CMDA ethics

Christian Medical and Dental Associations US (CMDA-US) is 93 years old this year, it started as a Bible study at Northwestern University Medical School in 1931. Since then, we have grown to approximately 13,000 members with more than 40 different ministries. I am privileged to oversee the advocacy work of CMDA, which has grown and taken on greater significance over the last few years because of our rapidly changing culture here in the US. We engage with our federal government and the governments of all 50 states, plus the District of Columbia. However, many branches of federal government are currently in political stalemate, so most of our advocacy is with state governments. We address four significant issues at the state level: protecting unborn life, preventing minors from being exposed to gender transition therapy, defending healthcare from the corruption of assisted suicide, and protecting the ability of our members to practice conscientious, Hippocratic medicine.

CMDA works closely with the American Academy of Medical Ethics (AAME) to advance our influence at the state level. The AAME is partially staffed with CMDA members who volunteer to serve as AAME State Directors. These AAME State Directors connect with other CMDA members within the state to promote specific acts of legislative engagement, such as giving oral or written testimony before a legislative committee on one of these four issues.

While abortion regulation is essentially settled in many parts of the developed world, the overturn of Roe v. Wade in June 2022 by the US Supreme Court returned the issue of abortion to the forefront in most of our 50 states. Progressive states emphasising personal autonomy are pushing legislation to expand access to abortion under the banner of ‘reproductive rights.’ States recognising the dignity of the unborn are advancing legislation to restrict abortion to varying ages in early pregnancy, depending on the local political climate. The AAME has had limited success blocking legislation expanding access to abortion in states like Oregon, Washington, and California because of the overwhelming progressive views within those states. The AAME has had better success supporting legislation restricting abortion in states like South Carolina, Ohio, and Tennessee.

One new and particularly egregious trend is the effort to prevent abortion pill reversal. Medical abortion is a two-drug regimen of Mifepristone and Misoprostol that induces chemical abortion up to the gestational age of ten weeks. Mifepristone is an anti-progesterone that is highly successful in competing with the natural hormone progesterone, causing the developing embryo to die in most pregnancies. The second drug, Misoprostol, is typically administered 48 hours later to cause uterine contractions that expel the pregnancy. If a woman regrets her decision to end the pregnancy after taking Mifepristone but before taking Misoprostol, natural progesterone can be administered safely in high doses to rescue her pregnancy in more than 65 per cent of cases. This is known as abortion pill reversal (APR).

APR is believed to be safe because the progesterone administered to the patient is the same hormone and in a similar quantity produced naturally in pregnancy. However, despite APR’s apparent safety and efficacy, Colorado recently banned the practice within the state, labelling it medical misconduct.

The other contentious issue invading the public square in the US is the treatment of gender dysphoria, especially in minors. Gender dysphoria is the subjective discomfort that arises from a discordance between a person’s perceived inner gender and their biological sex. Initially quite rare, the incidence of gender dysphoria has increased markedly in the last few decades because it has become a social contagion. For decades, gender dysphoria was viewed as a mental health problem, with therapeutic efforts focused on changing the internal perception of gender. However, several decades ago, physicians in the Netherlands began utilising a novel therapeutic approach to gender dysphoria in minors that involved altering secondary sexual characteristics.

There are three primary phases in what has become known as the Dutch Protocol, based upon the ideology that the essential problem in gender dysphoria is the appearance of the body, not the inner sense of gender. The initial phase is the suppression of puberty with a drug known as a gonadotropin-releasing hormone agonist (GnRHa). This drug is usually started at the earliest signs of puberty and continued until the patient reaches an average age of 16. The second phase of the Dutch Protocol is the initiation of cross-sex hormones, hormones that elicit the physical appearance of the perceived gender opposite the biological sex. Biological girls, whose inner sense of gender is male, would receive testosterone-based hormones, while biological boys, whose inner sense of gender is female, would receive oestrogen-based hormones. The final phase of the Dutch Protocol includes surgical alteration of the body to match the inner sense of gender. These surgeries can range from the removal of sexual organs to cosmetic surgeries such as hair removal and alteration of the larynx. Another term for the Dutch Protocol is gender transition therapy (GTT).

The major controversy surrounding the Dutch Protocol is the quality of evidence supporting its use. In 2020, excellent reviews evaluating the quality of evidence concerning the use of puberty blockers 1 and cross-sex hormones 2 in minors were published by the United Kingdom’s National Institute for Health and Care Excellence (NICE). These reviews revealed that the evidence supporting GTT in minors was either low-quality or very low-quality. The more recent Cass Review has further shown the lack of evidence for GTT and advocated a more cautious, evidence-led approach to the treatment of minors. 3 As a result of the lack of high-quality evidence supporting GTT in minors, the UK, Sweden, Norway, Finland, and France have recently adopted a more cautious approach to gender dysphoria in minors. For example, the UK is now limiting the use of puberty blockers and cross-sex hormones in minors to those enrolled in prospective clinical trials.

However, within the US, a number of states are essentially ignoring the UK evidence reviews, choosing instead to actively promote GTT to minors suffering from gender dysphoria, with few, if any, screening protocols. This stance is currently supported by the official position of the American Academy of Pediatrics (AAP), the largest paediatric professional organisation in the US, as well as the Endocrine Society, the American Medical Association (AMA) and other major medical associations.

CMDA-US opposes the use of GTT in minors both because of the great harm GTT inflicts upon these children, and also our Christian worldview that because God created us as male and female, the problem in gender dysphoria is the anomalous inner sense of gender. CMDA and the AAME have successfully promoted state legislation banning GTT in minors in 17 states during the last calendar year. Despite this success, we recognise our efforts to oppose the highly contentious issue of gender transition therapy in minors must continue within the US, especially since the AAP has recently reaffirmed its position on GTT.

Assisted suicide is now legal in ten US states and the District of Columbia. CMDA and the AAME oppose assisted suicide based on the view that we are created by God in his image, and he is the only one who can decide when death occurs. In addition, assisted suicide damages medicine by changing it from a healing to a killing profession. Pro-assisted suicide organisations are working hard to expand access to assisted suicide in other states through legalisation and legislation allowing residents of surrounding states to travel into states where assisted suicide is legal in order to obtain lethal drugs. Vermont and Oregon successfully opened their borders to become assisted suicide destination states. CMDA-US and the AAME are partnering with several groups opposed to assisted suicide to fight against pro-suicide legislation and introduce legislation that would criminalise any effort to provide assisted suicide drugs to a patient.

Despite the gravity of all these issues, the subject that presents an existential threat to CMDA-US is the ability of our members to practice Hippocratic medicine. Even with our constitutional freedoms of speech and the exercise of religion, the ability of our members to express their conscience freedoms by refusing to engage in effective referral and participation in offending procedures is met by increasing opposition, ranging from verbal abuse to outright termination of employment. Instances of vindication have occurred through arduous and expensive litigation, often taking many years to achieve, but many are left with their professional lives in shambles.

Many of our members recognise the echoes of first-century persecution in these experiences, drawing comfort from the call to take up their cross and follow Jesus. Nevertheless, we also comprehend that with the loss of each Christian healthcare professional’s ability to be salt and light, the character of healthcare is slowly shifting toward evil rather than the example of excellence it has modelled for the last 2,400 years since Hippocrates. Therefore, we acknowledge the critical importance of continuing this fight to preserve the character of healthcare and witness to the goodness, grace and mercy of our loving Lord.