Friday, July 28, 2006

The Anglican Confessional Network?

The Anglican Communion Network is meeting next week. On the agenda are a Theological Statement and a Mission Statement which the Network will consider “for adoption.” The statements were developed by the Common Cause Roundtable, a group of churches and organizations, all with Anglican roots, and all opposed to recent decisions in the Episcopal Church and in the Anglcan Church of Canada. The full text of the two documents is worth reading as an indication where at least some in the Network want to go. I will not respond to the both documents, but had some thoughts about the Theological Statement .

1) We receive the Canonical Books of the Old and New Testaments of the Holy Scripture as the inspired Word of God containing all things necessary for salvation, and as the final authority and unchangeable standard for Christian faith and life.

Note that this differs from the Chicago-Lambeth Quadrilateral, which speaks of “The Holy Scriptures of the Old and New Testaments, as "containing all things necessary to salvation," and as being the rule and ultimate standard of faith.” The ordination rites in the Book of Common Prayer (1979) use the same language regarding Scripture as the Quadrilateral. The change of reference to “inspired Word of God” and to “final authority and unchangeable standard” seem a significant departure.

2) We confess the historic faith of the Undivided Church as declared in the Catholic Creeds.

I do wonder whether this will affect discussion with the Eastern Orthodox, for whom the filioque clause has never been part of the “Catholic Creeds.”

3) We believe the teaching of the Seven Ecumenical Councils in so far as they are agreeable to the Holy Scriptures, and have been held by all, everywhere, at all times.

I wonder how important the Iconoclast Controversy might actually be to the Common Cause Roundtable. In any case, one can hardly speak of the decisions of the Fifth, Sixth, and Seventh Councils as being “held by all, everywhere, at all times,” as Roman Catholic participation was at best minimal. Those have not historically been held as important for the Anglican tradition.

4) We hold the two sacraments of the Gospel to be ordained by Christ Himself, Baptism and the Supper of the Lord, and to be administered with unfailing use of Christ’s words of Institution and of the elements ordained by Him.

To speak of the Eucharist as “the Supper of the Lord” does seem to make a significant statement regarding the sacramental theology embraced under these tenets. It does reflect the language of the 39 Articles, specifically article XVIII. One could argue that the Articles, and especially XVIII and XIX describe a receptionist doctrine of the Eucharist.

5) We accept the 1549 through the 1662 Book of Common Prayer and its ordinal as the foundation for Anglican worship and the standard for doctrine and discipline.

This would, then , exclude any American prayer book, and would seem to undercut the American history of reflecting the Scottish Nonjuror tradition in our Eucharistic prayers. Focusing on the ordinal of those Prayer Books clearly undermines the ordinal of the current American prayer book, including issues of ordaining women.

6) We believe the godly Historic Episcopate to be necessary for the full being of the Church.

I would note with interest the concern to focus on “the godly Historic Episcopate.” This again varies from the language of the Quadrilateral: “The Historic Episcopate, locally adapted in the methods of its administration to the varying needs of the nations and peoples called of God into the Unity of His Church.” Thus, the Episcopate is of the pleni esse of the Church, but with no latitude for local adaptation or of varying needs of different peoples.

7) We affirm the Thirty-Nine Articles of Religion as foundational for authentic Anglican belief and practice and as correctives to doctrinal abuses.

The crux of the issue, as is often the case, is seen most clearly in the very last words. Many of us see the Articles as “foundational,” without seeing them as dogma. However, to see them as defining what beliefs and practices are authentically Anglican and as “correctives of doctrinal abuses” is to elevate them beyond being foundational to being confessional. And that, it appears, is what many want: a new church, confessional rather than creedal, with Anglican roots. That may or may not happen. However, it is a clear departure from “the doctrine, discipline, and worship of the Episcopal Church.” Well and good, I suppose; but what I have sworn to as a priest is to “the Holy Scriptures of the Old and New Testaments to be the Word of God, and to contain all things necessary to salvation; and… to conform to the doctrine, discipline, and worship of the Episcopal Church.” And I imagine the bishops, priests, and deacons of the Network once swore to the same.

Wednesday, July 26, 2006

Toward An Episcopal Culture for Health Care: the Poor

"The poor you will always have with you." (Matthew 26:11a)

“Truly I tell you, just as you did it to one of the least of these who are members of my family, you did it to me.” (Matthew 25:40)

I work in a health system that is explicitly “faith-based” (those words are in the mission statement of the system and of each institution in it) and specifically (if not as self-consciously) Episcopal. That is, the system is a ministry of the Episcopal Church, and is one of the few hospital systems started by Episcopalians that still has some organic connection with an Episcopal diocese.

Once upon a time, before there was a system, there was the original hospital. I started with the system in that hospital, and still refer to it as “the Mother House.” (Yeah, I have heard “mother ship,” but in my old age I’m more monastic than sci fi fan.) And in the halls of the Mother House, along with other pieces of printed information, one could find a brochure describing the hospital’s policy on uncompensated care. The policy included this principle, if not these exact words: no one would be refused care based on the inability to pay.

We no longer have that brochure. We still have a policy, and under the policy we will still care for all who come to us - well, almost. You see, even we have had to set some limits.

Oh, we are still providing uncompensated care - more than all the other non-government hospitals in our area. But we've had to set some limits, asking patients for copays up front, and refusing some patient transfers if there's not a really clear medical reason for moving the patient. We've made some clear distinctions between "charity care," and "bad debt," based on whether patient and family cooperate on seeking resources. We want to care for all regardless of the ability to pay; but we can no longer do so, much less say so.

How does this fit with an Episcopal culture for health care? The Baptismal Covenant calls on us to “seek and serve Christ in all persons, loving your neighbor as yourself,” and to “strive for justice and peace among all people, and respect the dignity of every human being.” As I have noted before, the General Convention is on record as calling for universal access to quality health care. How, then, can we as an Episcopal health system turn anyone away?

The answer is, at least in part, well known: if we set limits, we serve fewer patients. If we set no limits and end up folding financially, we serve no one – not the patients, nor our staff, nor the larger community. This becomes part of any argument from a perspective of distributive justice: in a society in which health care is a limited resource, some choices will have to be made. We have made choices that we think will allow us to serve the greatest number of patients. We have provided options to assist in getting care those who have no resources. We will go to great lengths to help patients and families ho want help, and are willing to cooperate in the process. But we can’t take care of everyone.

Are there other options for us as an institution? One is, of course, to work so that health care is not so limited a resource. We can advocate with government to increase the funds and the services of Medicare and Medicaid. We can negotiate with insurance companies to offer our patients and their customers the best services at the best rate. In fact we do both; but those are difficult processes. Medicare and Medicaid are held hostage to the political will, and the will is not there. Indeed, Medicare reimbursements are figured something like this: “This is what you say a procedure costs. However, looking at your regional market, as we define it, this is what we think it should cost. Based on wanting to hold down that cost, we will pay you 60% or so of what we think it should cost, regardless of what you say it does cost.” We can advocate, working to change not just the naked figures, but more broadly the political will.

We can participate in research. This can help two ways. Some research directly affects costs, either demonstrating that the cheaper procedure is as effective, or developing the new procedure or drug that is so much more effective as to be worth the cost. Research can help indirectly by paying the health care costs of those who consent to participate, freeing up other dollars for patients who need assistance. And in fact we do participate in research. At the same time, questions remain. Just how much benefit, and for whom, should a new procedure or drug provide to be worth new and greater costs? If the older, cheaper drug or procedure is almost as effective, how close is close enough? And how do we determine which patients will only benefit from the newer drug of procedure?

These are some of the considerations as we consider how we will care for the greatest number of people. And, of course, none of them are simple. However, it seems to me that for an Episcopal culture for health care these issues must be grasped and engaged, as determinedly and as fiercely as at Jabbok. And we must not be complacent, either that we are doing enough or that we are doing enough more than someone else. Surely a vision of the Kingdom includes the opportunity for us to serve all, whatever the circumstances. And so it was that I said to our leadership, when the new policy was introduced, “We must make hard decisions, but we must not be satisfied with them. The Episcopalians who stand behind us and pray for us expect no less. We are not choosing today between good and bad, but between lesser sin and greater sin. Even if we're doing what we must, let us acknowledge that with a real sense of sadness.”

Monday, July 24, 2006

HCA and the Sin of For-Profit Health Care

It has been announced today that a group of investors is offering a leveraged buyout of HCA, the largest provider of for-profit health care in the United States – which suggests it’s the largest in the world. You can find news reports of this in the air, and certainly all over the web. You can find a news report here and a business-oriented report here.

What will this do to providing health care? I’ve had some time to observe on a (relatively) small scale what this might mean on a large scale. Several years ago HCA became the largest health care provider in my metropolitan area when it bought out itself the largest regional system in this area. HCA took on that system, and its existing debt, and took on additional debt to do so. Since that time they have consolidated services in some area where the previous system had purchased hospitals only blocks apart. They have built new facilities for the purpose in some places, and have closed facilities in others. They have also determined for their facilities that with regard to emergency services and services for the indigent that they will meet all the requirements of law – and no more. And so the number of patients in the emergency rooms and charity clinics of government and religious hospitals – services that often cost more money than can ever be recovered – have jumped.

In a larger sense, this must have some impact, even though we don’t quite know yet what it will be. After all, this is for-profit health care. Thus, the investors expect to receive a return on their investment. Since what they’ve offered is 19% over share value as of close of the market on Friday, they expect that within a reasonable period their return on investment will cover that premium price. Further, this is a leverage buyout, taking on debt to make the purchase. And in the process, they will be purchasing HCA’s existing debt. So, over some period of time investors believe they will receive sufficient return to pay those debts and still make an appropriate profit for shareholders. Now, to cover that they can try to increase revenues or to reduce expenses; most companies in buyouts try to do both. But increased charges for health care will meet resistance from insurers, both private and Medicare/Medicaid. And reducing expenses can result in challenges to reduce staff and/or services – again, all too frequently, both. Now, there will be some economies of scale and some capacity to negotiate expenses based on HCA’s sheer size. But sooner or later, I fear that something will have to give.

Now, I’m not in general offended by the concept of “profit.” All not-for-profit health care providers are also concerned with making a profit. They call it “margin,” but they still have to make it. If a hospital can’t raise salaries to meet the cost of living, or can’t provide contemporary (if not the latest) health care technology, they will lose patients to serve, and physicians and nurses and other staff to serve them. A hospital that sets some limits may serve fewer patients; but a hospital that goes out of business serves no one.

At the same time, there’s a significant difference, I think, between making a margin of 3% or 4% to keep up with inflation, and a profit that will address a 19% increase in value. There’s a difference between making a margin that gets plowed back into the institution for more staff, newer technology, and better services, and making a profit to serve the needs of external investors.

That’s why it’s been my considered opinion that for-profit health care is a sin (and as a priest I don’t use that word lightly). These investors are literally profiting on human misery; and the fact that they’re not the only investors to do so doesn’t make it right. Institutions that exist to serve patients face challenges and sometimes have to make difficult decisions; but service to the patient continues to be the telos, the end purpose. For-profit institutions may provide services to patients, but the end purpose remains to make money for investors. That certainly doesn’t square in my mind with serving “the least of these my siblings.”Now, I’m not commenting on the providers themselves. Doctors and nurses and other staff in those institutions are, I believe, providing the best care they can in the circumstances they have. There are chaplains in some HCA hospitals, and they’re caring for patients’ spiritual needs as best they can. But, then, they’re not motivated by profit, and my guess is that if the same institutions were not-for-profit they would still be there.

No, my problem is with the investors, and with the concept of health care for profit. We seem to spend little enough as a society to provide care. If things are really that tight, (and until we can find the intestinal fortitude and the political will to make changes, things will be that tight), siphoning off profits can only make things tighter. We don’t know yet what all the consequences will be of this buyout of HCA. I fear that when we do know we won’t be happy.

Wednesday, July 19, 2006

What Happened in New Orleans?

Today the Attorney General of the State of Louisiana has initiated charges against a physician and two nurses. It is alleged that in the aftermath of Hurricane Katrina these three administered pain medications to patients in a long term care unit housed at Memorial Medical Center, causing their deaths, and that the medications and/or their dosages were not appropriate. Therefore, the deaths are characterized by the Attorney General this way: “This is not euthanasia. This is a homicide.” There are many news stories about this on the web. Stories here and here seem relatively thorough. This report focuses on the ethical concerns.

The problem at this point, of course, is that we still don’t know what happened. We will have to wait to hear what facts come out at trial. We will have to hear the testimony and the affidavits. I’ll be particularly interested in pathology reports. I also expect there will be “expert testimony.” I think that will be, or perhaps should be, important.

And since we don’t know what happened, there are concerns that still hang out there. We have some sense of the desperate conditions in general in the wake of Katrina: hot and humid days without relief for buildings or for the people in them; loss of the electricity on which so many of our interventions depend; loss of the other professionals to provide the relief on which our physicians and nurses depend; loss of the technical means to move patients to safer, more controlled services; and loss of the social fabric to sustain all those things, leaving the sense that there was no end in sight. We also have some sense that part of providing care, even in the best of circumstances, is the necessity of decision: whether one acts or does not act there are consequences to the decision, consequences of pain and suffering or of their relief; consequences of living and dying.

There are some questions we can keep in the foreground as these facts come out. For example, what is an appropriate dose of pain medication, based not on professional standards or “best practices,” but on the conditions at the bedside when the decision was made. From my own exposure to palliative care and pain management, I’m aware that an individual patient in significant pain may require doses that far exceed normal practice. Moreover, responding to the physical suffering of patients who cannot speak for themselves (and, often, even for those who can) is a matter of art and not of science. Some patients will experience nonlinear results: small, incremental changes can have large, systemic effects. I have written before of my concern about the ethical principle of double effect: that while we need it, we should face it humbly. At the same time I continue to realize that actions intended to relieve suffering can themselves have those nonlinear consequences.

With that in mind, we need to consider what the conditions were for those patients at the time they died. To call the alleged acts homicide is to suggest that these patients could and would have survived the illnesses they suffered in the circumstances they experienced. Several reports since the events have quoted family members of patients who had died at Memorial Hospital. The gist of those stories has been “The last time I saw my loved one he or she seemed fine.” However, in twenty five years in health care I have learned that things can change with frightening suddenness. In the conditions in Memorial Hospital at the time the simply physical stresses on patients could certainly have been incredible. And we need to note that these were patients in long term acute care: that is, patients that required hospital levels of care for exceptionally long hospital stays. The fact that they were “doing well” at the time of Katrina relative to their individual conditions does not suggest that these patients were anywhere near being able to live outside the hospital, even under the best of circumstances.

I think we need to know, too, whether these patients had expressed wishes about their care in health care treatment directives. Sudden changes in a patient could result in the circumstances for which those documents were intended: a patient lacking the capacity to make health care decisions in a circumstance where the physician feels there is little or no hope that the patient will return to a quality of life acceptable to the patient. And, again, these individual cases would need to reflect the situation in the moment, and not in the best or even normal circumstances.

We need to learn about the conditions of the professionals, these and others, who were continuing to provide care to these patients. After days suffering the same environmental circumstances as the patients, doing their best with little rest, no professional relief, and perhaps no end in sight, what was their own capacity to make decisions? In recent years there have been many questions about long hours for medical interns and residents, and the effects of those long hours on patient safety. These were circumstances beyond even those stressful residencies. The defense attorneys have already suggested that this is pertinent. If exhausted professionals, stretched by horrific circumstances, make a decision while trying to do good, and the decision has undesirable consequences, how much weight to we give to the circumstances under which the decisions were made?

Again, we don’t have answers to those questions. We will know more when this actually gets to trial and the stories are told. In the meantime, we need to watch and wait. The headlines will be lively, perhaps sometimes inflammatory. We need to wait for facts, and as best we can use those as the basis for judgment.

Saturday, July 15, 2006

Without a Change of Clothes: Reflection on Proper 10, Year B

Jesus called the twelve and began to send them out two by two, and gave them authority over the unclean spirits. He ordered them to take nothing for their journey except a staff; no bread, no bag, no money in their belts; but to wear sandals and not to put on two tunics. He said to them, "Wherever you enter a house, stay there until you leave the place. If any place will not welcome you and they refuse to hear you, as you leave, shake off the dust that is on your feet as a testimony against them." So they went out and proclaimed that all should repent. They cast out many demons, and anointed with oil many who were sick and cured them. (Mark 6: 7-13)

When I went to General Convention, I decided I would take enough clothes for about five days. I figured that I would plan on doing some laundry while I was there. After all, most hotels I’ve been in recently had some small laundry available to guests – a single washer and dryer, coin-operated, somewhere out of the way. Even if they didn’t, there would be a service, even if it were expensive. And surely there would be a laudromat somewhere close. After all, Columbus is a college town. How hard could it be?

Well, it was certainly harder than I had planned. Yes, the hotel did offer a laundry and dry-cleaning service, but it was certainly pricey. And almost as a corollary there was no laundry facility in the house. I did find a laundromat – within walking distance, I thought, of the hotel. And so I found myself taking an afternoon, walking through Columbus, hoping I’d figured this correctly, glad that I’d decided to bring at least one bag that had wheels.

I did find it, thankfully, where it was supposed to be, although it was a longer walk than I had expected. And, in fact it was a laudromat and coffee bar and cybercafe with free access for customers. Who could ask for more?

Jesus sent out the disciples with almost nothing: no traveling supplies, no extra cash, not even a change of clothes. The disciples were to depend on the kindness of strangers, as Tennessee Williams wrote. They were to trust they would find welcome, and were not to stay where they didn’t. I’ve been watching “Survivorman” on the Discovery Channel, where an expert places himself in an extreme and isolated situation and shows how he would survive. The disciples didn’t have it quite that bad, but it almost sounds like it.

Why would Jesus do that? Surely he didn’t want them camping in the countryside, going to sleep hungry and cold, shivering through the cool nights. He’d been out there himself for a while. He knew, perhaps, that some would be hospitable; but he certainly knew that some wouldn’t: “shake the dust off your feet,” he said, knowing the likelihood that it would happen.

They did find hospitality, of course. They did proclaim the Kingdom, and call for repentance, and heal and cast out demons. But they did it without any equipment, any supplies, any preparation for the road.

Or, perhaps we should say, “And they did it without any preparation.” After all, the point was not for the disciples to look good. It was for them to reflect God doing good. When Jesus sent them out with little or nothing, the result was to make clear that the much and more that they accomplished was a work of God’s grace, and not of their own quality or preparation.

God has done that a lot. Amos left Judah to travel to Israel, to the royal shrine at Bethel, to proclaim God’s judgment on that kingdom. Amaziah, the official, sanctioned royal prophet threatened him, calling on him to flee home. “Go be a prophet there,” he said, “but don’t bother us with your pronouncements here.”

But Amos says, “But, I’m not a prophet. I’m no sort of religious professional. I keep some livestock. I tend poor fig trees. I’m here without any official status, but I’m here because God put me here and gave me this message to proclaim.” And by the time the message was fulfilled Amos had long been back on the farm. This was not about Amos. It was about the judgment of God.

And what about us? Think how much we worry sometimes about whether we have what we need to do the ministry to which God calls us. What about the seminary education? Or the good Sunday School? Or the lovely church building, with its good location and its adequate parking? It’s so easy, isn’t it, to say, “Well, we know we’re called; but what can we do? We don’t have any resources.”

But perhaps Jesus has already given us all that we need. We have his story to tell, just as we have heard it. We have his presence to proclaim, just as we have felt it. We have his Body and Blood to share, just as it has been shared with us. If that seems too little, we aren’t paying attention. It is these things that have called new souls to Christ, sometimes with and often enough despite the grand buildings and the rich trappings. Indeed, we’re entirely too prone to let those things get in the way. In the current troubles in the Episcopal Church, think how much energy and how many resources have been spent, or will be spent, over who gets to keep the building – money that could go to proclamation and to service.

This ministry is not about us, and it’s not about our resources. As Paul reminds us in Ephesians, again and again: this ministry we have we have at God’s pleasure, and for God’s glory. As we heard with Paul last week, God says, “My strength is made perfect in weakness.” So this week we hear that it is by God’s grace that the message is heard through us, and not through our skills or resources or preparation.

Now, we are rich people, we Episcopalians – rich in the worlds terms at least, most of us. These days we often do go out with good preparation and resources. Perhaps we need to step back and remember how this ministry started: without supplies or cash or even a change of clothes. If we have more when we start, we can certainly give thanks. But when all is said and done, and we see God working in the world, and even in and through our ministries, let’s remember whose word we proclaim, whose presence we reflect. This is not about us. It’s about God; and if we will only respond to his call, we will find welcome and we will see wonders wherever he sends us – even when it seems he sends us out with nothing at all.

Thursday, July 13, 2006

The Episcopal Church as Chimera

This reflection was stimulated in no small part by this reflective poem by Mark Harris on his blog, Praeludium.

In my first CPE residency the children’s hospital I served received a pair of conjoined twins – two boys, joined from breastbone to ankle, sharing a third leg between them, and with fully integrated circulatory systems. One child had a weak heart. The other child had poor kidneys. The parents were told it was only a matter of time. The children could not be separated, and one child or the other would, sooner or later, have a catastrophic organ failure. As the circulatory systems could not be separated, when one died so would the other. I was not the primary chaplain, but I was the chaplain on call when the children died. Mother held the two children as best she could. Father stood by, quiet and sorrowful. Staff were attentive, watching lines of fluid and lines on monitors. I don’t remember exactly which organ failed first, and it really didn’t matter. Within an hour after one child died, so did the other. The parents mourned. I prayed. The staff carried on, sad but purposeful.

In her appeal to the House of Deputies about Resolution B033, Presiding Bishop-elect Katherine Jefferts Schori described the divisions within the Episcopal Church as two churches, joined like conjoined twins. “Ethically, one cannot proceed to separate two conjoined twins until one is reasonably certain both can survive on their own and live full lives.” She went on to say, "I don't think we're certain that the two offspring are capable of living separately and healthily.” But, sadly, there are those – there were those at General Convention – who call for separation now, believing that theirs is “the twin who will live.”

This image troubles me. For one thing, the “conjoined twins” metaphor presumes that reconciliation is, ultimately, not possible. Conjoined twins are sometimes separated, and sometimes live lives conjoined. They never become one.

I wish to take another position: that for all our divisions we are one body, and not two persons whose interconnected bodies may be separable with enough time, care, and nurture of strength. We have heard about persons who are medical chimeras: fraternal twins at conception who, at some very early point during the process of gestation, integrate. At birth and for life there is only one person; but testing may demonstrate two distinct sets of genes in different parts of that person’s one body. I recently saw rerun on the Discovery Health Channel “I Am My Own Twin,” telling the story of two women who each discovered herself to be a chimera through a series of medical tests.

I think this is a more accurate metaphor for the Episcopal Church, at least as many of us have seen it who see ourselves as moderates. Yes, there have been two (and probably more) strains of the Christian tradition living in our body. For most folks this was largely invisible. That is, because folks were focused primarily on their own parish or their own diocese, these differences were not seen, or at least not noticed. Clergy and some in organizations of common interest were aware of the different strains (some of us remember the old Evangelical and Catholic Mission, and on the other hand Associated Parishes), but few actually thought about leaving the Episcopal Church, and none thought about taking chunks of the Church with them.

That did change, to some extent, between 1970 and 1980. Between the revision of the Book of Common Prayer and the ordination of women as deacons and priests some did leave to form new bodies. Those groups did leave – there were even a few property disputes – and did proclaim themselves as “true” or “orthodox” or “continuing” Anglicans. They were small, and so focused on their differences with the decisions of the Episcopal Church that once they were actually out of the Episcopal Church they discovered that they couldn’t agree with each other. They are still with us today. Indeed, there have been conversations with ACN about including those folks into some proposed future “orthodox Anglican” province. However, to this point they have been small and divided.

In fact this movement remains small and divided. Admittedly, the current scene is different: the thought of bishops taking both their episcopate and their dioceses out of the Episcopal Church is new. However, the movement remains relatively small. I have seen numbers as high as 70,000 – not an insignificant number, but between 4 and 5 per cent of the Episcopal Church. Those numbers do not take into account too clearly congregations within Network dioceses that want to remain in the Episcopal Church, and it's uncertain how they take into account congregations within non-Network dioceses that may want to leave; but I expect those numbers may roughly be a wash. While Network leaders may want to see their numbers as larger by incorporating AMiA and “continuing Anglican” organizations, that will not affect the Episcopal Church: those folks are already gone.

What is different is this vision of our Church as “conjoined twins.” While it was articulated most recently by Bishop Jefferts Schori, I think it’s been around for a while. Thus, folks at both ends of the spectrum cry, “Let them leave!” (or, sometimes, “Make them leave!”), as if each were the twin that would survive the separation. From the rhetoric, of course, there are those who see this as amputation: they represent the full body, which must cast off some diseased member lest the whole body be lost. But I don’t see the image of conjoined twins as much of an improvement.

You see, the image of conjoined twins might make us more cautious about separation. It might (accurately) predict how much more complicated separation will be than the image of amputation. It still presumes that we can never be one.

The chimera image recognizes that we are one, even though some tissues, and even whole organs, might have different strains of DNA. It acknowledges that it would be really difficult, really messy, and possibly fatal to both to actually separate these different strains. It emphasizes that if we separate (and I am becoming more convinced that those who will leave are committed to the goal, if not the means) it will be slower, more painful, and much more local than perhaps we realize, and with greater cost to both sides.

Some, of course, may take this image and argue that I’m right, and that we never should have come to be at all. However, such persons do exist, living normal lives, largely ignorant of the differences within their own tissues. The Episcopal Church has been such a “person,” and the evidence of the action of the Spirit in the history of this body suggests to me that we are in fact God’s creation, if not perfected as we will be when God is finished with us. There is always pain and danger in amputation, and even in separating conjoined twins. There is grief and phantom pain after. Are we really prepared to enter into the hazards that separating our different tissues, that have until recently been successfully (if not always comfortably) integrated? Or can we pursue reconciliation that allows us to continue to live with our differences, sometimes at cross purposes, but only whole if we are together?

Monday, July 10, 2006

Reflecting on Archbishop Sentamu's Statement

I was in conversation yesterday with my bishop. He had read Archbishop Sentamu's Presidential Address to the current General Synod of the Church of England, delivered a couple of days ago. He found it disturbing. Having heard my bishop out, I read it myself. I commend it for your reading in full.

Having read it, I'm not as disturbed by this as I thought I might be. In fact, I was right on line with this, until I got to the description of General Convention. Questioning our process seemed to me second-guessing of a high order, especially from someone who was witness to proceedings.

On the other hand, I did recognize one aspect in which, I had to recognize, he was right. Much of the debate, and much of the effort to respond to the Windsor Report was manipulated by folks who wanted all or nothing at all - either the response they considered "correct," or no response at all. So, the issues were not dealt with fully, not because the General Convention legislative process wouldn't allow it, but because technical procedural actions prevented it. Some seemed actively to pursue failure, feeling there would be something to be gained by having the center - and the process - fall apart.

No, there's plenty in here to appreciate. Unfortunately, like so many "balanced" statements, it can all be used to point to someone else. (I didn't see his acknowledgement of his own position as a question of balance nearly as much as a moment of "full disclosure.") For example, "They know the time when to stand on their rights would unquestionably be legal, and would just as unquestionably be completely unchristian." But, that does cut both ways. We Episcopalians value our autonomy in our interdependence. At the same time, the stance of the Church of Nigeria - Anglican has worked entirely within both canon and civil law in their stance toward GLBT persons and those who wish to support them.

Or, "It is impossible to be graciously-magnanimous when the book of practice and procedures is regarded as the last word." Is he speaking here only about The Episcopal Church's Constitution and Canons? It seems to apply just as well to creating an idol of historic Christian practice.

Or, "We live in a society where people insist on standing on their legal rights, where they will only do what they are compelled to do, and where they desire to make others do all that they can compel them to do." But, folks at both ends of the spectrum claim they have been victims of social pressures imposing on them someone else's values.

I think Sentamu was really trying to be even-handed, and would say that he was trying to speak to both ends of the spectrum. For good or ill (perhaps for good *and* ill) that simply allows both ends of the spectrum to point away from themselves to say, "Will you listen to what he's telling *you*?"

Friday, July 07, 2006

Some Clarification from Canterbury

The latest contribution to Anglican dialogue came today in the comments of the Archbishop of Canterbury to the General Synod of the Church of England on the state of the Communion. I certainly commend it to your reading. There is also comment available at Thinking Anglicans. That is where I left the comment below. I also thought I would post it here.

You know, this is helpful, and in more than the simple statement of "Don't overthink my comments, nor project onto them your own eisegesis." This offers a definition of "communion," as distinct from either Roman or Congregational models. The clarity of the limitations of his own office, and of depending on consent, describe things well. "Catholic sacramental unity without centralisation or coercion" - I think that'll preach.

I fear he has believed that progressives really want unalloyed, defensive independence. My own sense - and certainly my sense of the General Convention - is that most do not want that. We want the relationships, based on the thought that we might have something to learn from each other. Sadly, there are a few radicals, and a few more reactionaries, who are already convinced that they have nothing to learn from each other.

While "historic links to Canterbury have no canonical force," he seems to underestimate how highly they are valued emotionally and morally. Certainly, much of the discussion - shouting really, since there are far too few places where people really exchange with one another - has demonstrated that many value it highly, if not above all else. I do think decisions about who gets invited to Lambeth (and I hope he invites everyone, raising a first opportunity to consent) will be seen as particularly meaningful, whether "canonical" or not.

So, let's also not overthink this statement, or project onto it our own wishes. Let's mull this over for a while.

Thursday, July 06, 2006

The New Presiding Bishop and the World

Much attention has been paid to the election of Katharine Jefferts Schori as the 26th Presiding Bishop of the Episcopal Church, and the first woman to hold the position. Some are dismayed. Many are pleased. The many "It's a Girl!" buttons in Columbus were cute. (I was distressed that I didn't get one.)

Others may consider what difference it will make that she's a she. I've even seen one (favorable) comment about her background in science. But, I'm interested in a different question: what difference might it make that she's a "second career" cleric?

We've been talking about the "second career" phenomenon for some time. When I entered seminary, almost thirty years ago the average age of my class was about 35. One member of the faculty shared with me then that his standard admission interview question had become, "So, what have you failed at before hearing the call to ministry?" More recently there have been annual conferences for clergy under 30. Concerns have been raised about the scarcity of young applicants for orders; but God continues to call many older applicants.

Now, Bishop Jefferts Schori is not the first "second career" cleric to be elected Presiding Bishop. In fact she's sixth. You can review the histories of all the Presiding Bishops here. This is my list of those who spent time in another career before entering the ministry.

Alexander Viets Griswold 5th Presiding Bishop from July 17, 1836 to February 15, 1843 – practiced farming before studying theology

Thomas Church Brownell 7th Presiding Bishop from September 20, 1852 to January 13, 1865 – taught in college before studying theology

John Henry Hopkins 8th Presiding Bishop from January 13, 1865 to January 9, 1868 – superintendent in iron works before ordination

Alfred Lee 10th Presiding Bishop from May 31, 1884 to April 12, 1887 – studied and practiced law before entering seminary

Thomas March Clark 12th Presiding Bishop from February 7, 1899 to September 7 1903 – worked for two years as a teacher between college and seminary

Katherine Jefferts Schori 26th Presiding Bishop from November, 2006 – oceanographer

(I should note that I don’t include John Gardner Murray, 16th Presiding Bishop. While he worked to support his family after his father died, he was already in seminary at the time.)

But, if Jefferts Schori is not the first “second career” Presiding Bishop, she is the first in 100 years, and the first since the position of Presiding Bishop became a full time job, instead of being added on top of a diocesan bishop.

Will that make a difference? When I think of my colleagues who heard the call later in life, or perhaps fought it longer, I have to appreciate that their secular work experience provides experience that augments their ministry. It gives a perspective that I don’t have, having been ordained as a young man. It’s not that I never held another job, but I never had it as a career choice. It simply paid the bills while I waited through the diocesan application process and the seminary admission process. It’s not the same.

Specifically, I think it’s a different experience on the ministry of the laity, and of normative Christianity. After all, we clergy are the exception and not the rule. The normative Christian is a layperson; and the normative context of the Christian life, with all its blessings and challenges, is the Christian life of a layperson.
Within that, there is experience of living in institutions other than the Episcopal Church. Business and academic institutions have their own structures, their own cultures. We have sometimes thought that those cultures had something to offer us; and sometimes not. Remember the old joke, “When does a good businessman lose his business sense? When he’s elected to the vestry.” But sometimes I think those institutions do a better job at clarifying expectations up front, and at finding effective ways to share their messages in a changing culture.

I could be wrong, of course. However, perhaps Jefferts Schori will bring these to her new office. Of course, she brings a new and unique perspective; anyone would. But I have to believe that her experience in the world before hearing the call will help her to lead us to share that same call into the wider world. She should be able to lead us effectively into the larger culture: she’s been there.

Monday, July 03, 2006

What General Convention Did: Policy for Children

As promised, I will begin looking at actions of the 75th General Convention that won’t make headlines, but that could make a difference in the lives of Episcopalians, and in the ways that Episcopalians can serve others. I’ll take particular note of those that have some relation to health care, but some of those address a number of other issues as well.

A good example is Resolution B018. It was submitted by Bishop William Persell of the Diocese of Chicago. The title is “Comprehensive Children’s Policy,” and the opening resolutions are as follows:

“Resolved, the House of Deputies concurring, That the 75th General Convention urge Episcopalians and The Episcopal Church at every level to work to ensure that governments provide adequate funding for programs that combat social and economic conditions that place children at risk or diminish children’s ability to achieve their full potential in the world; and be it further
Resolved That the General Convention receive and endorse the National Council of Churches (NCC) comprehensive policy statement, entitled The Church and Children: Vision and Goals for the 21st Century Policy. The Episcopal Church is a member of the NCC whose governing body, the General Assembly, passed this statement on November 11, 2004 to ensure that all children have the opportunity to develop and flourish.”

The resolution goes on to include the full text of The Church and Children: Visions and Goals for the 21st Century, which is too long to include in this post. You can find the complete text in the resolution here. However, the NCC policy statement is broken down into paragraphs, and each paragraph begins with a statement of the rights of children. I list those initial statements to give a sense of the breadth and comprehensiveness of the policy statement.

All children need to be part of nurturing communities where they are included as full members and participants in the common life of worship, prayer, witness and service.
All children have a right to be a part of loving and safe families. All segments of society share responsibility for supporting families in raising their children and future generations.
All children have a right to quality public education that fosters their intellectual, social, emotional, physical, cultural and creative development.
Every child has a right to live in a physically and emotionally safe environment that cultivates acceptance and peace and in which they are protected from the myriad of dangers confronting them.
All children have a right to express and celebrate their souls and spirits through arts, culture and recreation. Children need to have open time to dream, play and create.
All children have a right to economic security and economic justice: meaning that all families have access to food, clothing, transportation and safe, affordable housing, and that all families have equal opportunities to provide these basic economic needs.
Every child and family has a right to guaranteed quality, comprehensive health care. All children deserve to live in a healthy environment that allows them to thrive."

Under each of these rights, those who endorse the policy statement further commit to specific goals. So, for example, under the rights to “quality, comprehensive health care,”

"Therefore, we commit to:
Ensure quality pre-natal care is available for all
Focus on prevention as a key to preserving the health and well-being of children
Ensure that no children go hungry
Implement an effective health and nutrition education curriculum
Work for publicly funded, integrated, accessible and high quality mental health care
Develop partnerships for clean air, water, land and a healthy ecosystem."

If we will publicize our support of this policy statement, and will allow it to shape our ministries and our advocacy efforts, this could, I think, be as powerful and important domestically as our embrace of Millennium Development Goals (MDG’s) can be internationally. Indeed, these efforts seem complementary to the pursuit of MDG’s. Imagine how our efforts abroad could be amplified if we were to parallel them with similar efforts in our own neighborhoods. And please don’t imagine that I want us to “take care of things at home before help folks in other countries.” That’s a common enough complaint on editorial pages in American, but it’s a false choice. We have been blessed with resources enough to share both at home and abroad. And at home we have been blessed with a system of government that is required to follow the priorities that we set, or face being the rascals that we throw out. This is amplified as our embrace of this policy statement puts us in partnership with other church members of the National Council of Churches.

I think that as we embrace the MDG’s and make that support public, we should also publicize our embrace of “The Church and Children.” I think it can help repair the damage done both at home and abroad to opinions of both the United States and of the Episcopal Church. This action of the recent General Convention is another opportunity – hardly the first, but certainly an important one – to show by our works the quality of our faith.

Saturday, July 01, 2006

The Episcopal Church and the Anglican Communion: Don't Panic!

One of the reasons I really like sailing is that things happen slowly – at least more slowly than in a powerboat. If you’re attentive and have prepared carefully, and if you don’t go out beyond your capacity (well, at least not far beyond your capacity) you don’t have to do anything quickly at all. It’s at the far end of the spectrum from responding to an emergency in the hospital.

With that in mind, let me say that I’m backing off on my concern about the consequences of the 75th General Convention for the Episcopal Church or the Anglican Communion. It is exciting and exercising to follow. All those dioceses calling for “alternative primatial oversight,” as if they know what it really meant, much less how it could be accomplished. All those exchanges of opinions and reflections about what actually happened, whether the response to Windsor was adequate, whether the process was manipulated by liberals or conservatives or the Archbishop of Canterbury. All those predictions of what a Covenant will look like, and who will be in and who will be out, and by how far, even though no one has actually decided what sort of process should be started.

But none of these things – none of them – can happen quickly. I have felt a bit like those days when I walk into a patient’s room and the first thing the patient sees is the collar. I often have to say, “Don’t Panic!” before the patient can speak (although usually by that time there’s been a clear physical reaction). So it is now: we need to not panic. There are many opinions of what the future holds, and a number of plans to shape the future. However, we can only participate in those plans and those events one day at a time, as was the case before.

Take “alternative primatial oversight,” for example. To seek a different primate is to leave one province for another – in this case, to leave the Episcopal Church. But, that will run counter to standards set down in primate’s comments on alternative episcopal oversight or to the procedures of the Committee of Reference. Both have stated they want to see efforts made to work these issues out within provinces before provincial lines are crossed. Moreover, the Archbishop’s last statement, reflecting on the General Convention, makes clear that he can’t make these decisions, that he doesn’t have that kind of authority. So, any such efforts will take years to make sense of.

The same is true of any Covenant. No process has been laid out. No one’s been invited to contribute, and no parameters have been established to contribute to. Those, too, will take time.

So, this is a time for us all to say “Don’t Panic.” Sure, these are important, and we need to think through how we will participate and/or respond. However, none of them will happen fast, whatever the opinions to the contrary.

So, I’ll be returning to my earlier tasks – to reflecting on chaplaincy and health care, on how the Episcopal Church and General Convention have spoken to health care, and on what might be an Episcopal context for health care. I should have plenty of time for those, while we wait to see how all these other changes shape up. And if I’m attentive and well prepared, and don’t stretch too far beyond my own capacity, I’ll see what I need to do and be able to act appropriately – but not quickly.