General Convention 2012: On Health

The General Convention is coming again this summer, and this brings me back to one of the first purposes I had for my blog: to share information about General Convention, and especially information related to health, ethics, and/or chaplaincy. The Blue Book, the collected reports of the Commissions, Committees, Agencies, and Boards of the Episcopal Church (CCAB’s) is now available on line. With those reports are included the  resolutions (“A” resolutions) that CCAB’s are bringing to Convention. I encourage you to download it (you can do that here), and check out those that interest you.

It will not surprise anyone that I turned first to the report of the Standing Commission on Health. This year the report is long and detailed. The Commission reported on few topics, but sought to address those in depth. They did do something that I wish more of us in the Church did more often. They went through the Electronic Archives of the Episcopal Church, as they said, “so as not to repeat the work of the past.” Clearly they made a concerted effort over the past Triennium.

I was impressed, though, because the report began, not with an issue or a resolution, but with a reflection. “Despite the archival evidence of vehement commitment to improved health for the Church and the world, there has been little time spent in articulating the Church’s motivation for this work. The Commission finds this to be an unfortunate oversight, and sought to lay a foundation for a future theology of health.” This is an interesting observation, and I see the point. The Commission was deliberate in responding to this lack:

During the summit in 2011, Steven Fowl of Loyola and Leonard Hummel of Gettysburg Seminary facilitated a theological brainstorm, and as a result of such study helped collect these springboard insights:  

• A belief that we are created by God, that creation is a gift, and that our health is a gift from God. We believe we are called to be thankful for and excellent stewards of this gift. 
• An acknowledgment that we are not all healthy and do not all have equal opportunities to be healthy, and that these disparities and suffering are marks of the need for reconciliation with God and God’s plan for us in the world. 
• A belief in the incarnated God, who lived as a person with a mind for the health of his people, who experienced bodily suffering, and who bore the wounds of his suffering in his resurrected body. The implication for health is the assurance that we have a God who suffers with, and cares deeply for, the human creation in body as well as spirit. 
• A belief that engagement in personal and communal health issues is a sign of our hope in God’s creation and redemption. Our commitment to justice is the living out of our faith in God’s gift of health. Conversely, a lack of commitment shows a lack of faith. 
• A belief that scripture provides a model for these efforts: including but not limited to Eden, the prophets including Amos, Jesus’ efforts towards healing, Jesus’ resurrected body, and the Christian community of Acts
• A belief that our tradition is rich in communal attention to a spiritual life that honors the body. We also experience in our tradition a valued engagement with the secular world, critically valuing participation and contribution at personal, local, national and international efforts. 

Again, these are the result of a brainstorming session, and not an analytically reflected theological position statement. That said, they seem quite encompassing. They reference explicitly Christ’s incarnation, and the Scriptural evidence of God’s desire that we be healthy. It also references our responsibility to reflect that desire in the world, and the Scriptural foundation of our ministries of justice and reconciliation. While I haven’t analyzed them in depth either, my sense is that these thoughts align well with the Baptismal Covenant.

I also find myself questioning the statement that, “there has been little time spent in articulating the Church’s motivation for this work.” As in everything else, we Episcopalians articulate our theology first liturgically. We might look to the Prayer Book and to the services for Ministration to the Sick, Ministration at the Time of Death, and perhaps Thanksgiving for the Birth or Adoption of a Child. We might look at the Public Service of Healing in the Book of Occasional Services. These are certainly not theological treatises, but, then, we don’t usually focus on theological treatises. We begin with worship.

I think these reflections are important, certainly because they are comprehensive, but even more because the Commission offers them as a place to start. I think we should appreciate these thoughts, and then take the Commission up in its call for a more reflected theological statement about the Episcopal Church’s understanding of health, of God’s commitment to health and healing, and God’s call to us to participate in that commitment.

General Convention 2012: Reactions to the Denominational Health Plan

Things come full circle. One of the reasons I started blogging six years ago was to comment on legislation and issues at the 2006 General Convention. Now we’re coming to the 2012 Convention.

So, I’ve started watching the legislation being posted for this summer’s Convention. As a reminder (and especially for those for whom details of General Convention are new territory), resolutions to General Convention come in four categories. “A” resolutions come from commissions, committees, agencies, and boards (CCAB’s) of the Episcopal Church. “B” resolutions come from bishops. “D” resolutions come from deputies.

And then there are “C” resolutions. C resolutions come because a diocesan convention or a provincial meeting (in Episcopal parlance a province is a regional gathering of dioceses) have passed a resolution on a subject that included instructions to “memorialize” the General Convention on the subject. That is, a diocesan convention or a provincial meeting passes a resolution to express an opinion and to put that opinion before General Convention as a resolution.

So far, C resolutions are the only ones that have been posted on line. You can already see on line those that have been posted (and I’m sure there will be more).

Right now, the significant majority of C resolutions posted are on the subject of Structural Reform, and most of those have almost identical language. However, there are a few outliers, and two have my attention. That’s because their subject is the Denominational Health Plan, an effort of the Church Medical Trust based on Resolution A177 in 2009. The resolution specified that the plan should be implemented no later than the end of this year. It specified that the Church Medical Trust would offer a plan (or, really a selection of plans), and that within those dioceses had a number of choices. However, one choice it didn’t include (and a choice that is available under canons before this change) was whether or not to participate. That is, dioceses of the Episcopal Church in the United States, their congregations, and any agencies they would designate as “Episcopal” have to participate in the plan. Now, individuals can opt out if they have other provision for health insurance; but institutions can’t opt out. The point of that is to have as many lives as possible covered in the insurance plan; because the more folks you have covered in the plan, the lower the premium (at last in general). (I wrote more about 2009-A177 at the time.)

So far, two dioceses have submitted C resolutions on the Denominational Health Plan, both asking that it’s implementation be delayed. However, they really say two very different things. One is resolution C22 from the Diocese of West Missouri. It calls on General Convention suspend implementation of the Denominational Health Plan “pending consideration of a more equitable and unified Denominational Health Plan that eliminates unfair regional differences and dramatic cost disparities between dioceses…” The point of this is

That the 77th General Convention instruct the Church Medical Trust to formulate a plan that creates a single, unified national plan for the entire Episcopal Church with no variance in premium costs from diocese to diocese, thereby eliminating dramatic cost differences for similar health insurance coverage between dioceses and regions of The Episcopal Church; and be it further

Resolved, That the suspension of implementation of the Denominational Health

Plan is lifted only when the Church Medical Trust presents a revised, unified

national plan consistent with the intent of this resolution to the Executive Council….

The result of this would be, if you will, truly a single plan for the Episcopal Church in which all would still be required to participate. It would be, essentially, an ecclesial form of a single payer plan covering a single, all encompassing risk pool. The suspension is in place until this is done which could take a while; and this resolution calls for things to stay as they are until that can be offered.

This is different from resolution C27 from the Diocese of Central New York. That resolution calls for the Denominational Health Plan to be delayed another three years. It also maintains that all Episcopal diocese, parishes, and institutions would be required to offer health insurance to clergy and lay employees. However, “each diocese or other ecclesiastical organization or body subject to the authority of the church has the right to make decisions as to whether the Episcopal Church Medical Trust or another plan sponsor shall provide health insurance;…”

This is a different result. While it does require all dioceses, congregations, and institutions to provide health care, and requires it within a limited period of time, it specifically rejects a single denominational plan, or having a choice of plans but only from those offered through the Church Medical Trust. This might improve things for some clergy and for many lay professionals, but it resists a church-wide mandate in favor of a multiplicity of health plans – essentially, an incremental change within the same health insurance market that we already have. It would not result in a single risk pool.

Now, full disclosure: for those who didn’t already know, West Missouri is my diocese. Although I voted on the resolution that resulted in C22, I did not participate in preparing it (and I’m not saying how I voted). My only point in this post is to note how different would be the results of these two resolutions. It could raise the question of what problem proposers of each wish to address. C22 is about equity for institutions across the Church accomplished by universal participation. C27 is about freedom of choice for institutions within the Church, albeit with a requirement that all provide something – essentially an individual mandate.

It does seem to reflect the same sort of arguments about providing health care that we’re hearing in the wider American society. Granted, both proposals are progressive enough to require some coverage (after all, we are Episcopalians); but the means, the choices, and (presumably) the costs would be very different.

Even with delay and suspension both of these plans will be overtaken by events if the Affordable Care Act is fully implemented. In that case, passing C27 could result in some dioceses, congregations, and/or institutions could find their coverage through state insurance exchanges. In addition, I will be surprised if there are not additional resolutions from bishops and/or deputies, which may offer other, different models.

Which brings us to this question: what sort of employer do we want the Episcopal Church to be. That’s not simply a matter of whether we think it important to offer health insurance. Not only do both these resolutions require it, but existing canons require it (albeit for a more limited collection of employees). Rather, this might be seen as another expression of the question whether the Episcopal Church is a single body made up of its dependent dioceses; or whether we are an association made up of dioceses which are themselves  associations of congregations and institutions. Both these opinions are being expressed within the Episcopal Church today, and perhaps we shouldn’t be surprised that they might be expressed in a variety ways, including this.

And perhaps that ought to be an aspect of any General Convention, and of any resolution to General Convention. Every day we have the opportunity to ask the question of what kind of church the Episcopal Church wants to be. Moreover, I can’t think of a better forum in which to ask the question than General Convention. It is, really, the same vocational question each of us faces, writ large: what is God calling us to do now? These resolutions raise the specific issue of health insurance for Church professionals. Other resolutions will raise other issues. However, the larger context remains the same: in each issue, to what is God calling the Episcopal Church now? Or, to put it more personally, as it were: before God what sort of institution do we want the Episcopal Church to be?

How? How Else?

How is it that we find these words to be words of hope, and not of fear:

Remember that you are dust, and to dust you shall return.

How is it that we find these words to be words of promise, and not of despair:

Remember that you are dust, and to dust you shall return.

How is it that we find these words to be words restoration and return, and not of loss and desolation:

Remember that you are dust, and to dust you shall return.

How, save by trusting in Christ and in the grace of God?

An Episcopal Perspective: Distinctions That Episcopal Chaplains Bring to Health Care Ministries

I wrote this article for Chaplair, the newsletter of the Assembly of Episcopal Healthcare Chaplains (AEHC). The latest issue of Chaplair is now in print, and so I feel free to also share the article here.

When I first began writing a blog four years ago, I had one topic that I especially wanted to think about. That is whether there might be an Episcopal culture for health care, comparable to the distinctive cultures of, say, Roman Catholics or Seventh-day Adventists.

As I wrote about it (for me, a way of thinking out loud), I identified some characteristics that I thought an Episcopal culture might include. For example, the General Convention has never given specific directives on health care procedures. We have made some clear statements, but not statements that somehow separated us within the larger health care community.

I haven’t given up on the concept of an Episcopal culture for health care, even though I don’t think I’ve found it yet. However, I do think some of the characteristics I have discerned do give the Episcopal Church something important to offer in chaplaincy, and for us to offer as Episcopal chaplains.

We are remarkably well prepared to work in the multicultural, multifaith, polyglot environment of contemporary health care. Central to this is our commitment to the Baptismal Covenant. We have embraced as definitive of the Christian life, and certainly of our Christian ministry, that we will serve Christ by serving all persons, and loving neighbor as self. We have claimed for ourselves that we will “strive for justice and peace among all people, “ and not just our own; and that we will “respect the dignity of every human being,” and not just those who agree with us. Certainly, all professional chaplains commit to these things in codes of ethics and professional standards. We, however, have declared this as fundamental to our faith and practice as Episcopalians.

We are also, I think, well prepared to speak of the eternal in a variety of images. This is in part because we embrace all of Scripture as meaningful, while recognizing that in Scripture God is described in many ways, and addressed in many titles. We have made this formative for us in how many of these titles have been reflected in the Book of Common Prayer. Consider the variety of attributions of God in the many Collects of the church year, both in the Collects for Sundays and in those of feast days. Think of the many titles of God provided in the Psalms. I find this variety makes it very straightforward for me to pray in multifaith groups in ways that respect both my listeners and my own faith.

We have an appreciation of the power of liturgy, of structured and familiar responses, in the most significant moments of life. We certainly know the reality of that for folks like us from “liturgical churches.” However, I think many, if not most of us, have experienced how true this also is for those who claim other traditions. Once again, the Book of Common Prayer is a resource. Even when our words are not the appropriate words per se, we have experience structuring words and phrases to express the concerns and feelings of those in crisis. And, how many of us have discovered a chaplain colleague from another tradition making use of the Book of Common Prayer in her or his own professional practice?

As AEHC has gathered over the years I have advocated that we chaplains claim our place in the church. Many have heard me say, “As we are the Episcopalians among the health care chaplains, we are also the health care chaplains in the Episcopal Church.” It is also the case, however, that we are the Episcopalians among the health care chaplains. We have not defined our presence in our society to any extent by distinctive positions on medical practices. We do, however, bring tools and perspectives to health care chaplaincy that allow us to standout among our colleagues, and to serve patients, families, and staff from many traditions.

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

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

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

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

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

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

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

How should Episcopalians regard other religions?

What does the Bible say about other religions

The path beyond pluralism

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

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

Sometimes It's Hard to Claim Middle Ground

 Published in Spirit, a new quarterly publication of the Diocese of West Missouri:

Some years ago at Clergy Conference I found myself in intense discussion with a colleague from the Southern Deanery.  He was more conservative and I more liberal, but the discussion was really good.  We were discussing how best to provide for the poor.  What made the discussion good had little to do with how.  We didn’t agree on how much at all.  However, we could agree that, however much we disagreed about how, we were called as Christians to be concerned for the poor.  We could disagree respectfully about the means because we could certainly agree about the end.

I was honored when Hugh Welsh invited me to write the first column in “The Middle Ground” in the new Spirit.  His goal for the column, as he shared it with me, was “to find a middle passage (if you will) between a hot topic with a stated pro and con.”  Certainly, there are a number of pros and cons related to universal access to health care.  Whether we speak about “health care reform” or “health insurance reform,” there are certainly different points we might consider. 

We can certainly have respectful arguments about the means.  We can ask just how much Government action is required, and how much we need to focus on personal accountability.  We can think about how to balance employer mandates and individual mandates and subsidies to help the working poor buy insurance.  We can discuss balancing cost control for physicians with tort reform.  We can discuss various means to provide access to health care for all Americans.

However, what we can all agree about as Episcopalians is that providing that access to health care is an appropriate end.  In General Convention we have called on our government to pursue health care reform since at least 1985.  We have reaffirmed it as recently as this summer, when General Convention passed three resolutions on to universal access to health care.

We take that position because it’s consistent with our faith.  It is consistent with the Summary of the Law, that in addition to loving the Lord our God we are called to love neighbor as self.  It is consistent with the Baptismal Covenant; for the Apostle’s teaching calls us to proclaim by word and example, serving Christ in all persons.  So, for us this is the end on which we can agree, even if we see pros and cons about how.

Unfortunately, there are those who do disagree that this is an appropriate end.  They may argue that we lose freedom if the government is involved.  They may argue that an informed individual can make better decisions for his or her own good than any bureaucrat.  However, if we listen carefully we will discover that their arguments come back to a single theme: that I have a right to make the decision that is best for me and mine without regard for anyone else.

That may be legal, but we wouldn’t call it “true,” because it isn’t true to the faith as the Episcopal Church has received it.  We continue to believe we are called to love neighbor as self in ways that proclaim by word and example the good news of God in Christ.  And so we agree that this goal, this service, and specific strategies to achieve it, like universal access to health care, is an end to which God calls us, even if we might disagree about the means.

What Now? Even More Brainstorming

Okay, back to brainstorming again. The previous entries are here and here.

My first suggestion reflects a story that many of us have heard. Some will know the story of the frog and the scorpion. I grew up hearing “The Snake” by Al Wilson. (Conveniently enough, I chanced up on a blog that has both posted.) The point of both stories has come into my vocabulary as a saying: “you can trust a snake – to be a snake.” I don’t mean this as a specific comment about a specific person these days. I simply mean to suggest that people will behave according to their nature, and you can’t expect a significant change in behavior to happen suddenly, or without a great deal of work.

With that in mind, it seems to me that the House of Bishops, and individual bishops as members of it, can trust one another without overthinking or tedious parsing. Look at what folks have said and trust that they meant it as they said it. We should then hold them to what they have said.

For example, we have two statements of the intent of the Windsor Bishops: the letter from the first meeting of “Windsor bishops,” and the presentation of Bishop MacPherson to the Primates’ Meeting. While both acknowledge the demand of a few for some “alternative oversight,” both also commit to work with the Bishops of the Episcopal Church. Their willingness to maintain relationships and share in the pursuit of reconciliation should thus be how the bishops as a body, and how we outside, should assess their participation.

Conversely, statements from AMiA and from Bishop Duncan of Pittsburgh, in his role as Moderator of the Network, state clearly that they believe they are not called by the Communiqué (or, really, by anything else) to seek reconciliation and/or (re)integration into the Episcopal Church. The House of Bishops should trust them on that point and act accordingly.

We are currently watching this dynamic working itself out in events. In light of the fact that as of Friday the bishop-elect of South Carolina had not received sufficient consents from Standing Committees, he has issued a statement that quite unambiguously commits to serve in, stay in, and conform to the “doctrine, discipline, and worship of” the Episcopal Church. Indeed, he says that he had actually said this in his earlier statement. If sufficient consents to arrive, then this should be the standard for assessing his behavior, and his leadership in that diocese.

We should look at the differences in interpretation of the Communiqué between Bishop Katherine Jefferts Schori and Archbishops Akinola and Orombi. There is a significant difference between a commitment “not to authorize rites” to bless same-sex couples and to “prohibit” such blessings. There is a significant difference between expectation that the Episcopal Church will “fast for a season” from confirming the election of a GLBT person in a relationship and a commitment “NOT to consent” period. We need to trust that those are the standards, and the minimal standards, that will impress those African prelates, and make our choices accordingly. We should trust that they aren’t about to stop their cross-provincial interventions short of that, and have appropriate expectations.

In sum, we should trust that folks have said what they mean to say (including those Episcopal bishops who have stated unequivocally “not one step back!” Check here.). We should not be surprised or shocked if they do as they say.

By the same token, our bishops must say what they mean. For example, we quibble over whether Lambeth resolution 1998-1.10 is “the standard of teaching” for the Communion. Like our arguments after the 2003 General Convention over the word “recognize,” we need to simply get explicit. We might say, for example, “If by standard you mean what we can normally and normatively expect to hear if we attend an educational event in most provinces of the Communion, then yes, perhaps we can call this a ‘standard.’ If, on the other hand, you mean a doctrine, an official teaching authorized by the appropriate council of the Church, we can’t agree; for neither the Lambeth Conference nor any other council of the Communion has ever claimed such authority to establish a ‘doctrine.” Moreover, a majority opinion is not the same as a consensus; and so we can’t agree to those definitions of ‘a standard.’”

The bishops might get explicit about how we view the Instruments of Communion and their authority. We have heard expectations from the Primates’ Meetings, and arguably from the Archbishop of Canterbury. The bishops might clarify their expectation to also receive guidance from the Anglican Consultative Council and the Lambeth Conference before deciding on next steps in responding to the Windsor Report. (Of course, that could raise an interesting question. Could we recognize – could anyone really recognize – the Lambeth Conference as an “Instrument of Communion” if a significant viewpoint, much less a significant portion of the bishops, isn’t invited to participate in communion?) If, as the Windsor Report holds, there is no meaningful priority between the Primates’ Meeting, the Anglican Consultative Council, and the Lambeth Conference (save perhaps in history), how can the Episcopal Church make a meaningful response without hearing from and participating in all three?

Finally, the bishops might take the initiative in seeking reconciliation within our own province. Certainly, that was envisioned by Bishop MacPherson in his presentation to the Primates. Thus, our bishops could support the Presiding Bishop and help her develop the role of a Primatial Vicar. They could even choose with her one of the Windsor Bishops for the role – perhaps Bishop Howard of Florida, elected for his conservative views, and still beset by clergy and congregations for whom he wasn’t conservative enough. Surely he is in a position to see both sides. Or perhaps Bishop Jenkins of Louisiana, or Bishop Wimberly himself. If the Windsor Bishops are committed to working within the Episcopal Church and to work with those who feel estranged; if the Communiqué endorses their interest in helping with reconciliation; and if the Communiqué has endorsed the model of a Primatial Vicar with authority and responsibilities delegated by the Presiding Bishop, why do we need to wait for a Primatial Pastoral Council? We can show our commitment to those who feel estranged in earnest, making the first move without being formally coerced – and making it on our own terms, within our own structures. No outside council, not English bishops sent as questionable emissaries: just Episcopal bishops working together to show that the goal is acceptance of both all our GLBT siblings and all our dissatisfied siblings.

Now isn’t that a thought? We’d have done as best we can what Bishop Katherine originally suggested, using the resources endorsed by the Primates’ Communiqué, and we’d have done it without waiting for outside direction. Now, how could folks disagree with that?

Anglican Communion and the Sin of Memory

At times in my life I have pondered what I call “the sin of memory.” The “sin,” in essence, is essentially justification of bad acts by selective recall. In other words, I can remember that injury I need to justify my actions today, and can conveniently ignore or discount other events, especially those that might mediate against the action I wish to take.

I grew up in the midst of it, really. In one sense it was all around me. I grew up in Tennessee, a state that to this day in some sense revisits the Civil War with every statewide election. For the past half generation that’s been muted: as the Republican Party came to represent social conservatism the divisions became less visible. Still, the cultural differences remain between the agricultural West (once cotton and now soybeans), the financial and governmental Middle, and the industrial and mining East within Tennessee. My mother’s ancestors fought for the Union Army, from that part of the state that in referendum voted against secession. The president who could not stop Reconstruction came from that region; and the other parts of the state have not forgotten either event.

In another sense I grew up with it in the house, albeit still at a distance. I grew up hearing folk songs, including many Irish songs of Republican resistance (an entirely different group, and an entirely different meaning of “Republican”). As a child I sang “At the Rising of the Moon” with enthusiasm, with no clear understanding just whom those folks were so ready to fight. I came to realize, of course, what history that referred to; and there were more than enough news stories in my youth to demonstrate just how acutely folks felt that history.

In my lifetime we have seen many such instances, and have been educated to many others. We know the names. As Yugoslavia broke into smaller and smaller pieces, for each group, whether Serb, Croat, Bosnian, Albanian, or Macedonian, there was some date, some event, some “battle” won or “massacre” suffered, that justified combat, resistance, and sometimes horrific personal and political violations. When Rwanda fell into bloodshed, we in the west did not know the history that motivated Hutu and Tutsi; but they certainly did. In the past three years we in America have learned of the events that shaped and separated Sunni and Shia within Islam. They shouldn’t surprise us, if we’ve been paying attention in the past half century to the history that has shaped violent acts and violent responses in land that is Holy to more than half the human race.

I’m mulling this over now, and the way this “sin” seems to be playing out in the current differences in the Anglican Communion. In all the discussion, framed as “what it means to be an Anglican” or “an Anglican church;” or “what are the essentials of the Anglican tradition,” all of us – all of us – find the way to those citations that each of us finds compelling. We begin, of course, with Scripture, each of us citing those “proof texts” that make our point, and interpreting in or out the “proof texts” that seem compelling to those with whom we argue. We all deride “proof-texting,” of course, as poor scholarship; even as we continue in the practice.

But I find we do the same thing with history. Sometimes we agree on the event, if not on its import. We all acknowledge that the decision regarding ordination of women to the priesthood at the General Convention of the Episcopal Church in 1976 was important. We disagree whether it was a triumph or a disaster. We also tend to forget that the first decision regarding a woman in the priesthood was not made in “western” America, but in “eastern” Hong Kong.

And so I have heard referenced many touchstones of what might be essential to the Anglican tradition. I have heard reference to the Book of Common Prayer; but to which one? I have heard reference to the reformation theology of Thomas Cranmer in 1549 and 1552 (growing more Reformed with a capital “R” from one to the other). I have heard reference to the 1662 Book, still the official prayer book of the Church of England, as for many others around the Communion. On the other hand, I have heard reference to the 1789 Book of Common Prayer of the then new Episcopal Church, its faithfulness to Bishop Seabury’s promise to follow the forms of the Scottish Nonjurors, and its discontinuity with 1662. I have heard almost nothing of the 1559 Prayer Book, that often took the Lutheran phrases of 1549 and the Reformed phrases of 1552 and simply tacked them together.

By the same token, I have heard raised up the memories of Thomas Cranmer to anchor the Reformed foundations of Anglican theology; or the Tractarians to anchor the Catholic foundations; or F. D. Maurice to anchor the Modern tradition. I have seen little discussion that would recognize the tradition as embracing all three. I have seen the arguments just what Hooker meant when he recognized Scripture as the “first” source of authority. I have heard little of Hooker’s insistence on “all things in Measure, Number, and Weight,” or of his commitment to Thomist method or Natural Theology. I have heard almost nothing of John Jewel, Hooker’s teacher and colleague, who argued against the Roman tradition as Hooker argued against the Puritan. Yet these are also part of the foundations of the Anglican tradition.

Indeed, we have been from the beginning, we Anglicans, people of paradox. There have always been two perspectives being expressed. The Lutheran and Reformed scholars who were tutors to Edward, Cranmer among them, would be met with Elizabeth’s sense of the pastoral need to retain more “catholic” services for the people in the pews. The early shape of Anglican theology took almost as much from Jewel’s Apology for Church of England as from Hooker’s Laws of Ecclesiastical Polity. Even a cursory knowledge of English church history highlights the movements between Puritan and Catholic. And in that history, the Elizabethan Settlement and the coexistence of the 20th Century were something of an exception. More often there were broad swings, with one group or another dominant for various periods of time. We have survived significant movements from one side to another, significant periods of “reappraisal” and “reassertion” over the centuries.

We have been a significant, too, if not unique, in our commitment to working, or at least talking, with other Christians. In the past generation we have had conversations on national and international levels with Roman Catholic, Eastern Orthodox, Oriental Orthodox, Lutheran, Old Catholic, Baptist, Methodist, Moravian, and Reformed Christians. We have managed to acknowledge the Christology of the Separated Churches of the East and of the Oriental Orthodox churches, even though they will still not recognize each other. We have held up for ourselves a self-image as a “bridge” church – between Catholic and Protestant, between Word-oriented and Sacramental traditions, between contemplative and active lives.

We have not maintained a single, simple, straightforward tradition. We are, in fact, heirs of a broad, varied, and sometimes conflicted tradition. Sadly, when we discuss that tradition these days, we rarely acknowledge that breadth. There is within that variety enough to justify our individual positions, our individual goals; but only so long as we deny, discount, or ignore those parts of our tradition that don’t support them. We have survived broad swings and strong disagreements now, and might again. But we won’t survive them if we continue to commit “the sin of memory.”

Toward An Episcopal Culture for Health Care: Justice

"Will you strive for justice and peace among all people, loving your neighbor as yourself?"

This is one of the promises in the Baptismal Covenant. I've written before here and here of the distinctive North American use of the Baptismal Covenant, and especially regular recitation by all present at baptisms, confirmations, and the Easter Vigil. Certainly, this would be important in developing an Episcopal culture for health care.

But, what comes under the category of justice? . Health care institutions are only involved in the justice system at the periphery. Some of us have cared for prisoners, and there are health care providers in that system; but for Episcopal health care institutions this is not a formative issue.

Moreover, in health care justice has a rather specific connotation. Justice is the fourth category in "the Georgetown Mantra," the categories of respecting personhood that currently pervade clinical ethics. In discussions of health care ethics, the question of justice is how the issue under discussion affects others beside patient and providers, including family, other patients, and society at large. Justice issues can be as large as national decisions of health care policy; or as intimate as which of two eligible patients gets access to the one available donor organ or mechanical ventilator. It can be both at the same time, as when a hospital decides how much care can be provided to patients who can't pay, and has to decide how this applies to the person who just walked into the ER.

Justice is also the category under which money issues are discussed. Almost inevitably, when a money issue is raised in an ethics discussion it is prefaced with an apology: " I hate to bring up money, but.... " We are appropriately wary of "putting a value on human life (or suffering or rights)." At the same time, care does cost something, and funds are not unlimited. Corporations have, in the past at least, practiced the notorious "Pinto planning" - calculating the cost of a safety-oriented engineering change against the probable liability and legal costs resulting from not making the change. Many now are making decisions regarding whether to reduce health benefits of employees. We do make such decisions, if indirectly. When we do, it is certainly an issue of justice.

So, how would an Episcopal culture for health care reflect justice among all people? Certainly, economic concerns would be one expression. In recent years, as so many Christians have wrestled with issues of human sexuality and family relationships, we have often been reminded that in the Bible there are many more references to economic issues than to issues of human sexuality. In most cases, those issues relate to economic behavior as an expression of justice and wholeness. The various laws related to the year of the Jubilee, and the restrictions on lending reflect that theme. The repeated calls for justice in Isaiah and Amos reflect behavior and class structures expressing significant economic differences. Micah tells us it is the first thing that God requires. Jesus’ proclamations of the Kingdom, whether in reading from Isaiah in Luke 4 or in the Last Judgment in Matthew 25, insist that the Kingdom serves the poor and the least. The promise that “the first will be last and the last, first,” seems to apply as much in financial status as in social status. I have already written about the poor in an Episcopal culture for health care. Caring for them is as much an expression of justice as of compassion.

Other aspects of justice would also seem to be important. For example, does the institution have policies to support a diverse leadership and staff? How many different expressions of diversity are recognized and celebrated? Issues of social justice respecting persons regardless of age, race, gender, creed, or sexual orientation may reflect contemporary political considerations, but they also reflect the Biblical tradition of welcoming the sojourner and the Christian tradition that all are equal before God.

Respecting patient rights in clinical and research ethics would also seem relevant to issues of justice. After all, justice is, as has been noted, one of the principles of “the Georgetown Mantra.” The intent in articulating those principles is to insure an approach to care based in respect for persons.

Related to that would be policies and practices in an institution built on obeying relevant laws and regulations. Federal, state, and municipal laws, and standards of various accrediting organizations are oriented directly or indirectly to protecting patients, families, and staff. And violation of laws would involve the institution with the justice system.

This is a preliminary reflection on how an Episcopal culture for health care would reflect this injunction from the Baptismal Covenant. Further reflection could center around our concepts of “peace” and “all people” and “neighbor.” However, justice is an appropriate place to start. It is where the injunction begins. It is a central theme of “walking humbly before God.” It would certainly be an identifiable dynamic of an Episcopal culture for health care.

I Think Bishop Schofield Has Missed a Couple of Things

This started, as so often happens, at Thinking Anglicans. The specific topic was the Diocesan Convention of San Joaquin. That Convention, led by Bishop John-David Schofield, passed on first reading changes in diocesan constitution and canons that would presume to distance San Joaquin from The Episcopal Church, and declare that diocese “constituent” within the Anglican Communion.

Among the other documents linked from the report on Thinking Anglicans was Bishop Schofield’s address to the Diocesan Convention. I read it, and felt moved to respond. Now, I initially responded on Thinking Anglicans; but I waxed eloquent (or at least verbose) and exceeded the 400-word guideline there (a wise guideline to which I humbly and happily accede).

But then, I have a blog. If I want to write so much, I can post it there. And here it is.

Perhaps there are many nits to pick in Bishop Schofield's address – issues of how accurately he recounts recent history, or how accurately he describes the positions and concerns of those with whom he disagrees; but others will do so, and probably better than I. Two things did strike me, especially in light of recent discussion in the blogosphere.

First, he specifically cited issues of ecumenical discussion and hope for union with Eastern Orthodoxy and with Roman Catholicism. Several recent discussions I've run across have noted that these are not the only large, international bodies of Christians with whom we interact ecumenically, much less nationally and locally in the Episcopal Church. A number of those other bodies are not so distressed at the ordination of women or full welcome of GLBT persons in the entire life of the Church, including orders. We are in conversation and sometimes in full communion with communities that maintain the historic Episcopate, but are not in communion with either Rome or Constantinople (the Lutherans, the Old Catholic Churches of the Union of Utrecht, and the Mar Thoma Church come to mind). We may find the similar structures - especially an initially similar Episcopate - of Rome and Constantinople attractive; but they hardly describe the whole Body of Christ. Citing ecumenical issues with only a part of the Body illustrates Bishop Schofield's inclinations regarding centralization of authority, and, in my opinion, clericalism.

Second, I find Bishop Schofield's image of Paul before Agrippa interesting. It certainly works to illustrate his perspective that San Joaquin is the prophetic voice. Or, perhaps it would if he were talking about San Joaquin. What impressed me was how very much he personalized the parallel with Paul. Yes, questions have been raised with and for him as an individual, ordained in The Episcopal Church (and for all his repetition of it, there is no institution called "The Anglican Communion" within which to be ordained - repetition doesn't make it so). However, his image of himself as so central, so pivotal, detracts from his focus on issues. Yes, there may be some consequences for him, but this is not about him, from either pole of the debate. His presentation suggests to me that he's not clear about that.

Let me make an analogy. I am a citizen of the United States, and of a State, and of a City. I am subject to all the laws of those various levels of government. I cannot deny one level to the exclusion of another, even it I might argue (even successfully) that the laws at one level supersede the level at another. Am I a citizen of the world? Yes, but only in a metaphorical sense. Am I subject to international law? Yes, but only under the terms of agreements between the United States. At this time, for all the promises or worries the phrase entails, there is no World Government.

In parallel (and if the analogy is imperfect, I still think it is apt), I am a priest with a specific position in a particular diocese within The Episcopal Church. I am subject to the canons and policies of all those levels of authority. I cannot deny one level to the exclusion of another, even if I might argue (even successfully) that canons at one level might supersede canons at another level. Am I a member of the Anglican Communion? Yes, but only metaphorically. Am I responsible within the Anglican Communion? Yes, but only under the terms of the relationships among those various provinces of the Communion, made somewhat substantial by recognition by the See of Canterbury and participation in the Instruments of Communion. And those relationships are provincial, and not diocesan. I am no more individually related to the Archbishop of Canterbury than to my own Presiding Bishop, or to the Primate of Canada or the Primus of Scotland. We share in Christ’s grace, and we are recipients of Anglican tradition; but in terms of the Anglican Communion, I am connected to them in and through the relationships between provinces. In those parallel structures of how we as human beings have organized ourselves under God, my specifically Anglican connections, unlike my general Christian connections, are through the structures and not despite them.

All in all, I do not find Bishop Schofield's argument persuasive. We have yet to see the consequences of his leadership of his diocese within the context of the institution he used to recognize as his church. In the meantime, I think it is important to see ourselves within the entire Body of Christ, and not simply within the Anglican limb; and to recognize that if I am heeding Christ’s call to seek and serve “the least of these,” I have to remember, however strongly I might feel, that this isn’t all about – it isn’t even, it can’t be, even mostly about - me.

Toward an Episcopal Culture for Health Care: Institutional Vocation

Last week I attended the fall meeting of the Executive Committee of the Assembly of Episcopal Healthcare Chaplains (AEHC). You may have noticed the link to AEHC in my sidebar. I am the Immediate Past President, a position that in general means I get invited to all the parties, but have very little for which I'm actually responsible.

We met, as we have in recent years, on a seminary campus. This year we met at the Church Divinity School of the Pacific, where folks were very hospitable to our little group. We have chosen to meet at seminaries in hope that we will have some opportunity to talk to students, and to talk especially about a vocation to healthcare ministries.

That intent brings me back to one of my ongoing occasional topics: what we would look for in an Episcopal culture for health care. Specifically, in an Episcopal culture for health care, how would we see, or how would we consider, vocation?

The first question to address at that point would be, I think, whose vocation? That is, are we asking about the vocation of the institution, or are we asking about the individual vocations of the persons who work in the institution? As you might guess, I think both are worthy of consideration. This post will consider the vocation of the institution.

How would we speak of the "vocation" of the institution? We know, of course, that the institution has a purpose: it exists to provide health care. That is not a distinctively Christian purpose, much less distinctively Episcopalian. In the area I serve there are Jewish institutions, and civic or governmental institutions that would claim no faith connection at all. In the rest of the world health care institutions have been founded by faithful Muslims, Hindus, and Buddhists, and probably by others not familiar to us.

How would we look beyond the purpose of health care to find some sense of vocation? In that light, what do we mean when we speak of "vocation?" The word itself, as we know, comes from the Latin vocare, "to call." We use it in the church to speak of a specific call from God to a particular ministry. In the Preface to the Ordination Rites in the Book of Common Prayer, we find reference to "The persons who are chosen and recognized by the Church as being called by God to the ordained ministry...." (BCP p. 510) We tend to think of vocation in relation to these and other specialized ministries within the Church: ordained ministries, or monastic orders and communities. However, we recognize that all are called. The Catechism in the Book of Common Prayer notes that "The Church carries out its mission through the ministry of all its members;" and that "The ministers of the Church are lay persons, bishops, priests, and deacons." (BCP p. 855)

But, if we commonly use the concept of vocation to speak of the ministries of individuals, how would we speak of the vocation of an institution? If health care as a purpose is not specifically Christian, how would we see in it any sense of vocation?

I would think that in part we would look beyond the basic purpose of health care to understand how the institution was established, and how it sees itself now. For-profit institutions are as much intent on health care as are not-for-profit institutions; but the establishment and the culture would surely be different. Both are involved in service, but one serves patients to serve shareholders, and the other serves patients for their own sake. An institution founded by Episcopalians would, one hopes, be different in focus and culture than one by a government agency or founded for profit. An institution founded by Episcopalians that became part of another system would surely experience some cultural change, whether the new system was another faith community, or the local civil community.

I think the first place we would look to see that difference would be in the mission, vision, and values. In general, some evidence of that should be easy to find, for institutions and systems have been for a generation developing and refining explicit statements of mission and vision and values. What words have they chosen? What values have they espoused? Do the works they choose seem in any sense congruent with the faith as the Episcopal Church has received it? Even if not specifically so, are they values that we as Episcopalians would embrace?

On a side note, while we might think about looking first to the name of the institution, it might not be as helpful as one would think. Many of the hospitals started by Episcopalians were names in honor of St. Luke the Physician. Unfortunately, between the small size of the Episcopal Church and the sale over the years of many of those institutions to non-Episcopal organizations, and also the success of our Roman Catholic siblings in establishing and maintaining health care institutions, many people, at least in my experience, assume all those hospitals are or were Roman Catholic. It's named for a saint; therefore, it must be Roman. A few institutions include "Episcopal" in their names. For the rest of us, we live with the confusion. (And there’s no shame there. Roman Catholic hospitals are good hospitals. They're just not Episcopal.)

So, we would look to those mission, vision, and values statements. We would then want to see how they function in the life of the institution. How, for example, are new staff and professionals oriented to those values, and to the history from which they arise? How are they expressed by the Administration and leadership, and how are they reinforced in the day to day practice of the institution?

Speaking of leadership, does the founding tradition affect who serves in leadership? Are there members of the Episcopal Church on the Board, for example? Are they there by design, by custom, by courtesy, or by chance? Does a bishop, or representative member of the clergy serve, and in what capacity? While no guarantee, visible presence of Episcopal clergy and lay leaders would lend credence to congruence of the institution's values with those of the Episcopal Church.

Are there positions in the institution held by Episcopal leaders by design? While this would be rare for most positions, it is not uncommon for an Episcopal institution to reserve a chaplain's position for an Episcopal cleric. And, to whom does the Chaplain report? One measure of how the institution values the position is to consider how high in the administration the reports. There is a distinct difference in the influence of a leader in an institution between reporting to a manager or to the chief executive officer.

Finally, does the institution acknowledge an explicit connection to the Episcopal Church, whether active or historic? Certainly, I would have higher expectations that an institution actively connected to the Episcopal Church would meet many of the criteria I’ve considered above. However, I would not disdain an institution that has had a change of ownership but continues to express Episcopal heritage by meeting many of those criteria.

It may feel a bit awkward to speak of the vocation of an institution, or at least of an institution that is not entirely religious in purpose or function. At the same time, we speak of the culture, the ethos of an organization; and that culture, that ethos gets expressed in specific actions. That culture, that ethos has a certain self-awareness about it. After all, it is to a great extent a matter of choices: “This is how we choose to act;” and, so, “This is who we choose to be.” When we explore the sense of vocation of an individual, that self perception, that sense of call by the Holy Spirit, is critical. We may be a Church in which personal call is examined for acknowledgement by the Church; but we don’t go forward unless and until that personal sense has been heard and examined. I think we can make a similar evaluation of the personal sense of call of an institution, expressed both in words and deeds. If an institution is an Episcopal institution, I think we can expect to see words and deeds that express not only a culture or ethos, but a consciousness of call. I think such a sense of vocation would be essential for an Episcopal culture for health care.

Toward An Episcopal Culture for Health Care: the Poor

"The poor you will always have with you." (Matthew 26:11a)

“Truly I tell you, just as you did it to one of the least of these who are members of my family, you did it to me.” (Matthew 25:40)

I work in a health system that is explicitly “faith-based” (those words are in the mission statement of the system and of each institution in it) and specifically (if not as self-consciously) Episcopal. That is, the system is a ministry of the Episcopal Church, and is one of the few hospital systems started by Episcopalians that still has some organic connection with an Episcopal diocese.

Once upon a time, before there was a system, there was the original hospital. I started with the system in that hospital, and still refer to it as “the Mother House.” (Yeah, I have heard “mother ship,” but in my old age I’m more monastic than sci fi fan.) And in the halls of the Mother House, along with other pieces of printed information, one could find a brochure describing the hospital’s policy on uncompensated care. The policy included this principle, if not these exact words: no one would be refused care based on the inability to pay.

We no longer have that brochure. We still have a policy, and under the policy we will still care for all who come to us - well, almost. You see, even we have had to set some limits.

Oh, we are still providing uncompensated care - more than all the other non-government hospitals in our area. But we've had to set some limits, asking patients for copays up front, and refusing some patient transfers if there's not a really clear medical reason for moving the patient. We've made some clear distinctions between "charity care," and "bad debt," based on whether patient and family cooperate on seeking resources. We want to care for all regardless of the ability to pay; but we can no longer do so, much less say so.

How does this fit with an Episcopal culture for health care? The Baptismal Covenant calls on us to “seek and serve Christ in all persons, loving your neighbor as yourself,” and to “strive for justice and peace among all people, and respect the dignity of every human being.” As I have noted before, the General Convention is on record as calling for universal access to quality health care. How, then, can we as an Episcopal health system turn anyone away?

The answer is, at least in part, well known: if we set limits, we serve fewer patients. If we set no limits and end up folding financially, we serve no one – not the patients, nor our staff, nor the larger community. This becomes part of any argument from a perspective of distributive justice: in a society in which health care is a limited resource, some choices will have to be made. We have made choices that we think will allow us to serve the greatest number of patients. We have provided options to assist in getting care those who have no resources. We will go to great lengths to help patients and families ho want help, and are willing to cooperate in the process. But we can’t take care of everyone.

Are there other options for us as an institution? One is, of course, to work so that health care is not so limited a resource. We can advocate with government to increase the funds and the services of Medicare and Medicaid. We can negotiate with insurance companies to offer our patients and their customers the best services at the best rate. In fact we do both; but those are difficult processes. Medicare and Medicaid are held hostage to the political will, and the will is not there. Indeed, Medicare reimbursements are figured something like this: “This is what you say a procedure costs. However, looking at your regional market, as we define it, this is what we think it should cost. Based on wanting to hold down that cost, we will pay you 60% or so of what we think it should cost, regardless of what you say it does cost.” We can advocate, working to change not just the naked figures, but more broadly the political will.

We can participate in research. This can help two ways. Some research directly affects costs, either demonstrating that the cheaper procedure is as effective, or developing the new procedure or drug that is so much more effective as to be worth the cost. Research can help indirectly by paying the health care costs of those who consent to participate, freeing up other dollars for patients who need assistance. And in fact we do participate in research. At the same time, questions remain. Just how much benefit, and for whom, should a new procedure or drug provide to be worth new and greater costs? If the older, cheaper drug or procedure is almost as effective, how close is close enough? And how do we determine which patients will only benefit from the newer drug of procedure?

These are some of the considerations as we consider how we will care for the greatest number of people. And, of course, none of them are simple. However, it seems to me that for an Episcopal culture for health care these issues must be grasped and engaged, as determinedly and as fiercely as at Jabbok. And we must not be complacent, either that we are doing enough or that we are doing enough more than someone else. Surely a vision of the Kingdom includes the opportunity for us to serve all, whatever the circumstances. And so it was that I said to our leadership, when the new policy was introduced, “We must make hard decisions, but we must not be satisfied with them. The Episcopalians who stand behind us and pray for us expect no less. We are not choosing today between good and bad, but between lesser sin and greater sin. Even if we're doing what we must, let us acknowledge that with a real sense of sadness.”

Toward An Episcopal Culture for Health Care: Prayer

I have commented that my discipline as an Associate of the Order of the Holy Cross includes saying Morning Prayer, as best I can, each day. In fact, on days when I am in the hospital I say Morning Prayer in my office. An important part in the Office, as well as in my midweek Eucharist in the hospital chapel, is to pray by first name for each patient in the hospital, as well as for those employees who have requested prayer, or whose particular needs have come to my attention.

I don’t think many patients are aware of this, although it is mentioned in the announcement of the Eucharist. I don’t think many employees are aware of it, although they are informed at New Employee Orientation. I do think it’s very important – on some days the most important ministry I have for patients – that I pray regularly for patients, families, and staff in my hospital.

Which raises this question: what is the role of prayer in an Episcopal culture for health care? That’s both too easy and complex a question. Most would, I think, say that prayer at the bedside is appropriate in health care, regardless of the faith culture, or lack thereof, of the institution. Perhaps; but, then, what would make it particularly Episcopal? Some might suggest that in modern health care prayer may be of personal value, but not of clinical value. Perhaps; but, then, how could that possibly be Episcopal? And what of prayers away from the bedside? If this is an Episcopal institution, when and how should prayer be a part of institutional life?

In an Episcopal culture for health care I would expect prayer for patients would be acceptable and even encouraged. However, there would still be an expectation that the decision whether or not to pray with the patient would lie with the patient and/or the family. (I am making a distinction here between praying with a patient, in the patient’s presence, and praying for the patient outside the patient’s presence.) To pray when prayer is not welcome demonstrates lack of respect for the patient’s own spiritual life (or decision not to have one). It would be a moral violation at least; and those of us who believe prayer has clinical value will also believe inappropriate prayer could do clinical harm, at least to the extent that the patient’s stress and anger would inhibit clinical benefit. Prayer requested by the patient or family, or offered by the practitioner and welcomed by the family, would seem an important intervention to be available in the institution.

And who would be the appropriate practitioner? Should prayer be reserved to religious practitioners – chaplains, clergy, and trained volunteers – or should it be approved from any provider? As Episcopalians we believe that the Laity are the first order of ministry. According to the Baptismal Covenant, all Christians are called to “continue in the apostles’ teaching and fellowship, in the breaking of bread, and in the prayers.” (Book of Common Prayer, page 304) The Outline of the Faith states, “The ministry of lay persons is to represent Christ and his Church; to bear witness to him wherever they may be; and, according to the gifts given them, to carry on Christ’s work of reconciliation in the world; and to take their place in the life, worship, and governance of the Church.” (Book of Common Prayer, p. 855) Might not a Christian surgeon have gifts to pray with a patient before surgery, as well as to do the surgery itself? On the other hand, will that Christian surgeon have the sensitivity – a gift in itself – to recognize the patient for whom prayer would be inappropriate? Some chaplain colleagues are wary of non-trained pray-ers, often out of experiences in which a sincere Christian lay person had fervor but lacked sensitivity. In my own hospital I emphasize that there must be an invitation to prayer, that the person invited must be free to accept or decline (a point of particular sensitivity with respect to the vulnerability of patients and families), and a free acceptance based on the comfort of both parties with the invitation. Rather than discourage such encounters, I hope that I will be informed of such encounters. When they go well I can support and encourage the layperson for spiritual care of patients and families. When they don’t go well, I can address with the layperson the reasons, and teach about appropriate spiritual support. Anecdotal information I have received is that these encounters are almost always welcome. Even those patients who decline the prayer appreciate the good wishes and good faith of the person who offers.

And what of prayer in the life of the institution? Should meetings begin with prayer? All meetings? No meetings? Some meetings? And if only some meetings, which meetings? In some religious cultures for health care, every meeting throughout the institution begins with some sort of devotion or prayer. What sort is determined by the person presenting it, and responsibility is usually rotated among regular participants. In my own hospital, a few meetings related to organizational leadership – meetings of the Board, of the Leadership, and of the Ethics Committee – begin regularly with prayer. They always begin with prayer if I’m present. If I’m not, and I don’t have a substitute, I’m pretty sure they don’t, inasmuch as no one has ever accepted my invitation to participate.

I haven’t chosen to make that an issue. But for an Episcopal culture for health care, perhaps it should be. We say that we express our faith, our principles, in common prayer. If so, in an Episcopal culture for health care should prayer not be a part of the expression of the principles of the institution? In fact this health system, or at least its central referral hospital, does have a semi-official prayer, shared with employees and others on a hospital bookmark. Should it not have a greater visibility, a greater place in the life of the institution?

And if prayer has a place in the institution itself, what sort of prayer? That is, how should prayer in and for the institution reflect the multifaith community that is the institution? This question should be the topic of its own individual post. However, we are all, I think, aware of the controversies regarding whether Christian clergy must prayer with reference specifically to Jesus. My own practice is to pray in God’s holy Name, and to use other Biblical images of God. I know that there is at least one practicing non-Christian in most of those meetings (not to mention all the non-practicing Christians), and I choose to pray in a way that doesn’t challenge that other faith. At the same time I am aware of and sensitive to the concerns of clergy who feel that not to pray in the name of Jesus is to violate their own faith. I will not resolve that here. I only note and acknowledge the problem.

Surely prayer as some place in an Episcopal culture for health care. Prayer is fundamental to our faith, to our relationships with God, and to our ministry. If health care institutions are part of the ministry of the Church, prayer must in some way be fundamental to that ministry as well. There still remains much reflection to be done on how that might be lived out, made incarnate, in the life of the institution and in the experience of patients, families, and staff.

Slow and Steady Wins - Doesn't It?

Every month I orient new nurses and other clinical staff to our hospital’s policies and procedures related to advance directives, organ and tissue donation, and patient rights. In the process I discuss just who speaks for the patient, and how we respond when the patient has lost the capacity to make decisions, and the family on one hand and the medical and clinical staff on the other see things differently. “It is always worth the effort,” I say, “to seek consensus between the family and the clinical staff. If that takes an extra day in ICU, it’s worth it. If it takes more time educating the family about what the staff are seeing, it’s worth it. It’s good for the patient, and good for the family, and good for you; and I’m convinced it’s good for everyone’s souls.”

What brought that to mind has been reading the various responses to the Report of the Special Commission on the Episcopal Church and the Anglican Communion. In one sense, I suppose the best thing to be said about the report is that folks at both ends of the spectrum find it inadequate. You can start your own review at Thinking Anglicans (link in the sidebar), from which you can link to a lot of other sources.

But specifically I was struck by the repeated reference in the Report to seeking consensus. The word occurs sixteen times in the Report and the related Resolutions, not counting the reference to consensus fidelium quoted from the Windsor Report. Now, it’s not a surprise that the SCECAC Report should refer to consensus. The Windsor Report, to which this is a response, does so as well (although not as extensively and primarily to point out that consensus does not exist. The Windsor Report spends a lot more time in "discernment;" but that can be the topic for a different post.). But focusing on consensus highlights the differences between the two poles in the difficulties in the Anglican Communion.

Working toward consensus, and particularly governing by consensus, is a religious practice. It is the primary way of doing business of the Society of Friends, the Quakers. It has recently been adopted by the World Council of Churches as that organization’s way of reaching decisions. You can read more about that here and here.

Essential to understanding consensus is appreciating that the decision process is not over until it’s over; and no one is left out. That may mean that decisions take a long time. It may mean that some will continue to disagree, but will accede to the larger group because they have been thoroughly and fairly heard. It may mean that when a group cannot reach consensus they choose to live with that, and to announce simply that consensus is not currently possible. It does mean everyone is heard fully and respectfully. One significant difference from democracy, a difference that I believe is an advantage, is that it works against the “tyranny of the majority” – the possibility that a majority may use agreement to justify persecuting, marginalizing, or excluding the minority (sound familiar?).

The Episcopal Church has consistently taken the position that consensus on human sexuality is desirable, and that until consensus is reached everyone needs to keep talking and to keep listening. The Windsor Report, overall, seems to say much the same thing. That, at any rate, seems to be the consequence of continuing to insist on the listening process.

But majorities can be very uncomfortable with consensus; and this is even more true of minorities who feel that they can link themselves to a majority. The Global South primates are a minority (if a large one) among the total primates of the Anglican Communion, and a minority in economic strength; but they are quick to proclaim their majority at the 1998 Lambeth Conference, and in numbers of believers. The AAC/ACN folks are a minority in the Episcopal Church; but they are quick to attach themselves to the majority they see as claimed by the Global South primates, and within the larger American context. The Episcopal Church and the Anglican Church of Canada are a minority within the Communion; but they cherish the Anglican Consultative Council and the majority there that wants to continue the Communion, as well as the majority of primates who have not severed relations (yes, I’m making a distinction between “broken” and “impaired” communion, but then so did the provinces that chose to use one of the other of those terms). GLBT members of the Episcopal Church are a minority, but hold fast to the majority in the General Convention of the Episcopal Church in 2003.

I fear, too, that all of these groups fear a consensus process, at least to some extent (and the more “fear-based” the position, the greater the fear). They fear the time it will take, during which their vulnerability (sometimes perceived, sometimes very real) continues. More critically, I think they fear that if there is a true consensus process, and everyone is fairly heard, those “other folks” may actually make some sense. They fear actually having to respect one another. There is a much greater sense of control when a democratic process ends with me in the majority. If I actually make the effort to listen in a consensus process, I might actually hear something that confronts me. I might actually be changed.

I have less hope than I once had that all of this will be resolved through a coherent process. I think we can seek a listening process and work for consensus; I think it’s worthwhile. I fear, though, that issues of fear and control will win the day in the short term, and that the Communion will be significantly changed, if not broken altogether. And perhaps that is God’s will. Still, if we are to seek to be one Body, we cannot simply dispense with the efforts for reconciliation and consensus. It is, we believe, God’s will that we all may be one. It may not be reached by a consensus process; it cannot be reached through efforts of fear, control, or expediency.

Toward an Episcopal Culture for Health Care: General Convention

I have been writing recently about actions of General Convention about health care. There's a lot more to be addressed in that vein: the Church's response to AIDS, abortion, care at the end of life, etc. General Convention has spoken on all those topics, and more.

And as I do this, it raises a question for me on my other ongoing subject: if there is an Episcopal Culture for health care, how is it affected by, responsive to, actions of General Convention? General Convention is the single authoritative voice of the Episcopal Church as a whole. Bishops can speak with authority, both as individuals and as a House. But as the current arguments in the Communion make clear, and as the bishops themselves have made clear, final authority to speak for the whole Episcopal Church rests with General Convention. So, how should an Episcopal culture of health care be affected by the actions of General Convention?

This is not an idle reflection for me. As the chaplain in an Episcopal hospital, in an Episcopal health system, I do get asked what the Episcopal Church has to say on certain issues. Abortion and end-of-life issues have been foremost among those, but there is also some general interest in other ethical positions of the Episcopal Church. Most folks here see that as in keeping with being a church-related hospital, in parallel with Catholic, Jewish, and Adventist hospitals. And taking seriously both the questions, and my own status as a priest of the Church, I do review General Convention actions that may be relevant.

First, we have to distinguish among the actions of General Convention regarding their authority for the Episcopal Church generally. We see differently actions affecting Constitution and Canons or Prayer Book and Liturgy from those expressing the opinion of the Church on social issues. While all have some room for personal interpretation and expression, the former are formative for us as a Church to a degree that the latter are not.

I think we can say also that the Episcopal Church has long valued individual conscience and individual thought. This is based on a number of themes in the tradition. The classic model in the Anglican tradition for sources of theological authority is the “three-legged stool” of Scripture, Tradition, and Reason. In theological reflection “Reason” is more clearly described as “reasoned reflection on the action of God with God’s people as reflected in Scripture, and in the history and tradition of the faith, and in the contemporary lives of the believers.” But even with those qualifications, it is clear that the capacity to reason is valued as one part of how we recognize God’s presence and action in the world. By the same token, we take local experience seriously. For example, in the Chicago-Lambeth Quadrilateral the clause describing the Historic Episcopate qualifies it as “locally adapted… to the varying needs of the nations and peoples….” Again, rational reflection on current experience helps make this sensible.

What, then, should be the relationship between actions of General Convention and an Episcopal culture for health care? To be considered an “Episcopal” institution, and particularly for those health care institutions maintain an official relationship with an institution or agency of the Episcopal Church, we should expect some responsiveness to the most authoritative body of the Episcopal Church. This would surely mean some awareness and reflection of actions of General Convention. I would suggest that special responsibility for providing education about those actions falls to Episcopalians within the institution and/or the Episcopal agency with which the health care institution is affiliated. There should, certainly, also be an expectation of recognizing local experience in how these actions are reflected in the policies and actions of the health care institution. To take an example from my own experience, the General Convention has expressed the opinion that “legislation concerning abortions will not address the root of the problem.” (Resolution 1988-C047, reaffirmed in Resolution 1994-A054) At the same time, health care institutions can be expected follow federal and state laws respecting abortion. And certainly, health care institutions would be expected to base clinical care on the best clinical information, and not simply on actions of General Convention.

As with most of these reflections, this is only a beginning. There can be a deeper examination, beginning with our own understanding of how we view actions of General Convention within the Episcopal Church itself. I have noted a more or less official distinction between “constitutional” actions of Convention, and those more expressive of opinion or education. We also make distinctions as individuals based on our own personal reflections and experiences, in light of Scripture, Tradition, and Reason. Still, it makes sense to me that to claim connection with the Episcopal Church, an institution must be responsive to the most authoritative voice of the Episcopal Church, the General Convention. That calls me as an Episcopal chaplain in an Episcopal institution to the responsibility to relate those actions within the structures of my institution; and for all of us who want the Church to be involved in health care to be aware once again of what the General Convention has said.

The Episcopal Church on Health Care, part 2

In a previous post I spoke about actions of General Convention regarding health care, and especially about Resolution A079, passed in General Convention in 2000. The first consequence, described in the previous post, was the Formative Symposium on Health Care. The second consequence was the conference, Waging Reconciliation: an Episcopal Response to Healthcare Barriers in April, 2003.You can read articles about the conference here.

Let me say more about the conference from a participant’s point of view. The first thing to note is that this conference was planned through the Episcopal Church’s Office of Government Relations. I’m not sure how many people in the Church know we even have an Office of Government Relations. I’m not sure how many of those who do know actually know what it does. In fact it is a lobbying office. Staff of the office work to make those in the federal government aware of stands taken by the Episcopal Church on various topics of interest. This may include resolutions of General Convention, and statements of the Executive Council, the House of Bishops, or the Presiding Bishop. In addition, they operate the Episcopal Public Policy Network. Through the Network interested Episcopalians are alerted to events taking place in Washington, how those events impact social and political issues, and how members of the Network may contact members of Congress and others in Government to express their opinions.

On the first day of the conference we heard from a number of interesting and important people, and had the opportunity to meet with Congressional staffers who are Episcopalians. However, as interesting as that was, the real action, I think, was on the second day. On that day we began with a review of how to be lobbyists: how to address an issue, how make the best use of the time of the member of Congress or of the staffer we met, and how to articulate the commitment of the Episcopal Church to elimination of barriers to health care. Then we went out individually and in teams, and hit the Hill. In appointments arranged by the Office of Government Relations we met with our members of Congress, or with members of their staffs, to present the concerns of the Church. Most of us actually met with staffers; a few were able to actually meet their Representative or Senator. Almost all felt we were well received.

Now, what did this accomplish? I know we haven’t yet accomplished universal health care. The President, raised as an Episcopalian and still attending an Episcopal Church (I imagine because it’s the church most convenient to the White House and the Secret Service), doesn’t seem responsive to the positions of the Church. However, I have maintained a relationship with two staff members for one of my senators. Now, the senator is more conservative than I am (but, then, most people are), as are the staffers; but the staffers do respond to my emails with more than a boiler plate response.

Some will know that most medical residency programs, and most clinical education programs for other healthcare professionals, are paid for in part by Medicare reimbursement. Two summers ago, when the Center for Medicare Services (CMS) was considering cutting reimbursement for education for ancillary services in health care, including CPE, I contacted one staffer, and through her was able to contact a staffer of my other senator. Both sent letters to CMS supporting reimbursement for CPE and other ancillary education programs. The decision was made not to eliminate the reimbursements, although some, including CPE, were clarified and somewhat narrowed. I can’t say that the letters from the senators were the critical pieces in the CMS decision; but I’m sure they didn’t hurt. And I continue to contact the senator’s office when I have an opinion to share.

Now, events like Waging Reconciliation and the Formative Symposium get reported in Episcopal Life and elsewhere; but I’m not sure how many people notice. At the same time, they are, as I said, concrete results of a resolution in General Convention. Once again, they are evidence that indeed the Episcopal Church does stand for something, and does try to make that stance visible in the world.