Position & Public Policy Statements

CMDA Transparent Background 2

Ethics statements deal with ethical issues. They are drafted by the Ethics Committee of the Board and the final version has to be approved first by the Board of Trustees and then by the House of Representatives representing the CMDA membership. These statements can be based on biblical, scientific, moral and social principles. They are not binding on CMDA members but are the official policies of CMDA and are represented to the media, church and government authorities.

Policy statements primarily deal with either public policy or scientific issues though those issues may have ethical implications. They are drafted by a policy ad-hoc committee of experts appointed by the President of CMDA. The board has the final authority to approve policy statements, which also become the official policies of the organization.

Complete this Form for Full Access to All Position & Public Policy Statements

Individual Position Statement Abstracts:

Abortion

ABSTRACT:

We oppose the practice of abortion and urge the active development and employment of alternatives.

  1. 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.
  2. 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.
  3. 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.

Approved by the House of Delegates
Passed with 59 approvals, 3 opposed, 1 abstention
May 4, 1985, San Diego, California

Revised by the House of Representatives
Passed with 52 approvals and 1 abstention
May 2, 2013, Ridgecrest, North Carolina

Abuse of Human Life

ABSTRACT:

Abuse of human life assaults the dignity of a person as a bearer of the image of God. Human abuse is an offense against God. Abuse may be physical, psychological, or emotional. Furthermore, there is a spiritual dimension to abuse. The resulting harm may be permanent, reparable, or only partially reparable. While not all harm is the result of abuse, abuse results in harm.

Abuse arises from pride, greed, lust, hatred, ignorance, or indifference. Abuse may be intentional or unintentional; it may result from inappropriate acts of commission or omission.*

General conditions of human abuse may be directed against people in many ways. For example:

  • Persecution or genocide of people sharing a common ethnic, political, racial or religious identity.
  • Misallocation or maldistribution of resources causing inadequate relief, starvation, or death.
  • Human trafficking for purposes of servitude or sexual exploitation, such as prostitution, predation, and pornography.
  • Coerced bodily mutilation, e.g. female circumcision, dismemberment.
  • Unjust treatment of prisoners.
  • Coerced retrieval of gametes, organs, or embryos.
  • Child abuse, spousal abuse, elder abuse and other forms of relational abuse.

Individual health care professionals engaged in the care of a person who is in an abusive situation have substantial attendant responsibilities in addition to providing appropriate medical care. They should affirm the victim’s worth as a person loved by God. Insofar as possible, they should assist in the reparation of the abusive situation, in the removal of the individual from the situation if there is threat of imminent harm, and in the rehabilitation of the abused individual. This almost always will involve reporting to authorities so that the perpetrator can be dealt with appropriately.

CMDA condemns human abuse. Abuse harms not only the victims but also degrades all humanity. As Christians, we recognize that evil is part of the human condition. We are thankful that God is able to redeem the results of evil to accomplish his glory. He often uses the health care professional in that process.

*Acts of omission may be acts of neglect. Not all acts of neglect rise to the level of abuse.

Approved by the House of Representatives
Passed Unanimously
June 22, 2007, Orlando, Florida

Advance Directives

ABSTRACT:

Whereas modern medicine has made available technologies that can prolong life, medical science alone cannot answer questions of whether life-sustaining technologies should be used in particular circumstances or whether such technologies are consistent with patients’ goals of care, values, and beliefs about health, life, and death. Therefore, patients should have the opportunity, while they have capacity, to indicate their desires about the use or nonuse of specific treatment modalities and to designate a surrogate (sometimes called healthcare proxy or agent) to make decisions on their behalf if they become incapacitated.

Definitions:

  1. Advance Care Planning: the ongoing process whereby the patient, in conversation with family and healthcare professionals, receives information about the types of life-sustaining treatments that are available, shares personal values, and makes decisions about medical care the patient would want to receive if no longer able to speak for himself or herself. Advance care planning may lead to completing a written advance directive.
  2. Advance Directive (or Advance Medical Directive): a patient’s medical directive, which may be a discussion, a written statement, or an audio or video recording, specifying what medical actions should be taken for the patient if, because of incapacity, the patient is no longer able to make decisions for himself or herself. An advance directive is a legal document. An advance directive has inherent limitations; as a static document, it may not anticipate all developing clinical scenarios as medical circumstances change, and it may not reflect the nuances of a patient’s preferences or choices in every potential context. Types of advance directives include:
    • Durable Power of Attorney for Health Care: a legal document that authorizes someone the patient trusts to be a surrogate decision-maker, that is, to make medical decisions on behalf of the patient in the event that the patient becomes incapacitated.
    • Living will: a written statement detailing a person’s desires regarding his or her medical treatment in circumstances in which he or she is no longer able to express informed consent, especially an advance directive.
    • AND (Allow Natural Death): a positive medical term defining the use of life-extending measures that emphasize comfort rather than life extension.
    • DNR (Do Not Resuscitate): a physician’s order, placed with the patient’s or surrogate’s consent, directing the withholding of cardiopulmonary resuscitation (CPR) and advanced cardiac life support (ACLS) in the event of cardiac or circulatory arrest. DNR means that electrical therapy, chest compressions, external cardiac pacing, or any medication intended to reverse cardiac arrest will not be provided to an unresponsive pulseless patient.
    • DNI (Do Not Intubate): a physician’s order, placed with the patient’s or surrogate’s consent, specifying the withholding of endotracheal intubation and ventilatory support during cardiac arrest or non-arrest circumstances.
    • POLST (Physician Orders for Life-Sustaining Treatment): actionable physician orders, signed also by the patient or surrogate, that support other forms of advance directives and are transferrable (implementable) across healthcare settings and the home. These vary in terminology and application from state to state, including signature by APRN or PA rather than physicians only, some examples being:
      • POST (Physician Orders for Scope of Treatment)
      • MOST (Medical Orders for Scope of Treatment)
      • MOLST (Medical Orders for Life-Sustaining Treatment)
      • DNR/COLST (Do Not Resuscitate Order / Clinician Orders for Life-Sustaining Treatment)
      • TPOPP (Transportable Physician Orders for Patient Preferences)
    • VSED (Voluntarily Stopping Eating and Drinking): the decision of a patient who has decisional capacity to stop eating and drinking by mouth for the purpose of hastening death in the setting of unrelieved suffering. It may include a directive not to be hospitalized.
AIDS

ABSTRACT:

Acquired immunodeficiency syndrome (AIDS) caused by the human immunodeficiency virus (HIV) is a growing epidemic that may surpass the ravages of any plague in human history. We extend compassion to all who have acquired this disease by whatever means. We urge the provision of medical care for them to the same degree that patients with other life-threatening diseases receive it.

Christian physicians and dentists, following the example of Christ, should care for HIV-infected persons even at the risk of their own lives.

We encourage all health care workers to do the same. In keeping with its historical precedents (e.g., the establishment of hospitals and orphanages), we urge the Church to become involved with the development of new health care ministries to provide compassionate care for persons with AIDS. They need the hope and peace that only the Gospel of Jesus Christ can give them.

We call for public health policies that balance patient confidentiality with protection of the uninfected. We urge screening of high-risk groups and sexual contact tracing of persons who are HIV-positive for both treatment and prevention of further transmission of infection. We encourage all health care workers to take reasonable precautions in caring for all patients.

Failure to inform one's sexual partner or any other person who may be exposed that one is HIV-positive is morally reprehensible, as is discrimination against an identified HIV-positive person. We believe that the interests of the uninfected have priority over the autonomy and confidentiality of patients who are HIV-positive and persist in high risk behavior. Physicians, dentists, and public health officials have a duty to warn in such life-threatening situations.

CMDA reaffirms the sanctity of marriage and deplores non-marital sexual intercourse, homosexual practices, and IV drug use, which account for the vast majority of AIDS cases. Family life teaching and sexual education are God-given responsibilities of parents. The Church's task is to assist both parents and youth in understanding their sexuality in the context of biblical values. Sexual education in these and all other settings should include risk behavior information and instruction on protective techniques to inhibit the spread of AIDS and all other sexually transmitted diseases. Education and protective techniques alone, however, will not stop the spread of AIDS.

Our society needs to understand and acknowledge that there are compelling emotional, philosophical, medical, sociological and historical reasons for practicing abstinence before marriage and for fidelity within marriage. Since God has designed sexual intercourse for monogamous heterosexual marriage alone, and since this form of sexual practice will ultimately help to solve this problem, the Christian Medical & Dental Associations call our world to affirm biblical sexual morals.

Approved by the CMDA House of Delegates
Passed unanimously
April 29, 1988. Seattle, Washington.

Allocation of Medical Resources

ABSTRACT:

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.

Alternative/Complimentary Therapy

ABSTRACT:

Alternative/complementary therapies have gained national prominence. We recognize the growing use of and request for these modalities by our patients. While some have been shown to be beneficial in certain clinical situations, we as Christian physicians and dentists have scientific, moral, and spiritual concerns about some of these therapies.

  • Some of these therapies raise concerns because they are not based on sound scientific principles and/or may not have been tested adequately for safety and efficacy.
  • Some of these therapies raise moral concerns because they may result in a harmful delay of diagnosis or treatment and may waste the limited resources available for medical care.* In the extreme, some therapies are outright fraud and quackery and are therefore morally reprehensible.
  • Some of these therapies raise spiritual concerns. Any therapy based on principles contrary to the teaching of Scripture is spiritually dangerous and should be condemned.

We recognize that general wide-sweeping statements regarding the appropriate use of alternative medicine are difficult. Each therapy should be investigated thoroughly with careful attention to the scientific evidence, moral implications, and spiritual beliefs underlying them. ** ***

* See statement on “Allocation of Medical Resources” in Standards for Life from the Christian Medical & Dental Associations.

** See Basic Questions on Alternative Medicine: What is Good and What is Not?, GP Stewart, WR Cutrer, TJ Demy, et al, (Grand Rapids: Kregel Publications, 1998). This booklet was the primary resource for the substance of this statement.

*** For more information and a comprehensive look at various therapies, reference Alternative Medicine: The Christian Handbook, Donal O’Mathuna, Ph.D., and Walt Larimore, M.D., (Zondervan, Grand Rapids, Michigan, 2001)

Passed by the House of Delegates
Passed unanimously.
June 13,2001. San Antonio, Texas

Anti-Progestational Agents (RU-486)

ABSTRACT:

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.

Approved by the CMDA House of Delegates.
Passed unanimously
May 3, 1991. Chicago, Illinois.

Artificially-Administered Nutrition and Hydration

ABSTRACT:

A frequent ethical dilemma in contemporary medical practice is whether or not to employ artificial means to provide nutrition or hydration[1] 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).
Assisted Reproductive Technology

ABSTRACT:

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.
Baby Doe

ABSTRACT:

This resolution was adopted following the decision of the Indiana Supreme Court in the case of a Down's Syndrome neonate in Bloomington, Indiana:

RESOLVED that the Christian Medical Society strongly opposes the decision allowing for the death of "Baby Doe" and urges that this Court decision not be seen as either legal or moral precedent for the future. The right of privacy does not allow for parents to decide the death of such infants.

Approved by the CMDA House of Delegates.
Passed with a vote of 41 for and 12 opposed.
May 7, 1982. Dallas, Texas.

Beginning of Human Life

ABSTRACT:

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.
Beginning of Human Life: Addendum I: Conception and Fertilization

ABSTRACT:

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”).

Biblical Model for Medical Ethics

ABSTRACT:

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.

Approved by the CMDA House of Delegates
Passed with a vote of 63 for, 3 opposed, 1 abstention
May 3, 1991. Chicago, Illinois.

Christian Dentist's Oath

ABSTRACT:

With gratitude to God, faith in Christ Jesus, and dependence on the Holy Spirit, I publicly profess my intent to practice dentistry according to the highest Biblical and professional standards for the glory of God.

With humility, I will seek to increase my skills, and I will respect those who teach me and who broaden my knowledge. In turn, I will freely impart my knowledge and wisdom to others.

With God's help, I will love those who come to me for healing and comfort. I will honor and care for each patient as a person made in the image of God, striving to put aside selfish interests.

With God's guidance, I will endeavor to be a good steward of my skills and of society's resources. I will convey God's love in my relationships with family, friends, and community. I will aspire to reflect God's loving kindness in caring for those in need.

With God's grace, I will live according to this profession.

Approved by the CMDA House of Delegates
May 3, 1991. Chicago, Illinois.

Revised and approved by the CMDA House of Delegates
June 11, 2003. Schroon Lake, New York.

Christian Physician's Oath

ABSTRACT:

With gratitude to God, faith in Christ Jesus, and dependence on the Holy Spirit, I publicly profess my intent to practice medicine for the glory of God.

With humility, I will seek to increase my skills. I will respect those who teach me and who broaden my knowledge. In turn, I will freely impart my knowledge and wisdom to others.

With God's help, I will love those who come to me for healing and comfort. I will honor and care for each patient as a person made in the image of God, putting aside selfish interests, remaining pure and chaste at all times.

With God's guidance, I will endeavor to be a good steward of my skills and of society's resources. I will convey God's love in my relationships with family, friends, and community. I will aspire to reflect God's mercy in caring for the lonely, the poor, the suffering, and the dying.

With God’s direction, I will respect the sanctity of human life. I will care for all my patients, rejecting those interventions that either intentionally destroy or actively end human life, including the unborn, the weak and vulnerable, and the terminally ill.

With God's grace, I will live according to this profession.

Passed by the CMDA House of Delegates
May 3, 1991. Chicago, Illinois.

Amended by the CMDA House of Representatives
June 10, 2005. Denver, Colorado.

Christian Response To Adverse Outcomes Arising From Medical Error

ABSTRACT:

CMDA recognizes that adverse outcomes arising from medical errors occur. Our response to adverse outcomes requires compassion, a prompt sympathetic response that expresses regret, our wish that it had not happened, and provision of appropriate medical care. With any adverse outcome, the patient should be assured of an expeditious and thorough evaluation and an honest explanation upon its completion. As Christian healthcare professionals we desire to respond to our mistakes in a manner that is just and that honors God. We may recognize error when a patient is injured by our care, although many injuries are not due to error and, thankfully, many errors do not lead to injury.

Upon discovering an error, we must distinguish our level of responsibility and culpability before God. This necessitates time to prayerfully reflect while relying on the Spirit and the Word of God to both make us aware and convict us, if a sinful action or attitude led to the error, whether by omission or commission.

Errors typically fall within three categories.

  1. Errors for which we are not directly responsible
    An example would be medical system errors. In that setting, we should work to prevent future occurrence.
  2. Errors for which we are responsible but not morally culpable
    If we conclude there was no moral failure, we need not be self-accusatory but respond in compassion. Errors with adverse outcomes for which we are responsible but not morally culpable engender an obligation to disclose the error to the injured party. We must recognize the complexity of disclosure. In addition, we must take necessary steps to prevent recurrence of the error.
  3. Errors for which we are both responsible and morally culpable
    If the error resulted from moral failure Scripture speaks of the following steps that should be prayerfully considered:
    • Thanksgiving: Dealing with sin and experiencing reconciliation based on forgiveness from God and others should lead to thanksgiving for the renewed relationship and should facilitate our worship.
    • Forgiveness: God’s forgiveness is freely given to us through Christ when we repent and confess our sins to Him. Confession and/or restitution, when appropriate, provides an opportunity to seek forgiveness from the injured party. One goal we have as Christians is to live peacefully with all, which may not be accomplished until there has been mutual forgiveness. Some patients may have difficulty ever forgiving; for others the timing may not be right. We must respect these feelings.
    • Restitution: There is biblical precedent for restitution. Malpractice insurance may be one source of restitution. There may be times when compensation is appropriate, but our malpractice carrier does not agree, and we may need to personally offer some form of redress.
    • Confession: Scripture requires that we confess our sins to God. It is wise for Christian physicians to have a small group of fellow believers to whom they are accountable.
    • Repentance: We must recognize and acknowledge our sin, and with genuine contrition determine not to repeat the sin while taking specific steps to guard against it.

Conclusion
We live in a world that is fundamentally flawed by sin. As Christian healthcare professionals we are called to do good. In spite of our best preparations, intentions, and efforts, medical errors and adverse outcomes occur. Whether or not we are morally culpable, we need God’s help to respond rightly to our errors.

Approved by the House of Representatives
Passed unanimously
April 28, 2011. Mount Hermon, California

Conflicts of Interest

ABSTRACT:

As Christian physicians and dentists, we seek to glorify God in our profession by serving our patients. The practice of medicine and dentistry necessarily poses situations in which clinicians' personal interests, financial and otherwise, may conflict with those of their patients. The existence of these conflicts of interest is not inherently wrong.

We believe that when interests conflict, clinicians should resolve the conflicts by voluntarily subordinating their personal interests to the best interests of their patients. On occasion, a clinician may need to arrange alternative means of providing patient care in order to respond to family or personal needs.

We recognize that some clinicians, Christians and non-Christians alike, may at times fail to make the virtuous choice of placing their patients' interests before their own. We therefore support professional efforts to prohibit health care practitioners from engaging in activities which place their personal interests above those of their patients, when such activities can be clearly defined.

Approved by CMDA House of Delegates
Passed with more than a two-thirds majority
April 29, 1994. Dallas, Texas.

Death

ABSTRACT:

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.

Disabled Persons

ABSTRACT:

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.

Approved by the CMDA House of Delegates
Passed with a vote of 52 in favor, 7 opposed, 1 abstention
April 30, 1993. Danvers, Massachusetts.

Doctor & Pharmaceutical/Medical Device Industry Relationships

ABSTRACT:

Introduction

Doctors appreciate the contribution that the pharmaceutical and medical device industries make to the practice of medicine. Without the discoveries made by industry, many of the medical advances and products of recent decades would never have been possible. However, there must be appropriate boundaries between practicing doctors and industry. Industry viability understandably requires fiscal integrity and a margin of profit. Doctors’ primary motive should be to promote the welfare of their patients. The resultant conflict of interest requires that a doctor deliberately evaluate the ethics of receiving gifts from industry. There are many published standards for appropriate relationships between industry and doctors. Many academic medical institutions and the US Government have adopted policies on these issues. CMDA, in an effort to give guidance to its members, addresses the question, “What is the appropriate responsibility of a doctor when offered incentives from industry?”

The Current Situation

The choice of what pharmaceutical or medical device to use is largely made by the doctor though this choice is often influenced by institutional or insurance company constraints and incentives. Therapeutic choices must be individualized with due consideration of the best scientific evidence available and costs involved. Industries seek to promote the use of their product to the doctor by providing, among other things, free educational opportunities, gifts, and services. Studies demonstrate that incentives from industry influence recipients more than doctors realize.

Double Effect

ABSTRACT:

All medical treatments have the potential for adverse secondary effects, some anticipated and others not. The medical acceptability of such adverse secondary effects is judged on a risk-benefit basis. This involves assessing the likelihood of their occurrence, their severity, and the ability to treat them.

Some secondary effects have moral implications. An assessment of the moral acceptability of adverse secondary effects requires consideration of principles, motives, consequences, and implications.* The Rule of Double Effect, introduced into the discipline of moral reasoning by St. Thomas Aquinas, is particularly useful in evaluating the moral acceptability of adverse secondary effects.

The Rule of Double Effect furnishes guidance in a variety of situations such as relieving persistent or intractable pain with addicting narcotics, administering drugs or performing procedures that have harmful side effects, treating terminally ill patients with drugs that have the potential to shorten life, withdrawing burdensome and/or futile interventions even though these are life-sustaining, or using “terminal (palliative) sedation.” The Rule of Double Effect distinguishes between morally permissible actions that allow a patient to die and morally impermissible actions that cause a patient’s death. This distinction applies in a variety of situations, but is crucial in the public policy debates regarding appro-priate end of life care, euthanasia, and physician-assisted suicide.**

Actions leading to undesirable secondary effects, even if anticipated, can be permissible when all of the following criteria are met:

  1. The primary act must be inherently good, or at least morally neutral.
  2. The good effect must not be obtained by means of the bad effect.
  3. The bad effect must not be intended, only permitted.
  4. There must be no other means to obtain the good effect.
  5. There must be a proportionately grave reason for permitting the bad effect.

CMDA endorses these guidelines, fully realizing that not all situations in patient care can be anticipated or provided for; nor can the intent of medical caregivers always be discerned with certainty.

* See CMDA statement Moral Complicity with Evil
**See CMDA statements Euthanasia and Physician-Assisted Suicide

Approved by the CMDA House of Representatives.
Passed by unanimous vote
June 10, 2005. Denver, Colorado.

Eugenics and Enhancement

ABSTRACT:

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.
Euthanasia

ABSTRACT:

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.

Approved by the CMDA House of Delegates
Passed unanimously
April 29, 1988. Seattle, Washington.

Fetal Tissue for Experimentation and Transplantation

ABSTRACT:

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.

Approved by the CMDA House of Delegates.
Passed by a majority vote for, 1 opposed.
May 5, 1989. Minneapolis, Minnesota.

Genetic Information and Manipulation Technologies

ABSTRACT:

As genetic knowledge increases and technologies to manipulate genes become more powerful, our need for wisdom in application intensifies. In regard to human genetics in particular, the conditions that allow for hubris call for an even greater measure of humility.

As Christian healthcare professionals, we affirm that:

  • 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 inestimable worth, regardless of genotype or phenotype (see CMDA statement on the Human Life: Its Moral Worth).
  • 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, historical, 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 for good.
  • God has mandated responsible stewardship of Creation, both of ourselves and of the surrounding world.

Therefore, in regard to genetic technologies in medicine, CMDA believes:

  • The presence of a disability, either inherited or acquired, does not detract from a person's intrinsic worth.
  • Fallen humanity lacks the wisdom and moral restraint necessary to take control of human genetic destiny.
Healthcare Delivery

ABSTRACT:

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.

Approved by the 1996 House of Delegates
with a vote of 79 in favor and 1 abstention.

Healthcare Education and the Christian Faith

ABSTRACT:

Education in the healthcare professions presents particular challenges in combining education, the profession and the care of the patient. Christians in healthcare education should look to their faith for support and guidance in addressing these issues.

Healthcare Trainees

Medical and dental students and residents are partially trained healthcare professionals. Christian healthcare trainees are subject to the same standards and guidance as are fully trained Christian healthcare professionals (see Standards For Life*)

All authority is established by God. Healthcare trainees should respect the authority of attending clinicians and others responsible for patient care. In situations where there is a difference of opinion between a trainee and those professionals in authority, excluding matters of conscience, the trainee should respectfully state his or her opinion and reasons, and should then honor the final decision of the person in authority. If the trainee believes a patient may be harmed by the decision, he or she should tactfully seek counsel from one or more experienced professionals.

Professional trainees should not place a patient at physical risk for the sake of learning, but should seek supervision from others with more experience or knowledge, when appropriate. They should not put themselves at moral risk, but rather graciously decline to participate in any aspect of training or patient care which would violate their conscience.

Healthcare in a teaching setting requires cooperation and communication among many members of the professional team. This presents unique challenges for the trainee in regard to patient privacy and confidentiality. Special efforts must be made in such settings to retain and demonstrate the highest respect for patients.

Trainees should be honest with patients about their level of training; e.g. medical and dental students must not introduce themselves to patients as "Doctor". They should likewise be honest with their professional colleagues and in matters of documentation, never compromising their integrity for the sake of being a "team player". They need to be honest with themselves and with those to whom they report when they make mistakes.

Healthcare Right of Conscience

ABSTRACT:

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.
Homosexuality

ABSTRACT:

CMDA affirms the long-accepted and widely held Christian teaching that the appropriate context for sexual relations is solely within marriage, defined as a consensual, exclusive and lifelong commitment between one man and one woman. This is the view reflected throughout the Bible and in Christian texts of all denominations—Protestant, Catholic, and Orthodox—throughout their history and, until recently, a view that was universal and uncontested among Christians. Commitment to this historic Christian view of sexuality benefits individuals, families, and all society.

CMDA recognizes that many individuals experience or struggle with same-sex attraction. In these matters CMDA distinguishes homosexual thoughts and desires from willful homosexual behaviors.

CMDA also recognizes that, in recent years, there has been a sea change in cultural acceptance and legal recognition of homosexuality, including voices that celebrate it and seek to make it conventional. These factors have placed Christian healthcare professionals in the position of being at variance with evolving views of sexual choices and behaviors that may be socially approved but which are contrary to a Christian worldview. Whereas the shift in cultural mores has been rationalized by a strong emphasis on the freedom of personal choice, CMDA believes that personal autonomy is not an absolute principle but one that must be weighed alongside other relevant moral principles. In matters of sexuality the broader impact of individual choices should be considered.

Because we are guided by Christ, who assisted all who sought his help regardless of sexual or social status, CMDA affirms the obligation of Christian healthcare professionals to care for all patients in need, regardless of sexual orientation, gender identification, or family makeup, with sensitivity and compassion, even when we cannot validate their choices.

Human Cloning

ABSTRACT:

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.

Approved by the CMDA House of Delegates
Passed with a vote of 63 in favor, 3 abstentions
May 2, 1998, Cincinnati, Ohio

Human Enhancement

ABSTRACT:

Humans have created and continue to create technologies that modify living substrate, manipulating existing functional performance or behavior. Many of these technologies are welcomed for their therapeutic potential to bring healing and restoration. However, such technologies have also been directed to the re-engineering of human life, which some refer to as "enhancement." They include, but are not limited to, genetic technologies, synthetic biology, nanotechnologies, pharmacology, and neurotechnologies. The purpose of this statement is to examine whether or not human re-engineering through technology is:

  • Acceptable within our place as created beings charged with stewardship of our lives before our Creator God,
  • Ethical within the historical norms of medical ethics, and
  • Prudent and just within the context of limited medical resources in a world in which suffering due to poverty and absence or profound deficiency of even simple life-saving technology is the reality for over one-third of humanity (according to World Health Organization data).

A critical aspect of this question is how the relevant terms are defined. The reader is encouraged to review the appended glossary before proceeding with the remainder of this statement, and in interpreting this statement to respect CMDA's use of these terms.

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)
Human Hybrids and Chimeras

ABSTRACT:

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.
Human Life: Its Moral Worth

ABSTRACT:

The moral worth of human beings is absolute and eternal. God has created humans in his image; therefore human life has intrinsic moral worth. The following concepts are essential to our understanding of a human being’s moral worth.

Image of God is the Scriptural term that refers to the transcendent dignity imparted by God to mankind at creation. The image of God is who we are, not something we possess. The image of God is intrinsic to the entire person as an embodied soul (or ensouled body). It is a gift of God that finds continuity in human procreation and finds expression in such aspects of our human nature as reason, volition, moral sense, God-consciousness, worship, etc. However, bearing the image of God does not require certain capacities such as self-consciousness, self-awareness, autonomy, rationality, ability to feel pain or pleasure, level of development, relational ability, etc. Bearing the image of God qualitatively separates humankind from the rest of creation and gives human beings their mysterious, unique, and infinite moral worth and dignity.

Every being of human origin is a person. A person is not a Homo sapiens with the superadded quality of “personhood.” Some, however, would attempt to withhold moral worth from human beings unless they “qualify” as persons. The status of “personhood” cannot be conferred by society.

The image of God confers upon each human being a sacred quality. The sacredness of human life calls forth respect and love for each individual as uniquely created in God’s image. Love and respect for human beings as created in God’s image require more than mere respect for autonomy or privacy. How we treat others reflects our attitude to God. “Whatever you did for one of the least of these brothers of mine, you did for me.”

The beginning and continuity of the moral worth of human life are concurrent with human life itself. Human worth begins with the one-cell human embryo and lasts lifelong. A living human being is an integrated organism with the genetic endowment of the species Homo sapiens. This includes the inherent active biological disposition for ordered growth and development in a continuous and seamless maturation process. It also includes the potential to manifest such fundamental traits 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 formation of the human being until death. Human embryos are not “potential” human beings; rather, they are human beings with potential. Moral worth is not dependent on potential. A human being with a defect or disease is no less a person.

The image of God, intrinsic to each individual, imparts moral worth in all stages of human life. The image of God makes each individual uniquely worthy of service. Each person is known and loved by God, and the image of God in man endows every one with a capacity to know and love Him. The capacity for this personal relationship with God demonstrates the immense value God places on each human life. CMDA believes the proper response to being made in God’s image is one of gratitude and should be borne out in faithful relationship to God and others.

Approved by the House of Representatives
Passed Unanimously
June 22, 2007, Orlando, Florida

Human Research

ABSTRACT:

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.

Human Sexuality

ABSTRACT:

God created human beings with many dimensions, one of which is their unique sexual nature. As men and women, we are physical, intellectual, emotional, relational, and spiritual beings, and thus distinguished from the rest of creation.

Many levels of sexual expression are possible between men and women.

One important expression of sexuality is friendship; the sexual differences between men and women enhance meaningful, warm, and healthy relationships. A second important area of sexual expression is intimacy between husband and wife. God has designed the most intimate expressions of sexuality, including intercourse, specifically for the marriage relationship. The Bible describes the covenantal relationship of love which God has for His people; the husband-wife relationship is analogous. Since God holds the marriage relationship close to His heart, its violation is a serious offense to Him.

Our integrated nature means that intimate sexual expression profoundly affects all dimensions of our being. While sexual expression outside of God's design may provide temporary pleasure, God's guidelines are meant to protect us from disease, fear, exploitation, and ultimately dehumanization.

CMDA affirms the biblical principles stated above. These principles are clarified further by the following statements:

  1. Sexual intercourse is to be reserved exclusively for heterosexual marriage.
  2. Single men and women who engage in sexual intercourse are outside of God's limits and are practicing sin.
  3. Married people who have intercourse with anyone other than their marriage partner are defiling a marriage union which God has sealed and are in sin.
  4. Like single heterosexuals who engage in heterosexual sex, or married persons who engage in extra-marital sex, homosexuals who engage in homosexual acts are practicing sin.
  5. We condemn the perversion of sexuality in pornography, rape, incest, and all other forms of sexuality that deviate from the biblical norm for Christian marriage.
  6. Family life teaching and sexual education are God-given responsibilities of parents. The Church's task is to assist both parents and youth in understanding their sexuality in the context of biblical values. When appropriate, sexual education should include risk behavior information and instruction on protective techniques to inhibit the spread of AIDS and all other sexually transmitted diseases.
  7. Education and protective techniques alone, however, will not stop the spread of AIDS. Our society needs to understand and acknowledge that there are compelling emotional, philosophical, medical, sociological, and historical reasons for practicing abstinence before marriage and fidelity within marriage.*
Human Stem Cell Research and Use

ABSTRACT:

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.

*At this time stem cells are classified either as adult or embryonic. Adult stem cells are derived from body tissues such as bone marrow, fat, heart, liver, lung, muscle, pancreas, skin, as well as from placenta and cord blood. Embryonic stem cells are removed from the developing embryo, resulting in destruction of the embryo.

**See Sanctity of Human Life.

Approved by the House of Representatives
Passed Unanimously
June 22, 2007, Orlando, Florida

Human Trafficking

ABSTRACT:

As Christian healthcare professionals, we affirm that all humans have inestimable worth, having been created in God's image, and should not be trafficked by others. Accordingly, we grieve for victims of human trafficking and are compelled to oppose this evil.

Human trafficking is the contemporary practice of slavery. Human trafficking involves acts of recruiting, transporting, transferring, harboring or receiving a person through the use of threat, abduction, fraud, deception, force or other coercive means for the purpose of exploitation. Its victims include, at a minimum, persons in forced labor, forced marriage (including child brides), child soldiers, persons trafficked for the removal of eggs or organs, and adults and children kept in bondage for the purpose of commercial sexual exploitation. Healthcare professionals should be aware that human trafficking is a widespread yet often hidden problem and alert to the possibility that it may reach into their local communities. Its victims may be forced into migrant agricultural, domestic, restaurant, factory, or commercial sex work.

Victims of trafficking may come into contact with healthcare professionals when seeking treatment for bodily injuries such as fractures resulting from violence, torture or sexual assault; traumatic brain injury; sexually transmitted diseases including HIV, gonorrhea, syphilis, urinary tract infections or pubic lice; infectious diseases including hepatitis and tuberculosis; miscarriages or the sequelae of forced abortions; malnutrition; and sequelae of delayed diagnosis or lack of adequate medical care. Victims of trafficking have increased rates of post-traumatic stress disorder and suicide. Social harms from trafficking include the public burdens of dealing with its health consequences as well as the dissemination of infectious diseases into the general population. These problems represent only a partial list of the enormous medical and social consequences of human trafficking.

Healthcare professionals who do not directly treat victims of human trafficking nonetheless provide care and counsel to patients who may be end-users of human trafficking industries. Individuals who pay for commercial sex acts or purchase or view pornography become complicit with human degradation and commodification, which are at the root of human trafficking. The viewing of sexually explicit material is not victimless; rather, it promotes the economic demand that sustains an international sex industry that contributes to marital instability and divorce, enslaves its users and keeps its victims in bondage (see CMDA Statement on Human Sexuality).

The counsel of Scripture is unequivocally opposed to the dehumanization, commodification, and devaluation of human beings (see CMDA Statement on Human Life, Its Moral Worth). Accordingly, Christians historically have opposed human slavery and ministered to the oppressed and neglected.

Imminent Death Organ Donation

ABSTRACT:

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:

  1. The unconscious patient who is imminently dying from a devastating neurologic injury and irreversibly lacks decision-making capacity but is not brain dead.
  2. 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:
    1. Permanently unconscious
    2. Minimally conscious
    3. Cognitively disabled or demented
    4. Neuromuscularly weak but cognitively unimpaired
  3. 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.
  4. 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.
Immunization

ABSTRACT:

Personal Safety and Public Health

Since the pioneering work of Edward Jenner and others in developing a vaccination for smallpox over 200 years ago, immunization has been of great benefit to individuals as well as the public. Immunization practices have prevented outbreaks of communicable diseases and resultant deaths or disability and continue to prevent an ever-increasing variety of illnesses.

The immunization process is based on safely activating the body’s own defense system against a specific disease. As with other medical treatments, it carries a small but real risk of an adverse reaction.

CMDA agrees with current medical opinion that immunizations are of great benefit to the individual and society. The decision to immunize an individual relies on the similar decision-making process used for that of any other medical treatment.

CMDA recognizes that immunization benefits society by protecting public health and that individual members of society have some reciprocal obligations to the society in which they live.

CMDA acknowledges the right of an individual to refuse immunization except in extraordinary public health circumstances. This decision may be motivated by moral or religious convictions, known risk, misinformation or fear. The Christian community needs to base its decisions on accurate information. Those who model their lives in imitation of Christ should reflect on their obligation to take personal risk for the good of others.

CMDA supports the current scientific literature that validates the general practice of immunization as a safe, effective, and recommended procedure.

Immunization and Potential for Moral Complicity with Evil

The use of medical information and technology obtained through immoral means raises concerns about moral complicity with evil*. Some currently available vaccines were developed using tissue from aborted fetuses, while others use technology or knowledge acquired from the use of aborted fetuses. We need to consider carefully whether it is morally permissible to benefit from knowledge or technology obtained from the intentional destruction of human life.

We attempt to determine whether our participation is appropriately distanced or inappropriately complicit by consideration of the medical facts and of our conscience as informed by the revealed Word of God.

CMDA provides the following examples to help determine whether it is permissible to manufacture, administer or receive a specific vaccine:

  • Using technology that was developed without any intentional destruction of human life or other evil is morally ideal. Most vaccines in use to date fall into this category.
  • Using technology developed from tissue of an intentionally aborted fetus, but without continuing the cell line from that fetus, may be morally acceptable.
  • Continued use of a cell line developed from an intentionally aborted fetus poses moral questions and must be decided as a matter of conscience, weighing the clear moral obligation to protect the health of our families and society against the risk of complicity with evil.
  • Using a vaccine that requires the continued destruction of human life is morally unacceptable.

CMDA encourages the use of and endorses the further development of medically effective and ethically permissible alternatives that do not raise the question of moral complicity.

See CMDA Statement on Moral Complicity With Evil

Approved by the House of Delegates
Passed unanimously
June 12, 2002

Amended by the House of Representatives
June 11, 2004 2 abstentions.

Limits to Parental Authority in Medical Decision Making

ABSTRACT:

Children are a gift from God to the family. Parents are entrusted with the responsibility to love, nurture, protect, and train for their children. In our society, when parents fail to carry out their fundamental responsibilities, the state is empowered to intervene to protect vulnerable children.

As physicians and dentists, we are obligated professionally to counsel parents regarding the health and safety of their children. In addition, we are obligated legally to report to the appropriate authorities instances of parental abuse or neglect.

We recognize that between the extremes of ideal child rearing and of abusive or negligent child rearing, there is a wide range of parental actions and choices which remains a matter of discretion. In regard to these discretionary matters, we must respect parental authority by working through the parents to improve the child’s welfare.

Some parents, acting on philosophical or religious beliefs may compromise appropriate medical care for their children. In professional encounters with these parents and children, we should attempt to honor their values and beliefs whenever possible. Nevertheless our obligation remains to oppose parental decisions that may significantly harm their children.

Approved by the House of Delegates
Passed with 51 approvals, 2 against
June 13, 2001. San Antonio, Texas

Malpractice

ABSTRACT:

The Christian Medical & Dental Associations affirm the following:

We are committed to providing excellent care to our patients and we hold ourselves to the highest possible standard.

We recognize that neither medicine nor dentistry is an exact science, and that all clinicians are subject to error. We further recognize that it is likely that we have all unintentionally practiced below the standard of care* at some time. We believe that the excellent practice of medicine and dentistry requires a willingness to recognize and learn from our professional mistakes and maloccurences.

We should take responsibility for bad outcomes that have been caused by our provision of substandard care. We lament that the climate of our culture discourages us from following biblical mandate of confessing, seeking forgiveness, and pursuing reconciliation. We believe that a patient who has been injured by substandard care may be entitled to restitution.

We oppose harassment or frivolous cases filed for vindictive or monetary reasons. We oppose the settlement of any case without the full involvement and informed consent of the doctor.

We recognize that a judicial judgment of professional liability does not necessarily mean that the clinician is incompetent or deserving of practice restriction. Nor does it suggest that we should withhold our compassion and love from that colleague. We should judge neither ourselves nor others too harshly because of an adverse malpractice judgment.

A malpractice suit can cause significant suffering to the individual professional. It may adversely affect his or her physical and emotional health, family and spiritual life, and Christian witness. We should protect our own physical, emotional, and spiritual health through Scripture, prayer, and appropriate counsel from others. In turn, we should volunteer our support and help to our colleagues when they are in need. Compassion and empathetic guidance from others may have a profound influence on the outcome. The manner in which Christian clinicians handle this difficult professional problem can be a unique opportunity to be a distinctive witness for Christ.

*The "standard of care" refers to those acts which a reasonable physician of like training or skill would do in the same or similar situation. The standard of care is not the optimal or best care possible when viewed with the knowledge of an adverse outcome, nor does it take account of less than perfect acts or results.

Approved by the CMDA House of Delegates
Passed with a unanimous vote
May 2000, Orlando, Florida

Medical Futility

ABSTRACT:

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.

Approved by the CMDA House of Delegates
Passed with 61 in favor, 10 opposed, 4 abstentions
April 29, 1994. Dallas, Texas.

Miraculous Healing

ABSTRACT:

In the Old and New Testaments God intervened in the course of human events with acts of miraculous healing. This is illustrated by a favorable medical outcome not fully explained in medical terms, attributable to the direct intervention of God. In the time of Jesus and the early church this was an essential part of ministry. Furthermore, Christ gave His disciples the power to heal miraculously. Scripture does not teach that sickness is necessarily due to personal sin, that the absence of healing is due to a lack of faith, or that perfect health is God's will for all. Disease and death are realities of life.

God's nature does not change. We believe in the healing power of Christ today.

God created the natural laws that govern health, illness, and the process of healing. We believe that God works both within and sometimes outside of these natural laws to heal people. We believe that all healing is accomplished by God's hand. Sometimes it is clear that scientific principles are used to facilitate that healing; sometimes the connection with known science is not so clear. We need to give God the credit at all levels of healing, whether we understand the science behind it or not.

Whether in illness or health Jesus desires relationship with us. Furthermore, God utilizes all situations for "the good of those who love Him." For the Christian this life is not all in all because eternity with God awaits hereafter. Even in dire circumstances, hope exists.

We promote specific interventional prayer, requesting God's healing as part of the treatment of disease, according to biblical instruction. We also encourage the use of all ethical means of standard medical care. As God increases medical knowledge, we are better able to use this knowledge to facilitate healing processes that God has designed.

Through our faith in Christ, knowledge of medicine, and compassion for His people, we choose to glorify God in all situations and assist in healing whenever possible. Healing is a gift of God's sovereignty, through His magnificent design and His specific intervention.

Approved by the CMDA House of Delegates
Passed with a vote of 59 in favor, 2 abstentions
May 2, 1998, Cincinnati, Ohio.

Moral Complicity with Evil

ABSTRACT:

Moral complicity with evil is culpable association with or participation in wrongful acts. Evil is defined as anything immoral or wrong based on Biblical principles. Questions about moral complicity with evil can arise in regard to an individual’s relationship to or involvement with past, present or future evil.

Moral complicity may occur with the use of information, technology or materials obtained through immoral means. This complicity may involve using, rewarding, perpetuating, justifying, or ignoring past or present evil. Moral complicity may involve enabling or facilitating future immoral actions of patients or professionals.

We must strive to never commit evil ourselves, nor should we participate in or encourage evil by others. While it may be impossible at times to completely distance ourselves from the evil actions of others, we are responsible to determine whether our action is appropriately distanced or inappropriately complicit. This determination is based on the revealed Word of God. In the absence of clear Biblical teaching, this determination is based on conscience as informed by the Holy Spirit, using but recognizing the innately fallible nature of human reason and prudence.

Biblical Guidelines

  1. We must avoid every kind of evil (1 Thessalonians 5:22)
  2. We may never do evil that good may come. (Romans 3:8)
  3. We must hate and oppose evil. (Romans 12:9)
  4. We should separate ourselves from evil. (2 Corinthians 6:17)
  5. We cannot totally separate ourselves from evil. (1 Corinthians 5:9-10)
  6. We should overcome evil with good. (Romans 12:21)
  7. We should seek wisdom. (James 1:2-5)
Non-Traditional Family and Adoption

ABSTRACT:

In 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.* Most current scientific studies** affirm that the Biblical model provides the optimal environment for the health of children, family, and society.

We believe the unique contributions of both father and mother are important for wholesome child development. However in our fallen world there are many wounded families in which one partner is absent. We encourage the Church to fulfill its Biblical mandate to support single parents in providing a nurturing environment for their children. In a situation of remarriage, it is possible to re-approximate the Biblical model for the family.

Adoption is an act of love that provides a beneficial environment for a child and reflects God’s act of love in adopting us into His family. CMDA enthusiastically encourages and supports adoption of children or frozen embryos into the traditional family. In addition, there may be circumstances in which a single person***, while not meeting the optimal Biblical model of the family, might adopt a child and provide a loving and nurturing environment that would outweigh the potential difficulties inherent in this situation. CMDA does not support adoption into family models other than these.

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.

*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.

** See Annotations. See Ethics Statement – Annotations for Homosexuality Statement

***A single person living according to Biblical standards. See Ethics statements: Human Sexuality, and Homosexuality.

****See Ethics Statement: Assisted Reproductive Technology.

Approved by the House of Representatives June 11, 2004 unanimously.

Scientific Statements

Public Policy Statements