Health and Well Being

Principles that General Assembly has endorsed

• In principle, a national health service is in harmony with the spirit of the gospel of Jesus Christ. (A&P 1963, pp. 316-317, 318, 78)
• Everyone should have equal access to the best available health care regardless of ethnic, religious, sexual, age or economic distinctions. (A&P 1982, pp. 326-327, 99)
• Everyone has the right to expect the implementation of those social, economic, occupational and environmental measures which encourage health. (A&P 1982, pp. 326-327, 99)
• Everyone has the right to effective participation in health decisions to ensure and maintain high quality individual and community health. (A&P 1982, pp. 326-327, 99)
• The five pillars of Canadian health care (they are the criteria of the Canada Health Act) system need to be affirmed and strengthened. They are: universality—all those eligible are covered; affordability/accessibility—coverage provided without cost to the user; comprehensiveness—all required medical services are covered; portability—coverage no matter where you go in Canada; public administration—health insurance is not a fit subject for profit. (A&P 1998, pp. 398-416, 27)
• Consideration needs to be given to expanding the health care system to include home care and the cost of prescription drugs. (A&P 1998, pp. 398-416, 27)
• The Canada Pension Plan and the Quebec Pension Plan should not penalize caregivers who leave the workforce to care for family members discharged from hospital to home care. (A&P 1998, pp. 398-416, 27)

Background Information
Several trends that coalesced around the turn of the 21^st century were undermining the comprehensiveness of public health care in Canada, prompting the church to comment. Many Canadians who could not obtain treatment in Canada or faced long waiting lists were seeking treatment in U.S. facilities where they faced significant expenses (which precluded those without means from accessing the same level of health care as those who could afford to go out of country). Several provinces had delisted some services so that they were no longer covered under medicare. More early releases and day surgeries meant more prescription drug costs were borne by the patient, since these were only covered for patients in hospital. Private, for-profit companies were becoming involved in home care, especially under Ontario’s competitive model for awarding contracts. Of particular concern was Bill C-11 tabled by the province of Alberta. This bill would permit private hospitals to accept contracts from local health authorities to provide surgeries requiring overnight stays. Questions were raised as to whether this was consistent with the principles of the Canada Health Act, whether it would actually reduce waiting times, whether it would introduce a two-tier system and whether it would jeopardize the protected status of the health care system under NAFTA.

Select actions of The Presbyterian Church in Canada

2023: General Assembly asked the moderator to write a pastoral letter to congregations encouraging continued prayerful support for those still suffering the effects of the COVID-19 virus, and its fallout, in Canada and around the world. (A&P 2023, p. 22, 102–09)

2022: The church advocated the Government of Canada that Canada become a hub for vaccine production, with a percentage being donated to middle- and low-income countries without the capacity to produce vaccines safely. Presbyterians are invited to learn more about Love My Neighbour, a Canadian campaign advocating for equitable access and delivery of COVID-19 vaccines to communities in vulnerable circumstances around the world. (A&P 2022, pp. 141-2, 45)

2021: The church supported the interfaith campaign “Love my Neighbour” which advocated for support to COVAX (the global initiative to provide funding for vaccines to low and middle-income countries) and to support the temporary waiving of TRIPS (Agreement on Trade-Related Aspects of Intellectual Property Rights) at the World Trade Organization to allow for increased production of COVID-19 vaccines in multiple countries.

2020: The church wrote to the Government of Canada advocating that the government prioritize the needs of vulnerable people as the impacts of the COVID-19 pandemic are addressed (including access to vaccines, health care, increased support for basic needs, addressing human trafficking and supports for people who experience violence at home). The church encouraged that “all in Canada, including in the Territories, more remote or difficult to reach areas, and Indigenous communities, have the ability to be vaccinated swiftly and equitably and have equitable access to all needed health care.”

2009: General Assembly adopted a report on homecare and pharmacare. Letters were sent to federal, provincial and territorial ministers of health inquiring about the progress in meeting the commitments they made on homecare and in establishing a catastrophic drug coverage program as agreed upon in the 2004 Accord (Ten-Year Plan to Strengthen Health Care). (A&P 2009, p. 342)

2007: A letter was sent to the Minister of Industry requesting information on the specific steps the Government of Canada is taking to address the obstacles in “Canada’s Access to Medicines Regime” so that life-saving medicines can be made available to the citizens of countries in the Global South who are intended to benefit from this legislation. (A&P 2007, pp. 289-290)

2005: General Assembly approved the Minister of Health’s commitment to strengthening public accountability of spending on health care, especially in identifying and assessing the impact of privatization on Medicare (a term referring to Canada’s publicly funded health care system). It called on the federal government to implement Recommendation 44 of the Royal Commission on the Future of Health Care in Canada (a call to ensure that Canada’s Health Care system is exempted from international trade agreements and potential legal challenges), and asked the Moderator to inquire about the specific steps the federal government is taking to address evergreening (a practice where companies make slight alternation to brand name drugs in order to extend patents) and the notice of compliance regulations as they relate to pharmaceutical drugs (the Patent Act requires that generic drug manufactures prove their product does not infringe a patent held by another company, rather than putting on the onus on the patent holder to prove infringement). General Assembly recommended that the Health Council of Canada establish annual consultations with the health care sector and individual citizens. (A&P 2005, pp 395-8, 29)

2004: General Assembly advocated that federal and provincial governments develop policies and procedures to assess the feasibility of Public-Private Partnerships (P3s) in the construction and management of health care facilities and that these studies compare publicly funded and managed projects to P3s based on the following criteria: compatibility with the Canada Health Act, cost effectiveness, efficiency, public accountability, risk liability and transparency. (A&P 2004, pp. 379-81, 17)

2003: General Assembly sought assurance from the Government of Canada that the health care system is not vulnerable to international trade agreements. It also advocated that the Government of Canada provide leadership at the World Trade Organization in changing trade and patent policies so that medicines needed to combat public health crises are accessible in an equitable manner to citizens in poor countries. (A&P 2003, pp. 366-367, 42)

2002: General Assembly received the report regarding the work of the Ecumenical Health Care Network (of which the church is a member) and the briefs presented on behalf of the participating churches to the Senate Committee on Social Affairs, Science and Technology, which was reviewing the health care system, and to the Royal Commission on the Future of Health Care (Romanow Commission). General Assembly recommended to the Prime Minister that the health care system be reformed and that all changes fall within the five principles of the Canada Health Act. General Assembly also encouraged synods and presbyteries to communicate in similar terms with provincial ministers of health. (A&P 2002, pp. 334-335, 25)

2000: General Assembly urged the Government of Canada to enforce the Canada Health Act, to increase funding for health care to the 1995 level and to co-operate with the provinces to introduce national pharmacare and homecare programs. (A&P 2000, pp. 332-333, 20)

1998: General Assembly adopted a report on the status of health care that was sent to presbyteries and congregations for study and local action. The church (Life and Mission Agency) was mandated to monitor changes in the health care system and letters were sent to health ministers affirming support for the established five criteria of the Canada Health Act (legislature outlining government responsibilities in health care). Congregations, presbyteries and synods were encouraged to participate in advocacy for justice in the health care system. (A&P 1998, pp. 398-416, 27)

1997: General Assembly affirmed the five pillars of medicare as set out in the Canada Health Act. The church was mandated to produce a public statement analyzing the economics and politics of health care in Canada from theological, ethical and pastoral perspectives, including participation strategies for congregations. (A&P 1997, pp. 28, 44)

1982: General Assembly adopted a set of principles on health care, directed the church to seek membership in the Canadian Health Coalition, encouraged synods and presbyteries to seek representation on provincial health coalitions, and mandated the production of resources and models to congregations and courts of the church for their participation in health care decisions. (A&P 1982, pp. 326-327, 99)

1963: General Assembly approved in principle a national health service, providing due recognition is given to the rights and best interests of the medical profession, and the plan is worked out in consultation with the recognized medical association. (A&P 1963, pp. 316-317, 318, 78)

The church has commented on human applications for biotechnology related to organ transplants, reproductive technologies and genetic engineering.

Principles that General Assembly has endorsed

• Organ transplants, including heart transplants, should be accepted as a normal part of surgical practice. (A&P 1969, pp. 324-325, 109)
• Research using embryonic tissue (e.g. embryonic stem cells) should proceed only under strict government guidelines. Such guidelines should not allow indiscriminate use of fertilized embryos but encourage development of cell culture lines from fetal material that will accomplish the same purpose. (A&P 1989, pp. 341-348, 67-68)
• Genetic screening must not be forced on any person without his or her consent. (A&P 1989, pp. 341-348, 67-68)
• In-vitro fertilization and amniocentesis must never be used as methods of sex selection. (A&P 1989, pp. 341-348, 67-68)
• Equality as a principle must prevail in the use of gene therapies. No one hereditary trait can take preference over another. Gene therapy must not occur to benefit one segment of humankind over another. (A&P 1989, pp. 341-348, 67-68)
• The reproductive cloning of human beings should be banned by law. (A&P 2000, pp. 333-342)
• Caution is advised regarding genetic determinism (belief that human behavior is controlled by genes). Humans are created in the image of God. We are more than our genes. Genetic determinism reduces humans to their genes and ignores environmental and social factors, such as our diet, how much or how little exercise we do, or whether we are rich or poor. (A&P 2013, pp. 373-4, 19)
• The federal government should be encouraged to develop specific and meaningful legal safeguards to protect genetic privacy (e.g. who has the right to access your personal genetic information?). (A&P 2013, pp. 374-5, 19)

Select actions of The Presbyterian Church in Canada

2013: General Assembly requested information from the Government of Canada regarding federal oversight of Canadian labs that provide direct-to-consumer genetic tests, inquiring how Canada’s laws ensure the genetic privacy of Canadians and whether additional legal safeguards are being considered. (A&P 2013, pp. 373-5, 19)

2000: General Assembly adopted a report on human cloning and biotechnology and recommended it to presbyteries and congregations for study in consultation with persons of experience and expertise in the church and in their community. General Assembly called on the Government of Canada to introduce legislation banning reproductive human cloning as recommended by the Royal Commission on New Reproductive Technologies. (A&P 2000, pp. 333-342)

1989: General Assembly adopted a statement on genetic engineering and advocated that the Government of Canada monitor developments in genetic engineering research as well as develop strict guidelines on embryonic research into correction of human genetic disorders. The World Council of Churches was requested to develop a special human rights code with respect to genetic engineering. The church mandated the establishment of a technically competent group of volunteers to monitor developments in genetic engineering, research and application. (A&P 1989, pp. 341-348, 67-68)

1979: General Assembly accepted an introductory study on genetic engineering and the meaning of human life. A task force was mandated to monitor developments in the field. (A&P 1979, pp. 225-232, 63)

1974: General Assembly adopted a report highlighting the need for evaluation and ethical guidance in regard to the uses of biological engineering. (A&P 1974, pp. 392-393, 51)

1969: General Assembly adopted a statement on organ transplants, noting that they should be accepted as part of normal surgical practice. (A&P 1969, pp. 324-325, 109)

The church commends those who minister with and to people who are living with addictions, and has advocated for, particularly in light of the opioid crisis, increased funding for addictions treatment services and affirmed safe consumption/injection sites as a life-saving, harm reduction measure. The church has made statements against the intemperate use of alcohol, and against the legalization of proscribed drugs, including cannabis, as not being in the public interest. Additional information about tobacco and alcohol use can be found in the Social Action Handbook.

Principles that General Assembly has endorsed related to narcotics, cannabis, LSD, opioids and other drugs

• The church commends the efforts of those who minister to drug addicted and drug hurt persons.(A&P 1970, pp. 101-102)
• Responses to the opioid crisis need to remove shame and stigmatism and address the suffering of people, caused by numerous factors that are often beyond the control of any one person, community or level of government. This is a multi-faceted public health crisis that will only be effectively addressed when all parties work together to respond.(A&P 2018, pp. 351-360, 13)
• Access to safe consumption/injection sites and naloxone kits are part of life- saving, harm-reduction responses to the opioid crisis. (Supervised injection/consumption sites save lives by reducing infections, preventing overdoses and more effectively connecting people with addictions to additional health services and treatment. Naloxone is medication that counters the effects of opioids and is used to treat an overdose.) (A&P 2018, pp. 351-360, 13)
• The legalization of proscribed drugs, including cannabis, is not in the public interest.(A&P 1971, pp. 305, 89)
• Penalties for simple possession of cannabis should not be overly severe.(A&P 1971, pp. 305, 89)
• Legislative control of the sale, use and possession of LSD is desirable.(A&P 1967, pp. 334, 340, 98)

Select actions of The Presbyterian Church in Canada

2021: Up to 70% of people who died in encounters with the police suffered from mental health and substance use problems. The church wrote to provinces and territories advocating that funding for wellness-checks is reallocated from police to community and healthcare based crisis intervention workers, including pathways for people to access healthcare lead interventions through 911 services that do not necessitate the involvement of police as first responders in mental health crises (A&P 2021, pp. 431-432, 38).

2018: General Assembly adopted a report that considered the opioid crisis (referring to a public health emergency caused by two different but overlapping issues: first, overdose deaths from prescription opioids and second, overdose deaths from illicit drugs laced with fentanyl or other synthetic opioids). General Assembly advocated that/for:

• governments approve safe consumption/injection sites as a life-saving measure in the opioid crisis;
• funding for addiction treatment services;
• for stronger print marketing regulations for drugs with habit forming properties;
• that the federal government provide procedures for medical professionals to register complaints with Health Canada about prescription drug print ads;
• affirming Health Canada’s decision that warning stickers are mandatory with all dispensed prescription opioids, as well as the distribution of a patient handout.

General Assembly wrote to medical regulatory authorities (Colleges of Physicians and Surgeons) inquiring how they assess the impact of their policies and guidelines for physicians’ interactions with the pharmaceutical industry. Congregations were asked to assess the need to keep a naloxone kit on church property, ensuring that staff and/or volunteers are properly trained in its administration, and to assess the need for safe disposal sites on church property (A&P 2018, pp. 351-360, 13).

1971: General Assembly adopted a position that, although continuing to oppose the legalization of cannabis, asked for separate legislation regarding possession, rather than expose young offenders to the harsh penalties of the Narcotics Control Act. (A&P 1971, pp. 305, 89)

1967: General Assembly called for legislation that covered all aspects of LSD use, distribution, sale and possession. (A&P 1967, pp. 334, 340, 98)

The church has made statements regarding the HIV/Aids pandemic that emphasize the need for complete and accurate information, support for global partners struggling with the pandemic, and advocacy for the provision of essential medicines.

Principles that General Assembly has endorsed

The church encourages its partners in Africa and Asia to 1) provide complete and accurate information about HIV/AIDS, 2) emphasize that sexual intercourse should be confined to marriage, and 3) advocate the use of condoms for those individuals who engage in extra-marital sexual intercourse.( A&P 1997, pp. 336-337, 26)

Select actions of The Presbyterian Church in Canada

2011: General Assembly encouraged congregations and presbyteries to reflect, pray and act on the major issue of HIV and AIDS that requires our continued commitment with global partners. (A&P 2011, p. 28)

2004: General Assembly approved a church-wide appeal in response to the global HIV/AIDS crisis to support our partners in a long-term program of gospel care and relief and asked all committees and agencies of the church to collaborate in this project. GA appealed that the church pray for:

• the children who have lost parents to HIV/AIDS,
• adults infected and affected by HIV/AIDS, struggling with daily life and worried about their families
• communities and nations scourged by HIV/AIDS,
• all searching for a cure and vaccine for HIV/AIDS, and working with ministries of care and relief, and
• ourselves that we may be moved to further action, to the good of neighbour and the glory of God. (A&P 2004, pp. 443-446, 33)

2003: General Assembly commended the Government of Canada for its commitment to the Global Fund for AIDS, TB and Malaria and recommended the Government of Canada provide leadership at the World Trade Organization in changing trade and patent policies so that medicines needed to combat public health crises are accessible in an equitable manner to citizens in poor countries. (A&P 2003, pp. 304-306, 308, 15)

2000: General Assembly invited congregations to recognize World AIDS Day (December 1). (A&P 2000, pp. 286-288, 19)

1997: General Assembly adopted a statement encouraging partner churches in Africa and Asia to develop practical and realistic educational programs on preventing the spread of HIV/AIDS. (A&P 1997, pp. 336-337, 26)

1988: General Assembly encouraged ministers and lay members to become accurately informed concerning the medical, social, and economic facts about AIDS and its transmission and to encourage public education about AIDS. Pastoral care committees were urged to exercise a compassionate ministry to persons with AIDS.

The following is excepted from “Pastoral Care of Persons with AIDS,” Board of Congregational Life report: “All illness, physical and spiritual, is the product of living in a fallen world, a world in which people have become alienated from God and from each other. As Christians, therefore, we are agents of reconciliation in the midst of alienation, including that alienation which is a product of illness. As Christians, we are called to care for all people who are sick, whether in body, in mind or in spirit, and to bring them within the community where we ourselves have found healing before God.

Some irresponsible statements have been made which interpret the AIDS crisis as a sign of God’s wrath or judgment. Such assertions seriously misrepresent the character of our loving God, and discredit the Christian gospel of wholeness and reconciliation. In the face of the AIDS epidemic, as disciples of Christ, we must imitate the behaviour of Jesus Christ the healer. If we fail in this responsibility, the good news we proclaim is empty” (A&P 1988, 346.)

Principles that General Assembly has endorsed

• The weight of Scripture endorses a standard of death with dignity. (A&P 1994, pp. 352-358, 29)
• The value and dignity of human life precludes any support of euthanasia or assisted suicide. (A&P 1994, pp. 352-358, 29)
• We support life but do not seek to prolong the process of death. (A&P 1994, pp. 352-358, 29)

Select Actions of The Presbyterian Church in Canada/h3>

2022: General Assembly resolved that the change of the title of the document “Physician Assisted Suicide” to “Medical Assistance in Dying (MAiD)” not be delayed to a future assembly, but be endorsed by the 2022 Assembly, and that the change be immediate. (A&P 2022, p. 38)

2021: General Assembly encouraged congregations, presbyteries and agencies to discuss a possible change to the title, from “Physician Assisted Suicide,” to “Physician Assisted Suicide: Medical Assistance in Dying” and report comments to the Committee on Church Doctrine. (A&P 2021, p. 49)

2017: General Assembly commended the Committee on Church Doctrine’s interim report entitled “Physician Assisted Suicide” for use by agencies, colleges, congregations, sessions, presbyteries, synods, committees and groups within The Presbyterian Church in Canada and that comments be reported back to the Committee on Church Doctrine by January 31, 2018. (A&P 2017, pp. 25, 242-273)

2015: General Assembly approved the recommendations of a Special Committee, responding to Overture No. 34 re preparing a statement regarding end-of-life issues, that the Committee on Church Doctrine undertake a study of the issues of physician assisted death. General Assembly approved a summary of church historical statements and positions on euthanasia and physician assisted death and recommended that the Moderator write a letter of pastoral concern regarding the complexity of end-of-life issues and that the summary and letter be circulated to sessions and congregations as a resource for conversations on this complex and sensitive matter. (A&P 2015, pp. 47-49)

1995: General Assembly urged sessions and congregations to speak with their Members of Parliament should legislation on the legalization of euthanasia and assisted suicide be introduced in the House of Commons. Justice Ministries staff prepared a brief for the Special Senate Committee on Euthanasia and joined a new coalition, Care in Dying, to work with others advocating with the government on proposed legislative changes. (A&P 1995, pp. 304-306, 31)

1994: General Assembly approved the statement “Euthanasia: A Matter of Life and Death” as study document for presbyteries and for use in pastoral care. (A&P 1994, pp. 352-358, 29)