A Healthcare Conundrum? Hip Replacements for the Terminally Ill

healthcare_letakWhat do you do? You are a healthcare administrator and you have to make a decision. You have a patient with terminal cancer who needs a hip replacement. While the hip replacement would increase mobility, the operation would cost untold thousands of dollars. There is also the fear of complications that can result for patients with terminal illnesses. Here’s what one study said about a few of the challenges,

Advanced cancer, severe cardiac and pulmonary disease, and other disorders that threaten overall survival have long been regarded as contraindications to total joint replacement… The reluctance to operate in these settings may stem from concern about a higher risk of perioperative complications in patients with terminal disease or from discomfort with using an expensive procedure for patients with limited life expectancy.

Do you decide to authorize the operation or determine to give the patient enough medication to endure the pain until death? What do you make of the patient’s desire to experience as high a quality of life as possible in the time of life remaining? Would your decision vary based on whether or not you sensed the patient would live only six months, a year, or up to two years? Would you also account for the possibility that if money goes to a hip replacement for this terminally sick patient there may not be enough money to
attend to patients with other pressing needs? Most people would imagine that health insurance would cover the hip replacement, so who cares? But the patient in question doesn’t have insurance or the insurance the patient has would cover the hip replacement.

For the Christian, other considerations will likely come into play. Someone might say that Jesus would leave the ninety-nine patients to go after the one who was in desperate need. Someone else might respond: Jesus would also make sure the ninety-nine were attended to until he returned; and what if it were not one who is in crisis, but ten or twenty in desperate need? Another person
might counter: who said anything about desperate-hip replacement does not rise to the level of a lost sheep’s soul needing to be saved! Prepare yourself for still another line of thought: the Bible doesn’t belong in the discussion since it is an ancient book and we are dealing with modern realities. If that is true, perhaps some hospitals will need to consider more than replacing hips to changing names, abandoning “Good Shepherd” and “Providence” for something more contemporary.

For all the differences in the debate over healthcare reform in our country, people on various sides would agree that we are facing huge challenges; there is a need for reform, whatever it may be. Rigid ideology of one sort or another straightjackets complexity and brings about short-sighted and ill-fated solutions. Complexity for complexity sake can lead to an affirmation of the status quo and paralysis. We have to engage in healthy conversations for the sake of advancing public health.

Easy answers are hard to find. Tough questions and nice names come more readily. We will be addressing such issues as these at The Institute for the Theology of Culture’s: New Wine, New Wineskins’ conference on healthcare Saturday, October 19th. We hope you will join us.

This piece is cross-posted at Patheos and at The Christian Post. Comments made here are not monitored. To join the conversation, please comment on this post at Patheos.

The Voting Rights Act and Post-Racialized America—Can We Vote on That?

By Paul Louis Metzger and Tom Krattenmaker

United States Supreme Court BuildingWhy is it that while talk abounds of growing racial diversity in our country, a new wave of voting restrictions is sweeping over parts of the country and falling hardest on minorities? Perhaps there is more than coincidence at play.

The Supreme Court’s reframing of the Voting Rights Act to make the individual states responsible for overseeing voting procedures has led many to fear the return of Jim Crow era policies to the country’s polling places. We share this concern. For us, it is not a liberal vs. conservative thing, since one of us is a self-described, secular-leaning progressive (Tom) and the other (Paul) is an Evangelical with more conservative views on many subjects. Nor is it something that only African Americans raise as a concern; we are both white.

No matter our demographic, we have a responsibility to hold accountable the leaders in our democratic system: our elected officials must remain diligent so that Jim Crow policies do not return but simply remain a terrible scar from a deep wound from our democracy’s past. Thus, we firmly believe the federal government must figure out a way to hold the states accountable on voting policies. Discussion ensues as to how Congress might step in so as to protect the rights of minority voters.

We don’t live in a post-racialized society, contrary to what many say. We wonder if those who have made this claim have asked minority groups for their opinion. Let these groups cast votes as to whether or not we live in a post-racialized America.

What is racialization? Racialization (e.g., race’s impact on health care, education, job placement, place of residence, urban development, etc.) does not express itself in fixed, constant terms, but through variables that ebb and flow and evolve. Further to what was stated in a previous post on the subject at this blog,

It is worth noting that according to Michael Emerson and Christian Smith, racialization does not proceed by way of “constants,” but rather “variables.” And yet, many Americans view racialization not in terms of its evolving nature, but in constant, static terms. Thus, Americans tend to limit racialization to a specific timeframe and do not comprehend that racialization is very adaptable and undergoes an evolution over time. Emerson and Smith maintain that there are “grave implications” for failing to recognize that racialization evolves over time…: the more we fail to account for racialization or think that we live in a post-racialized society, the more entrenched racialization becomes (Michael O. Emerson and Christian Smith, Divided by Faith: Evangelical Religion and the Problem of Race in America [New York: Oxford University Press, 2000], p. 8).

We are grieved to see the voter ID laws and the like already being implemented in states including South Carolina, Texas, and Mississippi. Take for example Texas. According to Frontline,

It only took a few hours for TEXAS to move forward on its voter ID law, considered the strictest in the nation. The law requires Texans to prove their citizenship and their residency in the state. To qualify, you’d need to present forms of ID that are expensive and difficult to obtain for some low-income Americans. It requires a passport — the cheapest of which is $55 — or a copy of your birth certificate, which not all Americans, particularly older ones, have.

A court blocked the law in 2012 because it discriminated against Latino and black voters.

This is not simply a Southern phenomenon, however. While the concern historically and in many respects presently focuses on Southern state voting procedures, racialization plays out in subtle but insidious ways in the North in places like our home city, Portland, Oregon, and it can have a huge and negative impact on voting for ethnic minority groups. As African Americans find themselves pushed to our less-well-off suburbs through property tax increases, subtle forms of red-lining in bank loan practices, and aggressive, even manipulative home buyer practices in some cases, they have less and less solidarity to advocate politically for policy changes at the state level of government. Since Portland is the largest city in Oregon, African Americans were able to advocate strongly for their concerns as a voting bloc for decades in the face of policies that would not represent them well. More and more, gentrification fragments their voices and weakens their ability to effect change. We must figure out ways as community leaders, politicians, bankers, real estate and business owners to reverse this trend. So, too, with the Voting Rights Act.

In a democratic society, all of us are at risk of losing our rights if any one segment loses its rights; after all, ours is a government of all the people by all the people for all the people—with justice (or injustice) for all. We need to guard against voting restrictions promoted as color blind, but that many of us know come down hardest on minorities. So, too, if we are going to say at any point that we live in a post-racialized America, we need to make certain that all people have a voice and a role in the political process—minority populations included. After all, that is the democratic thing to do.

This piece is cross-posted at Patheos and The Christian Post. Comments made here are not monitored. To join the conversation, please comment on this post at Patheos.

Beyond Obamacare vs. the Affordable Care Act: Caring for Healthcare Complexities

healthcare_letakJimmy Kimmel recently aired interviews of people who were asked which they preferred and why—Obamacare or the Affordable Care Act.  Person after person interviewed and taped preferred Affordable Care Act. As you probably know, the interviews were coordinated to expose people’s ignorance: Obamacare and the Affordable Care Act are one and the same.

One person interviewed whose ignorance is exposed responds in the affirmative to the question about whether or not a well-informed public is essential to our democracy’s vitality. Indeed, it is. Key to being well-informed about healthcare complexities related to any attempt at a comprehensive proposal is dealing with complex questions. Let’s take for example business owners.

Small business owners might face quandaries about providing health insurance like, “If I provide health insurance for my employees, will I have to reduce their compensation or raise the cost of my product or service? If an employee takes insurance through their spouse, will that employee ask that the benefits I have for their insurance be put toward their compensation? Should I cover an employee’s spouse and dependants? Will I lose a good employee to a competitor, if I don’t provide health insurance? How might the lack of healthcare coverage affect employee morale and productivity? Will the government provide incentives to my business that will support me in providing healthcare coverage?”

Those who are business owners may or may not believe the Affordable Care Act addresses adequately their various concerns and assists them with answering such questions. Any healthcare system put in place must account as much as possible for their concerns, as well as those of others, if we are to provide a comprehensive, workable, and sustainable model.  The upcoming New Wine, New Wineskins conference on healthcare (conference link) is not intended to champion one model, but to address the subject of healthcare from a variety of angles, including questions pertaining to whether or not a comprehensive healthcare system in the United States is critical to our nation’s public health.

While it is funny when a comedian like Jimmy Kimmel exposes people’s ignorance on the subject of healthcare, it is no laughing matter when our democracy is not shaped by a well-informed public. It is our responsibility as neighbors and citizens to care for the common good by asking questions and seeking to address the complexities surrounding such matters as comprehensive healthcare. A well-informed public is a healthy public.

This piece is cross-posted at Patheos and The Christian Post. Comments made here are not monitored. To join the conversation, please comment on this post at Patheos.

The Emperor’s Subjects Have No Clothes

kingHave you read Hans Christian Andersen’s tale, “The Emperor Has No Clothes”? It’s the story of an emperor who loves strutting about in glorious apparel. One day two swindlers come to town and deceive the emperor and his advisors into believing that the two of them can make the most splendid clothes for the Emperor from the finest material. However, the thread and cloth is so fine and refined that only those who are sophisticated and wise and those befitting significant positions in society can see it. Not wanting to appear foolish or unworthy of their high calling, the emperor’s advisors say nothing when he tries on the clothing, which is really imaginary. The emperor parades through town before the people’s eyes. While everyone sees the emperor’s nakedness, they are unwilling to say anything out of fear of being dismissed as foolish for not being able to see the garments. Finally, a little innocent boy who has nothing to lose cries out that the emperor is stark naked. Murmurs spread throughout the crowd until everyone finally exclaims that the emperor is wearing no clothes. While the emperor hears their shouts, he carries on as if everything is as it should be and he is wearing kingly garments until he finishes the procession.

In 1 Corinthians 1:18-31, Paul makes a big deal of talking about God’s son hanging from the cross. While Paul doesn’t say anything here about the details of the Lord’s crucifixion, we know from the canonical gospels that Jesus’ clothes were divided among the soldiers who crucified him (See for example John 19:23-24), as he hung on the cross naked, or at the very least, wearing exceedingly little. The subjects of the Roman emperor—Gentiles and Jews alike—mocked him (we were all in on it). We could see how foolish and pitifully weak Jesus of Nazareth appeared. Who knows if Paul was there as Saul? All we know from Acts is that he was in Jerusalem not long after when Stephen—the first Christian martyr—was stoned to death for his witness to the crucified and risen Jesus. In fact, those who stoned Stephen put their coats at the feet of Saul, who approved of Stephen’s stoning and death (Acts 7:58; 8:1). Saul hated Christianity because of its claim that the Messiah was this crucified corpse: for as he knew from the Hebrew Scriptures, anyone hung on a cross is cursed (Galatians 3:13; Deut. 21:23).

Saul wanted to stomp out Christianity completely. But as the story goes, Saul was later blinded on the road to Damascus and came to see how foolish he had been. He then became like a little child and saw that Jesus’ death reflected poorly on all of the Roman Emperor’s subjects (Acts 9:1-31; Acts 26:1-32).

At the time of writing his first epistle to the Corinthian church, the Corinthian Christians were reflecting poorly on their Christian faith. How so? They were trying to appear strong and wise in their own eyes, and in the eyes of those around them. They were boasting in their flesh—which was not all that noble, according to Paul: “Brothers and sisters, think of what you were when you were called. Not many of you were wise by human standards; not many were influential; not many were of noble birth” (1 Corinthians 1:26). God had chosen them as a lot so as to shame those who were truly noble in fleshly power and wisdom:

But God chose the foolish things of the world to shame the wise; God chose the weak things of the world to shame the strong. God chose the lowly things of this world and the despised things—and the things that are not—to nullify the things that are, so that no one may boast before him. It is because of him that you are in Christ Jesus, who has become for us wisdom from God—that is, our righteousness, holiness and redemption. Therefore, as it is written: “Let the one who boasts boast in the Lord” (1 Corinthians 1:27-31).

Why does God operate in this way? Paul answers this question: so that no one could boast before God and that people would come to boast in the Lord (1 Corinthians 1:29, 31).

One person who did not come to boast in the Lord as a result of the Lord or 1 Corinthians 1 is Friedrich Nietzsche. Here’s what Nietzsche writes in his book, The Antichrist, about the Christian teaching of the crucified God set forth in 1 Corinthians 1:

The Christian movement, as a European movement, has been from the start a collective movement of the dross and refuse elements of every kind (these want to get power through Christianity). It does not express the decline of a race, it is an aggregate of forms of decadence of locking together and seeking each other out from everywhere. It is not, as is supposed, the corruption of antiquity itself, of noble antiquity, that made Christianity possible. The scholarly idiocy which upholds such ideas even today cannot be contradicted harshly enough. At the very time when the sick, corrupt chandala strata in the whole imperium adopted Christianity, the opposite type, nobility, was present in its most beautiful and most mature form. The great number became master; the democratism of the Christian instinct triumphed. Christianity was not “national,” not a function of a race—it turned to every kind of man who was disinherited by life, it had its allies everywhere. At the bottom of Christianity is the rancor of the sick, instinct directed against the healthy, against health itself. Everything that has turned out well, everything that is proud and prankish, beauty above all, hurts its ears and eyes. Once more I recall the inestimable words of Paul: “The weak things of the world, the foolish things of the world, the base and despised things of the world hath God chosen.” This was the formula: in hoc signo decadence triumphed.

God on the cross—are the horrible secret thoughts behind this symbol not understood yet? All that suffers, all that is nailed to the cross, is divine. All of us are nailed to the cross, consequently we are divine. We alone are divine. Christianity was a victory, a nobler outlook perished of it—Christianity has been the greatest misfortune of mankind so far.[1]

It’s hard to match Nietzsche’s rhetorical flurry, so I won’t even try. Two things stand out to me at this moment. First, sometimes our worst enemies are our best friends: Nietzsche understood key aspects of what Christianity was about and rejected it; we Christians often accept the faith without really understanding its negative implications for boasting in our flesh (we cannot boast in the Lord that way and the Lord won’t boast in such fleshly escapades). Enemies like Nietzsche remind us of how costly Christian faith is—appearing all too foolish and pitiful to fleshly ways of thinking and living.

Second, Nietzsche goes too far when he says that everything that is nailed to the cross is divine; only God who is nailed to the cross is divine. We cannot be strong and wise if we do not see how weak and foolish we are apart from God who makes weak and foolish all human boasts that are made apart from him.

We need to become like the little boy in Andersen’s story of the emperor with no clothes, not like Nietzsche. We need to become like the Apostle Paul who became like a little child, once Jesus revealed to him that his fleshly power and wisdom were all too fleshly—they weren’t covering his nakedness before the Lord. Like the little boy in Andersen’s story, Paul called out people to be fools for Christ so that they could be truly wise. Maybe then all the others standing around gloating over the emperor’s imaginary clothing will finally come to their senses and realize that none of us are wearing clothes and that we need to be clothed in the wisdom of God’s Son.

Have you ever met someone like the boy in Andersen’s story? Would you like to be like him? More importantly, would you like to be clothed in the wisdom that Jesus exhibited while hanging on the cross? What was symbolized by his hanging there is that all our boasts according to our vain and autonomous forms of reasoning are in vain. Don’t get me wrong—reason done rightly has its place. Certainly, careful argumentation and rigorous reason are important—Paul models them here in 1 Corinthians 1. But what is he reasoning about in his letter? What does he value? What do you and I value? Do we value looking good to those around us? Have we forgotten that not many of us were all that much by the world’s standards, and certainly not much according to God’s standards, when God called us? So why should we put on/clothe ourselves in airs now?

Something that Nietzsche did not understand and that most Christians (including myself) so rarely understand is that the cross makes a mockery of all our forms of sophisticated rhetoric that elevates only our mental prowess. Such rhetoric often parades about, trying to cover up the fact that we’re wearing nothing.

It’s not only in our dream states that we show up at work or at a party wearing nothing. We do it all the time—every time we go about our business as if we’ve got it all together and merit positions of high standing. When God had his chance to parade about in his garments of power and wisdom he chose to elevate himself on a cross to show us how foolish we are and how great our need is to boast only and believe only in him:

For the message of the cross is foolishness to those who are perishing, but to us who are being saved it is the power of God. For it is written:

“I will destroy the wisdom of the wise;
the intelligence of the intelligent I will frustrate.”

Where is the wise person? Where is the teacher of the law? Where is the philosopher of this age? Has not God made foolish the wisdom of the world? For since in the wisdom of God the world through its wisdom did not know him, God was pleased through the foolishness of what was preached to save those who believe (1 Corinthians 1:18-21).

My dad, now deceased, used to say jokingly that my Ph.D. stands for “Pile it high and deep.” I fear that at times it just might mean what he said. For I have engaged with others in debates about divine mysteries and doctrinal formulas, including attention to the person and work of Christ. No question, these truths have significant positions in the Christian faith. But I fear that we cared far more about how smart we sounded and what status and positions our smartness would gain for us than about how deep the faith really is.

All of us need to stop strutting about in a dream state of appearing wise in everyone else’s eyes, when deep down inside in the subconscious realm we sense something’s wrong and that just perhaps we’re nude before God’s penetrating gaze. What happens when the dream turns into a nightmare and God wakes us up and we realize ever so clearly that we were naked all along? Will we even then play the fool or will we at last try Jesus on for size?

This piece is cross-posted at Patheos and The Christian Post. Comments made here are not monitored. To join the conversation, please comment on this post at Patheos.


[1]Friedrich Nietzsche, The Antichrist, in The Portable Nietzsche, ed. Walter Kaufmann (New York: The Viking Press, 1968), pp. 633-644.

The Court of Law and the Court of Public Opinion: Before Baby Veronica and Beyond

United States Supreme Court BuildingMuch has been made this week of the Supreme Court’s decision to return Baby Veronica to her adopted parents, removing her from her birth father. The decision is a cause of concern for many in Native communities, not simply Veronica’s Cherokee birth family, in terms of what it may signify for the Indian Child Welfare Act (ICWA).

What is the Indian Child Welfare Act? North American Institute for Indigenous Studies (NAIITS) scholar Andrea Smith explains, “This act was passed in 1978 which allows a tribe to intervene if a tribal member is going to be adopted outside the tribe. This doesn’t mean the child can’t be adopted out, because the tribe might approve that, but it does allow the tribe the right to intervene.”

So, what is the concern? While the Supreme Court did not overturn ICWA, ICWA and Indian Tribes lost a major battle in “the court of public opinion,” claims Jacqueline Keeler. Keeler adds that Indian people should take this matter very seriously.

One of the chief issues that Native peoples have to contend with today, as always, is the belief in many circles that they are savages who will destroy their children’s lives. The prescribed solution historically was forced removal and enculturation in Western “Christian” values. Smith argues:

Prior to ICWA, the US had a long history through the boarding school system of forcibly removing children from their homes, sending them to boarding schools at the age of 5, returning them when they were 18 and forcing them to be  Christian and give up their traditional ways. The point of this policy was to ‘Save the man by killing the Indian.’ There was massive sexual and physical abuse as well as starvation and neglect.  This is where socially dysfunctional behavior really began in Native communities. During the summers, rather than be returned home to their families, Native children were leased to white families essentially as slave labor.

While many Americans will no doubt argue that Smith’s claim involving the boarding school system and western Christianity is a sweeping generalization, the irony is that many people, including Christians, have viewed Native communities across the land in starkly negative, generalized terms for centuries. What about now? Keeler points out that in the case of Baby Veronica, the birth father’s family does not appear to have any of the problems that the broader public associates with Native peoples. She wonders why the case involving Baby Veronica was chosen as the focus of the challenge  to ICWA and the sovereignty of tribes. Keeler says that “it begs the question, are all American Indian families being painted with the same brush?”

The battle for the future of Native communities must be fought in the court of public opinion as well as in the court of law. Given the involvement of Christian groups, including Evangelicals, over the centuries in supposedly saving the man by killing the Indian, we need to introduce these groups to truly indigenous Christian organizations that will provide another perspective. Smith believes that the way forward is to bring together Evangelical organizations that have little exposure to Native American populations with Native American Evangelical organizations. In a Huffington Post piece, Smith is quoted as saying,

Probably the best way to develop alliances would be to mirror the organizing that Latino evangelicals did with Christian right groups around immigration reform. They just began with partnering with white evangelical churches to expose them to what immigrant families were going through and were gradually able to get most Christian right groups to reverse their positions.

If Evangelicalism at large is really concerned for seeing Native communities respond to the good news of Jesus Christ in a soul and life-transforming way, we need to be transformed as a movement. The best way we can do that is by being shaped by Jesus in relationships with fellow Evangelicals who are indigenous witnesses to the biblical Jesus rather than captives of the American western dream of manifest destiny. The more we know these indigenous Christians in particular the more we may come to know Jesus and also Native communities in particular ways. Otherwise, why should Native peoples not use a broad brush stroke and argue that Christianity is anti-Native and Jesus is the white man’s God? We must change public opinion in Native circles so that Vine Deloria, Jr.’s claim is no longer true for Native peoples at large: “Where the cross goes, there is never life more abundantly—only death, destruction, and ultimately betrayal” (Vine Deloria, Jr., God Is Red: A Native View of Religion {Golden, CO: Fulcrum Publishing, 1994}, p. 261).

This piece is cross-posted at Patheos and The Christian Post. Comments made here are not monitored. To join the conversation, please comment on this post at Patheos.