Sunday, December 18, 2011

In These Days of Advent

My Advent piece is now up at the Episcopal Cafe. Yes, I know it will be Christmas soon; but it's still Advent now. In fact, if you'll go read the piece, I think you'll want to hang onto these last days of preparation. It isn't Christmas until it's Christmas. Don't jump ahead.

While  you're there, as always I encourage you to take a look at the many other great essays and news items and opportunities for reflection that make up the Cafe. Take some time. Leave a comment. At the Cafe we want to offer some of the best of the Episcopal Church. We hope you'll feel we're successful.

Monday, December 12, 2011

"I Read About This Case...."

Just how valuable is anecdotal evidence? In my world, “anecdotal evidence” refers to the individual interesting story. In a world that is shaped – or at least believes it is shaped – by research, anecdotal evidence is interesting, but not all that valuable. They are almost always interesting, but usually too exceptional to be useful.

Unless, that is, it’s brought up by an anxious family member. In that case, it is a moment to grasp at slim hope; and in that case, the story almost always begins something like, “I read about this one case….”

So, it caught my attention when this AP story showed up in my paper. While they are not the whole content of the story, it is built around two exceptional young women. They share the distinction of each having weighed less than ten ounces, and having lived to tell about it (so to speak). They have had remarkably few ongoing health problems. They are perhaps as exceptional a pair as we might find in any set of health statistics.

And the article does note that. Early on the reporter notes,

A medical report from the doctor who resuscitated the infants at a suburban Chicago hospital is both a success story and a cautionary tale. These two are the exceptions and their remarkable health years later should not raise false hope: Most babies this small do poorly and many do not survive even with advanced medical care.

It would be more true to say, “most do not survive with advanced medical care.” The article notes the research of a physician who tracks data on this, and says that, “about 7,500 U.S. babies are born each year weighing less than 1 pound, and that about 10 percent survive.” Which is to say, of course, that 90 percent die, even with all the medical technology that we can bring to bear.

The article notes that this is especially important in trying to determine at what point a fetus is viable. This is an important consideration in two hot questions in medical ethics. The first is when it is or is not appropriate to treat. That is, what is the point after which all the medical technology might benefit this new child, and before which it won’t – and so arguably isn’t worth putting this new child through. All the medical technology is scarce and expensive; and while there is resistance to the idea of rationing that care, it’s a reasonable question whether there are circumstances in which it would be wasteful.

The second hot question is abortion. In efforts to regulate abortion, and especially after the first trimester, many states have sought to identify some point of “viability,” some point in gestational development after which most fetuses (and in application any individual fetus) will probably survive, and so should have some measure of legal personhood – enough at least for the state to defend.

The difficult thing is that these cases don’t really help us know about viability. Yes, they have survived, and indeed have thrived; and, like other anecdotal evidence, they are too exceptional to be really useful.

That doesn’t mean, though, that these stories won’t come up. Such stories always come up. It is at that point when physicians and other health professionals need to step beyond simple statistics. It is at that point when they have to become more specific and discuss why this case – this person, this fetus, this patient – is more likely to be on the 90 percent and not in the 10 percent. That’s not an easy task. It almost always involves telling people something they don’t want to hear, something that emotionally they may not be able to hear.

At the same time, it’s what we have to do (and I say “we” advisedly; because helping hear what they’ve been told is also part of what a chaplain might be called to do). It’s all we can do. Our best information and our best medical guidance is all we can offer in response to this opening: “I read about this one case….”

Saturday, December 10, 2011

The Good News Really Is Good News: Reflections for Advent 3, Year B

From the lessons for this Sunday, the 3rd of Advent:

“The spirit of the Lord GOD is upon me,
    because the LORD has anointed me;
he has sent me to bring good news to the oppressed,
    to bind up the brokenhearted,
to proclaim liberty to the captives,
    and release to the prisoners;
to proclaim the year of the LORD's favor….” (Isaiah 61:1-2a)

Wait a minute! Don’t we hear that somewhere else?  Of course!  We hear if from Jesus.

“When he came to Nazareth, where he had been brought up, he went to the synagogue on the sabbath day, as was his custom. He stood up to read, and the scroll of the prophet Isaiah was given to him. He unrolled the scroll and found the place where it was written:
‘The Spirit of the Lord is upon me,
   because he has anointed me
     to bring good news to the poor.
He has sent me to proclaim release to the captives
   and recovery of sight to the blind,
     to let the oppressed go free,
to proclaim the year of the Lord’s favor.’” (Luke 4:16-19)

So, this Sunday as we find ourselves in the story just before the public presentation of Jesus the adult (that is, just before the baptism and, in John, the encounter with the first disciples) and in the church calendar just before the celebration of Jesus the infant, we also find ourselves just at the beginning of Jesus’ public ministry, at least as recorded by Luke. In the context of Luke, we would say that this is Jesus’ opening description of his own ministry. Surely to those who heard Jesus in the synagogue at Nazareth this would bring to mind not just the memory of Isaiah’s prophecy, but also the context in which he prophesied. He prophesied to folks who had returned to Jerusalem, only to find that it wasn’t all that they had hoped. So in Jesus’ time Jerusalem was not all that the people might hope: occupied by Roman troops, ruled by cooperation – one might even say conspiracy – between a Roman governor, a puppet king, and the religious establishment, but certainly not by God.

In the midst of that confusion, that darkness, John comes baptizing and preaching. When representatives of the religious establishment come and ask, “Who are you,” all he says at first is who he is not: “Not Messiah, not Elijah, not even the prophet predicted by Moses.” Whoever he is, he finds more important who he is not. “I’m one calling you to prepare. Another is coming, greater than I, and I am not worthy to be his slave.”

These days as we look at a world that is not all that we might hope – wars and rumors of wars, economic injustice, and a world apparently ruled by those whose first question is, “What’s in it for me and mine” – we are called to be people of hope. We are called to proclaim as Jesus did that God’s intent is good news and health and freedom and restoration. We are called to proclaim the time when the Lord’s grace will rule all, when all things will be set just as God intends. It isn’t necessarily easy, and it won’t always be heard. That doesn’t matter. Jesus confirmed what Isaiah proclaimed: that God’s plan is for wholeness and restoration. In our generation, it’s our vocation to pass that on.

Thursday, December 01, 2011

Another Chaplain's Voice

I'm always interested in another blog about health care chaplaincy. There just aren't that many. However, I've discovered another. Check out The World of Pastoral And Spiritual Care. The author is a rabbi and chaplain in New Jersey. The posts and citations are interesting. So, give it a read.


Sunday, November 27, 2011

Remembering That Insurance Isn't Necessarily Enough

A friend picked up on this video on YouTube:

If you don't know Elizabeth Warren, it's time you did. She was President Obama's choice to establish the new Consumer Financial Protection Bureau, intended to monitor investment practices on behalf of the general public. She got the Bureau established; but when the President wanted to nominate her as its first head, Republicans in the Senate made it clear she could never be confirmed - a telling point, if one can be known by one's enemies. She is now running for the Senate herself.

Her point in this video: even those of us with insurance can be bankrupted by medical expenses. This isn't the result of any one factor. However, with all the various reasons for this, it remains a cautionary tale.  Take a few minutes to watch.

Tuesday, November 08, 2011

On God and Job Descriptions: Reflections on Proper 17A

Yeah, I know this it a bit behind. It's been an interesting autumn. But, more about that another time.

Most of us – certainly, all of us who are adults – have at one time or another been through the process of hearing a job description. It might come as part of a job interview. It might come as part of a peer review process, or perhaps an annual review. But one way or another, most of us have listened to a detailed job description.

Which is, really, what happened to Moses.

Now, Moses had been coping with a serious identity problem. Was he a Hebrew slave? Was he an Egyptian prince? All of this came to head when he killed that Egyptian overseer – something that would make sense for a Hebrew slave, but which only an Egyptian prince could get away with. That was the reaction the next day of the other Hebrews: “Who are you? You’re nothing but a murderer!” Then he fled to Midian. There he married a preacher’s daughter, and became a shepherd. Hebrew slave, Egyptian prince, murderer, shepherd – that has to be an identity crisis to end all identity crises!

So, there he was, out in the wilderness with the flock, when he sees the bush; and it’s burning – except it’s not. It’s flaming – yet nothing goes to coal or ash. “This,” he says, “I’ve got to see.” He turns aside, and when he gets close enough, God calls to him: “Moses, take off your shoes. You’re standing on holy ground.”

And then God gives Moses a job: “I’ve seen how my people suffer at the hands of the Egyptians. I’m going to bring them out; and I’m going to send you to do it.”

Now, this is pretty basic as a job description – but Moses wants none of it! He starts to crawfish, coming up with every reason he can think of that he’s not the right person. He doesn’t speak well, and he doesn’t make much of an impression. First and foremost, he says, “Who am I to go? More important, when they ask, who can I say sent me?”

And God answers: “I am who I am;” or, “I will be who I will be;’ or, perhaps, “Is-ness. And that will be my name forever.”

But for all of that, Moses wants nothing to do with it; and won’t, until God eliminates all his objections. But, this got me to thinking: Moses doesn’t sound all that much like someone we’d accept into the ordination process. After all, when bishops and Commissions on Ministry and seminaries think about who they might consider for ordination, they tend to think about someone who is confident and competent, and certainly not someone with a serious identity crisis. They look for someone who can function independently. When I was in the process, they were looking for “a self-starter.” Fifteen years later, the phrase was “a change agent.” Recently, I’ve heard that the goal is someone who is “entrepreneurial.” And there’s a point to all of this. Most clergy are in one-person positions, or perhaps part of a small staff. The capacity to act independently has its value.

But, Moses wasn’t very “entrepreneurial.” He wanted nothing to do with this job, at least not at first. And yet look what God did with him!

We get caught up in these images of what things are supposed to look like, and especially what leaders are supposed to look like. That was Peter’s problem. He had just proclaimed that Jesus was the Messiah and the Son of God; and Jesus had proclaimed that this confession would be the foundation for the new body. And then he went on to give the job description, to say what being Messiah would mean. It would mean journeying to Jerusalem, where it would mean arrest and torture and crucifixion and death, and then resurrection. But as we know that didn’t fit Peter’s image of the Messiah. Wasn’t the Messiah supposed to raise up Israel again, and, not incidentally, to through out those oppressive Romans and those awful Greek-speaking pagans? So, he took Jesus, pulled him out of earshot, and said, “Wait a minute! Don’t tell them that! God forbid that should happen!”

But Jesus answered so that everyone could hear: “Get behind me, Satan. You are deceived and deceiving. You’re seeing things the way everyone has always seen them; but God sees them differently. And if you can’t see things right you’re a hindrance to me and not a help.”

He went on, “If you want to follow, you need to take up your own cross and follow. If you try to hang on to the life you’ve had, you will lose it. If you will let go of that life for me, you’ll discover new life that you haven’t imagined.”

So, Jesus laid out a new understanding of what it meant to be Messiah, one that included torture and suffering and death; and he laid out a new job description for his disciples. Peter was convinced it was all wrong. He wanted nothing to do with this new job. But, look what God did with him!

The thing is that this is entirely consistent with how God does things. Time and time again God takes someone who isn’t at all entrepreneurial, who often enough is unprepared and uninterested, and in and through that someone carries out God’s purposes. God takes folks who are unexpected and uninspiring and sometimes just flat incompetent, and does wondrous things with them. Those folks we think of as great heroes of the faith didn’t start out heroic at all. That’s just how God does it.

Which ought, I think, to make us both hopeful and anxious. It ought to make us hopeful because these are folks like us – like me. I have to admit that one of my favorite canticles in the Prayer Book is one we largely hear in Lent. I feel quite connected to the Song of Penitence, with its verse, “I have sinned, O Lord, I have sinned,/ and I know my wickedness only too well.” I think if we’re honest, we are all aware of our shortcomings. We can be hopeful to think that God can do wonderful things in and through folks like us – and usually does!

And that’s what might make us anxious. If God can work through folks like us, then we need to consider that God is always calling folks like us – that God is always calling us. Sure, that call doesn’t often come in some great and mysterious event; but it certainly will come. And we are people who say we will respond. Every time we attend a baptism in the Episcopal Church, and at Easter and other times, we say again and again that “We will, with God’s help.” We trust that God in Christ is calling, and we have committed to answer when we hear. In the Baptismal Covenant we have heard, if you will, a job description; and we have committed to the job.

Blessedly, rarely are we called to lead God’s people out of slavery into freedom; but we are called. And few of us will see a burning bush; but we will hear God call. And when we hear we can trust that God can work in us, because God has always worked in folks like us. From a Hebrew mother, who put her child in a basket because she was required to throw him in the river, to a teenage girl, who said to God’s messenger “I will do what God asks;” from a frightened shepherd with an identity crisis to a confused fisherman who, until after the resurrection, can’t keep his foot out of his mouth; God has worked in folks like us to carry out God’s purposes. So when God calls, we need not worry that we’re not good or competent or entrepreneurial or heroic enough. God can do wondrous things through folks like us. God always has.

Thursday, October 20, 2011

Spiritual Assessment in Three Questions

The following article was was published in PlainViews, the online journal for chaplains, on October 4, 2011. (Vol. 8 No. 17) I was happy for the publication. However, since PlainViews is a subscription journal (only limited articles are available for free), I'm aware that many may not have seen the article. Now that the next edition has been released (10/19/2011 Vol. 8 No. 18), I am now posting the article here.

A further note about PlainViews: while full access requires a subscription, many chaplains find it a worthwhile resource, and well worth the cost. You can find subscription information here. If you'd like to see the kind of articles PlainViews provides, you can find many earlier articles at the PlainViewsLegacy Archive Page. Peruse and see for yourself the quality of the material available.

Any profession must take on the task of setting standards of practice, and chaplaincy has been no exception. Especially important for chaplaincy has been the concept of spiritual assessment or diagnosis. Beginning with Paul Pruyser’s book, The Minister as Diagnostician, those of us in the field have been thinking about, and working to develop, means of assessing the spiritual condition and needs of a patient.

That’s not as simple to do as it is to say. What are the appropriate categories? What sort of language works, and how applicable is it to all patients? Especially difficult in our predominantly theistic and even Judeo-Christian culture (yeah, the institutions may be losing influence, and even coherence, but the vast majority of Americans say in surveys that they believe in God or a Higher Power) is coming up with forms that aren’t Judeo-Christian, or even theistic; because there are more folks around than we used to see for whom those categories don’t work.

I have been working for some time with my own system, and have taught it locally. I would also like to share it with and receive comments from colleagues.

I believe that those aspects of our lives that we might call “spiritual” can be discerned through three questions (with gratitude to Douglas Adams, author of The Hitchhiker’s Guide to the Galaxy series). The first:

“What do I believe about Life, the Universe, and Everything?” Is God, or is God not? Is the universe sensible and aware, or mechanical? Are events random, or somehow organized? Does the arc of the universe bend toward justice, or are we alone in the vast, soul-sucking emptiness of space?

The second question:

“Who am I, in light of what I believe about Life, the Universe, and Everything?” Am I the paragon of creation, or a worm and no man? Am I the result of a million years of random chance, or of God’s creative intervention? Am I alone or in a community? 

The third question:

“How ought I to act, based on who I am, in light of what I believe about Life, the Universe, and Everything?” Am I accountable; and if so, to whom? To God? To my fellow human beings? Only to my own conscience? Do I base my actions on principles, or on my emotions? Am I to do unto others as I would have done to me? Or, am I to do unto others before they do unto me?

As a shorthand, I think of the questions as “Reality, Identity, and Morality.” I think these questions can allow us to appreciate the spiritual circumstances of those we serve, and whether they are properly or maladapted.

Consider, for example, these questions, heard often enough by chaplains: “Why is God doing this to me? What did I do to deserve this?” The questioner believes in God, and believes that God is engaged in creation. Specifically, the questioner believes that God attends to this person, who is individually important enough to God to be under direct judgment. The questioner believes that he or she has some agency, which he or she may have misused, and so is accountable. So, just from these two questions we have some sense of the patient’s Reality, Identity, and Morality.

Alternately, consider this comment: “I’m not really religious. I just try to be a good person.” This suggests that the person believes that creation is orderly and not random, and that the person is a participant with meaningful agency. Indeed, this person believes that behaving properly is sufficient, and that there is no need to participate in a religious community to live in a meaningful way.

These are the categories that help me assess a patient’s spiritual status. With them I am able to develop a plan based on supporting the patient’s self awareness and helping the patient adapt to circumstances so as to live appropriately within the patient’s own beliefs. As the concept of adaptation and function are central to the practices of nursing and other ancillary services, it communicates will with other professions. It is simple to apply, and can be based on the patient’s own comments, without requiring interrogation. Finally, it is respectful of the diversity of our contemporary culture. 

Thursday, October 13, 2011

Hearing From Another Chaplain: After the Crash

I've been quiet for a while. I took two and a half weeks of vacation, and between prep time before leaving, and recovery time after returning (a recovery that is still a work in progress!), I haven't had much blog-able in my head, much less time and energy to get it typed and posted.

But I am beginning to catch up, and today took a few minutes to look at some sites I hadn't visited in a while. In the process, I returned to Susan Palwick's blog, Rickety Contrivances of Doing Good. In addition to being an academic and the author of works of science fiction, Susan is an Episcopal lay minister and serves as a volunteer chaplain in her local Emergency Room. (Which is why there's always a link to her blog on my blog.)  That ER is in Reno, Nevada, recently notable for the disaster at the air races. Susan responded to that mass casualty, and posted her reflection on her blog. I would encourage you to go and read it. I know it's been a while now since the event, but her thoughts are absolutely pertinent.

In health care institutions, and especially in hospitals, we drill regularly to prepare for such events. Such a drill is part of what has complicated this first week back. We drill to have our people and our processes prepared; but, blessedly, such events are actually rare. Whenever a colleague has such an experience and shares about it, it's worth our time to read and reflect. So, go over and take a look a what Susan experienced that morning and learned from her experience. It may well be valuable for you, too.

Monday, October 03, 2011

Rationing? What Rationing?

When discussion comes up of government support for universal access to health care, sooner or later an opponent will say, “That will lead to rationing of health care.” Well, there were two stories today on NPR’s “Morning Edition” that clearly demonstrate that rationing is happening right now.

The first story is about drug shortages. Although I’ve written before about “orphan drugs,” drugs that aren’t profitable for pharmaceutical companies because there are too few patients who need them (although they need them critically) to make a profit, these shortages aren’t of those drugs. They’re about labetalol, a well established drug for controlling blood pressure; and the form of calcium that’s used in IV parenteral nutrition; and a well established drug for ovarian cancer. The difficulties have to do with how few manufacturers there are for many of these drugs. But whatever the cause, the result is the same: decisions have to be made about which patients get the drugs and which don’t. In some cases – perhaps in most cases – there may be a substitute to offer. Often, however, the substitute isn’t as effective, or isn’t as cheap; and sometimes there isn’t a substitute to offer. One way or another, decisions are made about rationing care.

The second story is about the a case presented to the Supreme Court of the U.S. today, the first day of the new Court season. The state of California lowered reimbursement to physicians under Medicaid. However, Medicaid is jointly funded by the state and the Federal Government, and the law requires that such changes be approved by the Center for Medcare/Medicaid Services. At first, the changes weren’t even submitted; and when they were, they weren’t approved. They were put in place anyway, and so patients and providers, both hospitals and physicians, filed suit.

Now, the legal issue before the Supreme Court today was whether it was legal for the plaintiffs to sue. However, in the meantime the result is rationed health care. Medicaid doesn’t pay for all the costs of care (that’s not just an occasional problem; it’s part of how the reimbursement is set) so as to encourage providers to control costs. However, like any other good, you can only cut so much before you start doing damage. The patients who don’t get care because doctors can’t afford to provide care (and, yes, in many cases won’t afford – because, remember, the reimbursement doesn’t cover the costs) are the damage. Costs are “controlled,” and care is rationed.

Now, I won’t pretend: I know that care will be rationed, almost whatever program we provide. However, we can make the decisions haphazardly; or we can have the politically difficult conversation to set community standards about how we will ration. Or, I suppose, we could decide health care is a right, and make the political decision to provide it, including determining how to adequately fund it. Nah, that will never happen.

So, yes, I understand that rationing will happen. I just get annoyed when folks want to pretend that it isn’t happening right now.

Tuesday, September 13, 2011

Yes, Virginia, There Are Evangelical Episcopalians

Among the many places where I'm connected is LinkedIn. If you're not familiar with it, it's much like Facebook, but with an entirely professional focus.  Like other social networking sites, there are topical groups, including one for folks interested in the Episcopal Church. This week one member posted this question: "Are there any fellow evangelical Episcopalians out there?" This was my answer.

I think there are evangelical Episcopalians - by which I mean folks who experience Scripture as central to their faith, and who experience joy in living before Christ and sharing that with others, both within and without the congregation. Few of them are thorough-going Biblical literalists; but most believe the Gospels faithfully relate the experiences of the Evangelists with Christ, and that at least most of the events described, including the miraculous events, are historical.

By and large, they are not tied to a particular style of worship, although they enjoy some "praise" music. As the Prayer Book since 1979 has emphasized the Eucharist as normative Sunday worship, they have the Eucharist on Sundays, and not Morning Prayer. At the same time, most don't attend congregations where the liturgy is chanted most Sundays, or where incense is used, unless for Easter or certain special occasions.

Some of them are uncomfortable about decisions that the General Convention has made. However, they feel established in and supported in their individual congregations, and pastorally supported by clergy even when they disagree with them; and so they continue in the Episcopal Church. They see things changing around them, and regret some of the changes; but they have enough hope in Christ that they don't feel they have to fight things they can't control.

I spend half of my Sundays supplying in one church or another in two adjacent dioceses, and I meet these folks all the time. I'm happy they're with me in worship. 
 I know that the word "evangelical" when applied to an Episcopalian or other Anglican has meant something a little different: a literal use of more of Scripture, especially on social issues; a more exclusivist understanding of salvation; and, unfortunately, anti-Episcopal Church sentiments at home, and that plus anti-American culture sentiments abroad. However, I will stand by this as more accurate to the evangelical Christian tradition as folks live it out in the Episcopal Church; and I'm happy to have them with me in worship, and in my diocese, and in the Episcopal Church.

Friday, September 09, 2011

Remembering the Martyrs of Memphis

Many of my readers will be aware that the Episcopal Church remembers on certain days persons who have been especially noteworthy as models of the faith. Today is the day of Constance and her Companions, the Martyrs of Memphis. It is a day I make note of each year because the Martyrs of Memphis demonstrated their faith, and most of them died, providing health care.

Memphis, Tennessee, was wracked by yellow fever epidemics three times in ten years. The third epidemic occurred in August of 1878. 30,000 citizens – those who had somewhere else to go – fled the city. 20,000 had nowhere to go, and were forced to face the plague. Deaths averaged 200 per day, and before it was over more than 5,000 had died. The city was so depopulated that it lost its charter, and was not reorganized for fourteen years.

There were those who stayed by choice to care for the sick. The Episcopal Church remembers specifically six Episcopal nuns; four Episcopal priests, two of whom were physicians; a third physician; matrons at an Episcopal School for girls; and volunteer nurses and clergy from as far away as New York. However, we also remember that there were laypersons from many of the faith communities in Memphis who stayed: Roman Catholic, Baptist, Methodist, Presbyterian, Jewish, and other clergy and lay workers. They stayed to serve the sick, and died for their compassion. In Memphis today this is an ecumenical remembrance, when all faith communities commemorate one another’s honored dead as they remember their own.

In the last decade we’ve seen so much to make the commemoration of the Constance and her Companions more apt and poignant. We have seen cities wracked with expressions of human evil. We have seen images of another city, a sister city on the same river, emptied of people and filled with sickness and death. We have seen the entire region leveled by storm after storm, storms that continued to rage long after the wind and water appeared to have subsided. This year alone we have seen disaster after disaster, from the devastating tornadoes in the Central Plains; to more flooding in the Missouri and Mississippi Valleys; to the floods in the Northeast and Midatlantic states from hurricane and tropical storm. And we see colleagues providing care, often at great personal risk, to rescue those who can be saved from disease and dehydration, and from the inertia of isolation and shock. We support them in spirit, with our resources, and for many of us, with our prayers.

The Martyrs of Memphis are a part of the heritage at my hospital and health system. While we are not all Christian, much less Episcopalian, we are all in the tradition of health care. Watching the consequences of these events, we know that risks to the health of our communities are risks to us. We continue to serve, knowing of costs we hope we will never have to face. We serve those who come to us, knowing we are not immune ourselves. There is real courage and commitment in our service, and it is the same commitment shown by the Martyrs of Memphis of all faith backgrounds and of none.

As an Episcopal Chaplain, I consider each of my colleagues in health care to be holy and all of their works to be sacred. The compassion and commitment each of them shows reflects, I believe, the compassion of God. Today, as I honor the Martyrs of Memphis, I honor and pray for them; for each of them witnesses to individual faith at personal risk and cost, and reflects the presence of care here at in my hospital and health system, and in the whole of God’s creation.


There is a wonderful article today from the Episcopal News Service speaking to the work of chaplains on September 11, 2001, and in the days after. You can read the article here.

As we remember that day ten years ago, we can remember those noted in the article, and so many more. Quite a few Episcopal chaplains and other clergy and lay ministers assisted in New York; while many of our colleagues in military chaplaincy assisted in both New York and Washington, and so many places around the world. I remember the late Mike Stewart, then Treasurer of the Assembly of Episcopal Healthcare Chaplains (AEHC), who served in the Office of the Bishop Suffragan for Chaplaincies (now the Bishop Suffragan of Federal Ministries) to coordinate efforts in New York and the Episcopal Church’s efforts at disaster response. I think of Peggy Muncie, who walked virtually the length of Manhattan for the opportunity to serve (and those of us who know Peggy have some idea of what that took). I think, too, of our colleagues in other traditions. After all, the first victim identified from the disaster was a New York Fire Department Chaplain, Fr. Mychal Judge, a Roman Catholic priest and Franciscan friar. Many of us served as well in our own places, caring for the families of those lost and those affected; caring for our own frightened staff members and parishioners; and praying for God’s guidance in the midst of fear and grief and confusion.

In fact the Executive Committee of AEHC was scheduled to meet in New York on September 14 and 15. We talked and wrestled with what we should do, what duty required of us at that point.  Ultimately, we did not meet, which relieved our own families (in my household the words "baseball bat" and "kneecap" came up in the same sentence). However, AEHC members played our parts in cooperating with the National Office in responding to these disasters, and preparing to respond to the next.

As we remember this anniversary through this weekend, may God grant that we humans of all creeds will be guided more and more to love neighbor as self; and when we fail, may God continue to call chaplains to step forward to care for the fearful and the suffering, and for those who serve their needs.

Monday, September 05, 2011

When Your Sibling Sins Against You: Reflections on Proper 18, Year A

This sermon or something like it was preached September 4, 2011, at St. Mary Magdalene Church, Kansas City.

You can run on for a long time
Run on for a long time
Run on for a long time
Sooner or later God'll cut you down
Sooner or later God'll cut you down

If you were paying attention to the lesson from Ezekiel, you can understand why this song came to mind.  “I have appointed you,” says God, “if I have sent a word through you, you are to proclaim it. If you proclaim it, and they don’t pay attention, they’re still accountable, but you are not. But if you fail to proclaim it, they are still accountable, but so are you.”

And you know that all around us, and all across the world, that is the subject of the sermon. I bet you could throw a rock, and hit a church where this is being preached: “Tell them that God’s going to cut them down!” And any of us who have heard that sermon – and who among us hasn’t heard that sermon? – know that they have a laundry list. They have a guidebook to give them the list of sings to talk about.

Go tell that long tongue liar
Go and tell that midnight rider
Tell the rambler, the gambler, the back biter
Tell 'em that God's gonna cut 'em down
Tell 'em that God's gonna cut 'em down

And I have a problem with that. I don’t them they’re on the right track. I don’t think they’re paying attention to what Jesus said.

That’s not to say that we couldn’t talk about sin. I thought about preaching about sin. The thing is, I don’t really think there’s that much to say. Paul gave us the important handle on sin when he quoted Jesus, who quoted Leviticus. Paul said, “Love your neighbor as yourself. All the other commandments are covered if you love your neighbor as yourself.” And that’s the point. We could actually talk for a long time about sin. We could talk about original sin, or about sin as part of the environment we live in, or about the fallenness of creation. But at some point it comes down to this loving neighbor as self. The point where we experience sin is when someone fails to love us as we think they would love themselves – or when we fail to love someone as we would love ourselves.

And so we come to the Gospel. Jesus is talking to the disciples, to the gathered community. “When a brother sins against you…” – note that the word here is “brother.” Jesus is talking about siblings in the community, in the Church. I think we need to hold these things together. The word in Greek is “brother;” and while we think of it as a sibling in Christ, we need to appreciate that is applies when our relationships are at their most intimate. That’s when our sins are most difficult. It is when those closest to us fail us that we are most hurt; and when we fail those closest to us that we are most guilty.

And in that moment, Jesus tells us to do something difficult: “When a brother sins against you, go to that person individually; because if you can reconcile at that point, you’re saved the relationship.” Of course, our reaction is, “Lord, do I have to? Can’t I just let this slide? After all, it wasn’t that bad. That person isn’t that bad. Can’t we just let that pass?”

But, Jesus says to go, to reach that person, to save that relationship. It’s important to see this in context. The paragraph before this Gospel lesson is Jesus telling the parable of the lost sheep. “Don’t lose any of these little ones,” he says. “If you have a hundred sheep, and one goes missing, you leave the ninety nine and go looking for that one, however hard it is. And if a brother sins against you, go to him individually to try to save the relationship.” It’s about saving the relationship, about reconciling with that sibling in Christ. And if it doesn’t work one on one, take two witnesses with you – but not as witnesses about how God’s going to – well you know the song. Take two persons to witness how committed you are to saving the relationship. Take them for consultation to show how far you’ll go, even to the point of hearing about yourself. And if it still doesn’t work, take it before the whole congregation. And if you still can’t reconcile, then treat that person like a Gentile or a tax collector.

Now, once again this is a place where I think folks go wrong. There are Christian communities that take this very seriously – Anabaptists and others. It is important to involve the congregation. Confession is before the whole congregation. And if the person won’t confess, then the congregation treats them “ as a Gentile and a tax collector:” they cut them off. We call that shunning.

But as much as I respect their commitment to the faith, I think once again they’ve missed the point. Specifically, they’ve missed just how Jesus treated Gentiles and tax collectors. Like the tax collector that Jesus called to be one of the Twelve. Like the Gentile woman who taught Jesus that messiahship went beyond the people of Israel. Jesus didn’t cut off Gentiles and tax collectors. He reached out to them. He partied with folks that others wouldn’t be seen with, tax collectors and prostitutes, and said his mission was especially for them. He didn’t cut them off. He continually went after them.

And so it is for us. If we are to treat them as Jesus treated Gentiles and tax collectors, then we can’t cut them off. Even if with the support and consultation of the entire congregation the relationship can’t be reconciled, you don’t just give up. You keep trying, you keep hoping, you keep praying. No, it may not work. But like Jesus, you don’t give up. And he has promised us that, even when it isn’t working, Jesus will be with us.

Now, we are surrounded these days by folks that seem more interested in who God will cut down, or at least who must be cut off, than in bringing folks together. It has become a part of our political discourse. It has infected the debates among some Christians. It is all around us, and so many for one reason or another want to work out, not how to reconcile, but who to shun.

And we know that reconciliation can be difficult. Every one of us has someone around that each of us considers the most stubborn person in the world. (I won’t give the list of those who think that of me!) Sometimes it can seem easier to just give up.

But, that is not how Jesus has instructed to us. When your sibling in Christ, however close, sins against you, do what you can to reconcile. Try it in person. Get consultation. Get consultation even from the whole congregation. And if after all of that you can’t reconcile, don’t give up. Keep trying, keep hoping, keep praying. And trust that Jesus wll be with you. Whenever two or three are gathered, Jesus will be with you. Even when it isn’t working, even when you can’t reconcile, even when you’re the one who did the sinning, remember that he said he would be there whenever two or three are gathered. So, when your sibling sins against you – and certainly when you sin against your sibling – work to reconcile. Keep trying, keep hoping, keep praying; and trust that, even when it doesn’t seem to be working, know that Jesus will always be with you.

Wednesday, August 17, 2011

Sermon Prep, and Identity Crisis (Updated)

I’m looking at the lessons for Proper 16, for this coming Sunday, using the Genesis lesson for the Old Testament. One thing stands out for me immediately: there’s something important about personal identity in this.

Look, for example, at Moses. Was there anyone more set up for an identity crisis? Born of a Hebrew mother, nursed and raised by her, but as an Egyptian prince – is it any surprise that he will find himself very conflicted when he grows up? If you think about it, his confusion comes into focus with his murder of an Egyptian overseer brutalizing a Hebrew slave (something that is, unfortunately, skipped in the lectionary course). Is he the prince, with power of life and death? Or is he the Hebrew, defending his enslaved brother? Even the slave he saves will ask him, “Just who are you?” Is it any surprise that he will have to run away, in a sense to leave both identities, before he can encounter God and so find himself?

And then there’s Jesus’ question to the Twelve: “Who do you say that I am?” We know Peter’s response, because we know the story; and because we know the story, we think we understand what Peter’s response means. But, did Peter and the others? After all, Jesus tells them to keep it a secret – something that must have been a real trial for them. And he gives Peter, whether personally or as representative of the Twelve and so of the community, the Church, a specific role as the foundation of what will come after, with authority to speak for God: “Whatever you bind is bound, and whatever you free is freed.” Just who were they to have this authority, authority that they couldn’t tell anyone about?

And identity is central to Paul’s metaphor for the Church as Christ’s body. “I say to everyone among you not to think of yourself more highly than you ought to think, but to think with sober judgment, each according to the measure of faith that God has assigned.” That’s a real challenge to a community that has been given authority from God to bind and to free. “How do you know who you are, except in the concept of the Body and your specific vocation in it?”

So, while it may not be all about identity in these lessons, that issue is there. Who are we, if we are in this world but not of it? Who are we, if we are citizens of the Kingdom? Who do we say Christ is, and what does that say about who we are as Christ’s body? Sunday is yet a long way off, at least in how I prepare a sermon; but this is where I am today.

Update: I dashed this off today after reading the lessons, and then discovered this post at Miriam's Tambourine from Memphis Theological Seminary (and a hat tip to The Text This Week). I had not read this, but, seeing as it's been available a while, it was clearly written first, and we share a theme. Having lived in Memphis at one time, I have great respect for the folks at MTS. So, you might it to your reflections.

Tuesday, August 16, 2011

On the Importance of Being Earnest - Or At Least Honest

I have written a number of times of the importance for chaplains of being “research informed.” I’ve also written of the difficulties with this, and especially of knowing what we’re reading when we’re reading the research of other professions.

Well, this past week various news sources (for example, here and here)have noted a paper whose authors noted a troublesome trend. The paper itself was presented this spring at the Annual Conference of the Association of College and Research Libraries. Titled, “Retracted Publications in Biomedicine: Cause for Concern,” it was written by John M. Budd, Zach C. Coble and Katherine M. Anderson, all of the University of Missouri.

The paper is not that long, and is a straightforward read. I encourage you to read it. However, some of the problematic results are easily presented. The authors identified more than 1100 studies retracted in the twelve years from 1997 to 2099 by various journals (retractions noted in PubMed, the on line citation source of the National Institutes of Health). Of those retracted, fully 55% were for misconduct. Some of these showed up in the news, but most did not. They note that it is a small percentage of all published research, but it's more than enough. More troubling is they're comparison to an earlier study. In that study, using the same methods, Budd et al discovered that in the years from 1966 to 1996 235 articles were retracted, 40% for misconduct. So, in almost a third the time, almost five times as many articles were retracted, and the proportion retracted for misconduct increased by 15%!

The authors go on to point to several related causes for concern. One is just how long it takes for a retraction to be issued. In the study reported this spring, the mean time to retraction was 17 months. On the other hand, for the median (half took less time and half took longer) was 29 months and the range went to 304 months – more than 25 years! (Yes, that’s only one exceptional article; but still….) In all that time people could be and were put at risk, either in larger studies designed on faulty premises, or in treatment programs that proved unsound.

Even more troubling for the authors were the number of times retracted articles were cited after they had been retracted. Citations before retraction might be unfortunate, but they’re not in themselves evidence of poor practice. Citations after retraction, on the other hand, are – or may be. If a researcher is searching an online database, or looking at the online edition of the journal, it may be easy to see that an article has been retracted (if not always why). However, if the researcher is going from one print source to another – say, looking at the hard copy of a journal based on a citation in a book or other printed source – the fact that the article has been retracted won’t be immediately available. Budd et all note that “Finding a retraction statement does require some diligence on the part of authors and editors.” Much depends on how online sources make retractions apparent, and most make some effort. However, the individual researcher needs to check carefully.

We have a lot at stake these days in the quality of research that gets done, and especially, as Budd et al note, in biomedical research. Across the spectrum of healthcare, from providers to payers to patients, quality of care and demonstrated outcomes are critical. But demonstrated outcomes require good research that is careful about methods, resources, and ethics. Mistakes in research are unfortunate, but not entirely avoidable. On the other hand, misconduct in research unethical and sometimes dangerous. Compounding misconduct by poor review processes or slow retractions is also unethical, as is citation of retracted research. We all have a lot at stake in this. We as the recipients of research need to be able to trust that we’re receiving good information; and we who are researchers (and yes, chaplains are researchers, too!) need to be worthy of that trust.

Thursday, August 11, 2011

Healthcare: It's Where the Jobs Are

The website Health Leaders Media posted on Monday a brief story analyzing statistics from the Bureau of Labor Statistics.  The headline says a lot: Healthcare Sector Drives U.S. Job Growth.

The article notes, “Healthcare created 31,300 new jobs for the month and 170,900 new jobs in the first seven months of 2011. The healthcare sector has accounted for 18.4% of the 930,000 non-farm payroll additions in the overall economy so far this year, BLS preliminary data show.” The July increase is more than a quarter of all new jobs created in the economy. The latter point is despite the fact that hospitals lost 2,000 jobs in June, and that there were losses in July in long term and other care facilities. It represents more than four times the jobs created in health care in 2010 in the same time period. New jobs were evenly distributed largely between hospital and ambulatory care, with slightly more in ambulatory care.

That’s tremendous job growth, both for one month and for the year to date. Which raises a question for me. In a time when jobs are short, and people everywhere in the economy are looking for signs of growth, healthcare is showing great promise. Moreover, jobs in healthcare are good jobs.  They pay well, and have some staying power.  They can’t be outsourced overseas (and won’t, I think, be affected all that much by medical tourism), and the market is only growing, both as the population grows and as it ages.

So, why, then, is there so much interest in cutting reimbursement for healthcare?  I know that it’s expensive (after all, I’m not just a provider; I’m also a consumer), but I also know that, like other forms of maintenance, preventive care is an investment that will save a lot of money down the line – and preventive care also requires people employed to do the work. I know, too, that healthcare is driven, not by low costs or ego satisfaction, but by individual and immediate need; and so simply insisting on paying less isn’t really going to be an effective means of controlling demand. Indeed, because there are so much to be gained later from preventive care now, I think we need to question whether we want to simply reduce demand by reducing payment, or redirect demand by restructuring payment and actually increasing payment for some things.

One way or another, the numbers (albeit preliminary) indicate that healthcare is a sector of the market that is creating jobs, good jobs, in an economy that needs to put people to work. For all the criticism of the Affordable Care Act, this hardly seems the time to cut the payments, including Medicare and Medicaid, that will undermine that sector and all the jobs it includes now, and can add in the future.

Tuesday, August 02, 2011

What We Can Do With Collaboration - And Not Competition

Some time past I wrote about health care and the market.  I noted especially that when choices are negotiated, it isn’t patients who really do the negotiating.  Instead, hospitals, physicians, and insurers negotiate with one another to determine appropriate exchanges of services, reimbursement, and lives – which is to say, us as patients.

So, what would happen if the three parties got together and became partners?  Yesterday the Los Angeles Times reported on just such an event.  Three major players – an insurer, a hospital system, and a large medical practice – collaborated, and in the first year attained some remarkable results: “The collaboration among Blue Shield of California, Catholic Healthcare West and Hill Physicians Medical Group shaved more than $20 million in costs last year and prevented an insurance rate hike for public sector workers in Northern California.”  Now, these are two remarkable results.  The cost savings are remarkable in and of themselves, and would allow the various organizations to save money for patients, marginally reducing fees and premiums.  But just as important were the savings for both government employees and taxpayers in preventing the rate hike.

While the financial savings were significant, I was more interested in some of the clinical results.  For the clinical results reported, cost savings were an important measure.  However, I also they think they indicate quality care for patients.

For example, surgeries for weight loss were reduced last year by 13%.  They did it by offering guidance for better choices.  In essence, patients were taught preventive measures that so that fewer surgeries were required.  The thing is, the same measures are likely to result in fewer cardiac issues and lower incidence of diabetes.  So, the results are lower costs not only in surgeries now, but in improved health later.

Or consider that readmissions after hospital stays were reduced by 15%. The collaborators note that fewer readmissions indicate patient who were healthier at discharge. Readmissions have another consequence for hospitals.  Medicare has structured their reimbursement around Diagnostic Related Groups, or DRGs.  For a great many diagnoses, Medicare sets a specific reimbursement amount.  If the patient costs less, the hospital makes a little more money.  If the patient costs more, the hospital eats the excess expenses.  So, if a patient is healthier faster, not only has the patient benefited, but the hospital gets some financial incentive.  If a patient has a longer stay, the hospital loses money.  The thing is, if a patient is readmitted too soon after a discharge, Medicare considers it part of the same diagnosis, and so doesn’t pay the additional expenses. And it’s not just Medicare: insurance companies also use DRGs to guide their payments, especially in managed care contracts.  So, readmissions lose hospitals lots of money, and a15% reduction means the losses are a lot less. For a not-for-profit like Catholic Healthcare West, that means more money to plow back into equipment and personnel for patient care.

We might argue that there was a fourth partner involved in this.  More than three quarters of the $20,000,000 saved came from the California Public Employees Retirement System (CalPERS) because Blue Shield didn’t raise insurance rates for those covered through CalPERS.  However, this is no small thing: the costs of pension benefits are significant problems in many of our states.  Saving money in this way saves money, or saves services, for many of us.

So, this is an example of collaboration that worked. Of course, it worked precisely because the partners stopped competing, at least in this instance, and instead worked together.  They had some trust to build and some history to overcome before they could collaborate: "Our staffs had a history of combating with each other through negotiations," said John Wray, a senior vice president with Catholic Healthcare West. "We had to trust one another to make it happen. This was a very significant culture change between the organizations."  They even shared some proprietary information. This was simply not your typical “market-based solution.”  Note that it isn’t a government directed solution, either.  At the same time, it’s not competition but collaboration, not proprietary interest but partnership, that brought these results.

Maybe, just maybe, that’s a model that others can follow, so that more of us can benefit.

Monday, August 01, 2011

My Thoughts on Fair Taxation

So, I’ve recently seen once again this statement: “The top ten per cent (income) of Americans pay 55% of all taxes. Let them pay 65% instead.” The point that the author wanted to make was that increasing that to 65% would still not meaningfully address the deficit. It’s at least a different point than is usually made with such a statement.  Usually, the suggestion is that the top 10% are paying more income tax than they should, that in a fair tax structure, collected taxes would somehow be more evenly distributed across all income classes.

I have found myself wondering about those statements, and similar statements I’ve seen (all with varying numbers, but with much the same point).  So, I did a bit of searching, and found this paper, titled “Wealth, Income, and Power.”  The author is William Domhoff of the University of California at Santa Cruz.

The article is illustrated with some very helpful tables and charts.  For example, a chart on wealth distribution indicates that in 2007 households above the 90th percentile (90% of households had lower net worth) controlled 83% of financial wealth.  So, one could argue that instead of paying 55% if all taxes collected, they should be responsible for 83% of taxes. 

But, we don’t tax wealth.  We tax income.  So, let’s look at income distribution.  In 2006 more than 41% of all income received in the United States was received by only 20% of those who received income.  A different table from Citizens for Tax Justice indicates that this group above the 80th percentile of those receiving income received 59% of all income, and paid 64% of all taxes.  Now, that seems pretty even, doesn’t it?  But while it may look “equal” in some sense, it’s impact is not equally felt.  Those above the 80% pay roughly 30% of their income in taxes.  Those between the 60th and 80th percentiles pay about 29%, and those between the 40th and 60th percentiles pay about 25%.  Those below the 40th percentile pay 20% or less.  It looks progressive for a moment.  But, think about how this impacts standard of living.  Those above the 80th percentile receive in income $100,000 and up.  Those below the 40th percentile receive in income $25,000 and less.  30% of even $100,000 ($100,000 minus $30,000 leaves $70,000) has much less impact on purchasing power and standard of living than 20% of $25,000 ($25,000 minus $5,000 leaves $20,000).  $30,000 sounds like a lot of taxes; but $70,000 is still a pretty good discretionary income.  $5,000 sounds like a lot less; but it represents a lot of groceries for folks who are already living pretty close to the margin.

It seem pretty clear that the reasons to tax those who have more in a greater measure than those who have less are first and foremost that they have the wealth in the first place; and second, that they have benefited much more from this economy that we share than most of us.  And after all, they can afford it.  The one person in America whose name is more associated with paying taxes than Grover Norquist is Henry Bloch, the “H” of H & R Block.  He wrote an editorial that appeared in the Kansas City Star  His closing comments were, this past Saturday.

Those of us earning more than $250,000 a year are very fortunate. We have an obligation to help our nation overcome this challenge. While I don’t look forward to paying more taxes, it must be done. And it’s a small price to pay for living in this wonderful country. Responsible change that promotes good public policy and tax fairness is to be welcomed.

So, here are a couple of ways to think about what might make for “fair” taxation.  We could tax wealth, and set it up so that those who own 83% of the wealth are required to provide 83% of taxes paid (instead of 55 or 60%).  Or, we could figure out how to tax so that those at the top have their purchasing power reduced as significantly as those at the bottom.  See, it’s not whether those at the top pay more taxes than those at the bottom.  It’s whether those at the top pay enough more taxes that their lives are proportionally affected as much as those at the bottom.  That might be a truly progressive tax plan.

Sunday, July 31, 2011

Back at the Cafe

I have another post up at the Episcopal Cafe.  It's about heat and hummingbirds and current affairs.  Go over and give it a buzz.

I do want to commend to your  attention Notre Dame’s Science of Generosity Initiative, to which I refer in the post.  It might seem a stretch to most folks to think about studying generosity scientifically.  On the other hand, there are many expressions of human behavior and human personality that we study.  We study hope and optimism.  So, why not study generosity?  Go over and browse for a while.  You'll find interesting papers to think about, and a blog that's updated regularly.  I think you'll find it interesting.  If you're at all like me, you'll find some of it just fun.

Wednesday, July 20, 2011

Costs and Effectiveness and Vaccine Policy

I have written before about issues related to the costs of vaccines (for example, here and here).  They are expensive to develop, and have inherent risks.  At the same time, they’re not the greatest profit generators, in part because they’re used once or twice, unlike, say, cholesterol drugs that patients take regularly for years and years.

Today there was an interesting story on NPR’s All Things Considered.  Titled, “Rising Costs Complicate Vaccine Guidelines,” it looks at a meeting of the Advisory Committee on Immunization Practices (ACIP).  According to the ACIP web site,

The role of the ACIP is to provide advice that will lead to a reduction in the incidence of vaccine preventable diseases in the United States, and an increase in the safe use of vaccines and related biological products.

The Committee develops written recommendations for the routine administration of vaccines to children and adults in the civilian population; recommendations include age for vaccine administration, number of doses and dosing interval, and precautions and contraindications. The ACIP is the only entity in the federal government that makes such recommendations.

The NPR story focuses on a difficult place in our health care: the point where we discuss balancing cost and effectiveness.  While the specific vaccine in the example is for meningitis, it offers a good examination of all those difficult questions: at what cost do we treat, and with what effect? Who makes that decision, and on what basis? Each decision has both costs and benefits, and each choice excludes other choices.

Take a few minutes and listen.  It won’t give definitive answers (although it does tell us what ACIP decided in this case), but it will bring us back to important questions.

Friday, July 15, 2011

Political Thought for 7-15-11 (2)

I want to propose a new definition of tax equity.  When folks talk about fair taxes, some talk about the actual amount paid, or the rate at which income is taxed.  Sometimes someone even talks about taxes paid as a percentage of income.  I want to offer a new definition: I want to tax the wealthiest at a rate whereby their tax bill will affect their purchasing power to the same extent as it does someone living on minimum wage.  Too much?  I'd be satisfied if it affected their purchasing power to the same extent as it does mine!  But, the true measure of equity would not be dollars paid, or tax rate, or even percentage of income, but purchasing power.

Political Thought for 7-15-11 (1)

I can't imagine voting for anyone who appears to have failed American History in high school and college - who imagines, as we have recently seen, that the families of slaves were intact in any meaningful sense.  I can't imagine voting for someone who doesn't remember from their class that the Gilded Age was only gilded for those who had the gelt.

Thursday, June 30, 2011

A New Ethics Resource

From time to time I do try to point to new resources for chaplains and others in health care, and especially, when I can, to resources in Kansas City, my back yard.  In a recent conversation with my colleague, Dane Sommer, Director of Chaplaincy Services at Children’s Mercy Hospital in Kansas City, I learned of another.

Take a look at the web site of the Children’s Mercy Bioethics Center.  It is a rich resource of information specifically on pediatric bioethics.  There are a number of topics, each with its own page.  Many have attached PowerPoint presentations, lists of references, and links to other relevant sites.  There are links to information on relevant legal cases, and even a blog.  Moreover, the Center is offering a Certificate Program in Pediatric Bioethics in conjunction with the University of Missouri – Kansas City.

So, take a look at the site.  This is, I think, quite a resource in an important area in health care ethics.

Wednesday, June 22, 2011

Return to the Cafe

After a bit of a break, I'm back up at the Episcopal Cafe.  My latest piece is seasonal, in the Church's sense; and also not limited to one season.  I hope you enjoy it.  If you do (and even if you don't), I hope you'll leave a comment, whether there or here.

And, as always: while you're there, take some time to look around and read.  There's interesting news there, especially focused on the Episcopal Church.  There are interesting essays there on matters of faith and spirituality, and multimedia offerings.  So, go to the Episcopal Cafe and look around.  We think you'll like what you find.

Monday, June 20, 2011

Update on Endorsement for Episcopal Chaplains

I have done my best to keep track of the process for ecclesiastical endorsement in the Episcopal Church.  As I've noted, endorsement is perhaps the most common search terms that leads folks to my site.  I also noted that changes have been happening at the web site of the Episcopal Church.

Well, one of those changes has been to move the form to request ecclesiastical endorsement.  It is now available here.  Even better, the path to reach it on the Church's web site is not only simpler, but relatively logical.  I've given the direct link; but it you go the the Church's home page and click on the "Networking" tab, the link to the form is right there, on the "Networking" home page.  Granted, that's more straightforward if you know that endorsement for healthcare chaplaincy has been moved from the Office of the Bishop of Federal Chaplaincies to the Mission Department.  (Of course, if the search term led you to this site, you already know that.)

So, the form is readily available, and the process remains as it has been for a while now.  And I can only think of a couple of steps for the Church's web experts to take to make it even simpler.  One would be to have a page listing and providing links to all the forms the Church uses, or at least all those for use outside the Episcopal Church Center, and include that page in the links in the Church's "A to Z Directory."  The second would be for the link in the "A to Z Directory" to "Chaplaincies" to include all chaplaincies in the Church, and not just Federal chaplaincies.  I have the greatest respect for Bishop Magness and all of our Federal Chaplaincies; but other chaplaincies have resources at the Episcopal Church Center, and networks for, well, networking.  Making those directly accessible from the "A to Z Directory would simplify the process for a lot of folks.  Granted, it might mean fewer folks came here for this information; but I'd be willing to accept the pain.

So, if you're here to learn about endorsement for healthcare ministries in the Episcopal Church, the information is available.  I'm happy to help, and thanks for stopping by.