Instead of fostering serious, objective scientific inquiry and heeding concerns from within their own ranks, the establishment continues to rely on WPATH’s guidelines for dealing with gender dysphoria. And contrary to sound inquiry, WPATH cherry-picked studies instead of conducting a systematic review of the best available evidence. As one member of the Endocrine Society recently wrote about its guidelines, “the society’s full-throated endorsement of gender-affirming care implied condemnation of anyone who holds differing views.” This cows doctors into silence and coerces them into providing dangerous interventions to children.

This week, the American Academy of Pediatrics (AAP) is holding its annual leadership conference at its headquarters in Itasca, Illinois. One issue that won’t be on the formal agenda but will be on the minds of many members is how to treat gender dysphoria in children. AAP, along with most of America’s medical establishment, endorses the approach of the World Professional Association of Transgender Health (WPATH). This transgender advocacy group recommends that doctors irreversibly alter a child’s physical appearance to appear as a different gender through hormones and surgeries. But two transgender-identifying doctors in WPATH caution that teenage patients are receiving “sloppy care.” And there is dissent in AAP’s own ranks as to the legitimacy of this practice.
As many countries around the world turn to safer, non-invasive “watchful waiting” and psychotherapy to treat gender-confused kids instead of defaulting to hormones and surgeries, America is rapidly becoming an outlier. Now former patients (known as “detransitioners”), with the support of whistleblowers, are filing medical malpractice lawsuits and testifying in support of legislative limits on administering these experimental procedures to children. The architects of pediatric gender transition have built their arguments on flimsy evidence and the reputations of prestigious groups instead of objective, sound science. Their house of cards is starting to collapse.
Politicized Standards of Care
Gender dysphoria is a mental disorder that creates incongruence between one’s internal sense of gender and the reality of the sexed body. But unlike with anorexia, AAP’s recommended treatment does not focus on resolving the mind-body incongruence through counseling. Instead, doctors at “gender clinics” try to make a person’s body resemble their self-perception, disordered though it may be. Recently, 21 doctors from nine countries raised concerns that the American medical establishment has adopted “politicized” standards of care.
This isn’t the first time this has happened. Back in the twentieth century, another radical ideology captured the scientific and medical establishment. Eugenicists persuaded doctors to sterilize 70,000 Americans, who were disproportionately women and minorities. Medical schools taught eugenics. Wealthy tycoons funded the practice. And three presidents (Theodore Roosevelt, Franklin Delano Roosevelt, and Woodrow Wilson) lent their political support. The support for eugenics also existed on a systemic level: The American Neurological Association endorsed forced sterilization of people with schizophrenia, manic depression, epilepsy, and Down syndrome, and the American Medical Association relied on the research of a wealthy eugenics advocate for its contraceptive testing. Eventually, the premise of eugenics, genetic inheritance, was debunked and discredited by scientific evidence. But for three decades, doctors participated in one of the greatest ethical scandals of the last century.
Legal Endorsement of Eugenics and Growing Skepticism
Sadly, courts also enabled doctors to use their licenses, credentials, and skills to carry out experiments in eugenics on their patients. In the 1927 case Buck v. Bell, the U.S. Supreme Court upheld a Virginia law that allowed an 18-year-old woman, Carrie Buck, to be sterilized against her will. After Buck reported that she became pregnant through rape, her foster parents committed her to an institution for the “feebleminded.” Doctors sought to sterilize Buck on the grounds that it would eliminate an unfavorable trait from the population. In an infamously cruel endorsement of eugenics, Justice Oliver Wendell Holmes, Jr., declared, “Three generations of imbeciles is enough.”
The legal battle against eugenics reached a turning point when the U.S. Supreme Court recognized a prisoner’s human right to have children. In the 1942 case Skinner v. Oklahoma, the court rejected efforts to forcibly sterilize an inmate on the grounds that it violated the Constitution’s equal protection clause. Advocates for the disabled finally brought an end to eugenics in America by persuading state legislatures to pass “white cane laws” to protect the disabled from discrimination. The wave that began in state legislatures culminated in Congress’s passing the Americans with Disabilities Act in 1990. These laws made involuntary sterilization effectively unlawful and culturally unthinkable.
But, in a tragic echo of this dark moment from America’s past, some U.S. courts are now greenlighting a course of irreversible treatment for confused, vulnerable youth that would potentially render them sterile, often with a raft of lifelong medical complications and mental health challenges.
Fortunately, a contingent of courageous doctors is working to stop history from repeating itself. These doctors have repeatedly tried to introduce resolutions in the AAP calling for systematic evidence reviews, the gold standard in medicine.
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The most salient reason for the Dissent was that basically the SJC created a new Record of the Case (ROC).  Generally, the ROC consists only of the documents generated by the both parties in a case during the time of the original investigation and proceedings.  In this case, an additional investigation was commenced by the SJC long after the original case was documented.  This appeared to be for the purpose of identifying any changes in Mr. Johnson’s present views as compared to his previous views. This may be a laudable goal, but it is irrelevant to this case.

The Dissenting Opinion on the Case that was before the PCA Standing Judicial Commission (SJC) regarding the Missouri Presbytery and Greg Johnson has been published (The Aquila Report, 12/13/21).  I want to publicly thank this group of men for making known the reasons for their Dissent.  Actually, even though many of us consider the decision of the SJC to be a loss, yet this public statement representing the minority vote is an encouragement for countless numbers in the PCA.  I personally appreciate the position these men took in opposition to the majority of the Commission.  A few remarks may be in order.
First, I hold a minority position in the PCA.  I believe that anyone who identifies himself publicly as a homosexual is automatically disqualified from holding office in the PCA.  I therefore have my qualms about part of the process in the Case.
The Dissent asserts that there is good reason to believe that Mr. Johnson’s self-identity as a homosexual “compromises and dishonors” his identity in Christ.  This demonstrates my problem with the proposed changes to the Book of Church Order.  Rather than having a clear line of demarcation regarding the ordination of homosexuals, it creates a purity of thought test where no one can score 100, but no one can define what a passing score is. The Dissent argues that Mr. Johnson’s score is not high enough to pass.  The majority of the SJC concluded that he did pass.  This is highly subjective.  It will be highly subjective if the BOCO changes are adopted.
Secondly, the most salient reason for the Dissent was that basically the SJC created a new Record of the Case (ROC).  Generally, the ROC consists only of the documents generated by the both parties in a case during the time of the original investigation and proceedings.  In this case, an additional investigation was commenced by the SJC long after the original case was documented.  This appeared to be for the purpose of identifying any changes in Mr. Johnson’s present views as compared to his previous views. This may be a laudable goal, but it is irrelevant to this case.  If there have been changes in his views, then there are other ways to handle it.  According to the Dissent, “The SJC supplemental work produced 67% of the citations used by it in support of Presbytery’s conclusions…”  The SJC in essence created a new ROC, and thus, in a real sense, became the court of original jurisdiction.
By creating a new ROC, the SJC allowed Mr. Johnson to nuance his previous statements which happen to reflect the PCA Study Committee on Human Sexuality.  This was unfair to the Complainant.  He was not challenging the discovery statements that resulted from the later investigation of the SJC; he was challenging the original decision of Missouri Presbytery based on the statements made by Mr. Johnson nearly two years ago. (The Complainant’s framing of the original Statement of the Issue: “Did Missouri Presbytery err when it failed to find a strong presumption of guilt and institute process against TE Johnson regarding his stated views on human sexuality that appear to be significantly out of accord with and not in conformity with the Scriptures and the Westminster Standards?”)
Thirdly, the final vote on the SJC shows how important it is to know in more detail about the nominees for the Standing Judicial Commission at each General Assembly.  A difference in one single vote would have changed the outcome of this decision.
The PCA has a Standing Theological Examinations Committee which approves the orthodoxy of the nominees for positions at the General Assembly level, and declares them eligible to hold office.  The election of men to hold this important office has become rather perfunctory.  No doubt, the National Partnership (NP) has had a major influence on who gets elected.
Maybe it’s time to make public for the GA Commissioners a more thorough examination of these men, as is done with candidates for the United States Supreme Court. In some way we need to know the particular theological camp they represent in the PCA.  Judgment of the law is not always neutral.  Commissioners at the General Assembly need to be better informed about nominees.
Lastly, if the proposed BCO changes do not pass, then this will make two proximate losses for the conservative confessionalists in the PCA.  We might expect that some leaders in the PCA will begin to contemplate an exit plan in order to create a new denomination.
Some will plead for a continual fight, pointing out the victories at the previous General Assembly, and believing that they have the grassroots numbers to eventually gain back control of the PCA.  Others will not be so optimistic.  It is sad that it has all come down to this.
Larry E. Ball is a retired minister in the Presbyterian Church in America and is now a CPA. He lives in Kingsport, Tenn.

The doctrine of imputation is one of the most under-taught teachings in the church today, and every Christian needs to know it. God credits to us the righteousness of Christ, and this comes through faith alone, which is also God’s gift to us in Christ. Additionally, our sin is credited to Christ, who, though he knew no sin, was punished for the sins of all who trust in him for salvation.

Here are 10 words every Christian should know—and be able to explain—in order to “be prepared to give an answer to everyone who asks you to give the reason for the hope that you have” (1 Peter 3:15).
1. Faith
Saving faith is not, as is commonly believed, a blind faith. There are three aspects of saving faith:

knowledge of Christ and his salvific work;

agreement that the claims of Christianity are true;

hearty trust in Christ alone for our salvation.

Faith is the instrument through which, by God’s grace, Christ’s perfect righteousness and atoning sacrifice are credited to us. It is God’s gift, not a work of any kind (Eph. 2:8-9). For more on the definition of faith, please click here.
2. Grace
Grace is one of God’s attributes. According to theologian Louis Berkhof, the grace of God in our redemption in Christ

is God’s free, sovereign undeserved favor or love to man, in his state of sin and guilt, which manifests itself in the forgiveness of sin and deliverance from His justice. (Systematic Theology, p. 427).

There is nothing we have done or could ever do to merit God’s grace. We receive it by God’s sovereign choice alone (Rom. 11:5-6).
3. Peace
There are two aspects to peace—objective and subjective. Just as two countries have a status of peace with each other through official agreements, so Christians are declared at peace with God through Jesus Christ (Rom. 5:1). This means that we still have the status of peace with God regardless of how we feel or how well we keep his commands at any given time.
It is normal for Christians to still feel anxious in this troubled world and to feel a lack of peace from the sin in their lives. These feelings should spur us on to trust in God, repent of our sins, and seek to live in such a manner that honors our Lord. Christians should always be exceedingly thankful and find unfathomable comfort in the fact that the blood of Christ sufficiently atones for all their guilt and sin.
4. Cross
God in his perfection must uphold all his attributes. We cannot separate God’s love from his holiness, or his mercy from his justice. God must be true to all his attributes, because to do otherwise would be to deny his own self.
As theologian Michael Horton so aptly states in his book The Christian Faith, “God would not be God if he did not possess all his attributes in the simplicity and perfection of his essence” (229). Jesus was born in the flesh so he could fulfill the whole law and be the perfect sacrifice on behalf of all who put their faith in him (Heb. 10:11-14).
At the cross Jesus offered up his life as the perfect, once-for-all sacrifice for all who trust in him for salvation (e.g. John 10:14, 15). According to Horton we observe, “the clearest evidence of the complete consistency between God’s goodness and his sovereignty, justice, wrath, and righteousness in Christ’s cross” (p. 266). At the cross we see God’s “righteousness at the present time, so that he might be just and the justifier of the one who has faith in Jesus” (Rom. 3:26).
5. Law
According to theologian R. C. Sproul, the law is like a mirror: it shows us our sin, but it can do nothing to save us. In fact, the law condemns everyone who is not in Christ. Jesus was born in the flesh in order to be the perfect Son whom God had promised since the fall of Adam in the garden (Gen. 3:15).

For God has done what the law, weakened by the flesh, could not do. By sending his own Son in the likeness of sinful flesh and for sin, he condemned sin in the flesh, in order that the righteous requirement of the law might be fulfilled in us, who walk not according to the flesh but according to the Spirit. (Rom. 8:3-4)

Jesus kept the law perfectly on behalf of all who trust in him for salvation, and they are counted righteous in God’s sight through faith alone by God’s grace alone.
The law also serves the purposes of restraining evil and showing us what is pleasing to God. Christians should also strive to keep God’s law in joyfully thanksgiving for all God has done for them in Christ, although they will do so imperfectly in this life. For more on the “three-fold use” of the law, click here.
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