.

Keeping this in mind, how can we as Western Christian healthcare professionals play a role in helping to meet the needs? As we acknowledge the skills God has entrusted to us, and we consider Jesus’ example and admonishment to

First Fruits engages students, trainees and early career healthcare workers. The concept of “first fruits” appears repeatedly in Scripture and applies practically to this stage in one’s life. This type of giving is distinct from a tithe in that it’s not just giving a set percentage to God. It’s a gift of faith, giving God our first and our best wealth, time and talents. When we step out in faith and give to God from our hearts, we are trusting Him with our future and believing His promises will come to us, because God is faithful to give when we give.

In Deuteronomy 26:1-3a, 9-11 we read:

care for the poor, marginalized and lost, how would He want us to live?

We consider these types of questions frequently at CMDA’s Center for Advancing Healthcare Missions (CAHM).

Healthcare missions is integrated into the DNA of CMDA and our members. So how can we work together to step in and be a part of critical healthcare ministry happening both in our backyard and around the world? This is not a matter of putting out a “help wanted” sign to beg and plead with workers to fill remote and austere outposts by making them feel guilty. This is about creating open doors and clear glidepaths for Christian healthcare workers to be a part of moving God’s kingdom forward. It’s an effort that cannot and will not fail, as we rely on God’s provision. It’s an invitation to join the ultimate adventure. It may cost us everything, but there’s nothing more important to which we could give our time, treasure, talent and even our lives!

Stepping back a bit from this lofty agenda, the practical questions of who and how arise. Enter First Fruits and Capstone, our two mobilization sweet spots for healthcare personnel. While anyone can take first steps toward being involved in missions at any time, it is easier for some than for others. It would be more difficult, for example, for a 44-year-old mother of three with a busy practice, a mortgage, church and community commitments and college tuition looming to significantly engage in missions than some of her older or younger counterparts.

“When you have entered the land the Lord your God is giving you as an inheritance and have taken possession of it and settled in it, take some of the firstfruits of all that you produce from the soil of the land the Lord your God is giving you and put them in a basket. Then go to the place the Lord your God will choose as a dwelling for his Name and say to the priest in office at the time…‘…He brought us to this place and gave us this land, a land flowing with milk and honey; and now I bring the firstfruits of the soil that you, Lord, have given me.’ Place the basket before the Lord your God and bow down before him. Then you and the Levites and the foreigners residing among you shall rejoice in all the good things the Lord your God has given to you and your household.”

The Israelites were not only to give their first fruits upon entering the promised land, but also to make a habit of it. Israel’s annual festivals included first fruits giving. Most notable among these was the Feast of Shavuot or Pentecost, also called the Festival of First Fruits, at which time Jewish families gave their initial harvest (or first fruits) of wheat, barley, figs, grapes, pomegranates, olive oil and dates. Oftentimes these offerings were loaded on to oxen carts, and the oxen were adorned with garlands as they traveled toward Jerusalem. Music and parades accompanied these carts as they made their way through villages. Giving these gifts was an act of joyous thanksgiving, not begrudging obligation.

We read about first fruits in Proverbs 3:9-10 as well: “Honor the Lord with your wealth, with the firstfruits of all your crops; then your barns will be filled to overflowing, and your vats will brim over with new wine.”

Our gifts should be given from our first and best, not from our leftovers. God wants the prime rib, not the leftover bone and gristle. When we find a warning about giving God less than our best, we are wise to heed it, as we see in the Scriptures below. www.cmda.org | 21

“Set apart for the Lord your God every firstborn male of your herds and flocks. Do not put the firstborn of your cows to work, and do not shear the firstborn of your sheep…If an animal has a defect, is lame or blind, or has any serious flaw, you must not sacrifice it to the Lord your God” (Deuteronomy 15:19-21). “‘When you bring injured, lame or diseased animals and offer them as sacrifices, should I accept them from your hands?’ says the Lord. ‘Cursed is the cheat who has an acceptable male in his flock and vows to give it, but then sacrifices a blemished animal to the Lord. For I am a great king,’ says the Lord Almighty, ‘and my name is to be feared among the nations’” (Malachi 1:13-14).

So how does all this apply to the student, trainee or early career Christian healthcare worker? If this is your life circumstance, we would encourage you to commit to giving the first fruits of your career to God. He has entrusted you with an incredible set of skills. Begin your career with a mindset to give back to God. This establishes a practice that lines up with the reason most of us went into healthcare in the first place! The First Fruits initiative is not prescriptive, but rather it asks our younger colleagues to earnestly seek God as they transition from school and training to their first job.

Perhaps He’s calling you into long-term foreign service. Perhaps it’s serial short-term trips for two months a year to teach residents at a facility in south Asia. Perhaps it’s working at a Christian Community Health Fellowship (CCHF) clinic here in the U.S. In giving your time and talent to God, you demonstrate your gratitude for your blessings and faith for God to continue to be your provider in the future.

It’s also worth noting that with more than 320 campus chapters at professional schools around the country, and our recently launched Horizons e-newsletter and ministry to undergraduates, CMDA is in a unique position to bring this First Fruits challenge to the next generation of Christian healthcare workers. We can’t wait to see what God has in store. We hope you’ll be a part of it!

On the other end of the career spectrum, Capstone looks to mobilize later career workers into healthcare missions. A number of healthcare professionals in their 50s and 60s find themselves with bandwidth they lacked in prior years to get involved.

Might this be you? Perhaps your kids are grown, your debts are paid down and your clinical practice has some flexibility, but you still have tread on your tires. Perhaps you wonder how God might use you in a different way from your previous work in a clinic or hospital. Amazing opportunities exist to utilize your skills for kingdom purposes! While youth is celebrated and ag22 | CMDA TODAY | SPRING 2022

ing is not in the U.S., gray hair and balding heads are viewed as assets, not liabilities, in other parts of the world. Even if you’ve never been on a mission trip before, your clinical and life experience could truly be an incredible asset to communities and facilities in desperate need of healthcare professionals like you.

Might you be willing to give a few years to help get a residency established or strengthened in Africa? Could you do serial short-term trips to the same facility a few times each year to provide education to staff and a respite for the long-term missionaries who are there? Could you lead a Global Health Outreach team or join Medical Education International’s Advisory Council? Would you give 25 percent of your time to a Christian free clinic or crisis pregnancy center here in the U.S. instead of working at full tilt clinically until retirement, so you can max out your earnings? Would you consider shifting your goals and timeline to heed Jesus’ call to help the poor, the outcast, the marginalized and the lost? While participating in Capstone might require some adjustments, we read about different seasons of life in Ecclesiastes 3, and retirement is not one of them. As is the case with First Fruits, Capstone is not seeking to be prescriptive or one size fits all. Rather, it’s a challenge to CMDA members to commit themselves fully to kingdom work, perhaps in a different way than they did earlier in their careers.

If this article resonates, would you consider a next step? Pray and fast. Talk with your spouse or friend. Then visit www.cmda. org/cahm to indicate your interest. Doing so is not a promise or

a commitment, but it will help us connect you with resources to further explore how God might be leading you in this area.

If you’re interested in learning more about opportunities to serve, would like to set up a Zoom meeting to talk about your options or have any questions, please reach out to cahm@cmda. org. We’d love to be a part of your First Fruits or Capstone journey!

Doug Lindberg, MD, has served at CMDA as the Director for the Center for Advancing Healthcare Missions since 2020. He attended Loyola University, Chicago for medical school, completed a family medicine residency at Waukesha Family Practice Residency and then completed a one-year rural health fellowship at East Tennessee State University. The Lindbergs served in Nepal as missionaries from 2009 to 2013, and Doug served as the medical director at HDCS-TEAM Hospital in Dadeldhura. They returned to the U.S. in 2013 for what was intended to be a one-year furlough. However, a series of unexpected events, including his wife’s life-threatening cancer diagnosis followed by her miraculous healing, led them to relocate back to Wisconsin where they continue to reside. In addition to his work with CMDA, Doug works part-time clinically in urgent care. He and his wife Ruth are both family physicians, and they have two children, Maddie and James. He also enjoys running, hiking and coaching his son’s baseball team, and he serves as an elder at Elmbrook Church.

Order this book today!

from littlepeoplebook.com or Amazon “The moral uncertainty and apathy in our society to the plight of unborn children springs from our failure to identify them as real people.”

As a Board Certified Family Practitioner who has delivered 1500 babies, Dr. John Hey provides captivating vignettes from his 50 year-long practice, experiences that brought him to understand that these Little People are precious to God, protected by God, and deserve to be treated with the dignity, care, and legal protections afforded to all those who have already been born.

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www.cmda.org | 23

CMDA Ethics Statement EARN CONTINUING EDUCATION CREDITS See page 26

TRANSGENDER IDENTIFICATION PREAMBLE

A novel way of thinking about one’s body has entered into popular culture. “Transgender” individuals refer to their “gender” as a sexual identity that may be male or female, something in between, or neither.

This self-identification differs from, and takes priority over, their biological sex as recognized in their chromosomal DNA and innate physical sexual characteristics. The naming of gender as a category set apart from sex is an idea foreign to the holistic view of the person as understood within Christianity.

Christians affirm the biblical understanding of humankind as having been created male and female, with the two sexes having equal dignity and a complementary relationship to each other.

At the heart of disagreement over transgenderism is a difference in worldviews. If the human body is nothing more than the product of mindless, random, purposeless physical forces, then one may do with it what one wishes, even to demand medical and surgical cooperation in projects to alter, amputate, or reconstruct normal tissue to conform to the patient’s revised psychological sense of identity. If, on the other hand, our bodies are an inseparable aspect of our true selves and are a good gift from God, who has designed the sexes to be wonderfully paired, and who has a purpose for humanity, then respecting the gift of given sexual identity and the ensuing moral obligations to our neighbors is the surest path to human flourishing.

Both worldviews share the recognition that humanity is broken and in need of renewal, but they look to different answers for healing. Christians seek not a reconfiguring of the body, but a spiritual transformation of the mind to become more like Christ; not rejecting the gifts of God, but welcoming God’s purposes and demonstrating God’s love by loving our neighbors. This love of neighbors includes loving our transgender neighbors as persons who, like all people, are created in God’s image. However, loving them and validating them as people does not mean agreeing with their ideologies or use of language.

The Christian Medical & Dental Associations (CMDA) believes that healthcare professionals should not be forced to violate their conscientious commitment to their patients’ health and welfare by being required to accept and participate in harmful gender-transition interventions, especially on the young and vulnerable. CMDA affirms the obligation of Christian healthcare professionals caring for patients struggling with gender identity to do so with sensitivity and compassion, consistent with the humility and love that Jesus modeled and commanded us to show all people.

INTRODUCTION

CMDA affirms that all human beings are created in the image of, and beloved by, God. All human beings are our “neighbors”, 24 | CMDA TODAY | SPRING 2022

LEARN MORE This article is now available for continuing education credits in the online CMDA Learning Center. To learn more, visit www.cmda.org/learning.

and are to be loved by us as we love ourselves. All human beings possess intrinsic dignity and are worthy of equal respect and concern from Health Care Professionals.

CMDA considers “sex” (i.e., male or female) to be an objective biological fact (see section B.1. below). CMDA affirms the historic understanding of gender as referring to biological sex and the enduring biblical understanding of humankind as having been created male and female and that this is good. CMDA acknowledges the current cultural use of the word “gender” to refer to one’s sense of identity as male or female. CMDA cannot support the recent usage of the term “gender” to emphasize an identity other than one’s biological sex, that is, a subjective sense of self based on feelings or desires leading to identifying somewhere on a fluid continuum of gender identity.1,2,3,4 (See Glossary at the end of this document) CMDA cannot support the prevailing culture’s acceptance of an ideology of unrestrained sexual self-definition that, in celebrating gender fluidity and gender transition efforts, is indifferent to biological reality and opposed to the biblical understanding of human sexuality. Further, CMDA is alarmed that some proponents of transgender ideology, through activism and intimidation, are insisting that healthcare professionals cooperate with and affirm their beliefs in gender fluidity, even if the healthcare professionals believe that such cooperation and affirmation would be doing harm to their patients. This violates the most fundamental core value of medicine since Hippocrates, that of caring only for the good and benefit of the patient while abstaining from all unnecessary harm. The evolving scientific and medical facts demonstrate that the mutilation of normal tissue and profound disruption of normal physiology that occur during

gender transition procedures are very difficult to justify, as this constitutes deliberate harm.

CMDA affirms the obligation of Christian healthcare professionals caring for patients struggling with gender identity to do so with sensitivity and compassion. CMDA holds that attempts to radically reconstruct one’s body surgically or hormonally for psychological indications, however, are medically, ethically, and psychologically inappropriate. These measures alter healthy tissue and increasingly are not supported by scientific research evaluating behavioral, medical, and surgical outcomes.5,6,7,8,9,10,11 Accordingly, CMDA opposes medical assistance with gender transition on the following grounds:

A. BIBLICAL

1. God created humanity as male and female (Gen 1:27, 5:2; Matt 19:4; Mark 10:6). God’s directives – to have dominion over the earth and to fulfill his goals of procreation, union, fellowship, and worship – are given to men and women together (Gen 1:26-28, 2:18-24).

2. Men and women are morally and spiritually equal (Gal 3:28) and are created to have roles that are in some respects alike and in other respects wonderfully complementary (Eph 5). (See CMDA Statement on Human Sexuality) 3. All people are loved by God ( John 3:16-17). All struggle with moral failure and fall short of God’s standards (Rom 3:10-12) and, therefore, need the forgiveness that God provides through Christ alone ( John 3:36; Rom 3:22-24; Col 1:15-22; 1 Tim 2:5-6).

4. For the Christian, all of ethics, grounded in God’s moral law, is based upon the first and second greatest commandments: to love God with all our heart, soul, and mind, and to love our neighbors as ourselves (Matt 22: 37-40). If we encourage others to sin sexually, just as if we sin sexually ourselves, we are violating these two commandments. We violate the first greatest commandment by failing to love God in his holiness, wisdom, and rightful place as our Creator, and we violate the second greatest commandment as we fail to respect ourselves and each other by abetting lives of disobedience, deception and unholiness (1 Cor 6: 13b-20). Love may include a corrective component that should be applied in an appropriate and timely manner; affirmation can be enablement.

5. We live in a fallen world (Gen 3), and we all come into this world as fallen creatures with a sinful nature. (Rom 3:9-12). The fall is expressed in nature and in humanity in many ways, including sexuality. Confusion of gender identity is but one example of the fall, as are also marital breakdown and sexual immorality (Rom 1:24-32; Eph 5:3).

6. A lifestyle that is directed by pursuing sexual desires, or driven by personal sexual fulfillment, misses the divinely ordained purpose of sex, which is for procreation, bond creation, and re-creation12 and for facilitating unity in the lifelong commitment of marriage, which is defined as being between one man and one woman. Heterosexual marriage fosters a secure and nurturing environment for children and it reflects the unity of Christ and the Church

(Exod 20:1-18; Lev 20:10-21; Rom 1; Eph 5:23-33) (see also CMDA Statement on Homosexuality).

7. Believers in Christ, though having inherited the sinful nature common to all humanity, also receive a new nature in Christ. As the old nature, being crucified with Christ, dies, our new redeemed nature, sealed by Christ’s bodily resurrection, is actively transforming our minds and hearts to be more and more like Christ. This transformation is spiritual, not sexual, and is God’s work, not something of our own design (Psalm 100:3; Rom 12:2; Col 1:27).

B. BIOLOGICAL

1. Sex is an objective biological fact that is determined genetically at conception by the allocation of X and Y chromosomes to one’s genome, is observable at birth, is found in every nucleated cell, and is immutable throughout one’s lifetime. Sex is not a social construct arbitrarily assigned at birth and cannot be changed at will.2,3,13 2. Human beings are sexually dimorphic. Male and female phenotypes are the outworking of sex gene expression, which shapes sex anatomy, determines patterns of sex hormone secretion, and influences sex differences in the development of the central nervous system and other organs.2,3,14 3. Procreation requires genetic contributions from both one man and one woman.15,16 4. CMDA recognizes that exceedingly rare congenital abnormalities exist in which phenotypic sex characteristics are not what is expected from the genotype.1,2 These disorders of sex development are of a diverse nature, but usually impair fertility.3 Treatment (including nonintervention) of these disorders differs categorically from transgender interventions, which are performed on persons with no inherent defect in sex organ development, function, or fertility. Anomalies of human biological sex are conditions rather than identities, something one has rather than who one is.4 Disorders of sex development are not the fault of the patient, do not invalidate God’s design in creation, and do not constitute a third sex.17,18,19,20 5. Gender dysphoria21, the condition of experiencing discomfort or distress at one’s sex and preferring a different “gender” identity, has not to date been linked to a genetic cause and is a psychological disorder of unclear and complex origin.22,23,24 Gender dysphoria may cause profound distress. It should not be confused with transient genderquestioning that can occur in early childhood.25,26,27,28,29,30

C. SOCIAL

1. CMDA recognizes that gender identity issues are complex. The inclination to identify with the opposite sex or as some other gender identity along a spectrum may have non-genetic biological,31 familial,32,33 and social27,28,34 causes that are not personally generated by particular individuals.21-30 2. In our current social context, there is a prevailing view that removing traditional definitions and boundaries is a requirement for self-actualization. Thus, Christian healthcare professionals find themselves in the position of being at variance with evolving views of gender identity in which patients or their subcultures seek validation

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EARN CONTINUING EDUCATION

2.0 HOURS NOW AVAILABLE e are now offering continuing education W credits through CMDA Today. 2.0 hours of selfinstruction are available.

To obtain continuing education credit, you must complete the online evaluation at https://www.pathlms.com/cmda/courses/39311.

Continuing education for this article is FREE to CMDA members and $80 for non-members.

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

Review Date: January 11, 2022 Original Release Date: March 1, 2022 Termination Date: February 28, 2025

EDUCATIONAL OBJECTIVES

· Discuss the medical basis for discouraging the use of puberty blockers, cross-sex hormones, and surgical intervention to alter normal sexual anatomy. · Discuss the importance of competent and compassionate care of individuals suffering from gender dysphoria. · Describe how to integrate an approach to the treatment of gender dysphoria that avoids discrimination while also aligning with a biblical worldview. · Discuss ways to defend against being forced to assist patients in gender transition.

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 2 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(s)™ from organizations accredited by the ACCME. Individuals are responsible for checking with the AANPCP for further guidelines. Nurse practitioners may receive up to 2 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 2 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 1/1/2019 to 12/31/2022. Provider ID#218742. 2 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); Mandi Morrin, Editor; Barbara Snapp, CE Administrator; Sharon Whitmer, EdD, MFT; CE Committee Members; and CE Committee Dental Members.

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.

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by medical professionals of their transgender desires and choices through medical or surgical solutions to gender dysphoria. Although such desires may be approved by society at large, they are contrary to a biblical worldview and to biological reality and thus are disordered.

3. In contrast to the current culture, CMDA believes that finding one’s identity within God’s design will result in genuine human flourishing. CMDA believes, moreover, that social movements which assert that gender is a choice are mistaken in defining gender as something independent of sex. Authentic personal identity consists in social gender expression that is congruent with one’s natural biological sex but not limited to stereotypes.

CMDA recognizes that this traditional view has become counter-cultural; however, CMDA affirms that God’s design transcends culture.

4. CMDA opposes efforts to impose transgender ideology on all society by excluding, suppressing, marginalizing, intimidating, or portraying as hateful those individuals and organizations that disagree on scientific, medical, moral, or religious grounds. Such attacks are contrary to the freedoms of speech and religious liberty that lie at the very foundation of a just and democratic society.

5. There is a social contagion phenomenon luring young people into the transgender culture.32,33 6. CMDA opposes efforts to compel healthcare professionals to grant medical legitimacy to transgender ideologies.35,36,37,38,39,40 Cooperation with requests for medical or surgical gender reassignment threatens professional integrity by undermining our respect for biological reality, evidence-based medical science, and our commitment to non-maleficence (see CMDA Statement on Healthcare Right of Conscience).

7. Promotion of transgender ideology by educational institutions and teachers to children as young as 5 years of age is a danger to the health and safety of minor children (for medical reasons elaborated in the next section).41,42,43,44,45,46,47 Education should respect the value of every human being; in supporting and affirming the student, it need not affirm every desire.

8. No educational institution or teacher should ever block parents from supervising their child’s education or withhold from them knowledge of the educational content.

D. MEDICAL

1. Transient gender questioning can occur during childhood.

Most children and adolescents who express transgender tendencies eventually come to identify with their biological sex during adolescence or early childhood.48,49,50,51,52,53 There is evidence that gender dysphoria is influenced by psychosocial experiences and can be exacerbated by promoters of transgender ideology.27,33 Early counseling for children expressing gender dysphoria is critical to treat any underlying psychological disorders, including depression, anxiety, or suicidal tendencies, and should be done without promoting attempts for gender transitioning.

2. Hormones prescribed to a previously biologically healthy child for the purpose of blocking puberty inhibit normal growth and fertility, cause sexual dysfunction, and may aggravate mental health issues. Continuation of cross-sex

hormones, such as estrogen and testosterone, during adolescence and into adulthood, is associated with increased health risks including, but not limited to, high blood pressure, blood clots, stroke, heart attack, infertility, and some types of cancer.51,54,55,56,57,58,59,60 3. Although some individuals report a sense of relief as they initiate the transitioning process, this is not always sustained or consistent over time. Some patients regret having undergone the transitioning attempt process and choose to detransition, which involves additional medical risk and cost.56,61,62,63,64 4.

Among individuals who identify as transgender, use cross-sex hormones, and undergo attempted gender reassignment surgery, there are well-documented increased incidences of depression, anxiety, suicidal ideation, substance abuse, and risky sexual behaviors in comparison to the general population.21,22,23,61,65,66,67 These health disparities are not prima facie evidence of healthcare system prejudice. These mental health co-morbidities have been shown to predate transgender identification.24,25,26,27,28,34,68 Patients’ own gender-altering attempts and sexual encounter choices (or, in the case of children, their parents’ choices on their behalf ) are among the factors relevant to adverse outcomes in transgender-identified patients.

5. Although current medical evidence is incomplete and open to various interpretations, some studies suggest that surgical alteration of sex characteristics has uncertain and potentially harmful psychological effects and can mask or exacerbate deeper psychological problems.7,8,9,69 Evidence increasingly demonstrates that there is no reduction in depression, anxiety, suicidal ideation, or actual suicide attempts in patients who do undergo surgical transitioning compared to those who do not.7,70 The claim that sexreassignment surgery leads to a reduction in suicide and severe psychological problems is not scientifically supported.64,71,72,73 6. A patient has died because the medical records conveyed only the individual’s gender preference, and not their biological sex, leading to misdiagnosis and medical catastrophe.74

E. ETHICAL

1.

Restoring and preserving physical and mental health are goals of medicine, but assisting with or perpetuating psychosocial disorders are not. Accordingly, treatment of anomalous sexual anatomy is restorative.75 Interventions to alter normal sexual anatomy and physiology to conform to identities arising from gender dysphoria are disruptive to health.9,76 2. Medicine rests on science and should not be held captive to desires or demands that contradict biological reality.

Sex reassignment operations are physically harmful because they disregard normal human anatomy and function. Normal anatomy is not a disease; dissatisfaction with natural anatomical and genetic sexual makeup is not a condition that can be successfully remedied medically or surgically.

3. The medical status of gender identity disorder (currently termed gender dysphoria) as a mental or psychosocial disorder should not be discarded.

4. The inability of men, including men who identify as women, to bear children is not an illness to be remedied by medical or surgical means, such as uterine transplantation.77 Uterine transplantation into biological men cannot be justified medically (See CMDA Statement on Enhancement and CMDA Statement on Transplantation).

5. Fundamentally, it is unrealistic to remove or mutilate normal organs and tissue and to disrupt normal physiology, and then to expect normal function. This illustrates the reality that complete gender transitioning is not medically possible.

6. Christian patients struggling with transgender inclinations face not only the psychological distress of a desire for a gender identity different from their biological sex, but may also face the spiritual distress that comes to anyone who follows a path in life that departs from God’s design for humanity. Hormonal or surgical interventions cannot resolve spiritual distress but may lead to further spiritual turmoil. These, our neighbors, need and deserve the spiritual, psychological, and social support of the Christian community.

7.

CMDA is especially concerned about the increasing phenomenon of parents enabling their gender-questioning children or adolescent minors to receive hormones to inhibit normal adolescent development. Children and adolescents lack the developmental cognitive capacity to assent or request such interventions, which have lifelong physical, psychological, and social consequences.56 Facilitating hormonal or surgical transitioning interventions for those who have not reached the age of majority is a form of child endangerment and abuse.64 Highly affirming parents have been shown to not improve the mental health statistics of transgender-identified children.78 8. Many diseases affect men and women differently, according to biological sex phenotype. Transgender designations may conceal biological sex differences relevant to medical risk factors, the recognition of which is important for effective healthcare and disease prevention. As accurate documentation is necessary for good patient care, healthcare professionals should document the patient’s biological sex and any alterations of gender characteristics in the medical record.2,13,54,57,79,80,81 It is appropriate and should not be interpreted as disrespectful for healthcare professionals to discuss their patients’ biological sex with them as part of their medical care.80,81 9. For the overall health of the patient, the healthcare professional should be forthright with the patient that addressing the individual’s sexual reality is necessary for appropriate medical care and should not be interpreted as disrespect.

CMDA Recommendations for the Christian Community

1. A person questioning or struggling with gender identity should evoke neither scorn nor enmity, but rather the Christian’s concern, compassion, help, and understanding. Christians must respond to the complex issues surrounding gender identity with grace, civility, and love.

2. Christians should avail themselves of opportunities to help the

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larger society understand that male/female sexes are complementary and permanent. Both are good and part of the created order. For the reasons elaborated above, CMDA believes that attempting to define gender as fluid and changeable through technical means will have grave spiritual, emotional, cultural, and medical repercussions.

3. The Christian community, beginning with the Christian family, must resist stereotyping or rejecting individuals who do not fit the popular norms of masculinity and femininity. At the same time, parents should guide their children and adolescent minors in appropriate gender identity development. For children and adolescents experiencing gender dysphoria, the Christian community should provide appropriate role models and biblically informed guidance.

4. The Christian community must condemn hatred and violence directed against those struggling with questions of gender identity.

5. Since Christians are to love their neighbors as themselves, they are to love those struggling with gender dysphoria or incongruence of desired gender with biological sex. Love for the person does not condone or facilitate gender transitioning treatments.

6. In obedience to God who commands his followers to love one another, and for the sake of the common good, Christians should welcome inclusion of transgender-identified individuals into their communities, as we are all broken and sinners, not more or less valuable than each other. Transgender-identified individuals have the same rights shared by all other humans.

We oppose granting special rights and privileges based on transgender identification. These special rights can negatively impact the rights of others (e.g., bathroom designations that allow biological males access to shared female restrooms or showers, female athletic competitions that give participating biological males an unfair physiologic advantage, affirmative actions, or claims for unnecessary medical interventions).

7. The Christian community is to be a refuge of love for all who are broken – including the sexually broken – not to affirm their sin, nor to condemn, but to shepherd them to Jesus, who alone can forgive, heal, restore, and redirect to a godly, honorable, and virtuous way of life. God provides the remedy for all moral failure through repentance and faith in Jesus Christ and the life-changing power of the Holy Spirit. Though healing may be incomplete on earth, the promise of complete healing for those who are in Christ will ultimately be fulfilled in heaven.

CMDA Recommendations for Christian Healthcare Professionals

1. CMDA advocates that all Christian healthcare professionals provide ethically and medically competent care to all patients, including those who identify as transgender. Such care requires compassion, an open and trusting dialogue, a genuine effort to understand and respond to the patient’s psychological distress when present, and acceptance of the person without agreeing with the person’s ideology or providing a requested sex-altering intervention.

2. CMDA believes that the appropriate medical response to patients with gender dysphoria is to help them understand that they are people God loves and who are made in his image, even when their choices cannot be validated. Christian healthcare

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professionals should validate their right as individuals in a free society to make decisions for themselves. This right, however, does not extend to obligating Christian and other healthcare professionals to prescribe medication or perform surgical procedures that are harmful (see CMDA Statement on Healthcare Right of Conscience).

3. CMDA believes that Christian healthcare professionals should not initiate hormonal and surgical interventions that alter natural sex phenotypes. Such interventions contradict one of the basic principles of medical ethics, which is that medical treatment is intended to restore and preserve health, and not to harm.

4. CMDA believes that prescribing hormonal treatments to children or adolescents to disrupt normal sexual development for the purpose of attempting gender reassignment is ethically impermissible, whether requested by the child, the adolescent, or the parent (See CMDA Statement on Limits to Parental Authority in Medical Decision-Making, and CMDA Statement on Abuse of Human Life).

5. Supporting a patient’s pursuit of gender transitioning procedures is neither loving nor the best means to help that individual who is experiencing gender dysphoria.

CMDA Recommendations Regarding Nondiscrimination

1. Mutual respect and civil discourse are cornerstones of a free society, and so is truthfulness. In the context of health care, identification of sex and gender has both interpersonal and medical implications. In regard to medical documentation, the medical record should document the sex observed at birth even when the patient expresses a different gender preference or has obtained a legal change in gender status.

2. Christian healthcare professionals, in particular, must care for their patients with gender identity disorders in a non-judgmental and compassionate manner, consistent with the humility and love that Jesus modeled and commanded us to show all people. When questioning transgender ideology, Christian healthcare professionals should do so with an attitude of humility and love.

3. Those who hold to a biblical or traditional biological view of human sexuality, including CMDA members, should be permitted to question transgender ideology free from exclusion, oppression, or unjust discrimination. Healthcare professionals who hold the position that transgender identification is harmful and inconsistent with the will of God should not be stigmatized or accused of being bigoted, phobic, unprofessional, or discriminatory because of their desire to adhere to biological and medical reality as a sincerely held (and widely shared) belief.

4. To decline to provide a requested gender-altering treatment that is harmful, or is not medically indicated, does not constitute unjust discrimination against persons. CMDA affirms that Christian and other healthcare professionals should not be coerced or mandated to provide or refer for services they believe to be morally wrong or medically harmful to patients (See CMDA Statement on Healthcare Right of Conscience).

5. Healthcare professionals must not be prevented from providing counseling and support to patients with gender dysphoria and who request assistance with accepting and maintaining their biologic sex and gender identity.

GLOSSARY

PERSON AND IMAGE OF GOD

According to the Bible, human persons (as opposed to divine and angelic persons) are embodied from conception onward. At conception, at least one genetically unique human person is formed (twinning may occur during the first two weeks of pregnancy). So the psalmist offers a hymn to God in Psalm 139, “you created my inmost being, you knit me together in my mother’s womb. I praise you because I am fearfully and wonderfully made; your works are wonderful, I know that full well. My frame was not hidden from you when I was made in the secret place, when I was woven together in the depth of the earth, Your eyes saw my unformed body; all the days ordained for me were written in your book before one of them came to be” (13-16 NIV). Human persons are, however, the only persons who are made in the imago Dei (image of God). Thus, Jesus—fully God and fully human—is “image of the invisible God, the firstborn over all creation” (Colossians 1:15). Likewise, according to Genesis, “God created mankind in his own image, in the image of God he created them, male and female he created them” (Genesis 1:27).

SEX

Human sex and sexuality are aspects of God’s good, well-ordered creation. From the beginning he made humans sexual beings (Genesis 2:15-25). Humans are sexual beings who procreate through sexual reproduction. Sex is objective, identifiable, immutable, determined at conception, stamped on every nucleated cell, and highly consequential. 82,83,84,85 There are 2 sex cells or gametes, sperm and ova. There is no third. Human fallenness incurred pervasive distortions in humanity, including disorders of sexual biology, none of which limits either God’s love for each of us, or the inestimable value of creation in His image.

SEXUALITY

Human sexuality is a “very good” component of God’s well-ordered creation (Genesis 2:15-25). Sexuality is a broad and easily confusing term usually requiring contextualization for clear communication.

As noted by McHugh and Mayer, sexuality incorporates desires, attractions, behaviors, and/or identity.16 Furthermore, sexuality may vary regarding timing, intensity, consistency, and exclusivity. Its elements may be sporadic, temporary, pervasive, or long-term. Sexual expression may be healthful or unhealthful.

Because of human fallenness, sexuality has become disordered.

The goods of sexuality are often distorted by pathologies in biology, psychology (e.g., sexual addiction or adultery), and society (e.g., sexual revolution and polyamory). Redeeming sex requires the reordering of human desires and practice. Celibacy outside of marriage, sexual fidelity within heterosexual marriage between one man and one woman, and the presumption in favor of procreation are ways human sex and sexuality may be redeemed.

CHRISTIAN WORLDVIEW

A worldview is a way of seeing and understanding the phenomenon of the world around us. Like lenses of eyeglasses, one’s worldview provides a set of interpretive assumptions that enable us to make sense of our experience. One’s worldview is how one answers the big questions of life, such as: Is the world real? What is the nature of reality? Is there a God? What can we know about God? How do I know anything at all?

Is matter all there is? Is there a supernatural? The orthodox Christian worldview is grounded on certain theological affirmations found in the Bible, which Christians believe to be the revealed word of God, and summarized in the great confessions in the history of Christianity, for instance, in the Nicene (325 AD) and Apostles (390 AD) Creeds.

THE FALL AND HUMAN FALLENNESS

Rather than remaining faithful to God’s will and purposes, Adam and Eve fell from their original righteous state through disobedience (i.e., sin). Their sin brought with it not only immediate deleterious consequences for them (Genesis 3), but for the entire created order thereafter. Those well-ordered desires to love God and love another have become disordered by human depravity. Love for God and others was replaced with hatred, envy, and murder (as in the case of Cain and Abel). The goods of honest labor were turned into toil and struggle in a creation that is now filled with corruption, death, disease, pain, and hardship. After the fall, human beings are born with a propensity to disobedience, selfishness, and sin.

INTRINSIC DIGNITY

Because human beings are made in God’s image, they possess an

intrinsic dignity. They should never be used as a means to an end, but as ends in themselves. Their lives have sacred value and they should not be harmed without just cause. This dignity is intrinsic and equal for all human beings, not varied and dependent on level of function, cognitive or physical, presence of absence of injury or disability, age, or other traits or features for which human beings tend to impute upon others value or worth. Human dignity has been the foundation of Western ethics and jurisprudence and has been enshrined in secular language in the Nuremberg Code and global treaties in science, medicine, and public policy since that time.

LOVE

Christians are called to love God with all their hearts, souls, minds, and body and to love their neighbors as themselves (Deut 6:5; Lev 19:18; Mark 12:29-31). Love is a disposition of heart and life that impels one person to treat another person with respect and dignity quite apart from ethnicity, economic, social status, or what the individual can exploit or receive from the other. Furthermore, love seeks the best for another individual without the expectation any kind of recompense or remuneration.

HOLINESS

With respect to God, holiness is the supreme attribute of all of God’s attributes, setting the God of the Bible apart from all other deities. The Triune God is holy in his love, righteousness, justice, wrath, and mercy (among other attributes). With respect to human beings and objects, holiness is being set apart for sacred use (as with the Old Testament Temple). Christian holiness is the aspiration to live a life “set apart” from the corruptions of the world, and instead committed to fidelity, trust, and dependence on God, patterning ourselves after Jesus Christ.

REPENTANCE

Repentance is a response to the recognition of harm done, either by commission or omission. The word used in the New Testament (metanoia) means to “turn and go in the other direction.” To repent, then, is to acknowledge one’s sin and turn back toward God. Turning back toward God may include ceasing to perform or pursue sinful acts, reconciling with those who have been harmed, or restoring items or relationships that have been damaged through one’s behavior.

Repentance is not a one-time event, but a disposition of character.

FAITH

Faith is the virtue of trust and dependence on God and his promises, believing and acting in ways consistent with that confidence (Hebrews 11).

SEXUAL ORIENTATION

Orientation essentialism – the belief that a person has a given sexual orientation, be it innate or resulting from various combinations of biology and environment -- is an ideological position that has gained strong purchase in modern culture.

Per academics McHugh and Diamond, polar opposites in many ways: Psychiatry professor Paul McHugh states, “Sexual orientation is a complex and amorphous phenomenon . . . . There is no scientific consensus on how to define sexual orientation, and the various definitions proposed by experts produce substantially different classes.83 Psychology professor Lisa Diamond, “There is currently no scientific or popular consensus . . . that definitively ‘qualify’ an individual as lesbian, gay, or bisexual.”85 Genetic essentialism, like its orientation counterpart, is similarly ideological.

• In a 2011 Psychological Bulletin Dar-Nimrod and Heine define genetic essentialism as, “The tendency to infer a person’s characteristics and behaviors from his or her perceived genetic makeup” (p. 801).84 “Much of the ways that genes relate to human conditions can be described as weak genetic explanations” (p.

802).

• Eric Turkheimer of UVA states, “…the amount of influence that genes have on behaviors is considerably smaller than one might think.”84 And, “…genetic essentialists were wrong about gay genes and similar nonsense.”³ Diamond and Rosky: “In essence, the current scientific revolution in our understanding of the human epigenome challenges the very notion of being “born gay,” along with the “born” with any complex trait. Rather, our genetic legacy is dynamic, developmental, and environmentally

embedded.”85

SAME-SEX ATTRACTION

Sexual attraction to members of the same sex. The propensity and degree may vary from near exclusive to occasional attraction, and is shown to potentially change over time. It does not preclude the same individual from experiencing varying degrees of attraction to members of the opposite sex.

FORNICATION

Per theologian Robert Gagnon “fornication,” likewise porneia in Greek, is frequently an overarching reference to sexual sin as defined in Torah. In more common usage, fornication is sexual intercourse between two people not married to each other. Sex between male and female is implied in the term’s reference to anatomy, fornix being the curved vaginal recess created by the cervix and the term also being Latin for “arch.”

Fornication is separate from adultery or rape.

TEMPTATION

A trial, being put to the test.

It is not yet sin, but an invitation to it.

Jesus “was in all points tempted as we are, yet without sin.”

Hebrews 4:15.

It is inherent to the fallen human condition.

“No temptation has overtaken you except such as is common to man; …” I Corinthians 10:13.

God tests individuals.

Abraham (Genesis 22:1), Job (Job 23:10), I Corinthians 11:32,

Hebrews 12:4-11, etc.

Satan tempts individual to sin.

Matthew 4:3, I Thessalonians 3:5.

God provides means of rescue. “then the Lord knows how to deliver the godly out of temptations…”

2 Peter 2:9. “…but God is faithful, who will not allow you to be tempted beyond what you are able, but with the temptation will also make the way of escape, that you may be able to bear it.” I Corinthians 10:13.

Scripture describes temptation as something to be avoided if possible: “And do not lead us into temptation…” Matthew 6:13.

“Watch and pray, lest you enter into temptation.” Mark 14:38.

SEXUAL FANTASY - WHEN DOES IT CROSS INTO SIN?

Temptation is not yet sin. Everyone has a sex drive and the duty to manage it.

Experiencing sexual thoughts is not yet fantasy, or lust, unless willingly pursued. Some have compared the appearance of sexual thoughts to a bird flying over one’s head, thus out of our control; and fantasy or lust is compared to the equivalent of allowing that bird to build a nest on our head, something clearly in our power to resist.

SAME-SEX ATTRACTION CHASTE LIFE - DOES IT INCLUDE AVOIDANCE OF KISSING? IS THIS EQUAL TO HOMOSEXUAL CELIBACY?

This is a multi-faceted question.

1. Scripture speaks of greeting each other with “a holy kiss” (Romans 16:16, I Corinthians 16:20), which is a salutation, something non-sexual.

Greeting with a kiss is a pervasive practice in the general cultures of several nations to this day.

2. The kissing implicit in the stated question is sexual, romantic.

There is no part of homosexual practice that is endorsed in scripture; it is condemned without exception.

3. Though we mean abstinence from homosexual practices when we say, “homosexual celibacy,” the application of the term “celibate” to same-sex sexual practice is Biblically problematic. Lifetime celibacy is referred to as a “gift” by the Apostle Paul in I Corinthians 7:7-9.

A Celibate person is giving up the God-ordained institution of marriage (exclusively between one man and one woman in scriptural standards) along with its God-ordained sexual practice. God gifts, or graces, that person with something else God-ordained in its place.

But a person setting aside same-sex sexual practice is abstaining from or repenting of a sinful practice, which is both commanded and its own benefit. We wish to avoid canonizing homosexual temptation.

SAME-SEX LIFESTYLE

The willing practice of same-sex sexuality.

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GAY CULTURE

Any assemblage of like-minded people creates a culture. Culture itself is a neutral term that gains a moral dimension in its practice.

Gay culture endorses the ideological concept of gay identity along with its practices.

Scripturally and scientifically, we hold that sexuality is a verb and not just a noun. Gay and straight are category errors and false identities.

Homosexuality by any name is a practice and not an identity, what one does and not who one is.

Likewise, “gay Christian” language canonizes temptation behind a false identity. Any name preceding “Christian” is an implicit priority, contravening Paul’s instruction to the Galatian church (Gal. 3:28).

HOMOPHOBIA, -IC

Homophobia is an ideological and pejorative term that has gained common usage. It is often an accusation made against an individual failing to sufficiently celebrate same-sex sexuality, practices and politics.

But per MayoClinic.org: “A phobia is an overwhelming and

unreasonable fear of an object or situation . . . a phobia is long lasting, causes intense physical and psychological reactions, and can affect your ability to function normally at work or in social settings.”

Disagreement is clearly not a phobia.

Linguistically, “homophobia” is somewhat nonsensical, meaning “fear of the same thing.”

GENDER VS SEX

Sex is biological and stamped on every nucleated cell in a person’s body from conception onward. It is immutable down to the level of brain cells, so it is impossible to have “a man’s brain in a woman’s body,” for example.

Gender, in its common current usage, is an engineered term leveraging linguistics against biology; it is ideological and self-declared.

Historically, however, per theologian Christopher West: “ The root “gen”—from which we get words such as generous, generate, genesis, genetics, genealogy, progeny, gender, and genitals—means

REFERENCES

1. Hyde JS, Bigler RS, Joel D, Tate CC, van Anders SM. The future of sex and gender in psychology: Five challenges to the gender binary. Am Psychol.

2019;74(2):171-193. doi:10.1037/amp0000307 2. Cretella MA, Rosik CH, Howsepian AA. Sex and gender are distinct variables critical to health: Comment on Hyde, Bigler, Joel, Tate, and van Anders (2019). Am Psychol. 2019;74(7):842-844. doi:10.1037/amp0000524 3. Institute of Medicine (US) Committee on Understanding the Biology of Sex and Gender Differences, Wizemann, T. M., & Pardue, M. L. (Eds.).

(2001). Exploring the Biological Contributions to Human Health: Does Sex Matter?. National Academies Press (US).

4. Sullivan, A. (2020). Sex and the census: why surveys should not conflate sex and gender identity. International Journal Of Social Research Methodology, 23(5), 517-524. https://doi.org/10.1080/13645579.2020.176 8346 5. Anckarsäter, H., & Gillberg, C. (2020). Methodological Shortcomings Undercut Statement in Support of Gender-Affirming Surgery. American Journal of Psychiatry, 177(8), 764–765. https://doi.org/10.1176/appi. ajp.2020.19111117 6. Hruz P. W. (2020). Deficiencies in Scientific Evidence for Medical Management of Gender Dysphoria. The Linacre Quarterly, 87(1), 34–42. https://doi.org/10.1177/0024363919873762 7. Dhejne C, Lichtenstein P, Boman M, Johansson AL, Långström N, Landén M. Long-term follow-up of transsexual persons undergoing sex reassignment surgery: cohort study in Sweden. PLoS One. 2011;6(2):e16885. Published 2011 Feb 22. doi:10.1371/journal.pone.0016885 8. Kalin NH. Reassessing Mental Health Treatment Utilization Reduction in Transgender Individuals After Gender-Affirming Surgeries: A Comment by the Editor on the Process. Am J Psychiatry. 2020;177(8):764. doi:10.1176/ appi.ajp.2020.20060803 9. Van Mol A, Laidlaw MK, Grossman M, McHugh PR. Gender-Affirmation Surgery Conclusion Lacks Evidence. Am J Psychiatry. 2020;177(8):765766. doi:10.1176/appi.ajp.2020.19111130 10. Biggs M. Puberty Blockers and Suicidality in Adolescents Suffering from Gender Dysphoria. Arch Sex Behav. 2020;49(7):2227-2229. doi:10.1007/ s10508-020-01743-6 11. Davis SR, Baber R, Panay N, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab.

2019;104(10):4660-4666. doi:10.1210/jc.2019-01603

30 | CMDA TODAY | SPRING 2022

“to produce” or “give birth to.” A person’s gen-der, therefore, is based on the manner in which that person is designed to gen-erate new life.

Contrary to widespread secular insistence, a person’s gender is not a malleable social construct. Rather, a person’s gender is determined by the kind of genitals he or she has.” 86 But ideology does not bow to history. Sex is biology, and gender is ideology.

considered separate and distinct from sex (e.g., “your sex is irrelevant to your gender identity”) in a manner that is quite Gnostic (i.e., the “higher knowledge” that transcends lowly biology).

Therefore, it is best to mean what you say and say what you mean in context. Using phrases like “identified gender,” “identifies as,” “gender incongruence,” “gender dysphoria,” “transgender identified,” etc. work well, don’t surrender reality to a claim, and do not imply agreement.

Gender identity is a feeling, a self-perception, of how one identifies with their biological sex or not, and it is often a sex stereotype. It is subjective, self-declared and fluid. Psychologist Dr. John Money of Johns Hopkins initiated its use in professional journals in 1955, referring to “the identity of the inner sexed self.”87

That depends on the intended usage.

“Transition efforts” or “transition-affirming treatments/procedures” are both quite clear and do not surrender to ideology as compared to terms like “gender-affirming” or “gender confirming” treatments and procedures.

Best terminology for transgender identity?

“Transgender-identified” or “transgender identification” are well understood and non-capitulating.

GENDER IDENTITY

GENDER CONFUSION/DYSPHORIA

Gender identity confusion/dysphoria is a feeling/self-perception that one’s biology is not as one wishes it to be or not as one identifies most comfortably as. Sechner notes, “A gender-dysphoric youth experiences a sense of incongruity between the gender expectations linked to her or his biological sex and her or his biological sex itself.”88 The greater the discomfort/dissonance, the greater the dysphoria.

Gender dysphoria is not synonymous with transgenderism, the latter being an umbrella term within which gender dysphoria fits, but to which transgenderism is not limited.

GENDER - SHOULD WE BE USING THAT TERM OR IS THERE A BETTER TERM? IF SO, HOW IS IT BEST DEFINED?

The answer to that depends on the application and one must be careful.

Gender is an engineered term leveraging linguistics against biology; it is ideological and self-declared. Sex is biological, right down to each human cell containing a nucleus.

Though gender is sometimes used synonymously with sex (e.g., in forms asking if someone is male or female), ideologically it is

12. Giovannetti, B., 2014. Four Letter Words: Conversations On Faith’s Beauty And Logic. San Francisco: Endurant Press, p.178.

13. Bartz D, Chitnis T, Kaiser UB, et al. Clinical Advances in Sex- and GenderInformed Medicine to Improve the Health of All: A Review. JAMA Intern Med. 2020;180(4):574-583. doi:10.1001/jamainternmed.2019.7194 14. 2013. Diagnostic And Statistical Manual Of Mental Disorders. Arlington, VA: American Psychiatric Association, p.829.

15. Tournaye H. Is there any reproductive future left for men?. Facts Views Vis Obgyn. 2012;4(4):255-258.

16. Mayer LS, McHugh PR. Sexuality and Gender: Findings from the Biological, Psychological, and Social Sciences. New Atlantis (2016); 50:10-143. At pp.89-90.

17. Beale JM, Creighton SM. Long-term health issues related to disorders or differences in sex development/intersex. Maturitas. 2016;94:143-148. doi:10.1016/j.maturitas.2016.10.003 18. Sax L. How common is intersex? a response to Anne Fausto-Sterling. J Sex Res. 2002;39(3):174-178. doi:10.1080/00224490209552139 19. Słowikowska-Hilczer J, Hirschberg AL, Claahsen-van der Grinten H, et al. Fertility outcome and information on fertility issues in individuals with different forms of disorders of sex development: findings from the dsd-LIFE study. Fertil Steril. 2017;108(5):822-831. doi:10.1016/j. fertnstert.2017.08.013 20. Van Mol, A., 2019. Intersex: What It Is And Is Not – Christian Medical & Dental Associations. [online] Christian Medical & Dental Associations.

Available at: <https://cmda.org/intersex-what-it-is-and-is-not/> [Accessed 11 November 2020].

21. Some professional organizations appear to acknowledge the same, even if they generally claim gender-sex discordance is normal. The World Professional Association for Transgender Health says in its Standards of Care that “gender dysphoria” may be “secondary to, or better accounted for by, other diagnoses.” (Wpath.org. 2012. Standard Of Care For The Health Of Transsexual, Transgender, And Gender Nonconforming People. [online] Available at: <https://www.wpath. org/media/cms/Documents/SOC%20v7/Standards%20of%20 Care%20V7%20-%202011%20WPATH.pdf?_t=1604581968> [Accessed 11 November 2020]. p24) The British Psychological Society says, “In some cases the reported desire to change sex may be symptomatic of a psychiatric condition for example psychosis, schizophrenia or a

BEST TERMINOLOGY FOR GENDER TRANSITION?

A FINAL COMMENT ON LANGUAGE

Terms should be as descriptively accurate as possible while avoiding ideological programming. For instance, because an individual’s intrinsic sex cannot be changed, and gender is essentially a biologically meaningless term or concept aside from biological sex, terms such as “transgender identity,” as if it were an objective reality, should be replaced by “transgender-identified, -identifying, or -identification,” which are descriptively accurate. Similarly, because “gender transition” is not ontologically or biologically possible, more descriptively accurate terms, such as, “attempted transition efforts,” or “attempted transition-affirming treatments or procedures,” are more accurate and preferred.

Revised from 2016 CMDA Statement Approved by Board on January 30, 2021 Approved by the House of Representatives Passed with 54 approvals, 0 opposed, 0 abstention October 30, 2021, virtual

transient obsession such as may occur with Asperger’s syndrome....”

(Shaw L, Butler C, Langdridge D, et al. Guidelines and literature review for psychologists working therapeutically with sexual and gender minority clients. British Psychological Society Professional Practice Board. Leicester, UK, 2012, p. 26 [Accessed online 16 January 2021 at: https://beta.bps.org.uk/sites/beta.bps.org.uk/files/Policy%20 -%20Files/Guidelines%20and%20Literature%20Review%20 for%20Psychologists%20Working%20Therapeutically%20with%20 Sexual%20and%20Gender%20Minority%20Clients%20%282012%29. pdf]) The American Psychological Association’s APA Handbook of Sexuality and Psychology allows for the possibility that pathological family of origin dynamics may be causal. (Tolman, D., Diamond, L., Bauermeister, J., George, W., Pfaus, J. and Ward, L., 2014. APA Handbook Of Sexuality And Psychology. American Psychological Association, p.743.)

22.

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42. Doward, J., 2019. Politicised Trans Groups Put Children At Risk, Says Expert. [online] the Guardian. Available at: <https://www.theguardian. com/society/2019/jul/27/trans-lobby-pressure-pushing-young-peopleto-transition> [Accessed 11 November 2020].

43. Jones A, Kao E. Heritage.org. 2019. Sexual Ideology Indoctrination: The Equality Acts Impact On School Curriculum And Parental Rights. [online] Available at: <https://www.heritage.org/sites/default/files/2019-05/ BG3408.pdf> [Accessed 11 November 2020].

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46. Dee Knoblauch (2016) Building the Foundation of Acceptance Book by Book: Lesbian, Gay, Bisexual, and/or Transgender-Themed Books for Grades K–5 Multicultural Libraries, Multicultural Perspectives, 18:4, 209213, DOI: 10.1080/15210960.2016.1228325 47. Christian Concern. 2020. LGB Alliance Founder Criticises RSE Lessons. [online] Available at: <https://christianconcern.com/comment/lgballiance-founder-criticises-rse-lessons/> [Accessed 11 November 2020].

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49. Tolman, D., Diamond, L., Bauermeister, J., George, W., Pfaus, J. and Ward, L., 2014. APA Handbook Of Sexuality And Psychology. Washington D.C: American Psychological Association, p.774.

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www.cmda.org | 31

Bioethics The Dr. John Patrick Bioethics Column

MEDICINE IN TIMES OF John Patrick, MD

P

ublic health and traditional medicine have a serious logical conflict. Public policy decisions must be made in utilitarian terms, unlike medicine, for populations and not individuals. Decisions are made according to which action saves the most lives. All public health policies are tradeoffs in the context of having incomplete data and finite resources. In contrast, patient-based medicine asks, “What is best for this patient?”

The culture of medicine was conservative for much of its history. It was not until the 1860s that it became rational to go to the doctor in terms of outcome. Before the 1860s, the iconic picture of a physician depicted him sitting, head-bowed, beside a sick child unable to do anything except be there in the crisis and pray. That behavior bred respect, which included a respect for real knowledge, grounded in experience. In the past, people went to the doctor because they knew they were sick and wanted to know what they should do.

We all deeply need to do what is right. Ordinary people are, and rightly so, not impressed by academics who say, there’s no real right and wrong, it’s all personal—patients know differently. They have expectations of the doctor, expectations that have taken centuries to come about, as, indeed, all great ethical traditions do. Change is not achieved by listening to lectures but by inhabiting stories with meaning. Our stories have predominately come from the stories of the Bible, which are not didactic in the sense of rules but provide examples of how to bear our burdens and perform our duties. The long history of physician-patient interactions within communities bred respect for older physicians, who, in turn and without thinking, set the tone for practice. I have quoted Michael Polanyi on this point before, but I will do so again, because we need to have this written on our hearts if our profession is to survive. Polanyi writes: “…the adherents of a great tradition are largely unaware of their own premises, which lie deeply embedded in the unconscious foundations of practice… If the citizens are dedicated to certain transcendent obligations and particularly to such general ideals as truth, justice, charity, and these are embodied in the tradition of the community to which allegiance is maintained, a great many issues between citizens…can be left—and are necessarily left—for the individual consciences to decide.

The moment, however, a community ceases to be dedicated through its members to transcendent ideals, it can continue to exist undisrupted only by submission to a single center of unlimited secular power.”1

32 | CMDA TODAY | SPRING 2022

LEARN MORE Dr. Carl Trueman, the author of the book Dr. Patrick references at the end of his article, is the plenary speaker at the upcoming 2022 CMDA National Convention in Indianapolis, Indiana on April 21-24, 2022. For more information and to register, visit natcon.cmda.org.

History matters. Surely we can all see this disastrous direction in the COVID-19 public health policies which exist not by our choosing, but by political opportunism using the narrow vision of reductive science. Epidemiology and public health policy became scientific when physician John Snow investigated a cholera outbreak by using the streets of London as his laboratory. He could not have known he would become the father of epidemiology with its utilitarian ethics. The medical establishment in the 1860s was grudgingly forced to take note, but they refused to give up the ancient concept of humours being the real cause of cholera. They were soaked in Aristotelian and Hippocratic scientific error and paradoxically not sufficiently aware of the wisdom of these ancients.

They behaved as though they were in the pre-scientific world where purpose was real and knowable but were dragged along by a science which denied purpose any role. They certainly did not conceive of our age of identity politics, where designated victim groups determine what matters in politics and the aim is to do so by manipulating feelings. As C.S. Lewis put it long ago, “On this view, the world of facts, without one trace of value, and the world of feelings, without one trace of truth or falsehood, justice or injustice, confront one another, and no rapprochement is possible.”2 Experience is important. To take the discussion further, I will recount two episodes from my own experience. The first was watch-

ing a wonderful public health system swing into action when I diagnosed the last case of spontaneous smallpox in Europe. I had the privilege of watching the public health machine smoothly respond, despite not being used for this disease in more than 10 years. The second, in contrast, is the saddening lack of response to the research in Jamaica. I was part of a program which lasted about a quarter of a century. Its purpose was to understand the pathophysiological consequences of severe malnutrition and to work out the most efficient resuscitation program. It was successful. It took the prognosis for severely malnourished children (10-pound 2-yearolds, with or without oedema) from near 50 percent mortality to zero. Sadly, in the subsequent 40 years, I have yet to find either a mission hospital following this protocol or convincing evidence that nutrition education programs have worked. Why?

trembling. Everyone wants to believe that the horrors of pestilence, plague and war must be resolved, but there is no evidence we will ever produce a perfect world starting with fallen sinners. Conversion does not provide an immediate solution to society’s problems as Paul’s epistles continually remind us, but over time huge societal changes happen.

Cultural context is important. Science alone is not enough, and failure to realize this is to be guilty of unthinking reductionism and fatal historical ignorance. The first example resulted from programs set in place in society where a Judeo-Christian story had been operative for 2,000 years, and its do’s and don’ts were not taught explicitly but caught from the story. The second example made the fatal presumption that science was all we needed, and it was not. Malnutrition happens predominantly in societies where evil spirits are the primary way of explaining disease. As one intelligent African said to me, “An evil spirit took my child’s appetite away, so I paid the witch doctor, but he didn’t succeed.” Don’t laugh at that story! The belief in evil spirits has given structure to a society, just as humours did to medicine for centuries. Little immediate evidence for the God of love is present in the lives of countless Africans, but the church is growing. However, the Christian story has yet to dominate the African mind. It took more than 400 years for it to happen to us, and the way this happens starts with the biblical stories we tell to our children.

The U.S. story is a little different with more emphasis on experience. The Ivy league universities, founded by Christians as seminaries, became unbelieving, secular institutions where academics worked largely to receive scholarly applause. The established roots of the schools were ripped out, because we (Christians) were unwilling to do the work to maintain them. Jesus said, “Therefore by their fruits you will know them” (Matthew 7:20, NKJV). Unfortunately, we are known for our lack of fruit. It is time for repentance and change.

Australian atheistic philosopher David Stove understood the process when he wrote: “All ideas have a context and intellectual supporters who have a vested interest in maintaining the dominance of their views.”3 Physicians were comfortably settled in Aristotelian ideas and were not in favor of change. The philosophers who produced “idealism” were highly intelligent, but their ideas were primarily accepted because they met the existential needs of erstwhile orthodox Christians, demoralized by attacks on their faith by reductive scientists in the 18th century and Charles Darwin in the 19th century. The Bible, they were told, was incapable of handling scientific progress. British philosopher Mary Midgley describes what was being promoted as “science as salvation;” naive literalists were easy targets. Stove said the flood of intellectual refugees from Christianity was truly pitiful. The burden of their biblical embarrassment had become intolerable. In attempting to ward off biological, geological and logical criticisms of the book of Genesis, they had exhausted their interpretive ingenuity and accepted frankly irrational philosophy instead.

Ordinary folks were different. The Great Awakening in England of the late 18th century had led to a non-conformist evangelical church that was not even interested in these intellectual quarrels. The Great Awakening had come to a society in crisis, where drunkenness, poverty and crime were rampant. George Whitefield and John Wesley preached the gospel of grace, and Britain was changed, first by the personal peace and joy of repentance-led conversion and then by working out their own salvation with fear and

By the grace of God, revival in England led to the Clapham Sect, a group who understood the need to work out salvation and were eventually instrumental in abolishing slavery in the British Empire and child labor in Great Britain. They also led the reform of prisons and a growth of serious study in the churches, whose members were now encouraged to study for themselves and act on what they had learned.

No moral consensus. As Alasdair MacIntyre said, “We have no moral consensus. Emotion and feelings are filling the void caused by the undermining of the belief in objective moral truth.”4 As a result, particularly the young are not interested in logical argument and describe history as simply a means for patriarchal white supremacists to hold onto power. How this state of affairs happened has been elegantly described by Dr. Carl Trueman in his recent book, The Rise and Triumph of the Modern Self, which I hope to write about next time. In the meantime, buy and read it, as it is a brilliant book.5 Endnotes 1 Polanyi, M. (1946). Science, Faith and Society 2 Lewis, C.S. (1943). The Abolition of Man. 3 Stove, David. (1991) The Plato Cult 4 McIntyre, Alisdair. (1981) After Virtue 5 Trueman, Carl, (2020) The Rise and Triumph of the Modern Self

John Patrick, MD, studied medicine at Kings College, London and St. George’s Hospital, London in the United Kingdom. He has held appointments in Britain, the West Indies and Canada. At the University of Ottawa, Dr. Patrick was Associate Professor in Clinical Nutrition in the Department of Biochemistry and Pediatrics for 20 years. Today he is President and Professor at Augustine College and speaks to Christian and secular groups around the world, communicating effectively on medical ethics, culture, public policy and the integration of faith and science. Connect with Dr. Patrick at johnpatrick. ca. You can also learn more about his work with Augustine College at augustinecollege.org.

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you become one of the best practitioners you can be. You must be open minded, motivated to learn and grow, teachable and possess the skill set to become a leader. Experience is preferred, maturity and responsibility a must. Indianapolis, Indiana is a growing, thriving city with all the offerings of a major metropolitan area, yet still has the ability to welcome newcomers. Send a cover letter and resume to Ted Reese, DDS, MAGD, NMD, at treesedds@comcast.net. www. calmingfears.com OB/Gyn — Southwestern Medical Clinic, Center for Women’s Health is seeking part-time OB/Gyn to join our multi-disciplinary faith-based team. The preferred candidate will provide a full range of services. Enjoy a collaborative and collegial relationship with your colleagues!

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