Monday, April 06, 2009

General Convention 2009: Health Issues 2

Let me continue with the Report to General Convention of the Standing Commission on Health and highlight some other issues raised in the report.

As a hospital chaplain, I’m always particularly aware that papers like this Report focus on health issues as they’re visible in the parish. The fact is that this is appropriate. As important as I feel my ministry is, the sickbed is not the normative experience of the Christian; nor is my ministry at the sickbed the normative experience of Christian ministry for the Christian. Most Christians experience their faith in and with their congregations; and the normative experience they have of ministry, and even of ministry at the sickbed, is with their congregational clergy. I’m happy to support and to complement that; but when those relationships are established, complementary care is the best I have to offer.

So, I note with interest that one of the topics addressed in the report falls under the heading of “Episcopal Health Ministries.” The subject is health ministries developed in and from the parish, and especially Parish Nurses and Ministers of Health. This is the first topic for which the Commission offers a resolution to General Convention:

the House of ______ concurring, That the 76th General Convention urges the congregations of The Episcopal Church, which have not already done so, to explore and implement health ministry as an organizing concept or vital component of outreach and pastoral care of the congregations by 2012; and be it further

Resolved, That the General Convention selects the Sunday closest to St. Luke’s Day (October 18) to be observed annually as Health Ministry Sunday for the recognition of health professionals in the congregation; for consideration of health systems upon the lives of the congregation’s members; for study of the abundant biblical references to health and healing; and for expansion of understanding about health to include body, mind and spirit.

In the Explanation of the resolution, the Commission notes that “Health ministries play a unique and critical role in facilitating the overall health of clergy, staff and congregation.” This is consistent with their comment in the Report itself that “Much of this ministry helps prevent serious illnesses from developing
among the parishioners.”

The Explanation also highlights the work of National Episcopal Health Ministries (NEHM), noting that “NEHM is a valuable resource for those seeking assistance in the development of faith ministries.” I have been aware of the work of NEHM for some time. NEHM, along with the Assembly of Episcopal Healthcare Chaplains (AEHC), was named in Resolution 2000-A079, which first called for a gathering of “representatives of the Episcopal healthcare groups (including the Association of Episcopal Healthcare Chaplains and the National Episcopal Healthcare Ministries) and individuals representing various professions in healthcare and in healthcare policy (recognizing the need for advice on the financial challenges inherent in this area), as well as those engaged in the teaching of, and research on medical ethics and end-of-life issues,” and which resulted in the 2001 Formative Symposium on Health Care. The folks at NEHM have been faithful and consistent advocates for parish-based health ministries, while also appreciating the importance of spiritual care in clinical settings.

The report notes the value of ministries in the parish that might, among other things, provide screenings for many different health issues, to administer vaccines and to organize educational seminars on health issues.” In noting specifically the educational opportunities, the Report points to another issue of importance. That is “Health Literacy.” The Report notes,

In working with those who are carrying out ministries in health care, the SCOH notes that many report that patients and their families often do not understand the basic health information and services needed to make appropriate health decisions. The National Center for Educational Statistics has reported the following:

  • Nearly half (89 million) of American adults cannot understand basic health information.
  • One in three American adults has limited health literacy.
  • 40-80% of medical information that health care providers give is immediately forgotten by patients.
  • Reading level is not always the same as the highest grade of school completed.
  • Most adults read and comprehend information three to five grades below their highest grade completed.
  • One of the many side affects of lower health literacy is premature death. High risk individuals are elderly persons with severe disabilities; persons who are members of cultural, linguistic and ethnic minorities; persons who are chronically underemployed; and persons who are homeless.
  • The SCOH notes that church members can be of significant help in explaining and interpreting information to others as volunteers and friends. Informed decisions can only be made with informed minds and hearts.

Where I work health literacy is certainly a critical issue. It affects any number of healthcare issues. With limited health literacy and so many immediately forgetting what they hear (largely because of stress or because of failure of the provider to “speak English,” and not because of indifference or inattention), we have continuing crises with patient compliance and self-care. Those result in significant waste of resources including money, trying to remediate health crises that might have been prevented. They affect how people understand end of life issues, which the Report addressed; and how people understand news reports on health and fitness. Parish Nurses and Health Ministers, and other kinds of parish-based health ministries, are in a good position to identify parishioners with special needs, to companion them through health decisions, and to education the congregation as a whole on important health and wellness information.

As this Report has noted, the Episcopal Church has a history of supporting universal access to health care. I look forward to some significant changes (well, I think they’re improvements) in how health care is delivered in our society. However, improvements in the delivery system will not eliminate issues of health literacy, nor will they displace the opportunities for ongoing care and support that can be met in parish-based health ministries. These are important issues that the Episcopal Church can not only speak to, but can respond to in our local congregations. So, they are important issues in this Report to General Convention.


Rowena said...

I have begun to read your blog... As a Uniting Church chaplain in an Australian hospital, I find your account of your life really interesting... Seeing similarities and differences in our ministries and situations. Thanks.

Marshall Scott said...


Welcome. It's always interesting to hear from colleagues whose cultural settings are different. When you see interesting differences, feel free to comment.

By the way, if you'll look at the left column for the link to the blog, "Hoosier Daddy in Oz," you might want to check it out. The author is an American chaplain now serving in a Canberra hospital. He and I are acquainted from professional meetings here in the US before he went walkabout. He's also noting some of the differences.

Oh, and I had a great aunt and a cousin named Rowena. It's a name we don't hear as often these days.

Mark said...

As a person closely connected with health care, do you have an opinion on the Catholic position on 'conscience' refusal to make referals and especially on a pharamist refusal to dispense items (like birth control pills)that he/she regards the use of as 'sinful?' Jack

Marshall Scott said...

Now that Easter is over....

Jack, I do have an opinion. There are several facets to it.

First, in general I believe that professional practitioners have some moral autonomy, and so in most cases have the right to decline to participate in procedures they consider inappropriate.

Second, I believe that patients have the right to choose about health care interventions and procedures - whether to accept or not. There are other principles that can temper that right - especially not doing harm to the patient, the patient's best interests, how it affects the rest of us - but in health care as currently practiced in America (and, indeed, in American culture in general) the individual's rights tend to drive care.

I think in general these issues can best be addressed by practice standards as professional associations establish them and as states expect them, and within those as health care institutions and businesses set their policies and practices.

In light of what I've already said, practice standards as I'm aware of them allow a practitioner to decline to participate in a procedure, but not to prevent a patient from getting care. So, a physician might say, "I cannot in good conscience participate in this, but I will provide care while you try to find someone else to work with;" thus, to decline to participate but not without referral. That's works reasonably well, but there are exceptions: where the physician or pharmacist is the only qualified person within 100 miles, for example; or where the physician or pharmacist believes that even referral is too much "participation" in the declined procedure to bear.

As a society we have not formally defined health care as a civil right. So, while I personally believe it's not right to say to a person, "Not only can I not participate in this aspect of your care, I will also not assist you in finding someone else;" the fact is that, subject to legal challenge by the patient, there's nothing in law to prevent that. Moreover, that was already the case for professional providers and institutions before the Bush Administration tried to articulate a broader rule for "professional protection." The rule articulated was so broad as to apply to many folks who weren't professional providers (and, no, it's not appropriate for an admitting clerk or a drug store clerk to make decisions without any training in or knowledge of patients' medical needs or best interests). So, I support the Obama Administration's decision to rescind that broader rule.

The difficulty, of course, is that in general parties on opposite poles of this issue aren't talking the same language. The moral principles are sometimes not connected with the scientific information. So, while most folks are really somewhere in the middle, it's easy for polarized folks to control the rhetoric.

So, who has a right to refuse, and to what extent? I think professionals need to follow the guidelines of their professional organizations and their institutions. I think they need to take into account that sometimes declining is doing harm to a patient (refusing to participate in ending a tubal pregnancy, for example, or refusing to administer a morning after pill to a woman who's been raped), and so the right to decline includes at least an obligation to refer; and may well be limited. I think the rights of professionals to participate or decline are primarily those of the patient and the professional, and don't apply to nonprofessional staff. And I think sometimes that if we need to change jobs to maintain our moral integrity, that's the price we have to be prepared to pay (and there are cases where that applies to a chaplain, too).

Frankly, I believe that health care should be a civil right in the United States. That would, of course, only make these issues more acute.

Mark said...


Thank you so much. I agree these are difficult issues. But it also seems to me that if a person is holding themselves out as a "public provider." (such as a pharmacist)they would have an obligation to provide "legal" medications. This would include birth control pills, condoms, and other birth control items. This reminds me a bit of the "public accomodations" situation of the 60's. If I have a restaurant, for example, I cannot refuse to serve a minority I happen to dislike.

This has some importance to me, since my daughter works at a hospital and her insurance, provided by the hospital would not cover birth control pills. At least that was the hospital's policy several years ago. I do not check on such matters often.:)

As far as the guys Alice and I support, I hope you can undestand how issues like this come up. And how, despite some ridicule, they do need access to a knowledgeable person like you they can ask a question to at times without doing so face to face.

I am especially nervous about the young man who is going to marry the Unitarian; he is Catholic. Let me put it simply and straightforward: Alice and I, in no way, want to discourage or disparage his faith. My wife and I differ very strongly with the RC church on matters of birth control. And for the just turned 20 young man we are not shocked at all that he may engage in " touching himself" at times.When he first came to live with us Alice found a condom in his jeans she was washing.

I don't know if any of this makes sense,but all we are trying to do is find someone who can give some help. WE-ALICE and I--believe they should have a right to other points of view. For example, all of us go to an Episcopal doctor. No problem. But if you ever have a chance to read any of the short essays by the guy getting married, I think you would see why we have concerns. A bad past, I guess you would call it, and now membership in a very conservative church, and in love with a Unitarian.:)

You do not know how much I appreciate your help, despite the guffaws from so many. I sincerely hope these guys with all their bad pasts can seek your advice. Jack