“But God chose what is foolish in the world to shame the wise; God chose what is weak in the world to shame the strong; God chose what is low and despised in the world, things that are not, to reduce to nothing things that are, so that no one might boast in the presence of God.” (1 Corinthians 1:27-29)
I have been thinking about these verses since I celebrated the Eucharist today. I thought about it particularly when I was reviewing Thinking Anglicans and the many comments on what may or may not happen in the Episcopal Church.
One of the themes that keeps coming up in those discussions is leadership, and specifically the leadership shown, or according to many not shown, by Rowan Williams and Frank Griswold. Why do they seem so passive in the face of provocations from the conservative leaders, and especially those who choose to violate tradition and canons of the Council of Nicea and actions of the 1998 Lambeth Conference to cross diocesan boundaries? The others (Reasserters? Conservatives? Orthodox? Since I consider myself Progressive, sometimes I say “Regressives.”) make so much noise, and seem so aggressive and confrontational. Why do Rowan and Frank seem so quiet, so passive?
“But God chose what is foolish in the world to shame the wise; God chose what is weak in the world to shame the strong; God chose what is low and despised in the world, things that are not, to reduce to nothing things that are, so that no one might boast in the presence of God.”
I am not myself comfortable when the leadership of the Episcopal Church seems so silent in the face of confrontations, and even apparent betrayals by some of our own bishops. At the same time, I see those betrayals, and the larger actions of organization and consolidation and calls to “walk apart” as just the sort of power politics and power media that are the common currency of this world. How many times have I heard – how many times have I said – this is all a big power play. If it is that, then a Newtonian equal but opposite power play is still the common currency of this world. It is not the model that we have in Christ.
I fear in these days for the Episcopal Church. It may indeed not be here in a few generations. It will certainly be injured by these power plays and these militant acts. It will certainly be changed. I am not comfortable as my Church remains quiet in the face of these attacks on us, and on our commitment to include all Christians in all the ministries we have in Christ. I sometimes long to see a strong response, a response that claims and proclaims and calls to arms. But I have to recognize that I may be thinking as the world thinks, and not as God things. I have to recognize this week of all weeks that such a response is not what we see in Christ, and is not, ultimately, what will save this Church.
“But God chose what is foolish in the world to shame the wise; God chose what is weak in the world to shame the strong; God chose what is low and despised in the world, things that are not, to reduce to nothing things that are, so that no one might boast in the presence of God.”
Tuesday, April 11, 2006
Saturday, April 08, 2006
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.
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.
Wednesday, April 05, 2006
An Episcopal Perspective on the Massachusetts Insurance Experiment
The big news today in health care is the new legislation passed in Massachusetts which has the object of bringing all the state’s residents into some form of health insurance. While the new law will expand somewhat the state’s Medicaid coverage, the largest push will be to move most, and certainly almost all those employed, into some kind of private coverage. The law uses a combination of tax incentives and penalties for individuals, and incentives and penalties for employers, to bring this about. You can see a good description of the plan here.
I have posted recently on the action of General Convention in 2000 (Resolution 2000-A079) and of the Formative Statement on Health Care that was one result. But I want to put that statement in context. In fact the General Convention had been speaking on health care for all as far back as 1988. That 69th General Convention passed Resolution 1988-D108, titled, “Advocate for Appropriate Health Care for All Who Are Ill:”
This resolution was followed at the 70th General Convention in 1991 by two resolutions, A010, “Advocate Legislation for Comprehensive Health Care;” and A099, “Call for a System of Universal Access to Health Care.” Both called for universal health care as a basic right, the former calling for advocacy from agencies of the Episcopal Church, and the latter for action in the federal government.
The most complete statement, however, was passed at the 71st General Convention in 1994. That resolution was A057, “Adopt Church Principles on Access to Health Care:”
The most interesting aspect of these principles is their inclusion under the definition of “quality health care.” In the early 1990’s we were first seeing the spreading within the health care industry of principles of performance improvement and quality management (about which I have also written). The understanding of “quality health care” in the quality management environment has been based on clinical and organizational outcomes. In 1994-A057 we as the Episcopal Church asserted that to provide “quality health care” also required certain social justice outcomes. For us, I believe these outcomes would be considered essential if we were to “seek and service Christ in all persons, loving [our] neighbor as [ourselves],” and to “strive for justice and peace among all people, and respect the dignity of every human being.” (From the Baptismal Covenant, Book of Common Prayer, page 305).
It remains to be seen whether the social experiment in Massachusetts will produce quality health care, either in the sense of better clinical outcomes, or in the sense of fulfilling the social outcomes that we as the Episcopal Church would seek. It will be, I think, worth the effort. But however it turns out, we have made clear in actions of General Convention our own goals and standards: to provide health care for all persons, care for whole persons from cradle to grave. You know, it looks like this will be an issue in the next few elections. Think what it might mean if we all made clear to those we support that we also support these statements of the Church in General Convention.
I have posted recently on the action of General Convention in 2000 (Resolution 2000-A079) and of the Formative Statement on Health Care that was one result. But I want to put that statement in context. In fact the General Convention had been speaking on health care for all as far back as 1988. That 69th General Convention passed Resolution 1988-D108, titled, “Advocate for Appropriate Health Care for All Who Are Ill:”
Resolved, the House of Deputies concurring, That this 69th General Convention direct the Presiding Bishop and the Executive Council, in light of the strains upon the health care system exerted by the AIDS Epidemic, to direct the Washington D.C. office of the Episcopal Church in the United States of America to adopt a strategy to advocate for all persons suffering from illness by creating appropriate levels of cost-effective health care, for example, hospices and alternative health care facilities.
This resolution was followed at the 70th General Convention in 1991 by two resolutions, A010, “Advocate Legislation for Comprehensive Health Care;” and A099, “Call for a System of Universal Access to Health Care.” Both called for universal health care as a basic right, the former calling for advocacy from agencies of the Episcopal Church, and the latter for action in the federal government.
The most complete statement, however, was passed at the 71st General Convention in 1994. That resolution was A057, “Adopt Church Principles on Access to Health Care:”
Resolved, the House of Bishops concurring, That this 71st General Convention of the Episcopal Church adopt the following four principles as the position of the Episcopal Church regarding health care:
That universal access to quality, cost effective, health care services be considered necessary for everyone in the population.
That "quality health care" be defined so as to include programs in preventive medicine, where wellness is the first priority.
That "quality health care" include interdisciplinary and interprofessional components to insure the care of the whole person--physiological, spiritual, psychological, social.
That "quality health care" include the balanced distribution of resources so that no region of the country is underserved.
The most interesting aspect of these principles is their inclusion under the definition of “quality health care.” In the early 1990’s we were first seeing the spreading within the health care industry of principles of performance improvement and quality management (about which I have also written). The understanding of “quality health care” in the quality management environment has been based on clinical and organizational outcomes. In 1994-A057 we as the Episcopal Church asserted that to provide “quality health care” also required certain social justice outcomes. For us, I believe these outcomes would be considered essential if we were to “seek and service Christ in all persons, loving [our] neighbor as [ourselves],” and to “strive for justice and peace among all people, and respect the dignity of every human being.” (From the Baptismal Covenant, Book of Common Prayer, page 305).
It remains to be seen whether the social experiment in Massachusetts will produce quality health care, either in the sense of better clinical outcomes, or in the sense of fulfilling the social outcomes that we as the Episcopal Church would seek. It will be, I think, worth the effort. But however it turns out, we have made clear in actions of General Convention our own goals and standards: to provide health care for all persons, care for whole persons from cradle to grave. You know, it looks like this will be an issue in the next few elections. Think what it might mean if we all made clear to those we support that we also support these statements of the Church in General Convention.
Tuesday, April 04, 2006
Confusion to the French - and to Tom Delay
Tom “The Hammer” Delay has resigned! Huzzah! Huzzah! Confusion to the French!
Now, if that last seems a bit strange, it reflects my appreciation for the Hornblower novels of C. S. Forester and the Aubrey/Maturin novels of Patrick O’Brien. Much of the actions in both series takes place during wars between England and France. Both authors describe banquets involving military officers, both on land and at sea. Those banquets commonly end with stories and toasts given over wine and cheese, and one of the common toasts was, “Confusion to the French!” The point was that the French should experience bad communication and information, and uncertain leadership in battle and military campaigns; and that as a result the French should experience defeat, preferably at the hands of the British.
For some time now when I read the paper and observed setbacks for the militant social conservatives in this country, who were almost exclusively in the Republican Party, I would have a similar hope. I would hope that this would be a sign that their poor and uncompassionate leadership, and some significant corruption, was catching up with them. I would hope that this would result in better, more socially responsible, more compassionate leadership from both parties, and a rejection of policies of division of society and abandonment of the weakest among us. And so I would come out with the ancient toast as a sign of my hope.
Tom Delay has realized that the corruption that surrounded him will not wash over him, but will wash him away, especially if it is determined that he participated. Those who took him as a model of leadership, of governing by monopolizing power and manipulating policies and structures to suit their own ends, are seeing the consequences. The results are not yet what I would hope; but this is a significant step forward. I hope to see more. Confusion to the French!
Now, if that last seems a bit strange, it reflects my appreciation for the Hornblower novels of C. S. Forester and the Aubrey/Maturin novels of Patrick O’Brien. Much of the actions in both series takes place during wars between England and France. Both authors describe banquets involving military officers, both on land and at sea. Those banquets commonly end with stories and toasts given over wine and cheese, and one of the common toasts was, “Confusion to the French!” The point was that the French should experience bad communication and information, and uncertain leadership in battle and military campaigns; and that as a result the French should experience defeat, preferably at the hands of the British.
For some time now when I read the paper and observed setbacks for the militant social conservatives in this country, who were almost exclusively in the Republican Party, I would have a similar hope. I would hope that this would be a sign that their poor and uncompassionate leadership, and some significant corruption, was catching up with them. I would hope that this would result in better, more socially responsible, more compassionate leadership from both parties, and a rejection of policies of division of society and abandonment of the weakest among us. And so I would come out with the ancient toast as a sign of my hope.
Tom Delay has realized that the corruption that surrounded him will not wash over him, but will wash him away, especially if it is determined that he participated. Those who took him as a model of leadership, of governing by monopolizing power and manipulating policies and structures to suit their own ends, are seeing the consequences. The results are not yet what I would hope; but this is a significant step forward. I hope to see more. Confusion to the French!
Monday, April 03, 2006
The Episcopal Church and Health Care: Embryonic Stem Cells
There is a fight going on these days over embryonic stem cells, how they might be used, and how they might be obtained. The debate has been going on for some time as to whether this is or is not cloning a human being. Indeed, the term “cloning” often is used by those who oppose it, while those who believe that there is potential benefit in research on embryonic stem cells speak of somatic cell gene transfer, or somatic cell nuclear transfer.
And the fight has found a new arena: who will fund the research. Under the current administration in Washington there are a limited number of established cultures of stem cells that can be used for federally funded research. In reaction the state of California passed legislation that as a state it could and would fund research. Closer to home, there are those in my own state legislature in Missouri that wanted last year to pass a bill banning any research involving embryonic stem cells, reflecting a belief that those embryos destroyed in the process were fully human. In response the governor of Illinois made public that he would be delighted to see researchers, and their research dollars, leave Missouri for greener pastures in his state.
I have taken on the project of holding up actions of General Convention regarding issues in and related to health care. As you might expect, this is also a topic on which General Convention has spoken. In 2003 two resolutions were passed by General Convention. The first, Resolution 2003-A014, was titled, “Support Human Embryonic Stem Cell Research.” The text is:
A second resolution, 2003-A012, was titled, “Adopt Guidelines for Genetic Testing and Reproductive Technology.” While the point of the resolution was to address genetic testing of children and of prospective parents, it included the provisions that,
Thus, the Episcopal Church in General Convention is on record as supporting research on embryonic stem cells, provided the they are obtained appropriately; supporting use of therapies resulting from that research; and condemning cloning for purposes of reproduction.
This controversy isn’t going away any time soon. The arguments over legislation and funding will continue, reflecting the continuing arguments over when potential human life becomes actual human life, with full moral and civil rights. These resolutions don’t address that prior question. Nor would I expect these to be final: there may well be resolutions related to this issue in this General Convention in Columbus. However, they are the most authoritative statements to date of the position of the Episcopal Church; and if we know of them they can offer us guidance for our own decisions, and a public voice for the Church in the continuing debate.
And the fight has found a new arena: who will fund the research. Under the current administration in Washington there are a limited number of established cultures of stem cells that can be used for federally funded research. In reaction the state of California passed legislation that as a state it could and would fund research. Closer to home, there are those in my own state legislature in Missouri that wanted last year to pass a bill banning any research involving embryonic stem cells, reflecting a belief that those embryos destroyed in the process were fully human. In response the governor of Illinois made public that he would be delighted to see researchers, and their research dollars, leave Missouri for greener pastures in his state.
I have taken on the project of holding up actions of General Convention regarding issues in and related to health care. As you might expect, this is also a topic on which General Convention has spoken. In 2003 two resolutions were passed by General Convention. The first, Resolution 2003-A014, was titled, “Support Human Embryonic Stem Cell Research.” The text is:
Resolved, That the 74th General Convention of The Episcopal Church, believing that a wider availability of embryonic stem cells for medical research holds the potential for discovery of effective treatment of a wide variety of diseases and other medical conditions;
A. Support the choice of those who wish to donate their early embryos, remaining after in vitro fertilization (IVF) procedures have ended; and
B. Urge that the United States Congress pass legislation that would authorize federal funding for derivation of and medical research on human embryonic stem cells that were generated for IVF and remain after fertilization procedures have been concluded, provided that:
1. these early embryos are no longer required for procreation by those donating them and would simply be discarded;
2. those donating early embryos have given their prior informed consent to their use in stem cell research;
3. the embryos were not deliberately created for research purposes;
4. the embryos were not obtained by sale or purchase; and be it furtherResolved, That the 74th General Convention of The Episcopal Church urge the Secretary of Health and Human Services to establish an interdisciplinary oversight body for all research in both the public and private sectors that involves stem cells from human embryos, parthenotes, sperm cells, or egg cells, and have this body in place within six months of passing such legislation; and be it further
Resolved, That the 74th General Convention of The Episcopal Church direct the Secretary of General Convention to communicate this resolution to appropriate members and committees of the United States Congress and direct the Office of Government Relations to identify and advocate the legislation called for by this resolution.
A second resolution, 2003-A012, was titled, “Adopt Guidelines for Genetic Testing and Reproductive Technology.” While the point of the resolution was to address genetic testing of children and of prospective parents, it included the provisions that,
- Treatment for genetic diseases and the use of somatic gene transfer therapies
may be used if they are proven safe and effective; [and] - It is not morally
acceptable to use reproductive cloning, and it is therefore morally
irresponsible for physicians, scientists, and prospective parents to engage in
it.
Thus, the Episcopal Church in General Convention is on record as supporting research on embryonic stem cells, provided the they are obtained appropriately; supporting use of therapies resulting from that research; and condemning cloning for purposes of reproduction.
This controversy isn’t going away any time soon. The arguments over legislation and funding will continue, reflecting the continuing arguments over when potential human life becomes actual human life, with full moral and civil rights. These resolutions don’t address that prior question. Nor would I expect these to be final: there may well be resolutions related to this issue in this General Convention in Columbus. However, they are the most authoritative statements to date of the position of the Episcopal Church; and if we know of them they can offer us guidance for our own decisions, and a public voice for the Church in the continuing debate.
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