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.