[00:00:08] Speaker A: You're listening to faith in healthcare, the cmda matters podcast. Here's your host, Dr. Mike chupp.
[00:00:20] Speaker B: Welcome, friends, to Faith in healthcare. I'm Dr. Mike Chupp, and I'm glad you're with us today.
What do you do when a patient asks for something that you believe would actually cause them harm? Or when your employer expects you to participate in care that actually conflicts with your faith?
These questions become very personal when you're the one who has to respond as a healthcare professional.
Well, in this episode, I'm joined by Dr. Brick Lance, who's CMDA's Vice President of advocacy and bioethics, for another Q and A session on some of the difficult questions that Christian healthcare professionals keep bringing up to us. We cover a lot of ground, from pronouns and conscience concerns to in vitro fertilization and end of life care.
Through it all, we're asking where to draw the line and what it looks like to hold to the truth while still providing the best medical care and loving the person that's right in front of us. Well, here's our conversation today.
Well, today on Faith and Healthcare, we're going to be having our quarterly Q and A, if you will. And the idea for such a Q and A came from our vice president of advocacy and bioethics, Dr. Brick Lantz, who's with me in the studio today. So welcome all the way from Oregon, Brick.
[00:01:50] Speaker C: Well, thank you. And I've occasionally, very rarely been accused of being a caddy. What is it called? Chatty Cathy.
[00:01:57] Speaker B: Chatty Cathy. Even though I'm, I plead the fifth on my response to that. But you're not just a chatty, you're many things.
You are quite the amazing doctor adventurer. And you just got back from an adventure in Alaska, I think.
[00:02:12] Speaker C: Yeah, well, Yukon Territory in Alaska. Ye.
[00:02:16] Speaker B: With a bunch of buddies down some river.
[00:02:17] Speaker C: I've never heard of Tochancini. And we did see a few grizzlies,
[00:02:21] Speaker B: but what grade rapids did you face?
[00:02:24] Speaker C: Grade three at the most. But it's a very powerful river. And you're also hundreds of miles from anywhere and you don't see another soul.
[00:02:30] Speaker B: Biking, rafting, probably mountain climbing. We don't need to go into that. But anyway, thanks for the idea of us having a Q and A periodically. And it gives us an opportunity for listeners to actually ask questions from some incredible array of guests.
And also we have a blog that has generated some of our questions today.
[00:02:51] Speaker C: Yeah, the point of medicine. That's where a lot of these questions come from. And Mike, today we are going to talk about some of the hot buttons in bioethics, but people never cease talking about or asking questions on these issues, so they're worth talking about again.
[00:03:07] Speaker B: Yeah. And I think an overarching. Our producer has maybe for this particular conversation, giving me an overarching theme, which is, what does faithfulness and contending for the practice of conscientious medicine look like when you're sitting, not necessarily with a fellow leader at cmda, but you're sitting with a patient in an exam room or having a discussion in the doctor's lounge or on teaching rounds with those with all kinds of worldviews?
[00:03:33] Speaker C: Right, right, right.
[00:03:34] Speaker B: So my first question is this. One of the questions that we get repeatedly is what does CMDA think about the whole issue in the transgender revolution about acquiescing and using preferred pronouns? Now, we just recently released on Faith in Healthcare, an interview with Valerie Kloosterman, who lost her job because she didn't go along with what the U of M branch there told her she had to do.
So how are you responding when you get inquiries about this question? As a doctor, what should I do when I'm asked to use a pronoun that I know is not biologically accurate?
[00:04:12] Speaker C: Mike, I'm glad we put this question first, because every healthcare profession now faces this issue.
Everyone sees someone now with this transgender tsunami. Someone comes in their office. It could be very, very infrequent or rare, but someone's going to come in and this issue will come up. And I personally have made the mistake.
Sometimes I don't even know if they're male or female. I got to look at the chart. You know, what their biology is, and I say a mistake. So I do have my protocol, if you will, when I was in practice, and that is if they're in that transgender realm, to use their proper name, whatever their proper name is, what they choose to be called. That's what I would use. Avoid the he or the she or those words that have the male or female connotation with it because they will request to be called by their gender affirming. Again, air quotes there pronoun where I won't do that. And again, we want to live not by lies that Solzhenitsyn talked about. So there is a biological reality.
So this is very common in medicine. It's actually common in all kinds of situations, including education. It's not limited medicine, but I think every physician, every healthcare professional encounters this in some way.
I just had a phone call just a few weeks ago from one of our members who was also fired. He had put the biological pronoun in the patient's chart, even though the patient had transitioned. I hate that word transition, but was living by the opposite sex, if you will. And so we had a very long conversation. It's been a long, drawn out process, but he lost his job for that. So this is a very real issue.
Mike, I should also mention that we now, as cmda, are involved in a lawsuit in the state of Colorado.
And I don't want to say too much about it, but it is about the gender issue and really all ages, but particularly adolescents, and it's about providing medications, procedures, and actually being forced to do that. But it also involves the pronoun issue.
And we need not acquiesce. We need not acquiesce on this, but
[00:06:26] Speaker B: we also need to be honest about the risks involved. And we've been talking with those in Colorado about risks that are involved because it only takes a very, very small, active and passionate group to go after anybody.
[00:06:39] Speaker C: Absolutely. So my simple advice. And again, different CMDA members will have different advice, but as a leader here, just avoid the biological pronoun for that individual, both in conversation and in the chart. And just use the proper name throughout the chart.
[00:06:57] Speaker B: Proper name?
[00:06:57] Speaker C: That or Bill, John, Lisa.
[00:07:00] Speaker B: But if that's not the name that they want to be referred to.
[00:07:03] Speaker C: No, I even use the name that they choose, even if it doesn't quite match gender. You know, a Leslie can be male or female, but that's what I did in my career. And just avoid any of the pronouns that are male or female.
[00:07:17] Speaker B: Yeah, I tend to always use the names that patients want me to use. I don't feel that's living by lies.
[00:07:23] Speaker C: Right? Correct.
[00:07:24] Speaker B: Like the pronouns.
[00:07:25] Speaker C: Yeah. So that's the basic summary of that.
It's a difficult struggle. And I will just warn you, you'll make mistakes. You know, you may, you know, you come out with the he or the she when they want something else, or you say it to their gender identity when it's actually not true. Biologically, you'll make a mistake both ways.
[00:07:45] Speaker B: Even with married status, we doctors make mist takes all the time when we say things and we just. We accept. Oh, okay, that's right. You're not married. I'm sorry, you're not Mrs. So those things, we just. It requires grace in both directions, doesn't it?
[00:07:58] Speaker C: It really does. And so just be conscious of it and do the best you can.
So when medicine asks us to participate. So, Mike, there's a line between caring compassionately for a Patient with whom we profoundly disagree and other disagree with, they've chosen to do versus actually participating in something we believe is medically harmful or morally wrong.
Where is that line? Do you understand that question?
[00:08:27] Speaker B: Absolutely, I do. And we frequently bring up Farr Kurland's book, the Way of Medicine, because it's such a powerful book, and we give that out as gifts to people all the time. And I've heard, as I travel and meet with different physicians, some not even associated with. With cmda, they refer to that book. And the Way of medicine is I care about that person sitting across the exam or on the exam table, about their flourishing at the end of the day as a professional, how they can flourish. And so I think what Farr has emphasized that as he travels and speaks, that even those who are so adamantly supportive of patient autonomy that they come to understand that what really motivates what he has written, the Way of Medicine is, and which motivates you and me, and so many of you are listening, is I want the best for this patient. And so that's compassion. I mean, I want the best for you. In my case, general surgery, sometimes a patient would come in, referred by the ER having a CT scan with a gallstone in place. I start asking questions, and I find out they have no symptoms. It's an asymptomatic gallstone. The ER doc to cover, you know, check the box, sent them to me, and with the literature that I understand expertise and the training I've received is, I can tell them that the odds of them becoming symptomatic from that single large gallstone are pretty remote. If they have had no symptoms to date, and therefore observation is best, they say, Dr. Chupp, the ER doc, told me I would need my gallbladder out. And I come back and say, I appreciate their concern. I'm glad they sent you to me, but I'm just here to tell you that you don't at this point in time, even though, I mean, if I was just financially motivated, they have a gallstone, I could do a lap coli and take it out. But for their benefit, I know the literature says that they're okay until maybe they develop symptoms. So now if they continue to push me, Brick, and I'm sure you've got stuff like that in ortho all over the place, if they continue to push me, I'll say, I tell you what, if you'd like a second opinion, I'll be happy to refer you to Dr. So and so, whom I respect. And you see what they Say, and it's possible they wouldn't agree with me for whatever reason, and that's okay, but I'm just telling you professionally. So that's compassion. That's caring for the outcome of that patient. We had a guest a couple of months ago, just a fantastic interview we did with Scott Glasberg from New York, and he introduced the concept of positive and negative autonomy. And we've had some of our friends reach out and say, wow, I've never heard it put that way. But autonomy has always been in terms of negative autonomy, which is, I have the right of refusal.
A patient can refuse whatever we recommend to them in orthogenital surgery, whatever the specialty.
The idea of positive autonomy is just. It's really not existed in medicine that someone can force me as a healthcare professional to do what I don't feel is right for my patients. So I think that whole concept. We need to keep talking about it, that positive autonomy is not where our profession is. I don't have positive autonomy to tell my architect there's a way he must design my house. When he says, well, that's not safe. He can refuse.
[00:11:34] Speaker C: Going back to what your other comment, and we had the podcast recently when you released the lecture I gave at the Colson center about trust. And trust is so important in that patient doctor relationship.
And to be honest, I did not want to operate on someone if they didn't trust me. And so, like you said, if they had other questions, they think that I'm not telling the truth. I would always offer them a, you will not offend me at all if you get another opinion, because I want you to be, you know, knowing what is good and what's right for you, what is good for your flourishing, for your health, if you will.
Here's my fear, having been practiced for decades, is that medicine has become transactional.
It seems like it has changed in my career and that it's now just another business transaction that takes the joy out of medicine.
You know, the joy is actually caring for the person.
The benefit is, okay, then I get to do my surgery, you get to do your surgery. But the joy is actually taking care of the person. Now, I'm not saying surgery is not fun. You had a great time doing surgery. I had a great time fixing broken things. But the real joy comes from caring for the patient.
[00:12:43] Speaker B: Yes, Amen.
[00:12:45] Speaker C: And I always.
I frequently refer to John, chapter eight, with the woman caught in adultery or some type of sexual sin. And what does Jesus say? He says, you know, your sins are forgiven. Of course, he's Jesus. He can do that. We are to point people to Jesus to have their sins forgiven, but he doesn't go and sin no more.
The reason Jesus says that is because that's best for the patient. That's for this lady. That's to help her flourish, to live as God's designed her. We need not back away or fear of giving advice to patients of what is good for their flourishing and their health. That's part of being a doctor, being
[00:13:22] Speaker B: a profession, and love them even if they don't take our advice.
[00:13:24] Speaker C: Absolutely.
[00:13:25] Speaker B: We'll get to that here in a little bit.
[00:13:26] Speaker C: Yeah, absolutely.
[00:13:28] Speaker B: So, Brick, suppose your hospital or a med student or a resident comes to you and talks to you, and basically you're hearing from them, or you personally find that your employer is requiring you to participate in or referral for something that violates your biblical convictions. What should our listeners, Christian healthcare professionals, do when it is appropriate to say, I cannot do this?
And you know, the AMA says that we won't always agree with our patients decisions, their life decisions, and that we have an obligation to look beyond, you know, our personal beliefs of their life choices and still care for the patient. So how do you counsel folks?
[00:14:12] Speaker C: Okay, I want to use the word opportunity here, Mike. Again, people call me an opportunist, and I am. I'm very opportunistic. So if someone has made bad decisions, what we consider bad decisions in their life, we then have the opportunity to come and bring in love and compassion and point them again to the one for forgiveness of the bad decisions they've made.
That is different than being complicit in evil. Okay. In other words, prescribing a medication, performing a procedure that clearly is against the benefit of the patient, against God's design. And again, all the issues come up, such as abortion or sex rejecting procedures, as we now call it, or even assisted suicide, which my state of Oregon, first place in the world to legalize that. We're going to discuss some of these issues. But there's difference. Being complicit and then having compassion. I should mention, because you were there, Tennessee passed the Med act last year. So the Med act is the Medical Ethics Defense Act.
So this is interesting. First, liberty ranks states in religious freedom. In other words, us being able to practice according to our beliefs and our conscience. So Tennessee went from number 10 passing act number two in the country in regards to religious and faith liberty. And I find that fascinating simply by passing that act.
So I find it very important that we not miss the opportunity to care for the patient. At the same time, don't participate or be complicit. I think of the ER doctors, when someone comes in, take the chemical abortion drug and they're in the midst of an abortion, your doctor still needs to take care of that patient. You're not complicit in the procedure.
[00:15:55] Speaker B: No. In Kenya, where abortion was illegal, still, if a woman came in from a botched, backstreet country, abortion, I mean, we would never say, sorry, made a bad decision.
I mean, we. Intensive care, I mean, some really awful things happened from these abortions. And we didn't try to indict this woman at all. At all. And in fact, in most cases, we didn't even bring it to the attention of the authorities or the police because the family was afraid that their loved one, this woman, would somehow be thrown in jail. So we kept it on the down low because she was our priority.
[00:16:32] Speaker C: Right. And we need to make this emphasis, Mike, make this point. This is very important for all those that listen, there are healthcare professionals, if you will, in the name of Christ, who refuse care.
That's wrong.
[00:16:47] Speaker B: So let's go there. Let's talk about this. An article that just came out not long ago in World magazine. Tell our listeners about that situation.
[00:16:55] Speaker C: Well, again, it was a patient that was single and pregnant. Okay. Which is what, you know, pregnancy centers, that's what we do all the time.
And needed prenatal care because she wanted to keep the baby. And the doctor, as a Christian, and I put that in air quotes, okay. As a Christian, refused care for that patient because of the decisions that patient
[00:17:16] Speaker B: had made and in relation, I mean, to the med act. So the article was talking about this great move from 10th to second.
[00:17:22] Speaker C: Right.
And so somehow the patient probably wasn't very far across state lines to get prenatal care elsewhere. That's just wrong. That's wrong in the name of Christ to refuse care for someone in need, even if it's been a bad decision that led to the need for care that's so important.
[00:17:39] Speaker B: It's not consistent with anything that I read in my Bible to refuse that. And what an opportunity. It's Romans Paul said it's the kindness of God that leads us to repentance.
[00:17:50] Speaker C: Absolutely.
[00:17:51] Speaker B: And. And helping a woman through prenatal care. There's nothing outside of bioethics. There's nothing that is like sex rejecting procedures. That's a different issue.
[00:18:00] Speaker C: Yeah. And even though, you know, I had my patients that had gone through sex rejecting procedures but needed orthopedic care, they get the best orthopedic care possible. If those that are in a gay relationship need orthopedic care, they get the best orthopedic care.
[00:18:12] Speaker B: For me, screening colonoscopies.
Patient was there with her partner, lesbian. And I mean, I offered to pray over the course of time and that woman came to trust me a great deal.
[00:18:25] Speaker C: Yeah, yeah. So we need to care for the patient. That's so, so important.
[00:18:29] Speaker B: So, Rick, how should Christian physicians think through increasingly complicated questions around abortion, especially when we're confronted with maternal illness, fetal abnormalities or pregnancies in which the life of the mother may generally be at risk? And I just saw an article of gazillion. You get more than I do, but just all kinds where the accusation is that there's been a rise in ectopic pregnancies and it's all because of these laws against abortion access.
[00:18:57] Speaker C: Yeah. So several comments on this question. This is a very loaded question.
Obgyn doctors and whether you're a believer or not, they're going to take care of an ectopic pregnancy. That's just false. That's media fed. It's creating hysteria. But if someone is ectopic, it can be life threatening and they will care for that patient. They're not going to refuse care. It just doesn't happen. Now, whether there's been an increase, you know, talking to Christina Francis with Apolog recently, there may be a little bit of increase in ectopic pregnancies for some reason, but it's not related to not diagnosing or not treating it because of laws or policy that's been established. So that's just a false.
[00:19:36] Speaker B: My father used to tell me, Brick, that the best defense is a good offense. And ironically, I mean, just the whole idea that these laws are somehow making that happen to me is a smokescreen for defending the fact that mifeprex being given out like candy is leading to grave problems in the setting of ectopic pregnancy.
[00:19:57] Speaker C: Yeah. In fact, I was talking with someone yesterday about how there's an increase of depression with mifepristone. And that's actually on their label, by the way. And we already know there's a significant risk of postpartum depression for women. There's post abortion depression now. Mifeprostone adds to that. But again, as you know, CMDA and other organizations, we are working, trying to influence the fda and we have a new leader of the FDA to put some restrictions on this drug because it is not only killing babies, but it's harmful to the women.
[00:20:25] Speaker B: Any progress with the elections coming up.
[00:20:27] Speaker C: Yeah, I think we've put things on hold until after the midterm elections. Just because.
[00:20:32] Speaker B: And by we, you mean.
[00:20:34] Speaker C: Well, our advocacy team. And when I say our advocacy team, it's working with other organizations. It's working with Apolog, Americans United for Life, other organizations that we've written multiple letters to the fda.
[00:20:44] Speaker B: But the reality is.
[00:20:46] Speaker C: The reality is they're just not gonna make a decision before the terms. Now, you also mentioned when the life of the mother is at risk.
Now, before viability of the baby in the womb, that's extremely rare. Not that it can't happen. We can talk about all kinds of medical issues or whatever, but in general, when the mother's life at risk, you try to save both the baby and the mother. In other words, I think the research will bear this out. It's actually more dangerous to the mother to do an abortion versus delivering the baby or doing a C section and trying to save the baby and saving the mother at the same time, which
[00:21:25] Speaker B: is not an abortion.
[00:21:26] Speaker C: Right.
[00:21:27] Speaker B: Whereas the language. There's confusion from the other side. That is delivering that baby, precipitating the delivery is not abortion. And yet is taking care of mom and respecting the life of the baby.
[00:21:37] Speaker C: Absolutely. And so there are all kinds. And these questions come up very frequently, and we just need to set the record straight.
Now, what's come in the news recently, as you know, is this case with Lindsey Clancy, who apparently had a psychotic break and killed her three infant children, if you will. And I don't want to go into the case. It was a hung jury, if you will, because one of the 12 jurors would not acquit. The others wanted to acquit.
[00:22:01] Speaker B: I'm actually glad you brought this up. I actually had a personal email from a friend who said CMDA needs to talk about this. So I'm actually glad you're bringing it
[00:22:08] Speaker C: up, and I'm happy to talk about it, but not about the case, because I, you know, I don't. I don't know Lindsey Clancy. I don't know what the situation. I don't know if she clearly had a psychotic break. But here's the problem, Mike.
Here's the problem. It's a larger problem than her. And we grieve for the three children. Absolutely grieve for the loss of the three children.
But the cultural milieu that has now been created by abortion for the past 50 years is this loss of sanctity for God's creation in the womb.
We've lost this in our culture. So it's easy to sympathize with a patient who undergoes psychotic break and kills the three children, rather than grieving for the children. Now, whether she's guilty or innocent, that's beside the point. But if you read the media, if you have these conversations, we've lost this grieving over the loss of life, whether it be a child or someone in the womb, we've lost the grieving, and we need to be grieving.
And I think that's the issue to take away. Yeah, yeah.
[00:23:14] Speaker B: Moving on, Brick, the issue of in vitro fertilization, it's going to keep coming up, especially with federal level discussions about financial support for ivf.
So many Christian couples experience infertility. I know at least one couple in my church right now because of incredible, incredible situation with her having had breast cancer at the age of 24. And so the issue of wanting to get fertile but having had drugs to reduce her fertility. And so there are all kinds of situations. You've been on our board of CMDA when we've just talked through some challenging scenarios.
And so IVF can be looked at as a real answer to prayer. What questions should a Christian physician or Christian couple ask about the creation, selection, freezing, testing, transfer, you name it, the whole process, disposition of embryos. Moving forward, the questions seem more complex.
And, you know, if we have a guest that just says freezing is bad, we know we're going to get lots of feedback that people don't agree with that.
[00:24:20] Speaker C: So, first of all, Mike, as you know, we have a brand new in
[00:24:23] Speaker B: vitro fertilization statement, cmda.org ethics they'll find it.
[00:24:28] Speaker C: They'll find it. It's there, it's easy to download, don't have to be a member or anything. You can find that, that statement. It's a very robust statement. And I just want to give a shout out to our ethics committee led by Joy Reilly. They do due diligence on creating these statements.
Again, I'm biased.
[00:24:43] Speaker B: You're on the committee.
[00:24:46] Speaker C: It's probably the best ethics statement out there on IVF that exists today because it's scientific, it's rational, it's scriptural, it's compassionate. So it does cover the gamut of these issues.
Now, we also have good friends you've had on your podcast, I think, Warden McClelland, who does RRM, so restorative reproductive medicine. Okay. And I think that's so important.
And I do agree with some of our other guests that have discussed how IVF has become big industry, if you will, because there's a lot of money.
[00:25:16] Speaker B: Big fertility.
[00:25:17] Speaker C: Big fertility. There's a lot of money involved in that transaction.
We need to encourage those that listen to this podcast are involved in primary care, including our obgyn, pediatricians, family doctors, care for the whole patient, try to find the root cause of the infertility. Now, it's interesting what you mentioned. So my nurse practitioner at our pregnancy center, Sarah and I would go to local churches, you know, at invitations and speak on the beginning of life, everything beginning of life.
Invariably, the number one issue that church members fight is the issue of infertility. So in fact, more than 10% of church members, young couples. So it is an issue that's out there. We need to be thoughtful, we need to be compassionate because it is very frustrating for the couples. And again, there's all kinds of options such as adoptions or fostering as such.
But I think the physician who then addresses a couple just like we're talking about as real human beings with real issues and investigates the medical problems and not jumping to IVF immediately. In other words, maybe there is something else. Let's do some tests and they may need surgery for endometriosis or maybe a hormone imbalance, maybe need a thyroid test. Who knows what it can be? But do the full evaluation and treat what is treatable and then also be compassionate and come alongside the couple that is infertible is a rule for ivf. We have their podcast, we have our statement. You can look at that. And going back to your predecessor, David Stevens, is don't fertilize an egg unless you're going to implant it. So he would always advocate, you know, just implant what you're going to fertilize. So if you only just get a few ovum, if you will, and fertilize them, of course, that's a lot more expensive. You don't. Again, the reason we freeze and going back to big Fertility, the number one reason you freeze the embryos is out of convenience. Okay?
Convenience and efficiency.
[00:27:15] Speaker B: So there must be, and I can't tell our listeners because I personally don't know, there must be a resource for restorative reproductive medicine practitioners. I know that among all those who do IVF, it is a small percentage, very small, like maybe 1 or 2%, I don't know. So my natural instinct, as you know, would be go to ChatGPT and just ask some questions. Who closest to me is practicing restorative reproductive medicine that will consider other things along the way short of ivf?
[00:27:44] Speaker C: Yeah. And believe me, we actually get a few of those. You can reach out to advocacymda.org and we'll help find that resource. We just had one last month from another ministry partner that we work with and so one of their employees is struggling with infertility and so they reached out to us. We actually found someone in their state that practices rrm, if you will.
[00:28:14] Speaker A: Before we continue with this week's episode, here's a special announcement for you.
CMDA has a special October offer for you.
For a gift of any amount, CMDA will send a free copy of Scott Klusendorf's book, the Case for Equipping Christians to Engage the Culture.
To take advantage of this special offer, visit CMDA.org October and we will send this book out to you as soon as possible.
If you're facing an ethical or advocacy concern, you can find CMDA's ethics resources and position
[email protected] ethics plus you can reach our team at advocacymda.org for guidance, including support. When conscience rights are at stake.
You'll find a community of Christ followers in healthcare asking the same questions, walking the same road, and committed to living out their faith in every corner of the profession.
We also invite you to read, share and contribute to the point of medicine, because healthy dialogue matters, especially in a time like this.
Let's jump right back into this week's episode.
[00:29:44] Speaker B: I think Ward McClelland, Dr. McClellan that you brought up, mentioned genetic testing and the kinds of genetic testing that, in his perspective, should not be done. And I think even secular associations realize the risks of some of the more invasive, extensive testing. But it can help us diagnose and treat disease and can also be used to decide which embryonic or fetal lives are considered desirable.
So where we always want lines, we want boundaries. And maybe that's not not a fair question, but where is the ethical boundary between using genetics to heal and genetics to do selection?
[00:30:22] Speaker C: I'm going to answer this broadly, and it goes with any technology, Mike. If there's a technology that's of benefit, is it to restore or is it to enhance? We ought to ask that question every time. If it's to restore, that is what we as Christian healthcare professionals are to do. We are to restore what's broken, what's not normal. If someone is missing a leg, I want to give them a good prosthesis. I want to restore their ability to ambulate, okay? I don't want to grow my third leg, okay? I know I'm being a little facetious here, but this idea of enhancement, which now you can do with big fertility. You can go, you know, college women, and I don't want to advertise this, but college women, if you are a good looking woman and an athlete and a straight A student, you can make up to $50,000 by donating your eggs
[00:31:14] Speaker B: and pay college fees.
[00:31:15] Speaker C: Yeah, it's crazy. So then you can go and do this selection, select your embryo based on whatever criteria you want. That's not the way God designed us.
[00:31:25] Speaker B: And even that, even if you decided it's not perfect, I mean, obviously now what do you do with the baby that isn't what you expected, is it just, it's a production line and you can discard because it's not what you anticipated.
[00:31:40] Speaker C: We had this lady in Canada that was a surrogate for a couple in California. So it's a married couple in California that hired a surrogate to give birth to their baby. The baby had a heart defect and wanted the baby, demanded the baby be aborted. The surrogate refused, moved to Texas to deliver the baby. Texas did the first procedures, took care of her. Now that baby, by the way, is back with the family anyway. It is a legal mess, absolute legal mess.
So I think there is a role for genetic screen which is also different than genetic diagnosis. There is a role, it can be beneficial, but don't use it for a selection process. Use it for care, in other words. And we now are doing more and more in utero care, including in utero surgery. So if you use that as a tool to prepare the family not for screening, what you want is perfect or what you desire.
[00:32:32] Speaker B: And so patients maybe should be advised that if they do, they're going to carry this baby and they're going to do testing that their caregivers, their prenatal care, be instructed that this is. I don't want this test unless you tell me this is going to help us care for this baby in development.
[00:32:52] Speaker C: And part of that informed consent, by the way, also includes the false positives and false negatives. And they are real? Yes. Okay.
[00:32:58] Speaker B: Sometimes 50%. For what?
[00:33:00] Speaker C: Just genetic screening. Yeah, yeah. So I need to realize that.
So, Mike, let's talk about disability. So we're talking about those that may have genetic defects, but let's talk about disability in general.
So with down syndrome, there's increasing, of course, ability to diagnose down in utero because it is a genetic disorder and even other disabilities.
And that's kind of defined, you know, what lives are worth living.
So my question is, how should we as Christian healthcare professionals understand the idea of imago dei. And how do we counsel families that have children either in utero or living with disabilities?
[00:33:40] Speaker B: Yeah, really good question.
First of all, if others are looking in and defining what constitutes a life worth living, you have to ask the question, who gets to decide at the end of the day? I mean, who's making this decision?
Some medical society, the government?
I mean, at the end of the day it's who's, you know, who's got the power, who's got the gold, often makes these decisions as opposed to an imaga ut de perspective, materialists or those who are driven by a very secular worldview. It's all about biology and cells. And so at the end of the day, utilitarianism, function, normality, that's going to rule the day. But I go back to actually, our most listened interview on faith in healthcare ever was earlier this year by Michael Egnor, a neurosurgeon in New York.
And his book Immortal Mind and his experience as a pediatric neurosurgeon and how over and over again in his book, I highly recommend it. These prenatal situations with a baby with incredible significant hydrocephalus or what, some sort of condition that many would say, ugh, that's going to not turn out okay. And then the amazing thing is that with a shunt or just helping the baby be born and supported, he's blown away by the function of that child. That many would have said, nah, not worth, not worth it. It would have been counseled. The mom would have been counseled, you need an abortion. And so our ability to understand these things is so limited. Even the smartest among us, Dr. Egnor, would confound him, parts of brains missing after he would remove parts of brain still functional. So the whole idea that we're smart enough to understand of what is going to be the best kind of outcome, we just don't know. And coming back to the imago day, I mean, an outside standard of why life is worth living is where we at CMDA have to always come back to and influence our world.
That even that severely disabled child. I mean, I've read some incredible eulogies recently of an adult died young, but never able to communicate with the outside world, but was cared for and eulogy beautiful eulogies about the value of that human being not because they contributed to society, but because this family was impacted in a way because they got to care from a son or daughter that was created in God's image.
[00:36:17] Speaker C: Mike, I have several comments on this one. We just had a conversation with One of our employees this week, you and I did, who as a grandchild with a very severe abnormality, is now six months old, probably will die within the next couple of years, and wants to be with that child, their grandchild. And I understand that. So there's that love and that compassion.
In the United States, over 70% of down syndrome babies are aborted still today.
And you and I, I have dear friends that have children with down syndrome. They're some of the most joyful children.
I don't.
[00:36:49] Speaker B: They've given testimony in Congress. Some of them have.
[00:36:52] Speaker C: They have. And then of course, Iceland brags that they eliminated down syndrome. Well, they eliminated. By killing them all. Yeah, they have eliminated. Don't brag about it.
My goodness. And so, couple of comments.
Churches struggle with this, and I'm very thankful for my home church. A physical therapist, dear friend, you know, he's in the medical profession. He and his wife have several children, but one of them, I believe it's Angelman's disease. But anyway, it's an adult kid, so he's 20s, maybe 30, but he can't control his voice and his movement. So in church, when he's worshiping, he's making strange noises, waving his hands.
The pastor welcomes it as he's preaching.
We should not be bothered by that. So here's a person with disability that's worshiping. Don't be bothered by it. Just enjoy worship with this person with disability. So that's one. The second is again, privilege of my home in Eugene and knowing families that have children with disabilities and the joy they have taken care of them. Every summer I would do a pool party and I'd get the college kids from my medicine ministry, which my CMDA undergraduate chapter, pair them up one on one with those with severe disability. Give the parents someone's day, but give the parents a day off. Get the kids in life jackets and just have a fun day in the pool. Hot summer day in the pool, playing with them. It was a joy for the parents to have a break. It was a joy for the disabled child, you know, to have this fun day. It was a joy for the college students to be able to experience what it was like really to care for one of these just for a day.
[00:38:28] Speaker B: And we don't deny the difficulty of the situation.
[00:38:30] Speaker C: No.
[00:38:31] Speaker B: That this is devastating to families. It changes their lives. But as followers of Christ with scriptural mandates, nobody should seek his own good but the good of others. Paul told the Corinthians, let's segue to physician assisted suicide.
And of all people who live in a place where this is just ever present all around you in Oregon, what does it actually mean for a Christian physician to help someone die? Well, how do we distinguish relieving suffering, withdrawing, disproportionately burdensome treatment, futility of care, and intentionally causing death?
This is an issue where it seems like all the other issues, some of this we still have those who kind of were on the same side. Even with the ama, we're still saying, well, this takes us as caregivers, professionals in way a better bad direction. Still, there seems to be critical mass. And recently in Britain, the Parliament, much to the surprise of the CMF CEO and Mark Pickering was like, wow, we're glad this happened. We didn't think it was going to.
[00:39:35] Speaker C: Well, it was interesting. And it also came up in Great Britain, oh, seven, eight, nine years ago. And one of the parliamentarians reached out to CMDA and asked if I would give testimony. And it was interesting. The Belgium doctor gave statistics, the Canadian doctor, and bless Baroness Finley, she said, rick, I just want you to tell stories about what it means to die well. So I got to tell stories in front of Parliament, which was really fun.
But to put a plug in Mike, our national convention coming up in 2027, Cincinnati, Cincinnati, Dr. Ewan Gallagher, who's been on your podcast before, so he's going to be a plenary speaker as well as two different workshops, workshop in the ethics track, a workshop in the advocacy track on this very issue.
What does it mean to die well and how that is different than this that exist. So a Canadian physician who swims in this soup, come and listen to him.
[00:40:23] Speaker B: So he's gonna have some that joy and another ethics committee, maybe he's on our board. And you all said the best speaker you've ever heard on this topic.
[00:40:31] Speaker C: Yeah. So there is a way to die well. And again, the model for us recently in the public sphere was Ben Sasse, you know, ex senator.
It reminds me, you know, of Philippians 1, when Paul says, to die is gain, but to live is Christ. It's a win, win situation for the believer. Okay, if we stay alive, we get to live for Christ here in this world. If we die, we have to be with Christ. So it is a win, win situation.
My dad died well, and it was a joy.
I didn't, wasn't actually on the day that he died, but I was with him for a couple weeks that summer and he knew his time was coming pretty soon and he was just, he was joyful about soon to be with The Lord just joyful. So there is a way to die well. And we need to convey that message through healthcare as followers of Christ because there is a slippery slope to the physician assisted suicide. And we're going to hear that from our Canadians. That slippery slope. And it's just this denigration of what life is.
[00:41:31] Speaker B: And the other side on this issue will always bring.
They're so passionate because they've had a loved one suffering at the end of life. So when A patient says, Dr. Lance, I don't want to suffer, how do you respond when they say, doctor, I've had enough. Why can't you just help me end this? What's your response?
[00:41:49] Speaker C: I was at a memorial service last week, very, very dear friend of mine, he's a pastor and just lost his wife to cancer and his prayer that she wouldn't go through suffering because she knew she had metastases everywhere and she died in joy.
It's interesting to watch people die well, it's very interesting. So she had the pastor over a week before she died, knowing that the day was coming soon, and said, pastor, you're going to. It wasn't a question, it was a demand. You're going to teach on Second Corinthians, chapter five and okay, I will. And you did.
[00:42:22] Speaker B: Her earthly tent was about ready to.
[00:42:24] Speaker C: Her earthly tent was going away and her husband was there loving her there. Is this the way to take away suffering is to lead people to Christ?
I mean, that's how you take away suffering. Not that we're trained in how to control pain. And I think there's good ways. And I think palliative medicine is improving, I think will continue to improve. I think medications will continue to improve. But there doesn't really exist a reason to take someone away from their suffering because we have the answer.
Both medically and spiritually. We have the answer. Yeah.
[00:42:59] Speaker B: And an intensive care friend of mine a few years ago told me, Mike and had lots of patients who were dying. Death is never the treatment for life. It is never the treatment for life.
[00:43:10] Speaker C: And again, going back to what I said earlier, I'm an opportunistic person. What an opportunity to come alongside and
[00:43:16] Speaker B: love someone well and talk about eternal life.
[00:43:18] Speaker C: Yeah, talk about the disabled child. What an opportunity to care for someone who needs care. Same with end of life. What an opportunity.
[00:43:24] Speaker B: Open door.
[00:43:24] Speaker C: Yep.
So, Mike, now listen, we have gotten emails recently on this very issue. We're going to switch streams here about COVID And some things were done right, some things were done wrong. We made mistakes both within healthcare and within politics. You know, we talked about school closures, not understanding who was at greater risk, the complexities of vaccine induced immunity, risk to vaccines, mandates and personal choice, public health interventions, you know, the lack of randomized trials. There's all kinds of issues that came up during COVID And I know people want us to speak out at cmda. What did we learn and what can we do better? Yeah.
[00:44:14] Speaker B: And of course, this has recently been major in the public eye. It seems like we in our American culture want to find someone to blame and to crucify.
Like somehow that makes the pain go away or makes the future better. Which it doesn't.
[00:44:28] Speaker C: Right.
[00:44:28] Speaker B: It really doesn't. And you know, with the Tony Fauci congressional hearings, I was frustrated just like the rest of the country. You know, plead the fifth, plead the fifth and all of that stuff. So conversation that came out of that, lots of pundits, we don't need to repeat the pundit conversations.
But as I've been thinking about this and doing a little bit of research online, I think the good that's come out of COVID has been a conversation about what to do about future pandemics and how to prepare for those. And I think for our listeners that want to be reasonable, I remember what Jay Bhattataria said to you and me, you were in Kenya and I was here and we interviewed him, that he's like, it's like cancer. You can't take vaccines as a big bulk and say yes or no, that's foolishness. Because every vaccine has to be evaluated on its own merits. The problem with making it be an on, off switch with vaccines is that you then end up with measles outbreaks and so many. When I talk to our members, I mean, 99.9% are so reasonable. Well, of course I believe in vaccines.
The problem is if what your constituents here is complaining about the COVID vaccine and the problems that were there, they take the next step. And that is, well, vaccines are bad. And I've seen that over and over again in my own family, friends, church that there's this, oh, it's either yes or no with vaccines, not that there's nuance with the particular vaccines. And so I think we have to be so careful in how we communicate. Yes, but okay, there are problems with the COVID vaccine. Yes, but here were the advantages.
And then I think we just have to participate instead of so quickly going to try to hang somebody, you know, for blame because of what happened in 2020, 2021 is to be thinking about the future and how we want to invest in a future that's better prepared for the next pandemic. Because we all think that it's going to happen again. I mean, we know it's going to happen again and there's some good stuff happening. And if all we do is say, oh no, NIH or, or the federal government, CDC are talking about this, it's got to be bad. We can't go there. We can't go there. Regardless of how problematic it was for the Fauci era, mandates and so forth. What I have read is that people are looking back, even those who are super pro pro vaccine, some that our listeners, some of our listeners just don't appreciate at all and consider think skull and crossbones when they hear those names. But our are thinking that the mask mandates and all of that we see even now, even those most pro who were so supportive of mask mandates are saying, you know, it has to be contextualized. It really does. And that's all of medicine. Everything has to be contextualized. And so my plea is, my hope, my prayer listeners, is that we'll get to a place at our national convention or a regional meeting or a podcast conversation when we won't get so much pushback, that we're having a conversation about a Covid topic, that there won't be this automatic. They're talking about vaccines, therefore, this is what they must believe, therefore this is bad. We need to have a reasonable conversation, just like you would about a controversial topic in orthopedics, in a group of orthopedic surgeons, or I would in general surgery. We know that not everyone agrees, but wow, do we want things to be better for our patients.
[00:47:45] Speaker C: So let me make this personal, Mike, for the practicing healthcare professional that's out there, that's listening, there's two phrases.
I'm going to say this personally. There are two phrases that are very difficult for us to say, whether it be in a public health setting or even with a patient. The one is, I don't know.
That's hard to say. The other is I'm sorry.
[00:48:04] Speaker B: Yeah, apologies are really hard.
[00:48:07] Speaker C: So why is that so difficult for us?
[00:48:09] Speaker B: It shouldn't. As Christians should it? I mean, we should be leading the way.
[00:48:12] Speaker C: We should.
[00:48:13] Speaker B: And you and I have.
I don't know if it's joking or talked about. Maybe there should be an apology to her for a lot of things, including sex, rejection procedures.
[00:48:20] Speaker C: Yeah. So, yeah, there is some repentance, I think that is beneficial for us in our practice. But for Healthcare in general.
[00:48:31] Speaker B: And would you agree it's so easy to apologize for something that you're only kind of involved in, whereas if you were really like at the heart of it, that's much harder. And I think it's why our medical societies don't apologize for stuff anymore. There's a medical risk, but also there's pride. I really believed in that. I was at the core of that. Whereas if you're kind of on the periphery, you're like, yeah, we messed up, but if you were someone doing sex rejection procedures, it's going to be really hard. Or if you're a parent who pushed someone to do it, it's going to be really hard to apologize for that.
[00:49:04] Speaker C: And I think those again, physicians, healthcare professionals that have made mistakes, that have repented, man, are they effective in their future practice?
[00:49:14] Speaker B: Oh, yeah. What trust? I trust this is someone who's gonna speak truth to me.
[00:49:18] Speaker C: Yeah, absolutely. So talking about COVID I want to switch a little bit and that in fact, my sister in law, she moved to New York City when Covid started icu. She's an ICU nurse because she just wanted to be in there and take care of these patients at risk.
So my question is putting ourselves at risk.
There's got to be some wisdom, but compassion at the same time. I think of those that practice in the Middle east, war torn.
A friend of ours that practices in Lebanon, just north of Israel, which is under attack.
Those that practice were Ebola.
We've had CMD members become infected with Ebola.
How do you balance wisdom and compassion, putting yourself at risk, Whether it be war, illness or whatever else.
[00:50:09] Speaker B: I think of John Piper wrote a chapter, risk is Right, Risk is right. And in the context and when I think of that chapter, I think of one of the most incredible contributions that my oldest daughter made in a Sunday school class when I was home from Kenya.
And one of the dear elderly men who had briefly visited us in Kenya, his heart was right. But he said, you guys have really put your family at risk. And I even noticed that there were some potential risks for you guys in Kenya. And you know, I just, I fear for you guys. And just as I'm ready to answer my daughter, who's 16 at the time, who just happened, we said, can I go with you guys instead of going to this other class? Sure. She's sitting back, she said, well, of course, risk is right. I mean, God has called my parents to go to Kenya and to take care of people who are in need. And so we just accept that risk that was my 16 year old speaking up in the Sunday school class. But in getting to the heart of your question, I think my answer is it all depends.
Risk, evaluate, assessment, evaluation, it all depends. We talk about it here for our global health outreach teams and our medical education teams. And is it right in this situation? My first principle is that I can say yes for me and myself in terms of risk. But applying and saying yes for someone else and risk, that's not right. Also, often their institutions say they can't take that risk. Well, for a student or a residential, we can't do that. We can't make that decision because their institution, their training is in jeopardy. I think every situation is unique. So it all depends.
It all depends. I will go back to many articles during COVID pandemic that came out and many pundits talking about what happened in the Middle Ages for pandemics and the powerful testimony in the early part of the 2nd 3rd century in Rome. Who was it that took care of those who were sick and who took care of the abandoned babies? It was Christ followers, to set the example, say, wow, people had to stand up. And one of the emperors even said, these Christians, they're taking care of our deplorables. And it was powerful testimony. So taking risk always will. Jim Elliott in the Fab Five in the 1950s, that risk he took with the Waudani Indians and his giving his life set off a massive wave of advancement of the Great Commission in the Kingdom of God by being willing to take risk. And I don't read anything in my Bible but the nuance. The nuance is that not every risk, even for Paul, was right. I mean, the brothers held him back in Ephesus and said, brother, you're not going inside there, you're going to be torn to pieces. And Paul, I could just see him struggling, but the believers wouldn't let him take that risk. They were smarter than he was.
[00:53:00] Speaker C: Well, Mike, it reminds me because six years ago you were going to go with me to Haiti and do some general surgery.
And I've been leading a team down there, both general and orthopedic surgery for 14 years and the risk was too great. And your board said no, I think was the appropriate decision. I canceled that whole trip anyway. But there are precautions we should not ignore. Wisdom do take the right precautions, make sure it is safe as possible for those members that are going to go into that situation. And kudos to our CMDA members that have really create protocols in caring for those with Ebola, including the Hazmat suits and everything else.
[00:53:36] Speaker B: Yeah, we have insurance to take care of when those things happen, when there's illness or injury and so forth.
Rick, we need to bring this to a close and I'm going to skip right to our last question for you because we've run out of time. Maybe this is a question that lies underneath all the other questions.
Abortion, gender, medicine, so called gender medicine, reproductive technology, assisted suicide, genetics, all these other things.
There's actually one deeper question underneath all of them. What is a human being and therefore what is medicine for? The idea of anthropology. And I joked with Kimberly, Professor Kimberly at Dallas, when we were talking about GLP1s that I if you used the word anthropology to me at Taylor University as an undergrad, I would have fallen asleep.
[00:54:24] Speaker C: Sleep.
[00:54:25] Speaker B: What about antibiotics? But now it is central to our discussions, the desecration of Man. CARL Truman New Book so what is human being and therefore what is medicine for? How should a biblical answer to those two questions reshape the way we practice medicine right now?
[00:54:42] Speaker C: Yeah, so it's essentially answering the question, what does it mean to be human?
That is the essential question for bioethics and I would say for advocacy as well. What does it mean to be human?
And we do get the answer from the Bible. We also get through rational thought and philosophy and medicine and everything else. But Genesis 1 and 2 permeates all of scripture. Created in God's image. What does that mean? And to flourish, to multiply, to subdue the earth, to steward the earth, to steward the creation. That mandate didn't change with the fall in Genesis 3, with the sin. We're still called to steward God's world. And that means we are unique in being created in his image. That makes us separate from the rest of creation. And we need to have unique care for the individual human being. It goes back what I said earlier about transactional medicine. If you are out there and I know you have a busy day and you want to get through the day, I get that. But if your practice is simply a transactional practice, where a patient comes in, you take care of the problem, you know, you code it, the insurance pays the bill and you're done, you're missing out.
[00:55:56] Speaker B: Thank you for finishing. This way. We are people of the covenant.
We are people of the covenant. And that is not just a biblical concept. It's a Hippocratic concept that we have an oath, a promise that we have made. And transactional is, I mean, yeah, that's life, I guess, but not in medicine. We have made a covenant to do no harm above all else because of the value of that patient. And I just had a thought, Brick, that I want to finish up with our listeners that they've been listening in to this conversation, and certainly some things that we've said or maybe things that we've left out have challenged them to think, and maybe they'll send us in some questions in response to this conversation.
But I want to challenge you if you're listening or viewing the power of a conversation like we're having. I mean, thousands upon thousands listen to this podcast, healthcare professionals. What about talking to your pastor and some Sunday or Wednesday night, you and a friend, I mean, you can spend some time preparing, but you and a friend, a colleague who loves Christ, believes in biblical, the Bible is true. Getting in front of your congregations and going through questions like this and having a chat and then allow questions to come from the audience as well. I think that'd be a powerful way for us to do what you are so passionate about, which is to impact the church.
[00:57:17] Speaker C: As I always say, Mike, people are asking these questions and they're asking existential questions along with practical bioethical questions.
If the church doesn't get the answer for them, they're going to find it elsewhere and they're going to find the wrong answer.
[00:57:31] Speaker B: Yeah, yeah.
We're people of the book truthies, as you like to say. So I want to thank you. We've run out of time, and thanks, Brick, for a great conversation. I never know how these are going to turn out. It was always fun, but it's fun. So God bless you, and only for the truth. Paul said to the Corinthians, we cannot do anything against the truth in Ephesians
[00:57:51] Speaker C: 4:15, speaking the truth in love. So let's speak truth, but let's do it with compassion.
[00:57:56] Speaker B: Thank you.
You know, I'm most grateful to Bricklance for working through these questions with me today.
Underneath every single one of them is a deeper question.
What is a human being, after all? And what is medicine for?
Each person is created in God's image, the imago dei. And that shapes, friends, how we care for life, both at the beginning and how we walk with patience approaching death.
It also means that we speak the truth, and we always do it with compassion.
These issues also reach beyond our exam rooms.
People in our churches are asking, frankly, the same questions about infertility or caring for a loved one. As Brick put it, if the church doesn't help answer them, they're going to find answers somewhere else.
So consider talking with your pastor and hosting a conversation just like the one we've had today with a fellow Christian healthcare professional and let your congregation bring you those questions at that time.
If you'd like to learn more about CMDA and connect with our community of Christian healthcare professionals, you can just visit CMDA.org, our main webpage.
Well, next week I've got a very special guest, Dr. Matt Woodley, who joins the podcast and we're going to discuss a book that he worked on with his father, that beautiful question, A Father and Son's Quest to Love a Broken World.
It follows father and son through a pastoral burnout situation for dad and medical work as they wrestle with how to face the world's suffering and still go on loving it day after day.
I want to thank you for listening to Faith in Healthcare, where I promise to you as a listener, a viewer, or better yet, a subscriber to this podcast, whether you're a healthcare professional or a patient who loves Jesus Christ supremely, it's this we will do everything that we can to keep your faith and your health care connected intimately. So we'll see you next time, Lord willing.
[01:00:26] Speaker A: Thanks for listening to Faith in Healthcare, the CMDA Matters Podcast if you would like to suggest a future guest or share a comment with us, please email cmdamatterscmda.org and if you like the podcast, be sure to give us a five star rating and share it on your favorite social media platform.
This podcast has been a production of Christian Medical and Dental Associations.
The opinions expressed by guests on this podcast are not necessarily endorsed by Christian Medical and Dental Associations.
CMDA is a nonpartisan organization that does not endorse political parties or candidates for public office.
The views expressed on this podcast reflect judgments regarding principles and values held by CMDA and its members and are not intended to imply endorsement of any political party or candidate.
