CMDA Today - Summer 2023

CMDA TODAY

Volume 54 • Number 2 • Summer 2023

Count It All Joy

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From the CMDA President George C. Gonzalez, MD

Unity Among the Members of Christ “If it is possible, as far as it depends on you, live at peace with everyone”

C

(Romans 12:18).

hristianity is a team sport. As team players, we need to get on the same page of the playbook so we can work in a coordinated effort to accomplish the goal of winning the lost and glorifying God in our lives and in our organization. I love watching a good basketball team where they rely on one another to pass the ball, screen for an open shot, defend and be there to rebound the ball when needed. However, even LeBron James and Stephen Curry cannot win the game all on their own. Even when you have a team full of superstars, if they fight with each other and hog the ball, they often lose the game, as we witnessed of the 1992 U.S. Olympic basketball “Dream Team.”

More is at stake than losing a game when we fight amongst ourselves and become divided. The world will know we are Christians by our love for one another ( John 13:35). Our witness is tarnished and doors of opportunity to share the gospel close when we are unwilling to work together in unity.

I believe we are part of the greatest team ever assembled— God’s family. We are brothers and sisters in Christ (Ephesians 2:19-22). We are called to be members of one body where Christ is the head (Ephesians 4:15). And, though, we have different talents, gifts and backgrounds, we are to function for the good of one another and for Christ (1 Corinthians 12:27). In Colossians 3, Paul exhorts us to let peace rule in our hearts since, as members of one body, we function best when our members are at peace with one another.

During the COVID pandemic and after the election of President Biden, I was shocked by how Christians were being divided by opinions, theories or politics. Each side attempting to “cancel” the other, that is they were unwilling to have civil dialogue and consider the feelings and opinions of the others.

Consequently, such division led to even questioning a person’s salvation and Christianity. Ephesians 6:12 comes to mind. We forget that the battle we wage is not against flesh and blood or other people, but against the schemes of the devil that influence all of us. And one of his greatest schemes is to bring division in the body of believers. As the flock is scattered apart, the wolf culls and devours his prey.

CMDA’s vision is to bring the hope and healing of Christ to the world by being His hands and feet. However, that takes effort along with much prayer and good communication. Re-

cently, I witnessed a tremendous act of unity in the formation of the Alliance of Hippocratic Medicine by several life-affirming, Bible-believing organizations. I believe this speaks loudly to the world that the care of every human is valuable, such that we can unite on this central issue despite our differences.

Jesus prayed for us, His disciples in John 17:20-23 that we be one in Him, and He be one in us. We lead an active CMDA community chapter in Fresno, California. We have discovered over the years that the growth in our chapter and its unity was developed by serving together on mission trips through GHO and our local domestic outreaches. These teams are multi-generational and multiethnic including a wide spectrum of healthcare specialties and believers of different Christian denominations. Serving together we see how each person is essential to the team to accomplish our goal of bringing people to Christ.

We see our humanity and we see our need for one another.

Service has united us and grown our local CMDA graduate community chapter. We have become family. We have become brothers and sisters. We have become one.

We know through Scripture there are disputable matters and undisputable truth (Romans 14:1). In those disputable matters we must not take such a fervent stand as to ostracize those with a different opinion. But those matters clearly delineated

by God, through His Word, we must stand united as in the essentials of the faith.

Yes, we are to speak the truth, but always with love, grace and a spirit of humility.

“And now these three things remain: faith, hope and love. But the greatest of these is love” (1 Corinthians 13:13).

George Gonzalez, MD, is a Diplomate of the American Board of Family Medicine and has practiced for over 30 years in Fresno and Clovis, California.

Dr. Gonzalez has served as the medical director of Pregnancy Care Center of Fresno for 20 years. He has been the acting president of the local CMDA Fresno/Clovis Chapter for over 27 years. He is a founding member of Medical Ministries International (MMI) serving 17 years on the MMI Board. Dr. Gonzalez has been the team leader for over 30 international mission trips and 55 local mission outreaches in the Central Valley of California.

www.cmda.org | 3

VOLUME 54 | NUMBER 2 | SUMMER 2023

EDITOR Rebeka Honeycutt

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

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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.

12 ON THE COVER

ount It All Joy: A Bearded C Child, a Djembe and Faith

24

Jacob Morris, MD

A family on mission finding joy in the chaos

18

Don’t Use Ice Picks for Brain Surgery Amy Givler, MD, FAAFP

A look at the consequences of attempting to adjust biological reality

22

A Letter to Christian Physicians Jonathan Clemens, PA

Theology of Mythology: Of God and gods, Angels and Demons W. Curt LaFrance, Jr., MD, MPH

Acknowledging the dual existence of fact and myth

30

The Dr. John Patrick Bioethics Column

What Foundation Do Ideas of Ethics Have if Darwin is Right?

John Patrick, MD

Determining the source for ethics in modern society

See PAGES 34 & 35 for CLASSIFIED LISTINGS

The need for strong relationships between Christian physicians and physician assistants

REGIONAL MINISTRIES

Connecting you with other Christ-followers to help better motivate, equip, disciple and serve within your community Western Region: Wes Ehrhart, MA • 6204 Green Top Way • Orangevale, CA 95662 • 916-716-7826 • wes.ehrhart@cmda.org Midwest Region: Connor Ham, MA • 2435 Lincoln Avenue • Cincinnati, OH 45231 • 419-789-3933 • connor.ham@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 | SUMMER 2023

Ministry News MEMBER NEWS

CMDA Welcomes New President and President-Elect

Memoriam and Honorarium Gifts

During the 2023 CMDA National Convention, CMDA was honored to welcome both a new President and President-Elect.

This year, the gavel was passed from outgoing President T. Lisle Whitman, MD, to incoming President George Gonzalez, MD. Dr. Gonzalez is a family physician and serves as the medical director of the Fresno Pregnancy Care Center, and he is active in his local CMDA community. He previously served on the CMDA Board of Trustees for nine years, and he was President from 2009 to 2011.

Every two years, the CMDA membership elects a new President-Elect. This year, Omari Hodge, MD, was elected as the new President-Elect. He will begin his two-year term as CMDA President in 2025, and then he will continue his service for an additional year as Past-President. Dr. Hodge is the program director of the family medicine residency program at AdventHealth Wesley Chapel in Tampa, Florida, and he received his medical degree from Morehouse School of Medicine in Atlanta, Georgia. He has served as a CMDA Trustee since 2018.

Gifts received January through March 2023

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.

• Martin H. Andrews, MD – Oklahoma City, Oklahoma Member since 2005 • Kenneth J. Armstrong, DDS – Albuquerque, New Mexico Member since 2003 • Ronald P. Baker, MD – Berrien Springs, Michigan Member since 1969 • Jerry Brown, MD – Columbia, Tennessee Member since 2001 • James E. Eshenaur, MD – Boise, Idaho Member since 1958 • Gerald R. Fahs, MD – Lancaster, Pennsylvania Member since 1957 • William D. Pletcher, MD – Goshen, Indiana Member since 1952 • Howard G. Searle, MD – Rockford, Illinois Member since 1958

John and Emily Fowler in honor of Drs. Craig and Amy Fowler Mr. and Mrs. Thomas F. Titkemeier in memory of Michael L. Thomas Mr. and Mrs. Thomas F. Titkemeier in memory of John S. Robinson For more information about honorarium and memoriam gifts, please contact stewardship@cmda.org.

COMMUNITY

Northeast Regional Dental Coordinator Needed CMDA is seeking a part-time Northeast Regional Dental Coordinator committed to working 12 hours per week ministering primarily to dental students.

Our dental coordinators interact with all U.S. dental schools, with an emphasis on fostering Christian fellowship and spiritual growth, encouraging outreach to classmates and enabling new graduates to connect with CMDA as they begin their professional careers.

These goals would be pursued in cooperation with various CMDA field staff and faculty representatives who are ministering at various dental schools.

To express interest, please send your resume and cover letter detailing your personal faith journey and commitment to Christian values to humanresources@ cmda.org. To learn more about this position, visit www. cmda.org/careers.

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Ministry News

New Side By Side Director CMDA is excited to introduce Rebecca Lehman as Director of Side By Side.

Rebecca is a Christian leader whose and primary goal is to continually foster a passionate love for Jesus in her life. She has been married to Joshua for 15 years. They reside in Tampa, Florida with their four children, twins Noah and Lily, Levi and Emma Grace. The Lehman family is actively involved at Trinity New Life Church and in their community.

Rebecca has 15 years of experience in the areas of strategic planning, leadership development, discipleship pathways, teaching, equipping, administration and spiritual oversight. She has served as a Side By Side Southern Regional Director since 2020, co-led Side By Side Tampa since 2013, is the Women’s Event Coordinator at Trinity New Life Church and has extensive experience in the non-profit sector where she served as the Chief Executive Officer of PeoriaCheerz from 2009 to 2015. In addition, she holds a bachelor’s degree from Arizona State University. At 16 years old, Rebecca made the radical decision to give her life to Christ. Coming into relationship with Jesus was the most life altering, transforming decision she has ever made. She considers walking in sanctification and serving the kingdom an absolute joy and privilege. She looks forward to growing in character development, defiant generosity, sacrificial service, intentional evangelism, redemptive community and cultivating an eager desire for the Holy Spirit alongside the Side By Side Executive Team in this new role.

For more information about Side By Side, visit www.cmda.org/sidebyside.

SIDE

BY S I D E

A Ministry of CMDA for Medical Wives

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VIE Poster Session Winners

▲ T his year’s VIE Poster Session winners with VIE Committee Leaders Dr. Charlotte Paolini (far left) and Dr. Bill Ardill (far right).

At the 2023 CMDA National Convention, we were excited to welcome 20 students, three residents and three fellows who participated in the annual VIE Poster Session. All of the posters were reviewed by a panel of 12 judges, and the winners were announced during one of the plenary sessions at the convention.

VIE is a French word for “life” and represents the acronym for “Vignettes, Initiatives, Innovations and Education,” plus it represents our recognition of and commitment to stirring godly passions and life throughout CMDA and His kingdom through presentation of scholarly work. This year’s winners included: • • • • •

Student Vignette, First Prize —Erica Brown/Sarah Person: “Moving Forward: Mind, Faith, Connection” Student Vignette, Honorable Mention — Matt Augusta: “Intramedullary Nailing of an Intertrochanteric Fracture in a Centenarian: A Case Report” Student Research, First Prize — Jamil Haddad: “Patient Online Education for Hip Arthroscopy: An Internet Search Analysis” Student Research, Honorable Mention — Ndiya Emeaba: “Simulated Surgical Training in Sub-Saharan Africa: Sustainable or Stagnant?”

Resident/Fellow, First Prize — Andrew Wilson, DO: “Virtual Clinic to Optimize Management of Heart Failure with Reduced Ejection Fraction

Students, residents and fellows who are looking for an opportunity to be sharpened by like-minded believers while showcasing their research project are encouraged to join us for the annual VIE Poster Session at the 2024 CMDA National Convention in the Asheville, North Carolina area on May 2-5, 2014. They can share their clinical vignette, case report/series, basic-science report, clinical/transaction report or literature review. Abstracts and submissions will begin August 1, 2023, and limited scholarships are available for students and residents to attend the convention. Plus, cash prizes are awarded to the winners. For more information, visit www.cmda.org/vie.

Ministry News RESOURCES care 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.

Faith Prescriptions

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

In the 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.

CMDA Learning Center The CMDA Learning Center offers complimentary continuing education courses for CMDA members. This online resource is continuing to grow with new courses to help you in your practice as a Christian healthcare professional.

More than 100 hours of continuing education are now available at NO COST to CMDA members. For more information and to access the CMDA Learning Center, visit www.cmda.org/learning.

CMDA Matters Are you listening to CMDA’s podcast with CEO Dr. Mike Chupp? 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, health

New to the resources provided by CMDA is a video series called Faith Prescriptions.

This 25-part video series 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 video-ondemand. 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.

Bridging the Gap 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 on CMDA’s Church Commission. 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

CMDA 2023 Member Awards 2023 Educators of the Year Award Dr. André and Mrs. Evelyn Van Mol

2023 Missionaries of the Year Award Drs. John and Angela Condie

▲ D r. André (right) and Mrs. Evelyn Van Mol with CMDA Past President Lisle Whitman, MD (left), after receiving the 2023 Educators of the Year Award.

▲ C MDA Past President Lisle Whitman, MD (left), presented the 2023 Missionaries of the Year Award to Drs. John and Angela Condie.

André is a board-certified family physician who received training at the University of Southern California, the Medical College of Wisconsin, Charleston Naval Hospital and the Naval Aerospace Medical Institute. Evelyn is a pediatric and obstetrical nurse who trained at the Calvin-Hope University nursing program in Michigan. She has experience with healthcare missions in Mexico, the Philippines and Mozambique. They met while they were both serving as U.S. Navy officers in Okinawa, Japan during their last mutual military tour of duty, and they were married in 1995. They have two sons and two daughters, the latter of whom were among their nine foster children. Evelyn chose the ministry of being a mother from her first pregnancy onward. She studied extensively regarding the special needs present in their foster and adopted children. Through his extensive work to protect children from transgender ideology, Dr. Van Mol has become one of the premier voices in healthcare on sexual orientation and gender identity issues.

He co-chairs both CMDA’s Sexual & Gender Identity Task Force and the American College of Pediatricians’ Council on Adolescent Sexuality. Dr. Van Mol writes, speaks, addresses media inquiries and advises for CMDA on issues of bioethical and Christian concern, and he has been extensively published in professional and general literature. He works with Alliance Defending Freedom advising on policy matters addressing sexual orientation and gender identity, including serving as amicus curiae/friend of court in federal appellate and U.S. Supreme Court cases. He advises legislators, government agencies, courts and advocacy organizations internationally on sexuality and gender identity, among other issues.

John and Angela met when they were both attending medical school at the Keck University of Southern California School of Medicine in the late 1970s through their involvement with the CMDA student chapter on campus, and they married in 1980. After graduation, John and Angela began their residencies, during which they welcomed two sons.

After they completed their residencies in 1985, John joined his father’s surgical group in San Jose, California. Together, John and Angela knew God was calling them to long-term missionary service, so they began taking Bible courses and welcomed another son. In 1989, the Condie family joined The Evangelical Alliance Mission, known as TEAM, and relocated to Bach Christian Hospital in northern Pakistan.

After a year of language study and birth of their daughter, they began what became a three-decade adventure with God. They and the hospital team had continuous opportunities to share Christ with patients and relatives through ward messages, prayer, literature, personal testimony and media. They were also privileged to disciple several believers and partner with and mentor young Pakistani physicians who will be the foundation for future ministry. Since 2009, John also served as Area Leader for TEAM Pakistan. Throughout the last two years, he has overseen the transition of mission leadership into the hands of a godly Pakistani Board of Directors who will carry forward the ministries TEAM helped establish over the last 70 years. After 34 years of service, four married children and eight beautiful grandchildren, John and Angela will retire from full-time ministry in June 2023.

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Ministry News LEARN MORE The following awards were presented at this year’s National Convention. These articles are excerpted from the actual award citations which can be viewed at www.cmda.org/awards.

2023 President’s Heritage Award Robin Morgenthaler

2023 Servant of Christ Award Dr. David and Mrs. Jody Stevens

▲ R obin Morgenthaler (right) received the 2023 President’s Heritage Award from CMDA Past President Lisle Whitman, MD, and his wife Lauren.

▲ D r. David Stevens (right) and his wife Jody were awarded the 2023 Servant of Christ Award by CMDA Past President Lisle Whitman, MD.

Robin was born in Pennsylvania, to her father, a dentist, and her mother, a volunteer at their church and local hospital.

She graduated with a bachelor’s degree in nursing in 1979, and she took a job in obstetric nursing in New Hampshire in 1981, where she met Timothy, a medical student at Dartmouth. They were soon married, and Tim’s career in the U.S. Navy took them to new places where they found Christian fellowship and mentoring. In 1988, they moved to Rochester, Minnesota for Tim to begin residency, where God prompted her to start a Bible study. She asked five residents’ wives to join her for a Bible study in her home. They all agreed, and the Side By Side ministry was born. When Tim’s fellowship was complete, more than 40 women were attending Side By Side weekly. Their family continued to grow, as they welcomed two more children. With Tim’s fellowship complete, they moved to Tennessee where they welcomed another child. When the Lord called them back to Minnesota in 2000, Robin was elated to see how Side By Side had grown. That was also the year they added another daughter to their family. In 2001, Robin collaborated with a team of women to promote the ministry across the country. In 2005, they connected with CMDA, opening doors for growth. Through the next 20 years, Robin served as Executive Director of Side By Side, leading the charge to establish chapters in cities through the U.S. and internationally. Today, approximately 1,800 women in medical marriages are meeting through more than 90 active Side

By Side chapters. In 2022, Robin retired from her leadership position and is enjoying spending more time with Tim, their five children and their five grandchildren.

David and Jody were childhood friends who reconnected while attending Asbury College, where they began dating and were engaged. David realized God was calling him to be a medical missionary near the end of high school and first visited Tenwek Hospital in Kenya on a college mission trip. He knew God wanted him to serve at Tenwek with World Gospel Mission after his medical training. David and Jody married, and they moved to Louisville, Kentucky where David attended medical school and Jody taught middle school. They welcomed their first two children during residency and began preparing for the mission field when he finished residency in 1980. In 1981, they moved to Tenwek Hospital, where David became the third physician and Jody started a one-room schoolhouse. David worked to develop a community health program that later became the most successful project of its kind in East Africa. In 1984, they welcomed their third child. In 1992, the Stevens family left Kenya so David could become Director of World Medical Mission with Samaritan’s Purse. In 1994, David became Executive Director of the Christian Medical & Dental Society, as CMDA was called then.

Dr. Stevens continued to lead CMDA for the next 25 years. It’s not possible to cover all of the initiatives and programs that developed under his leadership at CMDA, but his vision to inspire, educate and equip healthcare professionals to glorify God led the ministry onto hundreds of healthcare campuses around the country, into new countries to provide free healthcare and share the love of Christ, into the halls of Congress to influence the government and much more. Since retiring in 2019, David and Jody have enjoyed spending more time with their family, including their 11 grandchildren. www.cmda.org | 9

Ministry News UPCOMING EVENTS

ADVOCACY

Voice of CMDA Media Training

CMDA Celebrates Victory to Protect Conscience Freedoms

CMDA is increasingly called on by the national media to give perspective on topics like abortion, transgender, assisted suicide and more. From congressional testimony to network television, God continues to open doors for CMDA to amplify the voice of Christian healthcare professionals on the critical life issues of our day.

If you are interested, we encourage you to attend the upcoming Voice of CMDA Media Training on August 18-19, 2023.

This two-day training is designed to teach you how to use the media as an educational tool and to sharpen skills as a CMDA media representative. We will use real-life examples to share a proven methodology that works in the most hostile situations.

Plus, we will explore how advocacy and media work hand-inhand together and how to prepare to use your media skills to testify in your state legislature. Participation is limited to 12 attendees in order to provide one-on-one training, so visit www. cmda.org/events now to reserve your space.

In April 2023, CMDA celebrated a victory in its lawsuit against the state of New Mexico that will allow healthcare professionals to decline participation in assisted suicide due to their conscience objections. Back in 2021, New Mexico legalized assisted suicide through a law that required healthcare professionals to inform their patients about assisted suicide and refer patients to participating physicians—regardless of their conscientious objections.

On behalf of our members in New Mexico, CMDA worked with Alliance Defending Freedom to file suit against the state of New Mexico. And in April 2023, New Mexico signed a new bill into law that specifically allows healthcare professionals to refuse to participate in assisted suicide for reasons of conscience. This new law was in direct response to the issues raised in CMDA’s lawsuit, and it’s another judicial victory in CMDA’s work to protect the conscience freedoms of our members.

Upcoming Events

News from the CMDA Ethics Committee

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

Mentoring with a Coach Approach August 3-31, 2023 • Virtual Women Physicians & Dentists in Christ 2023 Conference September 7-10, 2023 • Hilton Head Island, South Carolina Mentoring with a Coach Approach October 5 – November 2, 2023 • Virtual Biblical Turkey Tour – Seven Churches of Revelation October 21-31, 2023 • Turkey CMDA Marriage Enrichment Weekend October 27-29, 2023 • Lititz, Pennsylvania Pre-field Orientation for New Healthcare Missionaries November 6-9, 2023 • Louisville, Kentucky Global Missions Health Conference November 9-11, 2023 • Louisville, Kentucky 10 | CMDA TODAY | SUMMER 2023

Editor’s Note: This content was submitted to The Uniform Law Commission in February 2023 to express CMDA’s concerns and position on this issue.

For decades, the Uniform Determination of Death Act (UDDA) has served as the guiding clinical framework for establishing that an individual has died. In addition to the determination of death by the irreversible cessation of circulatory and respiratory functions, the statute affirms that death can be established by neurologic criteria.

Current guidelines hold that, in the face of a devastating and irreversible brain injury, death by neurologic criteria may be diagnosed when there is loss of all functions of the entire brain, including the brainstem, as manifested by irreversible coma, absent brainstem reflexes, and apnea. Since its inception more than 50 years ago, however, the UDDA has lacked the evidencebased scientific foundations that normally are requisite for clinical guidelines. The American Academy of Neurology (AAN) itself, which has published and promulgated these guidelines, acknowledges severe limitations in the current evidence base:

Ministry News “There is insufficient evidence to determine the minimally acceptable observation period to ensure that neurologic functions have ceased irreversibly. . . there is insufficient evidence to determine the comparative safety of techniques used for apnea testing. There is insufficient evidence to determine if newer ancillary tests accurately confirm the cessation of function of the entire brain.”1 Existing guidelines do not, in fact, assay all functions of the brain, specifically omitting functions of cerebro-somatic homeostatic control. Additionally, the tests to confirm apnea are of no benefit to the patient being tested and pose a risk to the patient of actually precipitating brain death and hemodynamic instability; yet, there is no requirement for informed consent by the surrogate decision makers.2 Because of the inconsistencies between the UDDA’s definition of death by neurologic criteria and the medical standards available to meet the UDDA’s criteria, a recommendation has been made that the UDDA be revised. The proposal that has received the most attention is that advocated by Lewis, Bonnie and Pope. Their revisions include the acceptance of the 2010 AAN practice guidelines and the 2011 Society of Critical Care Medicine, American Academy of Pediatrics and Child Neurology Society standards for determining brain death, that assessment of cerebro-somatic homeostatic control functions of the brain be excluded from the revised criteria and that formal clinical testing for the presence of brain death may proceed without a requirement for informed consent.3 The members of CMDA’s Ethics Committee agree that the current guidelines for determining brain death are inadequate and need revision. However, we respectfully voice strong opposition to the proposed revisions articulated by Lewis, Bonnie and Pope. Rather than codify non-evidence-based standards as a matter of expediency, we advocate instead for the safety and protection of patients who have not yet died, and for the integrity and beneficence of the medical profession in its covenantal relationship with these patients and their families.

The revised guidelines should maintain the current definition of brain death that requires the loss of all functions of the entire brain by addressing all pertinent brain functions, including the cerebro-somatic integrative functions. Because apnea testing carries significant risk and provides no benefit to the patient, such testing should require informed consent in the interests of professional transparency and respect for patient and family autonomy.

Our opposition to the proposal by Lewis, Bonnie, and Pope upholds the principles of autonomy, beneficence and non-maleficence, and sustains the covenantal relationship between physician and patient. Further, our position strengthens and safeguards our profession’s attentiveness to those whose lives may depend on organ transplantation by reinforcing the integrity of that very relationship.

Endnotes 1 E. F. Wijdicks et al., “Evidence-Based Guideline Update: Determining Brain Death in Adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology,” Neurology 74, no. 23 (July 2010): pp. 1911-1918, https://doi.org/10.1212/wnl.0b013e3181e242a8.

2 D Alan Shewmon, “Statement in Support of Revising the Uniform Determination of Death Act and in Opposition to a Proposed Revision,” The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine, 2021, https://doi.org/10.1093/ jmp/jhab014.

3 Ariane Lewis, Richard J. Bonnie, and Thaddeus Pope, “It’s Time to Revise the Uniform Determination of Death Act,” Annals of Internal Medicine 172, no. 2 (2019): pp. 143-144, https://doi.org/10.7326/m192731.

GET INVOLVED WITH ADVOCACY CMDA’s Advocacy and Communications Team is looking for healthcare professionals who have experience working with victims of human trafficking. We need expert assistance from healthcare professionals just like you in researching and developing resources, speaking in webinars, etc. If you are interested in learning more about this and other advocacy efforts, please contact communications@cmda.org.

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A Bearded Child, a Djembe & Faith Jacob Morris, MD

▲ The Morris Family: Jake, Genae, Walter (8), Evie (6), Harvey (5), Milo (2) and the twins, Ford and Eleanor.

12 | CMDA TODAY | SUMMER 2023

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T

hese last few months have squeezed our family like a grape. We have six kids aged eight and under—including infant twins, Ford and Eleanor, who joined our family in summer 2022. We are also about to move the whole Morris clan to Papua New Guinea in 2023 to serve as healthcare missionaries. I am sure you can imagine that our lives are as calm as a clam.

In August 2022, as the summer sunshine waned, my wife embarked on another year of homeschooling kids in three different grades, all while endlessly nursing newborn twins and corralling our 2-year-old, Milo. Have you ever tried to teach three levels of language arts, and prepare for a science experiment on the water cycle, while holding two voraciously hungry babies, and cleaning up after a toddler who scatters Goldfish around the house with greater alacrity than Hansel and Gretel? Or what about trying to prepare lunch, teach long division, do laundry for eight people, perhaps take a shower and help a 5-year-old find a Chaco sandal he lost somewhere outside for the thirteenth time?

desperately in need of the sleep that her very stress and exhaustion steals away. I haven’t described the doctors’ visits. I haven’t described the painful arguments Genae and I have had with each other because we are both frayed. I haven’t described how we have snapped at the kids over trivial things because we are so overwhelmed that every additional mess, fight and act of disobedience feels like the catastrophic straw that shatters the slumping and dejected camel’s back. Welcome to an average day in the Morris home.

Life is filled with contrast and paradox—with seemingly contradictory emotions and qualities in every situation. We are blessed with six kids aged eight and under, but we are reduced and refined under the weight of that blessing. We follow God’s leading to serve Him overseas as healthcare missionaries, but we struggle with the pain of preparation, transition and disconnectedness that results from that decision.

Nothing is easy. Every vibrant blossom is seemingly upheld by a stem of thorns. Nothing is perfect. Every joy is followed with pain. Every pain is lined with grace, and we rejoice in all of it.

“Count it all joy, my brothers, when you meet trials of various kinds, for you know that the testing of your faith produces steadfastness. And let steadfastness have its full effect, that Meanwhile, while you search for said Chaco, you are carrying twins in each arm, you may your 2-year-old wants more Goldfish and your 8-year-old is more interested in hot gluing toThese contrasts have been blazingly apparent gether a bottle rocket projectile than finishing his to us in this past season. Reckoning with these be perfect lesson on spelling rules. Also, is there something discrepant qualities—stress and joy—involves burning in the house? Yes…someone took the wisdom: Do we send our kids to and complete, practical turtle’s heat lamp out of the cage, placed it face public school? How do we find margin when down on a dresser, and there is smoke and an we feel like we are drowning? How much can acrid burnt paint smell billowing through the lacking in nothing” we bear with God’s grace, and what would bedroom! That could have been bad! It is still be wise to let go? These are not easy questwo hours until the twins’ nap time, and it’s only Monday. Welcome to an average day in the Morris home.

Have you ever felt like life feels out of control? I am truly amazed by the infinite tasks my wife Genae orchestrates in the storm of our lives. She is incredible and resilient. Trust me, working in the emergency department feels like an all-inclusive Cancun resort compared to our home. She has the difficult job.

I often joke that the emergency room is where I go to relax. Our life may sound humorous, and it often is, but I have left out describing the incessant noise that makes a Boeing 747 aircraft sound like a purring cat. I haven’t described Genae waking up at 2 a.m. with a panic attack for the second night of the week—so 14 | CMDA TODAY | SUMMER 2023

tions. We prayed. We cried. We argued.

We tried not to make decisions at peak moments of fear or stress. I thought of a wise piece of advice I once read, “When you don’t know what to do, just take the next logical step by faith.”1 So, we trudged forward in faith, instead of standing still in fear.

(JAMES 1:2-4, ESV).

We decided to transition our older three kids, Walter, Evie and Harvey, from homeschool to public school one month into the school year. It was a painful decision. The afternoon before their first day, we filled a Target shopping cart full of dinosaur pencil boxes, spiral notebooks and yellow folders. Both Genae’s heart and my heart were heavy. The twins cried the whole trip.

As we stood in the line to checkout, an older woman sidled to

▲ The Morris family departs to Papua New Guinea.

wait behind us and our loquacious kids began to chat her up.

She was kind and smiled. She saw us try to stack our multitude of supplies on the conveyor belt like it was a Jenga tower, and then she wisely disappeared into an adjacent line. A few minutes later, as I went to pay for our $250 trip, a Target employee walked up with a credit card and said, “Another customer wants to pay for all your groceries, she insists.” As I looked up in confusion, the employee slid the credit card and walked off, bringing the card back to the woman who had previously been in line behind us. I went over and gave her a hug. She said, “God bless, you have a beautiful family.” That is grace. A whisper from God that He is there even in the storm.

The next morning, we woke the kids up for their first day of public school. The paradoxes were not over. Though we all had some sense of anxiety, we nonetheless started the day with laughter. Milo’s older brothers had played the midnight van Gogh and painted their helpless sleeping sibling with a beard and mustache. Thankfully, the markings were ephemeral, and

when Genae dropped the kids off at school, much of the damage had been washed off. He still had a six o’clock shadow.

Later that week, after school, our evening turned into spontaneous family worship. I got out the acoustic guitar, Genae strummed the ukulele and sang, Walter kept rhythm by hitting the couch and Evie brought the djembe up from the basement to dance and drum like we were in a Kenyan village.

Everything was going swimmingly for about 20 minutes, until Harvey decided it was a good idea to insert his foot into the djembe. When he told me it was stuck, I laughed and kept playing guitar. I thought, “What a cute, silly kid.” Then I realized it really was stuck. Worship stopped. Harvey began to cry.

Pain followed joy.

Ten minutes later, we still had not extracted his leg from the djembe. Sharp, rough, wood fibers on the neck of the djembe cut his skin any time we tried to pull. He cried that he was going to lose his foot. He then said, through his tears, “Wait! I www.cmda.org | 15

▲ Genae attempts to remove Harvey’s foot from the djembe.

have a good idea! Call a drum maker and have them come take off all the drum strings! A drum maker will know what to do!”

I, unfortunately, do not have any drum makers on speed-dial.

So, after some puzzling, some frustration (mine) and lots of tears (Harvey’s), I retrieved a knife from the garage, cut off the drum skin (not his foot), slid the smooth drum skin between Harvey’s now visible ankle and the neck of the djembe, and we were able to extract his imperiled appendage.

Life is a mess. Joy and pain. Paradox. Beauty in the collision.

This last season has squeezed our family like a grape—but we are still here. We don’t want the stress, the panic attacks and the tears, but God shows up in the midst of brokenness. He stretches us, broadens our shoulders, helps our roots of faith grow tough in the darkness and teaches us to count it joy when we face trials of many kinds. Even though we have felt like an over-filled bag ready to burst, we wouldn’t trade these light and momentary afflictions for lives of passivity and ease. We are overwhelmingly grateful for our lives, for our family and for Jesus.

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Challenges and pain are not a symptom of dysfunction in following Jesus; instead, they are a feature. Jesus is no stranger to paradox. More than 2,000 years ago, He came to earth as a man, lived a spotless life and died on a cross to bear the punishment for sins He did not commit.

Author G.K. Chesterton once said, “The cross has at its heart a collision and a contradiction. It can extend its four arms forever without altering its shape. Because it has a paradox in its center, it can grow without changing. The cross opens its arms to the four winds; it is a signpost for free travelers.”

Our lives collide at the crossroads of pain and blessing. But, for those who trust in Jesus, at that intersection stands the One who bore the sharpest pain and granted the most superlative blessing. In Him, the pain and the blessing find meaning. Jesus is the greatest guide for our lives of paradox.

In your wearied life of pain and blessing, do you see the cross, with its arms spread wide as a signpost for free travel-

▲ Milo grows facial hair overnight.

ers? Have you found Jesus in the intersection? Do you see His strong hand, scarred with understanding, reaching out to hold you—and everything else—together? Be encouraged that in your life of stress and joy, peace and chaos, pain and grace, you are not alone.

“Fear not, for I am with you; be not dismayed, for I am your God; I will strengthen you, I will help you, I will uphold you with my righteous right hand” (Isaiah 41:10, ESV).

The Morris Family departed for Papua New Guinea on April 5, 2023. They may have forgotten a few belongings, but all of the children were accounted for. They are grateful for your prayers as they serve Jesus in the mountains of Papua New Guinea. You can follow their blog at www.morrisfamilymissions.org.

Endnotes 1 Robert J. Morgan, The Red Sea Rules: 10 God-Given Strategies for Difficult Times (Nashville: T. Nelson, 2001).

Jake Morris, MD, is an emergency physician who previously practiced in Eau Claire, Wisconsin. He completed his medical school at the Mayo Clinic College of Medicine and his chief residency in emergency medicine at the University of Alabama at Birmingham. He has been actively involved in CMDA since 2012. He was a Resident Trustee on the CMDA Board of Trustees from 2018 to 2019.

He previously served as the Wisconsin Assistant State Director for the American Academy of Medical Ethics. The Morris family moved to Papua New Guinea in early 2023 to serve as healthcare missionaries.

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.

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DON’T USE ICE PICKS Amy Givler, MD, FAAFP

T

he first time I ever heard of a lobotomy was in the early 1980s. I was a medical student, but I didn’t learn about it in class.

Instead, I was in a darkened room with a bunch of other family members, watching a family home movie filmed 30 years earlier. The scene was some kind of a garden party, and in the midst of the lively antics of my parents, their siblings and my great-aunts and greatuncles, there was a late middle-aged woman who just… stood there. Eventually someone took her arm and led her to a chair where she just…sat there. Completely still, no facial expression, no interaction with anyone else.

I turned to my aunt and whispered, “Who is that? What is wrong with her?”

“I’ll tell you later,” she replied, with a knowing nod.

It turns out she was my great-aunt Muriel, who’d had a lobotomy a decade before that garden party. She had

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been committed to an asylum in 1942 for being “unable to manage her affairs by reason of lunacy.” The exact nature of that “lunacy” is lost to history, but family lore says she was sad and agitated due to an unfaithful husband.

At any rate, she had the misfortune of being institutionalized when prefrontal lobotomies were being pushed as the cure for mental illness. In Britain, where Muriel was hospitalized, 12,000 procedures were done by 1954. In America, it was even worse—50,000 were conducted before the procedure fell out of favor in the 1960s. A total of 5,000 were performed in 1949 alone.

A lobotomy is surgery on the brain to sever the prefrontal lobes from the rest of the brain. The frontal lobes1 are key to controlling behavior and emotions—the “executive processes,” defined as2 the capacity to plan, organize, initiate and self-monitor. It was the brainchild of Egas Moniz, who won the Nobel Prize in Medicine for it in 1949.3

True, there weren’t effective medicines for mental illness back then, but lobotomies were an exceedingly blunt instrument. Claire Prentice has written about one of lobotomy’s biggest proponents, the neurologist Walter Freeman, who initially worked alongside a surgeon but later branched off on his own to do a quicker 15-minute transorbital procedure—using an ice pick.4 He wanted to empty America’s mental asylums of patients. Unfortunately, his complication rate was high, and numerous patients were left with profound mental deficiencies, some became blind or paralyzed and several died.

Who were getting these lobotomies? Mostly women. Though men outnumbered women in psychiatric hospitals, approximately 70 percent of lobotomies were performed on women.

The indications for lobotomy were exceedingly broad, including schizophrenia, depression, anxiety, headaches, arthritis, “suicidal tendencies” and, in at least one 12-year-old boy, “defiance.”5 Tragically, he was not the youngest to receive a lobotomy.

Dr. Freeman wanted to change people’s personalities— changing them from “dangerous and aggressive” to docile and compliant. Far too often, the change was a “tragic personality disintegration,” as contemporary neurosurgeon Ernest Sachs said on page 44 in Doctor Ice Pick.6 For my great-aunt Muriel, the result was indolence and helplessness. She never initiated action. Once she was seated, she remained seated. She had to be fed and clothed, and she was essentially mute.

Other patients became disinhibited, sexually promiscuous or oblivious to social cues. Some were left incontinent, sloppy or combative. Freeman, in a neverpublished autobiography, acknowledged that many patients became affectless and “infantile,” but he saw this as positive, calling it a “surgically induced childhood” rendering the patient “more amenable to the social pressures under which he is supposed to exist.”7

who were institutionalized and draining the public coffers were post-operatively sent home for their families to care for them.

Few doctors were willing to speak out.

Little by little, though, criticism of the procedure grew louder: “It was increasingly seen for what it was—a crude means of making those regarded as difficult, demanding, and dangerous patients cheaper and easier to manage,” as is written on page 49 of Doctor Ice Pick.

A prefrontal lobotomy destroyed intact brain tissue. Its purpose was to sever a part of the brain from the rest of the brain.

It was widely adopted on the basis of an idea, and careful studies of outcomes had not been done. Those who spoke up against it were fighting against strong resistance, both in the medical world and in the press, who were enamored with it. Once that tissue was destroyed, it was destroyed forever.

To its proponents’ credit, at least they thought they were destroying unhealthy tissue. That is, they thought patients’ mental disturbance could be directly linked to a malformation in a certain area of the brain, the prefrontal cortex.

This is not the case with the surgeries currently being done on children with gender dysphoria. Nothing is inherently wrong with the body parts being removed. That is, a child born with two X chromosomes in each and every cell of the body has developed two ovaries, one uterus and two breasts. There is nothing defective about those body parts. Removing them is removing healthy tissue.

You may be wondering why the medical establishment, seeing the carnage, didn’t rise up and put a stop to this brutal operation. As early as 1950, it was banned in the Soviet Union, Germany and Japan, yet it remained the darling of the press in America throughout the 1950s.

Newspaper articles of the time were overwhelmingly positive.

State governments were benefiting financially, as thousands of previously uncontrolled patients www.cmda.org | 19

Psychotherapy is a long process and requires skilled practitioners. It is expensive and is poorly compensated by insurance companies. Surgery, on the other hand, pays well. How many children or adults who have had this kind of surgery are supported emotionally afterward? Are the surgeons arranging for counseling? And were these patients properly advised on the lifelong consequences of the surgery, that is, its irreversible nature? If they were children when they began the process, were they truly at an age and maturity level to give proper consent?

As hard as it might be to believe, it was difficult in the 1950s to raise a voice of protest against lobotomies. Likewise, it is difficult today to voice opposition to these surgeries, even (and maybe especially) when they are done on children. Transgender treatments and surgeries are the darlings of the press. Yet, as reasonable voices break through the fog, more and more people are paying attention.

This is not to say gender dysphoria is not an incredibly painful condition. It is, but the pain is an emotional pain. The agony lies somewhere in that massive web of nerves that rests under our skulls. As miserable as that pain is, I’m not suggesting we operate on the brain. Let’s not make the mistake of the lobotomists.

And let’s not remove healthy organs outside of the brain, either. But, you may protest, what if removing these organs leads to healing of the emotional pain?

Wouldn’t it then be worth it? I’m not sure I would support surgery in that case, either. If the selfperception is out of step with the biological reality, then it doesn’t seem logical to me to try to adjust the body to conform with the mind. It seems much more health-affirming to treat the mind so it better correlates with the body.

It is clear the facts are lining up against “gender-affirming surgery.” True, those with gender dysphoria have a higher rate of suicidal thoughts, and of completed suicide, than those without gender dysphoria. But what is the solution? Those suicide rates dip after surgery, but they rise again to the same level a few years later.8,9,10 The same level.

The surgery didn’t resolve the emotional pain.

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The website11 of the American College of Pediatricians is full of helpful information, including extensive parent resources12 and a well-referenced article on “The Myth About Suicide and Gender Dysphoric Children.”13 CMDA’s Ethics Statement on Transgender Identification14 and a letter to the editor15 in The Journal of Clinical Endocrinology & Metabolism give references

and thoughtful arguments. The founder of 4thWaveNow considers herself “left-leaning” yet saw a need to bring together “a community of people who question the medicalization of gender-atypical youth.”16 The families of 1,000 children and adolescents who were “rushed into treatment” at the Tavistock gender-identity clinic in London, England recently filed a class-action lawsuit, stating they “suffered life-changing and, in some cases, irreversible effects.”17 I predict Great Britain is only a few years ahead of us here in the U.S. There will be a flood of lawsuits in the coming years, mark my words. You heard it here first.

READ MORE This article was originally published on The Point, CMDA’s weekly blog focusing on the issues facing Christians in healthcare. Visit www.cmda.org/thepoint to read more and join the conversation on breaking news stories in bioethics and healthcare. Our expert contributors also recommend additional resources and information.

On page 70 of Doctor Ice Pick, Claire Prentice, writing about Walter Freeman, the wildly enthusiastic proponent of the ice pick lobotomy, concludes with a sober warning: “Operation Ice Pick, when political power, medical orthodoxy, and an unquestioning press aligned behind a flawed man with a zealous belief in a dangerous and unproven medical procedure, should be remembered as a terrible parable of misplaced certainty and lax oversight.”

What is the best way to treat mental illness? Not with an ice pick. What is the best way to treat gender dysphoria? Not with surgery to remove healthy organs.

The future health and well-being of thousands of patients hangs in the balance.

Endnotes 1h t tps://pubme d . nc bi.n lm .n ih . gov/11898568/ 2h ttps://www.simplypsychology. org/frontal-lobe.html 3 h ttps://www.nobelprize.org/ prizes/medicine/1949/moniz/ biographical/ 4 h t t p s : // w w w . a m a z o n . c o m / Doctor-Ice-Pick-Claire-Prenticeebook/dp/B09X6QV51N 5 h t t p s : / / w w w . n p r . org/2005/11/16/5014080/mylobotomy-howard-dullys-journey 6 h t t p s : // w w w . a m a z o n . c o m / Doctor-Ice-Pick-Claire-Prenticeebook/dp/B09X6QV51N 7h t t p s : // w w w . a m a z o n . c o m / Doctor-Ice-Pick-Claire-Prenticeebook/dp/B09X6QV51N

8h ttps://4thwavenow.com/2017/09/08/suicide-or-transition-theonly-options-for-gender-dysphoric-kids 9 h ttps://journals.plos.org/plosone/article?id=10.1371/journal. pone.0016885 10 https://pubmed.ncbi.nlm.nih.gov/9373456/ 11 https://acpeds.org/ 12 h ttps://acpeds.org/topics/sexuality-issues-of-youth/genderconfusion-and-transgender-identity 13 https://acpeds.org/assets/SUICIDE-MYTH-HANDOUT-1592593440. pdf 14 https://cmda.org/policy-issues-home/position-statements/ 15 h ttps://academic.oup.com/jcem/article/104/3/686/5198654?login=f alse 16 h ttps://4thwavenow.com/about/ 17 h ttps://www.nationalreview.com/2022/08/the-u-k-turns-its-backon-transgender-ideology/

Amy Givler, MD, FAAFP, is a family physician in Monroe, Louisiana. She and her husband Don met in 1980 at a CMDA student event her first year of medical school, and they have both been active members of CMDA ever since. She works in two outpatient clinics and travels to Kenya yearly to teach LSU-Shreveport medical students and residents for their global health rotation. She is a regular writer for CMDA’s The Point blog, and she has also written a book for people newly diagnosed with cancer, Hope in the Face of Cancer: A Survival Guide for the Journey You Did Not Choose.

www.cmda.org | 21

A Letter to

Christian Physicians

Jonathan Clemens, PA

Dear Christian physicians, We need you.

Y

our Christian physician assistants, represented within CMDA by the Fellowship of Christian Physician Assistants (FCPA) specialty section, are caught in the middle of a transition. While it may just be an eddy in the class three rapids of healthcare evolution, the physician assistant profession has changed in the 12 years since I started PA school. Each PA’s story will be different, but themes and similarities recur.

In the beginning, a PA worked for a physician. With extensive prior medical experience and accelerated training in the medical model, a PA worked for a physician who had a practice vision that needed PAs truly to be physician extenders. When I started PA school in 2010, I wanted to be that kind of PA—someone who worked for an awesome physician who would be a true mentor, both a teacher and a supervisor.

As you know firsthand, medicine changed. Single physician practices are vanishing, giving way to group and corporate practices. Rather than being “the” doctor, physicians are increasingly “a” doctor: employees rather than leaders. Many senior physicians have retired rather than put up with the commodification of medicine, hallmarked by planned overbooks, electronic medical records and Press-Ganey scores.

This leaves your Christian PAs in a strange limbo. Outpatient PAs are now hired by practices, not physicians. We are often expected to see overflow appointments or same-day visits, used as a flexible workforce rather than developing deep relationships, either with our patients or our physicians. We are often

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assigned to “low acuity” tasks without adequate physician oversight or backup. The economics of salary and reimbursement muddies these waters further.

Unlike the administrative independence nurse practitioners enjoy in many states, PAs are tied to physicians in almost every state. In the new reality, this means they are tied to a group or corporate practice, not working in partnership with a single physician from whom a PA can absorb the art of medicine.

Thus, as Christian PAs, we find ourselves at an uncomfortable crossroads. We do not have the opportunities to work with and for Christian physicians that existed even a decade or two ago.

Instead, we have a choice of poor alternatives: • PAs can be—and are by default—absorbed into impersonal systems that are generally hostile to uniquely Christian care.

Even if we went into medicine with the goal of glorifying God by caring for the sick and injured, such motivations are at best tolerated.

• PAs can instead seek to sever our administrative ties with physicians. This is a strong preference among numerous PAs in the secular arena, sometimes driven by PA resentment that physicians have removed themselves from the relationship PAs depend on by selling their practices. The American Academy of Physician Assistants has adopted “Physician Associate” as the preferred title in an effort to maintain professional, but not administrative, ties with physicians.

Others point to the administrative independence of nurse practitioners as something we need to match.

GET INVOLVED WITH FCPA Are you a Christian physician assistant who wants to get involved with FCPA? We are always in need of faithful Christian PAs—from PA students to retired PAs—to serve in various capacities such as mentorship, missions and service. Mentors are welcome to join monthly group mentorship meetings where experienced CMDA members share knowledge with PA students and early-career PAs. FCPA is active at Global Missions Health Conference (GMHC), our members serve on Global Health Outreach (GHO) trips and we award grants to support member PAs and PA students’ short-term mission trips. FCPA is active at the American Academy of Physician Assistants (AAPA) as a caucus.

We host an exhibit booth, morning devotionals and evening speakers each May at the AAPA national convention. Our members serve in various roles in the larger, secular organization, and we have a voice at its house of delegates. We welcome any other talent not represented here! To learn more, email us at fcpa@cmda.org or visit cmda.org/fcpa.

Is there a third way? I hope so! I suspect most Christian PAs do.

As a Christian PA, I am at my best when I am working for a Christian physician. At least, I think I would be—I have never had the opportunity here in the United States. On short-term international missions, the collegiality of common Lordship has been such a blessing to me. I can only imagine how it would be in day-to-day life. A barrier to more PAs realizing this blessing is that as the PA workforce expanded, the number of Christian physicians in practice ownership has not.

So, what can Christian physicians do, other than starting new practices?

1. Mentor Christian PAs in your sphere of influence. While we graduate from PA school able to function on day one, we still need Christian physicians to teach us the art of Christ-centered patient care. If you want to help but don’t know of any Christian PAs in your practice or area, contact us at fcpa@cmda.org and we’ll connect you to one to mentor.

2. If you need a PA, hire a Christian one using CMDA Placement Services. The more Christian healthcare leaders seek to hire values-aligned employees, the better we can be at building environments that reflect Jesus’ love. They can’t guarantee you’ll find the perfect fit, but you’ll at least find someone serving the same Lord. For more information, visit www.cmda.org/placement.

3. Partner with Christian PAs. Some of us have ambitious, God-sized plans to improve healthcare through innovative service delivery, but we can’t do it, by law, without a physi-

cian in the mix. The partnership of young, idealistic and enthusiastic PAs with seasoned, experienced physicians could do such great things for the kingdom.

4. Pray for the PA profession. The evolution of medicine has not been kind to the PA-physician relationship.

Thank you to those who are already doing this. Know that your involvement, care and guidance is a real multiplier of our efforts to provide care in Jesus’ name.

For the Fellowship of Christian Physician Assistants, Jonathan Clemens, PA, 2022-2023 Chair Jonathan Clemens, PA, practices medicine as a PA in Thurston County, Washington, where he currently splits his time between eating disorders care with The Emily Program and occupational and family medicine at ErgoCare Clinic. Since his 2012 graduation from Pacif ic University’s PA program, he has experience in urgent care, sleep medicine, pain management, travel medicine, medical ethics and rural primary care. Jonathan is currently a doctoral student at A.T. Still University’s Arizona School of Health Science. Prior to PA school, Jonathan worked as a volunteer f iref ighter/EMT and as an information security specialist. He continues to serve as Chief EMS off icer and teach EMT classes for his f ire department.

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“You shall have no other gods before me” (Exodus 20:3).

Theology of Mythology Of God and gods, Angels and Demons W. Curt LaFrance, Jr., MD, MPH

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he people of ancient Palestine in Israel and Judea saw angels in anthropomorphic form, and they encountered demons inhabiting humans and animals. The angels (or even the Trinity) could eat at their table, unlock gates and move stones. The demons could cause convulsions and make swine swim (to their death). The thesis of this piece is that gods (with a little g) are real. The supports for this position are drawn not from mythology, rather from the Bible itself. Scripture refers to God being above other gods, not an absence of gods.

white robe sitting on the right side, and they were alarmed. ‘Don’t be alarmed,’ he said. ‘ You are looking for Jesus the Nazarene, who was crucified. He has risen! He is not here. See the place where they laid him. But go, tell his disciples and Peter, “He is going ahead of you into Galilee. There you will see him, just as he told you.’’’ Trembling and bewildered, the women went out and fled from the tomb. They said nothing to anyone, because they were afraid” (Mark 16:4-8).

“For the Lord is the great God, the great King above all gods”

Some maladies were attributed to demons inhabiting and afflicting humans:

(Psalms 95:3).

To begin, Christians have always readily accepted the reality and existence of spiritual beings. Numerous biblical references include Old and New Testament accounts of humans encountering angels in human form, where the angels interact with the physical world:

Moreover, demons were documented to have inhabited not only humans, but also animals, as depicted in Matthew 8:28-33.

“When they came to the crowd, a man approached Jesus and knelt before him. ‘Lord, have mercy on my son,’ he said. ‘He has seizures and is suffering greatly. He often falls into the fire or into the water.

I brought him to your disciples, but they could not heal him.’ ‘ You unbelieving and perverse generation,’ Jesus replied, ‘how long shall I stay with you? How long shall I put up with you? Bring the boy here to me.’ Jesus rebuked the demon, and it came out of the boy, and he was healed at that moment” (Matthew 17:14-18).

“The Lord appeared to Abraham near the great trees of Mamre while he was sitting at the entrance to his tent in the heat of the day.

Abraham looked up and saw three men standing nearby. When he saw them, he hurried from the entrance of his tent to meet them and bowed low to the ground. He said, ‘If I have found favor in your eyes, my lord, do not pass your servant by. Let a little water be brought, and then you may all wash your feet and rest under this tree. Let me get you something to eat, so you can be refreshed and then go on your way—now that you have come to your servant.’ ‘Very well,’ they answered, ‘do as you say.’ So Abraham hurried into the tent to Sarah.

‘Quick,’ he said, ‘get three seahs of the finest flour and knead it and bake some bread.’ Then he ran to the herd and selected a choice, tender calf and gave it to a servant, who hurried to prepare it. He then brought some curds and milk and the calf that had been prepared, and set these before them. While they ate, he stood near them under a tree” (Genesis 18:1).

New Testament depictions of human-angel interactions include, among others, Peter’s incarceration: “Then Peter came to himself and said, ‘Now I know without a doubt that the Lord has sent his angel and rescued me from Herod’s clutches and from everything the Jewish people were hoping would happen’” (Acts 12:11).

And at the site of Jesus’ resurrection: “But when they looked up, they saw that the stone, which was very large, had been rolled away. As they entered the tomb, they saw a young man dressed in a

Photos courtesy of Gene Rudd, MD. www.cmda.org | 25

If ancient Christ-followers and modern Christians believe in the spiritual manifestations of God, angels and demons, why do we dismiss the ancient Greeks and Romans as seeing and interacting with their gods and their miraculous works?

addresses the pagan religion of god-worship and the Satanic ties. In the book of Revelation, John writes to the Church in Pergamum, where the Altar of Zeus (of note, taken by the Nazis to Berlin, Germany) was used for sacrifices:

Two books I grew up reading were the Bible and Greek Myths. As a boy and even as an adult, I had no qualms with accepting the existence of God, angels and demons. In contrast, a mythological story of the character Zeus taking the form of a swan to interact with the character Leda was noted as a reflection of a simple-minded people trying to explain nature in the absence of scientific knowledge. As argued below, the people of ancient Greece and Rome were far from simple-minded, and we expose a modernist’s logical fallacy by accepting one premise (biblical angels and demons), while rejecting the other (mythological gods). The way to reconcile the Bible and myths is by addressing the uncomfortable and seemingly irrational question: Could it be that Zeus, or Jupiter as he was known by the Romans (as ruler of the Greek and Roman gods), was Satan (or other demon(s)) manifesting himself to the men and women of ages past? Perhaps the Pantheon and minor gods are his demons (other fallen angels), appearing to humanity, which were expressed in the ancient pagan worship of spiritual beings?

“To the angel of the church in Pergamum write: These are the words of him who has the sharp, double-edged sword. I know where you live—where Satan has his throne. Yet you remain true to my name. You did not renounce your faith in me, not even in the days of Antipas, my faithful witness, who was put to death in your city— where Satan lives” (Revelation 2:12-13).

Again, referencing from Scripture—and notably, not from D’Aulaires’ Book of Greek Myths, Homer’s Iliad and Odyssey or Virgil’s Aeneid—Christian New Testament writing

This begs the question, if we assert that their gods were “not real,” why do Yahweh, David and Paul all acknowledge their existence, as relayed in the Bible?

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The Old Testament writers are clear on the demon-presence in the false gods of their day: “But Jeshurun grew fat, and kicked; you grew fat, stout, and sleek; then he forsook God who made him and scoffed at the Rock of his salvation. They stirred him to jealousy with strange gods; with abominations they provoked him to anger. They sacrif iced to demons that were no gods, to gods they had never known, to new gods that had come recently, whom your fathers had never dreaded. You were unmindful of the Rock that bore you, and you forgot the God who gave you birth” (Deuteronomy 32:15-18, ESV ).

When Paul and Barnabas were confused for gods, their refutation was not “silly people, there are no gods,” rather, “we are human, not those gods you say we are.”

“In Lystra there sat a man who was lame. He had been that way from birth and had never walked. He listened to Paul as he was speaking. Paul looked directly at him, saw that he had faith to be healed and called out, ‘Stand up on your feet!’ At that, the man jumped up and began to walk. When the crowd saw what Paul had done, they shouted in the Lycaonian language, ‘The gods have come down to us in human form!’ Barnabas they called Zeus, and Paul they called Hermes because he was the chief speaker. The priest of Zeus, whose temple was just outside the city, brought bulls and wreaths to the city gates because he and the crowd wanted to offer sacrifices to them. But when the apostles Barnabas and Paul heard of this, they tore their clothes and rushed out into the crowd, shouting: ‘Friends, why are you doing this? We too are only human, like you. We are bringing you good news, telling you to turn from these worthless things to the living God, who made the heavens and the earth and the sea and everything in them’” (Acts 14:8-15).

When traveling through Anatolia/Asia Minor, Greece and Rome, it is readily apparent the ancients were not ignorant or “primitive.” Their architecture and artistry surpass any of the works of the “modern age.” Their ability to observe, reason and think without the tools (required) of modernity makes many in our intelligentsia seem limited in cognitive abilities.

Paul engages the greatest thinkers of Athens, identifying the polytheism of the Greeks, and even referencing them: “While Paul was waiting for them in Athens, he was greatly distressed to see that the city was full of idols. So he reasoned in the synagogue with both Jews and God-fearing Greeks, as well as in the marketplace day by day with those who happened to be there. A group of Epicurean and Stoic philosophers began to debate with him. Some of them asked, ‘What is this babbler trying to say?’ Others remarked, ‘He seems to be advocating foreign gods.’ They said this because

Paul was preaching the good news about Jesus and the resurrection. Then they took him and brought him to a meeting of the Areopagus, where they said to him, ‘May we know what this new teaching is that you are presenting?’...Paul then stood up in the meeting of the Areopagus and said: ‘People of Athens! I see that in every way you are very religious.

For as I walked around and looked carefully at your objects of worship, I even found an altar with this inscription: to an unknown god. So you are ignorant of the very thing you worship—and this is what I am going to proclaim to you’” (Acts 17:16-19, 22-23).

References in the Old Testament to other gods occur both with David and even Yahweh.

When David spared King Saul’s life, he shared what apostate people told him to do: “Now let my lord the king listen to his servant’s words. If the Lord has incited you against me, then may he accept an offering.

If, however, people have done it, may they be cursed before the Lord! They have driven me today from my share in the Lord’s inheritance and have said, ‘Go, serve other gods’” (1 Samuel 26:19).

And finally, when Yahweh provided the first commandment to Moses, for the people of Israel, even Elohenu (God) acknowledged other gods: “I am the Lord your God, who brought you out of Egypt, out of the land of slavery. You shall have no other gods before me. You shall not make for yourself an image in the form of anything in heaven above or on the earth beneath or in the waters below. You shall not bow down to them or worship them; for I, the Lord your God, am a jealous God…” (Exodus 20:2-3a).

Moreover, the purpose of the plagues was not a punishment of Pharaoh. God could have taken Egypt’s ruler out at any point. The purpose of the plagues was to show that the God of the enslaved Israelites was the Judge of all gods.

“Eat it in haste; it is the Lord’s Passover. On that same night I will pass through Egypt and strike down every firstborn of both people and animals, and I will bring judgment on all the gods of Egypt.

I am the Lord. The blood will be a sign for you on the houses where you are, and when I see the blood, I will pass over you. No destructive plague will touch you when I strike Egypt” (Exodus 12:11b-13).

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Scripture and archeology confirm that God exists and that there are gods (demonic manifestations of so-called deities).

These deities reflect their inherent nature. God’s character of goodness, wholeness and justice is just as consistent for Him, as with what a diabolical character of gods are. Anna Edmonds writes, “The [pagan] gods had little connection with morality: they were licentious, deceitful, quarrelsome and fickle.”1 We would not hesitate to call a person of that ilk, “a little devil.”

Acknowledging the reality and presence of the Pantheon of the ancients does not draw us away from the one, true God (who is identified in the fourth century Creeds); rather, the awareness makes us even more mindful of the world beyond the material, on which we are so focused. One reason why modern man may have dismissed the gods is because as we modernized, we demythologized. That is, we have become more concrete and less spiritually aware. As we explain nature with science, we need less of the numinous. Nevertheless, scientifically explaining that lightning is caused by a buildup of electrical charges, and thunder is a shock wave caused by the sudden expansion of air in and around the path of lightning’s discharge (and not by an angry god’s thunderbolts), doesn’t obviate the existence of Zeus (or a demon manifesting as such).

Just as nature abhors a vacuum, so do our souls. While we moderns scoff at idols of wood and stone, we have replaced them with other worldly idols, e.g., power, position, possessions, money, sex and experiences. We are as idolatrous in our “enlightened” age and culture as the ancient Egyptians, Greeks and Romans were. Writing of the early Greeks, Anna Edmonds goes on to write, “They [pagan gods] were to be worshipped at games and athletic events, at theatrical performances, before military undertakings and generally in daily life.” Could the same be said of today’s culture at a professional football game, the red carpet in Hollywood or a rock concert?

As William Pearson, PhD, discussed, “Myths help us understand our history qua cosmology—our cosmology is rooted in history. This is why, for example, for me, the garden of Eden being mythical and actual place are one and the same.”

In a personal conversation with Dr. Pearson, he also said, “Moderns jettisoned mythologies a century ago, and the church followed suit. Now, we live in Neo-pagan times, where the populace is searching for a mythology (just look at the box office), and the church doesn’t have one to offer.”

In closing, this reflection demonstrates that the Bible is clear that gods are real. We accept that angels appeared to men and women. We believe in Scripture that demons inhabited and influenced humans and animals. Likewise, we can acknowledge (by Scripture and reason) that the wonders of the world temples of ancient Greece, Rome and Asia Minor were built by men and women who saw and encountered gods—demons who manifested themselves in recognizable forms across time, geog28 | CMDA TODAY | SUMMER 2023

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raphy and cultures. This fascinoma, however, is not the point of application of the thesis. Rather, drawing from the Bible, myths, archeology, history and reason, we strengthen our personal and communal faith in the one God above all gods (whether spiritual or worldly), and also in our sharing of Him with others.

C.S. Lewis recognized that numerous cultures and civilizations share common myths and epics, e.g., the catastrophic flood, origins of viticulture, the birth mother to a god or life and the dying and rising pagan god(s). As Lewis wrote in God in the Dock, “We must not be ashamed of the mythical radiance resting on our theology. We must not be nervous about ‘parallels’ and ‘Pagan Christs’: they ought to be there—it would be a stumbling block if they weren’t…for this is the marriage of heaven and earth: Perfect Myth and Perfect Fact—claiming not only our love and obedience, but also our wonder and delight, addressed to the savage, the child and the poet in each one of us no less than to the moralist, the scholar and the philosopher.”2 Tracing its origin back in scriptural source documents that show the roots of the faith to the God-man, who walked among disciples and His deniers, and who engaged humans and spirits, Christianity shows that Jesus is the “myth become fact.”

Endnotes 1 Edmonds, Anna G. Turkey’s Religious Sites. Turkey: Damko Publications.

2nd Edition. 1998. p.51.

2 Lewis, Clive Staples. “Myth Became Fact,” in God in the Dock. Grand Rapids: Eerdmans. 1998. pp.66-7.

Acknowledgements Thanks to the following for review and helpful comments: William G. Pearson, PhD; Gene Rudd, MD; Matthew Doebler, MDiv, DMin; and Pastor Scotty Nesbitt, ThM

W. Curt LaFrance, Jr., MD, MPH, practices and teaches in Providence, Rhode Island.

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Bioethics The Dr. John Patrick Bioethics Column

WHAT FOUNDATION DO IDEAS OF ETHICS HAVE John Patrick, MD

C

harles Darwin’s great idea was that biological change could be endless if small, beneficial, naturally occurring variations could be selectively preserved and grow because of initially small survival advantages. He provided no theory of beginnings, only of process, which did not concern him too much because Aristotle’s belief in the eternity of matter had not been disproved. Furthermore, micro-evolution occurs all the time as Darwin describes so beautifully in the first chapter of On the Origin of Species. Healthcare professionals see patients every year with diseases like influenza, but no major alterations in body plans have been conclusively shown to have emerged from other groups. Most importantly, science only describes, it does not prescribe. The moral and cultural norms of society have no necessary individual benefits. Whence 30 | CMDA TODAY | SUMMER 2023

cometh human characteristics like fighting to preserve the lives of others at the cost of our own? There is no genetic benefit from young men who die before reproducing. No patriotic gene would survive.

We cannot flourish without societies that have a moral consensus—and one that recognizes our duties to one another regardless of ourselves.

That consensus in the Western world was derived from Judeo-Christian sources, and it can be argued that they served us well, but they are now decaying rapidly. The rise of bioethics implicitly acknowledges that past but does not revere it. Medical ethics were not taught in my medical school.

Basic principles were transmitted by our families before we could think abstractly, and they were mirrored and adjusted to the practice of medicine by our teachers, not didactically but implicitly. Good manners were expected, but they were mingled with much hypocrisy and were utterly unable to confront the rise of godless autonomy and Darwinian each against each.

When otherwise unemployable philosophers turned medical ethics into bioethics, they did not clarify problems but rather developed an industry of rationally defending the counter-positions to our culturally created norms. For example, never killing patients or keeping sexual activity only within marriage (incidentally, there is a good case to be made that sex confined to marriage increases creativity in business and science). The first thing that had to be done was to quietly suppress the question: In the beginning what or whom and allow the muttering of big bang to pass for an argument. Bioethics in medicine uses the Georgetown Mantra1 as a pseudo-foundation, which shirks not only the question of beginnings but also the question of where the authority to enforce their pontifications is to be found.

Some items to ponder: 1.

2.

Who, in the secular world, judges the elite?

If all truth is personal, then there is no logic. The idea that all truth is relative dies when it meets the question—“Including that statement?”

3. The post-modern response is to say only power matters.

4. We are all liars or cowards.

5. The parable of the wicked tenants.

6. The modern story of my desires.

7. The whole passion week story is about the denial of the truth of who Jesus is.

8. Polytheistic pagans like Aristotle spent their lives on the question of how to live well and virtue was their answer, but their primary virtues were courage, justice, prudence and temperance. They did not include women, slaves or the poor in their democratic processes.

9. We allow bioethicists to control our world without resistance. They encourage everyone to attend only to DIE: diversity, inclusion and equality (never adequately discussed and developed), although they know there are far more weighty principles needing attention.

10. Really smart academics are beginning to say that we live in a society without adequate foundations that science only describes and cannot generate values—a weasel word if ever there was one.

11. There is hope, but it requires renewed minds to flourish.

This list requires development. I would appreciate feedback from readers as to which items intrigue them most. On this occasion, I will only have space for four to seven which are my meditations on what I learned about reading the parable of the wicked husbandmen in my current favorite book—John Webster’s Confronted by Grace: Meditations of a Theologian.2

First, I had neglected to note that the parable is told toward the end of Jesus’ final journey to Jerusalem and, although the rulers of the Jews are the obvious targets, Webster convincingly shows that we are all guilty of the fundamental sin of wanting to make the world fit our desires rather than practice true obedience to the Lord. The wicked husbandmen wanted the vineyard for themselves, so they set about destroying any other claimants. The Lord has purchased our otherwise self-centered lives and remitted our sins, for which I trust we are all duly grateful. However, remember the washing of the disciples’ feet where Jesus draws out this conclusion: “You call me Teacher and Lord and rightly so, for that is who I am. Now that I, your Lord and Teacher, have washed your feet, you also should wash one another’s feet” ( John 13:13-14). It is a terrifying challenge. We all lie about the truth that He is Lord.

Here is Webster’s superb paragraph on why we lie: “Why do we tell lies? We lie to evade reality; we lie because the truth is too painful or too shameful for us to face, or because the truth is simply inconvenient and must be suppressed before it’s allowed to disturb us. We invent lies because for whatever reason, we want to invent reality. [The reality we invent] makes no claims on us. It demands nothing. It doesn’t shape us the way truth shapes us…

A lie is a made-up reality and so never unsettles, never criticizes, never resists, never overthrows us. It’s the world not as it is, but as we wish it to be, a world organized around us and our desires, the perfect environment in which we can be left in peace to be ourselves. (How modern this is, but from a 1999 sermon.)

He continues, “Lies are a desperately destructive force in human life. When they take the form of private fantasy, they rob us of the ability to deal truthfully with the outside world but when they go public, when an entire social group replaces reality with untruth, then the consequences are deadly. Lies can kill.

If the lie is to be maintained intact, then anything that speaks the truth must be got rid of.”

If that doesn’t sound familiar, you have been asleep for quite some time!

Endnotes 1 https://en.wikipedia.org/wiki/Principlism 2 Webster, John. (2015). Confronted by Grace: Meditations of a Theologian. Lexham Press.

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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