Wednesday, December 04, 2019

Striking a Balance

I was struck last week when I had these two articles on the Washington Post on the same day. The first, by physician James Hudson: “Our dangerous fear of pain”; and the second, by Amber Petrovish: “Some of us actually need painkillers. Can doctors ease up on us?”. As chaplain-types, we are, I think, aware (or we certainly should be) of the difficult balance. Our physician colleagues are caught between anxiety about over- or inappropriately prescribing and anxiety about leaving patients suffering. 

With that in mind, I would remind folks about General Convention resolution 2018-C037 “Call to Respond to Opioid Epidemic.”  The resolution explicitly speaks both to opioid addiction and to the need to adequately address real and chronic pain. It does spend more text on addressing addiction, but it is balanced in its intent.

It’s worth some time to read both opinion pieces, and then to review the Convention’s response. We need to be aware of the difficulty, and to be aware that the Church has spoken to it.

Thursday, October 17, 2019

In the Middle-Of: Sermon for Proper 23, Year C

Preached October 13, 2019, at St. Raphael's Episcopal Church, Crossville, Tennessee.

So, the story we have today of Naaman is one of my favorite stories in scripture. I've worked with it a lot. That shouldn't surprise you. Many of you will remember that what I retired from was nearly 40 years as a hospital chaplain. And so, it's an interesting healing story to me. I wish they had told you more. That is, they cut off some things in the lectionary selection that I think are very interesting and relevant to today's lessons. You heard that the King of Israel got la etter, but you have no knowledge about where that came from. They clipped those verses. Basically, Naaman was really important, and so the King of Aram sent an introduction letter from one King to another. But when the King of Israel read, “I'm sending Naaman to you to be healed of his leprosy,” then you see the King of Israel reads the letter. “Am I one to give life or take it away,” et cetera.

The other thing they cut off is what happens after the healing; because Naaman comes up, he proclaims that there's only God in Israel. And then he offers great gifts to Elisha who refuses them. And then he says, “Okay, but I want to tell you something. First I need two mule loads of dirt from here to take back with me to Syria because from now on I'm going to do all my praying in Israel. And the way to do that is to take some of Israel's dirt and that's what I'm going to stand on in kneel on as I pray. The only exception is I'm a big public figure. Once a year I’ve got to take the king in as he says his prayers and I want the God of Israel not to think I'm reneging on anything, because my regular prayers are going to be on this dirt from Israel.”

Now part of the reason I like this story is it is a great example of modern healthcare.Let me retell this story. There's an important official and he has a chronic wasting disease - can't get shed of it; but he gets a verbal referral. He gets a word of mouth referral. And so based on this word of mouth referral, he goes and he tries out a new practitioner. Now he gets to this new practitioner and the new practitioner says, “Okay, we're going to start with a very conservative treatment.” And the patient is really unhappy: “I'm too important. Shouldn't I have the latest medication? Shouldn't I have the latest procedure? Shouldn't we be going through about $1,200 worth of tests?”

But the family says, “You know, it's not a big deal. And if he'd ask you for a big deal, you'd have done it. Try this conservative procedure.” So he goes in, he tries just some basic self skin care and he's healed. And he comes back and he thanks the practitioner and then he goes and he says, “Okay, I'm going to need a new insurer to fit with this practitioner.” So he sets up his new insurance plan (that's the two mule loads of dirt). He sets up his new insurance plan, and he negotiates with his caregiver for ongoing after care and lifestyle change to deal with his disease. Doesn't that sound like modern medicine? 

But it also tells us something about how people saw one's relationship to God. You see, a god had to do with a place. And if you're in a different place, you're dealing with a different god. Zion is the Hill of God and all these other gods - you know, the gods are Tyre and Sidon -  you don't bring them here. It’s a constant refrain in the Books of Kings. And so Naaman says, “Well, if I'm going to be worshiping Israel's God, I need a piece of Israel,” and he takes two mule loads of Israel back with him.

So now we get to the gospel. Jesus is going through no man's land. Well not exactly, but he's on the boundary between Samaria to the West and the Galilee to the East, an interesting conjunction of places. It's sort of in the Jordan river Valley; and it's sort of culturally different. The Galilee was basically settled by Greek-speaking, folks. Now, a lot of them were now Jews. There were Jews in the Galilee, but it was traditionally a Greek kind of cultural area. 

And Samaria: well, we've all heard about Samaria, but let me remind you about Samaria because it'll also make sense of something else Jesus said. You’ll remember that Israel for a while did fine. And then after Solomon things sort of fell apart, and we find them divided into two kingdoms, Israel to the North and Judah to the South. And they don't agree on things. And one of the things they decide not to agree on is that Israel said, “We can't go down to Jerusalem anymore in Judah to worship. We've got to have our own place.” And so they set up worship according to the Torah, but on a different mountain, Mount Gerizim. And if you read through the Books of the Kings, you'll see the things that happened in Israel and you'll see the things that happened in Judah. And you'll find, for example, that Amos and his prophecy was primarily in Israel. They tell him, “We're not interested in you here. Why don't you talk to the folks in Judah?” Other prophets are much the same. And Elisha spends a good deal of time up in Samaria.

But the Samaritans are problematic. First of all, the folks who have Jerusalem think the Samaritans have gone too far by setting up their own altar and their own temple. And then when Israel falls to the Assyrians, the Assyrians have this relocation program. They take a lot of the population of Israel, and they move them and instead they import a lot of other folks. The idea is that, you take people away from the land they know and you give them land, and now they are not dependent on what they've known. They are now dependent on the empire. They're now dependent on the person who put them there and gave them land to live on. Honestly, it's kind of a lot like what China does in its Western territories these days. They keep trying to say everything is part of the Han culture and they keep moving more Han folks in.

And so that's what the Assyrians did. So now for the folks in Judah, that's a double problem. You've got these folks who claim to live by Torah and the new folks come in - and remember you go with the God of the locality. So, they begin to pick up with the God of the Torah, but now there’s an intermingling of bloodlines and of cultures. And as far as the Judeans are concerned - the Judah-ites and ultimately the Judeans, the Jerusalem folks, - as far as they’re concerned the Samaritans are impure. They are not right.  And, they make not right worse by trying to be faithful when they've already fallen too far away.

And now Jesus is well out of Judea, well away for Jerusalem. He's up between Samaria and Galilee and he encounters 10 lepers, 10 lepers, who are aware of what's going on and aware of something about Jesus.

Now we know actually remarkably, literally little about leprosy in the Bible. We think of Hansen's disease. We think of what puts people in leper colonies in a few places, even today, although now it's very treatable. But actually the old Testament describes a whole bunch of skin symptoms that are leprosy. So we didn't know what exactly was afflicting these ten medically. We do know what was afflicting them socially and culturally. Luke said they kept their distance, but they called out, “Jesus, Master, have mercy on us.” They kept their distance because that's what lepers did. They also were impure. They were not quite right. They weren't fit company for man nor beast, as we say, and they had to keep their distance from anybody. They were cursed, and their curse was very visible. It was on their skin. It was affecting their bodies. 

So they keep their distance and Jesus, he doesn't even get close. He just says, “Go show yourselves to the priests;” and they go. And they are all ten healed.

I found myself wondering who these 10 were. They're between Samaria and Galilee. That would make you a long way from Jerusalem. Likely they're Jews, although there wouldn't exactly be priests in the Galilee or in Samaria; except for this one, because he's a Samaritan. He's close to Samaria, and as far as he is concerned, there are priests that Mount Gerizim to go see. For all we know, they were all ten Samaritans.

But they are all ten healed; and one then comes back and gives praise, and says, “God did this.” Jesus says (we presume the entourage was there. It doesn't say that, but who else is he talking to?) -  Jesus says, “Wait a minute. Did 10 get healed? Only one comes back. And as far as my people are concerned, he's a - a foreigner! Go on your way,” he says. “Your faith has made you well.”

Think about how different and understanding this is from what I was talking about with Naaman. We are a long way from God's Holy Hill in Zion, and ten were healed. Only onr saw God in that, but ten were healed; and we are a long way from Jerusalem. And suddenly it looks like God is going to do things we don't expect and God is going to be where we don't expect.

Some of you may know that one of the things that complicates the lives of preachers in this season of the year is that, in fact, in the lectionary they give us two choices of Old Testament readings; and I read both of them. The second one is from Jeremiah and it's very interesting. This is after the fall of Jerusalem to the Babylonians. They also remove people, but they just remove the elite: most of the court, most of the professional class. They put their own puppet king in place, and they remove everybody above a certain income to Babylon. And by the same token, the Babylon community of Jews writes to Jeremiah the prophet - who they didn't listen to and now they realize a little too late was telling the truth -  they write and they say, “What do we do now? As the Psalm says, ‘How shall we sing the Lord's song in a strange land?’” And Jeremiah says, “Plant trees, plant vineyards, establish lives for yourselves. Have children, have families, have a future. And also, pray for the larger culture around you because they're prospering will lead to your prospering.”

Well, how could we do that? How could we do that, unless the God of Jerusalem continues to be God in Babylon; unless the God of Jerusalem continues to be God in the wasteland between Samaria and Galilee; unless God continues to be God in the wasteland that is illness. I spent all that time working in hospitals and also in nursing homes, and I came to the realization that being a patient in an institution is like foreign travel. It really is. It's like traveling abroad. The people speak a strange language that you don't understand. They have strange customs that you don't understand. They have a strange wardrobe that you don't participate in. They have really strange rituals that you do participate in; and your money's no good. It's like foreign travel and the God of Jerusalem is in the midst of that strangeness.

We need to hold onto that because, you know, being sick is one example, but all of us have some experience of having to take what we are to another place. I don't know how many others of you around here grew up in Crossville. I don't need to show of hands, but I know most of us moved here from somewhere else. I grew up in Knoxville and yet I moved here from Kansas City. And we brought some things, but some things we found. And all of us had that experience in different ways and in different times of our lives. And, when those experiences are tough enough, they can bring us even to despair. 

And the God of Jerusalem is in the midst of those places. Why? Because as the author of Second Timothy says, “You know, we can fall away. But God is always faithful because God can't deny God's Godness.“God cannot deny God's Godness, and God's Godness, as we human beings are slow to learn. embraces all of it. In the midst of it, God is there,

I was watching a YouTube video. And part of what it says is, is that Elon Musk is offering hope about going to Mars (some people hope Elon Musk goes to Mars), and about what that could mean for us as human beings. But, of course, going to Mars is going to mean some people take something with them to a very strange place; and the God of Jerusalem is there. It is important sometimes that we take our two loads of earth with us to get started. It is important that we have our new insurance plan in place; but in the face of the stresses and the troubles of being in that “middle-of,” of being caught between this territory and that, between this life and that - with the lepers, literally between life and death - the God of Jerusalem, God in Christ is there. Sometimes we'll notice. Maybe 10% of the time we'll stop and see that we’re healed and we'll turn and we'll say “We give thanks for what God has done for us.” That gratitude is the appropriate response, but it's not an appropriate response in a vacuum. It's not a discipline that we learn just to remember to say it. It is the appropriate response to the fact that between Samaria and Galilee, between Kansas City and Crossville, literally between life and death, God, God’s self is there: there with us; there for us.

Sunday, October 06, 2019

Ecclesiastical Endorsement in the Episcopal Church, 2019

As I have of late, this is also posted at Chaplair, the blog of the Assembly of Episcopal Healthcare Chaplains.

I’ve written before about ecclesiastical endorsement in the Episcopal Church. I have been through our process, and I have been watching the process now for going on 40 years. Over that time, some things have changed; and some things haven’t; and AEHC has been in the midst of it for almost all our 70 years.

In my last post I recalled how endorsement had gone from the individual bishop to AEHC, then the Office of the Bishop of Federal Chaplaincies. After that it went to the office of Mission. With that history in mind, let me clarify how the process works now. (And attached I have provided a flowchart.)

Once upon a time, it was individual bishops who endorsed for healthcare ministry. Now, it continues to be individual bishops who endorse for healthcare ministry. Yes, there is a process, but if an Episcopalian feels called specifically to healthcare ministry the first step is to be sure to have met with the bishop. This is true whether or not the prospective chaplain feels called to ordination or is pursuing certification. Healthcare chaplaincy is recognized as a specialized ministry and the Episcopal Church can endorse persons in any of the four orders for ministry. So, first be sure to connect to the bishop.

As referenced, for many of us the interest in ecclesiastical endorsement began in the pursuit of board certification. It is still required for the largest chaplain organizations (and I would encourage it for whether seeking certification or not). If you are pursuing certification, the next step is completing the form on line here. At this time this will be received by the Rev. Margaret Rose, Ecumenical and Interreligious Deputy to the Presiding Bishop, and our Endorsing Officer; and processed by Ann Hercules, Associate for Ministry Beyond the Episcopal Church. Note that the persons have changed at times, but the process has actually been stable for some time.

Note, too, when you look at the form, there is a requirement to affirm that you are up to date with the Church’s education on preventing and recognizing sexual abuse and ministry misconduct. This is normative for many ministries in the Episcopal Church, ordained and lay, paid and volunteer. Your diocesan office can help you get what you need.

Once the form is received, the Endorsing Office will reach out to the relevant bishop, asking if the bishop can endorse this applicant specifically for healthcare ministry (remember what I said to do first?). She or he will send the endorsement to the Office. Once received Margaret will send letters of endorsement to the endorsed chaplain and to the certifying body, with a copy to the bishop and a copy for the records.

Some have looked at the application and noted that it asks about certifying bodies. There has been concern that a person can only be endorsed if pursuing certification. Others have wondered whether chaplains not seeking certification are required to pursue endorsement. In fact, while many chaplaincy positions require certification, that’s not universal. However, I strongly believe every Episcopalian providing professional healthcare ministry should seek endorsement. For the reasons I have written before, I believe endorsement serves the Church, serves the chaplain, and serves the persons to whom the chaplain ministers. A person not seeking certification can be endorsed. Endorsement in that case, though, need not involve the form or the Endorsing Office. The chaplain can simply request and receive that directly from the bishop.

There is one further consideration. As noted the Episcopal Church will endorse persons in all four orders of ministry. However, if a lay person is endorsed, it is required that the endorsed chaplain arrange for a public service of commissioning. This both publically acknowledges the chaplain’s specialized ministry, and also the chaplain’s recognition of the authority of the Episcopal Church for that person’s ministry. Certifying bodies used to require this of all endorsed and certified lay chaplains. Because of the breadth of faith communities now involved in chaplaincy, the certifying bodies no longer require it. However, the Episcopal Church expects it, whether the endorsement is processed through the Endorsing Office or directly with the bishop.

Now, once endorsed, do you ever need to do it again? Really, that depends. Are you in a certifying body that requires periodic peer review or a similar significant review of the ministry? For example, APC requires that every five years. The Endorsing Office would like you to renew your endorsement at that point, including the Church’s abuse prevention training. 

It would also be appropriate to renew endorsement if a job change takes you to a new diocese. You would in any case want to meet with the new bishop, and would likely need to meet the expectations of that diocese for abuse prevention training. It would be appropriate at that point to renew endorsement. The process would be the same: either to resubmit the application through the Endorsing Office or to work directly with the bishop.

So, that is the process. Again, check the flowchart below. I have tried in it to concisely describe the steps of the process. Margaret Rose has also reviewed it, and approved it. We hope, then, that this description and the attached flowchart make the endorsement process clear. And, always feel free to reach out to AEHC colleagues for help.

Wednesday, October 02, 2019

Some Important History of Episcopal Endorsement

As I work on my post about how endorsement happens these days in the Episcopal Church, I rediscovered this paper. This was written in 2009, after the General Convention in Anaheim. Written in preparation for Bishop George Packard's retirement as Bishop of Federal Chaplaincies, it described how we came to work with Bishop Packard and his predecessors in the endorsement process. I thought it could be helpful to have some sense where we've  been when we talk about where we are now. Note that this post is also available at Chaplair, the blog of the Assembly of Episcopal Healthcare Chaplains.

A Concise History: The Relationship of AEHC and the Office of the Bishop of Federal Chaplaincies
The roots of this relationship are in issues of endorsement for certification in our various professional organizations.  In our polity in the Episcopal Church, endorsement came from our diocesan bishops.  A bishop might delegate that to a canon or archdeacon.  He (and at this point by and large it was always “he”) might choose to apply the same standards for endorsement for health ministries that he applied to military chaplains, and so only endorsing priests.  He might have specific standards for endorsement, or none at all.  To paraphrase Scripture, “everyone did what was right in his own eyes.”
This was a difficulty for the endorsing bodies, such as ACPE or the College of Chaplains (now incorporated into APC).  There was no standardization of what “endorsement” might mean in the Episcopal Church, nor how it was obtained.  They hoped for what they had in other endorsing faith communities: a single process overseen by a single office with authority from the community’s official structures.
In the late 1980’s under the leadership of Linda Smith-Criddle, AEHC approached Presiding Bishop Edmund Browning  and asked for assistance in this difficulty.  Linda was able to speak to a meeting of the House of Bishops and raise the problem.  Bishop Browning subsequently asked Bishop Hopkins, then his Assistant for Pastoral Care, to become our contact with the House of Bishops.  Linda also offered on behalf of AEHC that AEHC serve as the “office of record” for endorsements.  They would still be obtained from individual diocesan bishops, but AEHC developed a process and provided a contact point.  It offered a single process and a single point.  However, it still had no real authority from 815.
After several years, Bishop Hopkins asked to have the role as our advocate transferred. Bishop Browning asked the Bishop of the Armed Forces, Bishop Charlie Keyser to take this over.  Bishop Keyser was very willing and very hospitable to health care chaplains and health care issues.   At that point (I believe Razz Waff was President of AEHC), AEHC also asked Bishop Keyser to make his office the office of record for endorsements.  The decision was logical: the office was already familiar with administering the process of endorsement for military chaplains, and in most religious endorsing bodies it was already the case that both endorsements were coming from the same office.  Indeed, the list of military endorsement officers was the list that the College and ACPE were using to verify endorsing officers for health care.  It was also the case that, when a bishop was having difficulty or being difficult about health care endorsement, a call from another bishop was often more effective than a call from AEHC’s endorsing officer. Finally, in those days there was a good deal of concern about clergy misconduct and clergy liability. AEHC’s officers were concerned that as the endorsing agency, AEHC would incur liability if an endorsed chaplain were to be guilty of misconduct – liability that the national Church would be able to bear better than a membership organization within it.
So, the relationship was established.  For military and federal chaplains, the Bishop of the Armed Forces (known now, after several changes, as the Bishop of Federal Chaplaincies) had certain defined canonical responsibilities, and the chaplains had clear accountability. For others, including health care, corrections, and first-responder chaplains, the Bishop was an advocate and support, and the endorsing officer (although that title was usually with an Assistant for Health Care), while canonical accountabilities and responsibilties were between the chaplain and his or her diocesan bishop (and thus a reference to us as “diocesan chaplains” as opposed to “federal chaplains”).
When Bishop Packard became Bishop of the Armed Forces, he was happy to have the opportunity to advocate for health care chaplains in the House of Bishops and to oversee our endorsement process.  At the same time, he hadn’t been long in his position when the United States was attacked in 9/11.  Bishop Griswold gave Bishop Packard responsibility for disaster preparedness, in addition to his other duties.  With the help of our own Mike Stewart, who worked in the Office for a while, he helped dioceses make their preparations.  In addition, the responsibilities for military chaplains grew as the nation entered into war.  First there was Afghanistan, and then Iraq.  Then hurricanes Katrina, Rita, and Wilma added to his responsibilities in disaster response.  Since these were for him canonical responsibilities and responsibilities directed to Bishop Packard by the Presiding Bishop, he gave them the time necessary.  He could do so, even if it meant less time for health care issues, because we as chaplains were really responsible to our diocesan bishops.  He was bishop for military and federal chaplains, with disaster responsibilities added.  Our bishops were our respective diocesan bishops.  He did continue to maintain the endorsement process, but was not available for much else, however willing he might be.
Now Bishop Packard is preparing to retire, even as Presiding Bishop Katherine Jefferts Schori is reorganizing the offices of the national Church.  One of those changes has been to distribute offices and leadership out of New York, including an expanded office in Washington.  In that light, it makes sense for the Office of the Bishop of Federal Chaplaincies to move to Washington, closer to the center of those ministries.   She also decided that health care issues would remain with the Mission Center in New York, with a new person in staff support.  The person most likely to have those responsibilities when decisions are finalized after General Convention, is the Rev. Margaret Rose.  Some AEHC officers met her last fall.  The Rev. Bill Scrivener, President of ACPE and member of AEHC, and I had the opportunity to sit with her here in Anaheim for more than an hour.  I feel comfortable that she sees the importance in maintaining the endorsement process with as little change as is necessary.  It helps that Terry Foster, who handles that paperwork, is not moving to Washington.  We will still have a single endorsement process, overseen by a single office; and if a phone call to a bishop is necessary it will come from a member of the Presiding Bishop’s staff, if not from another bishop.
It has been good working with Bishop Packard.  While he has only been “our” bishop in a very limited sense, he has given us as much time and support as he could in light of his other responsibilities; and has always shown us clear enthusiasm and encouragement.  We will miss him, even as we trust we will still have clear and strong support from officers at 815.

So, since this was written some things have changed, but the process largely has not. That said, there are some comments to be made, and they will be in the next post.

Monday, September 30, 2019

It's All About Us All Being One: A Sermon for Easter VII

This was preached on Easter VII, June 2, 2019, at St. Raphael's Episcopal Church, Crossville, Tennessee. The transcription has taken a while, but here it is at last.

So, everybody has a dream or two that hangs with them. I have one that has hung with me for a long, long time. It goes back to my college days. I was in my room in the fraternity house. I was asleep and I had a dream. And in the midst of this dream I kept seeing the number nine and it was flying past me - nine, nine, nine. It was like a Sesame Street episode gone bad. And I woke up and quickly realized what was going on. My roommate was studying. He tended to prefer to study from 2:00 to 4:00 in the morning,  and he was listening to - wait for it - a Beatles album. Perhaps some of you will quickly figure this out. What was playing while I was asleep? The album was The White Album. The cut was “Revolution 9.” And that's what was coming out of the record player: “nine, nine, nine.” Oh, but I can still see those big graphic numbers flying past me. Well I guess because I had been watching Sesame Street, too. 

I feel that way a little bit about the Gospel of John and about the High Priestly Prayer because suddenly the number is one: that we are one, that they may be one, all one and one and one and one. 

So, John is talking about oneness, and John talks a lot about being in Christ - Christ being in the Father, the Father being in Christ, us being in Christ – and all this about being one; and we have been talking ever since about the call to be one: one in God, one in Christ, one in one another. 

What struck me with this morning's lessons was that in this morning's lessons, in the Acts lessons particularly, we have a remarkable example of two different ways of thinking about being one that are worth considering.

Paul and Silas are in Philippi. Philippi was a Roman colony and what that means is a bunch of Romans soldiers. Roman soldiers when they were pensioned out, were basically given this town and the lands around it to own, to farm as their pension plan. That's how the Roman army handled a pension plan. When a group was ready to get out, they basically gave them somebody else's land and set them up with their sort of equivalent of 40 acres and a mule. 

And that's where Paul and Silas are. But in this town there is also this slave woman and she has a spirit of divination. The Greek says a Python spirit, which is to say it's the same kind of spirit that they had at Delphi because Delphi's in Pythia. So she's following them - it says many days, many days -  and always calling out, “These men are slaves of the most high God and they offer you a way of salvation.” Now, I can imagine that for the first few days, even the first week Paul said, “you know, this could be useful. We might appreciate her being our advertising campaign.” But after a while, even Paul gets tired of that, and understanding what the problem is, he finally casts out the demonic spirit. So now she can't recognize who they are and can't call out after them. 

Now, we don't know what happened to her. There are scholars who want to reflect on that. It's not like she was out of a job because she wasn't an employee. She was a slave. I'm afraid they were going to find some other way to make her useful. But at the same time she had turned a lot of cash. That kind of predicting the future could be lucrative. So, her owners get angry, and when they get angry, they go to the authorities. And what they say is, “Hey, you know, we are one around here. We're all Roman citizens. We're all under Roman law. And these guys, they ain't one of us.” That was actually specious in one sense. Being Jewish was explicitly legal in the Roman empire. There were, as we will recognize when Paul writes about this later in Philippians, people of Jewish history in Phillippi

But that's not really important.  There’s a teaching story that I'm fond of, one about the character the Mullah Nasrudin. One of his neighbors came to him and said, “I want to borrow your rope for a clothes line.” And Nasrudin said, “I'm sorry, I'm using it right now to dry flour. The guy said, “You can't dry flour on a clothes line.” Nasrudin said, “If I don't want to lend you the clothes line, it's as good an excuse for me as any.” So they had as good an excused as any. “These guys are causing a disruption.” No, they didn't claim restraint of trade. They claimed, “These guys are a nuisance. These guys are asking us to do things that is not legal for us to do, and we are one!” 

They were proposing that all the citizens of Philippi were all Roman citizens. They all were accountable to Roman law. They were all ex-soldiers. Most of them or their families had a lot in common and a lot in common. This was one way of asserting, “We are one” 

So, they get Paul and Silas arrested. They have them beaten, they get them thrown into jail with other prisoners, but they give them - what's the opposite of the presidential suite? They take them all the way to the deepest part of the jail. They put them in stocks. 

Despite all of this, it's the middle of the night and Paul and Silas are singing and praying and the other prisoners are paying attention. They are hearing the proclamation in the darkness, in their punishment, and they are listening. And the earth moves; and every lock is broken, every chain is loose and every door falls open. 

Well , the jailer decides it is better to commit suicide than to be executed. I mean, that's the calculus on this. Better take accountability for this. Otherwise, it becomes a big trial. And my family gets hauled into this. So, he's about ready to fall on his sword. And then Paul calls out, “Hang on, nobody's run away.

The jailer goes in and he says, “Really, you're all here? Okay Lord, what do I have to do? What do I do to be saved?” After all, he's probably heard like everybody else that these are servants of the most high God who offer a way of salvation. Paul says, “Believe in the Lord Jesus and be baptized.” And he was with his whole household, and everybody rejoiced. 

Now that's a very different image of being one, isn't it? Because the jailer wasn’t a Jew. He wasn't a follower of Jesus. He was part of the system that had beaten and imprisoned them.The other prisoners were not a part of them, and yet they found the singing and the prayer so compelling that when the doors fell open, none of them left, either. That is an image of being one, not because we're all alikebut because we're all seeking to be in God 

So, if we're going to consider what Jesus was talking about in this prayer before his crucifixion, what does it mean to be one? Remember that he speaks of us in the Father and the Father in us. That’s a wonderful image, perhaps a compelling image; and yet often not enough in the history of the church, in the world around us, among our brothers and sisters in Christ. All too often, there's an awful lot of being one because we all agree, or because we're all alike, or because we all say the same things do it hard enough, we can be one. If we exercise enough, if we pray enough, if we….

That's not what Jesus was talking about. Those are good consequences. But first and foremost in this prayer, and in John, is the understanding that, not because we do it, nor even because we earned it, but by God's grace as we seek to be in Christ, we are one with anybody else who seeks to be in Christ - whether we like it or not, whether we know it or not. You and I are one. Jesus prays to the Father, “And now I pray for these that I'm leaving behind, that they may be one; and I'm praying for all of the rest of the people to whom they will tell the story, that they may be one - not because they're all alike but because they are in us, you and I. And because the Spirit empowers them to be in us, you and I.” Jesus prays and is accomplishing that we may all be one. 

And when we encounter those folks, even those folks who are our brothers and sisters in Christ, who want to say, “I don't know. Maybe they're not one of us,” remember that. That's not Jesus’ prayer and that's not Jesus’ promise. We are one because Christ is in the Father and the Father is in Christ and we by the Spirit can be in Christ. We who all these many years later got it from themperson by person. We are oneand we can say to anybody else who would be one, “Come;” trusting that the promise is made and is being fulfilled by God in Christ, in us.

Wednesday, September 11, 2019

A Classic on Ecclesiastical Endorsement

As I prepare to write about the current process for ecclesiastical endorsement in the Episcopal Church, I thought I would reflect on the value of endorsement itself. That's all the more important because things have changed in professional chaplaincy in the last few years. As a place to start, I looked back at the article below. It was written by Rod Pierce and myself and published in Chaplair in November 1999. When I write about the process I'll make some additional comments about the current situation; but while I work on that, please enjoy this reflection from twenty years ago.

Thursday, July 18, 2019

Who Is an Episcopal Chaplain?

I have posted this both here and on Chaplair, the blog of the Assembly of Episcopal Healthcare Chaplains. I would hope that comments would be posted there, or both there and here, to encourage conversation among members of AEHC and friends of Episcopal Chaplains.

Twelve years ago I posted on my own blog , “To Become an Episcopal Chaplain.” All these years later, it is the most viewed of any of my more than 800 posts. I will be revising that post, as I have done in the past. However, as I prepare to bring that up to date, I wonder if it’s not worth asking a slightly different question: who is an Episcopal chaplain?

I want to think about this for several reasons. One is that the healthcare industry has changed a great deal over my career.  When I was President of AEHC I received several calls with the same question (including one from an office in the Episcopal Church Center): how many Episcopal hospitals are there? But, the question at the time was based on the assumption that most care, or at least most chaplains, was associated with hospitals. One thing I can confidently assert, though: there are fewer hospitals than at the beginning of my career. At the same time, there are more places chaplains are working. For some time, the fastest growing arena of healthcare has been hospice, the one corner of the healthcare industry that requires some form of chaplaincy. While I don’t have specific statistics, I also have a sense that there are more retirement communities and long term care facilities; and any associated with the Episcopal Church will have some provision for spiritual care.

That leads me then, too, to think about the future of AEHC. AEHC in one sense also started with that assumption. Indeed, our original title was the Assembly of Episcopal Hospitals and Chaplains. (We did recognize that the number of hospitals was shrinking. That’s why we changed the name.) If we are to serve the Episcopal Church, and to serve chaplains in the Episcopal Church, we need to consider how we will reach out colleagues in many different venues. 

That also means thinking about how we communicate and reach beyond our certifying bodies. I first became part of the College of Chaplains, one predecessor of APC, more than 30 years ago, and I believe strongly in the value of certification. The annual meetings of our certifying bodies have also made it easy for Episcopalians to gather. That challenges us with two opportunities. The first is to reach out to those who are not certified, and whose positions aren’t going to press them for certification. The second is to demonstrate the value of certification and to support and mentor those Episcopalians who pursue it. 

So, who is an Episcopal healthcare chaplain? The answer is certainly not a matter of order of ministry. Happily, the Episcopal Church can endorse a person in any order of ministry – any of the four – who demonstrates a call to ministry in healthcare.  Nor, really, is it a matter of venue. If the venue is focused on healthcare, a chaplain there is a healthcare chaplain.

That does, though, press us to think about how much healthcare focus we would want to require. There is no question that the care of souls in a parish or a school or a university setting does involve caring for folks with health issues. However, chaplaincy is a matter of focus. Pastoral care of the sick engages the sick person and immediate community. The Chaplain does so, and also engages the institution and in some meaningful sense integrates with the staff and administration.  So, I would insist that the chaplain is serving all patients or clients, and not only Episcopalians. That may not mean that the chaplaincy is paid, or is central to the income of the chaplain. I’m aware of more than one Episcopal long term care facility served by a parish Associate. That Associate participates in leadership, provides an on call response, and serves all residents. The associate is paid through the parish, but functions as a professional chaplain in care of that long term care facility. Another venue to consider is pastoral counseling, Any parish cleric will provide some pastoral counseling; but the professional pastoral counselor is focused on the wider community, and not an individual congregation. These are examples to help us distinguish the healthcare chaplain from the school chaplain, the correctional chaplain, or the military chaplain. (I would note, for example, that the Association of Professional Chaplains will consider unpaid work toward required hours for certification, but the functions must be those of a chaplain.)

Is an Episcopal chaplain endorsed for healthcare ministry? I am a strong advocate of endorsement, and will be writing more about the current status of endorsement. However, there is a lack of information about endorsement, especially among the bishops. That’s a problem, because we’re an Episcopal church, and endorsements are provided by bishops. We have an Endorsing Officer, and an Office of Record to communicate endorsement to the certifying bodies; but the endorsement itself (or the critical confirmation of it) comes from the diocesan bishop. Bishops can also endorse persons for healthcare ministry who are not interested in being certified. While I would very much want to see all chaplains endorsed, I don’t think our recognition of them should wait.

Should we have educational expectations of an Episcopal chaplain? This is an interesting question, with some interesting ramifications. Our current endorsement process only requires that the individual meet the diocesan bishop, and that the bishop feel the person has a vocation for healthcare ministry. I have often observed that in at least this we are virtually pentecostal. Other communions are more rigorous, to the point that one must have completed all paperwork toward certification before requesting endorsement. To some extent, we are better preparing professionals for healthcare work. All our seminaries integrate clinical pastoral education (CPR) into their programs; and many dioceses require or encourage CPE for ordinands who are alternatively educated. On the other hand, these may not be requirements for jobs. While Medicare will not reimburse for hospice care without a chaplain on the team, Medicare takes no position about the qualifications of the chaplain. Also, not only do we endorse lay persons without specifying an educational track, but many dioceses have most if not all ordinands in alternative programs for education that will not integrate CPE. This, like endorsement, can only be addressed with our bishops; and I don’t want to require AEHC to wait to engage such chaplains.

And, for all my enthusiasm to engage those working in healthcare chaplaincy, regardless of how they got there, I want to see us strongly encourage education and endorsement. In one sense, if one is to call oneself an Episcopal chaplain, one must also recognize that those outside the Church will expect a reflection of the Church. Sooner or later, the question is will arise, “What does the Episcopal Church say about…?” An Episcopal chaplain must at least be competent in not only the words but also the faith of the Book of Common Prayer. An Episcopal chaplain must have some sense of what the General Convention has said regarding engagement in the larger community. This is what education can form, and endorsement can confirm. I don’t think that requires a seminary education; but perhaps the same canonical expectations should apply. I don’t know that it requires CPE, but I don’t know of many comparable programs to help a minister understand himself or herself in the practice of spiritual care.

So, these are my first thoughts on the question, “Who is an Episcopal Chaplain.” I would hope we can have an interesting and a helpful conversation on this. I think it would be something to offer to the Church, and something to help shape the continuing mission of AEHC.

Tuesday, June 18, 2019

The Executive Council of the Episcopal Church Speaks to Vaccination

Most of the world may not have noticed, but the Executive Council of the Episcopal Church met last week. For those who don't know, the Executive Council is charged with carrying forward the decisions and programs of the General Convention between meetings every three years.

And even among those who are aware of the Executive Council, not all are aware that they also pass resolutions. Resolutions of General Convention are the highest-level statements of the positions and programs of the Episcopal Church. However, actions of Executive Council are also important. They address specific actions to carry out General Convention resolutions, and address issues that have come up since General Convention. If you're interested in a summary of all the actions of the most recent Executive Council, you can find them here. And if you're a real Episcopal geek, you can look for actions of Executive Council for the last 40 years or so in the Digital Archives of the Episcopal Church, here. (And thanks to the Episcopal Cafe, where these news stories have been shared.)

One resolve of Council had particular resonance for me, and I reproduce it in full:

Express grave concern and sorrow for the recent rise in easily preventable diseases due to anti-vaccination movements which have harmed thousands of children and adults; condemn the continued and intentional spreading of fraudulent research that suggested vaccines might cause harm; recognize no claim of theological or religious exemption from vaccination for our members and reiterates the spirit of General Convention policies that Episcopalians should seek the counsel of experienced medical professionals, scientific research and epidemiological evidence; call on the Office of Government Relations to advocate to the United States government for stronger vaccination mandates informed by epidemiological evidence and scientific research; urge all religious leaders to support evidence-based measures that ensure the strongest protections for our communities; ask congregations and dioceses to partner with medical professionals to counter false information, and to become educated about programs in their communities that can provide vaccinations and immunizations at reduced or no cost to those in need (MB011).

Some of my readers may know that one of my responsibilities in my last position (happily, one I could share with colleagues), was to review requests for exemption on religious grounds from mandatory flu vaccination. It was an interesting process, and perhaps I'll write more another time.

However, one matter I brought to that process was a request I'd received years earlier. I had a call from a priest, a rector in Virginia. She needed some help. She had a parishioner, a mother, who was terrified because of the misinformation, then already rampant, about vaccinations for children and autism. The parish priest wanted to ask the hospital chaplain whether I knew of any support for exemption in the Episcopal Church. I took some time to look into the Digital Archives myself (I am a geek), and found confirmation of what I already thought. General Convention had not spoken specifically about vaccines, but had a long history of supporting receiving modern medical care. Indeed, I suggested to the priest that, if anything, most would lean on that verse in Ecclesiasticus,"The Lord created medicines out of the earth, and the sensible will not despise them." (38:4) I suggested that the priest accompany the mother and children to the pediatrician to help the mother hear clearly what the doctor had to say, and to support her in her anxiety.

There are a few - a very few - religious traditions that reject vaccinations, even if they don't reject all health care. There are more folks who take a moral position (sometimes expressed in religious language, but often not; and in either case often poorly) against vaccinations as a violation of one's person. In those latter cases, it is always in individualistic choice, rejecting the concept of accepting a vaccine to love neighbor as self, by accepting vaccination to protect those who medically cannot. In taking this position, the Executive Council is certainly standing on sound science. What is more important, though, is that they are standing on sound faith: the expectation that Episcopalians can accept vaccination, not only to protect themselves, but also to protect their neighbors.

Thursday, June 13, 2019

Distributing the Costs of Care, Part 3: It’s Already All of Us

So, I’ve asserted (and I hope folks have agreed) that a thing costs what it costs, whether a strawberry or a medical procedure. I’ve also discussed that what makes those things seem affordable to us (at least, to the extent we do find them affordable; but we’ll come back to that) is that costs aren’t really just costs to us: the costs are distributed across a lot of people in the network of the economy. The clear conclusion (and hardly a new one) is that we’re all in this together.

This always gives me pause when leaders in government and business talk about reducing healthcare costs. If I pay attention, it becomes clear that they’re not talking about reducing what a thing costs. They’re talking about reducing what it costs  in one category or another. And, they’re not always talking about the same category. When the political leader speaks about reducing costs, sometimes he or she talks about reducing what I as an individual pay out of pocket; or sometimes about what I pay in premiums; or sometimes about what I pay (and, sometimes, what we all pay) in taxes. And, sometimes when I listen the leader is talking about what a business pays in the process of being accountable (that’s what regulations do, after all); or what the total is paid through taxes, as opposed to how that affects my pocket.

But, note that, as the current system is running (employer based insurance for most, Government-based insurance for the elder and the poorer), those changes are mutually exclusive. To reduce what I pay out of pocket, I end up paying more in premiums; or, conceivably, I could end up paying more in taxes. A thing costs what it costs, and the difference is in how those costs are distributed.

Also concerning to me are those polĂ­tical leaders (and, I will say I don’t hear this from healthcare providers or from supply industries) who seem to want to reduce how much I pay for the benefit of someone else (and, really, usually someone elder or poorer or both). Now, as an Episcopal priest I will assert that such an argument is immoral - broadly un-Biblical, and definitely un-Christlike. However, I also want to look back at our discussion so far and suggest that it’s simply unworkable.

A thing costs what it costs. If costs are redistributed, they appear to change, but that’s deceptive. They will still come back to me, but in a different form - and sometimes one that is destructive.

For example, there are ongoing efforts to reduce Government expenditures for Medicaid, both federal and state. The visible consequence as of those are pretty hard. Look at the number of rural and regional hospitals that have closed over the past few years. People lose care. Communities lose jobs. But also, people end up getting care that costs more, traveling farther, needing more intense and expensive care, and dying. Since hospitals cannot by law refuse emergency care (and that is the law), they make up elsewhere what they lose on those patients. Their basic costs structures go up; their negotiations with insurers go up; and my bills go up. The analogy of squeezing the balloon is apt: it may appear to reduce my taxes, and look good for the political leader, but it will still hit me somewhere else.

What can most effectively reduce my personal expenses? To most widely distribute the costs across the most people. Which leads us to Medicare for All.

It wouldn’t surprise anyone who knows me that I think we would all benefit most from a system offering universal access and requiring universal participation. That is, everyone can get care, because this most widely distributes the amortization of costs of equipment and paying for professionals. And, everyone pays something, in some way that is progressive related to economic capacity (considering both income and wealth), because this most widely distributes, and most justly distributes, financial resources in the system.

Now, at this point no one knows what a Medicare for All plan would do, except perhaps these two points; mostly because there is more than one plan proposed under that heading, and they don’t all agree. However, I do want to note that in some ways we already have something for all in Medicare.  

We normally just think of the insurance for folks over 65 and folks with significant disabilities paid for by Medicare. However, that also means Medicare is perhaps the biggest insurer, and so has a great deal of influence in how widely costs are distributed. I’m not on Medicare, but my insurer knows what Medicare is willing to pay, and wants to negotiate my rates accordingly.

Another aspect in which Medicare serves all is that most if not all medical education is paid for in full by Medicare. This certainly applies to the vast majority of medical residency positions. For most medical residents, hospitals are reimbursed in full for the cost of salaries and perhaps for benefits. In addition, Medicare pays in part for many other kinds of clinical education. This includes nurses, therapists of various kinds, and even chaplains. If you get care from a physician who is in or has completed a residency, your physician was provided to you in part by Medicare. For teaching hospitals, this means that a good deal of the budget that allows them to take care of the poor and allows them to keep their equipment current is relieved by Medicare.

Finally, we can’t undervalue how Medicare has kept many, many seniors out of poverty. Some of us may remember commercials on television before Medicare was in acted, identifying the elderly in urban settings as particularly and acutely poor. Now that I am retired and up on the Plateau, I see that level of financial concern in the rural poor almost every day. Medicare by itself has raised many folks out of poverty and bankruptcy for the two generations we’ve had it.

These are ways in which Medicare currently serves all of us. These are also examples of the value of seeing our healthcare as a social good, and not just as an individual good.

A thing costs what it costs, whether a strawberry or a medical procedure. We are concerned about paying for the healthcare of others, but in fact we are already doing that. We can decide whether that continues to be something that happens outside our view, or if we want to be deliberate and public and all involved in those decisions. To do that, we need to distribute those funds and those costs as widely as possible; and in these United States as widely as possible means all citizens and all residents.

The thing costs what it costs, and we are all always  already sharing those costs, whether we are aware of it or not. Maybe it’s time to recognize that social connection and to see healthcare as a social good, and not just a retail product.