BETTY ROLLIN, correspondent: For years, Natalie Albin endured aggressive treatment for leukemia. She wound up in Memorial Sloan Kettering Hospital in New York. Death was near.

FRAN CRONIN: She’d had years of chemo. She was done with it. There was nothing left for her body to tolerate.

ROLLIN: Her daughter, Fran Cronin, says that what the family wanted at this point was a quiet time to be together and say goodbye.

CRONIN: But the doctors kept on coming back to us and asking us if we’d like to do tests, what else we could do, and we’d have to say, well, what kind of difference will this make? Is this going to change the prognosis? No. This might extend her life for a couple of months. What quality of life is she going to have? Nothing really better, can’t guarantee. In our effort to say goodbye to my mother we were always being interrupted by the hospital’s own need to be service-driven. They weren’t about hospice care. It wasn’t about saying goodbye. Their role and their interaction with us was to provide treatment.

DR. LACHLAN FORROW (Beth Israel Deaconess Hospital): We are wired as human beings, thankfully, to when in doubt you fight for life no matter what. Doctors and nurses are trained, first we want to try to save a life.

ROLLIN: While the person whose life is being saved wants to be kept as comfortable as possible, he or she doesn’t necessarily want to be saved, and often this hasn’t been made clear to either the doctor or the patient’s family. Dr. Lachlan Forrow is director of ethics and palliative care at Beth Israel Deaconess Hospital in Boston.

DR. FORROW: The tragedy is our health care system does not provide any context to help doctors and nurses have the time to talk with people about these hard things, and the whole system is greased to pay hospitals and others for expensive things people might not even want. One of the fundamental problems is what gets called our fee-for-service system. Doctors and hospitals get paid for the things that they do that tend to be expensive. The more expensive it is, the more you get paid.

ROLLIN: Our medical system can’t keep everyone healthy, but it excels at keeping people alive, which is expensive. Twenty-five percent of all Medicare spending is for the 10 percent of patients who are in their final year of life. For the year 2012 alone, that’s expected to be $137 billion. Most of the money is spent in the last 6 months of life, which is often of little benefit, if any, to the patient. And the conversations between patients and doctors and family members which might make a difference, Dr. Forrow says, aren’t happening, partly because people are afraid to talk about death and because the part of the Obama health care reform plan, which would have reimbursed doctors for these conversations, was shot down.

DR. FORROW: Cheap, political, inflammatory comments like “death panels” and “pulling the plug on grandma” for cheap political points have terrified the American people in a way that I think—I think that’s immoral.

ROLLIN: Dr. Susan Mitchell, who has studied advance dementia in nursing home patients, has found that even though these patients can be treated and kept more comfortable in a nursing home, they are often hospitalized where they receive aggressive and sometimes painful treatment that is covered by Medicare.

DR. SUSAN MITCHELL (Senior Scientist, Hebrew SeniorLife): The nursing home does not get reimbursed for taking care of a patient who’s acutely ill with advanced dementia, which can take a lot of staff time and resources. So it’s at no cost to them to send them to the hospital where they will get that care.

ROLLIN: The Alzheimer’s Association estimates that the cost for dementia care in 2011 will be approximately $183 billion, mostly paid by the government, and that cost will go up to $1.1 trillion in 2050.

DR. MITCHELL: I think there’s a lot of unnecessary and costly medical care being provided for patients with advanced dementia that is not what the families and patients want.

ROLLIN: But even if patients and their families have expressed their wishes, that doesn’t solve the entire cost problem.

PROFESSOR DAN BROCK (Harvard Medical School): At the end of life, people often have greater difficulty in giving up, in no longer using resources, and so you hear this notion, particularly from families, “I want everything done,” and implicitly there, or sometimes explicitly, “Don’t worry about the cost,” right?

ROLLIN: Professor Dan Brock, who teaches ethics at Harvard Medical School, is one of the few who believes America must ration covered health care based on efficacy and cost.

PROFESSOR BROCK: I was once at a meeting in Britain many years ago with British physicians, and we were talking about end-of-life care decisions, and the Americans asked, “Well, what do you do when patients demand or when families demand?” And the British docs sort of looked bemused and said, “Well, they don’t do that here. They don’t demand here.” We have insurance, so we say we’re entitled to it, and we have this view that rationing is a bad thing to do, and so we think we ought to get it.

ROLLIN: The problem is more acute when the patient is dying.

PROFESSOR BROCK: Should we cover this new cancer drug which extends life on average for three months and costs $200,000 or $300,000 to do so? And when you look at it that way, then people can begin understand that, well, it doesn’t seem to make sense.

ROLLIN: And the other difficulty, Professor Brock adds, is that once a drug is considered safe, Medicare does not consider cost in their approval of coverage. They ask only whether the treatment is “reasonable and necessary.”

PROFESSOR BROCK: Medicare is not able to deny coverage on grounds that—what’s usually called cost effectiveness. That is, the cost isn’t merited by the benefits.

ROLLIN: Many experts say if the question of cost is not dealt with it will surely get worse because of new treatments, which will be more expensive. Also, a growing population of the aged and their physicians will want these treatments, no matter the cost to Medicare.

For Religion & Ethics NewsWeekly I’m Betty Rollin in Boston.

BOB ABERNETHY, host: And now we look at the election results and what they mean with David Gibson, religion writer for PoliticsDaily.com, and with Kim Lawton, our managing editor. Kim, you’ve looked at the patterns. What did you see?

KIM LAWTON, managing editor: Well, not surprisingly Republicans made gains among all religious groups, but there were some pretty significant gains. White Protestants voted Republican overwhelmingly. They’ve done that, they usually do that in elections, but even more so this time. The interesting thing for me was around Catholics. In the last two congressional elections, overall Catholics have favored the Democratic candidates. But this time around they went Republican and by significant margins. Catholics have really become in some ways a swing voting bloc. Obviously there are some who always vote Republican, some who always vote Democratic, but there’s this group who keeps swinging, and this time around they really swung Republican.

ABERNETHY: David, why did so many Catholics switch so much from Democrats to Republicans?

DAVID GIBSON (Religion Writer, PoliticsDaily.com): Well, Bob, I think you, know, the governing issues here driving the election were the bread and butter, kitchen table issues of economics and the size of the federal government, and Catholics were swayed by those as well. But I think also there was, you know, a real degree of moral issues going on here—the debate over abortion funding in health care reform A lot of the things that the Christian right were hammering the Obama administration on for a long time—those also came into play. There was a sense that the Obama administration had been pushed over to the cultural left, and that really made a lot of Catholics very anxious and uneasy.

LAWTON: You know, a lot of people say, well, of course these religious groups went Republican because the whole electorate went Republican more so this time around, but I’ve been talking to some strategists who crunch the numbers, and they said, well, yes, that was a pattern throughout the electorate. Religious voters, especially Protestants and Catholics, voted more Republican at much bigger rates and margins than the general electorate.

ABERNETHY: And why?

LAWTON: Well, you know, David said there’s a lot of different issues why. People also say that the Republicans were doing a lot more outreach and specifically targeting some of these faith communities, and there was criticism this time around that the Democrats didn’t do that as much.

ABERNETHY: David, why do you think that was? Two years ago we were all, you all were talking a lot about Democratic outreach to religious voters and how well they were doing. Why not this time?

GIBSON: Good question, Bob. I think it’s really puzzling in many respects why the administration and the Democratic Party apparatus kind of punted on that religious outreach that had been so successful, that was really, I think, to a degree shifting the political culture where you had religious voters. The biggest predictor of how you’ll vote is church-going. Regular church-goers are going to go Republican more than they are going to go Democratic. In 2006, and certainly in 2008, Democrats had begun to shift that. They really, in the last two years, kind of gave up on that. I don’t know if they got complacent or whatever. But there’s some grumbling certainly on the religious left about the lack of Democratic outreach to religious voters, and you saw the results on Tuesday.

ABERNETHY: What about the Tea Party?

LAWTON: Well, clearly there was a big religious base in the Tea Party. Depending on who asked the question and what question they asked, almost half of people who consider themselves part of the Tea Party movement are religious conservatives, so that was a big factor in helping the Tea Party push some of the Republican candidates to victory. Not all of them did win, but it certainly has energized people on the religious right.

ABERNETHY: David, let me turn your attention now to the lame duck session of Congress coming up and particularly to the new Congress coming in, in January. What do you see them doing or failing to do that would be of particular interest to the religious community?

GIBSON: Well, I think two things in the lame duck Congress could possibly come up. One is immigration reform. Harry Reid on the eve of his election said that he was contemplating bringing that up. He said he would bring comprehensive immigration reform up for a vote during the lame duck session. Again, how is that going to work out? How would that play politically? One thing, referring to the Catholic vote that you have to break out, is that Latinos went very strongly for the Democratic Party this time, so you’ve really got, in a sense, two Catholic votes emerging and two votes overall—the white Catholic vote and the Latino Catholic vote. The other issue that could come up in the lame duck is the “don’t ask don’t tell” policy, and the Democrats may try and formally rescind that. Those could be two hot-button issues that would get some immediate push back from the right, but also could be supported by the religious left.

LAWTON: And I’m fascinated by some of the battles that could be shaping up in that, because while religious conservatives certainly are concerned about “don’t ask don’t tell,” they don’t want to see that policy changed, but on the other hand when we are talking about immigration, some evangelicals have, although they are fiscally conservative, some evangelicals have been supportive of some immigration reform. And so while the Tea Party really wants to focus on fiscal issues, and on those issues a lot of evangelicals and other religious conservatives are right on board with that conservative fiscal outlook, when it comes to these social issues or things like immigration, some evangelicals might want to support that, and so there are some complexities there.

ABERNETHY: Do you see anything coming up regarding right to life?

LAWTON: Well, I think that that’s always an issue that’s important to religious conservatives. Certainly on the health care bill, that played a role in terms of is there going to be funding for abortion? Or even the Catholic bishops were concerned about possible funding for birth control. So those issues came into play there and are likely to continue as those debates come up again.

ABERNETHY: David, how do you see that?

GIBSON: I think Kim’s exactly right, and I think there’s going to be a big Republican push to repeal health care reform, or to de-fund certain aspects of it, to undermine it in some way, shape, or form. On the other hand, we could have a couple of court cases in the pipeline that could provide a definitive answer to this question of whether there is funding for abortion in the health care reform bill, which experts say there isn’t but folks on the religious right believe that there is. If there’s a definitive answer one way or another that could really be a game-changer as well on that issue.

ABERNETHY: So many people looking at the election returns see a demand for civility, a demand that the Republicans and the Democrats start trying to work together better. To what extent do you see any of that coming?

LAWTON: Well, I hear that. I hear, especially in the religious community, people hoping that there might be some civility. But when you talk to some of the activists and people who were involved in the campaigns, you know, to me what I hear from them is common ground means you vote like I want you to vote, or you vote like I think, and not let’s find a compromise. I don’t hear people in a mood for compromise. I do also hear in the religious moderates and left sort of a renewed commitment to working for their social justice agenda, and so there’s still going to be some political battling ahead.

GIBSON: Kim’s exactly right. I think that the folks on the religious right and the real strong religious right lobby organizations have basically said that the next two years is going to be about 2012. So they are positioning for the next election, because they see that they can only really get their agenda across if they win the Senate and the White House as well. We are in a real winner-takes-all kind of political culture here.

ABERNETHY: David Gibson, religion writer for PoliticsDaily.com, Kim Lawton—many thanks.

“You cannot understand caregiving unless you do it,” says Arthur Kleinman. “Acts of caregiving come as close to what I think religion is as I could name.” Watch more of Bob Abernethy’s conversation with him.

In a July 28 roundtable discussion on Capitol Hill with religion reporters, Democratic senators acknowledged the involvement of faith communities in debating moral and social issues such as health care reform and economic recovery, but they also questioned whether there are limits to the role religious groups can play when it comes to what Minnesota Senator Amy Klobuchar called “dealing with the nitty gritty” of partisan politics.

No cameras were allowed at the meeting, billed by the Democratic Steering and Outreach Committee as a conversation about “shared values and common ground.” It was one of several “faith and media” discussions Senate Democrats have held since 2008, responding to criticism of weak Democratic outreach to religious voters and faith communities over the years. The last session with religion reporters was held in October 2009.

Michigan Senator Debbie Stabenow, a member of the United Methodist Church who chairs the committee, said Democrats have been “governing with a different set of values” for the past 18 months. “It’s not about a particular president,” she said. “It’s about a philosophy we debate every day on the Senate floor.”

Stabenow cited Wall Street reform, job creation, economic stability, small business credit access, and extension of unemployment benefits among the Congress’s recent accomplishments, despite what she called “a maze of filibusters.” She thanked faith communities “for being with us every step of the way” and for supporting passage of last year’s Recovery and Reinvestment Act and this year’s health care reform bill—domestic policy achievements that “wouldn’t have gotten done without the strong voice and commitment” of communities of faith, she said.

Ohio Senator Sherrod Brown, a member of the Evangelical Lutheran Church in America, praised the economic and social justice values of religious groups, citing a trip he took with Illinois Senator Dick Durbin earlier this year to examine peacekeeping issues and US foreign assistance programs in Sub-Saharan Africa, where Brown said “so many faith-based groups deliver direct services.” The values that underlie their work, he said, are “what bind us,” and such values should inform “what we ought to be doing in foreign policy.”

Both Durbin and Maryland Senator Ben Cardin addressed the looming foreign policy issue of America’s nine-year-old war in Afghanistan, where Cardin acknowledged that the lack of a legitimate, credible partner is “testing the resolve of the American people.” Durbin, who voted against the Iraq war but for the Afghanistan war, said the consequences of combat in Afghanistan, particularly growing numbers of wounded and disabled veterans, “weigh dearly on me.” He added that Americans must continue to ask not only what the US has achieved in Afghanistan but also “how will it end, when will it end, and at what cost.” This week, more than 100 Democrats in the House of Representatives voted against a $58.8-billion war funding bill, which passed 308 to 114.

Asked about arms control and nuclear nonproliferation, issues long of concern to religious groups, and about prospects for Senate ratification of the New START treaty, Oregon Senator Jeff Merkley said it will be “a very heavy lift to get it done.” Merkley said the treaty is in trouble “because it’s an election year,” and there are “not many voices to depoliticize” the debate, despite what he called “an international social contract around nonproliferation.” Merkley praised Republican Senator Richard Lugar of Indiana for trying to keep the treaty “out of the political realm” and called for more grassroots efforts to weigh in on its importance. At town hall meetings, said Merkley, he hears only from treaty opponents, and “that’s a problem.”

But just how far religious groups and communities of faith are willing and able to go when they enter the political fray on moral and social issues was a question raised by Klobuchar, who suggested there are “limits on advocacy” for religious coalitions. She said that is especially the case when Republicans represent “a clear obstacle to moving forward” in areas such as immigration reform, one issue that has attracted considerable faith-based support across the spectrum. “How far can they go in pointing out the obstacle?” asked Klobuchar. “How strong an advocate can they be?” Durbin added that while 11 Republican senators once supported immigration reform, now there are none. “That’s what’s stopping us” from passing a bill, he said.

Klobuchar said in conference calls with Minnesota faith leaders about Senate slowness on immigration issues she has been told that when it comes to pure political strategy, religious groups are “not involved” and “don’t deal with that stuff.” How, then, can faith communities “play a larger and louder role” and “push back,” she asked, at a time when the politics of immigration reform are most at issue? Can they serve as a force and a voice for getting past political differences to common ground? Stabenow added that some religious groups do, in fact, have “comfort in the partisan arena” and are willing to “get into strategy and partisan differences.”

Asked about a reported decline in Democratic Party outreach to faith communities, Stabenow characterized Senate Democratic outreach as “aggressive” and “not diminishing.”

“Every issue,” Stabenow said, “is about values.”

Originally broadcast October 9, 2009

KIM LAWTON, guest anchor: The president was on the road again this week trying to sell health care reform.  Meanwhile in Washington, behind-the-scenes negotiations continued over several potential stumbling blocks, including funding for abortion coverage. Another controversial question in the effort to create affordable health care is how treatment at the end of life might become more humane and less expensive.  Right now, in most states, when a dying patient can no longer communicate, doctors have no choice but to keep care going, even if it is painful for the patient, expensive, and unlikely to do any good. But is that necessarily the right thing to do?  Betty Rollin has our report.

FAMILY MEMBER: She’s been fighting cancer for five years, twice. She has emphysema of the lungs real bad. It’s gotten worse, they said, since she’s been in here, and right now she is fighting a bad stroke. They are not sure, but they are saying something like it could affect her left side and maybe her brain.

BETTY ROLLIN, correspondent: Did she leave any instructions about what to do?

FAMILY MEMBER: No, she did not.

ROLLIN: And that’s a major problem, says Dr. Jeff Gordon, an internist at Grant Medical Center in Columbus, Ohio. Dr. Gordon has had dying patients who have not made their wishes known and haven’t realized that some extreme measures are almost always futile.

DR. JEFF GORDON (Grant Medical Center): Most people think, that is for elderly people especially, that heroic measures like CPR and ventilator support is really effective, and the truth is, in older people with complicated medical problems, it just doesn’t work effectively, so the bottom line is people suffer needlessly at the end of life.

Ventilator–there is a plastic tube that goes through the mouth into the windpipe, and just imagine the gagging kind of feeling. Now we give high levels of sedation to inhibit that, but that alone, now think of yourself, these people typically have to be restrained so that they don’t just reflexively reach up and pull that tube out, and so they have their arms restrained. They can’t move freely, and think of yourself being on your back restrained, just the muscle aches and pains that you would develop.

ROLLIN: Dr. Gordon points out that sometimes aggressive treatment is a good idea.

DR. GORDON: Intensive care and heroic measures are awesome when they are used in the right people. The right people typically are younger people that have a chance of survival and having a good outcome.

ROLLIN: Dr. Philip Hawley, who is director of the intensive care unit, says the state mandate is to keep life going no matter the cost, so although doctors think their patients should be allowed to die peacefully, their hands are tied by custom and law.

DR. PHILIP HAWLEY (Grant Medical Center). We have people who are terminal on aggressive life support measures. Clearly they are not going to survive. We are spending all this time and money taking care of them. They are suffering, and it’s completely inappropriate.

DR. GORDON: What people need to do is talk about this with their family, with their physician, in advance. If they get a life-threatening illness, a lot of times they won’t be able to. Maybe they won’t be coherent, or they’ll be on a life-support machine. They can’t express their wishes, then they put their family in a bind, so they feel guilty, they don’t know for sure, and then what often happens is the sort of default is, well, let’s do everything, as much as possible.

ROLLIN: And sometimes families disagree about what to do. It’s hard for some to let go, which complicates things further.

DR. HAWLEY: If we could get families to deal with this we would not have this problem. We feel we as physicians should be able to step in and say we’ve got to stop the madness.

DR. GORDON (speaking at church service): Lord, help us have perspective. That’s what changes lives. That’s what gives us hope.

ROLLIN: Dr. Gordon, who is also a nondenominational pastor, was surprised to find that patients who are religious often want more aggressive treatment at the end of life than others.

DR. GORDON: I have even encountered people that are people of faith, and they are, what I think, pursuing futile-type measures, and they say well, we are going to let God have his way here, and I try as gently as possible to say we are not really letting God have his way. We are forcing the issue here.

(speaking to patient): Has anyone talked to you about this?

PATIENT: Oh, no.

DR. GORDON: No, no. It’s a topic that doesn’t get talked about.

ROLLIN: Dr. Gordon practices what he preaches by getting patients, as well as their families, to talk about what they want at the end of life while they still can, and he tries to make both patients and families aware of realistic rates of recovery.

DR. GORDON (speaking to patient): I just want you to understand is that those kind of things like CPR and breathing machines in somebody that’s got the problems that you have are not very effective. You need to decide whether that is something you would want or not, but you need to have all the facts about it, too.

ROLLIN: One of the reasons conversations like this rarely happen between patients and physicians, says Dr. Gordon, is that physicians are paid to treat, not to talk, which is not to say that some don’t talk anyway.

DR. GORDON: The person that needs to have this conversation is the primary care physician. They are going to have to call family members, they are going to have to gather these people, and besides that it’s a very difficult conversation, and so we are underpaying them. They are going to have to make a financial sacrifice to have this discussion, and then we wonder why it’s not happening.

ROLLIN: There are three things people can do to make their end-of-life wishes clear: Sign a durable power-of-attorney naming a person to make decisions if they are unable; sign a living will which is about long-term life-sustaining treatments; and deal with the DNR question—whether if your heart stops you want to be resuscitated or not.

Jill Steuer, who has metastatic breast cancer and has been given four months to live, has decided to stop any kind of treatment and receive hospice care.

JILL STEUER, RN: I’ve been through all the chemotherapy, and there is no chemotherapy to help me anymore. I don’t want to be stuck. I don’t want to have any extra medications. I want to just go peacefully. The only medications I want are going to be the ones that are going to comfort me. That’s all I want.

ROLLIN: Jill Steuer is a nurse and researcher at Grant Hospital.

JILL STEUER: I’ve seen patients who have died horrible deaths, where their families wanted everything, the doctors wanted everything, but it was not to be, and that scared me. I’m not sure they realize that it’s okay to say “I’ve had enough.” Even now people will stop me in the hallway and they’ll say keep up the good fight, keep up the good fight, and I think some people are afraid that they are going to disappoint others if they just say let’s have nature take its course. I’m putting up a good fight, but my goal is not to live a long and painful year or two. I would much rather say at this point in time I want the next four months to be as interesting as the last 57 years have been.

For Religion & Ethics NewsWeekly, I’m Betty Rollin in Columbus, Ohio.

LAWTON: Shortly after we produced that story, Jill Steuer passed away.

BOB ABERNETHY, anchor: Welcome. I am Bob Abernethy. It’s good to have you with us. We take our look ahead now to the stories we expect to cover in the new year with the help of Jason Byassee of the Duke University Divinity School, where he directs its Faith and Leadership Project; E. J. Dionne of the Brookings Institution, the Washington Post, and Georgetown University; and with Kim Lawton, managing editor of this program. Welcome to you all. Jason, we have a recession. What’s going to happen to it, do you think, and what effect has it had and will it have on the churches, the denominations, the charities—all those people that you cover?

JAYSON BYASSEE, Duke Divinity School: I am struck by how you can’t have a conversation with a religious leader now without talking about what the financial downturn means for their organizations. This is across the board, from left to right, whatever position one has. What this means is that people are laying people off. They are cutting back on ministries. I wonder if this isn’t the story upcoming. Lots of our denominational infrastructures were built at a time when you could assume money would keep coming in. Well, it’s not now, and how do you do more with less? Nobody is quite sure how to do that.

KIM LAWTON, managing editor, Religion & Ethics NewsWeekly: Talking about doing more with less, the recession is also having a terrible impact on the people in the pews of all of these religious congregations, the people that these ministries serve. These people are hurting more than ever. They need help. They need resources. They go to the religious institutions, who are struggling. So it’s a real problem.

E.J. DIONNE, Brookings Institution: The entire not-for-profit sector has been hurt. Now, there is some hopeful evidence that sometimes some people actually step up and give a little more when they can to groups helping the very poor, because they have an even better sense than usual about “there but for the grace of God go I”—that possibility. The economy is going to be critical to so much of what happens this year. It’s going to be crucial politically to what happens in the 2010 elections. You can almost predict on a straight line if the economy feels like it’s getting substantially better by the midyear, President Obama and the Democrats are probably going to do better; if it feels like it’s not getting better it will be a large problem for them. That’ll have an effect on how we discuss all kinds of questions, including moral and religious questions, in the course of the year.

ABERNETHY: Jason, do you see people going into the ministry, or not going into the ministry, because of the recession? Do you see seminaries closing, churches closing?

Jayson Byassee

BYASSEE: The standard assumption is that when the economy is bad people go to school, because work is not good. The problem with that is, if you can’t sell your house then it’s pretty hard to move across the country and go to school. Lots of seminaries are trying to do more online education. I expect more of that to come. But there is enormous pressure, especially on small seminaries that aren’t connected to a big university, and dire predictions about how many of those may close in the coming years. That might not seem like a big thing until you realize, okay, where my minister was trained means everything for what I’m going to hear about God. This has an outsize ripple effect on institutions across the board and religion in this country, I think.

ABERNETHY: E.J., it is an election year again. What do you see as a result of that that will be of particular importance to believers?

DIONNE: I think, first of all, we may have the discussion on morality and the economy that was, I think, a little bit delayed, that people were trying to come to terms with what the downturn meant. I think there is going to be now a real look back and look forward as to why did we get into this mess—how much of it were practical problems, how much of it were about people not taking responsibilities seriously that they should have—the stewards of our economy, the people with a strong position in our economy. I think that debate will very much affect the elections. I also think we’re going to have a kind of after-effect of our big health care debate. I think what you saw among religious groups, particularly Christian religious groups, were a real difference between those who laid the heaviest stress on the moral imperative to getting everyone, or as many people as possible, covered through insurance, versus those who felt that the major emphasis on whether abortion is or is not funded and how in this health care debate. I think that’s going to have a continuing effect, because I think there is this running dialogue, certainly in the Catholic Church that I’m part of, but I think in all of our traditions, between those who believe the central emphasis of our religious group should be on a certain relatively narrow—though they would say very important—list of moral questions: abortion, gay marriage, stem cell research versus those who say that the emphasis should be on a much broader agenda having to do with social justice and how we organize our lives together in the economy. I think that discussion is going to very alive, made all the more so by the controversy of an election year.

LAWTON: It’s going to be interesting to see how involved faith-based activists get in these midterm elections. Certainly Barack Obama mobilized a very active campaign effort among especially moderate and liberal faith-based individuals. There was activity on the religious right as well against him. But will a Democratic candidate at the state level be able to get that same sense of energy? Will they come out? Meanwhile, the religious right is still really trying to figure out who they are, who’s going to lead them, and what they’re going to do. The Republicans are trying to figure out what do we do with this core of our party? So it will be fascinating to watch all of that unfold in the coming months.

DIONNE: Although I do think there’s one interesting thing that’s happened on the right, at least in the last year, which is I think the religious conservative voice has been less powerful than the voice of, whatever you want to call it, this Tea Party movement. There seems to have been a shift within the right from an emphasis on moral questions that the religious conservatives were focused on to this very strong anti-government strain. Now, obviously, there are overlaps on the conservative side, but I think this is a different sort of direction that we’ve seen on the right side of politics.

LAWTON: But we’ve seen, especially with the health care debate last year and the role abortion played within that debate, those social issues are still very important to a lot of people and will still come up, I think, in the midterm elections.

BYASSEE: Much more quietly, along with that I am struck by how many dozens of churches in my area can’t afford a minister any more because of health care being so expensive, and yet the left has somehow not managed to have the kind of energy in favor of expanding health coverage by any stretch that the right has managed to have against it, it seems to me, because of this confluence of leadership in opposition.

ABERNETHY: Kim, what do you see coming about the all the issues around gay marriage and what jobs homosexuals can have in the churches?

Kim Lawton

LAWTON: This is going to be a very important year within the worldwide Anglican Communion. The US Episcopal Church, which is the branch here of the worldwide Anglican Communion, has moved forward. The Los Angeles diocese has elected an assistant bishop who is a lesbian. The worldwide community had asked the US church please don‘t move forward on this. She would be the second one. Her election needs to be confirmed within the next few months before she would be officially installed in May, so that’s still coming up. But the world is watching in the Anglican Communion, and many people are not happy about this, so this is going to be really important. We’ve been talking for years about is the Anglican Communion going to hold together? I think this year could be very crucial on that question.

BYASSEE: It seems like the first election, you could make space for it being a naïve move, or a misstep move, if you were in opposition. A second one, you can’t make that claim any more. The striking thing to me about this election is not so much that Mary Glasspool is a lesbian, but do you really need three Episcopal bishops in Los Angeles? Again, is it a structure set up for a time when the money was flush, and now does it make sense any more?

DIONNE: I’ve thought about this the last couple of years, where we have focused so much of the debate on the issue of gays and lesbians. It strikes me that, within the Christian Church for 100-150 years there have been episodes of modernity confronting tradition and that, right now, the center of that debate is around issues related to gay rights. But when you listen to some of the conversation—why people are for or against gay rights—it’s really part of this much deeper struggle that’s been going on within Christianity for a long time of how much its task is to resist modernity versus how much of its task is to respond to modernity, if you will, in a more dialectical way, with some opposition but also embracing some of what modernity has to give us. I think this episode is just—there is a particular passion behind this, because this is obviously a major step in this long argument.

LAWTON: Another interesting aspect to this particular debate, when you are talking about the Anglican Communion, is the demographic changes of Christianity around the world. So you have Christians in Africa and Asia who have the numbers. There’s millions of Christians in Uganda and Rwanda and Sudan. These tend to be more conservative on some of these issues—much more conservative, especially on the issue of homosexuality, and where their place is in the international Christian family is very much up for grabs in this particular debate.

DIONNE: Indeed, Christianity is growing. I think it’s a great shock for people to realize that there are many more Anglicans in Africa than there are Episcopalians in the United States.

BYASSEE: There’s twice as many Anglicans in Sudan as there are in the United States—just one big country in Africa. I don’t think we’re anywhere near catching up with what this means, not only on social issues but on doctrine, worship life, and all the rest. What’s it going to mean, not very long from now, that Christianity is essentially an African religion and not a Western one, not a North American or European one?

DIONNE: You’re seeing that, to some degree, in the debate about global warming. I do think the environment is another area where we’re going to see continuing activism and debate within the churches. The presence of a very strong group of Third World Christians in all of the denominations is going to put the focus not simply on the issue of reducing carbon in the atmosphere, but also on what kind of compensation Third World countries will get, which became a very critical issue in the discussions in Copenhagen.

ABERNETHY: Let me move to another point, Kim especially. There is an investigation going on, or a review, or whatever is the right term for it, of Catholic nuns in this country by the Vatican. Where is that going, and when will we know what comes of it?

LAWTON: The Vatican says that it wants to look into the quality of life for US sisters. That has created a huge amount of consternation here in the US, as there are questionnaires that have been sent to different communities of sisters with a lot of questions. Many of them feel like we’re not going to answer some of these. So that’s going to be moving forward throughout this year, as that sort of give-and-take moves forward. Do they answer these questions? What do they say? How do they say it? What’s really behind all of these questions in the first place? That’s what a lot of people, not just among nuns but across the Catholic community, want to know. What’s really behind this study, this investigation?

E. J. Dionne

DIONNE: There’s a great danger here. I think this could prove a very, very divisive move inside the church. There is enormous affection toward nuns among people who are Catholics. Many of us owe enormous debts to them for our educations and for so many other things they did. They are among the most activist—that’s a bad term in the eyes of some conservatives—as in giving comfort to the poor, helping the sick, doing all the things the Gospel says we should do. And so they risk, I think, a real backlash, if they don’t handle this very carefully. I think they are already confronting it, to some degree. They’ve got to be very careful with the nuns. I’ve got some nuns that sent that message.

BYASSEE: It is an interesting question. If you have an enormously radical form of life, based on what Jesus said we should do, can you be liberal doctrinally? It sounds like the answer may be no, right? That’s a very risky answer…

DIONNE: The answer from the Vatican may be no. It’s not clear to me that there is, first of all, any consistent sort of liberal doctrinal positions, and to the extent that they are somewhat more liberal—for example, in asserting that perhaps there is a bigger role for women to play in the authority structure of the church—it shouldn’t surprise that perhaps that the nuns, who have taken so much responsibility for helping run the church, just might have a view like that.

BYASSEE: My wife, who is a pastor, would “Amen” your claim. I think that’s right.

ABERNETHY: Jason, you study and help identify future leaders in the churches. What do you see? Some of the familiar old names are no longer so familiar. Oral Roberts died. Where is it going? Who do you see out there who’s going to succeed the people we used to hear about so intensively with the religious right?

BYASSEE: One thing that interests me is that there’s less of an emphasis, if you’re a younger evangelical leader, on starting a parachurch ministry like Billy Graham did, and more of an emphasis on being a pastor. I’m not exactly sure why this shift has happened, but if you’re a young pastor, you’re charismatic, what you want to do is plant a church usually and grow it big and have that be where your ministry is. So I see a lot of pastors of enormous churches—in places like Seattle and Grand Rapids—who have churches of 20-30,000 people. You don’t hear about them in the national news yet. You don’t hear Rob Bell’s name. You don’t hear Mark Driscoll’s name. You’re hearing Tim Keller’s name in Manhattan more because he’s writing books that have gotten attention. Same with Rob Bell. But these are pastors who are sort of a half-generation after Rick Warren, or Bill Hybels at Willow Creek, who are going to have an enormous impact, because if you want anyone to catch a religious allusion in politics in 20-30 years, it’s likely to be because one of these pastors helped teach a congregation to hear the Scriptures, right? If people are going to be serving the poor, it’s going to be because churches like this—like Adam Hamilton’s church in Kansas City, Church of the Resurrection—encourage people to do that and made space and structure for them to do it. So I think that’s an enormous shift.

LAWTON: One thing I’m watching is, with some of the folks you just referred to that already have these big megachurches, what happens when those leaders—people like Rick Warren at Saddleback Church, people like Bill Hybels in Willow Creek, built these giant congregations—what happens when they retire, though? What happens to those congregations? It’s really hard to step in to a congregation that’s already in process. That’s something I’m really going to be looking at.

ABERNETHY: I want to hear, Jason, what you have to say, and E.J.—each of you—about kind of the state of religious life and of organized religion in this country today. How is it going? Is secularism pushing it aside? What’s happening?

BYASSEE: It does seem to me that the new atheist books gave a certain permission to people to claim that they are not religious, that you don’t have to have the default be, oh yeah, I’m a Christian, even though I don’t do anything. Now it can be no, I’m not religious, and that seems to be more socially okay. Of course, being biased people in religious institutions—I spend all my time with religious leaders for whom things are very vibrant, right—but I think we shouldn’t overlook the fact that there are a whole lot of people who aren’t engaged by the church and its ministries and would much rather they go away, especially at election time.

ABERNETHY: Sixteen percent, I think, identify themselves as having no affiliation. E.J., what do you see? How is the tide running?

DIONNE: I wrote a column some years ago that ran under the headline, which I openly took from The New Republic. The headline was “God Bless Atheists.” I think one of the things about this atheist challenge that’s actually good for believers and good for Christians is that it has created a debate on the fundamentals. I don’t mean by that fundamentalists; I just mean the fundamental tenets of does God exist? How do you know God exists? What is the relationship between God and humankind? These debates have gone on for centuries. A lot of what the new atheists say are new versions of very old arguments that have been taking place. I think it’s far better to surface these arguments than to have people either pretend to believe when they don’t, or have believers not have to confront really core challenges to belief itself. And so, at bottom, if you can say this whole debate may be providential.

LAWTON: I think we need to be careful, too, when you look at some of these numbers. A lot of those people who are unaffiliated—it doesn’t mean that they’re not religious or spiritual in some way. They’re just not necessarily associating themselves with a particular organization or institution.

BYASSEE: It does seem important that these numbers bump when there is an election that people are unhappy about. It seems like there’s been some behavior from religious people that they’re displeased by, so it seems like the 2004 election, in particular, got a bunch of people book contracts to write about how bad God is.

ABERNETHY: Kim, there are some Supreme Court decisions coming down of some interest.

LAWTON: I think this coming year will see some interesting decisions about the conflict between religion and the public square. One is the Mojave cross. Can there be giant crosses in public property? Another one that I find particularly interesting is that the Supreme Court will be looking at a case with the Christian Legal Society and whether a law school can—the Christian Legal Society has a student club and they also believe that gays should not be in their leadership or their voting members, because that’s part of their religious belief. Well, the law school where they were operating said, well, if you believe that, you can’t be part of an official student group, because we don’t discriminate based on sexual orientation. So you have this clash of religious values. On the one hand, you have people who want to exercise their religious beliefs. And then you have people who say this is a matter of human rights or civil rights. Then those start clashing. Who trumps whom? So that’ll be interesting.

DIONNE: That’s a hugely important and really fascinating case, because you’re dealing with, in a sense, two conceptions of liberty, two conceptions of whether people should be free to be gay, and no organization on the campus should discriminate against them, and one can see how one gets to that conclusion, versus the right of the Christian Legal Society to constitute themselves as a group that has a very particular view on homosexuality. I think it could be a very bitter argument, precisely because each side is going to claim—they’re going to have competing goods, as each side will claim competing notions of freedom.

ABERNETHY: E.J., quickly, what are you going to be looking forward to particularly in the coming year? What stories?

DIONNE: I am going to be looking forward to a continuing moral debate about how we should organize this economy and what got us into the mess we’re in, in the first place. I think it’s going to be a real test of whether Barack Obama’s efforts to tamp down the culture wars have us get along a little better, whether that will succeed. Like everybody else, I’m going to be looking at how the test of these last two years—how the last two years are judged by the voters in November.

ABERNETHY: I’m sorry, but our time is almost up. Many thanks to Kim Lawton, to E.J. Dionne, and to Jason Byassee. Happy New Year to each of you and to our viewers.

KIM LAWTON, managing editor, Religion & Ethics NewsWeekly: President Barack Obama took office on a strong note of hope, and he signaled right off the bat that religion would have a role in his new administration.

Pres. OBAMA (in inaugural speech): We are a nation of Christians and Muslims, Jews and Hindus, and nonbelievers.

LAWTON: He expanded President Bush’s faith-based office and set up an unprecedented new advisory council of top religious leaders.  Many of his speeches included religious rhetoric, notably, his controversial visit to Notre Dame where he called for a new common ground on abortion, and his address while accepting the Nobel Peace Prize.  One of his most important speeches was at Cairo University in Egypt, where he pledged a new and improved relationship between the US and the Muslim world.

American Muslims praised the Cairo speech as a defining moment in their efforts to be considered part of the American mainstream. But the Muslim community also faced new challenges about extremism in its midst after the Fort Hood massacre–allegedly by a Muslim Army officer–and the arrests of five young American Muslim men who were suspected of going to Pakistan to join terrorists.

Religious activists waged aggressive campaigns for health care reform. But their efforts were hampered by a divisive battle over funding for coverage of abortions. Faith leaders actively lobbied on both sides of that question.

Lawmakers in Vermont, New Hampshire, Maine and the District of Columbia all approved measures to legalize same-sex marriage. However, voters in Maine overturned that state’s law before it could take effect. The new laws put increasing pressure on religious denominations about whether their clergy should be allowed to marry gay couples.

Issues surrounding homosexuality continued to divide mainline Protestants. The Evangelical Lutheran Church in America voted to allow local congregations to hire non-celibate gay and lesbian pastors. Opponents are now moving to split off and form their own denomination.  Delegates to the Episcopal Church’s General Convention voted to end their moratorium on gay bishops. The Episcopal Diocese of Los Angeles then elected a lesbian assistant bishop, whose election must still be confirmed by representatives of the entire Episcopal Church. The US actions heightened tensions within the worldwide Anglican Communion.

Meanwhile, Pope Benedict the Sixteenth made it easier for disaffected Anglicans to convert to Roman Catholicism. The Vatican announced new structures that will allow converting Anglicans to retain some of their distinctive beliefs and practices.  During a trip to the Holy Land, Benedict worked to mend fences with the Jewish community after he lifted the excommunication of a traditionalist bishop who denied the Holocaust.

The recession continued to take a toll on faith-based groups and the people they serve. Religious institutions were forced to slash their budgets and lay-off staff even as they were asked to do more to help people. The Jewish community also felt the fallout from the Bernie Madoff scandal with many Jewish organizations losing millions of dollars.

And, as the world faced a swine-flu epidemic, religious groups were among those struggling to respond.  Congregations made changes in their worship practices to help stop the spread of H1N1. New preventive policies were also instituted at this year’s hajj, or pilgrimage to Mecca.