Tuesday, November 23, 2010

For Episcopal Chaplains: Info on the 2011 Annual Meeting of AEHC

Let me share a brief note for my Episcopal chaplain colleagues.  Members of the Executive Committee of the Assembly of Episcopal Healthcare Chaplains (AEHC) are making preparations for our next Annual Meeting.  Once again this year we will meet in the context of the Annual Conference of the Association of Professional Chaplains (APC), meeting in Dallas March 24 through 27.  At this point, it appears that AEHC events will take place Friday, March 25.

Again this year AEHC will sponsor the Episcopal Breakfast on that Friday morning.  In light of changes to the APC Conference schedule, we will also incorporate the AEHC Conference Eucharist and the Annual Meeting into the Breakfast.  We will also have the AEHC Annual Banquet that Friday evening.  Our speaker will be Lee Hogan, Program coordinator for the Anglican Health Network (AHN).  He is particularly involved in the Health Microinsurance program that the AHN is piloting in Tanzania.  I have met Mr. Hogan, and have heard him speak on this subject.  His conviction about the program is contagious.  Look for more information as details are made final.

And if you’d like recent information about the Anglican Health Network, check out the website.  The October Newsletter is available there, with information about the Health Microinsurance program, and about growth of hospitals in India’s Kerala State, supported by the Church of South India.  It’s exciting reading for those of us who are interested in not only knowing about but supporting health ministries across the Communion.

Monday, November 22, 2010

Some Thoughts (Someone Else's Good Thoughts) on Interfaith Encounters

Years ago I served in a hospital where we used volunteers quite extensively.  We trained them ourselves to provide some basic introductory visits and help us identify patients who would need or want more attention from a staff chaplain.

One year an employee expressed an interest in becoming a volunteer.  He was a nurse aid working the night shift (11:00 p.m. tp 7:00 a.m.), and a minister in a small storefront church.  He offered in no small part to save us staff chaplains some relief with on call.  He could, he felt, respond himself, in that he was already in house (at least in the worst hours for us), and provide appropriate care.

That said, we quickly discovered that he wasn’t going to fit our structures.  His interest was in bringing patients to Christ, and especially in helping them see their need of Christ in the midst of a health crisis.  As such, he wasn’t really showing respect for patients in the terms of their own spiritual journies.

One night we met with him after the training session.  Being in Detroit, with the largest Muslim population in the country and also a large Jewish population, we asked how he would care for patients from those communities.  “Oh, I’m happy to care for Jewish or Muslim patients.  For the Jewish patient, I would speak of Jesus as the fulfillment of prophecy.  For the Muslim patient, I would speak of Jesus as a prophet, and also more than a prophet.”

After that, we pretty quickly determined that we couldn’t work with him as a volunteer.  We pointed out, too, that as one of the few aids working the night shift, his manager wouldn’t want him running all over the hospital providing spiritual care when that wasn’t part of his job expectations.

So, how is a Christian to approach folks of other religions, and appreciate how we might address those persons?  Well, Frederick Quinn, a colleague of mine at Episcopal CafĂ© has posted three essays on the subject, and I commend them to your attention.  They are:

I grant you that Quinn is an Episcopalian writing for Episcopalians.  However, for me and for my chaplain and clergy colleagues who are Episcopalians, this is a meaningful approach to the discussion.  For my chaplain and clergy colleagues who aren’t Episcopalians, I would suggest it is still worthwhile, at least to stimulate thought.

So, give these essays a few minutes.  Pluralism is the most common (and much argued) attitude that folks bring to interfaith relations.  Quinn’s essays can bring us back to foundations, and as his last essay suggests, see where we might yet go.

Wednesday, November 17, 2010

The New Game of the Proposed Anglican Covenant

The words are flying like a game of dodgeball on a playground. All of the players have points to score, and they do their best to combine speed and accuracy. The players twist and turn, trying to avoid being struck. When the balls do hit home, they certainly sting. None of the players really wants anyone else to walk away from the game, to take a ball and go home. At the same time, each of the players is wondering if elimination in the game will become elimination from the game, as if having to leave the field of play also means having to leave the neighborhood.

The topic is the Anglican Covenant. The occasion and the sense of urgency is the meeting of the General Synod of the Church of England, where there will be an initial vote on the Anglican Covenant as proposed. Proponents of the Covenant seem to seek in the same breath to be reassuring and convicting. Opponents seem convicted but certainly not reassured. Godwin’s Law has been cited.

Perhaps I’m too well informed, but I’ve been reading and paying attention. I think I understand several themes in the argument. Opponents say that this document creates new institutions, institutions that have authority at least for signatory churches, and perhaps within the existing Instruments of Communion. Proponents point out (with some merit) that there aren’t new institutions, and that any authority is persuasive and commendatory, and not juridical. Proponents say that the Covenant respects the autonomy and internal structures of signatory churches, and point to explicit language within the Draft. Opponents say that the commitments the Covenant seems to require undermine local constitutional structures in ways that belie the explicit language. Opponents say that the Covenant creates a coercive environment in which one province’s displeasure can stifle Spirit-led innovation, or at least make the cost such innovation excommunication. Proponents say that the Covenant provides ground rules to keep signatory churches in conversation while such differences are discussed, and so prevent excommunication, or at least forestall it as long as possible.

Yesterday, Canon Alyson Barnett-Cowan, Director for Unity Faith and Order for the Anglican Communion Office issued an interpretive comment.  That, too, has become part of the game, another ball to be thrown, another target to be thrown at. However, it did include one comment that everyone would agree to, if not to the same point. If we are to comment on the Covenant as proposed, we need to read it.

So, I went back and read it again, looking perhaps for a new way to think about it. That’s when I discovered something I found a bit confusing. It is that the Covenant doesn’t really clarify the relationship between churches of the Anglican Communion and signatory churches of the Anglican Covenant.

Now, that’s not obvious at first. After all, it is titled, “The Anglican Communion Covenant.” Moreover, in the Preamble it states that those who “solemnly covenant together in these following affirmations and commitments” come from the “Churches of the Anglican Communion.” Much of the text is dedicated to describing a common heritage among churches in the Anglican Communion. However, all that notwithstanding, the relationship between the churches of the Anglican Communion and the signatory churches remains unclear.

The thing is, the Covenant as proposed only applies to signatory churches. That’s clear, isn’t it? Churches that don’t sign on aren’t bound by the Covenant. This is clear in Section 4, considered critical enough that it survived three revisions. Certainly, the hope of those who propose it is that all the churches of the Anglican Communion will sign: as paragraph 4.1.4 states, “Every Church of the Anglican Communion, as recognised in accordance with the Constitution of the Anglican Consultative Council, is invited to enter into this Covenant according to its own constitutional procedures.” This clarifies a couple of important things. First, the proposers have decided that participation in the Anglican Communion is defined by the Constitution of the Anglican Consultative Council (ACC) – and, so, not by signing onto the Covenant. So, if the Anglican Communion is those churches recognized by the ACC, signatory churches of the Covenant are something else – churches of the Anglican Covenant.

The next paragraph goes even further in making the distinction:

(4.1.5) The Instruments of Communion may invite other Churches to adopt the Covenant using the same procedures as set out by the Anglican Consultative Council for the amendment of its schedule of membership. Adoption of this Covenant does not confer any right of recognition by, or membership of, the Instruments of Communion, which shall be decided by those Instruments themselves.

Now, this creates an even more interesting distinction. See, while some other churches may adopt the Covenant in response to an invitation to join the ACC (“procedures… for the amendment of [ACC] membership”), it’s also possible to adopt without that invitation. Under what other circumstances would adoption not “confer any right of recognition by, or membership of, the Instruments of Communion?” Adoption that includes joining the ACC would certainly confer such rights.

And, of course, “This Covenant becomes active for a Church when that Church adopts the Covenant through the procedures of its own Constitution and Canons.” So, the Covenant has no meaning, no authority for any Church that doesn’t adopt it; and even for a Church that does adopt it internally (“through the procedures of its own Constitution and Canons.”), adoption in itself does not make the Church a member of the Anglican Communion as defined by membership in the ACC.

This is confirmed by the acceptance of the reverse:

(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 of Communion or a repudiation of its Anglican character, it may raise a question relating to the meaning of the Covenant, and of compatibility with the principles incorporated within it, and trigger the provisions set out in section 4.2 above.

So, just as adoption of the Covenant doesn’t make a church a member Church of the Anglican Communion, withdrawal from the Covenant doesn’t in itself remove one from the Anglican Communion. It would certainly “raise a question relating to the meaning of the Covenant, and of compatibility with the principles incorporated within it,” and perhaps even “trigger the provisions set out in section 4.2 above.” But, those provisions are only applicable for those who have signed the Covenant, and not automatically to the Churches of the Communion

But, what about all those commitments made in the first three sections, commitments that are intended as meaningful consequences of accepting the characteristics of the Anglican heritage as described in those sections? While Anglicans broadly may accept them (indeed, with a few small reservations I can accept them), they are only grounds per se for agreement, or for disagreement, for those churches that sign on to the Covenant. Indeed, the commitments themselves state again and again that they are not specifically Anglican, but are “common pilgrimage with the whole Body of Christ” (1.2.8) and part of “the work of the whole people of God” (2.2.4)

So, we really do have two bodies. We have the Churches of the Anglican Communion, defined as such (at least for the Covenant) by the Constitution of the ACC; and we have this other body of those churches that are signatory to the Covenant. These two bodies are broadly overlapping but not identical. So, at least at the beginning, we have the Churches of the Anglican Communion and the Churches of the Anglican Covenant.

I grant you, it does add to the confusion that the Churches of the Anglican Covenant plan to make use of the Standing Committee of the Anglican Communion as overseer of common life and arbiter of differences. It doesn’t help that in disputes there is consultation with and deference to the Instruments of [the Anglican] Communion, even apparently for churches that have no “right of recognition by, or membership of, the Instruments of Communion.”

However, as I read this Covenant as proposed, it makes an important distinction between the Churches of the Anglican Communion and what I have called “the Churches of the Anglican Covenant.” Under the Covenant, “Churches of the Anglican Covenant” are accountable under the Covenant’s provisions to one another, and even (through respect for the Instruments) to Churches of the Anglican Communion. However, a church of the Anglican Communion (a member of ACC) is not necessarily accountable to a Church of the Covenant (whether or not that church is a member of ACC).

So, for example, we can do a thought experiment. Say that Uganda and Australia sign the Covenant and the Episcopal Church doesn’t. Say then that Uganda raises with Australia an issue regarding lay or diaconal presidency at the Eucharist. Under the Covenant Australia is accountable to Uganda. However, the Standing Committee would consult with one or more of the Instruments; and the Episcopal Church participates in three of them (Lambeth, the Primates meetings, and, critically, the ACC). So, even without signing the Covenant, the Episcopal Church would be at least influential in the recommendations to the Standing Committee, and so (at least possibly) in the recommendations of the Standing Committee to Australia – recommendations that, if not accepted, could lead to discipline of Australia under the Covenant.

I like my games analogy for understanding this, but I want to suggest different games. Bid whist is not contract bridge is not spades. All three games have similar play, but rules that are different in important ways. So, by establishing a new set of rules for those who sign on, the Covenant creates a new body and a new game – a coherent game, certainly, but not one by which players of other, earlier games are bound. There is no automatic relationship, and no automatic accountability, between a Church of the Anglican Communion and a Church of the Anglican Covenant. Canon Barnett-Cowan actually does get this. Look again at her statement,

It is also not true that non-signatories would no longer count as part of the Communion. There will be Provinces which have adopted the Covenant, and there may be (though one hopes not) Provinces which have not. They are equally members of the Anglican Communion, according to the Constitution of the Anglican Consultative Council. The difference would be that signatories will have made a commitment to live in that communion in a particularly enhanced way, and to a process of consultation and common discernment.

So, Churches of the Communion remain Churches of the Communion; and Churches of the Covenant, who may or may not be a Church of the Communion, have decided to embrace external accountability, and all the limitations that might come with it. Is this an “enhanced” way of “[living] in that communion?” Well, no, since member churches of the Covenant are not automatically members of the Anglican Communion; but also, yes, if perhaps in the sense that the penalties for differences within the Churches of the Covenant might be said to be “enhanced.”

Without doubt, and within its own terms, the Anglican Covenant as proposed creates a “new game,” refined from the terms of the “old game” as contract bridge was refined from whist. It creates less two tiers within the Communion and more two overlapping bodies, one accountable within the terms of the Communion (however few and vague they may be), and one accountable both within the terms of the Communion and of the Covenant. Somehow, I can’t imagine that bringing more clarity. Instead, it seems to me to bring less; and if it brings less clarity, then something less than “the highest degree of communion possible.” (3.2.7) And if that’s the result, I don’t see why the Episcopal Church, or any other Church, should be all that interested.

Monday, November 15, 2010

The Coming Medicare Bomb - Again

In my paper this morning was an editorial by a local physician pointing again to the issues raised by how we currently pay doctors for seeing patients under Medicare.  Here is a similar editorial in the Nashville Tennessean by a physician there.  Both point out as well that these reimbursement issues apply to Tricare, and so apply to the families of active duty service members.

Of course, receiving 25% less money for the same level of care, the same number of patients and procedures, is a problem for most doctors, who are, as private practitioners, essentially small business owners or participants.  While most are all for looking for more efficiencies and other ways to save money, that won’t be enough.  So, some doctors are deciding that they will not accept any new Medicare patients.  Of course, as our society is aging and living longer, there are more and more new Medicare patients all the time.

These doctors aren’t pointing to new discoveries.  These difficulties have been known for a while.  Yes, there was a new story in the Boston Herald this weekend; but, there was also a paper ten years ago.  In fact, I found a story in the New York Times in 1992.  That’s how far back this issue goes.

For a number of years now Congress has been acting every year for some time now to stave off the reductions in reimbursement.  They’ve prevented the problem from getting worse, but they haven’t done what needs to be done to make the problem better.  That would require reconsidering the way in which these reimbursements are set.  Unfortunately, that’s a lot harder than simply saying, “Well, we just won’t allow that change  - this year.”

It seems to me that there is a failed premise behind this.  The idea is that if Government restricts what doctors get paid, the doctors will buckle down, become more efficient, become more productive, and costs won’t rise.  Of course, other costs aren’t controlled that way.  So, the doctors have been paying more each year for everything from their supplies to their utilities.  They’ve had to pay their employees more each year.  They’ve even had to pay more each year to provide their employees with health insurance.  At some point these lines have to cross: doctors can see only so many patients, and can provide only so many services, and sooner or later they simply can’t “do more with less.”  There simply isn’t anything more to cut.  Politicians love to talk about “trimming the fat,” but sooner or later there’s no fat left to cut – and eventually damned little steak!

The doctors whose editorials I cite want folks to communicate to members of Congress.  I think that’s a good idea, even if in the current climate one could feel hopeless of actually being heard.  I think it’s a good idea to send an email or a fax, or make a phone call – or even send letter by post, despite the fact that security will slow delivery.  No, it probably won’t be fixed quickly.  But if we as citizens push steadily, it can be fixed.

Thursday, November 04, 2010

'Twas the Night Before Convention

Over the years, there is something I've said many times to students and new volunteers.  Eventually, it comes down to this: we pray for the Spirit, and trust our guts.  Barring a vision or an audition - and if it's going to come, it would be best for it to come to all of us - that may well be where many of us are for the election of the next bishop.

And after years of that approach, I remain convicted that if I'm praying faithfully, by God's grace my gut is trustworthy.

Monday, November 01, 2010

Thought for the Day Before the Midterm Elections

Remember, America: there's someone out there who doesn't want you to go vote!  Don't give that person the satisfaction!