is safe and recovery under way. The emotional problems which lead to the overdose can then be sorted through. In other cases, the respirator provides needed time to evaluate and diagnose, or to give further treatment. But when it is believed, but not yet a certainty, that meaningful life is not possible, no uncomplicated decision-making process exists to discontinue life-sustaining treatment.6 Hospital staff need the sustenance of their faith to adequately cope with the stress of being responsible for difficult decision-making.
Ministers and churches need also to be aware that, as health care systems and participating hospitals become more competitive, they also become more sensitive to public relations and community opinion. The Church can encourage support for chaplaincy as well as the pastoral care of individual ministers by communicating with the administrations or boards of the hospital. There are many services churches can provide to hospitals. For example, almost every hospital has an auxiliary for volunteers. A church which invites the director of that service to speak and encourages participation breeds good will. Parishioners hospitalized can communicate their appreciation for a chaplain's visit or the accessibility to their pastor, even in an intensive care unit. Obviously, any church expressing these interests must represent needs and concerns common to every denomination and not attempt to manipulate personal advantages. At times, a responsible Ministerial Association can assume this role.
Just as pastors are gaining new understanding regarding the emergence of health care delivery systems, parishioners will benefit from a similar exploration. Perhaps the idea of establishing a Health Care Committee in your church would assist in educating members to these new structures. Other, equally important concerns need exploring also. For example, most major faith groups are increasingly relying upon lay persons to provide ministry during life crises. Although a chapter of this book discusses the topic of lay ministry in depth, a Health Cabinet can provide a portion of that education.
Moreover, there are several direct ways in which the Church's educational program can speak directly to the national issues of preserving availability of health care and cost containment. First, the Church can remind its membership of stewardship which relates to care of the body. The larger issue is that of preventive health care. It is hoped that research will soon emerge to provide cures for many types of cancer. Even if this happens, most of the dramatic breakthroughs which impacted so positively on health, like the discovery of germ theory, antibiotics, and polio vaccine are past history. Most authorities agree that the major breakthroughs lie in the realm of individuals adjusting their life style, specifically reducing caloric intake, eating better foods, exercising more, and learning to manage stress. The major killers, such as coronary artery disease, strokes, and hypertension, cannot be cured with a vaccine. The Church should take a more active role in spreading the “good news” which relates to an abundant, physically healthy life.
Second, containing costs of health care is not simply the responsibility of physicians and hospitals. The need is for all persons to become informed consumers. Out of a false sense of fidelity, for example, an individual might decide against seeking a second medical opinion. Checking into a hospital on a weekend, apart from an emergency, will usually not result in any meaningful treatment until a weekday, but it increases costs to the consumer. Being hospitalized for minor surgery because you are reluctant to investigate an out-patient alternative does not mean you will receive better care. It does guarantee higher bills. The patient-physician relationship previously characterized as paternalistic but now becoming more collaborative is probably a healthy one.
Yet none of these changes is easy, not for individuals nor for institutions such as the health care system. What motivates the changes is the necessity to preserve availability of health care at a cost that is affordable to all. That is the hope. The voice of the Church and ministry is a powerful one. Informed and aware, it can assist in shaping the structures and practices which develop. Historically, it can continue to be a meaningful part of a life experience that is common to all. Its ministry, in both professional and lay forms, must be prepared to increase input. The alternative is further fragmentation of life experience, particularly the search for meaning and purpose in the midst of life crises.
Bibliography
Cousins, N. Anatomy of an Illness. New York: W.W. Norton Co., Inc. 1979.
The author recovers from a serious illness through following standard medical regimens in addition to his own prescriptions. This book is now a classic and highlights partnership between physician and patient.
Cousins, N. The Healing Heart. New York: W.W. Norton Co., Inc., 1984.
Cousins offers personal reflections on ways he managed his recovery from a significant heart attack through monitoring his own anxiety and developing a partnership with medical staff.
Florell, J.L. “Wholistic Health and Pastoral Counseling.” Journal of Pastoral Care. Vol. XXXIII, No. 2, June 1979, pp. 96–103.
Presents an overview of approaches to wholistic health care in a variety of settings.
Goldsmith, J.C. Can Hospitals Survive? Homewood, Il.: Dow Jones-Irwin, 1981.
The author puts forth a thoughtful and insightful discussion of the major changes occurring in the health care field. He describes the already intense competition among hospitals, which is resulting in restructuring of the entire system. Consumer choice as well as cost consciousness are guiding principles which will result in the closing of some facilities and the survival of others.
Tubesing, D.A. Wholistic Health. New York: Human Sciences Press, 1979.
The author provides an excellent comparison and contrast between traditional models of providing health care and those which include a wholistic philosophy. As a single resource it provides an excellent discussion of the issues.
Westberg, R. “From Hospital Chaplaincy to Wholistic Health Center.” Journal of Pastoral Care. Vol. XXXIII, No. s, June 1979, pp. 76–82.
Reports on developing programs bringing patients into the diagnostic and healing process.
1. In April 1983, the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research published a controversial report entitled Securing Access to Health Care (U.S. Government Printing Office, s/n 040-000-00472-9) which said, in part, that “society has the responsibility ethically to provide every person with an adequate level of health care without excessive burden to anyone.” The Commission did not say that everybody in society who could not afford it privately or cannot get it through other resources, is entitled to all the care that the person wants or all the care that may be beneficial. This is a position quite different from that which is politically expressed but may, in fact, more accurately describe what occurs in our society.
2. Meg Cox, “This Doctor Says: Take Two Aspirins and I'll Call on You in the Morning,” The Wall Street Journal, January 5, 1984, p. 25. The best available figures indicate that physician house calls dropped to 17 million in 1975 from 60 million in 1960.
3. Social Security Amendments of 1983, Pub. L No. 98–21, 601–07, 97 Stat. 65, 149–72 (1983). (Prospective payment for Medicare inpatient hospital services based on DRGs.)
4. F.H. Kerr, “Considering a New Structure: The Health Services Holding Company,” Law, Medicine and Health Care, Vol. 11, No. 5, October 1983, p. 214.
5. J. Naisbitt, Megatrends. New York: Warner Books, 1982, pp. 39–53.
6. “Deciding to Forego Life-Sustaining Treatment,” President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, March 1983. (Suite
