The Episcopal Tradition Religious Beliefs and Healthcare Decisions By Cynthia B. Cohen he Episcopal Church is a branch of the Anglican TCommunion, a worldwide group of self-governing Christian churches that grew out of the Church of England and continue in close association with it. Christianity was brought to England early in the sec- ond century, but the English church did not emerge until the seventh century when Celtic and Roman mis- Contents sionaries converted the pagan Angles and Saxons who The Individual and the 4 had taken over what had earlier been largely Christian Patient-Caregiver Relationship Roman Britain. Reforms introduced in the sixteenth century distinguished the Church of England as an ec- Family, Sexuality, and Procreation 6 clesiastical body separate from the Church of Rome. Genetics 9 These changes, catalyzed by King Henry VIII’s several Organ and Tissue Transplantation 11 marriages in his attempt to secure a male heir, were grounded in reforms set in motion by Protestants. Mental Health 12 Thomas Cranmer, whom Henry VIII appointed as Death and Dying 12 Archbishop of Canterbury, the chief clergyman of Special Concerns 15 England, supported making the Bible accessible in English translation and wrote the first Book of Common Prayer in 1549 with set services in English. He and other reformers, prompted by a desire to re- turn to the Christianity of the church councils of the first five centuries, carved out an Anglican identity that comprised a unique blend of Roman, Lutheran, Reformed, and Orthodox elements.1 Their reforms were consolidated by Queen Elizabeth I, who took pains to see that bishops maintained a continuous line of succession from the earliest times. Although a Part of the “Religious Traditions and Healthcare Decisions” handbook series published by the Park Ridge Center Cynthia B. Cohen, Ph.D., is a Faculty Affiliate at the Kennedy for the Study of Health, Faith, and Ethics Institute of Ethics, Georgetown University, Washington, D.C. THE PARK RIDGE CENTER Puritan party in the Church of England pushed The Thirty Nine Articles, a confessional statement for a more thoroughgoing reformation that would adopted by the Church of England in the six- abandon traditions that were without explicit war- teenth century, is an important benchmark in rant in the New Testament, they were eventually Anglican theology, but the communion tends not unsuccessful.2 In the wake of English colonial ex- to define itself confessionally.7 Richard Hooker, a pansion, the reach of the Church of England sixteenth-century theologian, set out the leading spread to the United States, other parts of Anglican view that theological judgments are to Europe, Africa, Asia, Latin America, the be grounded in the authority of Scripture and Caribbean, and the Pacific, leading to the forma- reason in light of the understanding and practices tion of the Anglican Communion in the mid- of the Christian tradition.8 Historically, nineteenth century.3 Anglicanism has been comprehensive, including Colonists brought this reformed Christianity Anglo-Catholics, Evangelicals, and Liberals in to America when they settled in Roanoke and one communion and fellowship. Spiritual liberty Jamestown, Virginia, and later in the middle has been important to Anglicans, and they have colonies.4 In the decade following the American exhibited considerable variation in belief without Revolution, Anglican settlers sent clergy back to censure. This is evident from the work of such Scotland and England to be consecrated as bish- varied Anglican theologians and writers as Jeremy ops and upon their return in 1789 established Taylor, John Donne, John Locke, Joseph Butler, the Protestant Episcopal Church in the United Samuel Johnson, Samuel Taylor Coleridge, F. D. States of America. Even as this uniquely Maurice, William Temple, Charles Gore, Evelyn American church retained ties with the mother Underhill, T. S. Eliot, C. S. Lewis, and Joseph church, it broke significant new ground in that it Fletcher. was independent of a state connection and in- The governance of the Episcopal Church is cluded laypersons, along with bishops and carried out by a bicameral legislature comprised clergy, in its governance.5 Today the Episcopal of the House of Deputies, which includes both Church includes about 2.5 million members. In laypersons and clergy, and the House of 2000, the Episcopal Church and the Evangelical Bishops. They meet and deliberate separately at Lutheran Church in America ratified a concor- the major gathering of the church, the General dat establishing a closer relationship between Convention, which is held every three years. them, although they remain separate bodies. Either house may initiate resolutions, but the The Episcopal Church also continues to partici- concurrence of both is required for their adop- pate in ecumenical conversations with other tion. Between sessions of the General Christian churches, including the Presbyterian, Convention, the work of the church is carried on Roman Catholic, and Orthodox.6 by an elected Executive Council of forty mem- The branches of the Anglican Communion in bers and the Presiding Bishop, who is elected countries around the world are united by their for a nine-year term by the House of Bishops ties to the Church of England through a structure with the concurrence of the House of Deputies. that includes regular meetings of the heads of the The Episcopal Church includes 100 dioceses national churches, an Anglican Consultative within the United States and eight more outside Council, a meeting every ten years of all diocesan the country. These are closely affiliated to main- bishops called the Lambeth Conference, and tain common doctrine, discipline, and worship. recognition of the Archbishop of Canterbury as Following its understanding of the apostolic suc- the head of the communion. The branches of the cession, each diocese is led by a bishop consecrat- communion have worship traditions in continuity ed in the historic episcopate. In 1976, the General with the Book of Common Prayer in versions dis- Convention of the Episcopal Church approved the tinctive to each and share an historic episcopate. ordination of women to the priesthood, and in 2 THE EPISCOPAL TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS 1988, the first female priest was elected bishop. This reformed casuistry was succeeded in the Each diocese also has a legislative body com- seventeenth century by an approach grounded prised of clergy and elected representatives of more firmly in general moral principles, even as congregations; this body meets annually and it revealed an empirical strain that took account elects the diocesan bishop with the concurrence of the complexity of moral life.13 Anglican evan- of all other bishops. Also common to each diocese gelicals and social reformers of the eighteenth is a standing committee of clergy and laity that and nineteenth century used this approach to shares in the governance of the diocese with the campaign relentlessly for social reforms and in- bishop and committees and boards that pursue dustrial legislation designed to ameliorate hard- various spiritual, liturgical, educational, social, ship and injustices suffered by the poor.14 The and missionary programs. Self-supporting congre- quest for a distinctively Anglican moral theology gations are governed by an elected vestry that, was continued in the twentieth century by with the concurrence of the local bishop, calls as Kenneth Kirk, who applauded the theological its pastor a priest, known as the rector, who is tolerance typical of Anglicanism.15 “Situation responsible for pastoral oversight and administra- ethics,” introduced by Joseph Fletcher in the tion of the parish. middle of the twentieth century,16 utilized a form Anglican moral theologians and ethicists of casuistry holding that love is the only moral have differed widely in approaches and em- norm, the end justifies the means, and decisions phases, including among their number casuists, ought to be made in view of the uniqueness of natural law theorists, principlists, consequen- each situation. Although it provoked a storm of tialists, communitarians, liberal individualists, protest from Anglican and other Christian moral and situation ethicists. They tend to agree that thinkers, it added yet another moral approach the community, with its past wisdom and expe- attractive to some Episcopalians. rience, shapes the individual conscience and No single document expresses the final provides the framework of moral values from teachings of the Episcopal Church concerning which reason operates.9 A distinctively Anglican bioethics and health care. Only canon law form of casuistry sprang up in the sixteenth passed by the General Convention has binding century and continues to provide a leading form character; canon law, however, generally ad- of moral thinking within the communion. Its dresses matters of governance and does not originators viewed this “casuistical divinity” as specifically address matters of health. The Holy a comprehensive moral science that included Bible assumes great importance as a source of not only the resolution of specific conflicts of fundamental Anglican convictions concerning conscience but also a systematic body of teach- ethical questions related to health care, exert- ing.10 They rejected a Roman Catholic approach ing much of its influence through the Book of focused on applying canon law to cases, instead Common Prayer, with its largely biblical con- developing broader accounts of Christian faith tent.17 Episcopalian understandings of ques- and life that often combined the moral and the tions of medical ethics and health care have ascetical, i.e. the practices of religion or what is also been enhanced by a variety of other writ- often spoken of today as “spirituality.”11 In par- ings, including reports from the House of ticular, the casuists dismissed the “probabilism” Bishops; pastoral letters from the presiding of the Jesuits, which held that any probable bishop and diocesan bishops; reports and spe- opinion could justify a moral choice, even if the cial studies from standing commissions, com- opposite opinion were more probable.