The United Methodist Tradition
Religious Beliefs and Healthcare Decisions Edited by Edwin R. DuBose
he Methodist tradition dates back to the late T1720s, when John and Charles Wesley and a num- ber of other students at Oxford formed a Holy Club meant to recapture the piety and intensity of the early church. In North America, Methodism separated from American Episcopalianism and was established as an ecclesiastical organization in 1784.1 The United Methodist Church, the largest church within Methodism, resulted from the 1968 merger of the Contents Methodist Church (itself formed by an earlier union of The Individual and the 2 three bodies) and the Evangelical United Brethren. In Patient-Caregiver Relationship 1999 the United Methodist Church had approximately 8.3 million members.2 Family, Sexuality, and Procreation 3 As represented by the United Methodist Church, Genetics 4 Methodism is a highly organized religious body. The Organ and Tissue Transplantation 5 quadrennial General Conference is composed of clergy and lay delegates, elected through their Annual and Mental Health 6 Central Conferences, and is the policy-making body of Medical Experimentation 6 the church. Proposals adopted by the General and Research Conference become United Methodist law and social Death and Dying 6 policy and are recorded in two books. The United Methodist Church’s law book, The Book of Discipline, Special Concerns 8 holds the higher status because it contains the laws of the church as well as the “Social Principles,” the high- est social policy of the church. The Book of Resolutions contains the social policy resolutions that are passed in a democratic process by the General Conference. These resolutions hold until they are overturned or repealed by a future assembly. Generally, reflection on the moral nature of specific medical interventions is done by Part of the “Religious Traditions and Healthcare Decisions” handbook series published by the Park Ridge Center Edwin R. DuBose, Ph.D., is a Research Associate at the Park for the Study of Health, Faith, and Ethics Ridge Center for the Study of Health, Faith, and Ethics.
THE PARK RIDGE CENTER theologians, though the number of churchwide Christian judgment, thoughtful and prayerful investigations and judgments with respect to par- consideration, and informed clergy counseling ticular technologies and procedures is likely to in- and support. The general tradition of Methodism crease.3 Moreover, official positions taken or is characterized by concerns for personal spiri- resolutions passed at the General Conference are tual growth and social welfare.4 not necessarily accepted by all Methodists. The following discussion is based on refer- Implementation of policy is carried out by a vari- ence to documents and specific resolutions of ety of boards and agencies. the United Methodist Church. Several clinical Within Methodism great stress is placed upon procedures have as yet received no attention but moral decision making carried out with mature may well be reviewed at future conferences.
THE INDIVIDUAL AND THE PATIENT-CAREGIVER RELATIONSHIP
ccording to the church, health is something tives, and of no treatment at all. Patients must Abeyond, but does not exclude, biological show that they understand what has been com- well-being. In this view, health care is inade- municated to them. If a patient does not have quate when it attends solely to the body and its decision-making capacity, consent is to be ob- physiological functions. Part of the task of tained from the guardian or others who are Methodists is to enable people to care for them- legally permitted to give such consent.8 selves, to take responsibility for their own Although no statement was found on the health, and to receive care that allows them to issue of medical experimentation, Methodist live a full life. This task demands spiritual, polit- views on self-determination and informed con- ical, ethical, economic, social, and medical deci- sent would correspond to accepted standards for sions that maintain the highest regard for the informed consent in that area. condition of society, the environment, and the total life of each person.5 These views have im- Truth-telling and confidentiality plications for the patient-caregiver relationship. Confidentiality is affirmed in several resolutions adopted by the United Methodist Church in 1976 and 1988. Expectation of confidentiality covers CLINICAL ISSUES treatment for alcohol and drug dependency, vene- real disease, abortion, contraception, psychiatric Self-determination and informed consent care, and HIV testing and counseling.9 The patient is an active participant in medical No specific resolution regarding truth-telling treatment decisions.6 Inasmuch as people are was found. Given the church’s strong emphasis created in the image of God, a person’s auton- on concern for individual and social well-being, omy and self-determination are highly valued. and its insistence on the importance of counsel- The right of persons to accept or reject treatment ing and informed consent, it would follow that is protected in a just society by norms and proce- truth-telling in medical care is valued. dures that involve the patient as an active partic- ipant in medical decisions.7 Proxy decision making and advance direc- Informed consent, therefore, requires that the tives patient be given all information that would be Methodists are encouraged to make advance di- useful to a reasonable person in the same cir- rectives, which provide for proxy, power of attor- cumstance, including the benefits, risks, and ney, or “living will” arrangements to protect one’s harm of the proposed treatment, of its alterna- desires and consent in medical treatment.10
2 THE UNITED METHODIST TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS FAMILY, SEXUALITY, AND PROCREATION
amily is an important entity within CLINICAL ISSUES FMethodism and is seen as the primary locus for the nurture and protection of children and Contraception youth.11 Recognizing that the relational and procreative The bonds of family define the acceptable levels of sexual union overlap, Methodists en- limits of sexuality and procreation. For example, dorse the use of contraceptive devices. The use sexuality is regarded as an integral part of of contraception must be acceptable to both human wholeness. The 1988 Book of husband and wife and must reflect a relational Resolutions acknowledges and affirms sex as commitment. Methodists also have recognized, “God’s good gift.” The only fully acceptable sex- however, that responsible care for the neighbor ual relationship, however, is within heterosexual and for the unborn child requires facing the re- marriage. If not informed by an intention of last- ality that sexual intercourse occurs outside of ing care and commitment, sexual intercourse marriage and among persons who lack relational may become an instrument of exploitation.12 At commitment or the ability to care for children. the same time, recent Methodist statements re- Therefore, the General Conference in 1976 con- garding the family have been broadening to in- cluded that every person, regardless of age, shall clude single parents and “those who choose to have the right to seek and to receive informa- be single.”13 tion concerning medically accepted contracep- In regard to child abuse, the Book of tive devices and birth-control services in Discipline calls for strict enforcement of laws doctor-patient confidentiality.17 The right, how- prohibiting the sexual exploitation or use of ever, is clearly subordinated to the responsibility children by adults, and the establishment of ad- to refrain from harming another person, includ- equate protective services, guidance, and coun- ing an unborn child.18 seling opportunities for children thus abused.14 Moreover, children have rights to food, shelter, Sterilization clothing, health care, and emotional well-being, Sterilization is ultimately the decision of the as do adults. These rights are affirmed regard- person.19 less of parents’ or guardians’ actions or inaction. Children must be protected from economic and Abortion and the status of the fetus sexual exploitation.15 Although belief in the sanctity of unborn human Every child has the right to be regarded as a life makes the church reluctant to approve abor- person and the right to receive appropriate med- tion, the United Methodist Church does uphold ical care and treatment. The church’s policy on abortion rights: medical rights for children is not to be con- strued as a bypassing of the family’s right to per- Our belief in the sanctity of unborn life makes us sonal privacy; it becomes operative when reluctant to approve abortion. But we are equally parental rights and the child’s rights are in di- bound to respect the sacredness of the life and rect conflict and it becomes necessary to act in well-being of the mother, for whom devastating the best interests of the child. The church urges damage may result from an unacceptable preg- the development of policies that encourage in- nancy. In continuity with past Christian teaching, clusion of youth and young adults in health care we recognize tragic conflicts of life with life that decision-making processes.16 may justify abortion.20
THE PARK RIDGE CENTER 3 Abortion is permitted if the mother’s life is in parental approval for treatment and abortion.23 danger, if the fetus is severely deformed, or if the conception was due to rape or incest. Social, Prenatal diagnosis and treatment economic, and familial concerns and the “men- Although no specific resolution was found, it can tal capability of the child to be” are also legiti- be inferred that prenatal diagnostic and treatment mate reasons to consider abortion.21 The United procedures are permitted with the informed con- Methodist Church opposes abortion, however, as sent of the parents-to-be. No position was found a means of birth control or gender selection.22 bearing on the treatment of pregnant women. The church has stated that the fetus is at least a potential person, embodying divine intention. It Care of severely handicapped newborns is on the way to full personhood, and as such it A 1976 resolution supports care for handicapped is a creature worthy of care and respect. For the newborns, stating that “every child . . . has the Methodist, moral decision making has to do with right to be regarded as a person and shall have acting responsibly. Therefore, those considering the right to receive appropriate medical care abortion must weigh their obligation to respect and treatment.”24 There is an expectation that the fetus against any other responsibilities they considerate and respectful care should be pro- may have. In this calculus, while recognizing vided to a handicapped newborn, regardless of “the tragic conflict of life with life,” the church the severity of his or her condition.25 supports the above stated concerns of the mother and other existing persons over the concerns of New reproductive technologies the fetus. No official positions were found on artifical in- Minors who are pregnant should be treated as semination by husband (AIH) or donor (AID), on adults and should not be subjected by law to in vitro fertilization, or on surrogate motherhood.
GENETICS
etween 1989 and 1992, members of the Because humankind has the responsibility of BGenetic Science Task Force reviewed in- stewardship for the whole of creation, sights, questions, and concerns about genetics Methodists generally approve genetic research and biotechnology based on genetic research and and technology relating to improvement of the drafted a report for the 1992 Annual Conference. food supply and efforts to heal diseases. In its report, the task force affirmed the inherent However, concern has been expressed about the value of all individuals as children of God re- possible economic, political, and military abuses gardless of genetic or medical conditions and of genetic research and its application. A posi- supported a universal right to health care educa- tion opposing animal, plant, and human patent- tion. It also urged greater public funding and ing was adopted by the 1992 General greater public control of genetic research. The Conference. The Genetic Science Task Force report opposed the use of genetic information by urged the United Methodist Church and its ap- insurers for the purpose of rating or denying in- propriate boards and agencies to educate laity surance coverage, as well as the use of such in- and clergy to deal constructively with these is- formation by employers in ways detrimental to sues. It also recommended further discussion in present and potential employees.26 The 1992 future General Conferences.27 General Conference adopted the report as official United Methodist policy.
4 THE UNITED METHODIST TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS CLINICAL ISSUES reject the use of genetic manipulation for the purpose of sex selection. Genetic screening and counseling Techniques of screening for therapeutic pur- Selective abortion poses are approved, and equal access to genetic Although no direct reference to selective abor- testing is supported. Informed, objective coun- tion was found, the church’s limited approval of seling should be available to individuals. abortion suggests that evidence of possible ge- Knowledge of any individual’s chromosomes netic disorders or damage might be grounds for must not be used to his or her disadvantage, and abortion. The church unconditionally rejects strict standards of confidentiality must be up- abortion as a means of gender selection.29 held concerning such knowledge. Exceptions may be made, however, in cases where an Gene therapy adopted person has a medical need to know Changes in human chromosomes are justified about a biological parent’s genetic make-up, only for therapeutic reasons and only if they do where the life of a relative is threatened, or not include experiments that produce waste em- where such genetic information is the only bryos, genetic enhancements, or changes in means to identify a deceased person.28 germ cells. All kinds of positive eugenics, cell- cloning, and hybridization must be prevented.30 Sex selection The United Methodist Church thus supports so- Although no direct reference to sex selection matic gene therapy but at this time opposes was found, it seems clear that the church would germ-line gene therapy.
ORGAN AND TISSUE TRANSPLANTATION
s long as the practice does not hasten death regard for maintaining the dignity of the de- Aand is carried out using reliable criteria, the ceased and his/her family.”32 United Methodist Church supports the donation of organs and tissue for transplantation.31 Donation is encouraged as an expression of the CLINICAL ISSUES Christian ethic of “selfless consideration for the health and welfare of others,” as a “life-giving” Denominational members are encouraged to be- practice, and as a source of comfort for sur- come prospective organ and tissue donors.33 No vivors, a positive outcome of what might other- positions on transplantation issues relating to wise seem a senseless death. Requests for organ living-donor donations, anencephalic newborns, donation and the procedure itself should be fetuses, or the use of human fetal tissue were “conducted with respect and with the highest found.
THE PARK RIDGE CENTER 5 MENTAL HEALTH
he United Methodist Church considers men- Confidentiality is important in psychiatric Ttal health to be a part of physical and spiri- care and counseling and in work with those who tual health. In a 1988 resolution on mental are dependent on drugs or alcohol.35 health, the General Conference specifically called upon churches to help their communities expand counseling and crisis intervention serv- CLINICAL ISSUES ices; to conduct public awareness campaigns to combat the stigma of mental illness; to promote In its official statements the United Methodist community and congregational involvement with Church appears to accept the existence of physi- mentally ill patients; to support individuals and cal and genetic bases for most serious mental ill- families caring for mentally ill family members; nesses, but it makes no specific statements on and to promote better interaction among sys- matters of psychotherapy and behavior modifica- tems involved with the care of the mentally ill— tion, involuntary commitment, psychopharma- courts, employers, housing offices, and so on.34 cology, or electroshock treatment.
MEDICAL EXPERIMENTATION AND RESEARCH
hysical and mental health has been im- CLINICAL ISSUES Pproved through discoveries in medical sci- ence. While such research and experimentation No positions were found on therapeutic and must continue, it is imperative that governments nontherapeutic medical experimentation or re- and the medical profession enforce prevailing search on fetuses, children, and adults, but ge- medical research requirements, standards, and netic experiments that produce “waste embryos” controls in testing new technologies and drugs or changes in germ cells were deplored.37 on human subjects. These standards require that those engaged in research shall use human be- ings as research subjects only after obtaining full, rational, and uncoerced consent.36
DEATH AND DYING
he Methodist tradition offers no binding rule by the dying and their physicians, families, and Tthat governs every painful decision regarding friends. It asserts the right of every person to die such topics as suicide, euthanasia, death with in dignity, with loving personal care and without dignity, cessation of life-maintaining medical efforts to prolong terminal illness merely because support systems, and palliative care. Applauding the technology to do so is available.38 One crite- medical science for efforts to extend the mean- rion of death with dignity is the ability to partici- ingful life of humans, the church also recognizes pate in “cognitive and affective activities that the agonizing personal and moral decisions faced enable conscious, loving relationships with
6 THE UNITED METHODIST TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS others in community.” To the extent that medical the benefits for the dying patient and the care- technology supports the preservation of this dig- giver.42 nity, its use is encouraged. “However, when tech- Patients have the right to protection from the nology becomes an end in itself, unduly extremes of premature or delayed termination of prolonging the dying process,” human dignity treatment. When a person is dying and medical may be undermined.39 intervention can at best prolong a minimal level of life, the objective of medical care should be to give comfort and maximize the individual’s ca- CLINICAL ISSUES pacity for awareness, feeling, and relationships with others. In cases when patients are undoubt- Determining death edly in an irreversibly comatose state, and when No statement defining death was found in any cognitive functions and conscious relationships resolution or document of the Methodist church. are no longer possible, decisions to withhold or In an amicus curiae brief to the United States withdraw mechanical devices that continue respi- Supreme Court in the Cruzan case, the General ration and circulation may justly be made by fam- Board of Church and Society of the United ily members or guardians, physicians, hospital Methodist Church cited a Presbyterian statement ethics committees, and chaplains.43 relating death to the irretrievable loss of the ca- The family is the proper context for decision pacity for human relationship, regardless of any making regarding “how best to cope with the biological function that can be sustained. “In natural ending of a life”; government should not medical terms, that means when brain function intrude in even a surrogate role.44 ceases and when a flat electroencephalogram There are no official statements about forgo- occurs, cardiovascular activity ceases, or other ing care of severely handicapped newborns, but tests of responsiveness have been conducted and “considered and respectful care” should be pro- found to be negative.”40 vided, regardless of the child’s condition.45
Pain control and palliative care Suicide, assisted suicide, and euthanasia The proper application of medical science, as “Suicide: A Challenge to Ministry,” a resolution demonstrated by hospice care, can in most cases adopted at the 1988 General Conference of the enable patients to live and die without extreme United Methodist Church, encouraged initiatives physical suffering. Such methods of controlling to prevent suicide by cultivating a caring attitude pain, even when they risk or shorten life, can be toward all persons within society. The appropri- used for terminally ill patients, provided the in- ate pastoral response for patients contemplating tention is not to kill. The law should facilitate suicide is to assist them in understanding God’s the use of drugs to relieve pain in such cases.41 gift of life, the human stewardship of life, and the responsibilities of the person in relation to Forgoing life-sustaining treatment the community and the exercise and limits of When a person’s suffering is unbearable or irre- human freedom.46 Pastoral caregivers should re- versible, or when the burdens of living out- spond to those contemplating suicide with theo- weigh the benefits for a person suffering from a logical and pastoral understanding and presence. terminal illness, the cessation of life may be a Survivors of those who choose suicide need the relative good. For the United Methodist Church, support of others who do not pass judgment on theological and ethical reflection leads to the the suicide or stigmatize the survivors. conclusion that the obligations to use life-sus- “Understanding Living and Dying as Faithful taining treatments cease when the physical, Christians,” a resolution adopted at the 1992 emotional, financial, or social burdens exceed General Conference, addresses the hastening of
THE PARK RIDGE CENTER 7 death by terminally ill persons. Some persons, “Understanding Living and Dying as Faithful when confronted with a terminal illness that Christians” makes several recommendations to threatens to prolong suffering and anguish for health care institutions regarding care for the them and for loved ones, may consider suicide dying.50 Institutions should encourage the forma- as a means to hasten death. Some may ask care- tion of institutional ethics committees for policy givers for assistance in taking their lives. No advising, discussion of issues, and educational statement pertaining to assisted suicide was leadership; encourage the establishment of poli- found, although it appears that the church sup- cies and procedures that support alternatives in ports controlling pain, even when such methods terminal care; and ensure the presence and shorten life, provided the intention is to relieve availability of persons and programs to assist in pain and not to kill.47 the resolution of doubt and conflict associated The United Methodist Church has no official with the use of life-sustaining technologies and position on active euthanasia.48 “Understanding support those who must make and implement Living and Dying as Faithful Christians” contains the decisions that arise at the end of life. ambiguous language regarding active voluntary No specific resolutions were found on au- euthanasia.49 Under certain circumstances, eu- topsy, postmortem care, last rites, or burial and thanasia might be an ethically permissible ac- mourning traditions. However, the assumption of tion, but United Methodists generally encourage the importance of human dignity would seem to alternatives to euthanasia. Through hospice care carry over into these areas. and pain management, patients can die without extreme suffering.
SPECIAL CONCERNS
Attitudes toward the use of drugs Religious observances he 1992 Book of Discipline calls for absti- Special religious observances or holy days in- Tnence from alcohol and from the misuse of clude Sundays and the traditional holy days and drugs. Moreover, the church encourages wise seasons associated with Christianity. policies regarding the availability of beneficial or potentially damaging prescription and over-the- counter drugs. The misuse of drugs should be viewed as a symptom of underlying disorders for which remedies should be sought. Included in this statement is a recommendation to discour- age the use of tobacco.51
8 THE UNITED METHODIST TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS NOTES
1. For a general discussion of Methodism, see 23. BR, 112. Vanderpool, “The Wesleyan-Methodist Tradition,” 330. 24. “Medical Rights,” 43. 2. Figures taken from the official website of the United 25. Holy Living and Holy Dying, n.d.:19–20; hereafter Methodist Church.
THE PARK RIDGE CENTER 9 BIBLIOGRAPHY
“Abortion Is Testing Our Church.” Christian Social Action Holy Living and Holy Dying—A United Methodist/Roman (March 1991): 25–27. Catholic Common Statement. General Commission on Christian Unity and Interreligious Concerns of the Campbell, Courtney S. “Religious Ethics and Active United Methodist Church and the Bishops’ Committee Euthanasia in a Pluralistic Society.” Kennedy Institute for Ecumenical and Interfaith Affairs, National of Ethics Journal 3 (September 1992): 253–77. Conference of Catholic Bishops. Cincinnati: General Carder, Kenneth L., et al. “United Methodist Church Board of Global Ministries, The United Methodist Genetic Science Task Force Draft Report to Annual Church, n.d. and Central Conferences, December 1990.” Christian “Medical Rights for Children and Youth.” Resolution Social Action (January 1991): 17–27. adopted in 1976. In Health and Wholeness, 42–46. Drug and Alcohol Concerns. Booklet in the Faithful Witness Ranck, Lee. “The Gift of Life.” Christian Social Action on Today’s Issues series. Washington, D.C.: General (December 1991): 31–33. Board of Church and Society, The United Methodist Church, n.d. Shelton, Robert L. “Recent Developments in Medical Ethics in the Methodist Tradition.” In Bioethics The General Conference of the United Methodist Church. Yearbook: Theological Developments in Bioethics, The Book of Discipline of The United Methodist 1988–1990, ed. Baruch Brody, 145–60. Dordrecht: Church. Nashville: United Methodist Publishing Kluwer, 1991. House, 1988. “Understanding Living and Dying as Faithful Christians.” ———. The Book of Resolutions of The United Methodist Resolution adopted in 1992. In Health and Wholeness, Church—1988. Nashville: United Methodist Publishing 31–42. House, 1988. Vanderpool, Harold Y. “The Wesleyan-Methodist Tradition.” Health and Wholeness. Booklet in the Faithful Witness on In Caring and Curing: Health and Medicine in the Today’s Issues series. Washington, D.C.: General Board Western Religious Traditions, ed. Ronald L. Numbers of Church and Society, The United Methodist Church, and Darrel W. Amundsen, 317–53. New York: n.d. Macmillan, 1986. Holifield, E. Brooks. Health and Medicine in the Methodist Tradition: Journey toward Wholeness. New York: Crossroad, 1986.
10 THE UNITED METHODIST TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS
Introduction to the series
eligious beliefs provide meaning for people gious views on clinical issues. Rather, they Rconfronting illness and seeking health, partic- should be used to supplement information com- ularly during times of crisis. Increasingly, health ing directly from patients and families, and used care workers face the challenge of providing as a primary source only when such firsthand appropriate care and services to people of different information is not available. religious backgrounds. Unfortunately, many We hope that these booklets will help practi- healthcare workers are unfamiliar with the reli- tioners see that religious backgrounds and beliefs gious beliefs and moral positions of traditions play a part in the way patients deal with pain, ill- other than their own. This booklet is one of a ness, and the decisions that arise in the course of series that aims to provide accessible and practical treatment. Greater understanding of religious tra- information about the values and beliefs of differ- ditions on the part of care providers, we believe, ent religious traditions. It should assist nurses, will increase the quality of care received by the physicians, chaplains, social workers, and adminis- patient. trators in their decision making and care giving. It can also serve as a reference for believers who desire to learn more about their own traditions. Each booklet gives an introduction to the his- tory of the tradition, including its perspectives on health and illness. Each also covers the tradi- tion’s positions on a variety of clinical issues, with attention to the points at which moral dilemmas often arise in the clinical setting. Final- ly, each booklet offers information on special concerns relevant to the particular tradition. The editors have tried to be succinct, objec- tive, and informative. Wherever possible, we have included the tradition’s positions as reflected in official statements by a governing or other formal body, or by reference to positions formulated by authorities within the tradition. Bear in mind that within any religious tradition, there may be more than one denomination or sect that holds views in opposition to mainstream positions, or groups that maintain different emphases. THE PARK RIDGE CENTER FOR THE STUDY OF HEALTH, FAITH, AND ETHICS The editors also recognize that the beliefs and 211 E. Ontario ● Suite 800 ● Chicago, Illinois 60611-3215 values of individuals within a tradition may vary http://www.parkridgecenter.org from the so-called official positions of their tradi-
tion. In fact, some traditions leave moral decisions The Park Ridge Center explores and en- about clinical issues to individual conscience. We hances the interaction of health, faith, and would therefore caution the reader against gener- ethics through research, education, and alizing too readily. consultation to improve the lives of individuals and communities. The guidelines in these booklets should not substitute for discussion of patients’ own reli- © 2002 The Park Ridge Center. All rights reserved.
12 THE UNITED METHODIST TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS