Tuesday, June 06, 2006

General Convention 2006: End of Life Resolution

I made reference in this earlier post to the discussion of medical futility in the Report to General Convention of the Standing Commission on National Concerns. I am happy to report that the following Resolution with Explanation has been submitted to General Convention. It has been submitted by the Rev. Fred Mann, Deputy from the Diocese of West Missouri, based on my original draft. It has not yet been numbered nor been assigned to a committee, but it has been accepted.

Nota Bene: As of today (6/7/06) this resolution has been designated as Resolution D023. It will be considered first in the House of Bishops, and will be sent to the Education Committee.

As is often the case, this is a short Resolution with a long Explanation. That is preferable to a long series of "Whereas" clauses. In any case, I believe this short Resolution can point diocese and parishes to valuable resources for providing support to Episcopal patients and families making decisions about the end of life. I certainly hope to see it approved in Columbus.

Resolved, the House of _____ concurring, That the 75th General Convention reaffirm Resolution 1991-A093a of the 70th General Convention, as amended in Resolution 1994-A056 of the 71st General Convention regarding Principles With Regard to the Prolongation of Life; and be it further
Resolved, That this 75th General Convention calls on dioceses and parishes of this Church to become informed of the laws of states and policies of health care institutions regarding decisions at the end of life and regarding medical futility; and be it further
Resolved, That this 75th General Convention commend chaplains endorsed by the Office of the Suffragan Bishop of Chaplaincies, members of the Assembly of Episcopal Healthcare Chaplains and of National Episcopal Healthcare Ministries, and chaplains certified by the Association for Clinical Pastoral Education, the Association of Professional Chaplains, or the College of Pastoral Supervision and Psychotherapy as appropriate resource persons for discussions regarding ethical care, medical futility, and decisions at the end of life.

The text of 1991-A093a as amended by 1994 A056 is as follows:
1.Although human life is sacred, death is part of the earthly cycle of life. There is a "time to be born and a time to die" (Eccl. 3:2). The resurrection of Jesus Christ transforms death into a transition to eternal life: "For as by a man came death, by a man has come also the resurrection of the dead" (I Cor. 15:21).
2. Despite this hope, it is morally wrong and unacceptable to intentionally take a human life in order to relieve the suffering caused by incurable illness. This would include the intentional shortening of another person's life by the use of a lethal dose of medication or poison, the use of lethal weapons, homicidal acts, and other forms of active euthanasia. Palliative treatment to relieve the pain of persons with progressive incurable illnesses, even if done with the knowledge that a hastened death may result, is consistent with theological tenets regarding the sanctity of life.
3. However, there is no moral obligation to prolong the act of dying by extraordinary means and at all costs if such dying person is ill and has no reasonable expectation of recovery.
4. In those cases involving persons who are in a comatose state from which there is no reasonable expectation of recovery, subject to legal restraints, this Church's members are urged to seek the advice and counsel of members of the church community, and where appropriate, its sacramental life, in contemplating the withholding or removing of life-sustaining systems, including hydration and nutrition.
5. We acknowledge that the withholding or removing of life-sustaining systems has a tragic dimension. The decision to withhold or withdraw life-sustaining treatment should ultimately rest with the patient, or with the patient's surrogate decision-makers in the case of a mentally incapacitated patient. We therefore express our deep conviction that any proposed legislation on the part of national or state governments regarding the so called "right to die" issues, (a) must take special care to see that the individual's rights are respected and that the responsibility of individuals to reach informed decisions in this matter is acknowledged and honored, and (b) must also provide expressly for the withholding or withdrawing of life-sustaining systems, where the decision to withhold or withdraw life-sustaining systems has been arrived at with proper safeguards against abuse.
6. We acknowledge that there are circumstances in which health care providers, in good conscience, may decline to act on request to terminate life-sustaining systems if they object on moral or religious grounds. In such cases we endorse the idea of respecting the patient's right to self-determination by permitting such patient to be transferred to another facility or physician willing to honor the patient's request, provided that the patient can readily, comfortably and safely be transferred. We encourage health care providers who make it a policy to decline involvement in the termination of life-sustaining systems to communicate their policy to patients or their surrogates at the earliest opportunity, preferably before the patients or their surrogates have engaged the services of such a health care provider.
7. Advance written directives (so-called "living wills," "declarations concerning medical treatment" and "durable powers of attorney setting forth medical declarations") that make a person's wishes concerning the continuation or withholding or removing of life-sustaining systems should be encouraged, and this Church's members are encouraged to execute such advance written directives during good health and competence and that the execution of such advance written directives constitute loving and moral acts.
These principles continue to be appropriate regarding decisions at the end of life. As noted in the Report of the Standing Committee on National Concerns, the issue of medical futility has become an important part of ethical discussion at the end of life, and a matter of great controversy in some situations. Many health care facilities and some states have established specific policies and practices regarding medical futility, policies and practices with which patients and families may not be familiar. The Church is in an important position to provide support and moral reflection regarding care and futility at the end of life
Professional chaplains and other ministers in health care and specialized ministries are specially trained and experienced both in the moral principles of the Church and of health care, and in interacting within the structures of health care institutions. Thus, they are particularly prepared to serve as resource persons in discussion of and in decisions regarding appropriate care and futility at the end of life.
The Office of the Bishop Suffragan for Chaplaincies has the responsibility of endorsing Episcopal chaplains for specialized ministries in military and federal positions, and in health care. The Assembly of Episcopal Healthcare Chaplains (AEHC) and National Episcopal Health Ministries (NEHM) are organizations within the Episcopal Church supporting health care ministries in health care institutions, and in parish-based ministries, respectively. Both were recognized in General Convention resolution 2000-A079s as "Episcopal healthcare groups." The Association for Clinical Pastoral Education (ACPE), the Association of Professional Chaplains (APC), and the College for Pastoral Supervision and Psychotherapy (CPSP) are national, multifaith organizations that certify chaplains for pastoral practice and education. Episcopal chaplains have been active as members and leaders in all three organizations. All are committed to supporting persons from all faith backgrounds in pastoral care and in decisions at the end of life.

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