By Andrè Van Mol, MD, David Stevens, MD, MA (Ethics), J. Scott Ries, MD

Article #1

Excerpted from “Obama proposal would let religious groups opt-out of contraception mandate,” CNN, by Dan Merica. February 1, 2013–The Obama administration proposed updated guidelines on February 1 that would allow religious-affiliated organizations opposing contraception to opt out of a federal mandate requiring that they provide their employees with insurance coverage for birth control. The draft rule would give women at non-profit, religious-based organizations, like certain hospitals and universities, the ability to receive contraception through separate health policies at no charge.

As part of the new initiative, groups that are insured — such as student health plans at religious colleges — would be required to let their insurer know that certain participants would like contraception coverage. “The insurer would then notify enrollees that it is providing them with no-cost contraceptive coverage through separate individual health insurance policies,” the HHS statement said. Although the agency has not estimated final costs of the plan, it said that offering free coverage would actually lower expenses over the long term, partly due to improvement in women’s health and fewer childbirths. Because the insurer would be covering the costs, the changes would allow religious organizations morally opposed to contraception to avoid paying for it.

An original mandate on providing contraception was part of the new federal healthcare law spearheaded by Obama, the Affordable Care Act. It required that insurers provide, at no cost to those insured, all forms of contraception approved by the Food and Drug Administration. Houses of worship were exempt immediately and the administration widened those exemptions last year to include other religiously affiliated organizations, like universities and hospitals. That still left groups across a wide spectrum of faiths, many of which teach that contraception is morally wrong, covered by the mandate. They denounced it as an infringement of religious liberty. A group of 43 Catholic organizations challenged the rules in federal court in May.

Not all groups characterized it as a compromise, however. Frank Pavone, National Director of Priests for Life, a group that launched a federal lawsuit against the mandate last year, said he was far from happy with the update and welcomes the opportunity to provide feedback. “We at Priests for Life remind the administration that religious liberty does not just belong to religious groups and individuals; it belongs to all Americans,” Pavone said. “We see only one acceptable change regarding the mandate: rescind it completely.” The Family Research Council, a conservative pro-life group, released a similar statement. “The proposal does not expand religious freedom to all organizations and does nothing to change the current policy that forces religious entities to pay for insurance plans that include abortion-inducing drugs, sterilizations and contraception,” said Anna Higgins, director of the group’s Center for Human Dignity.

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Commentary #1

David Stevens, MD, MA (Ethics): “In CMDA’s news release on the new ‘accommodation,’ I said, ‘This latest version of the contraceptives and sterilization mandate remains unacceptable. Since when does the government get to pick and choose which groups will get to enjoy First Amendment protections?’

“The amended regulations give no conscience exemption to businesses run by people of faith including Hobby Lobby and Tyndale House. It gives no exemption to individuals having to buy insurance that pays for abortifacients like Ella.

“For non-profit religious organizations, this is only smoke and mirrors as the administration employs verbal engineering to make sure every woman in the country has free so-called ‘contraceptives.’ HHS will require every insurance company to issue a separate policy that provides ‘free’ contraceptives and sterilization. Using its own government staff as ‘experts,’ it claims that there is no net cost to insurance companies in that mandate. That is a very debatable point, but this new process is just a smoke screen to obscure the moral complicity it imposes.

“Imagine this. You are required to put bottles containing lethal prescriptions on a shelf in your break room for your employees who may take the drugs if they decide their lives are not worth living. Co-pays or deductibles are not a hindrance as the medicines are a ‘free benefit’ provided by your health insurance provider by order of the government. They say it will save healthcare costs.

“Are you morally complicit? Of course you are. If you hadn’t bought the insurance, they would not have had this ‘lethal benefit.’

“Religious freedom advocates are not fooled by this phony accommodation. The lawsuits brought against the government—more than 40 in total—will continue to go forward. So far, the government has lost cases 10 to 4, but it is clear that the Supreme Court will make the final decision.

“Why is this important to you and me? Our religious freedom that our forefathers fought and died for is under broad attack and this is just one of the battlefronts. We dare not lose this battle or our freedom of religion will become merely a freedom to worship behind church doors. Woe to anyone who then tries to carry their conscience into the pubic square where government is god.

“And woe to us if we fail to stand up in these perilous times. With God’s help, CMDA will fight to maintain our religious freedom in the courtroom, in Congress, before the administration and in the halls of public opinion. You have my commitment on that—because we dare not do less.”

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Article #2

Excerpted from “Tackling the Problem of Medical Student Debt,” New York Times, by Pauline Chen, MD. December 13, 2012–The announcement from the University of California, Los Angeles, of a $100 million medical student scholarship fund should inspire all of us to question the fact that medical education in the United States is paid for largely by student debt. The new merit-based scholarships, established by entertainment executive David Geffen, will cover all educational, living and even some travel expenses for a fifth of next year’s entering medical school class, some 33 students. Mr. Geffen and school officials hope that eventually the school will be able to pay for all medical students and free them from the obligation to take out student loans. “The cost of a world-class medical education should not deter our future innovators, doctors and scientists from the path they hope to pursue,” Mr. Geffen said in a statement. “I hope in doing this that others will be inspired to do the same.”

There are several reasons for the runaway costs. One is that the academic medical centers that house medical schools have become increasingly complex and expensive to run, and administrators have relied on tuition hikes to support research and clinical resources that may have only an indirect impact on medical student education. An equally important contributor to the problem has been our society’s placid acceptance of educational debt as the norm, a prerequisite to becoming a doctor. Obtaining a medical education is like purchasing a house, a car or any other big-ticket item, the thinking goes; going into debt and then paying over time with interest is just the way the world works. And, say many observers, newly minted doctors will earn big salaries, allowing them easily to reimburse their loans.

While it is true that most doctors can pay off their debt over time, those insouciant observers fail to consider how loan burdens can weigh heavily on a young person’s idealism and career decisions. These choices have enormous social repercussions. Despite the well-studied benefits of a diverse physician workforce, more than half of all medical students currently come from families with household incomes in the top quintile of the nation. Even more worrisome, student concerns about debt are exacerbating the nation’s physician shortage. By the end of this decade, we will be short nearly 50,000 primary care physicians and an additional 50,000 doctors of any kind. Educators and groups like the Association of American Medical Colleges have been trying to address the problem of medical student debt for more than a decade. Some have suggested simply freezing costs or prorating debt according to the earning potential of a student’s chosen area of specialty. But the real importance of Mr. Geffen’s donation for the rest of us lies in not its historic largesse, nor its hopeful vision. Rather, it is in the dramatic impact one individual can make when he makes medical education a priority, and the inevitable question such a gesture raises: Why has our society been so slow to do the same?

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Commentary #2

National Director of Campus & Community Ministries J. Scott Ries, MD: “The philanthropic commitments of people like Mr. Geffen and the Lerner family are certain to be influential on the lives of a number of future doctors. Their generosity not withstanding, the rising costs of medical education are well documented, as are its persuasive effects on specialty choice and practice location. But the question is, even if medical education were “free” for all students, would that be enough? The answer is no.

The primary areas in which Christian doctors struggle consistently fall into four categories:

1. Overload
2. Marriage
3. Parenting
4. Finances

Yes, finances. But wouldn’t eliminating medical school costs then quell that fourth category of problems? Not likely. Financial struggles faced by our colleagues are often not those related to medical school loans, per se. In fact, they typically present themselves after those loans have been, or are nearly, paid off.

There is a subtle, but strong, undercurrent toward a perspective of entitlement pervasive in medical training, and it doesn’t let go when we graduate. Perpetually elusive, “enough” seems always just around the next corner. And it’s this entitlement mentality that leads to the financial struggles so common among students and doctors alike.

The best antidote to entitlement is found in the occasional email I receive from a medical or dental student relating their desire to give a financial gift to CMDA. It’s not the largesse of the gift or even the fact that God brought CMDA to their mind that makes my day. It’s the outpouring of their entitlement-free heart that brings a sense of grateful joy. “For where your treasure is, there will your heart be also” (Matthew 6:21, NIV 1984).

You may not have the resources to endow the medical education costs of a cadre of future doctors. But you do possess the antidote for entitlement…giving. It’s just what the Good Doctor ordered.”

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Article #3

Excerpted from “Deaf twins who discovered they were going blind and would never see each other again are euthanized in Belgian hospital,” Daily Mail, by James Rush and Damien Gayle. January 14, 2013–A pair of identical twins, who were born deaf, have been killed by Belgian doctors after seeking euthanasia when they found out they would also soon go blind. In a unique case under the country’s euthanasia laws, the 45-year-old brothers, from Antwerp, chose death as they were unable to bear the thought of never seeing one another again. They were euthanized by doctors at Brussels University Hospital, in Jette, on December 14 by lethal injection after spending their entire lives together.

Euthanasia is legal under Belgian law if those making the decision can make their wishes clear and are suffering unbearable pain, according to a doctor’s judgment. In Belgium, some 1,133 cases of euthanasia – mostly for terminal cancer – were recorded in 2011, about one percent of all deaths in the country, according to official figures. But this case was unusual as neither twin was suffering extreme physical pain or was terminally ill. David Dufour, the doctor who presided over the euthanasia, told RTL television news the twins had taken the decision in ‘full conscience’.

Belgium was the second country in the world after the Netherlands to legalize euthanasia in 2002 but it currently applies only to people over the age of 18. Other jurisdictions where it is permitted include Luxembourg and the U.S. state of Oregon. Just days after the twins were killed Belgium’s ruling Socialists tabled a legal amendment which would allow the euthanasia of children and Alzheimer’s sufferers. The draft legislation calls for ‘the law to be extended to minors if they are capable of discernment or affected by an incurable illness or suffering that we cannot alleviate.’ The proposed changes are likely to be approved by other parties, although no date has yet been put forward for a parliamentary debate.

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Commentary #3

CMDA Member, Moral Revolution Board member and “Ask the Doc” blogger Andre’ Van Mol, MD:“Physicians at Brussels University Hospital euthanized these adult brothers due to impending blindness, not terminal cancer or unbearable pain. They were described as ‘very happy’ and with ‘‘relief’ to see the end of their suffering’ when they were not suffering, but living as they had for decades. This is where disabled rights groups correctly see trouble ahead, when common disabilities are relabeled as needless and easily terminated suffering – lives not worth living.

“In his 1949 paper ‘Medical Science Under Dictatorship,’¹ Boston psychiatrist Leo Alexander wrote, ‘. . . Medical science in Nazi Germany collaborated . . . It started with the acceptance of the attitude basic in the euthanasia movement, that there is such a thing as life not worthy to be lived. . .’ He called this ‘the infinitely small wedge-in lever’ which got this mindset rolling, ‘the attitude towards the nonrehabilitable sick.’ Even without dictators, soon the right to die to becomes the expected duty to do so in the name of the common good and fiscal bottom line.

“The swath of people targeted for euthanasia (or ‘aid in dying,’ its recent and benign-sounding label)² is ever expanding. The article claims 1 percent of all deaths in Belgium are now by euthanasia. Dutch palliative care physician Dr. Ben Zylicz warned the British House of Lords, ‘If you accept euthanasia as a solution to difficult and unresolved problems in palliative care, you will never learn anything.’³

“A grand benefit of the end of life is the opportunity to make relationships right – with God and people. It is precisely the realization of mortal life’s impending end that can lead people to softened hearts, opened minds and receptive spirits. Euthanasia kills the last chance for the new birth in Christ.

“There is a conflict of interests between palliative care and euthanasia, aka aid in dying: doctors cannot be both patient advocates and executioners. Compassion means coming alongside and suffering with, not offing people for defects. Terminal patients need pain control, companionship and often anti-depressants, but not doctors deeming them better off dead.”

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¹NEJM, 241:39-47, July 14, 1949.
²Van Mol, A. “Premature Termination of Life Is Not Palliative Care.” CHEST. 2013;143(1):279a-279. doi:10.1378/chest.12-2187 http://tinyurl.com/ajh3xfj
³“Better palliative care could cut euthanasia” Hugh Matthews, BMJ 1998;317:1613 (12 December) News.

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