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.