Friday, December 28, 2007

Reframing (with the Stones in Mind)

Well, I knew it had to happen sooner or later. Indeed, I’m surprised it hasn’t happened sooner.

Outside the Chapel in my hospital, there is a Prayer Box mounted on the wall. Small sheets and a pen are provided, and people leave prayers there. They are collected regularly, and become part of both services and my own daily prayers.

Human beings being who and as we are, I was not terribly surprised, or even terribly disturbed, when I took out this “prayer request:” “I need to get laid.”

Well, there it was. In several years with the box in place, that was actually the first really inappropriate request. Oh, I’ve had illegible scrawls from children (and, I think, not a few adults), with only a name or two readable. But, I’ve not had this one, nor any like it.

I thought about what to do. The person who wrote it obviously needed prayer, if perhaps not what was specifically requested. So, I simply reframed the request. Humming faintly, “You can’t always get what you want,” I wrote below the request, “Prayer for healthy, wholesome relationships as God would wish.”

Now, while I don’t know, I imagine the reaction of the original requester would be negative. Believing as I do that God does answer prayer, I imagine this person will have opportunities for grace-filled relationships – relationships that may not result in “getting laid.” Still, I’m called to pray for God’s will for the person, and not simply the requester’s own. And in that light, I think I reframed it properly. Now, it would be interesting to see how God takes care of this one.

Thursday, December 27, 2007

GAFCON: the New ACC?

The Anglican news sites and blog sites are all excited about a meeting to take place in June called the Global Anglican Futures Conference, or GAFCON. You can, of course, read comments at all the usual suspects.

Since GAFCON is to take place in June of next year, prior to the Lambeth Conference, the question most kicked about is whether GAFCON is “an alternate Lambeth Conference.”

Perhaps the best response to this is in an article posted on line by Peter Jensen, Archbishop of Sydney in the Anglican Church of Australia. He is on the Planning Committee, and He addresses the question directly, and lists several reasons that in fact

The Anglican Future Conference is not designed to take the place of Lambeth. Some people may well choose to go to both. Its aim is to draw Biblical Anglican Christians together for urgent consultation. It is not a consultation which can take place at Lambeth, because Lambeth has a different agenda and far wider guest list. Unlike Lambeth, the Future Conference is not for Bishops alone – the invitations will go to clergy and lay people also. But it is a meeting which accepts the current reality of a Communion in disarray over fundamental issues of the gospel and biblical authority. It therefore seeks to plan for a future in which Anglican Christians world-wide will increasingly be pressured to depart from the biblical norms of behaviour and belief. It gives an opportunity for many to draw together to strengthen each other over the issue of biblical authority and interpretation and gospel mission.

So, GAFCON is more limited in interests and invitations than Lambeth. It incorporates lay and non-bishop clergy. Most important, its purpose is not simply consultation, but to develop a plan for the future.

I’m not surprised, really, that those involved in this wouldn’t have an alternate Lambeth. As this makes clear, they wouldn’t want one. They’re not interested in simply talking. They want to make decisions. They want to make plans. They have accepted that, 1998 notwithstanding, planning and decision-making have not been the purpose of past Lambeth Conferences, and will not be the agenda of the next one. So, while some participants may attend both GAFCON and Lambeth, that’s hardly the point of this.

So, what are they doing? They’re establishing an alternative Anglican Consultative Council. Consider their purposes in light of the description of the work of the ACC on the Anglican Communion website:

The role of the Anglican Consultative Council (ACC) is to facilitate the co-operative work of the churches of the Anglican Communion, exchange information between the Provinces and churches, and help to co-ordinate common action. It advises on the organisation and structures of the Communion, and seeks to develop common policies with respect to the world mission of the Church, including ecumenical matters. The ACC membership includes from one to three persons from each province. Where there are three members, there is a bishop, a priest and a lay person. Where fewer members are appointed, preference is given to lay membership.

So, here are the important elements GAFCON replaces: facilitating cooperative work, coordinating common action, and developing common policies.

This is actually quite an interesting development. Recall that there are four institutions that have been designated “instruments of communion:” the office of the Archbishop of Canterbury; the Lambeth Conference; the ACC; and the Primates Meeting. Note, too, that the only “instrument of communion” with structures outside Lambeth Palace is the ACC. Both Lambeth Conferences and Primates Meetings are at the invitation of and under the presidency of the Archbishop of Canterbury. While they have been dependable, any given Archbishop could simply decide not to hold a meeting. The ACC, on the other hand, the presidency of the Archbishop notwithstanding, has a Constitution and its own defined structure.

In addition, it is the only “instrument of communion” with an independent means of defining membership. Again, participation in Lambeth Conferences and Primates Meetings are at the invitation of Canterbury; and so membership is, essentially, dependent on the Archbishop. We’ve seen that in preparation for this Lambeth Conference. The bishops of the Episcopal Diocese of New Hampshire and the Central African diocese of Harare are not invited, nor are bishops of CANA or AMiA (I’m not suggesting any “moral equivalence” here; only the institutional equivalence: they are equally not invited). The ACC, on the other hand, has provisions in its Constitution for both adding and removing representation of member provinces, provisions that are not dependent on the sole decision of Canterbury.

Unfortunately, these folks from the Global South and their fellow travelers have seen that they have not been able to sway any of the “instruments of communion” to their agenda. The Archbishop of Canterbury is determined to keep everyone possible in the conversation, without pressing for resolution. Thus, he invited almost everyone to Lambeth, excluding only those arguably most problematic. He supported a planning committee that insured an agenda that would be limited to conversation and consultation, and not allow for decisions or conclusions. Even without voting participation by the Americans and the Canadians, the most recent Anglican Consultative Council could be induced to bring strong sanctions against the American and Canadian churches. Finally, even the Primates Meetings could not be swayed, as was best seen by the recent responses to Canterbury regarding reactions to the New Orleans meeting of the Episcopal House of Bishops. Those reactions were seriously evenly divided, with perhaps a slight plurality accepting the American bishops’ statements.

So, perhaps this is the alternative they are seeking: an alternative ACC. It would provide the control of agenda and decision that they could not have in Lambeth. It would allow a remarkably like-minded community to plan for future cooperative actions. It will allow them to establish and proclaim resolution, and get on with mission.

Of course, if they start replacing an instrument of communion – any instrument of communion – what sort of commitment can we expect them to show to the Communion itself? And if they’re replacing one instrument of communion, can replacing the rest be far behind?

Thursday, December 20, 2007

Latest Again at Episcopal Cafe

Once again, I have a new post up at Episcopal Cafe. I hope you'll take a look at it, and that you'll enjoy it. I hope you'll also look at the postings by my colleagues there. There's a lot there to read, reflect on, and enjoy.

Tuesday, December 18, 2007

One of Those Difficult Conversations

I heard this week one of those conversations I’ve heard any number of times before. It goes something like this:

“The doctor has said that the person you love is ready to be discharged to another institution for (long term care, or skilled nursing). We’re planning for the discharge tomorrow.

“But, we haven’t had time yet to find just the right place. We have three appointments today, but we can’t possibly be ready tomorrow!”

“Well, we’re not really doing the person you love any good here that can’t be done there. Insurance won’t pay for the additional time in the hospital.”

“I knew it! It’s about the money, isn’t it? That’s how hospitals are: they’re just interested in the money!”

The only thing that makes that worse for me personally is when I’ve worked with the patient and family involved, and I get a phone call that begins, “Chaplain, can you get the social worker off our back?”

I go back and forth about those circumstances. I understand all too well the factors that get us into them. Unfortunately, patients and families seem not to, or at least seem to think those factors don’t apply.

The circumstances, really, are pretty straightforward. Medicare, Medicaid, and commercial insurance companies by and large don’t really receive your bill, figure appropriate percentages, compute how this affects your deductible, and send the hospital a check. There are some folks who still have that kind of insurance, but they’ve been fewer and fewer over the years.

Instead, Medicare and Medicaid certainly, and commercial insurance and HMO plans of many patients, commit to a fixed amount. For Medicare it’s by procedure: they determine what they think that colonoscopy and all its expenses ought to cost in your neighborhood, and then commit to pay a percentage, based on what they think it ought to cost (whether it actually does or not). They call those “diagnosis related groups,” or DRG’s. If the procedure can be done at lower costs, or the patient can be discharged a day earlier, the institution gets to keep the difference. If the procedure costs more, or the patient needs another day, even if it’s because of legitimate needs of the individual patients, the institution eats the costs. Politicians and administrators hope that this will encourage institutions and providers to be more efficient, and to find new, more effective ways of treating patients more quickly. Providers and institutions just hope all the time that a few patients who receive more care because they need it won’t ruin the institution’s margin for the year.

For HMO’s and for some work-base insurance plans the fixed amount is simply a flat rate per person. It’s called “capitated care,” which literally means, “so much per head.” Once again, the numbers aren’t based on actual expenses, but on what someone things the expenses should be. The results are the same. It’s good if the institution or provider can reduce costs of care. It’s hard on the institution or provider if the person needs more care and more time.

In any case, insurers, whether from government or from the private sector, negotiate limitations of what they’ll pay for a given patient or for a given condition or procedure. At some point, they don’t pay any more. Unfortunately, it may have little to do with what the patients need, and therefore what the expenses actually are for the patient’s care. That point comes when the patient gets enough better to not need hospital care – as determined, not much by the doctor and certainly not by the patient, but by the standards of the insurer. The difference costs the institution or the provider; and in the best tradition of American business practices, those costs get passed on to the patient.

So, sometimes I have the thought that we should simply tell folks: “Your loved one is well enough not to need hospital care. This care can be given in a nursing home or a skilled nursing center. If you’re not ready for the transfer, we won’t ask you to leave, but we need to tell you that the expenses won’t be paid by the insurer. They’ll come to the patient. And they’ll cost you a lot more.” It’s simple and straightforward, and it gets past the anxiety that someone’s trying to discharge a patient too soon.

At the same time, we can’t do that. First and foremost, we may have another patient who need the room, and who legitimately needs hospital care. Allowing the less sick patient to stay means the more sick patient doesn’t get the necessary care. And we can’t make exceptions for a reason we’ve all understood since elementary school: if we are willing to make an exception for one, we have to be prepared to make exceptions for all.

Second, while it’s not “all about the money,” we do have to take money seriously. If we simply let the money slide, and we go out of business, many people don’t get care. Now, my hospital is in a suburb in a large metropolitan area; and some might want to say, “Well, then, I’ll just go to another hospital.” But, another hospital won’t have the capacity to take all the patients of another hospital; indeed, even all the hospitals in a given metropolitan area might not be able to absorb the new patients. And, of course, those patients will still face the same economic issues.

Finally, it’s important to remember that a hospital is not a hotel. Hospitals don’t exist to provide patients what they want; they exist to provide patients what they need. Now, within the parameters of “what they need,” we do our best to provide “what they want,” both because it’s good care and because it’s good business. But, that category of “what they need” can set some hard and fast limits. For example, we’re not going to bring that much-loved burger to the patient who can’t swallow. We’re not going to provide anyone with cigarettes. With all that we do to make them comfortable, attractive, and amenable, hospitals still exist first and foremost to give medical care, and not to cater to any request that might come.

Would universal access to health care make a difference in that? It might, depending on how it was structured. But in our culture, and for the near future, that’s a matter of hope, and not of promise. And even then, there will be limits to respect regarding the most appropriate care and the most appropriate patients, and the most appropriate use of limited facilities.

So, for the foreseeable future we will be facing these difficult conversations. We’ll keep doing our best to care for families, and to help them make transitions from one level of care to another. And we’ll keep smiling, and do our best to help them, even when they say, “See? It’s all about the money.”

Monday, December 17, 2007

An Intersection of Faith and Medicine

Let me call to your attention this story in American Medical News about physicians expressing their religious ministries in and through medical practice (and thanks for Episcopal Life for pointing to it). It would be worthy of attention even if one of the physicians in the article were not an Episcopal priest.

The article begins, "Anecdotal reports suggest that there are several hundred physicians who are both religious leaders and medical doctors. They see a connection between the physical world of medicine and the spiritual world of faith, a perspective that can cross into the exam room." My own "anecdotal evidence" would suggest that there are several hundred just within the Episcopal Church. Off the top of my head I'm aware of four just in my own diocese.

And, the article identifies "religious leaders" with ordination or the equivalent. If we were to include physicians in lay leadership, the numbers would go much higher. And then there are the other health care professionals - but, then, they wouldn't be part of the focus of American Medical News, with physicians as the target audience.

In any case, we need to give thanks for all those physicians, and other health care providers, who express their religious ministries in their medical and health care practices. They incarnate the love and compassion of Christ, and the concerns of Christ's Body, in times and places of great suffering.

Sunday, December 16, 2007

Is the Episcopal Church "Episcopal" Enough? (Amended)

Amended 12/19.

The Archbishop of Canterbury has issued his Advent Letter to the Primates. We’ve all been waiting for this. It has been expected that this would include his response both to the New Orleans statement of the Episcopal House of Bishops, and to the reactions of the various provinces of the Communion to the New Orleans statement. It does include those, and is worth the close reading it requires. As you might expect, there are already many reactions out there in the blogosphere. You can check out the usual suspects.

I have a number of concerns about it myself, and you can read an initial response here. However, there are additional concerns it raises for me.

On section in particular caught my attention:

A somewhat complicating factor in the New Orleans statement has been the provision that any kind of moratorium is in place until General Convention provides otherwise. Since the matters at issue are those in which the bishops have a decisive voice as a House of Bishops in General Convention, puzzlement has been expressed as to why the House should apparently bind itself to future direction from the Convention. If that is indeed what this means, it is in itself a decision of some significance. It raises a major ecclesiological issue, not about some sort of autocratic episcopal privilege but about the understanding in The Episcopal Church of the distinctive charism of bishops as an order and their responsibility for sustaining doctrinal standards. Once again, there seems to be a gap between what some in The Episcopal Church understand about the ministry of bishops and what is held elsewhere in the Communion, and this needs to be addressed.

This is for me an interesting paragraph, in that it raises a very interesting question: does the Archbishop of Canterbury believe that the Episcopal Church is not sufficiently “Episcopal?” That is, are we sufficiently “bishop-led,” which is, after all, what “episcopal” means? Does he believe that our bishops are not “bishops enough?” That they are not sufficiently independent within the Episcopal Church?

There are two places, really, to examine the ministry of a bishop, and both are in the Book of Common Prayer. (Interestingly enough, the Constitution and Canons of the Church say very little about the ministry of a Bishop, beyond certain institutional and administrative functions.) The first is the rite itself of Ordination of a Bishop. In that rite there is this description of the office of Bishop:

My brother, the people have chosen you and have affirmed their trust in you by acclaiming your election. A bishop in God’s holy Church is called to be one with the apostles in proclaiming Christ's resurrection and interpreting the Gospel, and to testify to Christ’s sovereignty as Lord of lords and King of kings.

You are called to guard the faith, unity, and discipline of the Church; to celebrate and to provide for the administration of the sacraments of the New Covenant; to ordain priests and deacons and to join in ordaining bishops; and to be in all things a faithful pastor and wholesome example for the entire flock of Christ.

With your fellow bishops you will share in the leadership of the Church throughout the world. Your heritage is the faith of patriarchs, prophets, apostles, and martyrs, and those of every generation who have looked to God in hope. Your joy will be to follow him who came, not to be served, but to serve, and to give his life a ransom for many.

After the description, there is a series of questions. To each the bishop-elect is to answer with some variation of “I will with God’s help.:”

Will you accept this call and fulfill this trust in obedience to Christ?

Will you be faithful in prayer, and in the study of Holy Scripture, that you may have the mind of Christ?

Will you boldly proclaim and interpret the Gospel of Christ, enlightening the minds and stirring up the conscience of your people?

As a chief priest and pastor, will you encourage and support all baptized people in their gifts and ministries, nourish them from the riches of God’s grace, pray for them without ceasing, and celebrate with them the sacraments of our redemption?

Will you guard the faith, unity, and discipline of the Church of God?

Will you share with your fellow bishops in the government of the whole Church; will you sustain your fellow presbyters and take counsel with them; will you guide and strengthen the deacons and all others who minister in the Church?

Will you be merciful to all, show compassion to the poor and strangers, and defend those who have no helper?

This description and these questions are the most complete description within the Prayer Book of the office and ministry of a bishop. My question for Archbishop Williams would be, are these so different from the description and commitments of bishops in any other province of the Communion? One can look, for example, at the parallel texts in Common Worship in the Church of England. There are differences, certainly; but none that seem to address the “authority” of a bishop. Bishops in both churches undertake the same responsibilities.

Another, albeit briefer, description is in the Outline of the Faith, or Catechism, in the Book of Common Prayer. In catechetical style, it is given this way:

Q. What is the ministry of a bishop?
A. The ministry of a bishop is to represent Christ and his Church, particularly as apostle, chief priest, and pastor of a diocese; to guard the faith, unity, and discipline of the whole Church; to proclaim the Word of God; to act in Christ’s name for the reconciliation of the world and the building up of the Church; and to ordain others to continue Christ’s ministry.

That seems a more succinct, but certainly consistent description of the ministry of a bishop. It reflects the same responsibilities described in the rite of Ordination.

So, it would be incumbent for the Archbishop to say in what sense this understanding of the office and ministry of a bishop is deficient. He has suggested that there might be “a major ecclesiological issue.” He needs to be more specific as to what he believes is the issue.

But, honestly, we know his issue is not in the office and ministry of a bishop of the Episcopal Church, but rather in the exercise of that ministry. We all recognize, I think, the differences in the exercise of that office between the Episcopal Church and, say, the Church of Nigeria – Anglican. However, we need once again to reflect on how much that is a result of the “local adaptation” of the episcopate as understood in the Chicago-Lambeth Quadrilateral. Do the differences between those local adaptations really rise to the level of “a major ecclesiological issue?” If so, then we need to consider as well differences involved in, say, Australia, where Sydney and the rest of Australia seem to operate as two different churches; or the differences in the unified Churches of North and South India. Surely these “local adaptations” might also cause some concern; and if not, why do those with the Episcopal Church rise to this, and not those others?

If it is about the exercise of the office and ministry, and about “insufficient” independence of Episcopal bishops, how is that to be distinguished from expectation of an autocratic episcopate? Can he or any of the bishops in the Church of England speak so independently of the General Synod, or make commitments that the next General Synod cannot alter? Are the Synods of Canada so different?

I would agree with Archbishop Williams that one of the major issues in current Anglican troubles involves the roles and ministries of bishops, and especially of primates, those primi inter pares. The Archbishop certainly highlights the issue in this paragraph. What is not clear, although it may be implied, is how he thinks that part of the issue should be resolved; and his implication seems to be that resolution would be easier if it could just be settled in councils of bishops (not unlike the Roman model). Perhaps that could be done without “some sort of autocratic episcopal privilege,” but the Romans haven’t done so well on that score; and if a frog had wings, it wouldn’t thump its tail so much, either.

Addemdum: In light of this discussion and comments, folks might want to read the opinion expressed here, or the summary available here, on the limitations of, among others, the House of Bishops. It was prepared by Sally Johnson, Chancellor to the President of the House of Deputies, Bonnie Anderson; and it is certainly relevant to this discussion.

Tuesday, December 11, 2007

Caught by a New Word

I’m not exactly how it came across my desk, but come across it did. “It” was the November, 2007, issue of Charisma. Charisma is a magazine that from its content reflects the life of the Pentecostal churches in the United States. I certainly found a number of the articles interesting.

The one that caught my attention, though, was “Hope for the Wounded Soul,” by Elizabeth Moll Stalcup. The article is about an approach to pastoral counseling called Theophostic Prayer Ministry. If I hadn’t been intrigued by another article on pastoral counseling, that word “Theophostic” certainly did.

You can read the article on line to get some sense of the history of this process. You can look at the TPM web site for detailed information, but in the article is a brief description of the process:

Typical TPM sessions begin by discussing the current situation, but the goal is not problem-solving as in traditional therapy, but rather helping the person connect with what he is feeling. After his current emotions are identified, the recipient is asked to let his mind connect with any memory that matches the present emotions.

Not all memories are traumatic. In fact, people often express surprise when they realize how much they have been negatively impacted by lies stemming from old, seemingly minor memories. The TPM facilitator is not to interpret the memory, express his opinion, diagnose the condition or make assumptions about what might have happened.

Instead, he encourages the person seeking healing to search his memories to determine his own beliefs. The facilitator asks questions such as, "What does that little girl believe is causing the pain?" "What do you believe will happen if you let yourself feel that?" to help the person identify what he believes in the memory.

After the core lie is identified, the facilitator asks the person if he is willing to hear what Jesus has to say. If he is, the facilitator will pray and ask Jesus to speak into the situation. Some people get mental pictures or words from God, while others just get a sense of what is true.

Now, when I read the description in the context of the article, I had a feeling I couldn’t shake that this was all somehow familiar. It took me a while, and then the connections began to come.

First, recognizing that feelings about current events may well reflect or be reinforced by similar feelings from past events is well established in counseling practice. A number of therapeutic practices include this sort of review for insight. Exploring the memory to understand the events, and especially the feelings involved, is common in many ways of supporting people.

In this case, the process begins to look a lot like an Ignation spiritual exercise. The counselor isn’t to tell the person how to interpret the event. Instead, the minister asks the person served how he or she remembers and interprets the event, and what feelings are involved. As the person served gets insight into the earlier experience, the minister invites the person to hear what Jesus might say to the person in or about that memory. This is much like the experience of entering into a story from the Gospels, imagining oneself in the story, to experience the feelings of the story and to hear what Jesus says in that story. (I’m not saying it is an Ignation exercise; only that they have some aspects in common.)

The hope is that the person served will hear a message from Jesus (whether in words or feelings) that will bring a new perspective to the memory, something that addresses the “core lie” that has held the person served in bondage to the memory. That sounds an awful lot like “reframing,” providing a new perspective on the situation that has provoked so much emotional energy.

So, I recognized that sense of familiarity. To help a person, a minister supports that person in finding insight on past events, supports that person in reflecting on those events in a manner similar to an Ignation exercise, with the hope that the experience will help the person reframe the past events and so better understand both past and current events. Again, I’m not saying that mine is an accurate description of Theophostic Prayer Ministry; only that those were the similarities or parallels that I saw in reading the articles.

At the same time, I would never suggest that Jesus couldn’t provide individuals with meaningful reframing. I’ve seen this sort of thing happen many times. As a chaplain, I’m quite inclined to see this as an act of God’s grace, whether explicitly labeled or not.

I don’t practice TPM, and I’m not endorsing it. There are certainly a number of web sites and publications arguing that in fact TPM is dangerous (try here or here) - although from my admittedly cursory review, they seem more concerned that it’s theologically dangerous than that it’s therapeutically dangerous. And, on the point of being therapeutically dangerous, it certainly seems as open to abuse as any other counseling modality.

But, how could I look at such a word as “theophostic,” and not want to see what it’s about?

Friday, December 07, 2007

Spiritual Care in Disasters: Recent Resources

I want to commend to your attention the September edition of the Southern Medical Journal. That edition has series of articles on emotional and spiritual needs of victims of disasters. (Your local reference librarian can help you. If you have access to a hospital or academic library, so much the better.)

The articles are a part of the Southern Medical Journal’s Spirituality/Medicine Interface Project. They begin with an introduction to the articles by Dr. Harold Koenig. He notes that, “As used here, spirituality involves religious beliefs, practices, and traditions, but also more broadly includes a search for the sacred, ultimate truth, or ultimate reality.” He clarifies that, while a traumatic event for an individual is a "disaster," these articles focus on community-wide catastrophes.

The purpose of these articles is to prepare physicians to address the unique emotional, social, and spiritual needs of survivors and of their families, of rescue workers, and of the treating physicians themselves. Besides generally preparing physicians to meet the medical and psychological needs of survivors, this issue will help to increase awareness of the spiritual needs of these potential patients, to learn how to sensitively identify those needs, and to determine when and whom to refer. The role that religion and spirituality play in helping survivors cope with the trauma of disasters is often quite significant. The ultimate result, we hope, will be a nation that is more resilient during times of catastrophe.

The articles are written for physicians, but are brief and very readable. Topics include things learned from Katrina at home and tsunamis abroad; spiritual needs of physicians in disasters; Jewish, Muslim, and Buddhist responses in disasters; and the work in disasters of chaplains and congregational clergy.

I took the time to review “Spiritual Needs of Physicians During and Following a Catastrophe,” by Walter L. Larimore, MD, Mitchell W. Duininck, MD, and Col. Gary B. Morsch, MD, MPH. The authors describe common spiritual reactions to catastrophe, and emphasizes that physicians providing care in such situations are as vulnerable to them as are those they serve. They note that, “There has been very little written about the spiritual needs of physicians in general, and nothing dealing with the needs that arise when a physician has to deal with a catastrophic situation.” They discuss resources for physicians for spiritual care. They emphasize self care, and suggest several means. Finally, they call for further research on the spiritual needs of physicians, both in catastrophe and in normal circumstances.

In a way, it might seem odd for a chaplain to highlight this and other articles by physicians on spiritual needs and spiritual care. Again, not all the articles in this collection are written by physicians. However, physicians are the intended audience for the collection, and it’s all too true that if you want the attention of physicians, you need to involve physicians in the presentation. In any case, each article will stand on its own.

We are more aware of, and more focused on, catastrophic events than ever before. Whether natural or human-caused, we are more alert to possible needs than ever before. I wouldn’t say we’re really prepared, but we’re putting more time and effort into preparation all the time. These articles address another area in which to be prepared, an area that I think many professionals tend to ignore, either trusting the religious establishment to meet all needs (whether involving them in preparation or not), or feeling them at best beyond their competence, and at worst irrelevant. These articles will be especially helpful as resources for professionals, or perhaps simply to raise consciousness. In either case, they are worth our time and attention.

Thursday, December 06, 2007

And the Bishop Is an Honorable Man

Bishop John-David Schofield, Bishop of the Episcopal Diocese of San Joaquin, has responded to a letter from Presiding Bishop Katherine Jefferts Schori. Her letter entreated him to “reconsider and draw back” from actions in the coming diocesan convention that would, in the opinion of those supporting them, remove the Diocese of San Joaquin from the Episcopal Church.

Bishop Schofield’s is the third response to the third such letter. Former letters went to Bishop Duncan of Pittsburgh and to Bishop Iker of Fort Worth. The three responses have been different, more different than the letters sent to each bishop. Bishop Duncan’s was short and to the point, if not sweet. It asserted resolution and sad necessity, using words from Scripture and the implied image of Martin Luther. Bishop Iker’s response was longer, and full of angry projection and disdain.

Bishop Schofield’s is different yet again. It is well written and subtle. It seems to meet a pastoral initiative with a pacific response. It even includes consideration that the diocesan convention might step back, and that he would then continue in the Episcopal Church, if in dissent.

To say it is “pacific,” however, is not to imply it is either passive or pacifist. If ever there was a case of damning with faint praise this would be it – well, perhaps, if there were actually any praise intended.

While saying he appreciated the “pastoral tone” of Bishop Jefferts Schori’s letter, he makes clear his perspective. The Episcopal Church is “an apostate institution that has minted a new religion irreconcilable with the Anglican faith,” guilty of “false teaching and sacramental actions explicitly contrary to Scripture.” Bishop Jefferts Schori is a liar, who “in Dar es Salaam, and in the presence of the assembled Primates... verbally signified... agreement to [the proposed scheme for alternative oversight]. By the time you returned to the United States, however, you denied your public statement and declared you had only meant to bring it back for further consideration.” He appears certain enough of his view through his window into her soul.

He, of course, does not need association with such a person or such an institution. “My understanding of the authority of the Holy Scriptures, as well as Catholic Faith and Order are shared by the Roman Catholic Church, Eastern Orthodox Churches and by some 60 million faithful Anglicans worldwide.” However, current understandings of "Catholic Faith and Order" in the Roman Catholic or Orthodox churches would not recognize his orders as valid. However he may dissent from matters of discipline in the Episcopal Church, his orders are Anglican, and so not recognized.

He asserts that the invitation of the Province of the Southern Cone to provide oversight meets the provisions of the Dar es Salaam scheme. That is, of course, incorrect, in that the Dar es Salaam recommendation required official participation of the Episcopal Church and of primates delegated by the Primates and by Canterbury in the decision. Whether that recommendation, did or did not violate Constitution and Canons of the Episcopal Church, this invitation is certainly no substitute. Here there is no participation, either from the Episcopal Church or from the wider Communion, in any form.

Will the diocesan convention reconsider? I pray it will, but I have little expectation. Certainly, Bishop Schofield is clear what he thinks necessary. And if they reconsider, will Bishop Schofield stay? He claims he will:

In the event that the clergy and laity reject this offer from the Southern Cone, I would, of course, follow your recommendation to participate as a dissenter of the present unbiblical course of action being pursued by the House of Bishops. To do anything else would be to abandon God’s people of San Joaquin and, in the end, prove to be a hireling and not a shepherd. For me, at least, this is the honorable course the Lord would have me follow.

If he did, of course, I would wonder about the content and the intent of his dissent. After all, he has labeled the Episcopal Church “apostate,” and the present course of action “unbiblical.” I believe that he means what he says.

But I don’t think he’s worried. I think he’s comfortable that the majority of diocesan convention agrees with him. I think that, with his full support, the diocesan convention will effect the changes in its Constitution, in pretense of separating from the Episcopal Church, and will seek support and “protection” from the Province of the Southern Cone.

And so Bishop Schofield has laid out the choices he sees. He can violate his (thrice) signed commitment to “conform to the doctrine, discipline, and worship of the Episcopal Church” (and, yes, the Book of Common Prayer is that specific), and ancient catholic tradition; or he can continue to “dissent” in a Church he considers “apostate.” Either course will certainly be hard; but I can’t imagine how either course can be considered “honorable.”

Monday, December 03, 2007

On "A Taxonomy of Cognition:" Reflecting With Canon Twinamanni

The Rev. Canon Benjamin Twinamaani of Uganda has published a very interesting reflection on current issues in the Anglican Communion. His reflections are based on his own experience serving in an Episcopal Church beginning in 1990. It is well worth the time to read. You can find it here at Covenant (and thanks to Thinking Anglicans for pointing to it).

Canon Twinamaani has an interesting analysis of the cultural differences between the United States and “other parts of the Anglican Communion, particularly from the Global South.” He offers “a taxonomy of cognition,” intent on analyzing the ways in which American Anglicans think differently, and the circumstances that have shaped them.

Let me say first that the Canon is clearly acting in good faith. He speaks of admiration for his American colleagues and friends, and I’m convinced he means it. Moreover, I think he is trying to provide for colleagues in the Global South a context for understanding the American scene, and the American church as part of it (including, although not equally, the Episcopal Church and its separatists, both from the 1970’s and from the past decade.”

However, there are some points about which I think he has missed important information. I think that these are important enough as critiques of his paper.

The Canon addresses three points (two of them integrally linked) which he considers relevant in understanding American thinking.

“Taxonomy Item No. 1A. The legal base of Episcopal churches in America (why it is easy for a congregation to break up or leave ECUSA and set up shop across the street under CANA, and for congregations to buck all and any authority, especially bishops).” In essence, the Canon’s point here is that “laws are enforceable.” That is, the institution of law, as well as other social institutions, are more powerful than individuals. As a result, Americans enjoy a level of social and political stability that most in the Global South do not experience, and perhaps cannot imagine. Institutions and communities can safely differ because, as the laws apply to all, none is significantly threatened by another.

However, because there is no real threat from difference, neither is there any danger in not reconciling; “live and let live” can function in a way it manifestly does not in other parts of the world. In troubled places in the Global South it is the Church that provides stability that the society does not. As a result, there is a need perceived for the Church that does not exist in America; and there is a need for the Church to seek reconciliation within the society for the stability and security of church members.

“Taxonomy Item No. 1B. The Canonical Base of the Anglican Church in America.” In essence, the same dynamic applies in the American Church that applies in the culture around it. The Church is not immune from civil laws, nor does a bishop in the Church see himself or herself as independent from canon laws. The power of bishops is restrained, and there may be actions a bishop cannot take, even against his or her better judgement.

In parallel, Canon Twinamaani sees that the Church in the Global South experiences both within and without the instability of the culture. Civil law exists, but is secondary to the power of individual political leaders. Canon law exists, but is secondary to the power of individual bishops. A bishop is free to act on his judgment, whether or not that accords with canon law.

“Taxonomy Item No. 2. The Civil Rights Legal Base and History in American Culture.” The result of the Civil Rights Movement was legal change. Specifically, “In 1964, President Lyndon Johnson signed the US Civil Rights Act into law. John F. Kennedy, killed the year before, initiated it. It stipulated that no American would be discriminated against on account of race, religion, and gender.” The point was primarily to bring civil rights to Black Americans; but once in place it allowed a “slippery slope” that could be used first by women and then by the gay community to pursue civil rights. Once this had become the law of the land, the Church was not immune from enforcement. Any theological argument that might be made in defense would be overwhelmed by the legal argument. Bishops, restrained as they were, could not prevent new groups from claiming rights, even within the Church; and since “laws are enforceable,” there’s nothing to prevent new groups from claiming the same rights (and, yes, he does descend to the same old “scare list,” mentioning explicitly pedophilia and polyamorous relationships).

In responding, let me take the last premise first. The Canon is correct that the Civil Rights Movement of the past century significantly shaped the agenda of American Anglicans. It is an interesting note, but it is shallow on two points. First, he focuses on the Movement as an effort to provide equal rights for African Americans, without appreciation that other minority communities were significantly shaped by it. Indeed, he posits that

Since in American history it is the black people that had the lowest legal status (regarded by law as slaves and property or as disenfranchised subhumans in the 1600-1890s and far beyond), once the black people got their civil rights legislated into law, it followed suit as night follows day, that all other groups in America must have the same rights, if not more. Let me be blunt. It is not possible for black people to have the civil rights that any other group cannot have, by virtue of the historical precedent that black people had the lowest status in the nation’s history.

Thus, other groups, either contemporary or subsequent, asserting civil rights are measured by that standard. By largely dismissing other cultural groups (Asian Americans, Native Americans, etc.) he misses the point that the movement for Civil Rights was that they were human rights, appropriate for all. He thus discounts the Women’s Movement, describing it as an effort to “keep ahead of black people,” rather than recognition of the humanity of women.

He also focuses on the results of the Civil Rights Movement as legal and social events. In a culture where “the laws are enforceable,” the legal consequences of the Movement are most important. Indeed, he contrasts making arguments for women’s’ rights or GLBT rights on a legal basis, which cannot be resisted, with making arguments on a theological basis, which apparently cannot be sustained.

In doing so, he completely misses how profoundly the Civil Rights Movement was a theological movement, and how many leaders of the Movement were profoundly motivated by the conviction that justice is a Biblical, even a Gospel mandate. He completely ignores the contribution of the Black Churches. Indeed, it was Black Christian leaders who sustained the Movement, and brought other religious leaders into the struggle. They saw this as indeed rooted in the Gospel and reflected in the teachings of the Prophets, and not simply a social or legal issue. To misunderstand the importance of the theological dynamics of the Civil Rights struggle then is to misunderstand them (or ignore them) today.

Returning to his first, linked theses, the Canon appreciates the importance in American thought of the stability we enjoy because "the law is enforceable." However, he seems to suggest that this is unique to the United States. He does not note how many other provinces enjoy such stability. I think the same could safely be said of Australia, Canada, Ireland, Japan, New Zealand, South Africa, and the United Kingdom, just to begin with. It is also notable that each of those nations has faced and is facing its own movements for civil rights, based on race, national origin, and/or immigration. The Canon, I think, overstates the uniqueness of the American context. In doing so, his assertion “that it is the American Church and its leadership and membership, and no other entity, that can solve the crisis,” misses the investment other provinces might have in the same issues relevant in America.

Canon Twinamaani clearly admires the stability Americans enjoy. At the same time, he expresses no thought (and perhaps he has no hope) that the Church might be an agent for change in the Global South. It is well known how important the Anglican Church was in those efforts in South Africa. It has been reported how the Church has advocated for justice in Kenya and Nigeria. The Canon, however, expresses no desire for change in the status quo.

That is true of his sense of the status quo both in the culture and in the Church. Arguably, however, the Church could make the necessary changes internally without waiting for the wider culture. Surely, the Anglican in the pew would feel encouraged if what was "enforceable" within the Church was "law," and not simply the agenda of the individual bishop, however well intentioned.

At that point, of course, it is the intentions of bishops that would be critical. It would involve bishops trusting clergy and laity, and delegating authority. In many ways, bishops would experience the biggest changes. Perhaps Anglicans in the pews would experience the greatest benefits, both in seeing the stability within the Church, and in seeing the Church model stability for the wider society.

Canon Twinamaani has offered a gift in his "taxonomy of cognition." To the extent it does indeed improve mutual understanding we can hope it will contribute to efforts to communicate and work together across cultural differences. At the same time, I think it is undermined by some apparent misunderstanding of the American context, lack of appreciation of similar dynamics in other Anglican provinces, and significantly less critical reflection on the Global South context he describes for contrast. He has offered his paper in good faith, and for that we should be grateful. I think we can best show our gratitude by critical engagement and reflection on his offering.

Friday, November 30, 2007

Take a Deep Breath, and Do It Right

The New York Times has reported today that Medicare pays medical suppliers significantly more than the market price for goods and services. While the specific example is those who provide oxygen and oxygen equipment, the point is that there are a number of areas in which companies providing medical supplies are being paid for goods and services at rates well above market.

The article reports two reasons. First, many of the payment standards were set some years ago. Second, when the Centers for Medicare and Medicaid Services (CMS) wants to renegotiate, or Congress wants to establish new standards, the companies rally their customers to complain, and to demand that nothing change. Using the example of oxygen supplies highlights just how anxious patients might be. They see it as a matter of life and death, and they might well be right.

That said, I have some concerns about the reporting. It’s not that I don’t think there’s waste; I’m certain there is, based only on my knowledge of human nature. And nobody wants to pay for waste.

However, there were hints in the report of the difficulties actually deciding what’s appropriate. Case in point: the reporters looked only at numbers, and not at the human context of health care. At one point, the report says, “Even for a simple walking cane, which can be purchased online for about $11, the government pays $20, according to government data.” At another point it quotes Representative Pete Stark as saying, “All you have to do is pick up an equipment catalog or search for ‘oxygen device’ on eBay to figure out better prices than what we’re currently paying.”

That’s all well and good, but it ignores the people who need service, their perception of what they need, and their perception of the means at their disposal. Patients in need, whether for oxygen or other services, aren’t likely to do an Internet search for the best price. They want goods and services now, and not in “three to six business days, depending on the shipment option you choose.” Their perception is that their needs are immediate, if not critical; and so they’re much more likely to seek out those who can promise to provide within hours, if not within minutes. Moreover, having established are relationship that has worked, searching for an alternate supplier might seem to entail a risk the patient or caregiver is not interested in taking. Haven’t we all said at some time, about some expense, “I know it costs a little more, but I know it’s dependable.”

In advising patients, prescribing physicians are likely to choose in the same way. This isn’t a matter of collusion, although that does sometimes happen. Doctors, too, have a sense of which providers come through and provide better service to patients. They hear from patients when there are problems. So, they, too, are likely to refer to the same companies over and over, unless patients or experience demand a change. The old saying, “You get what you pay for,” includes the calculations of service and of experience, and not simply the product in this one instance.

But local, immediate providers cost more for reasons beyond profit margin. They have overhead costs, including warehouse and transportation costs, which may well be different from online providers. They argue, too, that they have different personnel expenses. Local services providing oxygen may well have on staff respiratory therapists to oversee patient care and provide patient education. We’ve all heard of the shortage of nurses, but there’s a shortage of respiratory therapists as well, and providing that additional service for patients adds to the costs of local providers.

This tendency to focus on price and not on larger context can sometimes cut the other way. A good example is Medicare reimbursement for procedures done at specialty surgery centers and “boutique” hospitals. They’re popping up everywhere: smaller institutions with a largely outpatient practice, and a few inpatient beds. They serve a particular specialty or patient pool, and they’re commonly owned by physician groups, often in partnership with developers who specialize in medical facilities. Patients are frequently very happy about them. They’re smaller and more focused institutions, and they often provide a high level of amenities – a real “customer care” focus.”

Within the limited services they provide, smaller institutions can often provide services at lower cost. They tend to have good outcomes, too, and good numbers on their patient satisfaction statistics. Those things make them attractive to patients, and to the insurers who pay for their care. Patients and insurers alike are quick to ask, “If these doctors can provide this care for this price, why can’t larger hospitals do it?

Of course, insurers know the answer, even if patients don’t. They can provide care at a lower price for a number of reasons. First, unlike a full-service hospital, there are a lot of services they don’t have to provide, and therefore a lot of staff they don’t have to keep. They don’t provide emergency services, for example, and only limited lab services. Because their practice is limited in scope, they don’t need to maintain as full a pharmacy or central supply. With few inpatient beds, they don’t have to maintain a large staff, or pay shift differential for as many folks at night. In many ways their overhead is lower.

They also get to choose patients. Unlike a full-service hospital, patients don’t just roll up to the doors of a specialty hospital. Instead, they are selected by the physicians who practice there. The selection is made, by and large, for good, medical reasons: since services are limited, only low-risk patients are served at the specialty hospital. High-risk patients are served by the same physicians in full service hospitals, because they may well need the additional services. On the other hand, that also means the patients more likely to need the additional services, the patients more likely to cost more money to care for than insurers (especially Medicare and Medicaid) are going to pay, are brought to the full-service hospitals. By the same token, the specialty hospitals can selectively serve those who have insurance. Since those who don’t usually make their entry into health care through the Emergency Room, the specialty hospitals don’t have to wrestle with unreimbursed care to anything like the extent full-service hospitals do.

There is no substitute for a full-service hospital. Every community needs its share; and every full-service hospital needs to be fully staffed and fully stocked, even when its beds aren’t fully utilized. The community needs that breadth and level of service to be available all the time, and for all in need; and that kind of security costs. So, prices for care at a full-service hospital may well be higher than those in a “boutique” hospital. But if your analysis looks only at dollar costs, and not at contexts, you can’t fully appreciate the economics of health care.

Again, my concern here is not, first and foremost, with defending the expenses charged (and some would say overcharged) to Medicare, or the expenses that Medicare does or doesn't cover. (Those concerned providers can do that for themselves; and here, too.) Instead, I’m concerned with how well all of us, patients and providers alike, understand the real costs of health care. Folks are smart enough to understand the problems. The researchers who study these issues, and the reporters who report on them, or investigate them, need to do better in giving us the context; because if you don’t know the context, you don’t really know the story.

Wednesday, November 28, 2007

The Forbidden Dance of Lambeth

(No, I guess that was the lambada.)

There is currently a lot of questioning that we might phrase, “to Lambeth, or not to Lambeth?” Diocesan conventions in Utah and Olympia (the western area of Washington state) have recommended that our bishops not attend. Bishop Steven Charleston has had the same thought. It’s been a topic of discussion over at Fr. Jake’s place.

That discussion brought about this response from me. Having first raised that thought in a “Brainstorming” post, I thought I would go ahead and bring my response over here, and perhaps expand on it a bit.

Once upon a time, a humble chaplain floated the possible thought that American bishops not attend Lambeth. They would still pay for it (somebody important once said something about "heaping coals of fire on their heads"), but would choose themselves to stay home. They would also then return to full participation in the Anglican Consultative Council, so as to affirm our place in the Anglican Communion. It was thought then that it might be an expression of humility, and a choice not to participate in the climate of invective.

The humble chaplain has not forgotten the climate of invective that resulted. He might still be cleaning up the stains. (Okay, so I'm not so humble; but otherwise the recent history is accurate.)

But, things have changed a lot. First, it seems ever more clear to me that the definition of "Anglican Communion" will be determined by who shows up at Lambeth - thus my occasional reference to "cowboy poker."

Second, we have more detailed information that the Global South Steering Committee primates have a whole lot more bark than bite regarding opinions across the Communion. Between the report of the majority of the Joint Standing Committee and the subsequent responses of most provinces to questions from Canterbury, across the Communion the pluralities of those who think the Episcopal Church has done enough and those who think we've done enough to keep talking significantly outweighs those who want to throw us out.

Finally, the Canterbury has said time and again that this Lambeth is to return to "reflection and mutual consultation," and not fall into attempting to legislate. Of those provinces who would agree that these are the appropriate activities for Lambeth, we have the largest bloc. We are best prepared - possibly essential - for inhibiting this Lambeth from being hijacked, whoever shows up (acknowledging, too, that those who would most want to hijack Lambeth are also those who would least want to show up if we do). Lambeth 1998 was hijacked, and we may be able to take a significant role in preventing that happening again.

With these things in mind, I'm coming to believe that, with these new circumstances, our bishops, or at least most of them, should go.

I could add to the matters that have changed since my initial thought. For example, while remaining publicly ambivalent about Lambeth, the Church of Nigeria – Anglican has been creating new dioceses and bishops wholesale. I’m referring to new dioceses in Nigeria, and not to their divisive insertions into the United States. If they did choose to attend, nonattendance by so large a group as our bishops would leave them with a plurality, perhaps a dominant plurality, at Lambeth.

On the basis of the CAPA statement, “The Road to Lambeth,” the Ugandans have expressed their intent to decline Lambeth, and others may follow them. But leadership in CAPA is changing. The new Chairman of CAPA, Bishop Ian Ernest of Mauritius appears so far to be a moderate – a conservative moderate, no doubt, but not a reactionary. Watching the Province of Central Africa come apart at the seams may well give him and other CAPA leaders a different perspective on fragmentation within the Communion.

Retired bishops from both the Episcopal Church and the Anglican Church in Canada have been signing on with the Church of the Southern Cone to assist in what seems to be a new “Oklahoma race” to divide up territory in North America. The report of the Joint Standing Committee, cited above, highlights boundary violations for the violations of the Windsor Process that they are. One thing that Canterbury has stated clearly in the past couple of years is his belief that there really is a Windsor Process, that it is the way to discover new ways in which provinces might relate to one another, and that hasty action undermines it. To support him by attending Lambeth is to affirm his support for continued, measured discussion instead of overly hasty “clarity.”

So, yes, I did have the thought that our bishops might decline Lambeth, not in a spirit of pique but in one of humility. However, enough has changed that I think it not the best idea. We need to confirm our support for the process orientation of the Archbishop of Canterbury, whether or not we’re always excited about his statements. To do that, we need to join in the dance.

Friday, November 23, 2007

If This Is a King: Reflections for the Feast of Christ the King, Year C

If this is a king, why would we follow him? If this is a kingdom, who would want to be a citizen?

Jesus hung on the cross, one of three so executed on that day on that hill. After all the excitement, after all the hope, not even a week since his triumphal entry into Jerusalem, it had come to this: execution on a cross, shared with two common thieves.

It’s no surprise that those who walked by laughed and jeered. Whatever Jesus had claimed for himself, the crowds had called him Messiah, the Son of David. The crowds had proclaimed him the one to save Israel – and now here he was. It’s no wonder they ridiculed him, even to one of the thieves hanging with him. Some kingdom! Some king!

We have always been uncomfortable with kings, we human beings. We cheer them when times are good, and things seem safely under control. We laugh at their failings, at least when we think it safe. We fear them when they get too close – all that power, and no way we can resist. For all the cheers for the leader who brings home the spoils, we fear lest he ask too much, take too much from us. Remember that most of our own founding fathers weren’t so concerned about democracy when King George was far away. It was when he came close, in the taxes that were enforced, and in the barracks of soldiers that enforced them, that they began to think perhaps they could do it better themselves. Remember in “Fiddler on the Roof” the rabbi’s prayer for the czar: “May God bless and keep the czar – far away from us!”

What kind of king was this, then? The sign above him said, “This is the king of the Jews.” The hooting spectators, and even the cynical thief, called on him to prove it, and most of them simply laughed when he did not. Some kingdom! Some king!

Oddly enough, in the history of the people of God the image of the king isn’t someone so powerful, so dangerous, so far away. Instead, the image was of the shepherd – from the call of David from the pasture ,to Jeremiah’s proclamation in the last days of the Judah. “Woe,” he says. “Woe to the shepherds who destroy and scatter the sheep of my pasture! says the LORD. You have not attended to my sheep; but now I will attend to you! Then I myself will gather my flock; and I will raise up shepherds over them who will shepherd them, and they shall not fear any longer, says the LORD.”

But, shepherds are so very unlike kings, aren’t they? Kings live in castles and palaces, surrounded by courtiers. Shepherds live in the fields, surrounded by sheep. Kings do battle with other kings, and calculate their results in victories and defeats and acceptable losses. Shepherds do battle with wolves and bears and jackals, and are concerned for every sheep. Indeed, shepherds often enough work for someone else, to whom they are accountable for every sheep. Kings are, as often as not, laws unto themselves – and so often that seems the very definition of what it means to be king.

And yet through the history of God’s people, the model for the king was the shepherd, and not the law unto himself. The model was of one who lived among his people, accountable for every single one – accountable to God.

That was not the model of those who jeered. Even among the leaders of the Jewish people, that was not the model they held. They had seen ruler after ruler come through – from Assyria to Babylon to Alexander to Rome. They had seen those men, powerful, dangerous, and far away. They did not see on the cross the Shepherd of Israel.

But someone did. One thief – one thief who hung with Jesus saw, not with the eyes of the world, but with the eyes of faith. He saw, and proclaimed, “We’re getting our just deserts. This man has done nothing wrong!” And then, he prayed: “Jesus, remember me when you come into your kingdom.” And it was he who heard this promise: “Today you will be with me in paradise.”

But, what did he see? Clearly, he saw beyond the man on a cross, beyond the mocking, ironic sign over his head. Perhaps he saw the shepherd: the one who lived, not far away, but in the midst of the flock. Perhaps he saw the one who had called on the flock to stand together and to gather the lost. Perhaps he saw the one who battled the wolves and bears and jackals of the soul, for whom there were no acceptable losses. Perhaps he saw the one accountable to God – indeed, the one making God present in the midst of the flock. And seeing God in Jesus, he could see the promise of God’s kingdom, of all things reordered the way they God meant them to be. He could seek his place in that kingdom; and he could trust Jesus when it was granted.

This is what we celebrate when we observe this feast of Christ the King. We celebrate the one who is God among us, even to this day: the one so committed to life among us that he shared in our death, and then overcame death and the grave, not only for himself, but for all of us. We celebrate the king who falls in the eyes of this world and yet rises as the Shepherd of Israel, and rising, lifts us with him. We celebrate the one who see us, even in the midst of our failings, and offers us citizenship in the Kingdom of God – the one who sees us in the midst of our just deserts, and promises us Paradise.

This is the King we proclaim! Some kingdom! Some king!

Wednesday, November 21, 2007

Canada Feels the Pinch

The latest news from our Canadian Anglican siblings is about a bishop retired from the Anglican Church of Canada, and immediately taken up by the Province of the Southern Cone, who is now preparing to preside at ordinations within the Diocese of New Westminster. What makes this especially egregious is that the congregations are still ostensibly congregations of the Diocese of New Westminster. Bishop Michael Ingham of New Westminster has, of course, expressed his distress and disapproval (news and reviews here at Thinking Anglicans).

What hasn’t been mentioned so far is that this is an explicit rejection of the Windsor Process and the leadership of the Archbishop of Canterbury. That is certainly been implicit in other, similar events – ordinations for CANA, or for AMiA. However, this is different. What makes this explicit is that these parishes sought the guidance of the Panel of Reference to the Archbishop, created as a tool of the Windsor Process and intended to advise on questions about maintaining communion with Canterbury.

To remind everyone, the Panel issued their first report in October of last year. The topic was the inquiry of certain parishes within the Diocese of New Westminster as to whether the actions of Diocesan Convention and the Bishop had impaired their communion with Canterbury and the rest of the Anglican Communion. The critical paragraph in the Panels response is as follows:

The argument that in order to remain “in full communion with the Church of England throughout the world” it is necessary for dissenting clergy and parishes to separate themselves from the diocese of New Westminster, adopting a title for their organisation which implies that they represent the Anglican Communion in New Westminster, in addition to or instead of the diocese and Bishop Ingham, can not be sustained. The Church of England itself remains in full communion with the Diocese of New Westminster and Bishop Ingham, pending resolution of the presenting issue, and therefore with all of its clergy, members, and parishes, including those who dissent from its diocesan synod decision but remain in full fellowship with the Bishop and the diocese, together with the dissenting parishes unless they formally withdraw themselves from the Anglican Church in Canada. Even if this were not the case there is no evidence that communion with dissenting parishes would in fact be broken since such provinces which have declared impaired communion have made it clear that they remain in communion with those whom they regard as faithful.

The report went on to affirm efforts to resolve differences within the Anglican Church of Canada and the Shared Episcopal Ministry (SEM) program approved by the Canadian bishops. They rejected the claim of the applying congregations that only change in jurisdiction would allow them to remain in communion with Canterbury. Thus, while the applying clergy and parishes might have found themselves at odds with Bishop and diocesan synod, they remained in communion with Canterbury through the diocese in the first instance, and through the Anglican Church in Canada, “unless they formally withdraw themselves.” As St. Matthew’s, Abbotsford, the congregation where the ordinations are to take place, continues to be listed as a parish of the diocese, there had, presumably, been no withdrawal.

That is, until now. To have Bishop Harvey come without consultation and consent with Bishop Ingham, to have him ordain persons not recognized by Bishop Ingham, is to functionally and practically reject the jurisdiction of New Westminster, and of the Anglican Church of Canada, and so the recommendations of the Panel of Reference.

Now, I will allow I’m not surprised by this. The General Synod and House of Bishops of the Anglican Church of Canada have not taken the conservative turn that might have made this easier. They have perhaps slowed change, but they haven’t reversed it. The applying congregations predicted this accurately.

On the other hand, neither has it changed that the Church of England remains in full communion with the Anglican Church of Canada and its Diocese of New Westminster. Nor has the tenor of counsel from Canterbury changed: reconciliation should be sought within existing provincial structures. In addition, the recent statement of the Joint Standing Committee of the Anglican Consultative Council and the Primates’ Meeting explicitly pointed out that violations of provincial boundaries are explicitly counter to the Windsor Report and damaging to the Windsor Process.

However, these churches have given up. They have rejected communion with Canterbury through the Anglican Church of Canada. They have lost hope that they might see the movement in the Church that they wish. They have lost interest in reconciliation, whether through the SEM or through the Windsor Process. Let’s hope those still invested in the Windsor Process take note.

Tuesday, November 20, 2007

A Simple Proposition - in the Swiftian Sense?

Not long ago, I observed that a core issue in many in current ethical issues is personhood - literally, what it means to be a person. Well, it appears that at least someone knows this. A group in Colorado is seeking to bring before voters an amendment to the state constitution to attribute personhood "from the moment of conception." They have recently won a decision of the Colorado Supreme Court allowing them to go forward in seeking signatures to put the amendment on the ballot. The specific language of the initiative is this:

Be it Enacted by the People of the State of Colorado:

SECTION 1. Article II of the constitution of the state of Colorado is amended BY THE ADDITION OF A NEW SECTION to read:

Section 31. Person defined. As used in sections 3, 6, and 25 of Article II of the state constitution, the terms "person" or "persons" shall include any human being from the moment of fertilization.

This is certainly an emotion-laden issue. Obviously, I've never been pregnant. On the other hand, I've been listening for years to many pregnant women, including the mother of my children, in good time and in bad. Almost all have spoken of or acknowledged the sense that the fetus is “a baby,” virtually from the moment the woman knows she is pregnant. Both of my sons were “real” to me, if not in the same sense, from the moment I knew about them. That’s when the planning, the dreams, begin, along with a lot of hope and fear.

That doesn’t mean there aren’t sometimes hard choices to be made. We make quite a number of distinctions of the different sets of rights for persons in different circumstances: children vs. adults, or felons vs. the innocent, or, lately, enemy combatants vs. prisoners of war. We make distinctions of rights that amount do differentiating degrees of personhood. The devil is in the details.

Supporters of the movement want to understate that. According to their site,

Many amendments are worded confusingly, and already there are people who would have you believe this is an overly complicated issue, but the simplicity of the text of this initiative speaks for itself. It is not complicated, it is not confusing, it simply states what should be obvious to everyone…

But, as any Biblical scholar can attest, simple language is no guarantee of a simple issue. Looking only at medical concerns, let’s consider some of the different circumstances this might affect.

  • Up to 50% of fertilized ova fail to implant in the uterine wall. If these fertilized ova have rights, who is accountable for them?
  • In the instance of ectopic pregnancy, to what extent do we go to protect any rights of the fertilized ovum? The natural outcome for ectopic pregnancy is death for the fertilized ovum, and commonly for the mother as well.
  • To what extent is a pregnant mother responsible for her self-care in pregnancy as an expression of her accountability for the rights of the developing fetus? There have been efforts to prosecute women for use of illegal drugs for the potential damage done to the fetus. How far should we take such a thought? For example, is the woman responsible for a cigarette or a glass of wine? In law in many such instances each time a persons partakes is a separate violation. To what extent is a woman responsible for actions taken before she knew she was pregnant? And to what lengths are we prepared to go to seek such information? (We might recall here that the right to choose [including choosing to end the pregnancy] is based primarily on an implied right to privacy in medical decision making.)
  • If a woman has a form of cancer sensitive to hormonal changes, such as ovarian, uterine, and some breast cancers, and is also pregnant, she may well be advised to terminate pregnancy, based on the risks to her of delaying treatment, and the risks to the fetus of accepting treatment. Would this constitutional change in Colorado change that discussion? Whose rights would be prioritized? Whose decision would be compelling? That such cases are uncommon is not to say they are unknown.
  • How would this affect regulations regarding surrogate pregnancy, or the relative rights of genetic parents (father vs. mother), or their rights vs. adoptive parents? Who is accountable in protecting the rights attributed to this “person?”
  • How would this affect regulations regarding infertility treatment, and especially storage and/or disposal of stored embryos? What are the rights of each of those embryos, and how do they weigh against the rights of the genetic parents? Indeed, we have had cases regarding the “parental” (ownership) rights of each genetic parent when one was prepared to dispose and the other wished to continue storing the embryos. And, if an embryo that has been stored is tried and fails to implant, who is accountable for “losses” attributable to that embryo?

Those are just a few of the circumstances that might be involved, even without addressing directly the right of a woman to make her own choices about her health care, including the right to terminate a pregnancy, in accord with her individual values.

Which is, of course, what the group supporting the initiative really wants. They want to end abortions in Colorado, and they believe that this amendment would provide a foundation for laws that would accomplish that objective. It’s not uncommon for the state to step in to protect the rights of persons when in the eyes of the state appropriate surrogates do not have at heart the best interests of the children. This is the basis of laws protecting both children and seniors from abuse. This group would simply push this principle to its logical extreme: if, as Dr. Seuss said, “a person’s a person, no matter how small,” designating personhood from fertilization can give the state a compelling interest (and “compelling” might be the operative word) in protecting rights attributed to a fertilized ovum.

It seems so simple indeed – until we have to figure out how to live with it. And then it’s not so simple at all.

Saturday, November 17, 2007

Same Tune; Second Verse

A few months ago, I cobbled together this brief post (well, brief for me, anyway):

In light of the coming "deadline" in September, and all the rhetoric bouncing around the Anglican/Episcopal world, I was moved to recall the refrain of an old country song (Written by Don Rollins; made famous by George Jones, and covered by, among others, the Grateful Dead):

Now the race is on and here comes pride up the back stretch
Heartaches are going to the inside

My tears are holding back, trying not to fall

My heart's out of the running

True love's scratched for another's sake

The race is on and it looks like heartaches

And the winner loses all

In light of the recent offer from the Province of the Southern Cone to take in any Separatist diocesan bishop and party (remembering that a diocese per se can’t leave a province), the song came back to me again. It does seem, doesn’t it, that the race is on?

Southern Cone is angling for Separatist bishops, clergy, and parishioners. So far that’s been mostly in the West and Southwest (since Fort Worth is thinking about this even now). Nigeria through its CANA initiative is working, largely in the Midatlantic states, and perhaps in the Northeast. Kenya has consolidated a collection of congregations, most of them never Episcopal but filled with Separatist former Episcopalians, and largely in the Southeast and Midsouth. Rwanda, sponsoring AMiA, and Uganda have a wider distribution, less geographically defined. At the same time, there’s plenty to contest in the Midwest and Intermountain regions of the country. The Separatists in Kansas went with Uganda. The Separatists in Colorado Springs have gone with Nigeria. We wait to see what happens with Separatists in Illinois, and with the undecided centered in Pittsburgh.

And so, the race appears to be on. Somehow, it reminds me of Africa, and for that matter of North America, in the 19th Century. One of the things we don’t talk about as much in history of world missions is the competition, often bitter competition, that showed itself between different but arguably connected missionary societies. A blunt example, perhaps, is earlier: the displacement in Asia of Jesuit missionaries by Franciscans. It was a difference of internal culture that was visible in how each related to the surrounding culture. To paint broadly, Jesuits were looking for ways to express Christianity within the context of the local culture, while Franciscans were looking to introduce European culture, to their minds not only superior but necessary, to change the local culture. The Jesuits got to the Japanese and Chinese, and made some slow progress. The Franciscans got to the Pope, and got the Jesuits recalled; and China and Japan closed their borders to Christians without, and suppressed Christians within.

Similar competition between missionary bodies took place in the 19th Century in North America and in Africa, as well. And let’s remember that these conflicts were also sometimes bloody. There were a number of incidents in relations between Latter Day Saints and orthodox Christians, with blood on both sides. And even if the conflict was more visible in social conflict than in violence, it was certainly there. We tend to forget that two generations ago a marriage between a Roman Catholic and a Protestant was considered every bit as mixed, and was every bit as vulnerable to social stigma, as a marriage between an African American and a Caucasian American.

And so in this new “mission field,” trying to “rescue” Separatist Episcopalians from the dreaded forces of the Episcopal majority, we can expect there to be competition. Up to this point, it’s been congregation by congregation, with new “diocesan” structures being assembled as needed. However, the plucky folks from Southern Cone think big, for all their small numbers, and they’re looking to take in diocesan structures wholesale. It’s an ambitious step, but it’s one they’ve tried before (can you spell “Recife?” I knew you could!). Perhaps they hope it will work better this time.

I am convinced we will soon have on wider display something that’s really been happening in the United States for a generation. Since 1976 or thereabouts there have been numerous ecclesial bodies claiming the Anglican tradition, with one of them far and away bigger and firm in its historic connection to Canterbury. Soon, there will be fewer, but probably larger ecclesial bodies arguing both Anglican tradition and clearer connection to, if not necessarily communion with, Canterbury. The Episcopal Church will still be larger, and still in communion with Canterbury, although her communion to Canterbury and other Anglican provinces may be somewhat strained. We already have what Archbishop Williams prayed to avoid: divisions like those of the Eastern Orthodox churches, with so much in common and with some cultural and practical differences just important enough to maintain division. We’ve had it for some time, but now it will be harder to ignore.

And so the race is on, with every foreign province interested in supporting Separatists looking for their edge in the new “mission field.” They have so much in common, and yet enough little things and enough personal agendas that competition seems already in play. And all of us are wise to remember the last lines of the refrain:

The race is on and it looks like heartaches
And the winner loses all.

Thursday, November 15, 2007

Grief and Adapting to Change

We all know that romantic notion: "I want to save this moment forever. I never want anything to change." We see it literature and in the movies all the time. Of course, in the movies, as soon as we hear someone say that, we know things are about to fall apart. The disaster happens, as it does in every drama. In real life, too, as much as we might want to, we know that we can't hold those moments. Things change,

Life is change. Most of the time we want that. Children grow into adults. We learn new skills, and want to use them. We choose to move from work to retirement.

Sometimes we face changes we don't want, or have mixed feelings about. Those same children grow up and move away. Unwanted job changes happen (including, for some, retirement). Illness comes – and especially chronic illness

Whatever the change, it involves stress. We know there is good stress and bad stress. Good stress is stimulating. Think about that good challenge – the good game when you knew you performed at your best; the time in school when you knew the answer, and you really wanted to be called on; the night before the wedding. Bad stress, on the other hand, is unfulfilling, and literally dis-stressing. I’m sure we all have enough examples in our lives: the time when the results weren’t so good, and after all our excitement we were left weak, sad, tired.

But in either case it affects us in a number of ways. We know many of the physical symptoms of stress (or, is it excitement?) –

  • Dizziness or a general feeling of "being out of it" (or, is it ecstasy?)
  • General aches and pains
  • Grinding teeth, clenched jaw (or, is it determination?)
  • Headaches
  • Indigestion and upset stomach (or, is it butterflies?)
  • Increase in or loss of appetite
  • Muscle tension in neck, face or shoulders
  • Problems sleeping
  • Racing heart
  • Cold and sweaty palms
  • Tiredness, exhaustion
  • Trembling/shaking
  • Weight gain or
  • loss

And we know emotional symptoms of stress –

  • Anxiety
  • Relationship problems
  • Chronic sadness
  • Even depression.

More important, change always involves grief. Again, not all change is unwanted or unhopeful. At the same time, all change, whether wanted or unwanted, involves some loss; and with any loss comes some grief.

I think this is one of the most important issues missed when folks adjust to changes. I think we miss it whether we are those making the changes, or those encouraging others to make changes. When we see the change as “positive,” we have those hopeful aspects that counterbalance or distract us from what we lose. When we don’t see the change as “positive, we tend to try to “push through,” to “get on with it.” Only when the change is significant do we actually acknowledge that we might have grief. We’re conscious of grief in proportion to our sense of the importance of the loss. But the truth is all changes involve some loss, and so some grieving is part of the process.

So, what to do? The answer: we have to address the grief, to recognize that this is a part of adapting to changes in our lives. According to psychologist William Worden, that involves four tasks.

First, accept the reality of the loss. In this case, accept the reality of the change. That might seem straightforward. At the same time, it’s so easy to accept the change intellectually, and resist the importance of the change. How easy is it to say, “Yes, I know things are different; but that’s no reason life can’t go on as before.” In fact things can’t go on as before, because the circumstances, the very facts of “before” are changed.

That brings us to the second task. The second task is to experience the pain of grief – or in our current discussion, to acknowledge the consequences of the change. Because the facts of “before” have changed, things simply can’t go on as before. Grieving families will sometimes say to me, “I just want things to be normal again.” My answer to them is, “You can’t get the old normal back, but you can get a new normal, and it can be joyful and blessed.”

And to get to a new normal we come to the third task. In grief, that task is to adjust to an environment in which the deceased is missing. In addressing change, we’d describe it better as making the adjustments necessary because the old “normal” is gone.

What’s important is that the adjustments, the adaptations we need to make are frequently the life changes that we’re encouraged to make to cope with stress, or to cope with chronic disease. In essence, it’s about making the decisions and taking the steps that improve life and health: the exercise, the healthy diet, the discipline of taking medication, and so on. And especially important is using the support of folks around you to help with the new way of living.

Granted, all this doesn’t come easily or immediately. We expect grief to take a while to live through – longer than most people want to expect. We don’t make these changes perfectly right from the start. But, we keep at it, knowing this is necessary in developing the new “normal.”

Which brings us to the final task. In grief that task is to withdraw emotional energy and reinvest it in another relationship. In adjusting to change. we can say that we need to let go of our wishes for the old “normal” and put our energy into the new “normal.” In that sense, the new “normal” is the new relationship in which we reinvest. We see ourselves as worth investing in, and so the new “normal,” the new relationship, is worth investing in.

We may even discover that some things were not so good in the old “normal,” things that in the new “normal” are better. We deal with chronic disease at our house, and one of the things we realized when it was finally diagnosed, is that it had been taking a toll for a long time. Once it was diagnosed and treatment begun, we were more secure, less afraid that unexpected flare-ups would happen, and less afraid when they did happen. While it took a while to adjust, and, yes, to grieve, we discovered that the new “normal had a lot of good in it, without some of the fears and shocks of the old “normal.”

That won’t always happen, I know; but I do know that the new “normal,” as I said, can be happy and joyful and blessed. We reinvest our energies in the new situation, the new “normal,” because it is how we reinvest in ourselves.

I think that’s why it’s important that we recognize that there will be some grief associated with every important change, and that we need to accept and address that grief as a part of adapting to the change. Changes, and especially important changes, aren’t easy; but I think if we recognize that part of making the changes is addressing the grief that comes with them, we will understand ourselves better in the process, be more forgiving of ourselves in the process, and will know and embrace the new “normal” we discover.

Presented 11/14/07 at our hospital's Munch and Meet Diabetes Support Group

Tuesday, November 13, 2007

At Grand Rounds

One of my recent posts has been accepted for Grand Rounds, a carnival of blogs interested in health care. You can see the latest Grand Rounds, and a host of interesting articles, at the blog of Doctor Anonymous. Take some time for these voices from health care.

Monday, November 12, 2007

Bishop Iker Rewrites History

Updated Wednesday

So, Bishop Iker has responded to the letter from Presiding Bishop Katherine Jefferts Schori asking him to “recede from this direction” – that is, to turn back from attempting to leave the Episcopal Church, taking with him the Diocese of Fort Worth intact. It is no surprise that he’s not inclined; that we expected.

Perhaps it’s also not a surprise that he should try to rewrite history to suit his purpose. I speak of this assertion:

I must remind you that 25 years ago this month, the newly formed Diocese of Fort Worth voluntarily voted to enter into union with the General Convention of the Episcopal Church. If circumstances warrant it, we can likewise, by voluntary vote, terminate that relationship.

Unfortunately, that’s not the way it works, nor was it the way it worked then. I was at the time part of the division of the Diocese of West Tennessee from the continuing Diocese of Tennessee, and can say from experience that the substance of Constitution and Canon have not changed in this.

Article V of the Constitution of the Episcopal Church specifies three ways of forming a new diocese:

Sec. 1. A new Diocese may be formed, with the consent of the General Convention and under such conditions as the General Convention shall prescribe by General Canon or Canons, (1) by the division of an existing Diocese; (2) by the junction of two or more Dioceses or of parts of two or more Dioceses; or (3) by the erection into a Diocese of an unorganized area evangelized as provided in Article VI. The proceedings shall originate… with the approval of the Bishop, in the Convention of the Diocese to be divided; … After consent of the General Convention, when a certified copy of the duly adopted Constitution of the new Diocese, including an unqualified accession to the Constitution and Canons of this Church, shall have been filed with the Secretary of the General Convention and approved by the Executive Council of this Church, such new Diocese shall thereupon be in union with the General Convention.

Note, then, that first and foremost a diocese is formed with the consent of General Convention. Moreover, Fort Worth was formed “by the division of an existing Diocese.” that being the continuing Diocese of Dallas, and not in an “unorganized area. It was, therefore, formed within, and not external to, the existing Constitution and Canons. So, in the current Canons, Title I, Canon 10:

Sec. 1. Whenever a new Diocese shall be formed within the limits of any Diocese, or by the junction of two or more Dioceses, or parts of Dioceses, and such action shall have been ratified by the General Convention, the Bishop of the Diocese within the limits of which a Diocese is formed, or in case of the junction of two or more Dioceses, or parts of Dioceses, the senior Bishop by consecration, shall thereupon call the Primary Convention of the new Diocese, for the purpose of enabling it to organize, and shall fix the time and place of holding the same, such place being within the territorial limits of the new Diocese....

Sec. 3. Whenever one Diocese is about to be divided into two Dioceses, the Convention of such Diocese shall declare which portion thereof is to be in the new Diocese, and shall make the same known to the General Convention before the ratification of such division.

Sec. 4. Whenever a new Diocese shall have organized in Primary Convention in accordance with the provisions of the Constitution and Canons in such case made and provided, and in the manner prescribed in the previous Sections of this Canon, and shall have chosen a name and acceded to the Constitution of the General Convention in accordance with Article V, Section 1 of the Constitution, and shall have laid before the Executive Council certified copies of the Constitution adopted at its Primary Convention, and the proceedings preparatory to the formation of the proposed new Diocese, such new Diocese shall thereupon be admitted into union with the General Convention.

Thus, the Diocese of Fort Worth did not have independent existence before consent. Rather, division was an action of the Diocese of Dallas, and under the Constitution and Canons of Dallas, and therefore under that diocese’s accession to the Constitution and Canons of General Convention. Indeed, Dallas was not divided until after receiving consent from General Convention.

Consent for that division was given in Resolution 1982-B018, titled, meaningfully, “Ratify the Division of the Diocese of Dallas Into Two Jurisdictions:”

Resolved, the House of Deputies concurring, That this 67th General Convention ratifies the division of the Diocese of Dallas to create a new Diocese which, until the new Diocese adopts a name, shall be referred to as the Western Diocese with the continuing Diocese to be known as the Diocese of Dallas. The boundaries of the two Dioceses shall be as follows:
a) The Diocese of Dallas shall include 25 counties: Grayson, Denton, Collin, Dallas (excluding the portion of the city of Grand Prairie that is in Dallas county), Rockwall, Ellis, Navarro, Henderson, Kaufman, Van Zandt, Hunt, Fannin, Lamar, Delta, Hopkins, Rains, Wood, Upshur, Camp, Franklin, Titus, Red River, Morris, Bowie, Cass.
b) The Western Diocese shall include 23 counties: Wichita, Archer, Young, Stephens, Eastland, Brown, Mills, Hamilton, Comanche, Erath, Somervell, Palo Pinto, Jack, Clay, Montague, Wise, Parker, Hood, Bosque, Hill, Johnson, Tarrant, Cooke, and the portion of the City of Grand Prairie located in Dallas County; and be it further

Resolved, That this 67th General Convention receive the following evidence supporting this resolution:

1. Certified copy of the resolution, duly approved by the Diocese of Dallas, committing the Diocese to its division and to the formation of a new Diocese;

2. The consent of the Bishop of Dallas;

3. Certificate of the Secretary of the Convention of the Diocese of Dallas concerning the number of Parishes, Missions, Institutions and Presbyters in the continuing Diocese and in the new Diocese;

4. Map of the existing and proposed continuing and new Diocese;

5. Certificate of the Treasurer of the Diocese of Dallas concerning the financial abilities of the continuing Diocese and of the new Diocese, together with supporting financial data;

6. Certificate of the Chancellor of the Diocese of Dallas that all aforesaid documents have been duly executed, are accurate, and are entitled to full faith and credit, and further that all of the appropriate and pertinent provisions of the Constitution and Canons of the General Convention of the Episcopal Church in the USA and the Constitution and Canons of the Diocese of Dallas have been fully complied with in respect of this submission.

Thus, the new diocese was consented by General Convention before it had even been named, under the existing Diocese of Dallas, and before the Primary Convention had been called.

I remember the excitement in the division of Tennessee into two, and subsequently three dioceses. I remember the excitement when in convention Tennessee called for the division. I remember the excitement in New Orleans in 1982 when consent was given for formation of the Diocese of West Tennessee. I remember the excitement when the Primary Convention of the Diocese of West Tennessee met – like the new Diocese of Fort Worth, in the fall after General Convention. I remember the process, and so do many others in the Church.

There have, of course, been changes in Constitution and Canons over the years. Much is made, for example, of the fact that the “Dennis Canon,” clarifying the accession of diocesan conventions, constitutions, and canons to national Constitution and Canons, was only clarified in the 20th century. (On the other hand, it was in force when Convention consented to the division of the Diocese of Dallas that resulted in the Diocese of Fort Worth.) However, the process and order of events in forming new dioceses hasn’t changed.

It makes you wonder why Bishop Iker would make an assertion so demonstrably false; or, maybe it doesn’t.

Update: Esteemed colleague Mark Harris of Preludium has provided additional details in reaching the same conclusion. It's worth the time to read.