Christian Medical & Dental Associations

Official website: https://www.cmda.org/

Beginning of Life

Official Statement:

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

1. 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.

2. 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.

3. A human embryo is not a potential human being, but a human being with potential.

Biological basis for the beginning of human life

1. 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.

2. 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

1. 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.

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

1. 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.

2. 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

1. 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.

2. 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.

3. 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.

4. 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.

5. 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.

Official Statement:

Defining Ethically Relevant Terms

SUMMARY

Scientifically CMDA understands that human life begins at fertilization (See CMDA Statement: The Beginning of Human Life). The Bible states that human life begins at the absolute “beginning or inception” using the term “conception.” Because the term “conception” has been variously (re)defined in the current scientific, medical, and bioethics literature. Christian’s may become confused over the Church’s creedal, doctrinal, biblical, liturgical, traditional, and cultural language of, “Life begins at/with conception.” CMDA affirms that it is appropriate to maintain the traditional biblical and creedal language of the Church without accommodation, remaining biologically precise and accurate, with the understanding that “conception” refers to the absolute “beginning or inception” of life, which is determined scientifically and upheld by CMDA to be fertilization.

ARGUMENT

Questions of morality and ethics are frequently questions of language and definition. The terms “conception” and “fertilization” are central and critical terms in any definition of the beginning of life. In traditional ways of speaking conception was assumed to be synonymous with fertilization and, as used in traditional orthodox Christian language, marked the very beginning of individual human life. This is no longer the case. Presently these terms are being used in different ways by different organizations for the purpose of promoting certain ethical agendas. In particular, the previously univocal term “conception” is now open to multiple definitions and interpretations. For instance, the American College of Obstetrics and Gynecology has now (re)defined conception as “implantation.” The scientific and medical literature no longer defines conception in a manner consistent with Biblical and traditional use of this term in reference to the beginning of human life. The current CMDA Position Statement on The Beginning of Human Life correctly and precisely defines the biological beginning of individual human life as fertilization. Recognizing that a multiplicity of competing definitions may generate some confusion, there nonetheless remain good reasons for the Christian community to retain the language, “Life begins at/with conception” (understanding that the use of the term “conception” means “beginning” which is at the point of “fertilization”).

TRADITIONAL LANGUAGE OF THE CHRISTIAN CHURCH

The traditional language of Conservative and Evangelical Protestants, Orthodox, and Roman Catholic believers has always been, “Life begins at/with conception” (Cf. Euangelium Vitae). This has traditionally meant “beginning” and was assumed to be at the moment of fertilization.

CREEDAL LANGUAGE OF THE CHRISTIAN CHURCH

The strongest argument in the CMDA Statement on The Beginning of Life, and for any Christian, is the incarnation (Isa 7:14; Mat 1:20; Luk 1:31). The foundational language for this doctrine is that of the historic ecumenical Christian creeds, primarily the received text of the Apostolic Creed in which the term “conceived by the Holy Spirit (Ghost)” is used throughout in all English translations to designate the inception, or beginning, of the incarnation of our Lord and Savior Jesus Christ. The use of the term “conceived” in these passages is not to be confused with current scientific and medical definitions but is to be understood as referring to the absolute “beginning or inception” which is scientifically defined as fertilization.

BIBLICAL LANGUAGE

In all predominant English translations of the Bible (KJV, NKJV, RSV, NRSV, NAS, NIV, NAB) the terms “conception” and “conceived” are employed to translate Hebrew and Greek words that have the specific connotation of “beginning of life” or the “inception of life.” “Conception” or “conceived” are used to translate the Hebrew hrh (“harah”) and either the Greek gennaw (“gennao” in Mat 1:20, which can mean “conceive,” “beget,” “to father,” but unambiguously “to conceive” in this context; Cf. also John 8:41; 9:34 and the translation in BGD: “you were altogether conceived in sin”) or sullamba,nw (“syllambano” Gen 4:1; 30:7 in LXX, and Luke 1:24, 31, 36; figuratively in Jas 1:15, which can mean “to seize,” as with child, or “conceive”). Harah is used in Gen 4:1; 16:4,5; 19:36; 25:21; 30:7; 38:18, etc. (and see especially Isa 7:14; LXX: gastri. e[xei, “conceive” or “become pregnant” ) and its semantic domain is consistent with the traditional use of the term “conception” meaning “to beget,” “to become the parent of,” “to cause something to come into existence,” “to conceive.” It’s also important to appreciate this term’s use within the redemptive-historical language of YHWH’s “conception” of a people before “giving birth” to them in actual history (Cf. Num 11:12). In particular, Hos 9:11 implies that conception (!Ayr'h “herayon” a unique, single, one-time event, not a process or state of being; the inception of pregnancy; result of sexual intercourse, etc.) is to be distinguished from and precedes the state of being pregnant (!j,B,ÞmiW “yum-baten” “from,” “of,” or “on account of the womb”; “state of being pregnant”) or of giving birth (dl;y" “yalad” “bear, bring forth, beget”; “to birth”).

On the other hand, Psalm 5:7 uses the terms lyx (“chul” “writhe in pain” or “birth pains associated with labor and giving birth”) and ~xy (“yacham” “conceive,” used only in this instance in the Bible with respect to human conception or becoming pregnant by an act of sexual intercourse, otherwise used in respect to animals in heat). “Three words are used in relation to the birth process: harah “conceive,” yalad “bear, give birth” and chul “to labor in giving birth.” Another word for conceive is yacham, used more, however, of animals in heat (but cf. Ps 51:7). The first describes the inception and the latter two the termination of the process.”

Recognizing that these Hebrew and Greek terms were not used in the context of a modern biological understanding of human reproduction, the term “conceive” (or “conception”) is consistently used to translate those Hebrew and Greek terms that have the specific connotation of “the very earliest beginning,” “inception,” or “the very bringing into existence.” Consequently, “conception” and its cognates, as they are understood in the context of these passages, refer to the biological point of fertilization.

Abortion

Official Statement:

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.

Official Statement:

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

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Contraception

Official Statement:

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Infertility & Reproduction

Reproductive Technology

Official Statement:

As Christians, reflection on assisted reproductive technologies (ART) must begin with recognition that each individual, beginning at fertilization, is a unique creation with special worth to God.

Additionally, marriage and the family are the basic social units designed by God. Marriage is a man and a woman making an exclusive commitment for love, companionship, intimacy, spiritual union, and, in most cases, procreation.[1] Children are a gift and responsibility from God to the family. Parents are entrusted with providing and modeling love, nurture, protection and spiritual training.

In addition to natural conception and birth, married couples may choose adoption or seek assisted reproductive technology, especially when they are unable to have children naturally. Adoption emulates God's adoption of us as spiritual children. Many assisted reproductive technologies may be an appropriate expression of mankind's God-given creativity and stewardship. A husband and wife who suffer from infertility should pray together for God's wisdom (James 1:5). They should be encouraged to seek godly counsel and guidance when considering these technologies.

However, while we are sensitive to the heartbreak of infertility, certain assisted reproductive technologies present direct and indirect dangers to sanctity of human life and the family. As technology permits further divergence from normal physiologic reproduction, it can lead to perplexing moral dilemmas. Not every technological procedure is morally justified and some technologies may be justified only in certain circumstances. The moral and medical complexities of assisted reproductive technologies require full disclosure both of the medical options available and their ethical implications.

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.

Conclusion

CMDA affirms the need for continued moral scrutiny of developing reproductive technology. We recognize that as physicians we must use our technological capacity within the limits of God's design.

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Frozen Oocytes

Official Statement:

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Healthcare & Medicine

Access to Healthcare

Official Statement:

As Christian physicians and dentists we recognize that increasing treatment capabilities and increasing treatment costs, as well as societal priorities for the allocation of dollars, make it difficult to provide all people with all services which they might need (or perceive they need). Therefore, as individual practitioners, as a profession and as a society, we are often faced with difficult allocation decisions.

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.

International Concerns

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.

Public Policy Concerns

Society must evaluate its total resources and be certain that adequate dollars are made available for the health care needs of its people.(see Standards for Life**) 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.

Professional Practice Concerns

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.

Official Statement:

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.

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Conscience Issues

Official Statement:

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.

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Medical Tourism

Official Statement:

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Organ Donation & Transplantation

Official Statement:

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Privacy of Healthcare Information

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Science & Technology

Biotechnology

Animal-Human Hybrids & Chimeras

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Human Cloning

Official Position:

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Stem Cell Research

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Emerging Technologies

Ethical Use of Technology

Official Statement:

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Genetic Ethics

Gender Selection

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Gene Therapy/Genetic Engineering

Official Statement:

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.

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Genetic Screening

Official Statement:

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.

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Genetic Testing

Official Statement:

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.

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Patenting of Human Tissue/Gene Patenting

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Human Enhancement

Official Statement:

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 disting-uishes 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.

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Cyborgs

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Transhumanism/Posthumanism

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Human Research Ethics

Official Statement:

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.

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Experimentation on Human Embryos

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End of Life

Artificial Hydration & Nutrition

Official Statements:

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.

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Definition of Death

Official Statements:

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.

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Extraordinary Measures

Official Statements:

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Physician-Assisted Suicide/Euthanasia

Official Statement:

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Withholding & Withdrawing Treatment

Official Statement:

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.

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Issues of Human Dignity & Discrimination

Disability Ethics

Official Statement:

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.

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Eugenics

Official Statements:

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 move-ment. 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.

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