Healthcare workers are ministers of a God who loves life

Health workers are ministers for a God who loves life

By Professor Jim McManus

Catholics have a long history of working in health and social care. From the examples of the saints who have founded orders to the history of hospitals, to the work done today, the evidence is all around us.

Indeed, the Catholic Church worldwide today remains one of the biggest providers of health and social care globally, and is the single biggest provider of HIV and Aids care.

So why are we so interested in health and social care? Simply and solely because we see it as a commitment to human dignity and wholeness, and that in itself stems from the mission of Christ.

The fact is the Catholic Church’s position is and has been consistent for some time. Human beings are precious because they are precious to God. So we should cherish life, however weakened and disabled. It is precious. We should support people to achieve best health. But the Church has always balanced that by saying we should embrace natural death when it comes.

That means participation in this mission of health and healing is important to the Church because of what it sees as its participation in the mission of Christ. And workers who participate in this mission of health and healing – indeed, have a vocation to this – are important because they are doing something – paid or unpaid – that the Church sees as valuable and in many ways is central to its mission.

The Church has produced a range of consistent teaching for many years on this. What it hasn’t done terribly well is codify this or always make it readily accessible for us. St John Paul II created a Pontifical Council for Health Care Workers, and in his Apostolic Constitution Dolentium Hominum taught us much about suffering and our understanding of it.

Many would say he taught us even more by his bearing of it personally. In creating the Pontifical Council for Health Care Workers, he gave us a range of resources including a Charter for Health Care Workers which, sadly, have not received the coverage they should have. The council was recently, after 30 years, subsumed into the new papal organisation for Integral Human Development. Some see this as a retrograde step.

I disagree. Health and health care have to be about integral human development across the whole life course. And this gives us some new opportunities to articulate what being healthy means across our whole life.

Within the last month, a document which I believe needs a much wider audience was produced by the Vatican. Entitled A New Charter for Health Care Workers, this document – as yet, only available in Italian – represents nothing less than a major opportunity for us. I’ve already received invitations to lecture and teach on this. I hope an official English version will be made available soon. For the present, I am on my fourth reading of this document and it is nothing less than inspirational.

So why is this document important? I would like to advance a few reasons. First, it is a document which does joined up thinking. Health is hugely important to us as a human good, and it was important to Christ. That means that the ministry of healing, and the work of health and social care, is an important part of the Church’s ministry. This document rings that message out loud and clear. If you are a carer – paid or unpaid – you live the Church’s mission by encountering people in pain and need.

The document begins with a rather beautiful ‘ministry of health’ introduction and a preface re-iterating the teaching of St John Paul II. It frames the whole discussion of health and healthcare as part of the Church’s mission.

…the health care worker is ‘the minister of that God who in scripture is presented as “a lover of life”’ (Wisdom 11:26). To serve life is to serve God in the person: it is to become ‘a collaborator with God in restoring health to the sick body’ and to give praise and glory to God in the loving acceptance of life, especially if it is weak and ill.

The therapeutic ministry of health care workers is a sharing in the pastoral and evangelising work of the Church. Service to life becomes a ministry of salvation that is a message that implements the redeeming love of Christ. Doctors, nurses, other health care workers and voluntary assistants are called to be the living image of Christ and of his Church in loving the sick and the suffering: witnesses to “the gospel of life”.

Second, the document sets the whole journey of human life, and the issues of health and suffering, within the context of integral human development.

Third, the document links Catholic Social Teaching to issues of health quite explicitly. There is a framing of rights people have to health and healthcare within the duty of justice. The document frames healthcare quality within the context of justice too, and this theme of justice continues throughout. People have a right to the means to health (education, employment, food etc) and to good quality healthcare.

Fourth, the document takes a whole life course approach. The text is divided into sections on procreation, living and dying so there is a bioethical theme running through it (which sometimes dominates) but if you read closely the social justice for all theme is strongly there.

Fifth, and here I think very profoundly, the document attempts to join up an understanding of health, health care and the mystery of suffering. Health is a ‘good’ to enjoy. Suffering in some senses is something to avoid and so healing when we can cure is a participation in Christ’s healing ministry. But suffering is not valueless. It has a redemptive quality. We can offer it to God and unite ourselves with Christ in his suffering. We can learn through our pain – and I say that personally here.

Finally, I personally feel it says something profound about the nature of health. If people who suffer, or are disabled, are precious to God, health cannot be the perfect state of everything being wonderful that the aspirational 1948 World Health Organisation definition suggests. Health needs to be seen as an orientation to be the best we can be, for God, for self and for others, given our physical and psychological limitations. We need not be physically perfect. We must be realistic. But through it all we remain precious to God and the Church’s position on valuing all human life seen in this light is entirely consistent. Those we cannot cure we can support, sustain and learn from.

There is a wonderful section on death and dying which you would think was almost written as a development of some of the recent work on end-of-life care policy nationally. It says: ‘In the last days of life the dignity of the person should be understood as the right to die with greatest possible serenity, and with that human and Christian dignity which is their due.’ There’s a call to mission for Catholics if ever there was one.

It goes on to remind us of the importance of spiritual care at end of life. ‘The spiritual crisis which comes as death approaches, compels the Church to bear the light of hope to the dying person and their loved ones, a light which only faith can shed on the mystery of dying.’

Seen in this light, the Art of Dying Well website www.artofdyingwell.org is a clear attempt to communicate these riches of the Church’s understanding to a society which really needs them.

This document gives us some major opportunities. And it comes at the right time as in all of the four health systems of the UK, we see some significant changes being wrought.

The diocese of Westminster has already spurred a season – Called to Serve the Sick – which is intended to be a practical continuation of the Year of Mercy. This new charter lands right in the middle of that season.

A series of roadshows, championed by Bishop Paul McAleenan, will discuss a Catholic understanding of health and social care, why Catholics should feel a particular vocation to health and social care, and what parishes can do about it. “It is fitting that this season comes as a continuation of the Year of Mercy, giving us the opportunity to practise that most important act of Christian love, care for our neighbour,” says Bishop Paul. “Good health, poor health, disability and ultimately our death, are integral aspects of what it means to be humans precious to God, and so they are of huge importance to us as Catholics.”

To register and for more information and resources go to www.rcdow.org.uk/called-to-serve-the-sick

He added: “The Church has a special place of value for those who are sick, those with disabilities and those who work with and for them. Cardinal Vincent and I very much want priests, deacons, religious and lay faithful to understand that working with the sick is part of their core ministry and mission”.

At the same time, new resources are being published by CTS. A Priest’s Guide to Hospital Ministry and a Catholic Patient’s Guide to Being in Hospital are available from www.ctsbooks.org

Professor Jim McManus is director of public health for Hertfordshire, and a consultant to the Art of Dying Well.
For more, see www.artofdyingwell.org

Advertisements

Linking Health and Faith: re-learning old lessons

One of my scientific and theological interests has, for some time, been dialoguing scientific evidence on health and medicine with faith.  I believe dialogue between health and faith needs to be scientifically, theologically and epistemologically rigorous in equal measure.  A growing body of robust scientific research is remembering what people of faith seem to have not quite forgotten, than people mediate their understanding of health, and their coping and living strategies, at least in part through their belief systems. That has profound implications for our health and wellbeing.

 

 

Some practical examples

Less than a month from now, in October 2017 a new series of videos, and in November a website Positive Faith will be launched as one embodiment of this. This will be series of videos and resources by, about and for people living with and affected by HIV. This exercise has been funded by Public Health England, and led by Catholics for AIDS Prevention and Support.  The resource privileges the voices of People with HIV over professionals of any kind. People with HIV explicitly address these issues of health and belief.

The FaithAction health and faith portal remains, for me, one of the great things to come out of Public Health England’s partnerships with the community sector because it works at applying these lessons and collates practical examples.  There are many more. I have been privileged to work with  FaithAction for some time. Their report contextualising the evidence on faith and health for UK commissioners and policymakers is important reading.   Their work on mental health and dementia friendly places of worship has much to offer a prevention and community engagement agenda.  FaithAction have created a series of resources for commissioners, practitioners and faith communities to use together.

A series of Catholic mental health demonstration projects has been delivered.  A mental health access pack for Churches – written by professionals and experts by experience – has been created by a charity whose values commit them to work on disability and health. You can read my invited blog on why I endorse the pack, here.

The University of Leeds with Leeds Public Health team has explored the links and barriers between religion and public health in some really exciting work on mental health.

I don’t claim any of what I say here makes people of faith better or more special than those of no faith in the world of health and care. I merely say that we have legitimate and understandable motivations and values to be in that world, and we have a contribution to make every bit as valuable as anyone else.  And our values inform that. We can no more leave our values or identity at the door that anyone else.

Faith cannot be the one “protected characteristic” that is private when every other one is recognised to be part and parcel of the person. But that’s for another blog.

The scientific evidence behind this

Most of you who know me well know this is an area of interest. I do my job because of my value base.  Early next year my review article on some of the best recent publications in health and faith will make its appearance in Reviews in Religion and Theology

In the process of entertaining this interest I have amassed a smallish library of 200 volumes in several languages, including volumes which stand out like Ellen Idler’s (the polymath Epidemiologist and Sociologist) recent and rather excellent Public Health volume on Religion as a social determinant of public health , the brilliant theological/philosophical work Flourishing by one of my theological heroes Neil Messer  and a range of materials on psychology, psychopathology and religion.  I’m preparing this collection (well the stuff in English anyway) for donation to a library where people will get easier access to it.

Faith still relevant to our population

Some of you may think Faith – especially explicitly religious faith – is a minority interest. Well you may be right, but that minority is still between 37% and 43% of the population depending on who you speak to.  We wouldn’t now be so discriminatory as to dismiss LGBT populations because they’re 2% – 3% of the population depending on who you read, would we?   So let’s recognise that our value bases inform who we are, and most of us are part of some minority. It’s inclusion of every minority’s best offerings which makes social life vibrant.

Prof Stephen Bullivant a sociologist at St Mary’s University has undertaken analysis of ONS data (I believe as yet unpublished) which suggests that, for example, Catholics are present in the health and care field in numbers around eight times more than they would be if they were just present in the same proportion as their presence in the general population.  Incidentally, Stephen Bullivant’s recent report on the “No Religion” population is a good read for anyone in public policy.

People still understand and filter their health experiences, beliefs, behaviours and life choices (including the choice to serve) through their religious belief.  NICE guidance recognises that and has stated there is a strong evidential case for its salience in care.  It is folly not to engage with this. My invited paper to the Equality and Human Rights Commission on what this means for healthcare employers in terms of workforce strategy, service quality and equality and diversity law explores the practical and organisational implications of this further.  The growth of non-religious spiritual and pastoral care in our hospitals, recognising that humanists and others who describe themselves as non-theist and non religious, have spiritual needs too, is welcome and valuable alongside care for those who do have religious faith.

The Guild of Health and St Raphael

A short while ago, I was approached by the Guild of Health and St Raphael to become their president, a role which I shortly take on, after a bit of reflection and dithering on my part. I look forward to this immensely.  It came, to me at any rate, as something of a shock. I did the “why on earth would they want me, couldn’t they find anyone better?” And “why  on earth would they want a Catholic? ”  thing. I then thought of suggesting Archbishop Justin Welby before realising he’s a patron already.  And then I thought of Lord Rowan Williams, who’s a patron of something else they do already. Whoops!

In discussing this with a good colleague , she reminded me that she calls me “the health and faith babel fish”. By which she means I seem to be good at translating the field of health to the field of faith. She asked me “do you think the Guild does important things?” “Yes”, I answered. “Does it have a sound theology?”  “Yes”.  Have they got people who are scientifically credible?”  Again, “yes”. Just for starters, the Director, Gillian Straine is a PhD qualified Scientist and an ordained Anglican priest.  “Does it resonate with your desire to make clear the links between health and faith?” “Yes, vey much so.” “Well, then in your own words -get on with it.”   And so, with that kick up the motivations, here begins a journey.

Formed in 1904 to bring together members of the clergy and medical professions to study and promote the healing ministry of the Church, it claims to be the oldest organisation in the UK working in the field of Christian health.  Anglican in heritage it is now ecumenical in outlook. The two Anglican Archbishops of York and Canterbury are Patrons along with the Methodist Church’s President, and now the Guild has let in a – rather stumbling – Catholic President! (What were they thinking, I hear you ask?)  An academic journal is coming. And practical resources. We have plans!

Academic community of interest

The academic community interested in the crossover between health and faith in the UK is growing. From Professor Chris Cook (psychiatry and psychology) at Durham, to the Guild’s newly launched Raphael Institute collaboration with epidemiologists, scientists, medics and psychologists, through to the work of Professor Michael King at UCL and many others I could mention, a body of work is beginning to be pumped out in a UK context examining the links between health and faith.  Similar communities in German medical schools, Swiss Universities,  Italy and, of course, the United States are creating work of use and value to the public health community.

Putting effort where my mouth is

There are a number of reasons why I am delighted to take on the role of President. First, Health and Faith, and the links between it, are an enduring interest.  My paid professional role as a Director of Public Health seeks to improve and protect the health of a population, something to me which resonates deeply with the call I believe all faiths – including the humanists I am lucky to know and learn from – have to improve human life and hold in good stewardship our earth.  I have written elsewhere, in The Universe about the vocational aspect of this.   And I guess as part of that I need to play my part in dialoguing the health and faith world constructively and rigorously to help us find what mitigates for maximum human flourishing – for those of all faiths and none.  That doesn’t mean those of us of faith leave our values at the door of the office, by the way.

The second is that participation in the work of ensuring people are as healthy as possible, in all dimensions, is a direct participation in one of the ultimate purposes of what most people of faiths do – the cherishing of and service to the human. Visit a Sikh or Jewish social service centre if you haven’t ever done so. You’ll be amazed.

The third is that because of this insight, people of faith have much to offer from “all our best traditions” as the hymn goes to the world of healthcare, and to the whole issue of what health means.  In fact, we were here first. Long before the NHS, before organised health care, we were there.  And people like the Historian of Science Gary Ferngren and others are writing the history of that engagement.

Christian Social Teaching as a Health Inequalities Manifesto

A further reason is that this provides a much needed opportunity to explicitly link Catholic Social Teaching (sometimes called the Catholic Church’s best kept secret) and its seven principles embodying Justice, dignity of the person and so on to issues of health.  Read any book on inequalities in health and a book catholic social teaching side by side and they say very similar things.  People have a right to health, and the means to health including good , healthcare, education and so much else and this is part of doing justice to our world. Good quality healthcare is framed as an exercise in justice and love in such teaching. I can find that link implicitly or explicitly everywhere I look. The founder of the Science of Healthcare Quality and Healthcare Improvement, who was not a Catholic, explicitly defined Quality Improvement in Healthcare as an exercise in love.  The links are significant. For more on the seven principles of Catholic Social Teaching, read here. Recent changes over the past fifteen years in US health care policy have generated a significant body of Catholic thought on Just Health Care policy including a whole body of thought on access. I’ll be discussing my take on what Public Health and Catholic Social Teaching agree on with regard to access, equity, justice and commissioning policy at an International conference on mental health in Oxford in summer 2018.

The fourth reason is that now, explicitly in the policy frameworks of all of the four devolved administrations of the UK, there is the recognition that health has many social dimensions, and needs social actors. This is a Kairos moment – an auspicious time when we can speak into the agenda of what it means to be healthy, and what health and social care is about. We have things to say.  And that means re-energising communities about what they can do on their health.  Faith communities can be a part of this. And examples of good practice here abound, from dementia friendly places of worship to social inclusion programmes and projects for people with long term conditions.

The riches of tradition informs the progress of today

The fifth reason is that while each of us can offer things from our own tradition – I have a particular tradition which feeds my commitment to improve and protect the heath of the population.  I don’t claim it’s better, I just claim it has enduring relevance. Catholics founded religious orders dedicated to health and healing, for example. Countless people we call saints have been engaged in health.  The St Vincent de Paul Society is a Catholic charity providing help from white goods to holiday breaks to clothing to utility crisis payments and has a bigger volunteer workforce than CAB last time I looked.  Entirely funded by Catholics.  Mary Aikenhead, founded the order which created the hospice of which I am a trustee. Her values of advocacy for and inclusion of the most excluded (and said in those words) are a constant reminder to me not to become complacent in a public health system where it would be easy just not to try  to find a way through the cuts being imposed on us.

Those Catholic religious orders still run health and care services across the World and the UK (and over 150 centres from hospices to refuges for victims of human trafficking in England today).  One of those orders is the biggest non-governmental emergency aid agency in the world, among whose volunteers I am proud to count myself. My tradition is supposed to roll up its sleeves, include and serve. (and it often needs a good kick to remind it of that.) Moreover, my tradition attests to the fact that health is social as much as it is individual.  These must go together. No human being is anything other than precious.  Justice, Love and Hope are the hinges on which we embody that insight.

Institutions sometimes get decadent and fail people. That happens in the NHS and public sector as much as it happens in the churches. The point is that continual renewing of our purpose – maximum human flourishing. Every faith which has a sense of the divine is at its best committed to human flourish and justice – even if at its worst we shamefully can and do at times betray and sully that commitment – because we believe that’s what God wants for God’s world.

The whole person

The sixth reason I am keen to do this is because the scientific evidence supports these insights as much as it informs them. We are becoming increasingly aware that health includes the whole person, and especially for those who cannot be cured, health is about making a good response to the realities we face. Like the Guild’s Director, Gillian, I am a cancer survivor, lucky to be alive after a Grade IVB lymphoma. Like Gillian, that experience has shaped how I am rediscovering the riches of the Christian tradition to speak to today’s world on health. Her book Cancer: a pilgrim companion is a brilliant read.

For those with long term conditions or disabilities, those with long term mental health challenges, those who are dying, the World Health Organization’s definition of health as a complete state of psychological, physical, spiritual wellbeing is hopelessly optimistic, and unreal. It implies they are less than fully human, and with that comes the risk they become devalued.  That is not a Christian view. Suffering, limitations and disabilities are not valueless.  It is also not a view that sits with the science of health inequalities, otherwise why bother with the discourse of tertiary prevention?

The World Health Organisation’s vision is valuable, but its valuable because of where it points us. It is future rather than present, a hope for the future. That means we have to revisit what health means here and now. And I would argue that the science and our theology are mutually affirming on this, and the Guild is ideally placed to do that work from the academic work at one end of the spectrum to the work of caring, praying and doing at the other.

Called to serve

Earlier this year, The RC Diocese of Westminster led a season of events entitled Called to Serve the Sick. I hate the term “the sick” but that’s for another time.  The series was intended to be a practical continuation of Catholics being recalled by Pope Francis in 2016 to serve and welcome, when we sometimes exclude too easily.  A series of roadshows, which I was privileged to present at, discussed a Catholic Understanding of Health and Social Care, why Catholics should feel a particular importance of committing to health, social justice and social care, and what local communities can do about it. We had an audience of health and care workers, and people struggling with health issues. And people of all faiths and none. We’ve been asked to do more. There is a demand for this work. And a useful reflection on why should Catholics be interested in healthcare is here

The Bishop who led this season, Bishop Paul McAleenan said that “It is fitting that this season comes as a continuation of the Year of Mercy, giving us the opportunity to practice that most important act of Christian love, care for our neighbour. Good health, poor health, disability and ultimately our death, are integral aspects of what it means to be humans precious to God, and so they are of huge importance to us as people of faith.

On this, I hope, people of all faiths and none can make common cause.

Catholic Medical Association UK statement on the Liverpool Care Pathway

Catholic Medical Association (UK)

 

NEWS RELEASE

FOR IMMEDIATE RELEASE: TUES 16 JULY 2013

 

The CMA(UK) notes with huge sadness the deep anxieties about poor care which the Neuberger inquiry  into  the Liverpool  Care Pathway  has identified. Patients who are coming towards the end of their lives require the best possible care and excellent symptom control as well as careful review of their treatments to assure that they are appropriate.

 As Catholic Clinicians and Healthcare Professionals we support the need for high quality, personalised care for people at the end of their life, which enables them to die with dignity, free from pain and thirst.

It is vital for our society to get end of life care right.  We recognise that the Liverpool Care Pathway was well intentioned but as the Neuberger report has identified there have been problems with implementation where poor care has happened, or the pathway has failed. This has unacceptably harmed patients and their relatives at a time when the priority should be to give good quality care.

 Consistent standards and compassion are needed

As work progresses towards phasing out the Liverpool Care Pathway, care towards the end of life in the UK remains too much of a patchwork and we call on Government to ensure that consistent high quality standards driven by best possible evidence, strong clinical practice, motivated by compassion and love for the human person are put at the centre of the care of patients approaching death whether in hospital, hospice or the community.

Tick box and formulaic approaches to the care of the dying are not acceptable. Any Care Pathway which is not underpinned by training, commitment, resourcing and effective clinical practice will be likely to fail. It is vital that support of those who are dying is based more clearly upon individual assessment of need which is regularly repeated and where treatment and care is shaped and adjusted accordingly.

The elements of good care towards the end of life

 Good care towards the end of life is not so much about death, rather it is about how someone lives in their last months, weeks and days.

 Patients who are coming towards the end of their lives require the best possible care and excellent symptom control as well as careful review of their treatments to assure that they are appropriate. The CMA therefore strongly supports the principles and good practice of palliative care.

The true outcome of care is comfort, dignity and living as well  as possible while people die. As well as that, preparation for and acceptance of death  is important for many.

In many ways “End of Life Care” is a misnomer which prompts people to think that the outcome of care is death.  “Palliative Care towards the end of life” is a better term than “End of Life Care” which would focus minds better upon living well until someone dies, with the excellent palliative care that it necessarily entails.

Our clinical experience and practice convinces us that the emphasis in end of life care must be placed upon needs of those who are dying rather than decisions based solely around prognosis.

Deprivation of consciousness (inappropriately sedating people) is a serious issue that is contrary to Catholic teaching and which deprives people of time with their loved ones as they die.

The CMA is committed to delivering best possible care

As work progresses towards a better way  of supporting people who  are coming towards the end of their lives, the CMA wishes to express its deep  commitment towards the best possible care in all clinical situations, from those dealing with the whole of people’s lives to those where patients are possibly approaching death.

We attempt to work with all systems of Health Care to improve the delivery of care using the Catholic Christian model for (the) excellence of care according to the inviolable nature of the dignity of the human person. We feel that Catholic insights on the dignity of the person, providing care from compassion tailored to the individual, and ensuring people can spend their last weeks and months in dignity are insights the healthcare system needs to re-learn.

 

Useful  Questions for Relatives and Families and Carers to ask

Relatives, families and carers of patients should be seen as partners in care at end of life.  While we work to improve care towards the  end of life care, we suggest  the following questions that  patients and their families may  find helpful  as they  discuss their loved ones care with  doctors and nurses to  ensure that  care is appropriate .

·         Are you sure that death is imminent?

·         Can the patient give consent to the treatment proposed?

·         Will the treatment reduce consciousness?

·         What effects will the treatment have, including the combined effects of the drugs proposed, and their effectiveness in reducing severely troublesome symptoms?

·         Will you assure that the patient will not experience thirst and can fluids be given by mouth or another way?

·         Will death be hastened by what is proposed?

Soundbite 1

“The CMA works towards the best possible care in all clinical situations, from those dealing with the whole of people’s lives to those where patients are possibly approaching death. We attempt to work with all systems of Health Care to improve the delivery of care using the Catholic Christian model for the excellence of care according to the inviolable nature of the dignity of the human person.”

 

Note for Editors: About the Catholic Medical  Association

The CMA exists to support Catholic Health Care Professionals and students of those professions in their daily working lives. It does this by mutual  support,  meetings and education as well  as working nationally and internationally with all systems of Health Care to improve the delivery of care using the Catholic Christian model for the excellence of care according to the inviolable nature of the dignity of the human person. We also publish  the Catholic Medical  Quarterly.

www.catholicmedicalassociation.org.uk

Drug trials must not abuse peoples’ rights, European Bishops tell EU

Drugs trials necessary but must respect the vulnerable

Drugs trials are necessary before drugs come to market, but those conducting them have ethical duties to obtain consent and respect the rights of those from developing countries, says a statement on behalf of all Catholic Churches in the European Union.

COMECE, the Commission of the Bishops’ Conferences of the European Union, issued the statement through its Bioethics committee in response to the EU Proposal for “A Regulation on clinical trials on medicinal products for human use’ which aims at re-launching clinical research within the EU while at the same time ensuring protection to participants as well as the reliability of the acquired data. The European Commission proposed regulation which will be submitted to a vote of the European Parliament next 29 May

The statement on Ethical assessment of clinical trials on medicinal products: Respect and protection of vulnerable persons and populations  was released by COMECE this week in English and French.

Importance of consent

“Many people who are unable to give consent as well as people from less-developed countries often participate in clinical trials.” The COMECE statement asks how we can better protect them and vulnerable populations against abuse in the process.

The COMECE bioethics team conclude that  EU proposal could go further in the protection of the people concerned. A spokesperson said:

“The COMECE Secretariat welcomes this proposal for a Regulation as it goes in the right direction. The COMECE Reflection Group on Bioethics has monitored the issue from the launch of the public consultation by the European Commission and publishes today its Opinion on this proposal for a Regulation. ”

Key ethical concerns and principles

The COMECE team underlined some principles which they feel should be implemented in the proposed EU Regulation :

Volunteering

“The appreciation of the value of voluntary participation in research projects for the good of the community:  granting financial incentives to any person agreeing to take part in some medical research therefore raises ethical issues.”

Protecting those particularly vulnerable

“A key ethical consideration for research carried out on human subjects is that of respecting and protecting particularly vulnerable people and populations who could be unduly used as easily-exploitable objects for experiments.”

Benefits for the population concerned, especially in developing countries

“Clinical research with a disadvantaged or vulnerable population or community is justified only if it responds to its health needs and priorities and if it is likely that such a population or community will benefit from the results of the research.”

Security of the participants to tests

“The subject of research may agree to become involved in a research protocol that does not fully respond to the individual’s own interests but will do so for the good of others, in the “medical interest of the community” and consequently for the “common good”, insofar as the patient’s physical or psychological integrity is not endangered.” This underlines the importance of full and informed consent.

Benefits to the person incapable of consent

“Trial medicinal products should not be given to persons who are not capable of giving their consent except in cases where the same results cannot be obtained by resorting to persons capable of giving their consent and if the foreseeable benefits/predictable risks ratio is to their advantage.”

Ethics of testing in emergency situations

As for clinical trials in emergency situations, “the only acceptable research is specific research on individuals placed in such a situation that one may have good grounds for anticipating a direct benefit with regard to their condition and that would present a minimal risk and only impose a minimal burden. It is also important to give a sufficiently precise definition of the terms “minimal risk” and “minimal burden”. ”

The full statement on Ethical assessment of clinical trials on medicinal products: Respect and protection of vulnerable persons and populations is available in English and French

Vatican supports new direction on health for World Health Organization

This week has seen several interventions by the Vatican delegation to the World Health Organization’s key decision making body.

The Sixty-sixth World Health Assembly , which is the  decision-making body of the World Health Organization , and in turn the  public health body of the United Nations was taking place this week in Geneva.

Catholic support for improving population health

Archbishop Zygmunt Zimowski,  head of the Holy See’s delegation, in a brief but wide-ranging speech

  • called on WHO to affirm the centrality of spiritual needs to any approach to universal health care
  • supported the WHO’s aims to prevent non-communicable diseases such as Heart Disease and Cancer
  • affirmed the need to control and prevent disease in older people
  • supported WHO intentions to further reduce preventable deaths especially in women and children but differed on emergency contraception from WHO’s suggested stance
  • reminded the WHO of the significance of the Catholic Church’s health care agencies and infrastructure (up to 25% of HIV care worldwide, over 50% of health care in some countries)

Archishop Zimowski’s intervention is covered in more detail on Catholics in Healthcare blog.

Responding to WHO General Secretary on health of women and children

Dr Margaret Chan, Director General, outlined her goals for her time as Director General as including  “the health of women and of the people of Africa.” Archbishop Silvo Tomasi, the Holy See’s Permanent Observer to the United Nations and part of the Holy See’s delegation at the Assembly expressed his support for these objectives, and went on to explain the Catholic Church’s global and local experience in those areas.

Health of the people of Africa

The Archbishop went on to offer the experience of the Church in support of Dr Chan’s goal for improving the health of the people of Africa. “[M]any nations are still in the grip of famine, war, racial and tribal tensions, political instability and the violation of human rights.” Pope Benedict XVI’s exhortation to the international community is also very appropriate, “we must not forget Africa ….”

Emphasising the care of the whole person

Tomasi finalised his intervention with a vision of health that reminded the WHO of it’s own aspirational definition of health. We should seek a deeper care for every aspect of the human person.

“My delegation urges a perspective on health security that is grounded on an anthropology respectful of the human person in his or her integrity and looks far beyond the absence of disease to the full harmony and sound balance of the physical, emotional, spiritual and social forces within the human person.”

In recent years the Vatican has moved to emphasise not only its stance on reproductive health at WHO events but has taken on a stronger public health focus. This latest WHO Assembly has seen Vatican interventions aimed at sharing the wider health and social justice concerns of the Church.

World Health Organization told spiritual needs “integral” to universal health care

The Sixty-sixth World Health Assembly was told this week that any integral approach to universal health care coverage must include addressing the spiritual needs of populations.

The Assembly is the decision-making body of the World Health Organization , the health and public health body of the United Nations and has universal health care coverage as one of its key strategic aims.

In a wide-ranging intervention which also signalled strong Vatican support for universal health-care measures, Archbishop Zygmunt Zimowski, President of the Vatican’s Pontifical Council for Health Care Workers and head of the Holy See’s delegation to the World Health Assembly said that any “integral” approach to healthcare need must focus on “the spiritual state of the person” and not just medical interventions or economic growth.

“Health and development ought to be integral if they are to respond fully to the needs of every human person. What we hold important is the human person – each person, each group of people, and humanity as a whole.”

The archbishop said that health care contributes to the development of nations “and benefits from it.” The Holy See “strongly believes” that universal health care coverage as a goal of government policy is a more certain way to achieve “the wide range of health concerns,” including preserving present advances.

The archbishop said that health care contributes to the development of nations “and benefits from it.” The Holy See “strongly believes” that universal health care coverage as a goal of government policy is a more certain way to achieve “the wide range of health concerns,” including preserving present advances.

Archbishop Zimowski then turned to efforts to save the lives of millions of people who die each year “from conditions that can easily be prevented.” He praised a resolution before the assembly to improve the quality, supply and use of 13 “life-saving commodities.”

“The Holy See strongly agrees with the need to achieve further reductions in the loss of life and prevention of illness through increased access to inexpensive interventions that are respectful of the life and dignity of all mothers and children at all stages of life, from conception to natural death,” he said.

However, he voiced “serious concerns” about the assembly’s secretariat report and its executive board-recommended resolution that includes “emergency contraception.” He said some of these drugs have an abortifacient effect.

“For my delegation, it is totally unacceptable to refer to a medical product that constitutes a direct attack on the life of the child in utero as a ‘life-saving commodity’ and, much worse, to encourage ‘increasing use of such substances in all parts of the world’,” he said.

The archbishop welcomed the assembly’s proposed global action plan to control non-communicable diseases. He said his delegation was “especially pleased” that the plan recognizes the “key role” of civil society institutions including faith-based organizations in encouraging the prevention and treatment of these diseases.

“Our delegation is aware that Catholic Church-inspired organizations and institutions throughout the world already have committed themselves to pursue such actions at global, regional, and local community levels,” he said.

Archbishop Zimowski also voiced interest in aspects of preventing and controlling diseases in older age, noting faith-based institutions’ long tradition of care for the aged and the rapid growth of the elderly population. He noted that the Vatican will host an international conference Nov. 21-23 about caring for the elderly with neurodegenerative diseases.

 

Happiness, Happiness….a practical take on psychology and wellbeing

Jim McManus

Jim McManus is a Chartered Psychologist, Chartered Scientist and Associate Fellow of the British Psychological Society. He is Editor of Catholics in Healthcare blog

Happiness has been a concern of psychology and public policy since Seligman’s work at least, and the development of new orientations in psychology studying not human problems, but human thriving is just one of the remarkable signs that psychology as a field of science is flourishing. It’s an exciting time to be a psychologist as we see applications of psychology range from long term illness to organizational innovation, child development and human happiness.

The field of psychology has recently seen the emergence of sub-fields like Community Psychology, Positive Psychology and other specialisms, working on human strengths and human flourishing…so seeking strengthen, not problematize, ordinary lives.

The advent of scientifically sound research on this has given impetus to policy developments at national and international level that what we need to do as health systems and communities is help people thrive. With this comes the well-researched insight that population mental wellbeing and resilience is important. This has seen expressions in the last few years (all with good evidence base) ranging from the 5 ways to wellbeing (New Economics Foundation) to the recent Government Strategy no health without mental health and the Royal College of Psychiatrists no health without public mental health.

Doing this practically can often seem to be easier said than done, but there have been a number of practical initiatives run in local areas seeking to put these concepts into practice. Positive Psychology is taking off, and the accredited mental health first aid movement is just one example of how people can turn these insights into a series of programmes. Catholics have a series of demonstration projects and initiatives on mental health, wellbeing and dementia in the Catholic Mental Health Project

But now comes a timely and sensible intervention for faith communities. John Bingham, writing in the news and religion section of today’s Daily Telegraph, tells the story of how Livability, the disability charity with a Christian ethos, is busy rolling out a “happiness” course in parishes and churches across the Country.

Bingham’s piece says “The so-called “Happiness Course” combines basic principles of secular popular psychology with ideas such as forgiveness and gratitude, promoted for centuries by Christianity. It is based on the principle that applying simple Biblical ideas such as “counting your blessings” or forgiving enemies could actively improve people’s psychological well-being.”

In fact, this is not secular popular psychology. This course has links to well researched psychological insight. What is different about positive psychology and the psychology of happiness is that there has been a significant impetus to popularize it while, for the most part, keeping faith with the underlying science.

Positive Psychology,  some of whose  insights the Livability course seems to derive from, is defined by the  Positive Psychology Center at the prestigious University of Pennsylvania as “the  scientific study of the strengths and virtues that enable individuals and communities to thrive. The field is founded on the belief that people want to lead meaningful and fulfilling lives, to cultivate what is best within themselves, and to enhance their experiences of love, work, and play.”

The interesting thing is that Livability are synthesising faith concepts about what makes a healthy and happy life with sound scientific psychology, and finding not only that there is no conflict but that they work well together.

This too has a practical value well-grounded in research. Studies of organizational culture and take-up of health messages show that when people can relate scientifically sound messages to their own belief systems, there is more likelihood the messages will be seen to be salient and the messages will not only be taken up but sustained.

The Livability course is a neat innovation in the field of practical or pastoral theology, and an equally neat innovation in the field of public mental health.

We need to see more of this.

Some useful links

http://www.livability.org.uk/

http://www.ppc.sas.upenn.edu/

http://www.telegraph.co.uk/news/religion/10064228/Archbishops-daughter-spearheads-drive-to-teach-happiness-in-churches.html

http://www.mentalhealthproject.co.uk/

http://positivepsychology.org.uk/