Thursday, April 02, 2009

General Convention 2009: Health Issues 1

As I have already mentioned, this is a General Convention year. One thing that means is that I’ll begin once again to look at what has been proposed for this Convention on issues related to health care.

The first place to look is in the report to General Convention of the Standing Commission on Health. This Commission, long dormant, was officially reestablished at the 2003 General Convention, but without funding. In 2006 the Commission was incorporated into an extensive resolution on structure, and was given some (sadly, minimal) funding for the 2006-2009 triennium. Most meetings of the Commission were online, or by phone conference, with only one full face-to-face meeting. That said, the report addresses a number of issues, and I’ll deal with them in turn.

One issue addressed, one that is particularly apt, is that of universal access to health care. This section of the report is brief enough to include it in its entirety:

The [Standing Commission on Health] affirms the continuing advocacy of the Office of Governmental Relations in their lobbying for a health care system in which all may be guaranteed decent and appropriate primary health care during their lives and as they approach death. The SCOH remains concerned that approximately 45 million Americans lack health insurance, and that about 116 million Americans struggle to pay medical bills, are uninsured or underinsured for a time and go without needed care due to the cost.

The SCOH recognizes that the lack of access to medical care has resulted in some of the following negative health consequences for the uninsured: fewer cancer screenings, mammograms, and dental exams; delayed test results and treatment; unfilled or skipped drug prescriptions; and more emergency and hospital visits for care. The uninsured receive inadequate care, endure more pain and suffering and are more likely to die sooner than those who have health insurance coverage.

The SCOH calls attention to the critical impact of the lack of coverage on children, who are more likely to receive little or no care, develop chronic and serious conditions and have an increased risk of hospitalization.

For these reasons, the SCOH reaffirms the positions taken by General Conventions 1991 and 1994 decrying the inequitable health care delivery system of the United States of America and calls upon the President, the Congress, Governors and other leaders to devise a system of universal access for the people of our country and declaring that universal access to quality, cost effective health care services be considered necessary for everyone in the population. (Emphasis in the original)

I have written before of the resolutions cited in this statement. The situation has only become more dire since 1994, and so there is all the more reason for the Episcopal Church to continue a commitment to universal access to health care. That would not require a resolution. On the other hand, as short as our memories can be between General Conventions, I don’t think a resolution would hurt.

The next section of the report is on End of Life Issues. It is also concise.

The Association of Episcopal Healthcare Chaplains and the National Association of Professional Chaplains [sic], who serve on the front line in hospitals across the country and in the places where our military are serving, reported to the SCOH on their urgent concern about the appalling lack of knowledge of end-of-life issues on the part of patients, families, clergy and others as they face end-of-life decisions. The chaplains stressed the utmost importance of continuing and improved education about these issues, including educational opportunities regarding Hospice Care and Palliative Care.

With this report, the SCOH strongly reaffirms the positions taken by General Conventions in 1991 and 1994, found in Resolutions 1991-A093 and 1994-A056, which ‘Establish Principles with Regard to the Prolongation of Life’. Such principles include:

  • Although human life is sacred, death is part of the earthly cycle of life.
  • It is morally wrong and unacceptable to take a human life in order to relieve the suffering caused by incurable disease.
  • Palliative treatment to relieve the pain of persons with progressive incurable illnesses, even if done with knowledge that a hastened death may result, is consistent with theological tenets regarding the sanctity of life.
  • There is no moral obligation to prolong the act of dying by extraordinary means and at all costs if a dying person is ill and has no reasonable expectation of recovery.
  • The 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.
  • 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.
  • The patient’s right to self-determination should be respected when a decision is made to be transferred to another facility.
  • Advance written directives should be encouraged, and church members are encouraged to execute such advance directives during good health and competence. The executions of such advance written directives constitute loving and moral acts.

I fear there are a couple of mistakes here that need to be noted. I believe the report intends to refer to the Assembly of Episcopal Healthcare Chaplains (as opposed to Association), and to the Association of Professional Chaplains (I’m not familiar with any organization called the National Association of Professional Chaplains or NAPC). Also, while I’m a past president of AEHC and am Board Certified in APC, I’m also aware of chaplains in other organizations “who serve on the front line in hospitals across the country.” ACPE and CPSP come immediately to mind. This mistake notwithstanding (and I’m sure it is simply a mistake), I am sure that all of us who are Episcopal chaplains share an “urgent concern about the appalling lack of knowledge of end-of-life issues on the part of patients, families, clergy and others as they face end-of-life decisions.”

I have also written about the resolutions cited in this part of the report (here and here). I appreciate that the report quotes the central points of those resolutions. Once again, I appreciate that in receiving this Report the General Convention will be reaffirming positions already taken, so that a resolution would not be required. Once again, I wonder whether a resolution might not have emphasized and publicized the point.

So, let’s start there. These are the first two issues addressed in the report of the Standing Commission on Health. As of this date there have been no resolutions submitted on these subjects. It will be interesting to see whether any are submitted, and what their content might be.

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