Congress of Delegates Wrestles With Public Health Issues

The AAFP Congress of Delegates tackled public health topics in its late-September meetings, including end-of-life care, sex education and healthy food choices.

After being in what physicians termed "a persistent vegetative state" since her brain injury in 1990, Terri Schiavo died March 31. "The significance of the Schiavo case was the level of interference with medical decision-making," Oregon AFP President-Elect Michael Grady, M.D., of Silverton told a reference committee. "The U.S. Congress and the executive branch were involved. This went far beyond what we've seen for 30 years; it was unwarranted intervention and a superseding of due process."

Delegates called for CME programs and resources such as a template FPs could use when discussing end-of-life issues and advance directives with patients and their families. The AAFP "opposes unwarranted legislative interference in the medical and ethical decision- making process for end-of-life care issues for patients with or without an advance care directive," the delegates decided.

They also strengthened AAFP's policy on adolescent health care, sexuality and contraception. The delegates added this statement: "The AAFP defines effective sexuality education, pregnancy prevention and sexually transmitted disease prevention programs as those using a comprehensive approach to sexuality education that includes medically accurate information on contraception and abstinence."

Special constituencies delegate Noreen O'Shea, D.O., of Sioux City, Iowa, told the committee she and others instituted age-appropriate comprehensive sex education for fifth graders and high school students in Woodbury County, Iowa. Between 1997, when the education began, and 2001, the number of teen pregnancies dropped from 274 pregnancies per 1,000 teenage girls to 198 per 1,000," she said.

Shifting to the topic of obesity, the delegates approved a new AAFP policy on school nutrition, called for high-nutrition foods and drinks in health care facilities, and resolved that the Academy should provide healthy meals at its functions that include meals.