Wednesday, April 29, 2009

Another Voice of a Chaplain

Usually, when I'm pointing to Episcopal Cafe, it's usually to my own latest post there. Today, I'm pointing to someone else. As I find them, I post here links to articles from chaplains and about chaplaincy that I think are worth reading. Today's post at Daily Episcopalian is from the Rev. Joy Caires. Now a parish priest, she was early in her career a chaplain at Rainbow Babies and Children's Hospital in Cleveland, Ohio. Her post offers a reflection connecting one of her days in chaplaincy to the message of Easter. I encourage you to read and enjoy it.

Tuesday, April 21, 2009

Once Again at Episcopal Cafe

My newest piece is up now at Episcopal Cafe. I suppose you could say it is in keeping with some of my continuing professional interests, because it's about research - and Easter. I hope you enjoy it.

While you're there, take time to look at other posts and other reports at Episcopal Cafe. I'm in the company of some fine folks there, and I think you'll find their work interesting as well. So, take a look around, leave a comment, and come back again.

Monday, April 20, 2009

General Convention 2009: Health Issues 3

This is my third post on the Report to General Convention of the Standing Commission on Health. Let me address another topic from that Report.

Perhaps more attention in this Report is paid to issues related to disabled persons than to any other issue. Acknowledging thankfully the work of the Episcopal Disabilities Network, the Commission notes, “As a church whose mission is to be inclusive in welcoming all people to live in sacred community, the welcoming of disabled persons is often made difficult and sometimes impossible by the lack of attention to accessibility to facilities and to programs.” The Commissions first step is to point to resources:

The Disability Concerns Committee in the Diocese of Massachusetts has developed a series of leaflets and other printed material that are available for use throughout the church. The SCOH commends these excellent aids listed below.

  • How a ‘Disability Matters Committee’ can work in a parish.
  • Parish Prayer about disability matters.
  • A Cane Means ‘Don’t Bump!’ – an educational program for pre-schoolers.
  • Your rights and obligations as a parent or a godparent of a child with special needs.
  • Preparing my child with special needs for independent Christian living as an adult.
  • Disability policies for Episcopal parishes.
  • Your congregation is getting an elevator or a lift.
  • Where to place wheelchair cut-outs in sanctuaries.
  • Oh, so your parish is getting a ramp! Making it do its job.
  • Possible funding sources for disability work in Episcopal congregations.
  • Conducting a Visit-ability survey of parishioners’ homes.
  • Episcopal church web site disability notices.
  • Principles to use in church disability access work.
  • Facilitating relationships between parishioners with developmental disabilities and other parishioners.

  • Ideas for a Diocesan Disability Matters Committee.
  • Proposed sample web page for a diocese beginning disability work.
  • Establishing a diocesan architect consultation program.
  • Usher training workshop ideas regarding disability matters.

Having suggested meaningful resources, the Commission Report presents two resolutions. The first speaks to issues of discernment of vocations for disabled persons.

Resolved, the House of _____ concurring, That all Dioceses encourage qualified people with disabilities to begin ministry discernment as described in Title III of the Constitution and Canons of The Episcopal Church; and be it further

Resolved, That the discernment process for people with disabilities be the same as the discernment process for persons who are temporarily able-bodied; and be it further

Resolved, the Commissions on Ministry and Standing Committees apply the same standards to persons with disabilities as they apply to persons who are temporarily able-bodied.

That phrase, “temporarily able-bodied” might be considered an important corrective to our perspective. As the Report notes, “We are an aging church—50% of all Episcopalians are over 50 years of age. If one lives long enough, one will acquire one or more disabilities.” However, at this point, “Although people with disabilities comprise the largest minority in the country, there are no more than a handful of clergy with disabilities who are active in The Episcopal Church.” The Report also notes the unique gifts disabled clergy could bring, not only to ministry with disabled parishioners, but also to ministry with those with chronic illnesses, and also to the Church’s demonstration of full inclusion.

The second resolution speaks to full inclusion in official meetings of the Church.

Resolved, the House of _____ concurring, That reasonable accommodations, such as sign language interpreters, motorized scooters or similar adaptive equipment, be made available and financed by The Episcopal Church, dioceses or parishes sending staff members or volunteers who are disabled to conferences or meetings on behalf of the church.

It is worth noting that these resolutions are consistent with past actions of General Convention. Resolution 1985-A087 calls for “all Episcopal Church properties and all Episcopal Church meeting places be made (so far as possible) accessible… and barrier-free;” for “qualified persons with disabilities not [to] be disqualified for postulancy, for Holy Orders, for ordination or for further employment in the Church solely on the basis of their handicap;” and “[t]hat this Church at national, diocesan and local places encourage and support the assumption of leadership roles in both church and community by qualified persons who have disabilities.” Access to the ordination process was specifically affirmed in 1994 when resolution C020 added, among other important categories, physical disability to canonical categories for non-discrimination, and resolution D007 changed the Ministry Canons so that, again among others, those with physical disabilities would not be denied access to the ordination process. We can also note that resolution 1991-D089 commended the Americans with Disabilities Act, and called on Church organizations to comply.

With these references to past actions of General Convention, one might ask whether new resolutions are necessary. My own observation as one who is interested in what General Convention has said on various subjects is that we Episcopalians can have remarkably short memories from one Convention to the next. We are too prone to react to the exciting issue of any given year, and pay little attention to other actions of continuing merit. As a hospital chaplain, I can assure you that persons living with disabilities are still marginalized, and often invisible in our society. It is certainly helpful that more and more supermarkets and megastores are offering powerchairs for shoppers. In a way that important corrective that most of us are simply “temporarily able-bodied” is coming to our attention. At the same time, there are still barriers, physical, emotional, and social to the full participation of persons with disabilities in our the life of our society. We can renew our efforts that there may be no barriers to their full participation in the life of the Church.

Tuesday, April 14, 2009

Thoughts on Ecclesiastical Endorsement

Over the past three years that I've been writing this blog, I've paid some attention to why people find their ways to read something I've written. I use a service that will let me see, among other things, what keywords in a search engine lead a reader here.

It will not surprise anyone that one of those search strings is, "How do I become an Episcopal Chaplain?" It certainly helps that I've written a post describing the process of becoming a chaplain in the Episcopal Church. It helps, I must confess, that there just aren't that many Episcopal chaplains blogging. In any case, every week I have several visitors here who are exploring becoming an Episcopal chaplain.

And a critical piece of that is ecclesiastical endorsement. Ecclesiastical endorsement is an acknowledgement by an individual's faith community, or by an orqanization representative of the individual's faith tradition, that the individual has what a Christian might call a valid call to specialized ministry in health care. Some years ago I served on the Quality Commission of the Association of Professional Chaplains (APC). In those days, we spoke about endorsement as signifying "religious competence" in the pastoral care tradition within a faith community: something more than simply being in good standing, and something different than the "clinical competence" certified by such certifying bodies as APC or ACPE or CPSP.

Discussion of the role and value of ecclesiastical endorsement continues. Recently there have been three articles posted at PlainViews on the subject. The first is a complaint about the requirement, with a suggestion that ecclesiastical endorsement no longer be required. The second and the third are the collected responses to the first article, including one from representatives of the community of endorsing groups. I think it worth our time as chaplains to read both carefully.

I was especially struck in the second article by the rationale for endorsement according to the endorsing officers. They wrote,

  • Ministerial and theological competence
  • Good standing and accountability within that faith community
  • Ability to work collegially in diverse and pluralistic environments
  • Willingness to adhere to the codes of ethics prescribed by the faith groups, institutions served and the agencies providing certification
  • Continuing spiritual formation and review
  • Academic and clinical education
Endorsement is not a legalistic ritual; rather it is a mutual covenant and relationship between the endorsee, the endorsing faith group and the certifying body. Each and all are to benefit.

These are important considerations, and especially those relating to accountability, ethical standards, and continuing education.

At the same time, Dr. Paul Brassey, author of the original article. does have points to make.

More broadly, the endorsement requirement presents several problems. First, denominational bodies vary greatly in their requirements for endorsement. Second, some of these endorsing bodies and processes exist to exclude as much as to empower. This exclusivity is accomplished through ensuring that a chaplain’s primary obligation is to the religious denomination. Thus, otherwise gifted, trained, and qualified candidates will be excluded if their spiritual paths have not led them through a denominational structure, or if their personal spiritual journey has led them in a different direction from that of their denomination. Third, this necessity for denominational commitment and loyalty leads many chaplains into the pretense, rather than the reality, of denominational loyalty.

As an Episcopal Chaplain I was quite aware when I was involved in the discussion of the different requirements between and among endorsing bodies. In fact, since the point in endorsement within the Episcopal Church is a person’s call to specialized ministry, a bishop’s confirmation of that has been all that was required. (The process requires contact with the office of the Bishop Suffragan for Chaplaincies; but Bishop Packard’s office is first going to call the individual’s diocesan bishop to see if the applicant is known.) Some perhaps looked at experience and education as part of that decision, but there has been no requirement. Indeed, some bishops do not understand that, unlike endorsement for the Armed Services, lay persons can be endorsed for healthcare chaplaincy; or that under Canon III a position with a healthcare institution is recognized as a valid “call” just like a call to a parish position. Chaplains in other bodies may have to have as much academic and clinical education for endorsement as they have to have for certification.

There are other bodies too small or too congregational to have a central endorsing agency. There are joint efforts to provide some evaluation of persons within those traditions; but their endorsement isn’t really indicative of accountability to a specific faith community. Moreover, I’m not really all that sympathetic to the concern about “those whose spiritual paths have not led them through a denominational structure.” I continue both to bless and grouse about the student who taught me that enthusiasm is no substitute for groundedness. If a person can’t be determined to be religiously competent within a faith community, by what measure could the person be determined religiously competent at all? And if we’re not religiously competent, it’s awfully hard to distinguish us from spiritually conversant social workers or therapists.

I have also been aware of the many chaplains – perhaps most – who are “led… in a different direction from that of their denomination.” I would assert that most of us are in some sense “marginal” to our communities and our traditions. That’s often what fits us to work in multifaith institutions. At the same time, each of us can face decisions between integrity and institutional connection – which sometimes means between personal belief and institutional security. Each of us can face dilemmas balancing clinical work with denominational loyalty, and questions of how much, if any, “pretense” that might require. The question then becomes, as the endorsing agents note, whether that is the responsibility of the individual or of the certifying bodies who require ecclesiastical endorsement.

Episcopal chaplain discuss among themselves whether there ought to be more requirements for endorsement. Should there be requirement for some CPE? Should there be requirement for some formal ministry training – and if so, how much and what kind? Does it apply only to those of us who find our full time professions in healthcare ministry, or more broadly? How about clergy in parishes that also have nursing homes? How about clergy supervising extensive parish visitation programs, like Stevens Ministries or Community of Hope groups? And, how would such a requirement be established? Would if require an act of Convention? A change to Canons? And how would such a call be signified? It’s clear enough for the ordained. For lay chaplains there is an expectation of a public service of endorsement, usually done in a Sunday service. But, should there be some standardization of those services? And what is a lay chaplains accountability to the bishop and the Church? All those questions are coming up.

I believe strongly that endorsement for Episcopal Chaplains should be required, if only to establish accountability within the church. I strongly believe it needs to be normative for certified professional chaplaincy. Those things said, I do think our own questions about how we should view endorsement within and for the Episcopal Church are important. We need, too, to take Dr. Brassey’s questions seriously, even as we also need to offer support to him and to others who struggle with finding their place in faith communities and in chaplaincy.

Wednesday, April 08, 2009

Toward an Anglican Convenant: the Ridley Cambridge Draft

Today the Covenant Design Group has released the newest draft Anglican Covenant. As with previous drafts, this one is designated, because of where the Group met, as the Ridley Cambridge Draft. You can find the text here, and the text with attachments here.

Having spent significant time reflecting on the Nassau and St. Andrews Drafts, I found this one also interesting to read. I won’t do a line by line analysis. I’m sure others will get to that point. However, there are some changes for this draft that stand out quite clearly.

The Ridley Cambridge Draft includes a Preamble and four sections. This is roughly comparable with the St. Andrews Draft, which included three sections and an Appendix. The structure of the document is really much the same, with the issues addressed in the St. Andrews Appendix – addressing and perhaps resolving differences between and among member churches of the Communion – being addressed in Section 4 of the Ridley Cambridge Draft (albeit significantly differently). The Draft is also published with an Introduction. Moreover, the Draft addresses within its text the authority of the Introduction:

(4.4.1) The Covenant consists of the text set out in this document in the Preamble, Sections One to Four and the Declaration. The Introduction to the Covenant Text, which shall always be annexed to the Covenant text, is not part of the Covenant, but shall be accorded authority in understanding the purpose of the Covenant.

The Preamble is brief.

We, as Churches of the Anglican Communion, under the Lordship of Jesus Christ, solemnly covenant together in these following affirmations and commitments. As people of God, drawn from "every nation, tribe, people and language" (Rev 7.9), we do this in order to proclaim more effectively in our different contexts the grace of God revealed in the gospel, to offer God's love in responding to the needs of the world, to maintain the unity of the Spirit in the bond of peace, and together with all God's people to attain the full stature of Christ (Eph 4.3,13).

I find it interesting and helpful that the Draft speaks of “our different contexts.” However, by beginning, “We, as Churches of the Anglican Communion, under the Lordship of Jesus Christ, solemnly covenant together…” the Draft raises the question of whether a national or regional church must participate in the Covenant to participate in the Anglican Communion. In fact this is addressed later in the Draft, as I will note below. However, by distinguishing in 4.4.1 between the Preamble, which is part of the Covenant, and the Introduction, which is “always annexed” but is not, this Draft might raise an issue parallel to one we have considered regarding the Episcopal Constitution and Canons as to the authority of material in a Preamble.

Section One is titled, “Our Inheritance of Faith.” It includes a section of affirmations and a section of commitments. The language of affirmations in this new Section One is changed in reflecting explicitly the language of the Chicago-Lambeth Quadrilateral. In addition, there are references to “shared patterns of our common prayer and liturgy,” and “participation in the apostolic mission of the whole people of God.” There is also a reference to “The historic formularies of the Church of England, forged in the context of the European Reformation and acknowledged and appropriated in various ways in the Anglican Communion, [which] bear authentic witness to this faith.” However, these “historic formularies” are, for this Draft, more “historic” and less “formularies” for the Communion in their import and authority.

The Commitments in Section One are also largely unobjectionable, which is a change in its own right. It is balanced in interesting ways. So, the commitments to “to uphold and proclaim a pattern of Christian theological and moral reasoning and discipline that is rooted in and answerable to the teaching of Holy Scripture and the catholic tradition,” and “to ensure that biblical texts are received, read and interpreted faithfully, respectfully, comprehensively and coherently,” are balanced with commitments to “to hear, read, mark, learn and inwardly digest the Scriptures in our different contexts, informed by the attentive and communal reading of - and costly witness to - the Scriptures by all the faithful, by the teaching of bishops and synods, and by the results of rigorous study by lay and ordained scholars” (emphasis mine), and “to encourage and be open to prophetic and faithful leadership in ministry and mission so as to enable God's people to respond in courageous witness to the power of the gospel in the world” (again, emphasis mine).

Section Two is titled, “The Life We Share with Others: Our Anglican Vocation.” It, too, has both affirmations and commitments. I was especially struck in the affirmations by this item:

(2.1.3) in humility our call to constant repentance: for our failures in exercising patience and charity and in recognizing Christ in one another; our misuse of God's gracious gifts; our failure to heed God's call to serve; and our exploitation one of another.

While not taken from it, this language is to me remarkably like portions of the Litany of Penitence from the Proper Liturgy for Ash Wednesday in the 1979 Book of Common Prayer.

The commitments in this section are interesting, not so much in content, as in the effort to footnote almost each commitment to Scripture, to a broadly supported theological document (including reports to the Anglican Consultative Council and the World Council of Churches), or to both. There are commitments to evangelism, to serve the poor, and to proper care of the earth. There is also a commitment ‘"to seek to transform unjust structures of society" as the Church stands vigilantly with Christ proclaiming both judgment and salvation to the nations of the world.’ In an interesting coincidence, the Rev. Francisco Silva, General Secretary of the Anglican / Episcopal Church in Brazil, wrote asking “Could be human rights a criteria for to be part of the Anglican Communion?” (and thanks to Mark Harris for pointing this out). The Rev. Silva is not hopeful; but this particular commitment seems to point in that direction.

Section Three is titled, “Our Unity and Common Life.” Again, there are both affirmations and commitments. What is remarkable about this draft is that this section affirms repeatedly both explicitly and implicitly that the Anglican Communion is “a Communion of Churches. Each Church, with its bishops in synod, orders and regulates its own affairs and its local responsibility for mission through its own system of government and law and is therefore described as living ‘in communion with autonomy and accountability.’” There is a helpful clarification of the proper histories and roles of the Instruments of Communion, and elimination of the expanded role of the Primates Meetings. Consequently, each member church commits “to respect the constitutional autonomy of all of the Churches of the Anglican Communion, while upholding our mutual responsibility and interdependence in the Body of Christ, and the responsibility of each to the Communion as a whole” (emphasis mine). There are commitments “to seek a shared mind with other Churches,” and ” to act with diligence, care and caution in respect of any action which may provoke controversy, which by its intensity, substance or extent could threaten the unity of the Communion.” At the same time, there is also a commitment “to spend time with openness and patience in matters of theological debate and reflection, to listen, pray and study with one another in order to discern the will of God. Such prayer, study and debate is an essential feature of the life of the Church as its seeks to be led by the Spirit into all truth and to proclaim the gospel afresh in each generation.” Many of us in the Episcopal Church feel that if other churches had spent “time with openness and patience in matters of theological debate and reflection, to listen, pray and study with one another,” as we have done within the Episcopal Church, we might have been able to manage our current differences with clearer communication and greater grace.

Section Four of the Draft is titled, “Our Covenanted Life Together,” and it is this section that will require the most reflection and consideration within the Episcopal Church. As I have already noted, this section parallels in subject the Appendix to the St. Andrews Draft. However, it is broader, in that it includes discussion of adoption of the Covenant; and less juridical in discussing how difference between and among member churches might be addressed. Unlike the complicated framework through which such differences might be brought through various of the Instruments of Communion, in this Draft “The Joint Standing Committee of the Anglican Consultative Council and of the Primates' Meeting, or any body that succeeds it, shall have the duty of overseeing the functioning of the Covenant in the life of the Anglican Communion.” Focusing such work in the Joint Standing Committee simplifies responsibility, and also better balances the importance of the Anglican Communion Council with the Primates’ Meeting in the life of the Communion. This is confirmed in that “the Joint Standing Committee may make a declaration concerning an action or decision of a covenanting Church that such an action or decision is or would be ‘incompatible with the Covenant’” only “On the basis of advice received from the Anglican Consultative Council and the Primates' Meeting” (emphasis mine). So, both “the Primates and Moderators [who] are called to work as representatives of their Provinces in collaboration with one another,” and the ACC, which “is comprised of lay, clerical and episcopal representatives from our Churches,” must be involved in any decision that an action of a member church is “incompatible with the Covenant.” That makes the process both slower and more measured, and also more representative broadly both of all member Churches and all orders of ministry.

At the same time, there is again affirmation of the autonomy of each member Church. So, “Nothing in this Covenant of itself shall be deemed to alter any provision of the Constitution and Canons of any Church of the Communion, or to limit its autonomy of governance. Under the terms of this Covenant, no one Church, nor any agency of the Communion, can exercise control or direction over the internal life of any other covenanted Church.”

(4.1.4) Every Church of the Anglican Communion, as recognised in accordance with the Constitution of the Anglican Consultative Council, is invited to adopt this Covenant in its life according to its own constitutional procedures. Adoption of the Covenant by a Church does not in itself imply any change to its Constitution and Canons, but implies a recognition of those elements which must be maintained in its own life in order to sustain the relationship of covenanted communion established by this Covenant.

There are two interesting items in this section. The first is,

(4.1.5) It shall be open to other Churches to adopt the Covenant. Adoption of this Covenant does not bring any right of recognition by, or membership of, the Instruments of Communion. Such recognition and membership are dependent on the satisfaction of those conditions set out by each of the Instruments. However, adoption of the Covenant by a Church may be accompanied by a formal request to the Instruments for recognition and membership to be acted upon according to each Instrument's procedures.

One wonders who these “other Churches” would be. This would suggest the possibility that the Anglican Church of North America could also adopt the Covenant, and request recognition by one or more Instruments of Communion. One wonders what the consequences would be of ACNA adopting the Covenant, even if not recognized by any of the Instruments; especially as one of the commitments in Section One is “to seek in all things to uphold the solemn obligation to nurture and sustain eucharistic communion….” How would that prepare the ground, as it were, for a challenge from ACNA to some action of the Episcopal Church, whether or not ACNA was recognized by Instruments of Communion?

The second item is this:

(4.3.1) Any covenanting Church may decide to withdraw from the Covenant. Although such withdrawal does not imply an automatic withdrawal from the Instruments or a repudiation of its Anglican character, it raises a question relating to the meaning of the Covenant, and of compatibility with the principles incorporated within it, and it triggers the provisions set out in section 4.2.2 above.

Once again, there is this interesting distinction made between participating in the Covenant and participating in the Instruments of Communion. Looking back at the question implied in the Preamble, one can wonder what the relationships are among “participating in the Covenant;” “recognition by the Instruments of Communion;” and “membership in the Anglican Communion.”

I think there’s a lot to commend the changes that have been made between the St. Andrews Draft and the Ridley Cambridge Draft. As they note in their communiqué, the Covenant Drafting Group has listened to the comments they have received, including clearly those from member churches not considered part of “the Global South.” It remains to be see whether these changes would be enough for the Episcopal Church to participate; or whether they would be too much for some “Global South” churches to participate. It will be interesting first and foremost to see how the Anglican Consultative Council addresses this Draft when it meets next month. After that, it will take some time for member churches to consider this draft according to their constitutional and canonical processes and to decide whether they can participate or not – in the case of the Episcopal Church, at least three years. Over time, we’ll see whether and how this or some other draft Covenant will become part of the life of the Communion; and if so, what changes it will bring.

Monday, April 06, 2009

General Convention 2009: Health Issues 2

Let me continue with the Report to General Convention of the Standing Commission on Health and highlight some other issues raised in the report.

As a hospital chaplain, I’m always particularly aware that papers like this Report focus on health issues as they’re visible in the parish. The fact is that this is appropriate. As important as I feel my ministry is, the sickbed is not the normative experience of the Christian; nor is my ministry at the sickbed the normative experience of Christian ministry for the Christian. Most Christians experience their faith in and with their congregations; and the normative experience they have of ministry, and even of ministry at the sickbed, is with their congregational clergy. I’m happy to support and to complement that; but when those relationships are established, complementary care is the best I have to offer.

So, I note with interest that one of the topics addressed in the report falls under the heading of “Episcopal Health Ministries.” The subject is health ministries developed in and from the parish, and especially Parish Nurses and Ministers of Health. This is the first topic for which the Commission offers a resolution to General Convention:

the House of ______ concurring, That the 76th General Convention urges the congregations of The Episcopal Church, which have not already done so, to explore and implement health ministry as an organizing concept or vital component of outreach and pastoral care of the congregations by 2012; and be it further

Resolved, That the General Convention selects the Sunday closest to St. Luke’s Day (October 18) to be observed annually as Health Ministry Sunday for the recognition of health professionals in the congregation; for consideration of health systems upon the lives of the congregation’s members; for study of the abundant biblical references to health and healing; and for expansion of understanding about health to include body, mind and spirit.

In the Explanation of the resolution, the Commission notes that “Health ministries play a unique and critical role in facilitating the overall health of clergy, staff and congregation.” This is consistent with their comment in the Report itself that “Much of this ministry helps prevent serious illnesses from developing
among the parishioners.”

The Explanation also highlights the work of National Episcopal Health Ministries (NEHM), noting that “NEHM is a valuable resource for those seeking assistance in the development of faith ministries.” I have been aware of the work of NEHM for some time. NEHM, along with the Assembly of Episcopal Healthcare Chaplains (AEHC), was named in Resolution 2000-A079, which first called for a gathering of “representatives of the Episcopal healthcare groups (including the Association of Episcopal Healthcare Chaplains and the National Episcopal Healthcare Ministries) and individuals representing various professions in healthcare and in healthcare policy (recognizing the need for advice on the financial challenges inherent in this area), as well as those engaged in the teaching of, and research on medical ethics and end-of-life issues,” and which resulted in the 2001 Formative Symposium on Health Care. The folks at NEHM have been faithful and consistent advocates for parish-based health ministries, while also appreciating the importance of spiritual care in clinical settings.

The report notes the value of ministries in the parish that might, among other things, provide screenings for many different health issues, to administer vaccines and to organize educational seminars on health issues.” In noting specifically the educational opportunities, the Report points to another issue of importance. That is “Health Literacy.” The Report notes,

In working with those who are carrying out ministries in health care, the SCOH notes that many report that patients and their families often do not understand the basic health information and services needed to make appropriate health decisions. The National Center for Educational Statistics has reported the following:

  • Nearly half (89 million) of American adults cannot understand basic health information.
  • One in three American adults has limited health literacy.
  • 40-80% of medical information that health care providers give is immediately forgotten by patients.
  • Reading level is not always the same as the highest grade of school completed.
  • Most adults read and comprehend information three to five grades below their highest grade completed.
  • One of the many side affects of lower health literacy is premature death. High risk individuals are elderly persons with severe disabilities; persons who are members of cultural, linguistic and ethnic minorities; persons who are chronically underemployed; and persons who are homeless.
  • The SCOH notes that church members can be of significant help in explaining and interpreting information to others as volunteers and friends. Informed decisions can only be made with informed minds and hearts.

Where I work health literacy is certainly a critical issue. It affects any number of healthcare issues. With limited health literacy and so many immediately forgetting what they hear (largely because of stress or because of failure of the provider to “speak English,” and not because of indifference or inattention), we have continuing crises with patient compliance and self-care. Those result in significant waste of resources including money, trying to remediate health crises that might have been prevented. They affect how people understand end of life issues, which the Report addressed; and how people understand news reports on health and fitness. Parish Nurses and Health Ministers, and other kinds of parish-based health ministries, are in a good position to identify parishioners with special needs, to companion them through health decisions, and to education the congregation as a whole on important health and wellness information.

As this Report has noted, the Episcopal Church has a history of supporting universal access to health care. I look forward to some significant changes (well, I think they’re improvements) in how health care is delivered in our society. However, improvements in the delivery system will not eliminate issues of health literacy, nor will they displace the opportunities for ongoing care and support that can be met in parish-based health ministries. These are important issues that the Episcopal Church can not only speak to, but can respond to in our local congregations. So, they are important issues in this Report to General Convention.

Thursday, April 02, 2009

General Convention 2009: Health Issues 1

As I have already mentioned, this is a General Convention year. One thing that means is that I’ll begin once again to look at what has been proposed for this Convention on issues related to health care.

The first place to look is in the report to General Convention of the Standing Commission on Health. This Commission, long dormant, was officially reestablished at the 2003 General Convention, but without funding. In 2006 the Commission was incorporated into an extensive resolution on structure, and was given some (sadly, minimal) funding for the 2006-2009 triennium. Most meetings of the Commission were online, or by phone conference, with only one full face-to-face meeting. That said, the report addresses a number of issues, and I’ll deal with them in turn.

One issue addressed, one that is particularly apt, is that of universal access to health care. This section of the report is brief enough to include it in its entirety:

The [Standing Commission on Health] affirms the continuing advocacy of the Office of Governmental Relations in their lobbying for a health care system in which all may be guaranteed decent and appropriate primary health care during their lives and as they approach death. The SCOH remains concerned that approximately 45 million Americans lack health insurance, and that about 116 million Americans struggle to pay medical bills, are uninsured or underinsured for a time and go without needed care due to the cost.

The SCOH recognizes that the lack of access to medical care has resulted in some of the following negative health consequences for the uninsured: fewer cancer screenings, mammograms, and dental exams; delayed test results and treatment; unfilled or skipped drug prescriptions; and more emergency and hospital visits for care. The uninsured receive inadequate care, endure more pain and suffering and are more likely to die sooner than those who have health insurance coverage.

The SCOH calls attention to the critical impact of the lack of coverage on children, who are more likely to receive little or no care, develop chronic and serious conditions and have an increased risk of hospitalization.

For these reasons, the SCOH reaffirms the positions taken by General Conventions 1991 and 1994 decrying the inequitable health care delivery system of the United States of America and calls upon the President, the Congress, Governors and other leaders to devise a system of universal access for the people of our country and declaring that universal access to quality, cost effective health care services be considered necessary for everyone in the population. (Emphasis in the original)

I have written before of the resolutions cited in this statement. The situation has only become more dire since 1994, and so there is all the more reason for the Episcopal Church to continue a commitment to universal access to health care. That would not require a resolution. On the other hand, as short as our memories can be between General Conventions, I don’t think a resolution would hurt.

The next section of the report is on End of Life Issues. It is also concise.

The Association of Episcopal Healthcare Chaplains and the National Association of Professional Chaplains [sic], who serve on the front line in hospitals across the country and in the places where our military are serving, reported to the SCOH on their urgent concern about the appalling lack of knowledge of end-of-life issues on the part of patients, families, clergy and others as they face end-of-life decisions. The chaplains stressed the utmost importance of continuing and improved education about these issues, including educational opportunities regarding Hospice Care and Palliative Care.

With this report, the SCOH strongly reaffirms the positions taken by General Conventions in 1991 and 1994, found in Resolutions 1991-A093 and 1994-A056, which ‘Establish Principles with Regard to the Prolongation of Life’. Such principles include:

  • Although human life is sacred, death is part of the earthly cycle of life.
  • It is morally wrong and unacceptable to take a human life in order to relieve the suffering caused by incurable disease.
  • Palliative treatment to relieve the pain of persons with progressive incurable illnesses, even if done with knowledge that a hastened death may result, is consistent with theological tenets regarding the sanctity of life.
  • There is no moral obligation to prolong the act of dying by extraordinary means and at all costs if a dying person is ill and has no reasonable expectation of recovery.
  • The church’s members are urged to seek the advice and counsel of members of the church community and, where appropriate, its sacramental life, in contemplating the withholding or removing of life- sustaining systems, including hydration and nutrition.
  • The decision to withhold or withdraw life-sustaining treatment should ultimately rest with the patient or with the patient’s surrogate decision-makers in the case of a mentally incapacitated patient.
  • The patient’s right to self-determination should be respected when a decision is made to be transferred to another facility.
  • Advance written directives should be encouraged, and church members are encouraged to execute such advance directives during good health and competence. The executions of such advance written directives constitute loving and moral acts.

I fear there are a couple of mistakes here that need to be noted. I believe the report intends to refer to the Assembly of Episcopal Healthcare Chaplains (as opposed to Association), and to the Association of Professional Chaplains (I’m not familiar with any organization called the National Association of Professional Chaplains or NAPC). Also, while I’m a past president of AEHC and am Board Certified in APC, I’m also aware of chaplains in other organizations “who serve on the front line in hospitals across the country.” ACPE and CPSP come immediately to mind. This mistake notwithstanding (and I’m sure it is simply a mistake), I am sure that all of us who are Episcopal chaplains share an “urgent concern about the appalling lack of knowledge of end-of-life issues on the part of patients, families, clergy and others as they face end-of-life decisions.”

I have also written about the resolutions cited in this part of the report (here and here). I appreciate that the report quotes the central points of those resolutions. Once again, I appreciate that in receiving this Report the General Convention will be reaffirming positions already taken, so that a resolution would not be required. Once again, I wonder whether a resolution might not have emphasized and publicized the point.

So, let’s start there. These are the first two issues addressed in the report of the Standing Commission on Health. As of this date there have been no resolutions submitted on these subjects. It will be interesting to see whether any are submitted, and what their content might be.