Christian Medical & Dental Associations
Official Organizational Website: https://www.cmda.org/
Contents
Beginning of Life
Official Statement: from Christian Medical & Dental Associations, "Position Statements: Beginning of Human Life" (2006)
- "The Bible affirms that God is the Lord and giver of all life. Human beings are uniquely made in God’s image, and each individual human being is infinitely precious to God and made for an eternal destiny. The Christian attitude toward human life is thus one of reverence from the moment of fertilization to death.
- Definition of Human Life
- A living human being is a self-directed, integrated organism that possesses the genetic endowment of the species Homo sapiens who has the inherent active biological disposition (active capacity and potency) for ordered growth and development in a continuous and seamless maturation process, with the potential to express secondary characteristics such as rationality, self-awareness, communication, and relationship with God, other human beings, and the environment.
- Thus, a human being, despite the expression of different and more mature secondary characteristics, has genetic and ontological identity and continuity throughout all stages of development from fertilization until death.
- A human embryo is not a potential human being, but a human being with potential.
- Biological Basis for the Beginning of Human Life
- The life of a human being begins at the moment of fertilization (fusion of sperm and egg). “Conception” is a term used for the beginning of biological human life and has been variously defined in the medical and scientific literature as the moment of fertilization (union or fusion of sperm and egg), syngamy (the last crossing-over of the maternal and paternal chromosomes at the end of fertilization), full embryonic gene expression between the fourth and eighth cellular division, implantation, or development of the primitive streak. Scientifically and biblically, conception is most appropriately defined as fertilization. The activation of an egg by the penetration of a sperm triggers the transition to active organismal existence.
- It is artificial and arbitrary to use other proposed biological “markers” (such as implantation, development of a primitive streak, absence of potential for twinning, brain activity, heartbeat, quickening, viability, or birth and beyond) to define the beginning of human life.
- Biblical Basis for the Beginning of Human Life
- Procreation is acknowledged in the Bible to be the gift of God.
- The mandate for human procreation in Genesis 1:27-28 and 9:1,7 implies that the God-ordained means of filling the earth with human beings made in His image is the proper reproductive expression of human sexuality in marriage. Human beings do not merely reproduce “after their kind”; they beget or procreate beings that, like themselves, are in the image of God. (see CMDA Statement on Reproductive Technology)
- Human beings are created as ensouled bodies or embodied souls (Genesis 2:7). Together the physical and spiritual aspects of human beings bear the single image of God and constitute the single essential nature of human life. A biological view of human life beginning at fertilization is therefore consistent with the Biblical view of human life.
- From fertilization on, God relates to the unborn in a personal manner. Between fertilization and birth, which are regularly linked in Biblical language God continues His activity in the unfolding and continuous development of the fetus.
- The Bible assumes a personal and moral continuity through fertilization, birth, and maturation.
- The Bible, the Church in all its formative Creeds and Ecumenical Councils, and the witness of the Holy Spirit attest to the beginning of the incarnation, wherein the second person of the Trinity took upon himself human nature, being conceived (“conceived” is to be understood as “fertilization;” see The Beginning of Human Life, Addendum II: Conception and Fertilization: Defining Ethically Relevant Terms) by the power of the Holy Spirit in the womb of the Virgin Mary. The uniqueness of the event and its mode does not affect its relevance to the question of the beginning of human life. From conception the Son of God is incarnate, his human nature made like us in every way. It follows that authentic human existence begins at conception or fertilization.
- The Moral Worth of Human Life
- The moral worth of a human being is absolute and does not consist in possessing certain capacities or qualities—e.g., self-consciousness, self-awareness, autonomy, rationality, ability to feel pain or pleasure, level of development, relational ability—that confer a socially-defined status of “personhood” (a quality added to being). A human being consists in the entire natural history of the embodied self. A human being is a person.
- The moral worth of a human being at all stages of development consists not merely in a) the possession of human chromosomes nor b) the fact that he or she may someday grow and develop into a more mature human individual. In fact, he or she already is the same individual being who may gradually develop into a more mature human individual.
- Conclusions
- Every individual from fertilization is known by God, is under His providential care, is morally accountable, and possesses the very image of God the creator.
- Since human life begins at fertilization, the full moral worth afforded to every human being is equally afforded from fertilization onward throughout development. Vague notions of “personhood” or social utility have no place in decisions regarding the worth, dignity, or rights of any human being.
- Because all human beings derive their inherent worth and the right to life from being made in the image of God, standing in relation to God as their personal Creator, a human being’s value and worth is constant, whether strong or weak, conscious or unconscious, healthy or handicapped, socially “useful” or “useless,” wanted or unwanted.
- A human beings life may not be sacrificed for the economic or political welfare or convenience of other individuals or society. Indeed, society itself is to be judged by its protection of and the solicitude it shows for the weakest of its members.
- Human life, grounded in its divine origin and in the image of God, is the basis of all other human rights, natural and legal, and the foundation of civilized society." ("Position Statements: Beginning of Human Life")[1]
Abortion
Official Statement: from Christian Medical & Dental Associations, "Position Statements: Abortion" (1985, revised 2013)
- "1. We oppose the practice of abortion and urge the active development and employment of alternatives.
- 2. The practice of abortion is contrary to:
- Respect for the sanctity of human life, as taught in the revealed, written Word of God.
- Traditional, historical, and Judeo-Christian medical ethics.
- 3. We believe that biblical Christianity affirms certain basic principles which dictate against interruption of human gestation; namely:
- The ultimate sovereignty of a loving God, the Creator of all life.
- The great value of human life transcending that of the quality of life.
- The moral responsibility of human sexuality.
- 4. While we recognize the right of physicians and patients to follow the dictates of individual conscience before God, we affirm the final authority of Scripture, which teaches the sanctity of human life." ("Position Statements: Abortion")[2]
Official Statement: from Christian Medical & Dental Associations, "Position Statements: Parental Consent for Minors Seeking Abortion" (2002)
- "Authority in the family, as established by God, rests with the parents (1) for the protection and benefit of the children. Current law acknowledges and generally supports parental authority in medical decision-making, but makes a notable exception in the case of pregnant minors. State laws that allow pregnant minors to seek abortion (2) without parental consent undermine God’s design for the family and are ultimately detrimental to society.
- Especially in a time of crisis an adolescent needs to receive the love, wisdom, guidance, and support of parents and family.
- Under the duress of societal disapproval, peer pressure, guilt and fear, a pregnant youth and her partner may be tempted to secretly avoid the help of family at the very time when they are most vulnerable and family involvement is most needed.
- An adolescent may not fully appreciate the inherent moral, spiritual, physical, and emotional dangers of abortion or its associated long-term risks. This calls into question her ability to give truly informed consent.
- Sexual partners, incestuous family members, sexual predators, or others may successfully coerce a minor to have an abortion in order to avoid their personal responsibility and the consequences of their behavior. The requirement of parental consent helps protect the minor from such coercion.
- Minors who are in situations that may adversely affect their future need the support and counsel of their parents. We realize that not all adolescents are in a family that provides support and counsel as indicated in this statement. However, we believe that authority in the family is established by God. We therefore encourage the requirement of parental consent in the case of minors seeking abortion." ("Position Statements: Parental Consent for Minors Seeking Abortion")[3]
Contraception
Official Statement: from Christian Medical & Dental Associations, "Position Statements: Anti-Progestational Agents (RU-486)" (1991)
- "RU-486 and other anti-progestational agents were developed as abortifacients. Additionally, they may have other potential applications which remain to be demonstrated.
- While abortion is currently legal, it remains an issue of intense moral and ethical debate. We believe it violates the biblical principle of the sanctity of human life. RU-486, when used as an abortifacient, is thus morally unacceptable. The result of both surgical abortion and RU-486 is the destruction of a defenseless life. The apparent ease and simplicity of pharmacological abortion further trivializes the value of life.
- Some suggest that potential applications of RU-486 exist which justify further clinical investigation. Because its investigation for other uses will further threaten the unborn, we oppose such introduction of RU- 486 and all similar abortifacients into the U.S. We do not oppose its development for non-abortifacient uses in jurisdictions where the rights of the unborn are protected.
- If additional data suggest that there is a significant therapeutic benefit for these agents in life-threatening disease, we would support their compassionate use as restricted investigational agents. If they are demonstrated to have a unique therapeutic benefit for treatment of life-threatening disease, we would reconsider our position on their introduction into the U.S. We would, however, insist that there be strict control of distribution.
- We believe that introduction of RU-486 into the U.S. at this time is not justified because our society has not yet exercised its moral capacity to protect the unborn." ("Position Statements: Anti-Progestational Agents (RU-486)")[4]
Infertility & Reproduction
Reproductive Technologies
Official Statement: from Christian Medical & Dental Associations, "Position Statements: Non-Traditional Family and Adoption" (2004)
- "n spite of proliferating alternative definitions of the family, CMDA supports the Biblical model of the traditional family—an exclusive, committed, lifelong union of a man and woman living in an integral loving relationship with or without biological or adopted children. (The following alternative family forms do not meet this Biblical model: Same-sex couples, Domestic partners, Polygamy, Polyandry, Incestuous unions, Open marriages, and the like.) Most current scientific studies affirm that the Biblical model provides the optimal environment for the health of children, family, and society...
- Advancements in reproductive technology have likewise created complex ethical issues. CMDA believes it is morally inappropriate to use reproductive technologies to produce children outside the boundaries of the traditional Biblical family model." ("Position Statements: Non-Traditional Family and Adoption")[5]
Official Statement: from Christian Medical & Dental Associations, "Position Statements: Assisted Reproductive Technology" (2010)
- "These principles should guide the development and use of assisted reproductive technologies:
- Fertilization resulting from the union of a wife's egg and her husband's sperm is the biblical design.
- Individual human life begins at fertilization.
- God holds us morally responsible for our reproductive choices.
- ART should not result in embryo loss greater than natural occurrence. This can be achieved with current knowledge and technology.
- CMDA finds the following consistent with God's design for reproduction:
- Medical and surgical intervention to assist reproduction (e.g., ovulation-inducing drugs or correcting anatomic abnormalities hindering fertility)
- Artificial insemination by husband (AIH)
- Adoption (including embryo adoption)
- In-vitro fertilization (IVF) with wife's egg and husband's sperm, with subsequent:
- Embryo Transfer to wife’s uterus
- Zygote intrafallopian transfer (ZIFT) to wife’s fallopian tube
- Gamete intrafallopian transfer (GIFT) to wife’s fallopian tube
- Cryopreservation of sperm or eggs
- CMDA considers that the following may be morally problematic:
- Introduction of a third party, for example:
- Artificial insemination by donor (AID)
- The use of donor egg or donor sperm for:
- In-vitro fertilization
- Gamete Intrafallopian Transfer
- Zygote Intrafallopian Transfer
- Gestational Surrogacy (third party carries child produced by wife’s egg and husband’s sperm)
- Cryopreservation of Embryos
- CMDA opposes the following procedures as inconsistent with God's design for the family:
- Discarding or destroying embryos
- Uterine transfer of excessive numbers of embryos
- Selective abortion (i.e., embryo reduction)
- Destructive experimentation with embryos
- True surrogacy (third party provides the egg and gestation)
- Routine use of Pre-implantation Genetic Diagnosis
- Pre-implantation Genetic Diagnosis done with the intent of discarding or destroying embryos." ("Position Statements: Assisted Reproductive Technology")[6]
Official Statement: from Christian Medical & Dental Associations, "Position Statements: Three Parent Human Embryos" (2017)
- "CMDA affirms that all children—including those who are biologically flawed—are gifts from God, a heritage of their mother and father to be cherished, nurtured, and guided. Parents’ obligation to protect their children’s health extends also to healthcare professionals.
- Reproductive biotechnologies have introduced novel methods for correcting certain harmful genotypes by intervening near the time of conception. One of these methods involves starting with maternal egg and paternal sperm and transferring to the developing embryo genetic or cellular components from a third progenitorial donor with the aim of producing a healthy child. Depending on the specific technology, the added genetic component might be derived from chromosomal or mitochondrial DNA, or it might be an egg or enucleated embryo derived from a third contributor. Reproductive scenarios involving more than three parental genetic or cellular contributions are also foreseeable.
- Whereas preventing genetic disease is a laudable goal, the means by which that goal is achieved and the far-reaching consequences of developing such technology are also relevant to the ethical evaluation. Novel biotechnologies that create human embryos having more than two biological parents raise a number of ethical concerns, which fall into three broad categories:
- The threshold of germline intervention would be violated. These biotechnologies could introduce permanent changes into the human germline that, if passed on, would affect countless future generations. Whereas the simple editing out of the germline a single harmful gene causing a disease would itself be ethically praiseworthy, current technology cannot do this without causing a cascade of inadvertent consequences, which could be disproportionately greater. The genetic basis of most diseases is complex, and the repercussions of germline interventions, both beneficial and adverse, could be irreversible for succeeding generations. Once the ethical threshold of human germline editing were crossed, ethical limits on further and more far-reaching germline editing might be unsustainable as an initial attitude of caution gives way to a progressive technological imperative, whereby what is no longer impossible is viewed as irresistible, and what has become possible is viewed as necessary. Abuses would be difficult to detect or prevent. Further enabling of the development of germline intervention biotechnology would open the door to the threat of eugenics, potentially with more dreadful exercise of power over others than has heretofore been seen in history.
- Nascent life is destroyed. Some of these reproductive technologies entail a process whereby more than one human embryo must be created in order to combine components to produce one healthy embryo, resulting in the destruction of the other human embryos.
- Biological parentage may be redefined. These biotechnologies expand the gametal contributions to the child’s conception beyond the natural two, to include three or more biologic progenitors. They also raise dilemmas for parents, offspring, and society to consider:
- Disagreements are likely to occur over deciding what type or quantity of biological contribution is sufficient to define parentage in regard to moral, social, and legal responsibility or proprietary rights.
- Knowledge of additional parental contributions may confuse the offspring’s sense of identity and relatedness.
- Further development of these and related biotechnologies and their normalization could make it possible for male-male and female-female couples to conceive children. This fundamental alteration of the biological definition of the human family would have unforeseeable consequences. It could be seen as a positive development ensuring equality of fertility, or it could be seen as disrupting the natural order of the family to the detriment of offspring and society.
- In response, CMDA affirms the obligation of Christian healthcare professionals to care competently and compassionately for parents and children, including those with, or concerned about, inherited mitochondrial and other genetic disease. However, CMDA also believes that, whereas parental responsibility includes the right to make a wide range of decisions on behalf of their children, this authority is not absolute and does not extend to proprietary control of their children’s genetic make-up. CMDA’s position is based on the following considerations:
- A. Biblical
- Every person is created by God and bears His image (Genesis 1:26-27; Psalm 139:13-16).
- God has instituted the unique marital bond between one husband and one wife joined together as one flesh (Genesis 2:21-25; Ephesians 5:22-33).
- Children are a gift from God, a blessing and the fruit of marriage (Psalm 127:3-5; Psalm 128). Human procreation is a mystery only partly explained by biological science.
- Marriage is an exclusive covenant ordained by God (Mark 10:6-9), affirmed (Matthew 19:4-6) and blessed (John 2:1-11) by Jesus, and for Christians a symbol of Christ’s special union with His bride, the church (Ephesians 5:21-33; Revelation 19:7-8; Revelation 21:9-10).
- The incorporation of a third person in the marital relationship in an attempt to conceive children historically has produced strife and fractured relationships (Genesis 16; Genesis 21:1-21; Genesis 29:30-30:24).
- B. Biological
- Human beings are sexually dimorphic, and nature requires contributions from both female (mother) and male (father) for procreation.
- Producing human embryos through novel combinations of three or more parents does not occur in nature but requires technological manipulation beyond in vitro fertilization (see
- CMDA statement on Assisted Reproductive Technology).
- The long-term consequences of germline manipulation are unknown.
- C. Social
- Children have a need to know and understand their identity and ancestry, including their direct progenitors. Children also have a need to know their siblings, both relationally and as a means to avoid consanguinity later as adults. Considering that gamete donor-conceived offspring tend to view the donor as a whole person rather than just a source of genetic material, children conceived through three-parent biotechnologies would bear a potentially burdensome sense of self identity, whether or not they know the identity of the third parent.
- These children might also be perceived by other children, including their siblings conceived naturally, as different and suffer discrimination.
- The psychological effects on children who are conceived utilizing an additional parent outside of the marriage bond have been insufficiently studied to conclude that these children are not harmed by depriving them of natural relatedness to their parents and siblings.
- D. Medical
- Hormonal manipulation and egg retrieval procedures provide no direct medical benefit to egg donors, but do subject them to medical risks, such as ovarian hyperstimulation syndrome.
- Micromanipulations of gametes may not have the intended results. They may introduce birth defects as well as genetic diseases that become evident during childhood or that may not become manifest until later in adulthood or even generations later. The degree of risk for novel interventions cannot be known prior to experimenting with them, although the risk is known to be increased for technologies such as intracytoplasmic sperm injection of eggs to accomplish fertilization.
- Some genetic manipulations of gametes may potentially introduce new unforeseen harmful mutations. The use of assisted reproductive technology is associated with a disproportionate number of infants with low-birth-weight, as well as a variety of chromosomal alterations, genetic and epigenetic defects.
- E. Ethical
- Producing children through the genetic manipulation of mitochondrial or nuclear DNA, such as “three-parent embryo” biotechnologies, are inherently experimental on a vulnerable human population—nascent human beings—who lack the capacity to consent to such experimentation. Furthermore, truly informed consent by the parents is impossible because the enduring outcome of germline manipulations cannot be known.
- Three-parent embryo technology is ethically distinct from treatment. Genetic manipulation to determine the genotype of children not yet born is not equivalent to the treatment of persons with illness. The genetic manipulation of mitochondrial or nuclear DNA in a human embryo potentially alters innumerable succeeding generations of human progeny. Developing the ability to alter the human germline at will opens the door to eugenic manipulations, such as “designer babies” in whom desired traits are enhanced or selected out. Eugenic manipulations commodify human beings and, as history teaches, dangerously set the stage for genetic discrimination, societal divisions, and persecution (see CMDA statement on Eugenics).
- Perfection and implementation of three-parent biotechnologies are very likely to result in unintended genetic or developmental errors along the way, creating the additional ethical dilemma of whether to raise and care for the resulting genetically impaired disabled children or to terminate their lives at some point during development.
- Three-parent reproductive technologies entail unacceptable harm to nascent human life. Destruction of extra human embryos created during the process of three-parent embryo procedures causes their deaths. Human beings at all sizes of life and stages of development are much more than assemblages of molecules. To deny moral value to the human embryo, who is fully alive, has a unique genome, and possesses the intrinsic capacity to develop into a fully conscious human, would be to believe incorrectly that not all human lives count as members of the human community (see CMDA statement on the Beginning of Human Life).
- Conclusion
- Because human procreation is a mystery only partly explained by biological science, CMDA believes that caution and great humility are needed in regard to proposals to intervene in this special natural order. Human beings, not the novel biotechnologies used to assist with their conception, are sacred.
- CMDA affirms human procreation as the fruit of marriage between one male and one female. CMDA opposes the use of technologies that would create children having more (or less) than two biological parents.
- CMDA believes that the stewardship mandate to subdue the earth (Genesis 1:28) entails moral responsibility that does not extend to absolute control over human procreation. Altering the conditions of human procreation to incorporate more than two biological genetic contributors to edit the germline would exceed the boundaries of moral prudence.
- CMDA opposes the creation of human embryos destined for destruction as raw material for reproductive or research programs. Even if we are not answerable directly to those lives who are not allowed to develop the capacity to protest their destruction, we are still answerable to God, who created us all and knew us all as persons when we were but embryos (Psalm 139).
- CMDA affirms that children are not products to be manufactured, commodified, or controlled, but are blessings to be cared for and cherished.
- Recognizing that children may come to be born through three-parent procreative biotechnologies, CMDA affirms that such children, whether healthy or genetically impaired, nonetheless bear the image of God and deserve full inclusion in the human community.
- CMDA affirms that biotechnology and medical care directed toward treating children and adults living with mitochondrial and other genetic diseases are ethically praiseworthy.
- Even if the biological, medical, and social difficulties were to be resolved, CMDA nevertheless has grave reservations on theological grounds concerning the procreation of human lives through biotechnologies involving genetic contributions substantial enough to constitute triple parentage, because these disrupt the biblical ideal of human procreation through the uniting of one mother and one father, which for the created order is normative and for Christians holds special value as the visible representation of Christ and His church." ("Position Statements: Three Parent Human Embryos")[7]
Frozen Oocytes
Official Statement: from Christian Medical & Dental Associations, "Position Statements: Assisted Reproductive Technology" (2010)
- "Guidelines for Cryopreservation of Embryos:
- Cryopreservation of embryos should be done with the sole intent of future transfer to the genetic mother.
- The number of embryos produced should be limited to eliminate cryopreservation of excessive numbers of embryos.
- There should be agreement that all frozen embryos will be eventually transferred back to the genetic mother. Should it become impossible to transfer the frozen embryos to the genetic mother, embryo adoption or gestational surrogacy should be pursued." ("Position Statements: Assisted Reproductive Technology")[8]
Healthcare & Medicine
Official Statement: from Christian Medical & Dental Associations, "Position Statements: Biblical Model for Medical Ethics" (1991)
- "Christians believe in the divine inspiration, integrity, and final authority of the Bible as the Word of God. This is our starting point for Christian medical and dental ethics. In affirming the authority of Scripture, we follow the command and example of the Lord Jesus Christ, in whom all authority in heaven and earth is vested.
- We believe that in His Word, God has graciously provided us with the principles necessary to make difficult ethical decisions. Ethical concepts which are not specifically taught in Scripture can be derived from principles which are found there.
- In addition, our ethical perspectives are guided by the Holy Spirit and enriched by the teachings of Christian tradition, moral reasoning, and clinical experience. The circumstances of each case must be considered to discover the moral issues raised, but we do not accept such philosophies as ethical relativism, situational ethics, or utilitarianism.
- Neither do we follow mindless legalism. Our Lord stated that the weightier matters of the law are justice, mercy, and faith in God.
- Biblical ethics is concerned with motives as well as actions, with process as well as outcome. The integrity of moral decisions rests on the prudent use of biblical principles. We acknowledge, however, that sincere Christians may differ in their interpretation and application of these principles.
- Patients or their advocates, families, and clinicians are morally responsible for their own actions. We, as physicians and dentists, are ultimately responsible to God as we care for the health of our fellow human beings." ("Position Statements: Biblical Model for Medical Ethics")[9]
Access to Healthcare
Official Statement: from Christian Medical & Dental Associations, "Position Statements: Healthcare Delivery" (1996)
- "As Christian physicians and dentists, we believe God commands Christians to attend to health care needs of people. Jesus taught, and His life demonstrated, that caring for people includes providing for their spiritual, emotional, and physical needs. Values inherent in God's Word and Jesus' teaching include kindness, compassion, responsibility, impartiality, stewardship, and the sanctity of life. Therefore, Christians should work toward a system of health care delivery consistent with these values.
- We affirm the following guidelines for health care delivery:
- Society as a whole should seek a basic level of health care for all. Purchase of additional health care not covered by the basic plan should not be prohibited.
- Public and/or pooled funds should not be used to finance the taking of human life.
- Institutions, clinicians, patients, and their families should share responsibility for good stewardship of medical and fiscal resources.
- The Christian community should share responsibility for health care, especially of the poor.
- All clinicians should strive to deliver health care to the poor.
- The clinician's priority should be the best interests of the patient. Clinicians should not make allocation decisions at the bedside that violate this priority, nor should clinicians allow health care delivery systems to coerce them to do so. Patient care decisions should never be influenced by clinician income considerations.
- Individuals should be responsible for their own and their dependents' health, including lifestyle choices.
- Individuals should provide for their own and their dependents' health care to the best of their ability.
- If competent physicians and dentists practice the love and compassion of Christ toward all patients, recognizing that in the eyes of God each individual has intrinsic worth, good health care delivery will be enhanced. ("Position Statements: Healthcare Delivery")[10]
Official Statement: from Christian Medical & Dental Associations, "Position Statements: Allocation of Medical Resources" (1999)
- "The scriptural principle of justice requires us to treat patients without favoritism or discrimination. The scriptural principle of stewardship makes us, individually and corporately, accountable for our decisions about the provision of medical and dental care. The scriptural principles of love and compassion require that we place the interests of our patients and of society before our own selfish interests. Recognition of the finitude of human life, along with the higher calling of eternal life with Jesus, should help Christian healthcare professionals resist the disproportionate expenditure of funds and resources in an effort to postpone inevitable death. Christian healthcare professionals, however, must never intentionally hasten the moment of natural death, which is under the control of a sovereign God.
- Christian doctors have a responsibility in helping to decide who will receive available health care resources. To refuse that responsibility will not prevent allocation decisions, but will instead leave those choices to institutions and individuals with purely utilitarian or materialistic motives. If this happens, allocations may generally shift toward people who have wealth or other forms of privilege, which is not the biblical way to value human life.
- We must be sensitive to the unmet health care needs of most of the world compared to the position of great privilege we enjoy in the United States. As Christian doctors we must seek to address the suffering of the international community through our personal actions and through our influence in public policy decisions.
- Society must evaluate its total resources and be certain that adequate dollars are made available for the health care needs of its people.This involves the understanding that choices must be made between the value of health care and the competing values of lifestyle, entertainment, defense, education etc. Society must minimize waste caused by unnecessary administrative and malpractice costs. Waste can also occur in expenditures for ineffective or unproved therapies or by funding perceived, rather than true, healthcare needs.
- Society must also make decisions regarding the allocation of resources to individual patients but should not place patients in the situation of choosing less effective care because of costs. These decisions must always be made with compassion and recognizing the inestimable value of human life. The choice between similarly beneficial therapies may be made on the basis of cost in order to maximize resources. Limits on therapeutic and diagnostic procedures may need to be based on cost and outcome. Outcome assessments based on "Quality of Life" determinations are problematic. We need to remember God's great love for all individuals and the great value He places on each individual life regardless of the world's valuation of that life. Purely utilitarian considerations should not determine the allocation of absolutely scarce, lifesaving resources (e.g. transplantable organs). All humans are equal in the eyes of God.
- Society must recognize the value of research in continuing to improve the healthcare of its people, and must therefore allocate adequate funding for promising areas of research.
- Christian doctors should earnestly examine their lives and practices and prayerfully seek God's guidance about their charges for professional services. They must be careful not to offer unnecessary diagnostic and therapeutic interventions. They should be actively involved in the provision of professional care for the poor and uninsured. Doctors should offer the best care available and inform their patients if that care isn't covered by their insurance plan. Whenever equally beneficial therapies are available the doctor should offer the less expensive therapy in order to benefit others who might use the resources.
- The practice of medicine at the level of the individual doctor is primarily an exercise in mercy. Society, because of limited resources, introduces the concept of justice. We as Christian doctors must strive in our practices and in our society to model the person of Christ, and His grace." ("Position Statements: Allocation of Medical Resources")[11]
Conscience Issues
Official Statement: from Christian Medical & Dental Associations, "Position Statements: Healthcare Right of Conscience" (2004)
- "Healthcare Right of Conscience
- Respect for conscientiously held beliefs of individuals and for individual differences is an essential part of our free society. The right of choice is foundational in our healthcare process, and it applies to both healthcare professionals and patients alike. Issues of conscience arise when some aspect of medical care is in conflict with the personal beliefs and values of the patient or the healthcare professional. CMDA believes that in such circumstances the Rights of Conscience have priority.
- Patient’s Right of Conscience
- The right of competent patients on the basis of conscience to refuse treatment, even when such refusal would likely bring harm to themselves, should be respected.
- The right of competent patients on the basis of conscience to refuse treatment, when such refusal would likely threaten the health and/or life of others, should be resisted and should become a matter of public interest and responsibility.
- The right of a healthcare surrogate on the basis of conscience to refuse treatment, thereby threatening the health and/or life of another, should be resisted and should become a matter of public interest and responsibility.
- The Healthcare Professional’s Right of Conscience
- All healthcare professionals have the right to refuse to participate in situations or procedures that they believe to be morally wrong and/or harmful to the patient or others. In such circumstances, healthcare professionals have an obligation to ensure that the patient’s records are transferred to the healthcare professional of the patient’s choice.
- The Healthcare Institution’s Right of Conscience
- Healthcare institutions have the right to refuse to provide services that are contrary to their foundational beliefs.
- Healthcare institutions have the obligation to disclose the services they would refuse to give.
- Healthcare institutions should not lose public funding as a result of exercising their right of conscience.
- Healthcare Education Right of Conscience
- Institutions, educators and trainees should be allowed to refuse to participate in policies and procedures that they deem morally objectionable without threat of reprisal.
- Healthcare professionals at all levels should seek to learn about and understand policies and procedures that they deem morally objectionable.
- No organization or governing body should mandate participation in policies or procedures that violate conscience.
- CMDA believes Christian healthcare professionals in our society should give dual service* to a Holy God and the humanity He created and sustains. We believe the Christian healthcare professional’s conscience should be informed by available evidence and Scripture. We believe obedience to conscience is obligatory for all Christians." ("Position Statements: Healthcare Right of Conscience")[12]
Organ Donation & Transplantation
Official Statement: from Christian Medical & Dental Associations, "Position Statements: Overview on Human Organ Transplantation" (2011)
- "CMDA affirms the ethical use of human organs for transplantation. Organ transplantation offers the opportunity for selfless, altruistic acts of service to our fellow humans. Since clinical demand exceeds the supply of available transplantable organs, well-reasoned policies and responsible stewardship are needed to realize the good of human organ transplantation while avoiding the harms of donor exploitation or unjust recipient distribution.
- Cadaveric human organ transplantation necessitates that the donor be dead. [See CMDA statement on Death.] The definition of death should not be enlarged for the purpose of increasing the supply of available organs. Such expansions include, but are not limited to, infants with anencephaly and persons who are in persistent vegetative or minimally conscious states.
- Consent for organ procurement must be free of force, fraud, or coercion by individuals, groups, organ procurement agencies, government or others.
- Living donor transplantation has additional unique issues.
- CMDA encourages increased educational efforts to inform the public of all aspects of organ donation and transplantation." ("Position Statements: Overview on Human Organ Transplantation")[13]
Official Statement: from Christian Medical & Dental Associations, "Position Statements: Organ Transplantation after Assisted Suicide or State Execution" (2014)
- CMDA affirms the sanctity of every human life, recognizing that life is a gift from God. For individuals with life-threatening disorders, organ transplantation may offer hope of a longer and healthier life. CMDA affirms ethical organ procurement (organ procurement that is not coerced, in which the organs are not purchased or sold, and through which vulnerable persons are not exploited). Organ procurement is not an end to be gained at all costs or through any means. Medicine primarily entails a covenantal relationship between physician and patient, and secondarily with society. This is not merely a utilitarian calculus of the greatest good for the greatest number. The ends, even if they represent a perceived good, are not justified if the means are not God-honoring and according to his biblical statutes.
- Persons killed through assisted suicide and prisoners executed by the state are not appropriate sources of organs for transplantation. In both situations coercion is present and renders the decision to donate organs illicit. Assisted suicide is a moral evil; using organs thus obtained may involve complicity in that evil if such use incentivizes such practice or justifies this moral evil. In the case of executed prisoners coercion is overt and inherently subject to abuse. In the case of assisted suicide those utilizing the organs do not have valid informed consent.
- Christian physicians appropriately argue in the public square for the dignity of all persons based on the sanctity of life given by God. While we may work to inform and encourage living donor or cadaveric organ transplantation, we may not encourage organ transplantation after assisted suicide or state execution." ("Position Statement: Organ Transplantation after Assisted Suicide or State Execution")[14]
Official Statement: from Christian Medical & Dental Associations, "Position Statements: Organ Donation After Circulatory Death" (2014)
- "Donation after Circulatory Death (DCD) criteria have the goal of increasing the supply of available organs for transplantation. Various DCD protocols have been implemented, for example, for potential donors with devastating brain injuries who have no reasonable prognosis for neurologic recovery yet who do not meet the conditions for determination of death by whole brain criteria. CMDA supports the ethical practice of DCD to enable the altruistic act of organ donation for transplantation for the purposes of saving and prolonging life, treating disease, and relieving pain and suffering (see CMDA statement on Organ Transplantation). However, CMDA has grave concerns about the implementation of DCD protocols in actual practice. (See Appendix)
- Therefore, CMDA advises that the following strict criteria must be met for the ethical practice of DCD:
- The donor candidate must have terminal or end-stage pathology that would allow for planned withdrawal of life-sustaining medical treatment or ventilatory support, with the expectation that natural death is likely to occur soon thereafter (see CMDA statements on Euthanasia and Vegetative State).
- Patients with disabilities who are not imminently dying should not be presented with premature options for organ donation. The disabled, the frail, and the elderly should not be led to believe that they have a duty to relinquish their organs as if their lives were of inferior value (see CMDA statement on Disabled Persons).
- Psychological assessment to evaluate for possible depression and taking a spiritual history are recommended for any conscious patient who expresses a preference for withdrawal of life-sustaining treatment for donation of organs.
- The patient's care and treatment decisions at the end of life should be free from external pressure from organ solicitations. Discussions whether to remove life-sustaining medical treatment or ventilator support must occur prior to initiating organ donation requests. Such decisions must be independent of donor status and made prior to and separate from the organ procurement organization contacting the patient, the patient's surrogate or family. The patient must not be coerced into a decision to hasten death.
- Consent for donation can be withdrawn at any time prior to withdrawal of life-sustaining support. No coercion shall be used to maintain consent.
- Quality palliative care and spiritual care must be provided prior to and during the dying process. Support to the family during this process is also crucial.
- Any narcotics or sedatives administered must be justified by their being effective in the provision of the patient's comfort and not for the purposes of preserving a more usable transplant or hastening the time of death.
- Any procedures performed for the sole purpose of preserving donor organ viability that would cause the patient distress or discomfort are prohibited. These include some pharmacological agents and the placement of vascular cannulae.
- The diagnosis of death, whether by whole brain or circulatory criteria, must be based solely on the medical condition of the patient and made independently of any influence by the organ procurement organization.
- The surgical staff responsible for organ procurement shall in no way participate in the weaning process or certification of death.
- The dead donor rule must be scrupulously followed, i.e., at the time of organ retrieval the donor must meet valid criteria for death. Ethical organ retrieval occurs after the brain is dead but before transplantable organs have lost viability. It is ethically permissible to declare death either by the criterion of whole brain death or permanent cessation of circulatory function, in the latter case provided circulatory arrest has been present for a minimum of 5 minutes and the brain is not hypothermic or chemically or metabolically suppressed. Criteria for determination of death should be consistently applied and not relaxed with the intent of creating an opportunity for organ procurement.
- Interventions performed for the purpose of maintaining or improving the quality of transplantable organs must not be the proximate cause of the death of the donor. CMDA opposes the use of interventions prior to the declaration of death that would intentionally deprive circulation to the patient's heart or brain, for example, inflating an occlusive balloon in the thoracic aorta during extracorporeal membrane oxygenation procedures to prevent oxygenated blood from reaching the heart and brain, since such interventions could directly cause the patient's death.
- Physicians and other healthcare professionals who find DCD protocols to be morally objectionable or otherwise harmful to the patient must not be coerced to participate but should be allowed the freedom to recuse themselves without threat of reprisal (see CMDA statement on Healthcare Right of Conscience).
- Hospitals should be free to implement DCD protocols based on ethical criteria more stringent than those of organ procurement organizations without being penalized or disenfranchised from collaborative organ procurement and transplantation networks.
- Conclusions
- CMDA affirms the importance of sufficient ethical safeguards in the determination of death prior to organ procurement in order to protect and respect the dignity of patients and to uphold the moral integrity of the medical profession.
- CMDA opposes abandoning the dead donor rule as a means of increasing the supply of transplantable organs. The dead donor rule is a fundamental moral principle that never should be transgressed for the sake of competing interests. Procuring life-sustaining vital organs from patients who have not yet died is incompatible with the ethical practice of medicine.
- CMDA finds proposals that would broaden DCD eligibility to include cognitively intact patients with irreversible neuromuscular paralysis who are not imminently dying yet who autonomously consent to donate their organs after electing to discontinue ventilator support to be morally problematic.
- CMDA finds the practice of DCD as an avenue to euthanasia and physician-assisted suicide to be ethically unacceptable; this may include proposals that would extend DCD eligibility to those who are not terminal but who despair of their perceived quality of life.
- CMDA is concerned that unethical DCD practices could, by associations, discredit the ethical practice of organ procurement. Publicized abuses of DCD could damage the public’s trust in transplant medicine and the public's willingness to volunteer as future organ donors.
- CMDA opposes policies and procedures that shift clinical emphasis from the care of patients toward their use as a means to others’ ends. Subordinating the best interest of the patient to a purportedly higher utilitarian good is antithetical to Christian love and the ethical professional practice of medicine." ("Position Statements: Organ Donation After Circulatory Death")[15]
Official Statement: from Christian Medical & Dental Associations, "Position Statements: Imminent Death Organ Donation" (2017)
- "CMDA affirms the sacredness of every human life, recognizing that life is a gift from God and has intrinsic value because all human beings are made in His image and likeness. For persons with illness that threatens life or health, organ transplantation may offer hope of a longer, healthier life. CMDA affirms ethical organ donation, meaning organ donation that is not coerced, in which organs are not purchased or sold, and through which vulnerable persons are not exploited or killed by vital organ procurement.
- Ethical donation of solid organs is guided by the dead donor rule, according to which a potential organ donor must be dead before vital organs are removed for transplantation. Although medical criteria for the determination of death have been debated, decisions at the end of life nonetheless must distinguish ethically between acts of killing and allowing to die.
- Proposals are undergoing evaluation in the U.S. and already are implemented in some other countries to increase the supply of potentially transplantable organs by procuring organs from patients who are imminently dying. Imminent death donation (IDD) by living patients could potentially apply to several types of donors:
- The unconscious patient who is imminently dying from a devastating neurologic injury and irreversibly lacks decision-making capacity but is not brain dead.
- The patient who is not actively dying but, as the result of a devastating neurologic injury, is chronically dependent on life-sustaining technology, and who, through an advance directive (made when the patient had full decision-making capacity) or substituted judgment by a legal surrogate, has made a decision to withdraw such technology. Organ donation would precede or occur simultaneously with such withdrawal. Such a patient might be:
- Permanently unconscious
- Minimally conscious
- Cognitively disabled or demented
- Neuromuscularly weak but cognitively unimpaired
- The conscious, altruistic patient with decision-making capacity who is approaching death as the result of a progressive or devastating neurologic disease and requests assistance in an earlier death in order to donate organs before circulatory collapse renders them nonviable for transplantation.
- The patient who has been diagnosed with a terminal disease, is dissatisfied with his or her present or anticipated future quality of life, and requests assisted suicide (so called “assistance in dying”) before the disease advances to its final stages.
- In each case, death would be accomplished or hastened by the act of organ procurement. The rationale for these proposals includes the following arguments:
- 1. It has been argued that the donor’s autonomy to choose the manner and timing of death and to donate organs should be respected. However, this argument raises a number of concerns:
- Imminently dying patients are vulnerable and may not be truly autonomous. Illness may deprive the potential donor or surrogate of the capacity to make informed decisions or resist coercive efforts under the guise of persuasion, which may be subtle or prey upon the patient’s despair.
- The claim that procuring vital organs from the imminently dying honors the donor’s autonomy may be driven by underlying utilitarian or economic motives.
- Individual autonomy is neither incontestable nor an absolute principle. If autonomy were absolute, then a healthy person would have the right to sacrificial assisted suicide by donation of vital organs. The claim of autonomy must always be balanced with the principles of beneficence, nonmaleficence, and justice, as well as the need to preserve the integrity and trustworthiness of the medical profession.
- Elevation of the patient’s autonomy to absolute mastery that extends to being killed or assisted in suicide so long as the act is voluntary is a distorted sense of freedom that denies both the giftedness and sacredness of life, over which medicine has a stewardship responsibility, and God’s providential purposes for that life.
- Whereas the patient’s autonomy encompasses the right to receive medical attention and the negative right not to receive a recommended treatment, it does not include the positive right to receive any particular treatment requested that may be outside the physician’s expertise, skills, or judgment.
- According a positive right to premature death to those who are autonomous would place at serious risk others who are less fully autonomous, such as patients with dementia, intellectual disabilities, or impaired consciousness.[19]
- Assisted suicide is a moral evil; using organs thus obtained may involve complicity if such use incentivizes or presumes to justify the practice (see CMDA statement on Moral Complicity with Evil).
- 2. It has been argued that the practice of medicine has evolved in such a manner as to legitimize and even require physician assistance in, and hastening of, medical death when patients no longer consider their lives to be worth living. However,
- Whereas technologies have evolved, unchanged are the moral conditions at the bedside, which include the reality of illness, the vulnerability of the patient, and the promise of the healthcare professional to endeavor to heal and not to harm.
- Public opinions that may currently be in vogue are not a valid test of truth.
- 3. It has been argued that the donor’s altruism in donating organs for the purpose of saving another’s life should be honored. However,
- Patients who die as a result of physician-assisted suicide or who may request that their deaths be accomplished in the very act of procurement (“donation euthanasia”) are not ethically appropriate sources of organs for transplantation, because they deny the sacredness of life of the dying patient. To accede to such a request is unacceptable, because it communicates that the patient’s life has no further meaning.
- To codify imminent death donation of solid organs would open the door to abuses and coercion and thereby place at risk the most vulnerable.
- 4. It has been argued that procuring organs from the imminently dying is an act of compassion on behalf of other patients in need of transplantable organs. However,
- Procuring organs from the imminently dying ignores good palliative medicine and compassion for the dying patient.
- Assisted suicide and euthanasia violate both the Hippocratic Oath and the Hippocratic directive, “First, do no harm.”
- 5. It has been argued that organs should be procured from the imminently dying or in conjunction with euthanasia because, when retrieved from patients with a functional circulation, they are more viable and lead to better outcomes for the transplant recipient than ischemic organs retrieved from patients without circulation at the time of retrieval. However,
- Organ procurement is not an end to be gained at all costs or through any means. Organ procurement should be performed within a covenantal relationship among patient, physician, and society, eschewing a utilitarian ethic of the greatest good for the greatest number as determined by secular ethical systems that may be susceptible to influence by financial, social, or political interests.
- The argument that the dying patient should relinquish his or her organs sooner presumes that the interests of the potential transplant recipient are of greater importance than and should overrule the needs of the dying patient, and thus that the dying patient is someone of lesser value. This attitude comes very close to asserting a claim of ownership of the dying patient’s organs. Human beings’ organs are not the property of the state, healthcare institutions, or the transplantation industry.
- 6. It has been argued that the currently-accepted practice of withdrawing life-sustaining medical interventions is already equivalent to euthanasia; therefore, a more aggressive agenda of ending life sooner for the utilitarian purpose of obtaining organs is justified. However,
- CMDA affirms that there is a meaningful ethical distinction between euthanasia and allowing a patient to die of natural causes. When life-sustaining treatment is withdrawn, the proximate cause of death is the underlying disease.
- Proposals to procure organs in the imminently dying would necessitate revocation of the “dead donor rule.”
- It is ethically impermissible to kill some people to benefit others.
- 7. It has been argued that physicians whose religious beliefs or moral conscience prevents them from using their knowledge and skill to terminate their patient’s lives are duty bound to refer their patients to others willing to perform such an act, or else should be forced to resign from the practice of medicine. However,
- Medicine is a healing vocation into which many healthcare professionals enter as a calling (See CMDA statement on Professionalism) and is fundamentally unlike a service industry defined by a job description. The most exemplary and trustworthy healthcare professionals are those who identify with and live out the moral ethos of their healing vocation. To impose on healthcare professionals, who are committed to healing, a legal duty to kill would dangerously violate their moral integrity and severely damage the trustworthiness of their profession.
- Whereas the state can legitimately limit healthcare professionals in doing what they believe to be good, the state does not have the legitimate authority to force healthcare professionals to commit acts that they believe to be morally wrong.
- 8. The opinion has been asserted that time-honored moral prohibitions against taking innocent life, such as those expressed in the Hippocratic Oath and the Bible, “have no legitimate bearing on the practice of 21st century medicine” because there is no scientific test (accepted by atheists) for the existence of God. However,
- Nor can any scientific test limited to empirically-verifiable factual data prove that atheism is correct or disprove the existence of God. Additional sources of knowledge are needed to discern moral values.
- Medicine, of all the professions, should affirm the value of human life and embody an ethic of healing rather than a rush to death. The healing orientation of medicine benefits all of society.
- Atheism also is a belief system, but in comparison to theism, atheism provides an impoverished ethical basis for the healing mission of medicine, as it rejects the sacredness of human life and accommodates the view that humans are nothing more than biological machines with interchangeable parts.
- 1. It has been argued that the donor’s autonomy to choose the manner and timing of death and to donate organs should be respected. However, this argument raises a number of concerns:
- Conclusion
- Donation euthanasia and procurement of organs from the imminently dying are incompatible with the ethical principles of the Christian Medical & Dental Associations. Specifically:
- Christian physicians affirm that God, in His mercy, has provided the possibility of organ transplantation for many patients in need and that this life-saving technology comes with great moral responsibility.
- CMDA upholds the ethical practice of uncoerced solid organ donation, including single kidney or partial liver donation from living patients and vital organ donation from patients determined to be deceased by whole brain or circulatory criteria (see CMDA statements on Death, Overview on Human Organ Transplantation, Organ Transplantation after Assisted Suicide or State Execution, and Organ Donation after Circulatory Death).
- CMDA upholds the “dead donor rule” as an inviolable boundary for the ethical removal of vital organs for transplantation and opposes efforts to circumvent or abolish it.
- CMDA emphatically rejects in practice and in public policy organ donation by acts of medical killing, including
- Assisted suicide in the patient who has been diagnosed with a terminal illness or a severe disability and requests donation of vital organs, the removal of which would cause or hasten the donor’s death.
- Euthanasia with intent to obtain transplantable organs.
- Under no circumstances should healthcare professionals be encouraged or coerced to participate in the hastening of death for the purpose of organ procurement, nor be required to be complicit in such killing by referral to others who will comply (see CMDA statement on Healthcare Right of Conscience)." ("Position Statements: Imminent Death Organ Donation")[16]
Privacy of Healthcare Information
Official Statement: from Christian Medical & Dental Associations, "Position Statements: Genetic Information and Manipulation Technologies" (2018)
- "CMDA supports:...
- Strict confidentiality of an individual's genetic information, as for all personal health information.
- Healthcare professionals informing the patient with a genetic diagnosis of potential familial risk and encouraging the patient to share information about heritability risk with family members." ("Position Statements: Genetic Information and Manipulation Technologies")[17]
Science & Technology
Biotechnology
Animal-Human Hybrids
Official Statement: from Christian Medical & Dental Associations, "Position Statements: Human Hybrids and Chimeras" (2008)
- "Science has developed the capability to create novel organisms by combining cells or tissues (chimeras) or genetic information (hybrids) from different species. The creation of novel organisms that combine human and animal living cells or human and animal genetic material raises moral concerns not only regarding individual patients but also the whole of humanity and the human future.
- CMDA believes that a distinct moral boundary separates human from nonhuman animal life. This boundary is not definable by cognitive, physical or genetic criteria alone. God established this boundary when he created humankind in his own image. God granted humankind alone a spiritual nature and gave humankind responsibility and dominion over all other creatures, which, by his design, reproduce according to their own kind. We must respect the created and clear boundary between humankind and animals.
- Nonhuman animals are a valuable resource for medicine. From animals medical science has acquired knowledge about cellular and organ function, gained insights into genetics, and developed models of human disease and drug effects. For example, from animals we obtain transplantable heart valves that save human lives. CMDA recognizes valid ethical frameworks for each of these enterprises, which derive benefit for humankind from the anatomical, biochemical, genetic and physiological similarities that humans and nonhuman animals share as earthly creatures.
- Ethical Guidelines
- 1. As Christians and as medical professionals, we are bound to actively seek the spiritual and physical well being of all humankind.
- 2. The use of research and technology must be guided and limited by ethical principles. There is no unlimited or unrestricted technological imperative.
- 3. There are compelling moral reasons to refrain from applying biotechnology to create chimeras or hybrid organisms that are partly human and partly nonhuman. These reasons include:
- Humankind alone was created in God’s Image.
- We are not to desecrate the image of God by reducing a human being to animal status.
- We are never to elevate animals to human status.
- We are not to create intermediate or indeterminate species sharing human and animal genetic material.
- Humankind alone has the unique capacity to enter into a personal relationship with God through Jesus Christ his Son. Because human dignity is not wholly reducible to cellular matter or fully determined by genes, some limited combinations of cellular or genetic material across species lines may be ethically permissible (see Appendix). However, there are certain human characteristics that are inviolate and should not be blended with animal characteristics. We must not compromise that which makes us human. Fundamentally this includes the ability to know God and may encompass such characteristics as human reasoning, free will, and sexuality. The formation of human organisms that have nonhuman progenitors or are capable of generating nonhuman offspring is an affront to God, his created order, and his image within us.
- It is not permissible to use human subjects for research purposes without disclosure and informed and voluntary consent.
- In matters this consequential, full disclosure and discussion should extend to society as a whole. Societal consent, however, does not determine moral acceptability.
- Preventing harm to human beings is a moral mandate. The potential consequences of human chimera/hybrid research are so far-reaching and troublesome that the most stringent precaution is required. For example:
- Chimeras and hybrids will enable diseases to cross species lines, bypassing normal barriers and resistance, imperiling both the individual and the species.
- Transferring genes encoding disease may cause novel virulence, or create new diseases, gravely threatening the host species and public health.
- We are stewards of the animal kingdom and owe to it our care and concern. Although it is permissible to use animals in experiments designed to improve human care, we must not violate the mandate of stewardship by engaging in cruel or needlessly destructive experiments.
- The creation in the laboratory of creatures or species with novel sentience would place upon society moral obligations for which we are unprepared.
- Moral problems are not resolved by terminating the life of the chimera prior to the emergence of any particular stage of development.
- Moral problems are not nullified by anticipated scientific or medical gains.
- Humankind alone was created in God’s Image.
- Conclusion
- CMDA endorses ethical chimeric and hybrid research and technology designed for the benefit of humankind, provided that these are safe and do not degrade the unique status of humankind.
- CMDA opposes chimeric and hybrid research and technology that fundamentally alters human nature as designed by God." ("Position Statements: Human Hybrids and Chimeras")[18]
Human Cloning
Official Statement: from Christian Medical & Dental Associations, "Position Statements: Human Cloning" (1998)
- "As Christian physicians and dentists, we believe that human life is sacred because each individual is made by God in His own image. God's design is that each individual is formed by the union of genetic material from a husband and wife. We further believe that the family is the basic social unit designed by God to receive and nurture new human life.
- There are moral reasons to refrain from proceeding with human cloning.
- First and foremost, the development of this technology will require the deliberate sacrifice of human embryos. We believe this to be immoral. The use of human life merely as a means to an end is likewise morally unacceptable. Another moral concern is the question of the timing and significance of ensoulment. Furthermore, cloning may deviate from the wisdom of God's design for human genetic diversity and therefore may be unwise.
- There are scientific reasons to oppose human cloning such as the potential for mutation, transmission of mitochondrial diseases, and the negative effects from the aging genetic material. There are also societal reasons to be hesitant about human cloning such as questions about parentage, lineage, family structure and the uniqueness of the individual.
- Therefore, we believe that human cloning should not be pursued given our current understanding and knowledge. We affirm the need for continued moral scrutiny as research on animal cloning proceeds and proposals for the application of this technology to humans are advanced." ("Position Statements: Human Cloning")[19]
Stem Cell Research
Official Statement: from Christian Medical & Dental Associations, "Position Statements: Human Stem Cell Research and Use" (2007)
- "The field of stem cell research offers great promise for the advancement of medical science. Adult stem cells are presently being used to treat a variety of illnesses. However, the isolation of human embryonic stem cells in 1998 and resultant research have raised moral concerns because current methods of procuring embryonic stem cells require the destruction of human life.
- CMDA recognizes the potential value of stem cell technology:
- We endorse the goals of stem cell research to treat human illness and relieve human suffering.
- We endorse retrieval and use of adult stem cells from a variety of sources – umbilical cord blood, placenta, amniotic fluid, adult organs, etc.
- We endorse human adult stem cell research and use if it is safe for human subjects.
- We endorse animal stem cell research provided it is not cruel to experimental animals.
- CMDA has moral concerns regarding embryonic human stem cell research and use. We recognize the sacred dignity and worth of human life from fertilization to death.
- The destruction of nascent individual human life even for the benefit of others is immoral.
- We condemn specious arguments that “excess” embryos may be used as a source for embryonic stem cells, “because they would have been destroyed anyway and that good may come.” There is a moral difference between intentionally taking a human being’s life and the embryo dying a natural death.
- We are concerned that stem cell research will involve exploitation of women (especially poor women) by using them to produce the eggs necessary for stem cell research, thereby subjecting them to the risk of attendant procedures and potential complications.
- We are concerned that the instrumental production, use, commodification or destruction of any human being will coarsen our society’s attitude toward human life itself.
- Conclusion
- CMDA advances the following moral guidelines to direct stem cell research and therapy:
- No human life should be produced by any means for primarily utilitarian purposes – no matter how noble the ends or widespread the benefit.
- Technology and research must not involve the abuse or destruction of human life.
- We encourage the careful and ethical development of alternative methods for procuring stem cells that do not involve the destruction of human life.
- CMDA encourages life-honoring stem cell research for the advancement of medical science and the benefit of all patients. In this pursuit, CMDA advocates the protection of all human life, for humans are made in the image of God." ("Position Statements: Human Stem Cell Research and Use")[20]
Genetic Ethics
Gender Selection
Official Statement: from Christian Medical & Dental Associations, "Position Statements: Genetic Information and Manipulation Technologies" (2018)
- "CMDA opposes:...
- The use of genetic information for positive or negative discriminatory purposes, including sex selection of human embryos, or infringement upon the right to procreate." ("Position Statements: Genetic Information and Manipulation Technologies")[21]
Gene Therapy/Genetic Engineering
Official Statement: from Christian Medical & Dental Associations, "Position Statements: Eugenics and Enhancement" (2006)
- "Goals
- CMDA affirms the primary goals of medicine – the treatment and prevention of disease and the reduction of suffering, whenever possible, by legitimate and moral means.
- CMDA supports the effort to understand our genetic code for purposes of increasing knowledge, treating disease, and bettering the human condition.
- CMDA opposes the use of any genetic manipulation that has an unacceptable risk of harm to any human being.
- Safety
- Although the use of somatic and germ cell genetic therapy has the potential to correct genetically determined disease, there are significant concerns regarding the safety of genetic therapy, particularly germ line therapy.
- Somatic cell therapy: If critical concerns regarding the safety of somatic cell therapy can be resolved, the use of somatic cell therapy may be acceptable for correcting genetically determined diseases.
- Germ cell therapy: CMDA believes that germ cell genetic therapy is unacceptable - at least until safety issues are resolved. The use of germ cell therapy is more problematic due to the transmission of any changes to future generations. Safety issues are magnified in this instance since changes not only affect the patient but future descendants. Even if safety issues are resolved, germ cell therapy still raises significant moral issues, e.g., the impossibility of obtaining consent from those yet to be born." ("Position Statements: Eugenics and Enhancement")[22]
Genetic Screening
Official Statement: from Christian Medical & Dental Associations, "Position Statements: Eugenics and Enhancement" (2006)
- "Mapping the human genome has been a significant aid in the identification and possible treatment of genetically determined diseases. Like all powerful information it can be used for good or for ill.
- CMDA endorses ethical efforts to increase the scope and accuracy of science used to identify, understand, and treat human genetic diseases.
- It should not be mandatory that persons be genetically screened, be made to know their own genetic information, or be required to act upon that knowledge.
- In this context, no person’s genetic information should be used against him or her.
- Morals
- The application of genetic knowledge for eugenic agendas is unequivocally problematic.
- The goals of modern genetics must be sought within the limits of moral boundaries and qualifications. Medicine, and therefore genetics, must be practiced according to principles of ethical behavior delineated by conscience under the authority of Scripture.
- When an undesired trait or gender is identified by pre-implantation or prenatal screening the discovery is often followed by destruction of the human life exhibiting the undesired trait. CMDA opposes destruction of human life for eugenic purposes. This includes the destruction of embryos, abortion, infanticide and genocide." ("Position Statements: Eugenics and Enhancement")[23]
Genetic Testing
Official Statement: from Christian Medical & Dental Associations, "Position Statements: Genetic Information and Manipulation Technologies" (2018)
- "As Christian physicians and dentists we affirm:
- All human beings have been individually created through the providential interest and design of Almighty God. Being created in the image of God, every human being has infinite worth, regardless of genotype or phenotype.
- The diversity of individuals is part of the wonder and strength of God's sovereign design.
- Each human life is a composite of genetic, environmental, social, volitional and spiritual factors.
- God has endowed humans with minds capable of exploring but only partially understanding the magnificence and intricacies of His Creation. Human knowledge and wisdom are limited and may be used for evil or good.
- God has mandated good stewardship of Creation, both of ourselves and the surrounding world.
- Therefore, we believe:
- The presence of a disability, either inherited or acquired, does not detract from a person's intrinsic worth.
- The scientific exploration of life, including its genetic foundation, is proper and consistent with God's mandate and humanity's created nature, but must be conducted within biblical constraints.
- Genetic information may be of legitimate value in guiding the care of patients.
- Because a minor is unable to give informed consent, for genetic testing of a minor to be performed, it should benefit him during the period of time prior to majority. Therefore, pre-symptomatic testing of a minor should not be performed for disorders that will not either affect his health until after majority or result in therapeutic intervention before majority.
- An individual's genetic information should be kept strictly confidential.
- Somatic cell manipulation to replace absent or defective genes is consistent with the goals of medicine, and may be good stewardship of knowledge. Such manipulation should be performed only after extensive study demonstrates the specificity, benefits and risks of these interventions, or as part of an approved clinical trial.
- Germ cell manipulation as a technology carries with it a much higher risk of harm and abuse than somatic cell manipulation, in that it affects future generations. But, we do not believe it is appropriate to preclude categorically the potential use of this technology. It may become possible to correct safely and specifically some severe deficiencies (e.g. hemophilia) for multiple generations, and we do not wish to condemn such a beneficial use of technology.
- We oppose:
- The search for and use of genetic information to justify destroying an existing life, born or unborn.
- The use of genetic information for discriminatory purposes including infringement upon the right to procreate.
- The use of genetic manipulation to augment human attributes.
- The use of a patient's genetic information for societal benefit if such use harms or could potentially harm that individual.
- The reductionist belief that humans are simply the product of their genetic destiny.
- As more knowledge becomes available, we need to seek humbly and prayerfully God's wisdom and guidance in the use of genetic information and technology." ("Position Statements: Genetic Information and Manipulation Technologies")[24]
Official Statement: from Christian Medical & Dental Associations, "Position Statements: Eugenics and Enhancement" (2006)
- "Mapping the human genome has been a significant aid in the identification and possible treatment of genetically determined diseases. Like all powerful information it can be used for good or for ill.
- CMDA endorses ethical efforts to increase the scope and accuracy of science used to identify, understand, and treat human genetic diseases.
- It should not be mandatory that persons be genetically screened, be made to know their own genetic information, or be required to act upon that knowledge.
- In this context, no person’s genetic information should be used against him or her." ("Position Statements: Eugenics and Enhancement")[25]
Human Enhancement
Official Statement: from Christian Medical & Dental Associations, "Position Statements: Eugenics and Enhancement" (2006)
- "The practice of genetic alteration evokes deeper concerns on a more fundamental level. The prospect of using genetic technology to enhance human characteristics is now a theoretical possibility. CMDA recognizes that the distinctions between treatment and enhancement are difficult to discern and are arbitrary in many cases. As Christians, we hold that all humans are made in the image of God. This essential characteristic distinguishes us as human. The goal to recreate man in man’s image raises profound questions about human nature and man’s relationship with his Creator. The ultimate end of man is to glorify God; the re-creation of man to glorify himself is idolatry." ("Position Statements: Eugenics and Enhancement")[26]
Official Statement: from Christian Medical & Dental Associations, "Position Statements: Human Enhancement" (2015)
- "CMDA Affirms:
- That the purpose of human life is defined by God, not by the sinful desires of human beings (Rom 9:20-21; 1 Cor 6:19-20; Eph 2:10; Gal 2:20; Mark 7:21-23)
- That, according to Scripture, the purpose of human life is fellowship with God and our fellow human beings within the confines of our created nature (Rom 8:22-30; Deu 6:4-5; Matt 22:37-40; John 17:3)
- That the model of human being and flourishing is the person of Jesus Christ (Rom 8:29)
- That no human re-engineering technologies are capable of attaining the model of Jesus Christ or are necessary for human flourishing (2 Cor 3:18)
- That immortality can be achieved only by the saving work of Jesus Christ (1 John 5:12); utopian false promises of re-engineered, matter-based, so-called technological immortality are an idolatrous illusion and a counterfeit salvation
- That human beings should commit to stewardship of their talents and gifts for the glory of God, the development of godly character, and service to one another (Micah 6:8; Matt 25:14-30; Rom 12:1-3; 1 Cor 10:23-24; 1 Peter 3:3-4)
- CMDA Concludes:
- That the goals of medicine should remain healing, restoration, and palliation, never commodification of persons or purveying of narcissistic wish fulfillment
- That the pursuit of human re-engineering would, in contrast, sinfully distract from God's intentions for human flourishing and stewardship
- That the pursuit of non-healing or non-restorative endeavors for the purpose of human re-engineering is unjust; a deviation from the historical goals of medicine; and a misappropriation of medical knowledge, training and resources
- That the misuse of biomedical technology to address issues caused by social pathology is poor stewardship that aggravates rather than solves those issues and is ultimately futile, as it fails to legitimately or effectively address the true problems, which lie outside the domain of medicine
- That the human biomedical re-engineering project, which has the potential to radically alter or even eradicate dimensions of God-given human nature is, therefore, unacceptable, unethical, and imprudent
- That the refusal to support or perform human re-engineering technologies is not a violation of respect for patient autonomy, properly understood
- That coerced re-engineering of human beings by governments, military forces, insurers, or private enterprises for the condition of employment or service is contrary to human dignity and freedom; health care professionals should maintain the right of conscientious objection against complicity with such coercion (see CMDA Statement on Right of Conscience)
- That acceptance of some forms of cosmetic enhancement about which conscientious Christian health care professionals disagree should not imply tacit approval for biomedical enhancements in general or re-engineering specifically
- That every scientist, researcher, engineer, and medical professional should interrogate each biomedical technology and its use in specific situations with the following 10 questions to assist in the determination whether the application is God-honoring, acceptable, ethical, prudent, and just:
- Does the technology treat our common, limited medical resources responsibly within the constraints of just stewardship before God?
- Has the technology been sufficiently evaluated in regard to its possible risks and benefits, short-term and long-term? What are the consequences, reversible and irreversible, of the technology for future generations?
- Does the technology diminish or exacerbate unjust social inequalities?
- Does the technology facilitate healing or restoration from disease or disability, or is it intended for human re-engineering? Is the technology being used to address biomedical pathology or social pathology?
- Does the technology enrich or impoverish human relationships?
- Does the technology truly ennoble, assisting virtue, or would it subvert authenticity, misrepresent and distort identity, or corrupt attitudes?
- Does the technology promote a community that values and accepts all individuals regardless of their attributes?
- Does the technology require or promote the commodification, exploitation, or destruction of human life?
- Does it demean, debase, or degrade individuals?
- Does it require or reinforce diminished views of human life, human value, and the human being?
- Does the technology primarily appeal to our basest inclinations?
- Does it appeal to our pride?
- Does it encourage materialism?
- Does it promote narcissistic self-absorption?
- Does it appeal to lust or promote sexual commodification?
- Does it promote servitude or enslavement to fickle whims of fashion?
- Does it support or perpetuate obsession with one's body image?
- Does the technology promote genuine human flourishing, or does it more likely promote technological or economic imperatives?" ("Position Statements: Human Enhancement)[27]
Transhumanism/Posthumanism
Official Statement: from Christian Medical & Dental Associations, "Position Statements: Human Enhancement" (2015)
- "CMDA Affirms:
- That the purpose of human life is defined by God, not by the sinful desires of human beings (Rom 9:20-21; 1 Cor 6:19-20; Eph 2:10; Gal 2:20; Mark 7:21-23)
- That, according to Scripture, the purpose of human life is fellowship with God and our fellow human beings within the confines of our created nature (Rom 8:22-30; Deu 6:4-5; Matt 22:37-40; John 17:3)
- That the model of human being and flourishing is the person of Jesus Christ (Rom 8:29)
- That no human re-engineering technologies are capable of attaining the model of Jesus Christ or are necessary for human flourishing (2 Cor 3:18)
- That immortality can be achieved only by the saving work of Jesus Christ (1 John 5:12); utopian false promises of re-engineered, matter-based, so-called technological immortality are an idolatrous illusion and a counterfeit salvation
- That human beings should commit to stewardship of their talents and gifts for the glory of God, the development of godly character, and service to one another (Micah 6:8; Matt 25:14-30; Rom 12:1-3; 1 Cor 10:23-24; 1 Peter 3:3-4)
- CMDA Concludes:
- That the goals of medicine should remain healing, restoration, and palliation, never commodification of persons or purveying of narcissistic wish fulfillment
- That the pursuit of human re-engineering would, in contrast, sinfully distract from God's intentions for human flourishing and stewardship
- That the pursuit of non-healing or non-restorative endeavors for the purpose of human re-engineering is unjust; a deviation from the historical goals of medicine; and a misappropriation of medical knowledge, training and resources
- That the misuse of biomedical technology to address issues caused by social pathology is poor stewardship that aggravates rather than solves those issues and is ultimately futile, as it fails to legitimately or effectively address the true problems, which lie outside the domain of medicine
- That the human biomedical re-engineering project, which has the potential to radically alter or even eradicate dimensions of God-given human nature is, therefore, unacceptable, unethical, and imprudent
- That the refusal to support or perform human re-engineering technologies is not a violation of respect for patient autonomy, properly understood
- That coerced re-engineering of human beings by governments, military forces, insurers, or private enterprises for the condition of employment or service is contrary to human dignity and freedom; health care professionals should maintain the right of conscientious objection against complicity with such coercion (see CMDA Statement on Right of Conscience)
- That acceptance of some forms of cosmetic enhancement about which conscientious Christian health care professionals disagree should not imply tacit approval for biomedical enhancements in general or re-engineering specifically
- That every scientist, researcher, engineer, and medical professional should interrogate each biomedical technology and its use in specific situations with the following 10 questions to assist in the determination whether the application is God-honoring, acceptable, ethical, prudent, and just:
- Does the technology treat our common, limited medical resources responsibly within the constraints of just stewardship before God?
- Has the technology been sufficiently evaluated in regard to its possible risks and benefits, short-term and long-term? What are the consequences, reversible and irreversible, of the technology for future generations?
- Does the technology diminish or exacerbate unjust social inequalities?
- Does the technology facilitate healing or restoration from disease or disability, or is it intended for human re-engineering? Is the technology being used to address biomedical pathology or social pathology?
- Does the technology enrich or impoverish human relationships?
- Does the technology truly ennoble, assisting virtue, or would it subvert authenticity, misrepresent and distort identity, or corrupt attitudes?
- Does the technology promote a community that values and accepts all individuals regardless of their attributes?
- Does the technology require or promote the commodification, exploitation, or destruction of human life?
- Does it demean, debase, or degrade individuals?
- Does it require or reinforce diminished views of human life, human value, and the human being?
- Does the technology primarily appeal to our basest inclinations?
- Does it appeal to our pride?
- Does it encourage materialism?
- Does it promote narcissistic self-absorption?
- Does it appeal to lust or promote sexual commodification?
- Does it promote servitude or enslavement to fickle whims of fashion?
- Does it support or perpetuate obsession with one's body image?
- Does the technology promote genuine human flourishing, or does it more likely promote technological or economic imperatives?" ("Position Statements: Human Enhancement)[28]
Human Research Ethics
Official Statement: from Christian Medical & Dental Associations, "Position Statements: Human Research" (2010)
- "CMDA recognizes the mandate God gave to be wise stewards over our world (Gen 1:28). We also delight in responding to God’s call to alleviate suffering. Research on human subjects is often an appropriate way to accomplish these ends. Research on humans should never intend to harm the subject and any harm caused to the patient must only be allowed with the expectation or the achievement of a greater benefit for the patient.
- Research involving human beings is invaluable, and it provides important new information as well as broad benefits for mankind. Scientific rigor and ethical principles – providing for the respect and dignity of human life – are paramount in this research. CMDA believes Scripture (Matt 22:37-40) provides the moral foundation that informs these ethical decisions.
- There are recognizable and intangible benefits to research subjects. Some patients near the end of life, and healthy volunteers, knowing that they will not benefit personally from the research are willing to participate for the benefit of others.
- Research involving human beings has a domestic and an international history of abuse (for example, the Tuskegee Syphilis Study and the Nazi atrocities of World War II) that must be remembered. Learning from the past moral violations in human research is essential to safeguard future endeavors. The Nuremberg Code, the Declaration of Helsinki, and the Belmont Report are historical documents that addressed past abuses of human beings.
- Human research ethics involves institutions, investigators, sponsors, subjects, and data. Research ethics is necessary to provide guidelines and boundaries for research teams and sponsoring organizations in order to protect human subjects from harm. This is especially needed when research crosses biologic, economic, social, ethnic and cultural boundaries.
- The participants – human beings made in the image of God (Gen 1:27) – must be treated as unique and special creations and the researchers must exercise compassion, dignity, fairness, and respect for human beings.
- Research should only be conducted if the proposed benefit outweighs the burdens and risks to the human subjects. Vulnerable populations – such as children and prisoners – must be granted additional protection
- Informed consent must be obtained in advance from the participant or appropriate proxy
- Participation must be voluntary, and researchers must make conscientious effort to avoid coercive situations. Coercive situations may arise in the context of disparities such as wealth, social (or institutional) class, education, age, gender, ethnicity and race
- Participants must be allowed to terminate their participation in the trial at any time without reprisal
- The research team must be cognizant of its obligations and act appropriately. (1 Cor 4:2)
- Research studies must ask a question of significant importance for human benefit and health, and must be designed to obtain unbiased data and be sufficiently powered for statistical significance
- Research studies should be reviewed by an Institutional Review Board, and they must be assessed for predictable risks and burdens, maximizing the foreseeable benefits
- Potential conflicts of interest, at any level (e.g., institutional review board, the research subject, the publishing journal, and/or the sponsor) must be disclosed, and they must be adequately addressed
- Conflicts of interest arise when the researcher has a dual relationship with the subject (as investigator and treating clinician), and as such, the researcher must act in the best interest of the subject
- Placebo and non-treatment trials are not permitted when a proven therapy is available and omission of a proven therapy would result in harm
- All results, including beneficial and non-beneficial data, must be openly reported without bias
- Confidentiality of the subjects must be maintained
- Fabrication, falsification, and plagiarism are to be assiduously avoided and punished
- Responsibility and appropriate care for subjects suffering adverse research outcomes must be provided
- Authorship criteria and credentialing must be accurately reported
- Research performed in any country or culture requires that:
- Researchers and host authorities share responsibility for the protection of the research subjects in accordance with their human dignity as bearers of the image of God.
- The research study must be responsive to the health needs of its people
- Research results and ensuing benefits should extend to the people of the host country
- Neither research location nor selection of subjects should be chosen to take advantage of a lower research standard
- Research study information should be disclosed to the public when:
- Results are scientifically valid
- Research findings offer therapeutic implications for the study population or the study condition
- Important new data (positive or negative) have been discovered
- Research study information may be withheld when research is incomplete and premature disclosure would compromise the study validity.
- Research studies must be discontinued when:
- Clear and unequivocal improvement or harm in the study group is identified
- Research protocols have been irrevocably compromised
- Conclusion:
- CMDA endorses research using human subjects with proper consent if the studies are transparent in design and implementation, providing it is protective and non-exploitive. CMDA believes that human subject research, with the above conditions, respects God’s design of human beings made in His image." ("Position Statements: Human Research")[29]
Experimentation on Human Embryos
Official Statement: from Christian Medical & Dental Associations, "Position Statements: Fetal Tissue for Experimentation and Transplantation" (1989)
- "We affirm that human life warrants protection from the time of fertilization because it bears the image of God. Medical interventions that involve the unborn child should be permitted only with the intent of providing diagnostic information or fetal therapy, and only when the potential benefits clearly outweigh the potential risks to both child and mother.
- The use of fetal tissue for experimentation and transplantation introduces the opportunity for the gross abuse of human life, such as conception and abortion for the sole purpose of obtaining fetal tissue.
- Also, the use of fetal tissue from elective abortions could be interpreted as further justification for abortion.
- CMDA does not oppose the use of the tissues of spontaneously aborted, non-viable fetuses, with parental consent, for research or transplantation." ("Position Statements: Fetal Tissue for Experimentation and Transplantation")[30]
Fetal Tissue Research
Official Statement: from Christian Medical & Dental Associations, "Position Statements: Fetal Tissue for Experimentation and Transplantation" (1989)
- "We affirm that human life warrants protection from the time of fertilization because it bears the image of God. Medical interventions that involve the unborn child should be permitted only with the intent of providing diagnostic information or fetal therapy, and only when the potential benefits clearly outweigh the potential risks to both child and mother.
- The use of fetal tissue for experimentation and transplantation introduces the opportunity for the gross abuse of human life, such as conception and abortion for the sole purpose of obtaining fetal tissue.
- Also, the use of fetal tissue from elective abortions could be interpreted as further justification for abortion.
- CMDA does not oppose the use of the tissues of spontaneously aborted, non-viable fetuses, with parental consent, for research or transplantation." ("Position Statements: Fetal Tissue for Experimentation and Transplantation")[31]
End of Life
Official Statement: from Christian Medical & Dental Associations, "Position Statements: Advance Directives" (1994)
- "We believe that God is sovereign and is able to intervene in human affairs using natural or supernatural means. We also believe we are stewards of our bodies, our health and our resources, and therefore we are responsible to God for our lifestyle and healthcare choices.
- Advance directives are discussions or written statements which convey a person's wishes to his or her family and physician in the event that he or she becomes unable to discuss such matters. They may (1) explain the individual's values about health, life and death; (2) give directions to family and physician about treatment goals or the use or non-use of specific treatment modalities; or (3) designate a surrogate to make decisions on behalf of the individual.
- As Christian physicians and dentists, we believe that advance directives can be an important part of good stewardship. We should consider prayerfully having such discussions and completing written advance directives ourselves. We should encourage our patients to do the same.
- Prior to completing an advance directive, the Christian should consider prayerfully God's will for his or her life. Family, clergy and other Christian advisors may be of assistance to the believer who is uncertain about the application of biblical principles and Christian tradition to his or her particular situation. The believer should formulate his or her advance directive to assure that it clearly and accurately reflects his or her values and wishes.
- After completing an advance directive, the individual should discuss its content and meaning with his or her family, surrogate, and physician. Individuals should review their advance directives periodically to assure that they accurately reflect their current values and wishes.
- Clinicians should examine carefully the verbal and written wishes expressed by their patients. They should be willing to follow these wishes provided they do not conflict with the clinician's personal moral or religious values. If such a conflict exists, the clinician should discuss it with the patient and transfer care if the conflict cannot be resolved." ("Position Statements: Advance Directives")[32]
Artificial Hydration & Nutrition
Official Statement: from Christian Medical & Dental Associations, "Position Statements: Artificially-Administered Nutrition and Hydration" (2016)
- "A frequent ethical dilemma in contemporary medical practice is whether or not to employ artificial means to provide nutrition or hydration1 in certain clinical situations. Legal precedents on this question do not always resolve the ethical dilemma or accord with Christian ethics. CMDA offers the following ethical guidelines to assist Christians in these difficult and often emotionally laden decisions. The following domains must be considered:
- BIBLICAL
- 1. All human beings at every stage of life are made in God’s image, and their inherent dignity must be treated with respect (Genesis 1:25-26). This applies in three ways:
- All persons or their surrogates should be given the opportunity to make their own medical decisions in as informed a manner as possible. Their unique values must be considered before the medical team gives their recommendations.
- The intentional taking of human life is wrong (Genesis 9:5-6; Exodus 20:13).
- Christians specifically (Matthew 25:35-40; James 2:15-17), and healthcare professionals in general, have a special obligation to protect the vulnerable.
- 2. Offering oral food and fluids for all people capable of being safely nourished or comforted by them, and assisting when necessary, is a moral requirement (Matthew 25:31-45).
- 3. All people are responsible to God for the care of their bodies, and healthcare professionals are responsible to God for the care of their patients. As Christians we understand that our bodies fundamentally belong to God; they are not our own (1 Corinthians 6:20).
- 4. We are to treat all people as we would want to be treated ourselves (Luke 6:31).
- 5. Technology should not be used only to prolong the dying process when death is imminent. There is “a time to die” (Ecclesiastes 3:2).
- 6. Death for a believer will lead to an eternal future in God’s presence, where ultimate healing and fulfillment await (2 Corinthians 5:8; John 3:16, 6:40, 11:25-26, and 17:3).
- 7. Medical decisions must be made prayerfully and carefully. When faced with serious illness, patients may seek consultation with spiritual leaders, recognizing that God is the ultimate healer and source of wisdom (Exodus 15:26; James 1:5, 5:14).
- 8. Illness often provides a context in which the following biblical principles are in tension:
- God sovereignly uses the difficult experiences of life to accomplish his inscrutable purposes (Job; 1 Peter 4:19; Romans 8:28; 2 Corinthians 12:9).
- God desires his people to enjoy his gifts and to experience health and rest (Psalm 127:2; Matthew 11:28-29; Hebrews 4:11).
- MEDICAL
- 1. Loving patient care should aim to minimize discomfort at the end of life. Dying without ANH need not be painful and in some situations can promote comfort.
- Nutrition: In the active stages of dying, as the body systems begin to shut down, the alimentary tract deteriorates to where it cannot process food, and forced feeding can cause discomfort and bloating. As a person can typically live for weeks without food, absence of nutrition in the short term does not equate with causing death.
- Hydration: In the otherwise healthy patient with reversible dehydration, deprivation of fluids causes symptoms of discomfort that may include thirst, fatigue, headache, rapid heart rate, agitation, and confusion. By contrast, most natural deaths occur with some degree of dehydration, which serves a purpose in preventing the discomfort of fluid overload. As the heart becomes weaker, if not for progressive dehydration, fluid would back up in the lungs, causing respiratory distress, or elsewhere in the body, causing excessive swelling of the tissues. In the dying patient, dehydration causes discomfort only if the lips and tongue are allowed to dry.
- 2. Complications of ANH.
- Tube feedings may increase the risk of pneumonia from aspiration of stomach contents.
- Tube feedings and medications administered through the tube may cause diarrhea, increasing the possibility of developing skin breakdown or bedsores, and infections, especially in an already debilitated patient.
- Patients with feeding tubes will, not infrequently, either willfully or in a state of confusion, pull at the feeding tube, causing damage to the skin at the insertion site or dislodging the tube. Prevention of harm may require otherwise unnecessary physical restraints or sedating medications.
- The surgical procedure of inserting a percutaneous gastrostomy (feeding) tube can occasionally lead to bowel perforation or other serious complications.
- Complications of TPN include those associated with the central venous catheter, such as blood vessel perforation or collapsed lung; local or blood stream infection; and complications associated with the feeding itself, such as fluid overload, electrolyte disturbances, labile blood glucose, liver dysfunction, or gall bladder disease.
- 3. Disease context
- Cancer: End stage cancer often increases the metabolic requirements of the body beyond the nutrition attainable by oral means. When the cancer has progressed to this stage, the patient may experience considerable pain, and ANH may only prolong dying.
- Severe neurologic impairment: This frequently has an indeterminate prognosis rendering decision-making problematic. It requires a careful evaluation of the probability of improvement, the burdens and benefits of medical intervention, and a judgment of how much the patient can endure while awaiting the hoped-for improvement.
- Dementia: If a patient survives to the late stages of dementia, the ability to swallow food and fluids by mouth may be impaired or lost. ANH has been shown in rigorous scientific studies to improve neither comfort nor the length of life and may, in fact, shorten it (see Appendix).
- ETHICAL
- 1. There is no ethical distinction between withdrawing and withholding ANH. However, the psychological impact may be different if withdrawal or withholding is perceived to have been the cause of death.
- 2. If there is uncertainty about the wisdom of employing ANH, a time-limited trial may be considered.
- 3. Any medical intervention should be undertaken only after a careful assessment of the expected benefit vs. the potential burden.
- 4. The decision whether to implement or withdraw ANH is based on a consideration of medical circumstances, values, and expertise, and involves the patient or designated surrogate in partnership with the healthcare team.
- 5. It is best that all stakeholders strive for consensus.
- SOCIAL
- 1. Eating is a social function. Even for compromised patients unable to feed themselves, being fed by others provides some of the best opportunities they have for meaningful human contact and pleasure.
- 1. People suffering from advanced dementia frequently remain sentient and social.
- CMDA endorses ethical guidelines in four categories
- 1. Strong indications:
- Situations where the use of ANH is strongly indicated and it would be unethical for a medical team to decline to recommend it or deny its implementation. Examples of these situations would be:
- A patient with inability to take oral fluids and nutrition for anatomic or functional reasons with a high probability of reversing in a timely manner.
- A patient who is in a stable condition with a disease that is not deemed to be progressive or terminal and the patient or surrogate desires life prolongation (e.g., an individual born unable to swallow but who is otherwise viable, or the victim of trauma or cancer who has had curative surgery but cannot take oral feedings).
- A patient with a newly-diagnosed but not imminently fatal severe brain impairment in the absence of other life-threatening comorbidities.
- Gastrointestinal tract failure or the medical need for total bowel rest may justify the use of TPN in some contexts not otherwise terminal.
- An otherwise terminal patient who requests short term ANH, fully informed of the risk being taken, to allow him or her to experience an important life event.
- 2. Allowable indications:
- Situations where the use of ANH is morally neutral and the patient or surrogate should be encouraged to make the best decision possible after the medical team has provided as much education as necessary. Examples of these situations would be:
- A patient with severe, progressive neurologic impairment who otherwise desires that life be prolonged (e.g., end-stage amyotrophic lateral sclerosis).
- Conditions that would not be terminal if ANH were provided but, in the opinion of either the patient or surrogate, there is uncertainty whether the anticipated benefits versus burdens justify the intervention.
- 3. Not recommended but allowable:
- Situations where the use of ANH may not be recommended in all instances but, depending on the clinical context, would be morally licit, assuming the patient or surrogate has been informed of the benefits and potential complications and requests that it be initiated or continued. Examples of these situations would be:
- A patient who has a disease state, such as a major neurologic disability, where, after several months of support and observation, the prognosis for recovery of consciousness or communication remains poor or indeterminate. In cases where ANH is withdrawn or withheld, oral fluids should still be offered to the patient who expresses thirst.
- A patient whose surrogate requests overruling the patient’s advance directive and medical team’s recommendation against ANH because of the particular or changing clinical context.
- Placement of a PEG in a patient who is able but compromised in the ability to take oral feeding as a convenient substitute for the sometimes time-consuming process of oral feeding, for ease of medication administration, or to satisfy eligibility criteria for transfer from an acute care setting to an appropriate level of short-term nursing care, long-term care, or a rehabilitation facility. ANH decisions in such cases should consider the potential benefits versus risks and burdens of available feeding options, the capacity of caregivers to administer feedings, and prudent stewardship of medical and financial resources, always in regard to the best interest of the patient.
- 4. Unallowable indications:
- Situations where it is unethical to employ ANH. Examples of these situations would include:
- Using ANH in a patient against the patient’s or surrogate’s expressed wishes, either extemporaneously or as indicated in an advance directive and agreed to by the surrogate. There may be particular medical contexts in which a surrogate may overrule an advance directive that requests ANH on the basis of substituted judgment if the surrogate knows the patient would not want it in the present context.
- Compelling a medical professional to be involved in the insertion of a feeding tube or access for TPN in violation of his or her conscience. In this situation the requesting medical professional must be willing to transfer the care of the patient to another who will provide the service. (See CMDA statement on Healthcare Right of Conscience)
- Using ANH in a situation where it is biologically futile, as in a patient declared to be brain dead. An exception would be the brain dead pregnant patient in which the purpose of ANH is to preserve viable fetal life; ANH in this circumstance is not futile for the life in the womb.
- Using ANH in an attempt to delay the death of an imminently dying patient (except in the context in 1.e. above).
- CMDA recognizes that ANH is a controversial issue with indistinct moral boundaries. Disagreements should be handled in the spirit of Christian love, showing respect to all." ("Position Statements: Artificially-Administered Nutrition and Hydration")[33]
Definition of Death
Official Statement: from Christian Medical & Dental Associations, "Position Statements: Death" (2004)
- "Background
- The Bible speaks of both physical and spiritual death. Physical death is the irreversible cessation of bodily functions. Spiritual death is a lack of responsiveness to God as a result of mankind’s natural alienation from and hostility to God due to sin. Both physical death and spiritual death are the consequences of and penalty for sin. They are the universal lot of all mankind because all have sinned.
Because of Christ Jesus’ atoning sacrificial death on the cross and subsequent resurrection, and through the indwelling of the Holy Spirit, believers have been given new spiritual life. All believers still experience physical death.
- Definition
- God created human beings as ensouled bodies (or embodied souls). Together the physical and spiritual aspects of human beings bear the single image of God and constitute the single essential nature of human life. Human physical death can be defined as fundamentally a biological phenomenon whereby the human organism as a whole ceases to function.
- The Bible clearly demarcates physical life and death; death is not a process, nor is there a transitional physical state between life and death. Death can therefore be defined as the point in time when the critical functions of the organism as a whole permanently and irreversibly cease. These critical functions include all of the following: 1) The vital functions of spontaneous breathing and autonomic control of the circulation; 2) the integrating functions that assure homeostasis of the organism; 3) the neurological function of consciousness. Death should not be defined in terms of a “loss of personhood” or by appeal to the loss of “higher functions” of the organism, such as loss of self-awareness, rationality, self-control, or social interaction.
- Criterion
- Based on the above definition of death, the necessary and sufficient criterion of death is the irreversible cessation of all clinical functions of the entire brain (whole-brain concept). Although both a higher brain (cortical) and brain stem criteria are necessary for death, neither alone is sufficient for death.
- Patients in permanent vegetative state or irreversible coma, and anencephalic infants do not meet the necessary criterion for this definition of death and are therefore to be considered and treated as living human beings.
- Testing
- Tests of the above criterion will be dependent on the current state of medical knowledge and technology. These tests should be valid and reliable, accurately determining death by neurologic criteria, and should have an extremely low incidence of false-positive results (high specificity). Tests should be readily applicable at the bedside, focusing on neurological examination: apnea, profound coma and unresponsiveness, and the absence of brain stem function in the absence of reversible causes or pathology. In some situations, additional tests may be indicated.
- The traditional bedside tests of death, which include examination for the presence or absence of breathing, responsiveness and pupillary reaction to light, are all measurements of brain function. Heartbeat is an indirect measurement since heartbeat stops shortly after the cessation of breathing. The whole-brain definition and criterion of death is consistent with both the traditional concept of death and the Biblical definition of physical death.
- Respect
- The bodies of the dead return to the “dust of the ground” and yet are destined to be resurrected. Because the bodies of all men and women have once displayed the image of God, however marred by sin, they deserve to be treated with loving care, dignity, decorum and respect. Post-mortem procedures such as dissection (except in the case of legally sanctioned autopsies), organ retrieval, and medical procedures should not be done without respecting the wishes and views of the patient (as in an advance directive), family or guardians." ("Position Statements: Death")[34]
Physician-Assisted Suicide/Euthanasia
Official Statement: from Christian Medical & Dental Associations, "Position Statements: Euthanasia" (1988)
- "We, as Christian physicians and dentists, believe that human life is a gift from God and is sacred because it bears His image.
- The role of the physician is to affirm human life, relieve suffering, and give compassionate, competent care as long as the patient lives. The physician as well as the patient will be held accountable by God, the giver and taker of life.
- We oppose active intervention with the intent to produce death for the relief of suffering, economic considerations or convenience of patient, family, or society.
- We do not oppose withdrawal or failure to institute artificial means of life support in patients who are clearly and irreversibly deteriorating, in whom death appears imminent beyond reasonable hope of recovery.
- The physician's decisions regarding the life and death of a human being should be made with careful consideration of the wishes and beliefs of the patient or his/her advocates (including the family, the church, and the community). The Christian physician, above all, should be obedient to biblical teaching and sensitive to the counsel of the Christian community. We recognize the right and responsibility of all physicians to refuse to participate in modes of care that violate their moral beliefs or conscience.
- While rejecting euthanasia, we encourage the development and use of alternatives to relieve suffering, provide human companionship, and give opportunity for spiritual support and counseling." ("Position Statements: Euthanasia")[35]
Official Statement: from Christian Medical & Dental Associations, "Position Statements: Physician-Assisted Suicide" (1992)
- "We, as Christian physicians and dentists, believe that human life is a gift from God and is sacred because it bears God's image. Human life has worth because Christ died to redeem it, and it has meaning because God has an eternal purpose for it.
- We oppose active intervention with the intent to produce death for the relief of pain, suffering, or economic considerations, or for the convenience of patient, family, or society.
- Proponents of physician-assisted suicide argue from the perspective of compassion and radical individual autonomy. There are persuasive counter arguments based on the traditional norms of the medical professions and the adverse consequences of such a public policy. Even more important than these secular arguments is the biblical view that the sovereignty of God places a limit on human autonomy.
- In order to affirm the dignity of human life, we advocate the development and use of alternatives to relieve pain and suffering, provide human companionship, and give opportunity for spiritual support and counseling.
- The Christian Medical & Dental Associations oppose physician-assisted suicide in any form." ("Position Statements: Physician-Assisted Suicide")[36]
Withholding & Withdrawing Treatment
Official Statement: from Christian Medical & Dental Associations, "Position Statements: Euthanasia" (1988)
- "We do not oppose withdrawal or failure to institute artificial means of life support in patients who are clearly and irreversibly deteriorating, in whom death appears imminent beyond reasonable hope of recovery." ("Position Statements: Euthanasia")[37]
Official Statement: from Christian Medical & Dental Associations, "Position Statements: Medical Futility" (1994)
- "As Christian physicians and dentists, we recognize the limitations of our art and science. We realize that not all medical interventions will offer a reasonable expectation of recovery or achieve the therapeutic goals agreed upon by the physician and the patient or the patient's surrogate.
- We believe that it is our duty to acknowledge the limits of medicine to our patients and their families.
- We believe that clinicians should present the range of therapeutic options to their patients and recommend against therapy that does not offer a realistic expectation of benefit. To do otherwise engenders false hope in our human abilities and represents poor stewardship of medical resources.
- However, the term medical futility should not be used when the real issue is one of cost, convenience, or distribution of medical resources. The determination of medical futility should not be made without the Christian physician realizing the heavy responsibility of no longer being able to prolong the life that God has created.
- Because the physician-patient relationship is at heart a covenant, clinicians should work with their patients to reach treatment decisions that are mutually acceptable. They should not terminate treatment unilaterally on the basis of medical futility. However, they are not obligated to provide treatment that is contrary to their clinical judgment or moral beliefs. If a conflict cannot be resolved by further discussion or consultation, transfer of care is appropriate.
- When transfer of care is not possible and the requested treatment is outside accepted medical practice, the clinician may be justified in withholding or withdrawing the treatment. In all situations, the clinician should serve as a healing presence of love, care and compassion. Our personal commitment to patients and their families is never futile." ("Position Statements: Medical Futility")[38]
Official Statement: from Christian Medical & Dental Associations, "Position Statements: Patient Refusal of Therapy" (1994)
- "As Christians, we believe that human life is a gift from God and that all individuals are accountable before God for their lives. This accountability includes decisions to accept or refuse therapy.
- As Christian physicians and dentists, we will assist patients, families and clergy in making decisions within the framework of patients' values and beliefs. A patient may refuse therapy that violates his or her moral values or religious beliefs. However, the right to refuse therapy is limited by the harm it may cause to innocent third parties.
- For the Christian, to be absent from the body is to be with the Lord. Physical death need not be resisted at all costs. In certain circumstances, medical treatment only prolongs pain and suffering and postpones the moment of death. It may then be appropriate for a patient with decision-making capacity to refuse medical interventions.
- The patient's decision should be made after thoughtful consideration of his or her responsibilities to God, family, and others. When the patient refuses life-prolonging therapy, we will respect that choice and compassionately support his or her medical, social and spiritual needs." ("Position Statements: Patient Refusal of Therapy")[39]
Issues of Human Dignity & Discrimination
Disability Ethics
Official Statement: from Christian Medical & Dental Associations, "Position Statements: Disabled Persons" (1993)
- "We hold all human life to be sacred as created in God's image. This includes persons who might be regarded as disabled or handicapped. The importance of a person does not reside in the functioning of the body or mind or in the person's ability to contribute to society, but rather in his or her intrinsic value as God's creation.
- We believe the Bible teaches our mutual interdependence. All people, including disabled persons, are responsible to realize their potential insofar as possible. The family holds the primary responsibility for the additional support needed by the disabled person. The family's resources should be supplemented by those of the church and community.
- The role of the physician and dentist is to provide appropriate medical care as needed. In all cases, our response should be characterized by an attitude of compassion, free of condescension and marked by action. In the case of extreme disabilities, legitimate questions may be raised regarding the appropriateness of various levels of treatment.
- Having accepted our own spiritual disability and God's forgiveness, we desire to honor, assist, and bring healing to the physically, mentally, and spiritually disabled in our community." ("Position Statements: Disabled Persons")[40]
Eugenics
Official Statement: from Christian Medical & Dental Associations, "Position Statements: Eugenics and Enhancement" (2006)
- "Eugenics has historically been the effort to improve the inheritable qualities of a race or species. Traditionally eugenics has been practiced through the use of selective breeding, but it is now moving toward direct manipulation of the genome. Advances in molecular genetics that make this possible are also leading to a resurgence of the eugenics movement. This is emerging as the science of directly treating or eliminating undesirable in-heritable characteristics and as the quest for individual human enhancement.
- History
- The word, eugenics, was coined in 1883 by Charles Darwin’s cousin, Francis Galton, a biologist who used statistical correlations to study the inheritance of intelligence. The term was built out of the Greek Eu (good) and Genics (in birth).
- Eugenics has a sordid history. During the late 19th and early 20th centuries in America, and especially in Nazi Germany, eugenics promoted the practice of eliminating human life and races judged to be “inferior.” While eugenics may initially appear attractive, it has by its very nature always led to morally repugnant consequences involving broad facets of society. Therefore, we are concerned that the modern practices of eugenics will repeat history. The increased power of modern technology demands increased vigilance.
- Goals
- CMDA affirms the primary goals of medicine – the treatment and prevention of disease and the reduction of suffering, whenever possible, by legitimate and moral means.
- CMDA supports the effort to understand our genetic code for purposes of increasing knowledge, treating disease, and bettering the human condition.
- CMDA opposes the use of any genetic manipulation that has an unacceptable risk of harm to any human being.
- Screening
- Mapping the human genome has been a significant aid in the identification and possible treatment of genetically determined diseases. Like all powerful information it can be used for good or for ill.
- CMDA endorses ethical efforts to increase the scope and accuracy of science used to identify, understand, and treat human genetic diseases.
- It should not be mandatory that persons be genetically screened, be made to know their own genetic information, or be required to act upon that knowledge.
- "In this context, no person’s genetic information should be used against him or her.
- Determinism
- We oppose the concept of genetic determinism, that we are our genome or that genes are destiny. Humanity’s prospects for the future will be enormously impoverished if its outlook is limited to its own perceived genetics.
- Morals
- The application of genetic knowledge for eugenic agendas is unequivocally problematic.
- The goals of modern genetics must be sought within the limits of moral boundaries and qualifications. Medicine, and therefore genetics, must be practiced according to principles of ethical behavior delineated by conscience under the authority of Scripture.
- When an undesired trait or gender is identified by pre-implantation or prenatal screening the discovery is often followed by destruction of the human life exhibiting the undesired trait. CMDA opposes destruction of human life for eugenic purposes. This includes the destruction of embryos, abortion, infanticide and genocide.
- Genetic Intolerance
- Society, while advocating tolerance, has become increasingly intolerant of any “defective” human life. Our society exerts increasing pressure on parents to neither accept nor bring to birth a child perceived as defective. This intolerance violates the sanctity of human life.
- We must not deem inferior anyone with a “defective” genetic heritage. We recognize that all persons, no matter how normal in appearance, carry defective genetic information within their genome, and that all human physical life is defective to some degree and with certainty becomes more so with aging.
- There are no superior or inferior racial groups. Any efforts to create or eliminate perceived superior or inferior individuals are to be condemned. Similarly, there is no superior or inferior gender. There are no “lives unworthy of life.”
- Continued improvements in genetic diagnosis sharpen the dichotomy between those who “have” a good genetic endowment and those who “have not.” With the possible advent of genetic enhancement this dichotomy will increase.
- Far more serious and damaging than our genetic deficiencies are our moral deficiencies. Intolerance of those deemed genetically inferior is an example of this moral deficiency.
- Safety
- Although the use of somatic and germ cell genetic therapy has the potential to correct genetically determined disease, there are significant concerns regarding the safety of genetic therapy, particularly germ line therapy.
- Somatic cell therapy: If critical concerns regarding the safety of somatic cell therapy can be resolved, the use of somatic cell therapy may be acceptable for correcting genetically determined diseases.
- Germ cell therapy: CMDA believes that germ cell genetic therapy is unacceptable - at least until safety issues are resolved. The use of germ cell therapy is more problematic due to the transmission of any changes to future generations. Safety issues are magnified in this instance since changes not only affect the patient but future descendants. Even if safety issues are resolved, germ cell therapy still raises significant moral issues, e.g., the impossibility of obtaining consent from those yet to be born.
- Genetic Enhancement
- The practice of genetic alteration evokes deeper concerns on a more fundamental level. The prospect of using genetic technology to enhance human characteristics is now a theoretical possibility. CMDA recognizes that the distinctions between treatment and enhancement are difficult to discern and are arbitrary in many cases. As Christians, we hold that all humans are made in the image of God. This essential characteristic distinguishes us as human. The goal to recreate man in man’s image raises profound questions about human nature and man’s relationship with his Creator. The ultimate end of man is to glorify God; the re-creation of man to glorify himself is idolatry.
- Conclusion
- CMDA considers genetic research and therapy to potentially be of great benefit to humanity. We endorse the effort to make progress in this field. We diminish our own prospects both individually and communally if we refuse to work for scientific advancement. However, we must build moral safeguards around our technology. We must accept, learn from, and care for those who are vulnerable and suffering." ("Position Statements: Eugenics and Enhancement")[41]
Notes
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