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The C of E must speak louder on medical ethics

31 August 2018

Society needs help to navigate the health issues arising from rapid technological advances, says Christopher Exeter

THE Archbishop of Canterbury’s Commission on Urban Priority Areas published Faith in the City: A call for action by Church and nation, in 1985, which investigated the causes of poverty and unrest in the UK. It devoted an entire chapter to health, which said: “Since the late 1970s, resources available to the Health Service overall have not kept pace with . . . the greater numbers of older people, and the increasingly expensive methods of treatment now available.”

These phrases are as relevant today as they were in 1985. The question is: why has the Church of England abnegated ethical leadership in health care in the way that Faith in the City proposed? And why has there not been any attempt to address this through a multifaith approach? Instead of building on the report, the C of E has lost the ethical argument on social policy by becoming atrophied with internal politics.

In contrast with Rome, the Anglican Communion’s part in social teaching is all but non-existent. William Temple, Archbishop of Canterbury from 1942 to 1944, and probably the C of E’s last significant thinker on social policy, said that secular policy should be founded on Christian truth. Other faiths also make valuable contributions to health care.

IN THE past 12 months, the ethics of health have come to public attention with debates over the treatment of two children: Charlie Gard and Alfie Evans (Comment, 18 August 2017, News 4 May). The Vatican, no stranger to medical ethics, intervened. The Church of England remained silent. Who was correct? Ethics abhors a vacuum.

Both babies sadly — but not unexpectedly — died. In the ensuing discourse, one issue was lost: not only will such cases become more common, as society is faced with decisions arising from new therapies and emerging diseases as others have been tackled, but, increasingly in this, the 70th anniversary year of the NHS, how should our expectations of health care evolve?

Let us be clear: it is not the place of the Church to opine on individual medical decisions or the wishes of patients. It does, however, have a part to play in helping society to navigate the complex ethical issues that arise from the rapid advances in biomedical science and our own responsibilities for our health.

This is not about GP opening times, or how much more money the NHS should receive. It is about how society responds to the epidemiological transition away from infection to non-communicable disease — cancer, cardiovascular disease, Type 2 diabetes mellitus, and lung disorders, etc. — as the principal causes of ill health and premature death, after the introduction, in the 20th century, of antibiotics, which eradicated infection as the main threat to human life.

Many non-communicable diseases are avoidable, either through lifestyle changes or through screening. That requires personal responsibility, however, not a prescription. Patients all too frequently present once symptoms have taken hold and require intensive treatment, resulting in further, related diseases.

It is completely unethical to say that the strain on health services comes from an ageing population: the triumph of biomedical science that is enabling people to live longer should be celebrated. Instead, it is how health is delivered — and people’s expectations — that have not always kept pace with science. As medical interventions based on data, robots, and artificial intelligence soon become as common as the stethoscope, not only will the bureaucratic question deepen, but, critically, ethical questions will intensify.

DOES the Church have a part to play? Currently, theological contribution is weak, and the C of E’s voice is, at best, muted. The consequences of treatment and the reasons that personal responsibility is now crucial to keep us well will result in confusion, and, arguably, the part played by faith becomes an important source of comfort and direction.

This is not always confined to the philosophical. Take, for example, obesity. Currently, 20 per cent of the UK population are obese: five percentage points above the European average. By 2030, nearly 50 per cent of the UK are forecast to be obese. The Journal of Medical Internet Research recently reported success in church-based interventions, combining group sessions and technologically reinforced behavioural therapies, in decreasing weight among African-American adults. This is an interesting experiment, and underscores how traditional ways of clinical intervention can adapt.

This is not to say that nothing happens. Recently, the Bishop of Norwich, the Rt Revd Graham James, and a former Bishop of Liverpool, the Rt Revd James Jones, have chaired inquiries into medical errors. And many churches run events in an attempt to overcome social isolation, as serious to health as smoking 15 cigarettes a day.

But there is much more that the C of E could be doing. Health ethics works at many levels; at its core is responsibility and guidance. Faith has its place. Synodical debates, which serve to reinforce the C of E’s obsession with navel-gazing, do not. The combination of new therapies and technologies, how and when people should and should not be treated, and how and why people need to understand health in a different way, however, all demand attention.

It is time for the Church to take up the mantle of Faith in the City and lead a forward-looking multifaith commission on health, shaping the ethical debate for the coming decades.

Christopher Exeter is a health researcher and is leading an initiative looking at the part played by faith in health.

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