Bishop Morgan drew attention to the document "The New Covenant" stating that appeals have been received from native people that the Sunday before the First Minister's Conference be designated a Day of Prayer.
That this House of Bishops respond to the request of Native leaders for the Churches to name a Day of Prayer to precede the final First Ministers' Conference to be held on March 26-27, by designating Sunday, March 22, as a Day of Prayer for Aboriginal Peoples:
And that we commend the document entitled "A New Covenant" prepared as a Pastoral Statement by leaders of the Christian Churches to be used as a focus for this Day of Prayer. CARRIED
Dr. David Gould expressed appreciation for the invitation to address the House. He said that the Doctrine and Worship Committee asked him to give some thought to ministering to patients with AIDS. His paper "Eucharistic Practice and the Risk of Infection" was made available to all the Bishops.
Dr. Gould spoke of the risk of infection through the use of the common cup and other practices such as intinction in Holy Communion. He said that the likelihood of contracting AIDS through the use of the common cup is remote enough to be consider impossible.
Bishop D. Jones reported that there have been instances in the Dioceses of Huron where people have absented themselves from the Eucharist because they fear the catching of infectious diseases.
It was stressed that, up until now, scientific evidence indicates that there has never been a case of a major disease being transmitted by the common cup.
That we affirm the continued use of the Common Cup in the light of the medical evidence which we have received to this point. CARRIED
EUCHARISTIC PRACTICE AND THE RISK OF INFECTION
(Submitted to Doctrine and Worship Committee -- April 1987)
David H. Gould, M.D., ATh.
The Acquired Immunodeficiency Syndrome (AIDS) is a new disease entity which was first recognized in the United States in 1981. In Canada, the first case was diagnosed in 1982, and since that time 685 cases have been reported to the Laboratory Centre for Disease Control in Ottawa. (1)
Within the past 2 1/2 years the virus responsible for the destruction of the immune system has been identified. This virus, called Human T-Cell Lymphotropic Virus Type III (HTLV-III) may cause the disease on its own, or may require additional co-factors which have not yet been identified. Once the virus had been found it was then discovered that it could be cultured from lymphocytes (a type of white blood cell) found in the saliva of some AIDS patients, as well as from other body fluids.
With this discovery a number of fears arose regarding the risk of infection being spread by the use of the "common cup" at the Eucharist. This in turn has led to a re-examination of Eucharistic practices and their potential for transmission of infection.
At the outset, it is important to recognize that there are a number of general principles which govern the transmission of infection. In no case can exposure to a single virus or bacterium result in infection. For each disease there is a minimum number of the agents (generally in the millions) which must be transmitted from person to person before infection can occur. Our defenses against stray bacteria are immense and can only be overwhelmed by very large numbers of the infective agents. Each infective agent has its own virulence, and each individual has his/her own "host factors" which determine that person's susceptibility to infection. The interaction of the two determine the risk of infection for the individual.
Six years of experience with AIDS has served to confirm the fact that the HTLV-III virus is of low infectivity. There are only three modes of transmission of the AIDS virus which have been identified.
1. Sexual transmission
2. Blood or Blood products
3. Perinatal transmission
The transmission of AIDS by blood and blood products is no longer a major concern, since all donated blood is now being tested for antibodies to the AIDS virus. These tests have been refined to the point where they are 99.9+-% reliable. In addition to the screening, all blood concentrates used for Hemophiliacs are heat-treated which inactivates the virus.
Perinatal transmission is essentially a form of blood transmission, occurring either at the time of delivery or crossing the placenta earlier.
There is no evidence that the AIDS virus has been transmitted by any other route, such as saliva or tears. In one case transmission by breast milk has been implicated.
As indicated above, there are now tests for AIDS antibodies. Their presence indicates only that the individual has been infected by the virus, not that he has the disease, or indeed will ever develop it. In this case an analogy can be made to the TB skin test -- a positive test means that exposure to the agent has occurred -- not that the disease is present. The present evidence suggests that 90 % of those who react positively to the test (i.e. have antibodies to the HTLV-III virus) do not have the disease and most may never get it.
Within 1 to 3 months after exposure to the virus the tests for the antibodies will become positive. If the individual is going to develop the disease, symptoms will appear within 2 to 5 years. Thus it is important to note that the breakdown of over 15,000 AIDS cases in the USA by risk groups has not significantly changed since the illness was first described, showing that the disease has very limited modes of spread. No single family member of an AIDS victim has contracted the disease, even though occasional sharing of drinking cups, eating utensils and on occasion, toothbrushes has occurred.
The low infectivity of AIDS was shown in a study of 1758 health care workers with a wide variety of intensive exposures to AIDS patients, including persons working solely on AIDS units, persons inadvertently exposed to contaminated blood or body fluid at the time of surgical or other invasive procedures, several hundred persons accidentally punctured with needles drawn out of the arms of persons with AIDS, and persons otherwise intensively exposed to the HTLV-III virus. Twenty-six (1.4 %) of these 1758 health care workers have become seropositive (i.e. show antibodies to the virus). Interestingly, 23 of these 26 persons have admitted to being homosexuals. (2)
In 1986, in an atmosphere increasingly dominated by litigation, no one in the medical profession is going to give any absolute reassurance even when scientific data indicates that strong reassurance can be provided. Thus this writer cannot absolutely guarantee that one cannot acquire HTLV-III infection via the cup -- he can only cite the evidence above.
It should also be pointed out that the HTLV-III virus is destroyed by exposure to air, soap, and virtually any disinfectant (including alcohol) and therefore that normal cleaning procedures if performed carefully ensure protection. This should be remembered not only in the context of the eucharist, but also in reference to those who minister to AIDS patients.
In this regard the recent statements of the Bishop of Edinburgh, the Rt. Rev. Richard Holloway are relevant. "... in the last analysis we must care for the victims. It is, after all, our business". Christians have always been called to care for outcasts, he goes on; and while he acknowledges that society has not yet abandoned AIDS victims he feels that attitudes will harden. It will be the business of Christians to resist the calls for the quarantining of AIDS carriers, and he has no doubt that they will do so. He expects that the epidemic will claim its martyrs before it is over, "but that also is our business. We know about dying. We take over where everything else finishes because we are always on the margins. We endure `as seeing him who is invisible'."
The Bishop also warns that Christians will be spending an increasing amount of time helping the young to die with trust and without anger. "It'll be a better use of our time than many of our trivial pursuits," he comments, "and it help to call us back to the heart of the gospel -- the offer of eternal life".
It must be admitted that it is difficult to be as reassuring in regards to the use of the common cup in the case of other infectious agents such as is the case with AIDS. In the case of Hepatitis B virus -- also of concern to health care workers because it too has been isolated from saliva of victims -- it is possible to be reassuring. There is no evidence of any transmission by the oral administration of hepatitis-positive saliva. (4 sic i.e. 3)
Were there any significant risk to the eucharistic practices of the Anglican church for so many centuries it would seem likely that Insurance Actuary Tables would reflect an increased risk for Anglican Priests, who have been performing the ablutions for centuries. In fact the opposite is true. Nor do Priests appear to have been regularly stricken with any communicable disease that could be traced to the chalice in all that time.
Thus for the average communicant it would seem that the risk of drinking from the common cup is probably less than the risk of air-bourne infection in using a common building. (4)
It must be pointed out that while the relative risk is low, it is not impossible that infection could be transmitted. In particular is this true of communicants with low resistance to infection, cancer patients on immunosuppressant therapy, and AIDS victims. Further examination of alternate Eucharistic practices is therefore warranted.
Intinction is in use in many Episcopal Church parishes and is increasingly being suggested in Canadian Churches as well. A serious difficulty with intinction however is that it basically undermines the character of the sacrament. If the sign of participation in the sacramental meal is eating and drinking as per our Lord's words of institution, then intinction confuses that sign in that dunking is neither eating nor drinking.
There is also real concern that many of the modes of intinction used in parishes do not diminish the threat of infection. Retention of the wafer in the hand of the recipient then intincting it merely means that the wafer becomes contaminated by the hand of the recipient and that a contaminated wafer is then placed in the wine -- spreading the infection to it. Hands are equally as likely to be a source of infection as are lips. If a priest retains the wafer, intincts it and places it on the tongue of the communicant there is the possibility of his hand coming in contact with the tongue, and thereafter spreading the contamination. Meticulous technique would avoid this and it would seem better to trust in the technique of one individual (the priest) than in the individual techniques of the communicants should they do the intinction themselves. Obviously a separate chalice used only for intinction would be required unless all communicants are to receive by this method.
A further consideration with the practice of intinction is that it is only feasible when wafers are used. More and more churches are starting to recognize the sacramental value of the one loaf of bread which is then divided for distribution. Intinction would not be an esthetically tenable option, in these circumstances.
When communicating the ill in hospital many of these considerations would not apply. Wafers would ordinarily be used, and where the illness is infectious the patient would be communicated last using intinction by the priest. Conversely, when the ill person is debilitated or otherwise susceptible to infection, normal prudence would dictate that he/she receive first.
The other option for eucharistic practice which should be examined is communication in one kind only. While Anglicans have asserted since the Reformation that reception under the species of both bread and wine is normative for our church, it must be recognized that many would find themselves able to accept the doctrine of Concomitance -- the doctrine that either part of the Sacrament by itself mediates the whole and entire Christ. Inasmuch as the living Christ is received in Communion and the blood is inseparable from the living flesh it seems difficult to believe that the Body and Blood of Christ can be separately received. Although the doctrine was promulgated in the thirteenth century, it would appear to have been accepted in the primitive church particularly in the case of communication of the dying and of infants. Some evangelical Anglicans may have difficulty with this doctrine, but it would seem that for the majority of Anglicans this represents both the safest, most esthetic, and sacramentally most sound of the alternate modes of administration of the elements.
It must be stressed, however, that the present use of the common cup is normative for Anglican churches, follows the practice of the universal church from its beginnings until well into the middle ages, and poses no real hazard to health in normal circumstances.
(1) As of 2 September 1986
(2) CDC: Recommendations for preventing transmission of infection with human T-lymphotropic virus type III/lymphadenopathy associated virus in the workplace. MMWR 1985: 34 (Nov 13): 691-695
(3) Glaser & Nadler, Archives of Internal Medicine Vol 145: 1653, 1985.
(4) Bishop of Huron, Report to the Primate and House of Bishops regarding Cross Contamination via the Common Cup (a report on proceedings of a multidisciplinary consultation in the Diocese of Huron)
Discussion took place about the re-examination of the statement on the common cup (this was due to a concern expressed because of the spread of AIDS, tuberculosis (TB), hepatitis "B" in society today).
Some members suggested that a new statement would risk sending an unintentioned message to the constituency. It was agreed that TB is of growing concern and would warrant a re-investigation about the tradition of the common cup. However, AIDS is not (a concern), and any new statement would have to be clear about the distinction. It was agreed that the national Doctrine and Worship Committee together with the library would be requested to prepare a summary of contemporary material for the House of Bishops for its consideration.
That the Doctrine and Worship Committee draft a summary of recent literature regarding the use of the Common Cup and report back to the House of Bishops. CARRIED