Our Health Is Public

So, I was listening to the news last evening on my drive home, and I heard this story from NPR. The story is about a hearing before the New York City Health Board about eliminating trans-fats in commercial food. In the midst of this, I was struck by the following quotation. The speaker was Audrey Silk, a retired NYC police officer, Libertarian candidate for mayor, and founder of NYC Citizens Lobbying Against Smoker Harassment. (N.Y.C.CL.A.S.H.)

“You invent for public health a role and a power that it’s never historically had and never ought to have. That’s social engineering. Eliminating choice and coercing behavior is not the American way.”

Now, we could discuss long and hard the just how un-American it is to eliminate choice or coerce behavior. However, I was most struck by her suggestion that this is “a role and a power that [public health] has never historically had.”

First and foremost, how food is cooked in restaurants has long been a public health issue. Inspecting restaurants and overseeing the safe handling of ingredients is nothing new to public health. Neither is deciding that some ingredients simply aren’t safe. That’s why classic absinthe, made with wormwood, is illegal. It’s why cattle “found down,” collapsed alone in the pasture, no longer make it into butcher counters in the United States.

Secondly, there’s hardly any question that trans-fats are as harmful for us as are saturated fats. Adding hydrogen (“hydrogenating”) oils to make them solid and stable at room temperature makes for great ease of use. It also makes for great biscuits and pie crusts (there is no substitute in the Southern kitchen for Crisco!) It just happens to make for blocked arteries for young and old alike.

So, we have a known disease (coronary artery disease) and a significant contributor (trans-fatty acids). How is this not a public health issue? How is this significantly different that cleaning up standing water to reduce mosquitoes?

I have a more basic disagreement with Ms. Silk. She speaks as if these were necessarily matters of private choice, and not of public health. However, private choice or no, all our health is “public.” That’s true because very few of us pay the full cost of our own health care. Most of us have our health care supported by one third party payer or another, whether insurance from government (Medicare, Medicaid, TriCare) or from a private commercial insurer. Yes, we make contributions toward that in the form of co-pays and premiums and salary deductions; but put one of us in the hospital and all of that is covered and exceeded in a matter of hours. We participate in risk pools of various sizes, and so may be able somewhat to adjust our contributions; but few of us pay all of the expenses ourselves.

Indeed, even those who try that, who choose not to participate in insurance plans, end up dragging us into participation. Cost-shifting by providers and insurance requirements by government bodies (for example, to drive a car) are different ways of including the rest of us in the risk pool, and in paying the costs. And that doesn’t even get into support for public educational institutions for physicians, nurses, and other health care professionals – all supported by tax dollars.

That, you know, is the most ironic thing about opposing a single-payer national health plan. We’re already sharing those costs, whether through higher premiums or higher bills due to cost shifting or higher taxes to cover the gaps for a few. A national health insurance plan would spread the risk over the greatest possible number of people, and so offer each of us the lowest relative risk; and at the same time would offer the possibility of efficiencies of scale and of uniformity of forms and charges (check it out: Medicare actually has some of the lowest administrative expenses out there, far lower than most commercial insurers).

In any case, we’re all participating already in health care that is publicly supported, whether we’re honest about it or not. If reducing your trans-fats in restaurants reduces your risk of heart disease, and so your medical expenses, it also reduces my expenses (much less my risk of heart disease). Is that coercive? Perhaps a little. On the other hand, we have an alternative: expect those who choose not to make these decisions and not to carry insurance to actually pay the expenses of their actions. I live in a state that requires motorcyclists to wear helmets, but work in a state that does not. I’ve heard the suggestion that we allow motorcyclists to ride without; and if they crack their heads open, to let them do without – without, that is, expecting the public or an insurer to pick up their Emergency Room bills.

All our health is “public:” publicly supported and publicly funded. So, maybe restricting trans-fats in restaurants isn’t coercive behavior after all. Perhaps it’s as American as a barn-raising or a neighborhood watch. Perhaps it’s just a decision based on a realization of common interest.

Sharing a Different Vision

The Diocese of West Missouri meet in Convention yesterday and today – well, really only today. The Annual Convention and Gathering spends the first day on the Bishop’s Address, educational offerings, and the Convention Eucharist and Banquet – the Gathering, which is open to anyone who wishes to participate. The actual Convention, the business meeting of the Diocese, met today.

There were few resolutions, and most were about internal government of the Diocese. The exception, and it is a significant one, was the resolution on stem cell research. The final form is reproduced below.

Resolved, the 117th Convention of the Episcopal Diocese of West Missouri meeting in Kansas City, Missouri, October 27 and 28, 2006, affirms the value of stem cell research, both embryonic and adult, and

Resolved, it is the opinion of this Convention that stem cell research is consistent with the theological teachings and moral practices of the Episcopal Church, and

Resolved, press releases of other public statements issued by all diocesan officers or officials regarding this 117th Convention of the Diocese of West Missouri should include these resolves regarding stem cell research.

The authors of the resolution cited Resolution A014 of the 2003 General Convention as support and resource for their statement. I have posted my own reflections on General Convention statements on this subject.

If you’ve paid even the least attention to any political race in America beyond your own ward and precinct, you may well be aware that there is currently in Missouri an initiative to amend the state constitution so as to protect the rights of institutions to participate in research on both embryonic and adult stem cells, and the rights of Missouri residents to any therapies developed from such research. The initiative follows several years in which bills have been introduced in the legislature to ban research on embryonic stem cells, and to criminalize both such research and any resulting therapies. Those resolutions have failed each time, but the margins of victory have gotten slimmer each year.

The political interest of the initiative has been extended because both candidates in the election to the U. S. Senate have been connected with the intent of the initiative. State Auditor Claire McCaskill has supported the initiative and stem cell research, and Senator Jim Talent has opposed it. Each candidate has had celebrities and sports figures making commercials in support of the candidate’s position, and so in support of the candidate as the person to defend that position.

That political visibility did somewhat affect the debate on the resolution in Convention. Indeed, in it’s original language the first clause qualified “stem cell research, both embryonic and adult,” with the clause, “as described in Amendment 2 on the November 7 ballot in the state of Missouri….” The authors of the resolution believed that the specifics of the proposed amendment described some limitations on the sources for embryonic tissue that correlated well with a resolution passed in General Convention in 2003. Those who disapproved of the clause felt it tied the Diocese too closely to the political rhetoric current these days in Missouri. The campaigns, both for and against the initiative, and for and against each of the senatorial candidates, have become sufficiently nasty that few really wanted to be associated with it; and so the specific reference to the initiative was removed.

The debate did not neglect the predictable moral perspectives. Those positions were stated clearly and concisely, and, blessedly, not repeated endlessly or mindlessly (there’s little that exhausts me in a legislative debate like a series of “me, too!” statements that express emotion but offer no new insight). Two spoke to the belief that personhood does or might begin at fertilization, and requires respect in light of the sanctity of life. Two spoke to the belief that personhood is a process, and that the personhood of a person already born should exceed that of a cluster of 20-odd cells, and the opportunity to heal also demonstrates the sanctity of life. Those four statements, following on an educational session on Friday on the resolution and the issues, concisely summarized the moral issues.

There was also a certain amount of attention to the last clause of the resolution. For those who drafted the resolution, it was not sufficient to simply pass it. In a political atmosphere in which “Vote NO!” signs have been popping up like mushrooms in church yards across the state, they wanted to be sure that another Christian voice was heard, a Christian voice with a different Christian perspective. While there was some question about that clause, it wasn’t removed.

I was glad of that. On Thursday morning I was with a small gathering of Episcopal clergy of the Diocese of Kansas. I shared that this resolution would be introduced in our diocesan convention, and that I thought it would result in some debate. One of my younger colleagues questioned whether diocesan convention, or General Convention for that matter, should speak to such issues.

Those of you who have read my blog before will not be surprised that I disagreed vehemently. If we as the Body of Christ are to exercise prophetic ministry in the world, that must include commenting publicly on affairs of the world. I have said before that we lead our people poorly when we do not share with them opinions expressed in General Convention or diocesan conventions. As Episcopalians we cherish the belief that each of us works out our individual relationship within the parameters of the faith. We cherish the fact that such statements are not dogmatic, and are rarely doctrinal, so that people of differing perspectives on matters of faith and morals can live and work and worship together. At the same time, these legislative statements come closest to expressing the mind of the Church, whether of the province in General Convention, or of the diocese in diocesan convention. Even if for our people these statements are advisory and not mandatory, we cannot expect them to include them in their reflections on the faith if we do not share them. We cannot expect the world to distinguish us from our differing Christian siblings, or to see a different vision of finding life in Christ, if we do not share them with the world.

The Diocesan Convention of West Missouri is now on record in support of stem cell research, both embryonic and adult. We know that good Episcopalians may disagree. But as Diocesan Convention represents the people of the diocese through their elected representatives, we can have some confidence that this will represent the majority. And we know that those who have heard one perspective from Christians as if it were the only Christian perspective will have the opportunity to hear something different: a voice that looks at the same Scriptures, and in light of the moral tradition of the whole church, hears the possibility that God might call us to a different decision.

On the Internet Radio

I've been invited to be a guest on the internet radio show, "LANTERN OF THE SOUL " with Jari Holland Buck on The Progressive Radio Network . The online broadcast will be this Monday, October 30, at 9:00 a.m. EST/8:00 a.m. CST/6:00 a.m PST. It can be heard live, or later from the PRN Archives. The subject will be advocacy in health care chaplaincy. Folks can learn more about the show and host, and the network, at the PRN web site. If you're interested in the topic (or just in putting a voice with the picture) I hope you'll listen in.

Straying On Message

A news item first came to my attention during my drive home, which is to say it was reported on my local NPR station, KCUR. It seems that the Kansas City Star called for the campaign staff of Senator Jim Talent, who is in a close race for reelection against State Auditor Claire McCaskill, to withdraw certain television ads. It seems the ads took certain statements published in the Star and used them as if they were either editorial or reported statements of the Star. Reportedly, a similar misuse was made of an editorial statement from the St. Louis Post Dispatch.

Now, I had already seen the ads, and had made the assumption that this was in fact the case. Granted, I personally lean away from the positions of Senator Talent, something known to at least one member of his staff (an Episcopalian who is kind enough to receive emails when I want to express an opinion on an issue); but that wasn’t what made me suspicious of the ads. It was the lack of specific attributions. Earlier ads from the Talent campaign that quoted statements that were actual editorial or reported content from the paper had cited the specific date on which the statement was published. The new ads did not. They used the paper’s logo, but didn’t actually say when the alleged statements were published. (They also said, as required by law, that he had approved the ads – something I think he was ill-advised to do, but that, I suppose, remains to be seen.)

I was also inclined to distrust ads solely because they were political ads. I have come to distrust political ads in general. Sure, I think it’s better when there are specific citations. I note when a candidate makes statements of his or her own record. But I know that the latter are always a matter of putting one’s best foot forward.

So, I have come to see some things I’m seriously tired of, things that are objectionable enough any time, but are pandemic during the election season (which is, I suppose, all but the first six months after the election).

First, I have become tired of officials who “stay on message.” We don’t watch many political/talking head programs on television. (We do sometimes watch Meet the Press on NBC. We watch it specifically for Tim Russert’s technique of confronting guests with their own words.) I’ve largely given up on watching political debates on television. One reason is the determination of some politicians to “stay on message” – whether it answers the question or not. I have come to believe that those folks committed to staying on message, and those who advise them to do so, think we’re stupid. They think we’re so stupid that we won’t notice that the given response didn’t answer the question. They think we’re so stupid that we’re not capable of understanding thoughtful, nuanced response. They think we’re so stupid that we’ll somehow believe that repeated repetition makes true that which is false. (Perhaps I should be less upset about that. All too often it seems to work.) Why should I trust someone who thinks I’m stupid?

Second, I’ve become tired of negative ads, and especially of ad hominem attacks. The Talent ads descend to that, because the statements in question misused from the Star don’t actually speak to Claire McCaskill’s record in public office. Now, the campaign has also produced some ads that questioned whether the McCaskill’s record indicates she would be the best senator. I didn’t find them compelling, but I also didn’t think them beyond the pale. For one politician to look at another, point to an action taken, and argue that it was not the correct action may not be fun for the other, but it isn’t nasty. Even statements of malfeasance in office, if proven and therefore part of the public record, are fair game (although the politician running for election carrying that weight is blessedly rare). Is the other person actually a crook? Prove it from the public record, and it’s reasonable, if perhaps unpleasant. But personal attacks are not acceptable.

What would I rather see? I’m glad you asked. I do have some ideas.

First, I would like to limit the election season. I understand in the United Kingdom it’s limited to six weeks. I think that kind of limitation is a great idea, one that would save a great deal of energy and money. Any ads for specific candidates or specific parties for specific offices would have to fall within that time. Now, I don’t want to limit most political speech. I’d be willing to accept issue ads outside that time, as long as they didn’t advocate for or against a candidate or official – not even so much as “let [your representative here] know how you feel.” People who are so inclined already know they can do that.

Second, in those six weeks I don’t want any negative ads, even if based on an opponent’s record. Let the candidates speak of issues and platforms. I don’t want to hear them speak of or to one another.

Instead, I would like to see every candidate – every candidate – given half an hour in prime time, in a market determined by the office in question (so, a national broadcast for President, statewide for senator or governor, etc.). In that half hour the candidate could describe the situation as he or she sees it; the problems in the situation; the changes the candidate thinks should be made; and the candidate’s qualifications for making those changes. I don’t want to hear what an opponent or an opponent’s party has done wrong. I want to hear what the candidate thinks is right, and what the candidate has done in the past to suggest why I should trust this candidate to do it.

With that in place, I think we can dispense with “debates.” These media events are not debates in any real sense, and most of us know it. They are a capitulation to the “sound bite” addiction of broadcast media. They might appear to challenge candidates to think on their feet. In fact they simply become more opportunities for candidates to “stay on message,” spouting canned answers memorized over weeks of practice. They don’t educate the public, and they don’t show much education on the part of the candidates.

Now, as to political conventions: I don’t have a great problem with them. Why should I begrudge anyone participation in a party (and I don’t mean the political organization)? I do enjoy some real rhetoric on the rare occasion I hear it. I do wish they would speak during prime time when decent folk are awake enough to focus. But I’ve heard some great and moving speeches from the conventions; and if they can still provide a few they’ll be reasonably justified.

Now, there are other opinions I could share; but those are enough for one night. I would like to come to vote some year feeling like this was about platform and not about person; about serving the public, and not about winning my affection. I would like to come to vote some year with a feeling of excitement that is not undercut by relief that the media blitz will stop. I would like to come to vote some year when I wasn’t sorry I had a television or a radio or an answering machine. I would like to come to vote some year without feeling like I’ve been watching a food fight among toddlers armed with mud pies.

I will certainly vote this year. Not only is it my duty, it is my privilege; and those who don’t vote don’t have a right to complain. I will vote this year despite all that galls me in the process. But I will still hope that some year it will be better.

What If It's Nobody's Fault?

In my web surfing recently I ran into two stories from The Toronto Star on how medical errors are addressed in New Zealand. You can read an article from health care researchers here; and an article from a professional who’s practiced under the system here.

The point of the articles is that in New Zealand medical errors are adjudicated on a "no fault" basis. That is, if an error occurs and a suit is filed, the case is addressed on a "no fault" basis. Settlements are reached, or damages are awarded, but they do not include punitive damages. The articles do not speak specifically to compensatory damages - costs of care, lost wages, etc. But there are none of the large - some would say too large - awards that come from making an individual or a small group personally responsible.

In my own neighborhood, this is an issue that affects the care that people receive. I live in Missouri and work in Kansas, crossing the state line twice a day, and usually more. The laws regarding medical liability differ in Missouri and Kansas, and some physicians, especially in some high-risk specialties, have moved their practices from the Missouri to the Kansas side of the line. The reason cited most often is the difference in the cost of malpractice insurance; and the reason most often cited for high insurance rates is high damage awards. This has made it harder for some patients to reach the doctors they had been seeing. It has made it necessary for some to change hospitals; and since most of those decisions in the American context are driven by insurance plans, many have not been able to afford the change, and so have had to find new practitioners, selected from a smaller pool. Those physicians who haven't moved have had to raise their rates. And to in Missouri, as in many states, the hottest topic in health care, outside of election year issues, can be tort reform, the effort to change civil law procedures to shield physicians from massive legal and insurance expenses.

The authors of the two articles, writing for a Canadian audience, acknowledge that establishing a "no fault" standard for medical liability cases would be difficult to establish in Canada. My guess is it would be even harder in the United States. At the same time, it's not really a new thought. Within health care in recent years there have been great efforts to establish a "non-punitive culture." The point is to establish an environment in which a person making a mistake can admit to it without fear of being fired. The value of that is that mistakes will be reported rather than hidden, and so the necessary changes can be made. It includes recognition that people make mistakes within the context of a system, and often making changes to the system can reduce errors, sometimes greatly. That may mean new equipment or new procedures or new education for the employee. But, it's having the errors reported that makes it possible to take the corrective action.

And this is the most important benefit the authors of the articles cite for the New Zealand practice: practitioners admit to mistakes, and so corrections can be made. In addition, they report that settlements are reached faster and aren't swallowed up in legal fees. So, patients are offered a safer environment on the front end as mistakes are addressed and systems are reformed. And those who do suffer receive settlements more quickly. Practitioners also can be less defensive in their practice, and can establish better relationships with their patients.

Now, again, I don't know what it would take to establish this as a standard in the American context. We may blame "bad doctors" or "greedy lawyers" for the state of things. But, let's be honest: we cherish as a right the possibility of establishing blame and holding the person or persons responsible, and then insisting on being compensated far beyond simple restitution. We're quite ready to cry, "It was just a mistake!" if we make it, even if someone is harmed. We’re quite ready to cry, “Someone must pay!” if we’re hurt by someone else’s mistake. So, if I’m prepared to hold my suffering as priceless, how can I limit that right to others?

Moreover, we consider punitive damages a deterrent to bad practice. We trust that the vast majority of practitioners are always doing their best. At the same time, we want some incentive for all practitioners, and especially for careless, impaired, or untrustworthy practitioners, to focus and always do their best. We are in many ways a punitive society, distrusting until trust is earned. So, we want practitioners to have something to fear. We feel vulnerable, and we want them to feel vulnerable.

But in our efforts for a non-punitive workplace, we have not discarded those limitations that allow us to take dangerous practitioners out of practice. We make the assumption that the majority of practitioners are indeed intent on doing their best. We establish procedures for determining when errors are the result of systemic problems, and when they are truly malpractice, bad practice. I do not know the New Zealand system, and the authors do not speak to this specifically; but I would expect they do have procedures to do the same.

In health care we believe that a non-punitive workplace prevents errors, and so makes things safer for patients and for staff alike. According to these reports, the New Zealand legal system has applied this to all of health care, and not just to those facilities that incorporate it into their corporate culture. It would be worth watching. If it can make people safer and make compensation when necessary faster and more sure, and help reduce expenses for practitioners and patients alike, it would seem worth pursuing.

What Will We Give Up?

For several years earlier in my career I was the Episcopal Chaplain to Memphis State University. (Yes, I know it’s now the University of Memphis; but my wife, who graduated from Memphis State, insists on that designation, and says she knows of no “University of Memphis.” As it is, I grew up in East Tennessee, where we called it “Tiger High….”) I was the Chaplain at Barth House of the Diocese of West Tennessee. During the academic year I served students and faculty of the University. During the summer, I had a program to gather kids from Memphis who had gone away to school and were home for the summer.

One student I worked in the summer group I had known for several years. Before taking the campus position I had been Associate Rector and then Interim in his home parish. He had honored me by inviting me to participate when he became an Eagle Scout. He was a fine young man from a fine family.

One evening he and I were talking about jobs. He was working on a degree in engineering, and was considering his prospects when he graduated. In that context, he raised some concerns about affirmative action. “How is it fair for a less qualified candidate – even if only slightly less qualified – to get a job because of race or poverty or both? It’s not that I think black people should be discriminated against because they’re black. I just think qualifications for a job should be clear, and they’re not affected by someone’s race.”

Now, understand that I believed him. As best he could, he wanted to be just, and not to discriminate based on race or poverty. Still, I said to him, “You and I, upper middle class white males, have had advantages that we didn’t earn. Some of them came from parents who worked hard, but some of them came from just being upper middle class white males. We both know of folks who have had none of those advantages, and by dint of hard work they have become as qualified as, or perhaps only slightly less qualified than, you or I. You and I have had advantages, and they have had none. But there are only so many jobs. There is only so much room in the economy for them to rise, and that room is affected by advantages or lack of advantages that had nothing to do with work or merit. I believe that you want a just world. So, what are you willing to give up to offer an opportunity to someone else? How are you willing to fall toward the middle so that they can rise toward the middle?”

To give the young man credit, he didn’t argue. He didn’t even answer. He walked away quiet, and perhaps a little sad. I have long lost track of him; but I continue to believe that he continued to be a man of good will, who did indeed consider his answer, and to make decisions about his life based in good faith.

Still, I can’t think of the story of the rich young ruler without remembering that conversation. It makes concrete a story that we can often see as an abstraction. After all, in our day-to-day lives we don’t think of ourselves as rich. When pressed we acknowledge how much better off we are than the rest of the world. But just on a day-to-day level, we don’t think of ourselves as rich. There’s always a Gates or a Soros or a Buffett out there; and in contrast we can always say we’re not really rich.

But we say that knowing that we are – we are in fact rich. Oh, there’s always someone with more, unless you actually are a Gates or a Soros or a Buffett; but we know that in fact by the world’s terms we are rich. One of the aspects that we value of being part of a worldwide Church in a worldwide Communion is the awareness it offers of how our brothers and sisters in Christ fare in the rest of the world. And so we can learn what’s happening in Sudan or in the Episcopal Diocese of Haiti. We know that in fact by the terms of some even of our neighbors we are rich. I remember that wonderful quote from the musical, Finian’s Rainbow. Finian’s daughter asks him “In America are there are no ill fed or ill clothed or ill housed?” His answer: “Yes, there are. But they are the best ill fed and the best ill clothed and the best ill housed in the whole world.” And we know that in many cases that’s actually true.

Yet, even knowing that we’re rich, it’s hard to imagine giving it all up to follow Jesus, even for the promise of treasure in heaven. It’s so hard that the Church is troubled again and again by those who preach a “Prosperity Gospel:” God doesn’t want you to be poor, and if you’ll just trust God enough and contribute enough to my church, God will provide for your physical needs.” In places in Africa such churches are competing with Anglican churches. But this is not new. I remember well the ministry of the Rev. Ike, and this was his promise: that those who believed God would bless with material sufficiency. He’s still around: you can find his web site here.

But I stand by my question: what must I be willing to let go of for justice? How am I willing to fall so that another may rise? God’s grace may be sufficient, may be free and equally available to all. Unfortunately, in this fallen creation nothing else is. God may escape the “zero-sum” game, but we cannot. We’re reminded of that regularly by those who we elect to govern. Universal health care? “Sadly, there’s not enough money.” Truly well funded public education? “We don’t have the resources.” Childcare to help the working poor? “We have to set limits somewhere. The funds just aren’t available.”

And yet politicians continue to make promises, and some things do get funded; and heaven help the person in government who suggests we raise taxes to pay for other programs. It is the economic parallel of a war on terror that doesn’t need national service or increased taxes. Some want to tell us we can bring up the poor without having to give up anything ourselves, that we can give enough to others without having to lose any privileges ourselves. But in this fallen world, there just aren’t enough resources for that.

Jesus told a rich young man to sell it all and give it to the poor, and then to come and follow. He told the disciples that those with worldly wealth could only get into heaven by God’s grace, because the great had to become small – even as small as the eye of a needle. He said here and in many places that a better, more just life in this world would require not just our good wishes, but also our sacrifices; and not just sacrifices offered to God, but sacrifices offered to serve the least among us.

We Christians, we are the people who know that God’s grace is in truth sufficient. We are the people who know that we need not fear going through the eye of the needle, because it is not just possible but is promised by the God who loves us. That shouldn’t make us less concerned about losing what we have to benefit someone else. It should encourage us – literally, it should give us courage – to let go, to trust God, and lose something – some money, some privilege, some power – so that someone else might have more. After all, if God’s grace is sufficient, why do we need so much? If God’s grace is sufficient, why do live as is he who dies with the most toys wins? Jesus tell us he who dies with the most toys has no advantage, because it’s only by God’s grace that a rich man – or anybody, really – will get into heaven.

Jesus said to the rich man and says again and again to us, “What are you willing to give up, how are you willing to come down, so that another might come up?” Can we let it go and follow? Or will we also just walk away, sad?

Faith, Unity and Discipline

It came to my email address at work. I’m not sure how they got it, but they did get my email address, and they did send the invitation.

Specifically, the organization Lay Episcopalians for the Anglican Communion (LEAC) sent to me an invitation to “ ‘Best Ever’ For Survival of Robust U. S. Anglicanism,” a “U.S. Pan-Anglican Renewal and Restoration Conference” next month in Orlando. The theme for the conference is “One Christian Question for Episcopalians;” and the question seems to be, “Do you want to follow Christ, or do you want to stay in the Episcopal Church?” LEAC also has as a goal establishment of a new province of the Anglican Communion in North America to displace the Episcopal Church within the Communion, and there does seem to them to be a connection between staying with the Anglican Communion as they expect it to change and “following Christ.” That seems clear from their online brochure, which includes “Five Facts about our Church.” The first three are,

1. The American Episcopal Church has abandoned Christianity.
2. The Anglican Communion remains our Christian home.
3. LEAC Rises Up to preserve with you our Christian faith and values.

I won’t be attending, of course. Any regular or even cursory reader of this blog would recognize that I disagree with LEAC on a number of issues, not least in my belief that the Episcopal Church continues to follow Christ, and lives well within what has been the Anglican Communion. And certainly I don’t agree with their goal, stated in the cover letter of the invitation, of a “NEW PROVINCE: Together, we can partner with many others to strengthen our church as the Communion moves to charter a new American province.” This reflects their assertion earlier in the same letter, “Credible leaders on all sides insist that reconciliation is now impossible, that schism has occurred and soon will be formalized. Lay Episcopalians for the Anglican Communion (LEAC) has risen up as a catalyst for the survival of a strong Anglican presence, not a small remnant, when TEC leaves officially.” To prepare for that, “Cadres trained in Orlando will carry educational models and strategies to the “Middle 80%” in their own and other churches.”

In light of that, I was struck by a statement in the same letter, “Four bishops will be among a faculty of 20 successful “doers.”” Now, that got my attention, and was the primary reason I actually looked at the brochure on line. There are indeed four bishops named. One is from the Anglican Province of America, and another retired from the Anglican Mission in America. Their presence is not of concern to me. They have neither responsibility nor accountability to the Episcopal Church (although arguably the AMiA bishop did at one time).

However, I also noted the participation of the Rt. Rev. Keith Ackerman of the Diocese of Quincy and the Rt. Rev. Peter Beckwith of the Diocese of Springfield. Now, these two do indeed have responsibility and accountability to the Episcopal Church. These are active members of the House of Bishops and ordinaries in their dioceses. I have to wonder about their participation in this conference, the clear intent of which is to disassemble the Episcopal Church.

Recently there has been a great deal of interest in the Diocese of San Joaquin, and its bishop the Rt. Rev. John-David Schofield. Other bishops in California asked whether there were grounds for a presentment against Bishop Schofield for abandonment of communion based on actions of the Diocesan Convention. The appropriate committee of the House of Bishops determined that a presentment was not appropriate (and almost immediately after that it was learned that the Diocesan Convention had gone even further). My own thought on that was that while the Convention of San Joaquin had acted and Bishop Schofield had presumably approved, Bishop Schofield had himself not acted on the Diocesan Convention decisions in a way that definitively left the Episcopal Church. This is not to suggest that I could agree with him or with that Diocesan Convention. It simply acknowledges that there cannot be action based on what we think someone might think.

But, it seems to me that Bishop Ackerman and Bishop Beckwith are taking action. They are participating in a conference the purpose of which is to train and empower “cadres” to take back to the “Middle 80%” within the Episcopal Church, so as to lead them out of the Episcopal Church. Both were ordained bishop according to the Book of Common Prayer (1979), and in their ordinations committed to “solemnly engage to conform to the doctrine, discipline, and worship of the Episcopal Church.” (BCP p. 513) Both committed to “guard the faith, unity, and discipline of the Church.” (BCP p. 518) But, how are unity and discipline and even faith guarded by “cadres” sent out to parishes to lead away the “middle 80%?” How is unity, discipline, or even faith guarded when two bishops participate in training and empowering those cadres for that purpose? These bishops are not simply agreeing with an action of a diocesan convention, however unfortunate it might be. They are choosing actively to participate with those who want to tear the Episcopal Church apart. LEAC isn’t simply interested in being there when dissatisfied Episcopalians leave. LEAC wants to lead them out; and it appears these two bishops want to lead with them.

Now, I have no doubt that these two men believe that their action is necessary for their integrity. Perhaps they do not feel they can defend the faith as it has been understood by the General Convention, and by, I believe, the majority of the Episcopal Church, including that “middle 80%.” In that case, they could honorably and in good faith put the affairs of their dioceses in order and retire or resign. Once out of office, each could consider how he should continue to find his ministry within the larger Body of Christ. Such action would be unfortunate, but it would establish and not impugn anyone’s commitment and integrity. On the other hand, participating in leadership in LEAC seems a clear step to damage the discipline and unity and even faith of the Episcopal Church, and not simply in their own dioceses.

I have written elsewhere on the limitation we face when we speak of ordaining bishops for “the whole Church.” The commitments I made as a priest I made to and within the Episcopal Church, however I might see the Episcopal Church within the larger context of the Body of Christ. Those commitments are institutionally meaningful, whether or not I want to see them as theologically meaningful beyond the limits of the Episcopal Church. If I don’t meet those commitments, it is the Episcopal Church, and not the Anglican Communion, that holds me accountable. The same is true of every member of the House of Bishops. If one bishop can be investigated for agreeing to possibly damaging decisions within a diocesan convention, can two be investigated for specific actions that support specific attacks on the integrity of the Episcopal Church?

What General Convention Did (and Didn't Do): Abortion

I’ve written a number of posts about what the 75th General Convention did. However, there were many things that General Convention started and didn’t finish (such as my own resolution on issues at the end of life); and a number that were not addressed at all.

Two such resolutions caught my attention. They were resolution 2006-C048 from the Diocese of Tennessee; and 2006-D063 from the Rev. Lorne Coyle of the Diocese of Central Florida. As the longer text, let me quote from D063:

Resolved, the House of _____ concurring, That the 75th General Convention rescinds the Executive Council’s January 2006 decision to join the Religious Coalition for Reproductive Choice and re-affirms its 1994 Resolution A054 that includes the statement “We emphatically oppose abortion as a means of birth control, family planning, sex selection, or any reason of mere convenience.”

C048 only disagrees by failing to include any reference to previous actions of General Convention.

Now, I wasn’t aware that the Episcopal Church was a member of the Religious Coalition for Reproductive Choice (RCRC). However, on January 12 of this year the Executive Council did indeed approve a motion from the National Concerns Committee to approve membership in RCRC. It’s reported in this release from the Episcopal News Service.

These two resolutions were in response to this action of the Executive Council. However, neither was reported out of legislative Committee, and so neither was considered by the General Convention.

Now, in any General Convention many resolutions don’t make it through, or even to the floor of either house. There are just too many proposed, and too much discussion on some for all to get considered. This year, with the responses to the Windsor Report on the agenda, I think that was even more true than usual. I’ve referred to a number of resolutions “getting Windsored.”

At the same time, membership in RCRC is in keeping with previous resolutions of General Convention on abortion. Two resolutions have spoken most completely to this issue.

The first was 1988-C047. That resolution reads as follows:

Resolved, the House of Deputies concurring, That the 69th General Convention adopt the following statement on childbirth and abortion:

All human life is sacred. Hence, it is sacred from its inception until death. The Church takes seriously its obligation to help form the consciences of its members concerning this sacredness. Human life, therefore, should be initiated only advisedly and in full accord with this understanding of the power to conceive and give birth which is bestowed by God.

It is the responsibility of our congregations to assist their members in becoming informed concerning the spiritual, physiological and psychological aspects of sex and sexuality.

The Book of Common Prayer affirms that "the birth of a child is a joyous and solemn occasion in the life of a family. It is also an occasion for rejoicing in the Christian community" (p 440). As Christians we also affirm responsible family planning.

We regard all abortion as having a tragic dimension, calling for the concern and compassion of all the Christian community.

While we acknowledge that in this country it is the legal right of every woman to have a medically safe abortion, as Christians we believe strongly that if this right is exercised, it should be used only in extreme situations. We emphatically oppose abortion as a means of birth control, family planning, sex selection, or any reason of mere convenience.

In those cases where an abortion is being considered, members of this Church are urged to seek the dictates of their consciences in prayer, to seek the advice and counsel of members of the Christian community and where appropriate the sacramental life of this Church.

Whenever members of this Church are consulted with regard to a problem pregnancy, they are to explore, with grave seriousness, with the person or persons seeking advice and counsel, as alternatives to abortion, other positive courses of action, including, but not limited to, the following possibilities: the parents raising the child; another family member raising the child; making the child available for adoption.

It is the responsibility of members of this Church, especially the clergy, to become aware of local agencies and resources which will assist those faced with problem pregnancies.

We believe that legislation concerning abortions will not address the root of the problem. We therefore express our deep conviction that any proposed legislation on the part of national or state governments regarding abortions must take special care to see that individual conscience is respected, and that the responsibility of individuals to reach informed decisions in this matter is acknowledged and honored.

This resolution was reaffirmed in toto in resolution 1994-A054, which also added this clause:

Resolved, That this 71st General Convention of the Episcopal Church express its unequivocal opposition to any legislative, executive or judicial action on the part of local, state or national governments that abridges the right of a woman to reach an informed decision about the termination of pregnancy or that would limit the access of a woman to safe means of acting on her decision.

These are really quite balanced statements, acknowledging responsibility for family planning, the “tragic dimension” of abortion, the inadequacy of legislation as a means to resolve this issue, and the importance of a woman’s freedom to make an informed decision regarding a pregnancy, with the support and informed counsel of the Christian community. We oppose abortion when it is undertaken casually, or for “any reason of mere convenience,” even as we also oppose actions of government to “abridge the right of a woman to make an informed decision… or would limit the access of a woman to safe means….”

With more time, the 2006 resolutions might have made it out of committee. At the same time, I don’t believe they would have passed. We have said that in the context of difficult moral decisions individual conscience and choice must be protected. In these times when that moral freedom seems under attack in so many arenas, and not least in legislatures and courts, the Religious Coalition for Reproductive Choice seems good company to be in.

The Voice of a Chaplain

Of the various predictable questions that plague chaplains, this one causes perhaps the most annoyance, or at least tired sadness: “So, would you ever consider returning to the ministry?” The point of the question is to ask whether we might consider congregational ministry. And while I continue to uphold the position that the normative experience of the believer is the congregation, and so the normative minister is the minister in the congregation, I get as tired as most at the suggestion that my ministry is not real ministry at all.

Thus, I was pleased to hear this evening during my evening commute the voice of a colleague. The voice was that of Susan Cosio, a chaplain at Sutter Medical Center in Sacramento, California. The venue was her essay in the “This I Believe” series on “All Things Considered” on National Public Radio (NPR). You can hear her essay or read the text here. I encourage you to do so.