Tuesday, February 27, 2007

It's Not About Us: a Sermon for First Lent

As all families have, our family has its collection of personal sayings; and behind each one of them is a story. There’s always a story.

One of our family sayings is, “Marshall is heading off again into the tall grass.” It means that I’ve gone off in a new direction and into uncharted territory, or have decided to wander down a new road just to see where it goes. If I choose to explore a new route, even to a known place, my wife will say it. Even my kids will comment, if I decide to try a different way, “Dad, are you going off into the tall grass?”

And there is, of course, a story behind this. When we were first married, my wife and I lived in the Chicago suburbs. Not far from where we lived was one of those regional parks known in Chicagoland as a “forest preserve.” In the midst of this particular park was a lake, and we loved to go over there and do some fishing. Of course, as a small lake in the midst of the Chicago suburbs, there was only so much bank to fish from, and there were many folks who wanted to fish. It could be hard some days to find a stretch of bank along the lake with enough room to really work the water. So I was always looking for new places to fish, places that other folks hadn’t discovered, or weren’t intrepid enough to find.

One say we were walking along a path around the lake, and I noticed a small stream flowing under the path and down toward the lake. I decided I could follow that stream down to the lake, and perhaps find a new place to fish, one that no one else had discovered. My wife didn’t really want to come with me, but she didn’t want to wait on the path, either; so she followed me, if at a distance.

Well, as I got closer to the lake the undergrowth changed. At first it was low scrub, typical of the understory of a forest. But soon it changed to grass and then to reeds – at first three feet, then five feet, and then eight or nine feet – well over my head. Pretty quickly I couldn’t see for the reeds. I couldn’t see where I was going, and I really couldn’t see where I had come from. If I hadn’t kept the stream at my feet, I wouldn’t have any idea how to find my way in either direction.

Pretty quickly I decided to turn back. I didn’t really know how close I might be to the lake; and I’d been often enough in reeds along streams and lakes to realize that shortly I was likely to be up to my knees in mud. So, I turned around and followed the stream back the way I had come.

Jesus came up out of the waters of his baptism, and he was led by the Spirit – some commentators say “thrown” – into the wilderness.

We have some sense that we know about that “wilderness.” There have been enough photographs or pious paintings of the Holy Land and of the wilderness. We have some sense of desert, dry and arid terrain. But desert isn’t really the chief characteristic of wilderness. It’s really being in a place where you can’t see where you are, where you’ve come from or where you’re going. It’s a place where things aren’t under your control, where you might meet God, and might see angels or devils.

If you live in the country, downtown at night can be wilderness. You can’t see the horizon for the buildings. There are pools of shadow, pools you can’t see past or see through. We think of “wilderness” as being away from things, away from people, out where there’s no one but you. But the chief characteristic is that in the wilderness you can’t see where you’re coming or going, and things are not under your control.

Jesus came up out of the waters of his baptism, and he was led by the Spirit – some commentators say “thrown” – into the wilderness. There he went to be with God; and there he was tended by angels, and he was tempted by the Devil

When we’re in the wilderness, we can also meet angels and devils. And the first devil, often the worst one, is the one we bring with us. Out in the wilderness, out of our control. our first concern is often, “What do I do now? What can I do? How will I survive? What will happen to me?” We know that devil well. It taps into our fear, and it takes us away from encountering God to focusing on ourselves.

If you think about it, that’s what the Devil was doing when he tempted Jesus: he was trying to get Jesus to turn from God and to focus on himself. “You’re hungry. Make these stones bread, and you can eat. You’re powerless. Look at all the power in the world. Worship me and I’ll give it to you. No one knows you, and no one knows why you’ve come. Throw yourself down, and make yourself famous.” He was trying to make Jesus focus on himself.

But each time, Jesus returned to God. “Humans don’t live by bread.” What then? “Every word that comes from God.” Jesus said, “You worship only God.” He said, “You trust God, you don’t test him.” He knew at that point that it wasn’t about him. It was about encountering God.

We need constantly to be reminded of this. That was the point of the instructions Moses gave to Israel. “When you come to the land of promise, and you receive your harvest, and you bring your harvest in thanksgiving, this is what you need to say, and to remember: ‘My ancestor was a nomad, wandering in the wilderness. When he was enslaved in Egypt, God took him again into the wilderness; and it is only by God’s grace that we have come from slavery and through the wilderness to this blessed and fruitful land.” The point was that Israel remember that it wasn’t about them: it was about God.

But it can be particularly hard when we’re in the wilderness. At first we suffer, we struggle in our fear. Then we’re tempted to suffer guilt for failing in our faith. In this season of Lent, when we’re particularly aware of our sins; when we discipline ourselves to turn to God, and are then all the more conscious when we slip and fall, it’s so easy to fall into fear: fear that we’re not worthy, that we’re not good enough.

In that moment, once again, we need to remember that it’s about God, and it’s about what God has done for us in Christ. That’s what Paul is talking about when he said, “if you confess with your lips that Jesus is Lord and believe in your heart that God raised him from the dead, you will be saved.” Our salvation is not about our strength or our goodness or our worthiness. It’s about what God has done in Christ. “For, ‘Everyone who calls on the name of the Lord shall be saved.’ "

So, when we wander into the wilderness – and sooner or later, we will wander into the wilderness, whether by decision or by circumstance, or just by a need to head into the tall grass – we can trust that we will not be lost. We can seek God there, and perhaps meet angels. And if we meet devils, and even if they tempt us, turning us back to ourselves, we will not be lost. Because salvation is not about us: it’s all about God.

Saturday, February 24, 2007

One Episcopalian's Question

Romans 10:8b-13

"The word is near you,
on your lips and in your heart"
(that is, the word of faith that we proclaim); because if you confess with your lips that Jesus is Lord and believe in your heart that God raised him from the dead, you will be saved. For one believes with the heart and so is justified, and one confesses with the mouth and so is saved. The scripture says, "No one who believes in him will be put to shame." For there is no distinction between Jew and Greek; the same Lord is Lord of all and is generous to all who call on him. For, "Everyone who calls on the name of the Lord shall be saved."

So, here's my question: if we believe this, what are we fighting about? And we all believe this, don't we? Don't we?

Thursday, February 22, 2007

Who's Calling for a New Ecclesiology?

I have read Archbishop Williams’ article in the Telegraph newspaper. It is an interesting article – interesting less for what it says about the Primates’ Meeting in Tanzania than what it says about the Archbishop of Canterbury.

One point that struck me was this one:

[Those who were troubled by American decisions regarding GLBT Christians] needed more than an assurance that it had been thought about in America and that a lot of people there had concluded it was all right. The other question followed on: if an issue just might be in the "not mine to give away" category, how did the Church as a whole decide whether it really was in that category or not? How did it decide as a Church, not as a conglomerate of local independent bodies? And if it couldn't decide as a Church, how could it carry on talking with other worldwide Christian bodies on the same foundations?

The clear import of this is that the vision of unity of Cantuar is “a Church,” in contrast to his previous image of “even less than a federation.” It might be a “Church that could balance unity and consent…,” but it is a Church and not a federation.

Indeed, it is to be a Church that will be recognized as such by “other worldwide Christian bodies.” But therein I find myself confused. In the David Frost interview in which he expressed the concern that the Anglican Communion might end up “less than a federation,” he also said, “There are other world churches, the Lutheran Reform Churches, which get on with a federal pattern.” Here certainly is a “worldwide Christian body” that is able to enter into ecumenical conversations and pursue unity of the Body, operating our of a “federal pattern.” The Lutherans have perhaps as much diversity as the Anglicans, but their “federal pattern” hasn’t inhibited their capacity to interact with other “worldwide Christian bodies.” Various “provinces” of Lutheran national bodies have been able to reach full communion, including mutual recognition of ministries, with various Provinces of the Anglican Communion. The Lutheran World Federation was able to participate in the Anglican Lutheran International Commission. They have been able to meet and issue agreed statements with the Roman Catholics, and the Orthodox, as well as with Anglicans.

Of course, in that contrast to the Lutherans, Archbishop Williams also said, “There’s always been, I think, a higher expectation in the Anglican Communion, that we, we have more, more at stake than that.” That, I think, is why we have spoken of our body as a Communion. It speaks to the activities that have traditionally brought and held us together: communicating with one another at the Lord’s Table, and communicating between rites in fellowship and conversation.

On the other hand, there has been another authoritative voice that has made the distinction between a “Church” and other sorts of Christian bodies. Pope Benedict XVI when as Cardinal Ratzinger he issued the declaration Dominus Iesus, wrote of, “these separated Churches and communities as such, though we believe they suffer from defects, have by no means been deprived of significance and importance in the mystery of salvation.”

Now, some might recall that the Cardinal spoke of “true particular churches.” Specifically, he wrote,

Therefore, there exists a single Church of Christ, which subsists in the Catholic Church, governed by the Successor of Peter and by the Bishops in communion with him.58 The Churches which, while not existing in perfect communion with the Catholic Church, remain united to her by means of the closest bonds, that is, by apostolic succession and a valid Eucharist, are true particular Churches.59 Therefore, the Church of Christ is present and operative also in these Churches, even though they lack full communion with the Catholic Church, since they do not accept the Catholic doctrine of the Primacy, which, according to the will of God, the Bishop of Rome objectively has and exercises over the entire Church.

As encouraging as that might sound to us, who uphold the validity of our Episcopate, it is in fact cold comfort. The official position of the Roman Catholic Church, affirmed as well by Cardinal Ratzinger, is that in fact we do not have valid orders. For all our recent conversations and gestures, the opinion of Leo XIII is still the official teaching, and our orders are viewed as “defective.” And on that point, Cardinal Ratzinger wrote, “On the other hand, the ecclesial communities which have not preserved the valid Episcopate and the genuine and integral substance of the Eucharistic mystery,61 are not Churches in the proper sense;…”

Thus, it seems to me that the Archbishop of Canterbury envisions something less “defective;” and if he does not seek true reunion with Rome (at least in the short term), perhaps he hopes for something more visibly and structurally parallel. There may still be a desire to “balance unity and consent,” but only within a structure that is “more,” and has “more at stake,” than “a federal pattern;” much less “something less than a federation.”

And so I am troubled by his concern about how we “decide as a Church, not as a conglomerate of local independent bodies.” We have in the past functioned as a Communion, local bodies more closely related than simply a conglomerate, but not so closely structured as “a Church.” Indeed, one could argue that such a structure has not affected our ability to communicate with Rome, in that it is basically the same structure as that lived out in the Orthodox family of autocephalous churches. Unfortunately, it doesn’t seem to satisfy the vision of Cantuar.

I would agree that how we as a Communion decide which issues are really Communion-wide is important. Sadly, in the current arguments there is a powerful drive to decide these issues before we’ve really determined whether they are or should be Communion-wide issues, or even how we identify Communion-wide issues. We have seen ourselves in some sense as “autocephalous,” until now. But for Cantuar apparently that isn’t good enough.

We have thought, on this side of the Atlantic, that the drive for a centralization of authority and for conformity of teaching was coming from our Anglican siblings in the Global South. That seems certainly true of conformity, and may be true of centralization; but it sure looks like the drive for centralization is getting at least some enthusiasm from the very top.

Wednesday, February 21, 2007

The Health Care Dilemma: The Value of Investing Up Front

Yes, I am thinking about current Episcopal and Anglican events. However, I’m just not settled yet on what to say. And in the meantime, there is plenty to talk about in health care.

These days everyone in the United States is talking again about health care. It’s almost like the heady days of the early years of the Clinton Administration. All the presidential candidates declared and not, are saying it’s important. President Bush wants to encourage folks to buy family health plans by changing the tax code. Massachusetts, California, and Pennsylvania want to add as many people as possible to State Children’s Health Insurance Plans (SCHIP) and to Medicaid, and then require all employers to provide health insurance for their employees. Even Wal-Mart and the Service Employees International Union, along with a number of other organizations, agreed that there is a need for “quality, affordable” health care.

Now, I think there are problems with almost all of the plans, problems that revolve around assumptions about the value of “the market.” Those assumptions manifest themselves in various ways, but they all reflect a belief that competition in a free market will resolve all concerns. And we all know what happens when we “assume…”

There are several reasons that the principles of “the market” don’t work too well on health care. Over time I’m sure I’ll address several. However, for the moment let me focus on one. Many of the market proposals involve the assumption that we can save money if only people will use health care less. Today at a roundtable in Chattanooga, Tennessee, President Bush said, “People can save money with health savings accounts. These are innovative products, innovative ways of providing insurance for yourself and you're family, where you actually save money, tax-free, if you don't spend money on yourself.” That suggests that there are many people out there misusing health care resources, seeking professional care, for example, when they don’t really need it. That does happen, of course. Folks use emergency departments for primary care. They expect antibiotic medications for viral conditions, that antibiotics don’t touch.

At the same time, these proposals aren’t really directed at eliminating those concerns per se. They are interested simply in encouraging folks to spend less money on health care, encouraging them with the thought that they will benefit from the money they don’t spend.

That may look like good economics, but it’s bad health care. In fact, because it’s bad health care it’s bad economics. We are not served by people using less health care. We are better served by them using more health care, and using it earlier. We know well that preventive care is cheaper in the long run than pathologic care; that is, every dollar we spend preventing disease is multiplied in terms of what it saves over treating diseases once they’re established. Over the years I’ve seen estimates of savings as high as ten times the initial expense.

But to accomplish that benefit we have to spend money. We don’t get the savings if we don’t make the investment. Yes, encouraging lifestyle change will help, but it won’t do the job. We can go a long way toward preventing major diseases, but only if we’re spending the money to catch them while they’re minor. We can prevent many of the consequences of high blood pressure, but only if folks are seeing primary care physicians to have their blood pressures checked and receiving the medications they need. We can keep many people out of operating rooms, cath labs, and intensive care units; but to do that we have to pay for screenings, cardiologist visits, and cholesterol medications. We can keep folks from coming to the Emergency Room with pneumonia, but only if we can insure their access to primary care physicians when it’s still just a troubling cough. If we don’t invest the money and time to keep small problems small, we don’t get the benefit of not having to deal with big problems.

And that’s where the rub is. The system as we have it does a good job of paying when there is an identified problem; and the bigger the problem, the better the system is at paying. It’s much harder to make the system pay when there isn’t an identified problem. It’s much harder to get the folks who control what the system will pay to respond when there isn’t an identified problem. And so, instead of considering how to invest in health care when it’s easy, they wait until they have identified problems to address. Unfortunately, the longer they wait to make sure the problem is identified, the more it costs to address it.

This has many applications. For example, we have invested more in Medicare while we have allowed investment in Public Health to slip. We have argued whether we can afford to pay for health care for non-citizens, or at least for undocumented aliens. However, it is precisely among the poor, the transient, and the newly arrived – categories that circulate around undocumented aliens – that contagious diseases are more likely to surface. Even in the suburban hospital that I serve infectious diseases have shown up disproportionately among newly arrived folks, some documented and some not. If we are to be prepared for a pandemic, whether it’s avian flu or something else, we need a strong, active public health service, and we need to make it accessible to the poor, the transient, and the newly arrived. And we need to be willing to pay for it.

There are many other examples. The same principle applies to preventing problems at birth and the major expenses of neonatal intensive care; to reducing absenteeism from industry and from public schools; and to expenses for wound care and eye care associated with diabetes. All these concerns are much cheaper to address early than to address later when they’ve developed serious consequences. But they only remain cheaper if we spend the money and address them. If we don’t invest the money up front, we don’t get the benefit of prevention, and we end up once again paying the high costs.

That’s only one of my problems with a market approach to addressing our health care. There are others, but they will wait for future posts. For my point today, the problem is simple enough: if we want to save money on health care over the long run, in the short run we don’t need to spend less money. We need to spend more.

Sunday, February 18, 2007

A Familiar Voice

I listen to a variety of NPR stations around the country, and for a variety of reasons. This past week, listening to KQED in San Francisco, I heard a familiar voice. It was that of Susan Cosio, Chaplain at Sutter Medical Center in Sacramento. I have pointed in an earlier post to her statement as part of the "This I Believe" series on NPR news. This time I heard her speaking as part of the "Perspectives" series for KQED. Once again Chaplain Cosio speaks of the ministry of the chaplain, the ministry to which God has called her. I would encourage to take just a few minutes and give a listen.

Thursday, February 15, 2007

Where Have All the Scholars Gone?

This past Friday, February 9, Jim Naughton of the Daily Episcopalian wrote "On Feeling Unprepared," specifically for the meeting of the Primates in Tanzania, and whatever consequences might come of it. Among other things I included in a comment on his post, I said, “We have long looked to our scholars to articulate possibilities that the rest of us can consider. What are our scholars writing? Those publications don't get to the blogosphere much, but they could be very helpful.”

This is certainly true. Much of what we cherish in our articulation of the Anglican tradition has come not from ecclesiastical authorities but from scholars (one consequence of which has been a history of elevating scholars to ecclesiastical authority). Long before he made him Archbishop, Henry valued Thomas Cranmer as the scholar who could help him with problems of marriage and succession. John Jewel and Richard Hooker were academics who carved out for the young Church of England space in the faith between the Romans and the Puritans. The authors of the Tracts for the Times were more commonly scholars than bishops. F. D. Maurice, Charles Williams, C. S. Lewis – our understanding of the Anglican tradition passed down to our generation reflected more notably the work of scholars than of princes of the Church (again, notwithstanding that some scholars also were or became princes of the Church). In a sense, the meetings at Lambeth and the meetings of the Primates articulating what it “the Anglican tradition” is the innovation and exception.

Now, there are folks in the blogosphere trying to bring scholarship and academic tools to understanding the Anglican tradition and the issues today within the Anglican Communion and the Episcopal Church. I look with some frequency at Gower Street, HALIGWEORC, Catholic in the Third Millenium, and The Anglican Scotist, among others. That list is not intended to be exclusive or exhaustive, and there are bloggers from various perspectives with scholarly credentials. I think they are better represented among the (choose the term you consider appropriate: reasserter, conservative, “orthodox”) voices. At the same time, I wonder where we might see our academics today, and especially (again, choose your term: progressive, reappraiser, “prophetic”) voices, bringing their scholarship to our current difficulties.

One scholar who is heard from with some frequency is Dr. Michael Poon of the Center for the Study of Christianity in Asia. He is also Convener of Global South Theological Education & Formation Track, and I do not always agree with his opinions. At the same time, his work is always thoughtful and stimulating, and does not fit neatly into a stereotypic image of a conservative scholar. His recent article, “The Long Road to Full Inheritance: Anglican Communion, Anno Domini 2007,” has been linked from both Thinking Anglicans and Praeludium.

Dr. Poon’s article is an interesting reflection written in preparation for the meeting in Dar es Salaam, and is worth reading in its own right. At the same time, one of his footnotes pointed to an article by Clare Amos. Dr Clare Amos is Director of Theological Studies in the Anglican Communion. The article in question is “Anglican Theological Education: What Next?” published and available on line in The ANITEPAM Journal (The African Network of Institutions of Theological Education Preparing Anglicans for Ministry). In the article she writes of Theological Education for the Anglican Communion (TEAC) and of its “Anglican Way Target Group.” She writes, “In drawing up the initial detailed brief for their work, the members of the Anglican Way Target Group felt it right to set out a working definition of ‘The Anglican Way’, and it was this that accompanied the questionnaire.” She then lists the “working definition,” as I shall do shortly. She goes on to comment,

"One of the interesting and slightly unexpected side-effects of the work of TEAC has been that this ‘Anglican Way brief’ (as we still call it) has begun to acquire a bit of a life of its own. Published on TEAC’s website, and therefore fairly widely available, it has been read and shared by a number of people semi-independently of other TEAC documents and has a certain ‘status’ as a definition of what the Anglican Way is. "

It is important to remember, however, that it is ‘work in progress’, and was originally produced for a pragmatic purpose. But of course we are pleased if people are finding it useful more widely."

From the TEAC website, the “working definition” is as follows:

Understanding and describing our unique ethos and contribution to the wider Church; defining the Anglican Way:
1. The Anglican Way, though rooted in its history and historical formularies, nevertheless is not fixed but continues to be shaped by its multiform cultural settings. The Anglican Way is a particular expression of the Christian Way (Acts 9:2).
2. Understanding and describing a distinctive theological method incorporating, for example, 'contemplative pragmatism', 'inhabiting doctrine', doing theology by preaching, liturgy, hymnody, artistic creativity, etc.
3. Scripture, tradition and reason: Reading the Bible together, corporately and individually, with a keen and critical sense of the past, a vigorous engagement with the present context, and with patient hope for the future.
4. Awareness and critical assessment of other defining characteristics commonly associated with Anglican identity - for example, spirituality nurtured by Word and Sacrament, Lambeth Quadrilateral, Book of Common Prayer, distinctive polity, comprehensiveness, unity in diversity, Via media, bridge between denominations, balance of freedom and order, balance of pastoral, mission and prophetic, exercise of ministry, etc
5. The polity of the Anglican Way includes the threefold order of bishop, priest and deacon, intended to be united collegially with the laity in synod; and the interaction of provincial, diocesan and parish structures, governed by constitutions and canons.
6. An approach to mission which is holistic, incarnational and transformational and which shapes the engagement of the church with the world in each context.
7. Acknowledgement of provisionality, incompleteness and vulnerability as potential strengths.
8. The four formal instruments of unity (Archbishop of Canterbury, Lambeth Conferences, the Anglican Consultative Council, the Primates' meeting) offer cohesion to global Anglicanism, limit the centralisation of authority, rely on bonds of affection for effective functioning but are put under strain in situations of acute disagreement. Other emerging instruments of unity include Anglican networks, commissions and taskforces.
9. Awareness of Anglicanism's past and present failures, and its susceptibility to particular kinds of abuse (for example, aspects of colonial heritage, excessive association with power and privilege, hierarchical authoritarianism, clericalism at the expense of the ministry of women and laity, its identification with Englishness, etc).
10. The Anglican Way encompasses communion (koinonia) with the united churches and other churches in full communion with the See of Canterbury. These relationships enrich our understanding and experience of koinonia.
11. The Anglican Way is deeply committed to building ecumenical relationships and strives to define itself through statements made in ecumenical dialogue.
12. The Anglican Way as interplay between witness to the Lordship of Jesus Christ; yearning for and working towards mutual respect, peace and just relations with other faith communities; and a prophetic critique of religious and political ideologies.

Now, this working definition has several aspects of interest to me, largely independent of its specific content. First, since its source is the TEAC Working Group I think we can presume that scholars were involved in its development and that there is wide representation across the Communion (although I can’t seem to find a list of participants; if someone else can, I’ll add the link). Second, since the TEAC Working Group was established by the Primates, this definition is one that most of the Primates would accept, at least as a starting point.

In the context of my ministry as a hospital chaplain, physicians and researchers value and actively seek consistent descriptions of individual diagnoses. That makes it possible for physicians and researchers to communicate more clearly. Looking to this definition as an agreed starting point for discussions would facilitate communication as we explore together what it means now and what it will mean in the future to follow “the Anglican Way.”

Some will ask – some have asked already in other settings – whether the Chicago-Lambeth Quadrilateral isn’t a sufficient set of standards of what it means to be Anglican. It has the authority of acceptance by not only The Episcopal Church, but by the Lambeth Conference in 1888. At the same time, the standards of the Quadrilateral were proposed as “principles of unity exemplified by the undivided Catholic Church during the first ages of its existence,” and not as definitively Anglican. It was intended, as it were, as minimal standards, standards that have made possible conversation with other communions. The TEAC “working definition,” on the other hand, attempts to articulate specifically Anglican understandings of how the standards of the Quadrilateral are lived out.

Regardless of the results of the Primates’ Meeting in Tanzania, currently in progress, we will still be involved in exploring and arguing what it means to follow “the Anglican way,” and how we see ourselves as Anglicans, at Communion, provincial, and even individual levels. I hope we will see more exploration from our scholars of these questions, and see more of them in the public arena, and not simply in academic journals. That scholarly contribution to our life as Anglicans has been critical to our history. And for the scholars, established and new, who would like to explore these issues, I think the TEAC working definition of “the Anglican Way” would be a good place to start.

Tuesday, February 13, 2007

Anglican Communion and the Sin of Memory

At times in my life I have pondered what I call “the sin of memory.” The “sin,” in essence, is essentially justification of bad acts by selective recall. In other words, I can remember that injury I need to justify my actions today, and can conveniently ignore or discount other events, especially those that might mediate against the action I wish to take.

I grew up in the midst of it, really. In one sense it was all around me. I grew up in Tennessee, a state that to this day in some sense revisits the Civil War with every statewide election. For the past half generation that’s been muted: as the Republican Party came to represent social conservatism the divisions became less visible. Still, the cultural differences remain between the agricultural West (once cotton and now soybeans), the financial and governmental Middle, and the industrial and mining East within Tennessee. My mother’s ancestors fought for the Union Army, from that part of the state that in referendum voted against secession. The president who could not stop Reconstruction came from that region; and the other parts of the state have not forgotten either event.

In another sense I grew up with it in the house, albeit still at a distance. I grew up hearing folk songs, including many Irish songs of Republican resistance (an entirely different group, and an entirely different meaning of “Republican”). As a child I sang “At the Rising of the Moon” with enthusiasm, with no clear understanding just whom those folks were so ready to fight. I came to realize, of course, what history that referred to; and there were more than enough news stories in my youth to demonstrate just how acutely folks felt that history.

In my lifetime we have seen many such instances, and have been educated to many others. We know the names. As Yugoslavia broke into smaller and smaller pieces, for each group, whether Serb, Croat, Bosnian, Albanian, or Macedonian, there was some date, some event, some “battle” won or “massacre” suffered, that justified combat, resistance, and sometimes horrific personal and political violations. When Rwanda fell into bloodshed, we in the west did not know the history that motivated Hutu and Tutsi; but they certainly did. In the past three years we in America have learned of the events that shaped and separated Sunni and Shia within Islam. They shouldn’t surprise us, if we’ve been paying attention in the past half century to the history that has shaped violent acts and violent responses in land that is Holy to more than half the human race.

I’m mulling this over now, and the way this “sin” seems to be playing out in the current differences in the Anglican Communion. In all the discussion, framed as “what it means to be an Anglican” or “an Anglican church;” or “what are the essentials of the Anglican tradition,” all of us – all of us – find the way to those citations that each of us finds compelling. We begin, of course, with Scripture, each of us citing those “proof texts” that make our point, and interpreting in or out the “proof texts” that seem compelling to those with whom we argue. We all deride “proof-texting,” of course, as poor scholarship; even as we continue in the practice.

But I find we do the same thing with history. Sometimes we agree on the event, if not on its import. We all acknowledge that the decision regarding ordination of women to the priesthood at the General Convention of the Episcopal Church in 1976 was important. We disagree whether it was a triumph or a disaster. We also tend to forget that the first decision regarding a woman in the priesthood was not made in “western” America, but in “eastern” Hong Kong.

And so I have heard referenced many touchstones of what might be essential to the Anglican tradition. I have heard reference to the Book of Common Prayer; but to which one? I have heard reference to the reformation theology of Thomas Cranmer in 1549 and 1552 (growing more Reformed with a capital “R” from one to the other). I have heard reference to the 1662 Book, still the official prayer book of the Church of England, as for many others around the Communion. On the other hand, I have heard reference to the 1789 Book of Common Prayer of the then new Episcopal Church, its faithfulness to Bishop Seabury’s promise to follow the forms of the Scottish Nonjurors, and its discontinuity with 1662. I have heard almost nothing of the 1559 Prayer Book, that often took the Lutheran phrases of 1549 and the Reformed phrases of 1552 and simply tacked them together.

By the same token, I have heard raised up the memories of Thomas Cranmer to anchor the Reformed foundations of Anglican theology; or the Tractarians to anchor the Catholic foundations; or F. D. Maurice to anchor the Modern tradition. I have seen little discussion that would recognize the tradition as embracing all three. I have seen the arguments just what Hooker meant when he recognized Scripture as the “first” source of authority. I have heard little of Hooker’s insistence on “all things in Measure, Number, and Weight,” or of his commitment to Thomist method or Natural Theology. I have heard almost nothing of John Jewel, Hooker’s teacher and colleague, who argued against the Roman tradition as Hooker argued against the Puritan. Yet these are also part of the foundations of the Anglican tradition.

Indeed, we have been from the beginning, we Anglicans, people of paradox. There have always been two perspectives being expressed. The Lutheran and Reformed scholars who were tutors to Edward, Cranmer among them, would be met with Elizabeth’s sense of the pastoral need to retain more “catholic” services for the people in the pews. The early shape of Anglican theology took almost as much from Jewel’s Apology for Church of England as from Hooker’s Laws of Ecclesiastical Polity. Even a cursory knowledge of English church history highlights the movements between Puritan and Catholic. And in that history, the Elizabethan Settlement and the coexistence of the 20th Century were something of an exception. More often there were broad swings, with one group or another dominant for various periods of time. We have survived significant movements from one side to another, significant periods of “reappraisal” and “reassertion” over the centuries.

We have been a significant, too, if not unique, in our commitment to working, or at least talking, with other Christians. In the past generation we have had conversations on national and international levels with Roman Catholic, Eastern Orthodox, Oriental Orthodox, Lutheran, Old Catholic, Baptist, Methodist, Moravian, and Reformed Christians. We have managed to acknowledge the Christology of the Separated Churches of the East and of the Oriental Orthodox churches, even though they will still not recognize each other. We have held up for ourselves a self-image as a “bridge” church – between Catholic and Protestant, between Word-oriented and Sacramental traditions, between contemplative and active lives.

We have not maintained a single, simple, straightforward tradition. We are, in fact, heirs of a broad, varied, and sometimes conflicted tradition. Sadly, when we discuss that tradition these days, we rarely acknowledge that breadth. There is within that variety enough to justify our individual positions, our individual goals; but only so long as we deny, discount, or ignore those parts of our tradition that don’t support them. We have survived broad swings and strong disagreements now, and might again. But we won’t survive them if we continue to commit “the sin of memory.”

Saturday, February 10, 2007

Faith, Physicians, and Ethical Practice

I was alerted yesterday to a recent study on physician ethics by this report on NPR’s Talk of the Nation. Dr. Farr Curlin, assistant professor, Section of General Internal Medicine and the MacLean Center for Clinical Medical Ethics at The University of Chicago, was interviewed regarding the article, “Religion, Conscience, and Controversial Clinical Practices,” of which he is one of the authors. You can find the article in the February 8 edition of The New England Journal of Medicine.

Ethical norms and practices of physicians is, of course, an important subject. There is ongoing debate about balancing the principles of patient autonomy (which at its worst I often characterize as “Whatever Lola wants, Lola gets”) and of the moral integrity and autonomy of physicians. As the authors note,

Recent controversies regarding physicians and pharmacists who refuse to prescribe or dispense emergency and other contraceptives have sparked a debate about conscientious objection in health care.1,2,3,4,5 On the one hand, most people believe that health professionals should not have to engage in medical practices about which they have moral qualms. On the other hand, most people also believe that patients should have access to legal treatments, even in situations in which their physicians are troubled about the moral implications of those treatments.6 Such situations raise a number of questions about the balance of rights and obligations within the doctor–patient relationship. Is it ethical for physicians to describe their objections to patients? Should physicians have the right to refuse to discuss, provide, or refer patients for medical interventions to which they have moral objections?

Physicians in the study were asked to focus on three questions:

The primary criterion variables were physicians' responses to the following three questions: "If a patient requests a legal medical procedure, but the patient's physician objects to the procedure for religious or moral reasons, would it be ethical for the physician to plainly describe to the patient why he or she objects to the requested procedure? Does the physician have an obligation to present all possible options to the patient, including information about obtaining the requested procedure? Does the physician have an obligation to refer the patient to someone who does not object to the requested procedure?" Response categories were yes, no, and undecided.

We also assessed physicians' intrinsic religiosity and religious affiliations. Intrinsic religiosity — the extent to which a person embraces his or her religion as the "master motive" that guides and gives meaning to his or her life12 — was measured on the basis of agreement or disagreement with two statements: "I try hard to carry my religious beliefs over into all my other dealings in life" and "My whole approach to life is based on my religion…." Intrinsic religiosity was categorized as being low if physicians disagreed with both statements, moderate if they agreed with one but not the other, and high if they agreed with both.

Physicians were also asked about religious affiliation and about frequency of attendance at worship.


To determine whether physicians' judgments about their ethical obligations are associated with their views on controversial clinical practices, we asked the survey respondents whether they have a religious or moral objection to terminal sedation (administering sedation that leads to unconsciousness in dying patients), abortion for failed contraception, and the prescription of birth control to adolescents without parental approval.

These measures provided some of the results of greatest interest to me. For example, a majority of respondents described their religiosity as either “High” (36%) or “Moderate” (27%). Only 10% stated that they never attended worship, with the largest segment attending “Twice a month or more” (46%). Again, only 10% claimed no religious affiliation (a category that included identifications as atheist, agnostic, or none). While that’s not different from my experience of physicians, it suggests physicians are at least as religious, both in self-report of religiosity and in regular worship, as the general population.

Of greater interest as a chaplain and chair of an ethics committee are the responses to the primary questions. A majority felt it would be ethical for a physician to describe in detail objections to a procedure (63%). Larger majorities felt an obligation to inform a patient of all available treatment options, including those to which the physician objects (86%), and to refer a patient to another physician who did not share those objections (71%). These numbers suggest a strong commitment to fully informing patients.

At the same time,

Physicians who were more religious (as measured by either their attendance at religious services or their intrinsic religiosity) were more likely to report that doctors may describe their objections to patients, and they were less likely to report that physicians must present all options and refer patients to someone who does not object to the requested procedure. As compared with those with no religious affiliation, Catholics and Protestants were more likely to report that physicians may describe their religious or moral objections and less likely to report that physicians are obligated to refer patients to someone who does not object to the requested procedure.

In one sense, this is not a surprise. Issues were suggested in the study to which physicians might object, and on which many religious communities have taken positions. Those positions would certainly suggest moral norms for responding to those issues. With physicians in this study as religious as the reported, it doesn’t surprise me that those who would not inform or refer for those positions to which they object would also be among those who are religious.

At the same time, it would certainly make a difference to a patient to know where the doctor stood. The patient may be pleased, or may want to seek another physician; but the patient would not be likely to consider it irrelevant. Unfortunately, the question would be unlikely to arise until the issue was acute. In that case the accuracy and timeliness of information would be highlighted. In addition, among the citations in this article are several articles that suggest the state licensing of physicians, and thus state establishment of a de facto “monopoly,” creates a greater responsibility for public service and public utility that would argue against physicians’ professional autonomy. And if the physicians here are in the minority, they would still represent significant numbers of physicians.

The authors conclude,

the results of our study suggest that when patients request morally controversial clinical interventions, male physicians and those who are religious will be most likely to express personal objections and least likely to disclose information about the interventions or to refer patients to more accommodating providers. Ongoing debates about conscientious objections in medicine should take account of the complex relationships among sex, religious commitments, and physicians' approaches to morally controversial clinical practices. In the meantime, physicians and patients might engage in a respectful dialogue to anticipate areas of moral disagreement and to negotiate acceptable accommodations before crises develop.

I would step beyond the suggestion of “might engage” to argue they “must engage.” The physicians who care for us are every bit as human as we are, and every bit as prone to moral anxiety and ambiguity. Perhaps it seems unfortunate that we as patients might need to take initiative to clarify with physicians where they would stand on moral issues and controversial procedures. At the same time, both patients and physicians are responsible for the quality of doctor-patient relationships, and for the honesty and clarity that contribute to them. We want them to be clear with us – whichever side of that exchange we are on.

Tuesday, February 06, 2007

Perhaps Wright Is Not Wrong; Just Misinformed

I’ve been reading Thinking Anglicans again. Today there is a highlight of an interview with N. T. Wright, Bishop of Durham of the Church of England, and noted Biblical scholar. It’s worth the time to read.

I, of course, have some reflections from what I read. I have no doubt that Bishop Wright is a far finer Biblical scholar than I. I have no doubt that he is no "scholar" of the difficulties facing the Anglican Communion and (as he notes, among others) The Episcopal Church.

First, Bishop Wright says,

“The more sharp-edged question is who is seen to be speaking for the American evangelicals. Rowan has invited to Dar Es Salaam two of the leading Windsor bishops, the ones holding the ground around the Windsor report, who are not seceding and going to Nigeria but who are not going to waver in the terms that Ecusa [sic, and presumably the responsibility of Ms. Gledhill] got it wrong and it is still getting it wrong and needs to be called to order.”

To equate Bishop Duncan and Bishop MacPherson in their commitment to The Episcopal Church is simply inaccurate. Bishop Duncan has expressed his willingness to leave the institution of The Episcopal Church, and has by his statements and by his support of actions changing the canons of his diocese has amply demonstrated it. Bishop MacPherson may be "Windsor-compliant" in the terms of the Camp Allen meetings; but by his acceptance of election as Chair of the Presiding Bishop's Council of Advice he has demonstrated his readiness to continue in The Episcopal Church. When he says later, “We are not talking here about dissident conservatives. These are people who are not dissidents,” he is only half right.

Second, I reviewed this paper linked from the interview, to explicate Bishop Wright’s statement on “doctrinal indifferentism.” I found this definition:
"doctrinal indifferentism -- that attitude which regards the individual’s or church’s experience of Christ as essentially separable from, more important than, or even opposed to, a clear understanding of his person and work...."

Surely Bishop Wright has been listening to Neo-Separatists and not to any of the progressive bishops or scholars. It is precisely the ministry of Jesus, and the commitment to his statement, "I have not lost any of those you gave me," that is central to acceptance of homosexual persons into the full life of the Church. It is acceptance of the word of the Risen Christ to Peter, "What I have cleansed you shall not call unclean," that has called us to this point. It is conviction that God meant it when he said through Amos, “Let justice roll down like waters.” We are not at all indifferent to the person and the work of Christ. We are committed to the idea that his person continues among us and his work still goes on.

Nor are we indifferent to the doctrine of the Holy Spirit. We do indeed believe that the Spirit is and continues to be “the Lord, the Giver of Life,” leading the “one holy catholic and apostolic Church.” We remain committed to the faith that there is “one baptism for the forgiveness of sins,” and that thus salvation does not depend on our righteousness. We are not indifferent to doctrine. Neither are we indifferent to the natural theology tradition in Anglicanism, which allows us to seek where God is in new learning, and where the Spirit might lead with new experiences. With all that, the work has been precisely to see experience in light of the continuing person and work of Christ, and not separable from it.

Perhaps this is his misunderstanding: he says, “All that has happened subsequently [to the consecration of Bishop Gene Robinson] is the rest of the Communion saying we really hope you did not mean that but if you did, have you thought through the consequences?” Indeed, we had thought the consequences for a generation. As has been noted, that process of “thinking through” was incumbent on all Provinces of the Communion from the 1978 Lambeth Conference. That ours was among the few that actually did that work seems something of which Bishop Wright seems unaware.

I appreciate his belief that no one will, as it were, push Archbishop Williams around. I appreciate, too, that he makes no specific prediction of Tanzania. I share with him his prediction of difference and difficulty still ahead.

I appreciate his comments about the Windsor Report, although I disagree with his description of its import, and even its content. From its publication Bishop Griswold changed his participation in formal “councils of the Communion;” and if Bishop Wright is not satisfied by the presentations of the American Church at the last Anglican Consultative Council meeting, surely he recognizes the entirely voluntary decision to step back from participation. As for participation in Lambeth: there have been in these past few years significant retirements and new elections within The Episcopal Church. It remains to be seen just how great is the “problem” of bishops who participated in Bishop Robinson’s consecration. In any case, the rejection among the Neo-Separatists of certain parts of the Windsor Report - those acknowledging that provincial autonomy, even if not absolute, has been normative within the Anglican Communion; that The Episcopal Church made decisions within its own Constitution and Canons; that violation of provincial boundaries is as clearly an innovation in the Anglican tradition as full acceptance of homosexuals; and that the purpose of the Windsor Report itself was to maintain communion and not to excommunicate – makes his hope for it quixotic at best, and near-sighted at worst.

Now, I do not appreciate the title of the Gledhill article, "Primates: Schismatics to be "pruned from the branch." It bears little meaningful relation to the interview. Bishop Wright spoke of "pruning," but made no specific prediction, much less suggesting that he had either heard such an assumption from the Primates or that he might give such instruction to the Primates. On the other hand, that’s the kind of provocative remark that sells papers, and that I have seen before from Ms. Gledhill.

But that is not the fault, I imagine, of Bishop Wright. He is not responsible for it. What he should be responsible for is accurate information on The Episcopal Church, and on the hard theological and doctrinal work that brought the Episcopal Church to the decisions of the past few years. I respect him enough to believe he would acknowledge what he knew. So, I can only assume he’s been misinformed.

Monday, February 05, 2007

2 Kings 5:1-19: A Story of Contemporary Health Care

I think there might be two ways to look at well known healing stories. For example:

Naaman, commander of the army of the king of Aram, was a great man and in high favour with his master, because by him the LORD had given victory to Aram. The man, though a mighty warrior, suffered from leprosy.* 2Now the Arameans on one of their raids had taken a young girl captive from the land of Israel, and she served Naaman’s wife. 3She said to her mistress, ‘If only my lord were with the prophet who is in Samaria! He would cure him of his leprosy.’* 4So Naaman* went in and told his lord just what the girl from the land of Israel had said. 5And the king of Aram said, ‘Go then, and I will send along a letter to the king of Israel.’

He went, taking with him ten talents of silver, six thousand shekels of gold, and ten sets of garments. 6He brought the letter to the king of Israel, which read, ‘When this letter reaches you, know that I have sent to you my servant Naaman, that you may cure him of his leprosy.’* 7When the king of Israel read the letter, he tore his clothes and said, ‘Am I God, to give death or life, that this man sends word to me to cure a man of his leprosy?* Just look and see how he is trying to pick a quarrel with me.’

8 But when Elisha the man of God heard that the king of Israel had torn his clothes, he sent a message to the king, ‘Why have you torn your clothes? Let him come to me, that he may learn that there is a prophet in Israel.’ 9So Naaman came with his horses and chariots, and halted at the entrance of Elisha’s house. 10Elisha sent a messenger to him, saying, ‘Go, wash in the Jordan seven times, and your flesh shall be restored and you shall be clean.’ 11But Naaman became angry and went away, saying, ‘I thought that for me he would surely come out, and stand and call on the name of the LORD his God, and would wave his hand over the spot, and cure the leprosy!* 12Are not Abana* and Pharpar, the rivers of Damascus, better than all the waters of Israel? Could I not wash in them, and be clean?’ He turned and went away in a rage. 13But his servants approached and said to him, ‘Father, if the prophet had commanded you to do something difficult, would you not have done it? How much more, when all he said to you was, “Wash, and be clean”?’ 14So he went down and immersed himself seven times in the Jordan, according to the word of the man of God; his flesh was restored like the flesh of a young boy, and he was clean.

15 Then he returned to the man of God, he and all his company; he came and stood before him and said, ‘Now I know that there is no God in all the earth except in Israel; please accept a present from your servant.’ 16But he said, ‘As the LORD lives, whom I serve, I will accept nothing!’ He urged him to accept, but he refused. 17Then Naaman said, ‘If not, please let two mule-loads of earth be given to your servant; for your servant will no longer offer burnt-offering or sacrifice to any god except the LORD. 18But may the LORD pardon your servant on one count: when my master goes into the house of Rimmon to worship there, leaning on my arm, and I bow down in the house of Rimmon, when I do bow down in the house of Rimmon, may the LORD pardon your servant on this one count.’ 19He said to him, ‘Go in peace.’

Or, as we would see this in modern health care:

A successful business man, an important official, suffered a chronic disease, debilitating but not fatal. He receives a word of mouth referral from a supportive employee. Before he tries the new health care provider his choice is cleared with his primary insurer. He comes prepared for a significant copay.

The first provider consults with the appropriate specialist. He agrees to take the case, and the patient receives the referral. At the specialists office he meets a Physician Assistant rather than the physician. Through the PA the patient given a conservative treatment program based on patient compliance. The patient is angry: isn’t there a wonder drug or a dramatic procedure? “Surely my problem is too important for anything but the specialist’s personal care and the latest, most powerful treatment.” Ultimately, however, the patient is compliant, and the conservative treatment plan works. Moreover, the specialist does not require a copay. To stay with the specialist the patient takes on a new insurance plan. He works with specialist to adapt the care plan to his lifestyle, and goes on his way, successfuly treated.

Thursday, February 01, 2007

Other Voices from Other Provinces

I have noted with interest the information on the coming meeting of the Primates in Dar es Salaam, Tanzania. The official information at the Anglican Communion web site is here, and thanks to Thinking Anglicans for pointing to it.

I was intrigued by the number of Primates for whom this will be their first Meeting. I found myself wondering what new insights they might bring from their different corners of the Communion. New voices might bring new insights to what has become all too strident a conversation.

I would be thrilled to hear some new voices. While I don’t question that there is much agreement, for example, among the primates of the Global South Steering Committee, in general we hear much from Nigeria, Uganda, and Kenya, and little otherwise. We have recently heard from Tanzania, and previously from Southern Cone and the West Indies, but not with anything like the frequency. By the same token, we have heard from the United States, and somewhat from Canada, Ireland, and Aotearoa, New Zealand, and Polynesia. My point here is not to be inclusive or exhaustive. However, it seems to me that there are many of the 38 provinces of the Communion from who we have heard little over the past few years of controversy.

I hope that after this Primates’ Meeting we might hear more. Beyond the official statements that will come, I would be interested in individual voices. They would be found in reports and pastorals written to and for their individual provinces once the meeting was over. Some will, I imagine, be available on web sites and in publications; but not all provinces have the same resources for communication. Still, I hope that we will find ways to hear all those voices, and to share them around the Communion. I think they would add depth and subtlety to discussions that have become simplistic, polarized, and, again, strident.

If we are to maintain the Anglican Communion – or any communion at all – it will be good for all voices to be heard. I would want that to include the voices of lay and ordained Anglicans in addition to the Primates; but in the short term I would be interested to hear the comments of each of the Primates, and especially of those whose voices haven’t yet been heard.