Tuesday, January 31, 2006

Reflections on the Death of Coretta Scott King

Before I came to Kansas City, I served in a hospital in downtown Detroit. One of the outreach programs of that hospital was support for three middle schools in the inner city. The schools served poor and working-class African-American neighborhoods, and many of the children would fit into someone's category of "at risk."

As a part of that program, the Sixth Graders from each school were brought to the hospital for breakfast with an African-American professional who was a leader in the hospital. The purpose was to offer role models, images of possible futures that were not a part of their common experiences.

I was present to say grace for one of those breakfasts - another call to "sing for my supper," or at least to pray for my eggs and sausage. The speaker was the new head of the Pediatric Medicine, the first African-American in the position.

At breakfast I found myself sitting across from the speaker. As we spoke, we discovered we had many experiences in common (although I am careful never to claim we had a common experience). We were about the same age. We had both grown up in the South - he in a small town in Alabama and I in a small city in Tennessee. And we both had clear memories of growing up in the Civil Rights era, and in the culture that made the struggle necessary.

Again, I would never claim we had “a common experience.” He was on side of the racial divide, and I was on the other. And yet there were those events in our lives that were parallel. Each of us had been gently but firmly turned away from drinking from wrong fountain and using the wrong bathroom; and each time by an elderly African-American man. Each of us remembered expectations of how we were to behave, how to associate, expectations so common in the culture that it didn’t matter that we didn’t learn them from our parents.

And each of us remembered being afraid. In a culture that spoke in discrete colors I was white and he was black; but both of us knew to be afraid. Each of us remembered encountering gatherings of white-robed Klansmen – public gatherings Saturday mornings on courthouse lawns. And each of us knew that it didn’t matter whether you were white or black: if they decided you were “dangerous” by their standards they might come for you, and the results would be horrible.

As we spoke about these things the 11- and 12-year-olds around us were quiet, their eyes wide and attentive. They had heard about that world, but they had not grown up in it. They knew a little about the history, but for many of them these specific injustices were more legend than fact. It’s not that they didn’t encounter the consequences of racism and bigotry. It was simply that Detroit in the 1990’s was not the South of Jim Crow; and like all children they were inclined to see their own experience as the way it had always been. Here now were two adults, two professionals – a priest and a doctor – providing independent confirmation of family stories and school lessons of what it had been like, from their perspective, “long ago.”

We finished breakfast and the doctor went on with his speech. He spoke to them of opportunity and education and hard work and hope. My hope is that each of them heard him and that each was inspired by his model to pursue futures of promise. Still, I like to think that our witness, our sharing that those stories of days gone by were true, was also important. We cannot either acknowledge progress made or goals still to be pursued if we don’t also acknowledge the truth of how it was. If we forget why the Civil Rights movement was necessary then, we are risk ignoring why it is necessary now, what goals of justice and compassion are yet to be achieved.

Coretta Scott King died today. Her husband Martin Luther King, Jr., died working to bring the justice and grace of God to American society – that there might be “neither Jew nor Greek, neither slave nor free, neither male nor female” – neither oppressor nor oppressed, for race or any other reason. Coretta Scott King lived for that ministry, not because it was her husband’s call, but because it was God’s call to all of us. Those of us who were witnesses to those times – even, and perhaps especially, those of us who were the beneficiaries of an unjust society - can have a special part in that ministry by testifying to the facts of that history. If we are ever to be able to say “Never Again!” we must continue to say “Never Forget.” Those of us who remember, beneficiaries and victims alike, have a special role in remembering what was, seeing what is, and working for what can be. Those of us who were beneficiaries have a special responsibility to acknowledge the sin of racism, and to give, work, and pray for the spread of the Kingdom, and of a society of justice and equality.

Sunday, January 29, 2006

The Epistemological Question

I began my sermon today with a family joke on the epistemological question. I had to define “epistemology” for the congregation. I will admit that any family joke for which the punch line is “OH GOD! It’s the Epistemological Question!” is a bit obscure; but what would one expect from a couple one of whom is a priest and the other of whom has her first degree in philosophy?

Still, when I look out at my church – at the Episcopal Church and at the larger Anglican Communion – I find we are wrestling with the epistemological question. I don’t find we’re being clear about that, or in some cases even honest about that. However, as far as I can tell, epistemology is a critical question for the church.

Usually, the question is assumed to be settled. The two poles in the argument don’t agree about how it’s settled; but both are clear about how they know what they know. At one end are those who look first, and usually solely, to Scripture. Some will say, “Scripture first, and other sources only as they support or illuminate Scripture.” However, there is no reflection offered about the history or forms of Scripture; and Scripture, at least as they interpret it, trumps all other sources.

At the other end are those who speak about justice as the critical theological principle. They usually speak from the authority of the traditional Three-legged Stool of Anglicanism: Scripture, Tradition, and Reason. As a rule, they want to place a great deal of emphasis on Reason. They never want to deny Scripture; but they have, at the very least, a very different understanding of the primacy of Scripture as a source of authority for Christians.

Today, as I preached, I returned to today’s Gospel: ‘They were all amazed, and they kept on asking one another, "What is this? A new teaching-- with authority! He commands even the unclean spirits, and they obey him."’ (Mark 1:27, NRSV) Indeed, we are the people, we Christians, who have encountered the risen Christ and have experienced that authority. More to the point, we know not only that he has authority, but that he is authority. Jesus Christ, risen and present, is the primary authority for Christians.

In that light, Scripture is a source of authority because it is contains either the words of Jesus, stories about Jesus, or stories that point to Jesus. Scripture is the first repository of the experiences of our ancestors in the faith living before God. Is it revealed, in whole or in part? I think so; but, then, what is revelation but the experience of the faithful? And Scripture is the record of those experiences and what sense our spiritual ancestors made of them.

But, then, we don’t believe God’s presence ended with the latest writings of John the Elder. The Evangelists and New Testament Authors reported experiences of Jesus; but the community continued to experience the presence of the risen Christ. Our brothers and sisters in Christ, those Christians of earlier generations, continued to record and reflect on their own experiences of Christ and of life in Christ. As those experiences came to us we called them our Tradition. But it was not their antiquity that made them authoritative for us: it was their continued witness to the presence and activity of Christ.

And we continue to believe that Christ is present in the Spirit. When we gather for worship or take time for prayer, we do so believing that Christ is present in us as individuals and as a community. We will be aware of that presence at some times more than others; but we believe Christ is present and calling to us always. We are called to use our Reason to reflect on our experiences and on the experiences of our siblings in Christ. But Reason is not authoritative simply because we’re rational, or because the logic makes sense. Our Reason is authoritative as we hold Christ central in our reflection, as we know Christ in Scripture, in Tradition, and in contemporary experiences.

And so the answer to the question of Christian epistemology is Jesus. That is to offer an answer that is simple but not easy. There is a lot of work in looking for Christ in Scripture, in the experiences of Tradition, and in our Reasoned reflection on contemporary experiences, our own and others’. At the same time, we continue to recognize, as did those first listeners in Capernaum, the voice of on who speaks with authority – one who has authority because he is authority.

To be clear: I have a position in the epistemological struggles in the Church. I cannot look to Scripture uncritically, or see it as the sole source of authority. However, I am convicted of my own position: that Scripture, Tradition, and Reason are sources of authority for Episcopalians, subject to the primacy of Jesus Christ, risen, present, and active.

Thursday, January 26, 2006

Further Thoughts on Ethics in Health Care

I have written already about physician-assisted suicide and what the General Convention has said on the subject. I also want to commend again "Faithful Living Faithful Dying" as a valuable resource for theological and ethical reflection on care at the end of life.

I must admit, though, that I have some further thoughts about ethical reflection in health care. There is a distinct consensus, even a culture, that shapes how ethics are discussed and decisions made in health care. I have worked within that culture for some time. I appreciate its strengths; but I also have some questions.

First, let me review briefly the clinical consensus and where it came from. The 20th century had several scandals involving medical practice - or, more accurately, gross malpractice. Two were especially notorious. The first was the series of experiments on human subjects by physicians under the Nazi regime. Prisoners were compelled to suffer horribly under the justification of the greater good of new medical knowledge. The second was the Tuskegee Experiment, intended to learn the natural history of syphilis. For decades African American men in Alabama with syphilis were deceived about their condition. They were followed but not treated while syphilis took its toll.

In reaction to these atrocities the international medical community came together to articulate principles of appropriate protection of human subjects for research. Statements such as the Declaration of Helsinki and the Belmont Report laid out principles to protect human dignity. These principles were then applied to therapeutic practice, incorporating and transcending (or at least clarifying) the principles of the Hippocratic Oath, and its most familiar phrase, “First, do no harm.” The most common articulation of these principles is referred to as the Georgetown Mantra. Under the Mantra, respect for persons is expressed in the following principles:

1. Autonomy – that is, the independent autonomy of the patient or of the patient’s representative.
2. Beneficence - to act always in the best interest of the patient.
3. Non-maleficence - to do no harm to the patient.
4. Justice – that is, what is the impact of this action on the larger community?

Other principles have been derived from these, including truth-telling, that benefits should outweigh risks, and that life should have dignity and quality. However, the Georgetown Mantra has become the pervasive basis for ethical discussion in health care.

And within the Georgetown Mantra, the principle of Autonomy has risen to a primacy of sorts. In the American context, this isn’t really a surprise. We are quite defensive of our individual rights. This has been supported in law in the authorization of the various forms of Advance Directive and Living Will documents. These exist to give instruction from patients as to how to be cared for, and as to who can make decisions for the patient, when the patient cannot decide for himself or herself. Even at the bedside, and in the absence of a document, the first question to the patient’s family isn’t, “What do you think is right?” but, “Has the patient ever said what he or she wanted?”

The Georgetown Mantra is important and helpful in ethical discussion and ethical decision making. The principle of Autonomy certainly seeks to protect the integrity of the individual, even when the individual is not capable of protecting his or her own integrity. At the same time, I find myself at times struggling with its apparent primacy. Certainly, it seems to get all of us – both family and health care professionals – off the hook: “It’s not necessarily what I want, but it is what the patient wants.”

On the other hand, it can’t take us off the hook entirely. John Donne wrote famously, “No man is an island, entire of itself; every man is a piece of the continent, a part of the main.” While that image may be too big, too global for us to embrace, we can appreciate what we have learned and articulated in Family Systems theory: we all live in a web of relationships, however shallow or strained they may be. When we stand at the bedside of a patient who lacks capacity to make decisions, and who is not expected to recover to an acceptable quality of life, we stand almost always with others who will be affected by the death of this patient. Even though we die individually, we do not die without having affecting someone else. (You can trust my observation that the most apparently isolated patient strongly affects those who care for that patient, who are acutely aware of the emotional importance of the care they provide.) We may die individually, but none of us dies alone, without impacting someone else.

This is more acutely true of the Christian. We act as individuals, but we understand ourselves to be integrally part of something larger. We are all part of the Body of Christ, and individually members of it. We have an effect on others by action or inaction, by presence or absence. As we are integrally part of families, we are integrally part of this larger community – and sometimes more integrated into it. After all, we do not choose our families, at least in the first instance; but at some point we claim our part of the Body of Christ as an act of will, at least as often as we affirm our faith in the Creed.

In light of these thoughts, can I stand so absolutely on my own autonomy in making decisions about my medical care? Must I not at least elevate Justice on par with Autonomy? I personally think I should. Now, like many things I should do, I realize I will sometimes fail. I may not know what is just. I may not be able to see what is just through my own pain or fear. I may be able to make justice equal with autonomy for myself, and unable to do so for those I love best. I am conscious of Miroslav Volf’s response in “Exclusion and Embrace” to a hard question about his beliefs on reconciliation: “No, I cannot – but as a follower of Christ I think I should be able to.”

And so I think I should do in considering ethics in health care. I am not an island, either. How, then, can I think like one? It is not clear how I should do this when the shoe is on the other foot: when I am the chaplain, and neither patient nor family member. Still, I believe the Gospel calls me to see the patient in context; to advocate for those affected by the patient’s illness and death; and to recognize the interconnectedness of patient and family and community in the process of making moral decisions in health care.

Monday, January 23, 2006

Spotting the Bad Ones Early

In my hospital I serve on the committee of the Board that reviews and approves the credentials of physicians and other professional staff. The actual work is done by a group of physicians, the Credentials Committee of the medical staff. We meet with them, oversee their work, raise our own questions, and then act on behalf of the Board. Thus, it was of interest to me to learn that in December of last year the "New England Journal of Medicine" published an article on the behavior of physicians. It seems there is a correlation between misbehavior in medical school and professional misbehavior after physicians are out in practice.

You can read the article on line if you like. In brief, those medical students who were found guilty in medical school of unprofessional behavior were up to three times as likely as physicians to be brought before state medical boards for unprofessional behavior. That might seem so predictable as to be trivially true; but the study, written by faculty members of three medical schools, documents it.

Note that these are not suits filed against doctors. "Anyone can file a suit," as the saying goes, and a suit may represent honest mistakes, uncontrollable circumstances, true acts of God, or greed or fraud on the part patients or attorneys. It is much less common and usually much more serious for a physician to be brought before and disciplined by a state medical board. A physician could be entirely professional and have a series of bad outcomes. At the same time, a sharp clinician can show unprofessional, even criminal, behavior. That can become the stuff of art. Recall the surgeon played by Alec Baldwin in “Malice,” or the organ-stealing Jefferson Institute in Robin Cook’s “Coma.”

I spoke of this to several physicians. All thought the study interesting, but also predictable. One I spoke to said, “Medical schools have focused so much on tests and grades. So, they get very smart people. And there are a lot of really smart people out there who are sociopathic.” Now, I’m not inclined to agree with a blanket condemnation of “smart people.” Sometimes I even like to think I’m one of them. At the same time, I do think there is something about medical training – how we choose who will enter, and how we train those in the process – that can bring out the worst. To enter and attend medical school can require a powerful drive to succeed. For some, the drive, the ambition, can overwhelm emotional maturity and moral sensibility. It is only half in jest that I sometimes celebrate the physician who has come through medical school “and is still a person.” It is a tribute to human resilience, I think, that, really, there are so few physicians who are so troubled.

Now, as one of those who reviews and approves the credentials of physicians, and as chair of the hospital’s Ethics Committee, I find myself wondering whether and how I should incorporate this information. Professional behavior on the part of the physician is important in protecting the patient. And yet, how shall we take this into account? How shall we even learn of it? By the time they come for review, they are past medical school and through residency. They have all graduated, and as the old joke goes, the last person in any class at medical school is still called “Doctor.” We require references, and they could be helpful; but who asks a reference from a person without some expectation the reference will be favorable?

No, the information reflected in the study is of most help to medical schools and state boards. With it perhaps some limits can be set, and schools can catch the worst offenders before they have the opportunity to enter practice. What we can do in our own setting is to listen. We can listen to our patients, both at the bedside and in those customer satisfaction surveys we ask of them. We can listen to the physicians as they review their colleagues, noting those things that concern them. We can listen to our nurses and professional staff, paying attention to their experiences. We can listen and celebrate that great majority of physicians who work conscientiously for their patients and for their profession. And when we encounter that rare physician who can do so much harm, we can act on behalf of patients and profession, and expose the unprofessional behavior. Still, how much better could it be if we could know ahead of time that the clues to this behavior were available long before.

Saturday, January 21, 2006

Episcopal Thoughts on Suffering and Dying

This week the Supreme Court ruled on the case of Gonzales vs. Oregon. This was the case related to the Oregon Death with Dignity Act, and the issue of physician-assisted suicide.

The issue in the case was whether Federal drug control legislation supercedes the rights of the state of Oregon to regulate medical practice. Under the previous Attorney General of the United States, John Ashcroft, federal policy was established that prescribing a predictably fatal dose of medication to enable a patient to commit suicide was a medically inappropriate use of a controlled substance for which doctors could lose their DEA license, and perhaps be prosecuted. The state of Oregon sued, claiming that regulation of physician practice was a prerogative of the states, one that federal law could not overrule. The Supreme Court agreed with Oregon.

It’s noteworthy that this is in fact a very narrow ruling. For example, it apparently doesn’t affect another recent ruling by the Court against medical marijuana. More important, it doesn’t really address whether a person, even in search of palliation of suffering, has the right to commit suicide.

As one who works with people who are suffering, I take this issue seriously. We wrestle, many of us, with the appropriate response to people in pain, people in severe disability, people who find their current experience unbearable. When we ask patients to consider health care treatment directives and living wills, those instructions on care in extreme circumstances, we do not use the language of life and death, but of quality of life and experience of dying. When is life not worth keeping? When is death better than the process of dying?

I will have several comments to make to this. For this post I want to point out that the Episcopal Church has spoken to this. When our people say the Church does not speak to contemporary issues, it is largely because they do not know that the General Convention and the various diocesan conventions do speak to these issues. They do not know, I believe, because we as clergy do not tell them. Before we let anyone complain – before we ourselves complain – that the Church says nothing, we need to look to General Convention. Very often in fact General Convention has spoken.

In this case, General Convention spoke as far back as 1991. It first spoke in Resolution 1991-A093, “A Resolution to Establish Principles With Regard to the Prolongation of Life.” This resolution was then amended in 1994 in resolution 1994-A056. (You can begin a search to find these and other resolutions of General Conventions back to 1976 at http://www.episcopalchurch.org/13299_502_ENG_HTM.htm?menu=menu5393.) Let me share some parts of the resolution as amended that I think are worth note and discussion.

“1. Although human life is sacred, death is a part of the earthly cycle of life.”
“2. Despite this hope [of resurrection in Christ] it is morally wrong and unacceptable to take a human life in order to relieve the suffering caused by incurable illness…. Palliative treatment to relieve the pain of persons with progressive incurable illnesses, even if done with the knowledge that a hastened death may result, is consistent with theological tenets regarding the sanctity of life.”
“3. However, there is no moral obligation to prolong the act of dying by extraordinary means and at all costs if such dying person is ill and has no reasonable expectation of recovery.”

These are from the first three paragraphs of an eight-paragraph resolution, and there is much to discuss even in these passages, much less the entire resolution. I am struck most powerfully by the recognition that physician-assisted suicide is presented in no small part in the belief that there are some conditions for which no other adequate palliation exists. At the same time, much has changed in palliative care since the Church first spoke in 1991, or the Oregon Death With Dignity Act was passed in 1994. If the current generals are always fighting the last war, as the proverb goes, is the current Supreme Court arguing a problem out of date?

But, no, I don’t think we can accept that. Suffering continues. Patients continue to experience intractable pain, and need all the palliative care we can morally provide. We need to continue to reflect on what is appropriate in easing that suffering, in taking the fear out of the process of dying. And as we reflect, we as Episcopalians need to be aware that the Church has not been silent. We may not feel compelled by acts of General Convention (and that also may be the topic of another reflection), but we should not ignore them, if we are to maintain our integrity as Episcopalians. And if it shows little integrity to ignore them, it shows less integrity to remain ignorant of them.

(One further reference I can recommend: "Faithful Living, Faithful Dying" from Morehouse Press. This book, prepared by the End of Life Task Force of the Standing Commission on National Concerns, was received at the 2000 General Convention. It addresses these and other issues of care at the end of life.)

Tuesday, January 17, 2006

With the Ears of a Chaplain

I have been listening with interest to the reports of the status of Israeli Prime Minister Ariel Sharon. I am, of course, conscious that there are significant political ramifications to his condition. However, I listen with a different concern, another ear.

I have spent the last 25 years in health care ministry, full or part time. Much of that time has been spent in intensive care in general, and in neurological and neurosurgical services in particular. It is that experience that shapes the way I hear news of Sharon’s condition.

The latest reports are that members of the family are seeing small movements, small signs that give them hope. They play a tape of a grandchild’s voice, and his eyes move. They speak, and he seems to move, to respond.

The doctors are more cautious. They speak of reflex responses, of random motions from random neurons firing in the brain. They know all too well that it takes more than the flutter of an eyelid, the withdrawal of an arm, to demonstrate purpose and intent, to document that in fact there’s someone in there.

I have been with families in that situation too many times. I know too well how much a family can hope. Events that seem inconsequential, even invisible to health care staff are understood by loved ones as incontrovertible evidence: the person they love is not only physically alive but cognitively intact. Somewhere, behind those tubes and lines and wires, behind the blank, often swollen face, there is still a person, the same person they knew and loved before the injury.

These can be difficult times for me as the chaplain. Let me be clear: I believe in miracles, and I’ve seen more than my share. Still, I dread the question that may come next, the question they will ask the chaplain because when the doctor’s there he or she is too focused, too authoritative to ask; or because most of the time the doctor isn’t there at all. “Chaplain, have you ever seen someone this sick, this badly injured recover?”

I have to stop and consider how to address that question. Ever? I’ve been in this business a long time, and I’ve seen a lot of patients. This sick? Much of the time we don’t know just how sick the patient really is; there are too many variables, even with all the technology we can bring to bear. Recover? What would it mean to recover? How able was the patient before this happened? How far could this patient go, even with the best of care and all the time in the world? Are they asking about physical function, or basic activities of daily living, or complete physical and intellectual wholeness? If I am to answer this question with integrity, I have to think this through.

For good or ill – for good and ill – I’ve had years to think this through. So, when the question comes I can review what I’ve learned about this patient and about this family fairly quickly. I will not lie. I do not want to destroy hope, but I dare not give false hope. The families of the Sago Coal Mine disaster have shown the cost of that. There are matters beyond my control, promises I can’t keep; and I must speak carefully. “I have been a chaplain a long time. I believe in miracles, and I have seen some. But, no: I have never personally seen someone this injured recover to be the person they were before.”

This is, of course, not what families want to hear. And I would be pleased to be wrong, and happy to give thanks. But it is the most honest answer I can give. It does not deny what God can do. It also does not deny all the patients I have seen who did not recover. It honors the family’s question with the honesty and integrity it deserves, and with all the love and compassion I can muster.

And so I pray for the Ariel Sharon and for his family, not because of his political position or his international stature, whatever they may be. I pray because I know the road his family is walking, a road I have walked with other families on their way to grief.

Monday, January 16, 2006

On the Vocation of a Christian

“In behalf of the Superior, and in the absence of the Prior, I welcome you to this meeting of our religious Order.” That was how I opened my supply sermon yesterday – but, let me back up and share how I got to that beginning.

I wrote last about my thoughts on the lectionary. When I wrote I also shared something of the direction of my reflections. I also said that those were my thoughts “unless the Spirit compels me to something else.” Well, inspired by the Spirit, and with the suggestion from Milton, I found myself preaching about something else – all about an hour and a half before the service began.

Milton was, of course, correct: the lessons were about vocation. The Old Testament lesson was the call of Samuel. The Gospel lesson was Philip’s call that brought Nathanael to Jesus. Even Paul’s lesson on moral living could be seen as reflecting vocation, and the commitment of the professing Christian to demonstrate faith in all of life.

Now, in my home that has some specific applications. I am an Episcopal priest, and so have that vocation. In addition, I am an Associate of the Order of the Holy Cross (OHC) a Benedictine order for men in the Episcopal Church. That, too, is a part of my vocation. My wife is a Novice with the Worker Sisters of the Holy Spirit, an Episcopal community for women, and so is finding her vocation. (There is a brother organization, the Worker Brothers. I have added links for both the Order of the Holy Cross and the Worker Sisters/Worker Brothers in the sidebar to your left.)

What came to me was that being a Christian is to be a member of a religious order. We take vows, or vows are taken for us, in baptism. In the Episcopal Church we speak of those vows as the Baptismal Covenant. (You can find them in the Book of Common Prayer on page 304 or on the web at http://justus.anglican.org/resources/bcp/baptism.pdf.) We claim those vows as our own in Confirmation or Reception or Reaffirmation. We reaffirm them at every subsequent baptism, and at the Easter Vigil, when we repeat the Covenant once again. Indeed, we reaffirm them in some sense every time we recite either the Apostles’ or Nicene Creed, reclaiming the faith on which the Covenant is based.

It seems to me there are two consequences to this vocation when we live into it, with God’s help. First, we will indeed see “angels ascending and descending on the Son of Man.” After all, as we are the Body of Christ we become that vehicle, that context within which God’s message can be conveyed. At the same time, as we proclaim the faith that is in us in word or deed (remember blessed Francis of Assisi: “Proclaim the Gospel always. When you have to, use words.”) we indeed become those angels, those messengers relaying God’s grace to the world, and raising prayer for the world to God.

The second consequence is that sometimes we have to say things we don’t necessarily want to say. Samuel didn’t want to tell Eli what God had said, even though Eli was faithful enough to hear, even in the face of such dreadful news. And sometimes we confuse what we want with the message of God. We proclaim in the name of Christ words and deeds that are frighteningly un-Christian. It is, after all, folks who call themselves Christian who cause the world to ask, “Can anything good come from Nazareth?”

But if we are to live into our vows, our Baptismal Covenant, we can make two responses to our vocation. When God calls, we can say, “Here I am. Speak, Lord; your servant is listening.” When we call others, and they ask, “Can anything good come from Nazareth?” we can respond, “Come and see!” Those are the responses required of us; and if we and those we worship with are living into our vocations, we can trust Christ to take it from there.

Saturday, January 14, 2006

Reflecting on Homiletics

I’m working on a sermon today. Now, what that means for me and what that means for others is not the same. I’m not one to write out a text, unless there are specific circumstances I need to speak to. Instead, for the last 20 years I’ve been preaching extemporaneously. I stand up in front of the congregation and say what I think God wants me to say. That is, I stand up after hours of reading and reflecting and churning. I may not write out a text, but I do my homework.

Still, preaching extemporaneously has some distinct hazards to it. As I say to students who ask me about it, preaching extemporaneously requires that one learn to live with fear. While the Spirit hasn’t failed me, and I haven’t failed often, I continue to consider the possibility that I’ll stand up and go blank. There is an old joke about the seven-word sermon: the preacher stands in the pulpit and says, “I have nothing to say this morning.” I won’t say I’m terrified of that thought; I will say I do not forget it. It is possible that some time I’ll find myself utterly empty.

A more common hazard is the possibility that the lessons will have no central or compelling theme. As an Episcopalian I’m committed to preaching from the Lectionary. I’m not concerned whether I’m using the lectionary from the 1979 Book of Common Prayer or the Revised Common Lectionary. Both work well enough, and the differences are too small, or I’m not scholar enough, to notice. But since I am committed to using the lectionary, I’m not one for choosing my topic and then choosing lessons to fit.

Unfortunately, there are times when the lessons chosen for the day don’t fit. Now, I’m not talking about a misfit with the season or the date. The apparent (and only apparent) misfit between the liturgy for Ash Wednesday, and the Gospel lesson for Ash Wednesday (including the verse, "And whenever you fast, do not look dismal, like the hypocrites, for they disfigure their faces so as to show others that they are fasting.”) simply makes me stop and think (and chuckle, embarrassed). Instead, I’m talking about those Sundays, usually in Pentecost, when I look at the three lessons and can’t find a theme or idea that connects them. On rare occasions I look at all three lessons and can’t find anything moving to preach on in any of them.

More often, I look at the three lessons and one of them simply doesn’t connect. That is the issue for this weekend, at least for me. The Old Testament lesson is the call of Samuel the prophet. As a young boy he hears a voice, but doesn’t know who he’s listening to. The Gospel lesson is the call of Nathaniel. He receives an invitation from Phillip, but he doesn’t know who he’s going to see. (The astute reader may pick up on where my head is, at least at the moment, for tomorrow’s sermon.) However, the Epistle lesson is Paul writing in I Corinthians about the purity of the body and refraining from sexual immorality of all types. I find myself looking at a lesson that doesn’t fit, a reading that won’t integrate. It’s not that it’s not possible to preach on that lesson, although in the current climate in the Episcopal Church and the Anglican Communion, and as an unabashed progressive, I’m not sure what I’d want to say. I could, I suppose, say something out of that lesson that could reflect the love and compassion of Christ. But I can’t see how it would connect with either of the other lessons.

Now, in reality this is simply an intellectual difficulty. I can (and probably will) preach tomorrow on the theme I’ve found connecting the other two lessons, unless the Spirit compels me to something else. I can preach and have preached on two lessons without reference to the third and no one will think it unusual or inappropriate. I doubt anyone else in the congregation will note or think much about it. But I am the preacher tomorrow. I have the responsibility to read, mark, learn, and inwardly digest the lessons, and then discern God’s word in them and share that in public. So, yeah, it is only, really, an issue for me. Still, I enjoy those Sundays when the lessons all connect, and wrestle on those Sundays when they don’t. Since I do take all of Scripture seriously, even when I disagree with it – even when I have to wrestle with it painfully – I sometimes wish that all three lessons in the Lectionary for each Sunday fit better together.

Wednesday, January 11, 2006

Reading Between the Lines of "The Book of Daniel"

I find it interesting in my hospital ministry that there are questions I don’t get. By that I mean that I encounter social phenomena that I expect to get questions and comments about, and then they don’t come. For example, I had fewer questions than I expected about the movie, “The Passion of the Christ.” I did get a few comments – mostly along the lines of “Oh, you’ve just got to see it!” However, I received very few questions about what I thought of the movie, and what I thought of Gibson’s perspective on the Passion. (For the record: I have expressed little opinion on it because I haven’t seen it. On the other hand, I’ve read the book any number of times.)

And so in the past few days I have had no questions whatsoever about the new NBC television show “The Book of Daniel.” Perhaps because I’m a hospital chaplain and not a parish priest those I care for in the hospital are not so attuned to my Episcopal affiliation. In any case, I have been prepared for questions and comments that haven’t come.

However, this show I did see. At least, I watched the first hour and most of the second hour – flipping in and out. I found it tiresome after a while. It’s not that I found it offensive, at least for its portrayal of all the characters as fallible, even venal, human beings. I just thought it wasn’t very well done. Throwing all the dysfunction of this family at me all in one eruption left me tired and disinterested. It wasn’t that I couldn’t believe any of those problems might occur in a family, even a clergy family; but so many, and all at the same time, seemed simply like “piling on.” Any entertainment requires some suspension of disbelief. “The Book of Daniel” went too far, not in any one human failing, but in the sheer volume of them, for me to maintain interest. (A side note: I don’t watch situation comedies for much the same reason.)

I will admit I was pleased with Jesus, or the Jesus of Daniel’s faith. He is grounded, compassionate, sensible, and mature. He holds Daniel accountable, and yet is prepared to forgive. It’s an image of Jesus that I could hear, could trust, could accept reproof from, could feel love from.

On the other hand, there simply wasn’t enough else about the show to engage me. I am not a fan after the first night. I expect the first night to be my last.

Having said all that, I find there were some things done right in “The Book of Daniel,” things that I as an Episcopal priest, can appreciate. They are things I haven’t heard other commentators talk about. There are characteristics of Daniel that I want to honor.

First, Daniel is trying to be a good pastor. As you might expect, I was particularly struck by the hospital scene. When the family wanted their priest for emotional and spiritual support, their priest was there, giving comfort and proclaiming hope. He was trying to do the same thing at the funeral of his wife’s brother-in-law, and that in spite of the personal consequences to Daniel of the brother-in-law’s apparent crime. When the prospective bride and groom each come to him, acknowledging his and her fear and unreadiness for marriage, he doesn’t try some sitcom manipulation. He encourages them to talk to each other, and to share the truth.

Even his sermon wrestling with temptation was an attempt to communicate with his congregation in terms of their own lives. I would also note that it was theologically stronger than was implied. No less a theologian than Martin Luther commented that we benefit from sin in that it makes us more conscious of our need for salvation that only God can provide.

Second, Daniel has worked hard to have a strong family life. He loves his wife. He tries to convey values – even some traditional values – to his children.

Daniel has an active prayer life. Indeed, each conversation with Jesus constitutes prayer. Some would say the style was unconventional, but I would argue it is quite traditional. How much more profoundly could one “take it to the Lord in prayer” than through simple conversation? In the Spiritual Exercises Loyola included the step of Colloquy, which is just this sort of conversation with Christ as perceived in the believer’s meditation. It perhaps seems more surprising coming from an Episcopalian. If, on the other hand, an Evangelical Christian were to speak of “going to Jesus” we wouldn’t be surprised at all. Even more remarkable (and Jesus does remark on it) Daniel actually listens.

Finally, and most critically, Daniel actually believes in Jesus. There will be those who will say, “If he truly believed, wouldn’t he act differently?” I would suggest that we don’t get to see perfection until God brings the Kingdom in all its fullness. Daniel is still, as Luther put it, “simul iustus et peccator:” “at the same time justified and still a sinner.” Daniel trusts in the love and acceptance of Jesus, even when he fails to live up to his own understanding of what Jesus calls him to. In a time when Episcopalians have been accused of losing faith in Jesus because we do not take a sufficiently rigorous stand on some issues, here is a response. Here is an Episcopalian, and a priest, who believes firmly and profoundly in Jesus, accepting his confrontation, trusting in his love, and asking his guidance.

Now, all these things won’t make me a fan of the show. I still think it’s poorly written and over broad, and I expect it won’t last beyond whatever has already been taped. On the other hand, I believe in credit where credit is due; and if I’m planning not to watch because of what I think it does poorly, I will at least give praise for what I think it does well.

Tuesday, January 10, 2006

Mourning Dreams

I am a member of several news lists and lists servers. Today on one of them a colleague described a person who had asked for his pastoral support. This person had entered into a relationship, one which she thought showed promise of growing and becoming permanent. She even thought that this might be a part of God’s plan for her. Unfortunately, the relationship did not last. My colleague asked for thoughts about supporting her. Her distress brought to my mind the mourning of dreams.

One of the things I find true of human beings, and yet often overlooked, is that we mourn dreams. That is, we imagine our lives in the future, and sometimes we imagine lives that we desire greatly. When those dreams are lost, we mourn greatly as well - perhaps as profoundly as we would have grieved had the events actually taken place and then been lost.

I notice that most with parents who lose a baby during pregnancy or at childbirth. They have hardly had a chance to know this child; but they know all too well the hopes they have had for this child. I knew it in my own divorce. For almost 20 years I have had a wonderful life with my wife; but when the first marriage was lost, so were many plans and dreams. I am proud of my sons. They are good young men: but when they left to live with their mother all those years ago, so did significant dreams about how I had wanted, had planned, to be their father. Indeed, since I do have my sons, and their mother is still alive, I find myself revisiting those dreams, grieving them all over again (albeit with less intensity).

I think we underestimate the importance of grieving for lost dreams. I speak often with persons in grief. They say, “I just want things back the way they were!” We appreciate those concrete losses, those persons, objects, situations that were treasured and how are gone, as a part of the way things were. Even those of us who work with grieving people regularly may not always think beyond that. But we are creatures of fantasy, we human beings. We may speak of living in the moment. We may imagine we are straightforward, pragmatic, feet-on-the-ground people. But in fact we all have our dreams and make our plans. We can hardly live without them. We cannot attend to our current needs without preparing for our future needs. And if we have the latitude, after we’ve thought of our future needs we will think of our future wants. Only a little of that, and we have moved on to hopes, to plans, to projections in which we, too, become invested. And when any of us is invested emotionally, we grieve that which is lost, whether it’s as tangible as a loved one or as ephemeral as a wish.

Cherish your dreams, and the dreams of those you care about. They are as real as they are fragile. If lost, they must be grieved, and grieved in full. Treat your dreams as the treasures they are. Treat with compassion those who have lost theirs.

Wednesday, January 04, 2006

NB: I wrote the original of this before Christmas and circulated it to employees of the hospital as my annual holiday message. While the controversy related specifically to the holidays may fade for year, recent issues in the news about "nonsectarian prayer" in the Indiana Legislature and the U.S. Navy suggest that similar issues will be before us for some time. Therefore, I have decided to go ahead and post the message.

Holiday Message 2005

I have been mulling over this year’s holiday controversy – or, perhaps I should write “Holiday Controversy.” Specifically, I’m thinking about the discussion that has been raised in the public media over whether extending “Season’s Greetings” or wishing someone “Happy Holidays” is an attack on or an affront to the sacredness of Christmas.

A great deal of attention has been generated on this topic, if only briefly. There is even a book on the topic, written by a television news figure. I’m not going to speak to the book, as I haven’t read it; nor will I speak to the excesses that seem to come from institutional anxiety of various governmental and commercial bodies. Rather, I want to reflect on our life together here at this hospital.

I must admit I’m more concerned about the hype than I am about the problem. I’m not terribly concerned whether governments at all levels or major retailers endorse Christmas. Indeed, I don’t want them to at all. When governments act, they act on behalf of all of their constituents, even the minority who didn’t vote for them. By the same token, retailers have a right to consider all their possible customers, and not simply the majority. So, I’m not concerned, much less offended, when the card I receive says, “Happy Holidays,” or the banner on the facade says “Season’s Greetings.”

In my professional practice I’m conscious just how varied we are. When we share this time of celebration, largely by sharing in time off and gifts between colleagues, we do it from a variety of traditions and perspectives. Indeed, there is something accurate about saying “Happy Holidays:” we have so many holidays among us to celebrate. Even within broad traditions there are differences. Catholic and Protestant Christians observe December 25 as the Nativity, while Orthodox Christians observe January 7. Other traditions follow a different calendar. Since Muslim worship follows a strict lunar calendar rather than the solar year, the dates consistent in the Muslim calendar are not consistent in the solar. Thus, a few years ago the Fast of Ramadan coincided with Christmas and Hanukkah. This year Ramadan is past, and the season of the Hajj, the pilgrimage to Mecca, is at hand.

In a way, I want to move beyond “Happy Holidays” and change “Season’s Greeting.” That is, I want to move from Greetings for the Season to Greetings for the Seasons. Each of the current holidays in fact represents a season. Hanukkah extends for eight days, recalling eight days of miraculous light. Twelve days extend between Christmas and Epiphany, marking both the private revelation of Jesus in his family and the public revelation at the arrival of the three kings. During the days of the Hajj the Muslim expresses his or her faith, reflecting the great acts of faith of Abraham and his family. So, in this holy time there is not simply one Season. To acknowledge all of us who celebrate these holidays literally as holy days requires that I acknowledge that mine is not the only season that celebrates faith. In each of our different seasons each of our different communities celebrates the presence and the power of God, both in creation in general and in the life of the believer in particular.

Many of you may remember my part on the orientation of new employees. I speak about this hospital being a “spiritually safe place” for patients, families, and staff, where each of us “can be who we are spiritually here as much as we are outside.” That reflects my own professional responsibility to care for each person as best I can within the tradition, or decision not to be part of a tradition, that each person already has, as well as the System’s commitment to respect the diversity of all who are here, whatever the role.

With that in mind, I want to suggest that we attend to one another and rejoice with one another. Be aware of the celebration of each person around you. Greet those who celebrate a holy season with the greeting appropriate to the celebration. Celebrate, too, with those who do not observe a religious festival, but who enjoy the change of pace, the extra food, and the time away. Celebrate with enthusiasm that which is holy in your own life, and appreciate the enthusiasm of another’s celebration. Express the love and compassion that is integral to the care we give and the service we provide in rejoicing with one another, that these may indeed be happy holy days and blessed seasons for all of us.

Merry Christmas. Happy Hanukkah. Blessed Hajj and Eid. And the happiest of New Years for you and yours and each of us.

Monday, January 02, 2006

Thinking ahead

Notwithstanding that today was officially a holiday at the hospital, I was working. I was in today to chair a Consultation of the Ethics Committee. You will understand that I cannot speak specifically to the Consultation, either in subject or content. Still, it was certainly thought provoking.

As is the case in many such discussions, an Advance Directive was central to the conversation. I have for some years participated in educating patients, families, and staff on Advance Directives. I can remember the time before Living Wills were generally accepted. I remember the passage of the Patient Self-determination Act. I have been part of many discussions on the topic, not least because I live in the state where the case of Nancy Cruzan was fought out. In all those discussions, I have come to some conclusions.

First, I think Advance Directives are valuable and important, whether a Health Care Directive or a Durable Power of Attorney for Health Care Decisions. Developed thoughtfully, used carefully, they can bring a good deal of peace to those who have them, and to those called upon to exercise them.

Second, I think the conversation leading to an Advance Directive is more important than the piece of paper. Truly understanding what a person really wants takes more knowledge, more relationship, than a document can record. I have helped patients complete documents they did not want to share with family; but I have always counseled sharing. For someone to carry out my wishes, in light of how much gray area there is in many medical crises, someone needs to spend time with me, to know me with some sophistication.

Third, I think those conversations need to happen over breakfast or dinner. It’s hard to think about those decisions in those controlled, relatively calm circumstances. It’s that much harder in the context of a new diagnosis or a medical mystery. The conversation needs time to reflect, to digest, to settle in. Trying to address it in a hurry, in grief or anxiety, doesn’t allow for that. It needs to happen when the family has the time and room to “fuss, cuss, and discuss.”

Finally, we need to advocate for this in season and out of season. I do my share of supply work. I often begin the announcements by speaking of my “second sermon:” a reflection on Advance Directives in light of the Prayer Book rubric requiring clergy to speak on occasion about the fact that we die, and that we need to make provision for our estate, caring for family, and, if we can, for the Church (a gold star for those who recall where in the Prayer Book that rubric is). Based on that I also call for Advance Directives in the same vein. We can remind those we serve outside the hospital that before we die we are quite likely to be sick, and we can also serve family by preparing for that eventuality.

An Advance Directive may or may not be worth the paper it’s printed on. We need to also encourage the support of family and communication with family and friends that will prevent the patient’s wishes to come as a surprise. We may serve families in the hospital in times of critical decision. We can serve those outside the hospital if we can help them make preparation, and help those times of crisis require fewer decisions.

One final thought: the Center for Practical Bioethics in Kansas City has a program called Caring Conversations. It is designed to help families think through and then talk about end-of-life concerns before putting pen to paper. You can get more information about Caring Conversations at http://www.practicalbioethics.org/cpb.aspx?pgID=886.

Sunday, January 01, 2006

There is an old joke about a young man who said, "A few years ago I couldn't even spell "graduate," and now I are one." That's something of how I feel starting as a blogger. There are several blogs I read, but none that seems to quite fit where I am.

Of course, "where I am" calls for some further explanation. I am an Episcopal priest, and a hospital chaplain. I am in middle age, at the younger end of the Boomers. I am married - actually, divorced and remarried - with children who are adult, if just barely. In all of those categories, and several others that will come to light over time, I often find myself in the middle. I find myself negotiating competing loyalties and responsibilities. I say "competing" and not "divided" because sometimes the separate responsibilities are not related, not directly in conflict, but still requiring me to make choices.

In this blog I'll be writing about most of the areas of my life, and like as not, often about those competing choices. I will not always have answers, but I will have questions, and I will have opinions. Those who know me will not be surprised at that. I will welcome opinions from others. I won't always agree. I won't even speak to every opinion, I expect; but I will be interested.

Today is the beginning of a new year, and the beginning of new things. It is the Feast of the Holy Name, when Jesus was first identified publically by name. This is a first for me. I think I'm going to enjoy this. I hope others will as well.