Friday, February 05, 2016

On Days and Numbering and Other Things

Regular readers know that I am an occasional contributor to the Episcopal Cafe, so it won't surprise anyone that I am a daily reader. This morning, I followed this post, Bishop Katherine Jefferts-Schori contributing to the series on Faith and Science in the 21st Century at Day1, the radio and on-line resource supported by mainline Protestant churches. I certainly commend Bishop Jefferts-Schori's video and her reflection on re-framing and repentance.

And then, looking further in that series, I discovered another contribution: the Rev. Dr. Tom Long reflecting on Psalm 90 and the call to Number Our Days. I was especially interested because the point of his sermon (on the link, and then scroll down past the interview portion. If you're registered with Day1 you can hear the audio of the sermon.) was to reflect on numbering our days in light of the capacities of contemporary medicine. He speaks to a difficulty that I have described by saying, "When will folks understand that Dr. House lied to them? We don't get every patient cured, much less in 60 minutes!" Tom Long points this out himself, if more gently, and reflects on numbering our days and wisdom.

Often enough I have spoken to this myself, frequently addressing (all right, complaining about) the tendency in the media to hype every small study with an apparently positive result, without presenting that result in its longer - and not necessarily so positive - context. Tom Long does it with a bit more grace and a bit more Scripture, and I commend this to you, too.

Wednesday, January 27, 2016

Extending God's Party: Sermon for Epiphany 3, year C

I had the pleasure of preaching again at St.Mary Magdalene Church in Belton, Missouri (or, yes, Loch Lloyd). You can link to the sermon here.

Just one explanatory note: I also preached there on Sunday the 17th, and, reflecting on Jesus at the wedding at Cana, spoke of God's party, the celebration and celebrating we do that demonstrates the presence of Christ in the world. So, if you're not sure what "party" I mention in the sermon, there it is. God calls us to celebrate by demonstrating God's presence in Christ; and to use all our gifts for the party; and to invite to the party those who most need to hear about the Year of the Lord's Favor.

Tuesday, January 19, 2016

We're Here to Help

I do still look up health news now and again, considering topics of interest. And, this evening I ran across this story from ABC News.

The headline captures the point well: “Many Doctors Choose End-of-Life Care Differently Than the General Population, Two Studies Show.” In fact the two studies appeared today in JAMA. the Journal of the American Medical Association. You can review them here and here. The points are that doctors are less likely than the general public to die in a hospital, or to use medical procedures and technology at the end of life. Both studies are based on the medical records of literally hundreds of thousands of people, and as we all know, those large numbers mean statistically meaningful results.

Perhaps this would be a surprise to someone, but not to those of us who work in healthcare. Indeed, the second study looked at folks who worked in healthcare who were not doctors; and their results were closer to the doctors than to the general public. The comment in the article is that the general public isn’t prepared to discuss what the limits might be to appropriate care. I think we need to respect the other side of that coin: those of us who work with it every day are more likely to discuss it, precisely because we have seen what those hospital stays and late life interventions do – and don’t -  accomplish.

I don’t want to press these results too far. While the differences are statistically significant, they aren’t absolute. In fact, a lot of those late life interventions in hospitals happen before the decision is reached that it is in fact the end of life. And, of course, there are certainly enough doctors who also have difficulty talking about decisions at the end of life – their own lives and those of their patients.

At the same time, perhaps the opportunity is for folks who don’t work in healthcare to ask those of us who do, whether doctors or not. It would be even better if they were to ask us especially when it isn’t a crisis. I have said often enough that these topics should be discussed over breakfast at home; and that the worst place to discuss the patient’s wishes is at a bedside in ICU at 2:00 in the morning.

So, perhaps the ABC News article can stimulate more of these conversations. It is a bit easier to have these conversations with one’s physician these days, but you don’t have to wait for that annual appointment. Perhaps it would be better to have the conversation with friends and family, especially (but not limited to) any who work in healthcare. We know the stakes. We want to help. And if it does get to 2:00 in the morning at a bedside in ICU, it’s likely to be those family and friends who get asked just what your values would be.

Friday, December 25, 2015

Christmas in Three Movements

My readers all know, I think, that I work in an Episcopal hospital. More to the point, the hospital’s chapel is really not the hospital’s chapel. It is an Episcopal chapel, under the jurisdiction of the Bishop, with me as the Bishop’s vicar. The important aspect of that for this post is that there are certain Episcopal services that are maintained: Sunday Eucharist and Wednesday Eucharist with Healing Service.

During most of the year, preachers at those services are CPE students. However, at times during the year the students get a break and staff chaplains preach. So it was that one of my colleagues came to me and asked, “Do you guys [read “Episcopalians”] actually do John 1 for the Sunday after Christmas?” He is scheduled for this Wednesday, and so  would use the lessons from the previous Sunday, this Sunday, Christmas 1. I assured him that we did – that, in fact, for the third Eucharist of any Christmas (usually Christmas morning) we read John 1 and the beautiful “Hymn to the Logos.” “Well,” he said, “I have to write a sermon for Christmas on Luke. So, on Wednesday I’m preaching on Luke.” I blessed him, shrugged my shoulders, and told him to be sure to let the celebrant know.

We have a rather interesting way that we tell the Christmas story, we Episcopalians, in our Christmas services. (I don’t know whether others do it this way. Yes, the Episcopal Church uses the Revised Common Lectionary; but we use it with some of our own idiosyncrasies.) If one were to do three Christmas services (Eve and Day both), we would actually read three different Gospel passages. At the first, we would read from Luke, but only half of what most people expect. We would read about the census, and Mary and Joseph arriving at Bethlehem, and about angels announcing good tidings to shepherds. At the second service we would read only the second part of Luke, about shepherds going “even unto Bethlehem” to actually see for themselves. Finally, in the third we would read, not from Luke, but from John, about the Word becoming flesh.

I don’t know how often that actually happens. We always have an option at the first two services – and, really, at the third – to read the entire Luke account of Jesus’ birth. It’s the story as everyone knows it, and has all that wonderful imagery and drama. Still, the plan as laid out in the Lectionary is to break the Luke account up, and to include the John. The point is pretty clear: to read, again and again and with different emphases, this sentence:

God did this.

Or, better perhaps, since we do break it into three parts:

God. Did. This.

Let me sort this out. It is an event in three movements, if you will. In the first movement, Luke’s story spends a lot of time on the power of the Emperor, and how civil necessity can make people move. However, the critical point comes when shepherds in the fields are confronted with the angel of the Lord; which is to say, with a message from God. “Today in Bethlehem is born a savior, God’s Messiah” Augustus may make some claims, but it is by God’s plan that David’s heir is in David’s city. It is God who proclaims it, and lets us know that God has done it. In the first movement, our sentence is,

God! did this!

In the second movement, the shepherds investigate. They go, and they find, and they see. The message from God is confirmed, and the faith of the shepherds is affirmed. We have the first witnesses. Sure, they’re not folks who are highly esteemed, nor terribly important; but, then, how many of us are? Rather, they are common folk, people who were, as my mother used to say, “of the earth earthy.” Sure, wise men will be great when they get there, but the first witnesses are witnesses we can trust because they are witnesses just as common as we are. The important sentence turns to,

God Did! this!

Which brings us to the third movement, the movement that takes us from Luke to John. It is John’s opening hymn that really lays out what God did. After all, we’ve all heard those sermons – I’ve certainly preached those sermons – about how the common concept of “messiah” in First century Judea was not what God was about. We’ve also realized often enough just how few people really understood. The Twelve didn’t really understand until the end of the story, much less the Seventy (or Seventy-two, depending). The women come closest, I think: Mary his mother, Mary and Martha of Bethany, Mary Magdalene; but those stories, by and large, are also in John, and so already in the context of the opening hymn. John helps us all to get it: that what God was about on Christmas wasn’t just shaking things up a little. What God was about was wholesale reordering of how God had been doing things. What God was about was Incarnation, about Emmanuel, about no longer being apart but instead being with us. It is in John that the sentence is really completed:

God did This: the Word became flesh, and lived – and lives – among us.

A blessed Christmas Season to all, and a happy and healthy New Year.

Friday, July 31, 2015

Episcopal Ecclesiastical Endorsement 2015

I am writing this about Ecclesiastical Endorsement, and some refinements in the Episcopal Church's process. I do get to those in this post, but I encourage you to read the whole post so that those changes make sense. I could, I suppose, put the changes first and the explanation after; but, as Scripture says, “what I have written I have written.” Those who know me well won't be surprised.

As many of you know, I do my best to keep track of and post information about and changes in the process of becoming an Episcopal Chaplains. Indeed, my post To Become an Episcopal Chaplain, now all of eight years old, is still the most read post on the site. (Actually, if you’ve found this post because you’re interested in becoming an Episcopal Chaplain, you might want to read it first.)

One of the ways that I learn about changes is my own process. As a Board Certified Chaplain (BCC) with the Association of Professional Chaplains (APC), I am required to undergo a peer review process every five years. It’s part of maintaining my certification. I know that other professional organizations for healthcare ministries have similar requirements. As a part of that process, I apply to renew my Ecclesiastical Endorsement. Ecclesiastical Endorsement is required by APC and by other professional organizations; and while periodic renewal isn’t, it is a best practice that the Office of Mission at the Episcopal Church Center, which is where we connect for endorsement, has come to strongly encourage. (I have also written specifically about Ecclesiastical Endorsement. You can read those posts here. Be sure to sort by date to see the posts in order.)

Renewal of certification is not the only time when one might want to renew Endorsement. If an Episcopalian with Endorsement changes positions and moves from one diocese to another, we would recommend renewing endorsement even if not changing canonical residence. This would be true whether the chaplain is ordained or lay.

Let me give some explanation of that and remind us all of how endorsement works in the Episcopal Church.  I usually say that endorsement is a joint action of the Episcopal Church Center and the diocesan bishop. That’s true of the process. You complete the application and it goes to the Office of Mission. When that is received electronically, either the Rev. Margaret Rose or Terry Foster will reach out to the diocesan bishop for confirmation that the individual applying is known (both person and ministry) and has a vocation for healthcare ministry. When confirmation is received, the Rev. Margaret Rose will send a letter to the individual and to the professional organization confirming Ecclesiastical Endorsement in the Episcopal Church. (There may be some interested in Endorsement who are not seeking to gain or maintain certification. More about that below.)

If you think that through, the most important contact that happens in that process isn’t the application or the phone call from New York to a bishop. The most important contact is the meeting and conversation with the diocesan bishop (or bishops, if you live in one diocese and work in another) so that the chaplain and ministry and vocation are known to said bishop(s). We are, after all, an episcopal church; and so nothing of this nature will happen without a bishop’s consent.

That’s more than just a procedural concern. In my earlier post, I quoted from “A Covenant Between Religious Endorsing Bodies And Pastoral Care Certifying Bodies.” That covenant also includes this:

Endorsement is an exclusive covenant relationship between the faith community/tradition and endorsee. The faith community pledges to provide support and discernment to those seeking to enter pastoral care ministry and guidance, support and oversight to those who serve in these ministries. The endorsee agrees to ongoing participation in the life of his/her faith community as well as maintaining communication and accountability to the endorsing agent.
Endorsement addresses the following core standards through a process of written papers, interviews and mutual discernment:

• Ministerial and theological competence• Good standing and accountability within that faith community• Ability to work collegially in diverse and pluralistic environments• Willingness to adhere to the codes of ethics prescribed by the faith groups, institutions served and the agencies providing certification• Continuing spiritual formation and review• Academic and clinical educationEndorsement is not a legalistic ritual; rather it is a mutual covenant and relationship between the endorsee, the endorsing faith group and the certifying body. Each and all are to benefit.

Accountability is important for the chaplain serving, for the person served, for the employing institution, and for the faith community providing endorsement. The certifying bodies aren’t in a position to determine whether someone has “good standing and accountability within [a] faith community,” or “continuing spiritual formation and review.” For us as Episcopalians, our accountability within our faith community is expressed in accountability to a bishop, and without the awareness and acceptance of the appropriate bishop(s), endorsement will not happen.

In that instance, the Office of Mission serves as a single contact for most of us involved. It’s where the certifying bodies look for confirmation of endorsement. It is where bishops connect to give imprimatur. It is where we send our applications. However, in that process, while we might talk of the Office of Mission as the Endorsing Office, it is more accurately an “office of record,” where our application and the bishop’s response is recorded for the benefit of all three parties.

So, does every Episcopalian engaged in healthcare ministry need to request Endorsement? At this date, the application is focused on those who are seeking certification. Are there other circumstances? Yes, there are. There are employers who are not committed to certification but who request Endorsement to demonstrate accountability. There are colleagues who are engaged in institutional healthcare ministries on a regular basis because there's an institution associated with the parish; or because a local institution knows the minister and feels the minister suits the needs of those served. For those persons, it would still be important to be in contact with the bishop. Because ultimately it is the word of the bishop that endorses, those individuals can request the bishop to endorse individually. Moses said, "Would that all God's people were prophets;" and I have sake, "would that all God's bishops required endorsement in some form of all the healthcare ministers in their dioceses." Once again, what makes for functional accountability and functional endorsement is the knowledge of the bishop about the healthcare minister and her or his ministry.

So, central to the process of Ecclesiastical Endorsement in the Episcopal Church is the connection between applicant and bishop, which begins directly and is may be recorded by the Office of Mission. To better reflect that connection and accountability, there have been changes to the application form for endorsement. Specifically, there are three questions you might not have seen if it’s been a while since you renewed endorsement.

The first is a request to give the specific date when the applicant informed the bishop of the intent to apply for endorsement. If you are in reasonably regular contact with your bishop, that may take no more than an email. If you’re applying for the first time, or you’ve recently changed dioceses, a meeting is in order.

The third question (yes, I’m coming back to the second) is for those who are canonically resident in one diocese but working in another. It asks who that second bishop is. It’s a clear reminder that it would be important to be in contact with that bishop.

The second question is the one that will take a little more effort. The applicant is asked when he or she completed the sexual misconduct training required in the Episcopal Church and provided in every diocese. The Office of Mission is now asking that the training (or renewal of training) has happened within the last five years. Indeed, you can’t choose a date more than five years ago. 

That was one that applied to me. I’ve been trained and retrained several times, what with job and diocese changes and all. However, I’ve been in the same diocese and the same system for 21 years now. My last renewal was about eight years ago. Now, there are behaviors for which I am accountable to my health system, and to which I recommit each year with my annual goals (and the behaviors our misconduct prevention training teach are covered, generally if not specifically). I certainly have the date when last I renewed my accountability to my employer. However, I thought it worthwhile to contact the diocesan office and learn what renewal education might be available. That protects me, the Office of Mission, and the bishop from questions later about my accountability. A renewal module was available on line from the Church Pension Group. It took me about an hour to complete. Now I have a record that I’m up to date, and so does my diocese. It was a change I hadn’t originally expected, but well worth the small amount of time required.

Note that I had originally been trained and retrained because of my ordination. However, any of us active in ministry in a parish (lay or ordained) probably know by now the expectations of the Episcopal Church (through the Episcopal Insurance Corporation, and so the Church Pension Group) that all in significant ministries have the sexual misconduct training. It is just a basic component of how we make our churches safe places for all, and especially for children and youth. If you’re endorsed and you haven’t run across this, I’m very surprised. If lay and applying for the first time, when you meet with the bishop be prepared to talk about this. It is an important measure in our accountability as ministers who function in healthcare, and who reflect the ministries of the Episcopal Church.

So, that’s what’s newest about Ecclesiastical Endorsement in the Episcopal Church. Read, mark, learn and inwardly digest. Get endorsed. Get endorsement renewed. These are simply opportunities for us to claim both our ministries and our accountability as chaplains serving as ministers of the Episcopal Church.