Healthcare Concerns and Liturgical Practices

A September 2009 memorandum to the priests and deacons of the diocese, from Bishops Sisk and Roskam

Healthcare concerns, as they relate to liturgical practices, have been brought to the fore by the threat of an H1N1 (Swine Flu) epidemic. It is worth noting that the Center for Disease Control has stated that “…no documented transmission of any infectious disease has ever been traced to the use of the common cup….”(1) We hope this statement, and what follows, will helpfully address some of these anxieties.

The Common Cup

Recently the Archbishop of Canterbury, in response to the swine flu epidemic, recommended to the parishes of the Church of England the suspension of the sharing of the chalice at the Eucharist. While this statement was intended to be a temporary measure in Great Britain, it resulted in widespread confusion about its connection to us and genuine concern about the risks of the common cup during a health crisis. We believe some comment would be helpful, partly to address the fear that some may have over contracting an illness from participation in worship, and partly to outline and recommend some practical procedures.

We believe the common cup is an essential symbol of our Christian life and identity. We, naturally, do not want to expose anyone to danger and contagion, but we are convinced that those risks are benign when Eucharistic worship is conducted responsibly. We do not believe such a suspension is necessary in the Diocese of New York. We do, however, strongly advise all of our priests and deacons to recall the theological justification for a common cup and we recommend some specific steps that can preserve our custom and ensure our safety.

First – we offer some reflections on the Cup of Blessing. In addition to the symbolic weight borne by the contents of the chalice, the chalice itself is a powerful, indeed essential, symbol of our communion one with another. Just as there is “one bread” so too there is “one cup of blessing which we bless.” This symbolism remains powerful even if we do not use one physical loaf of bread (as some liturgists encourage) and even if large parishes and cathedrals often have more than one chalice for the distribution of communion. The Book of Common Prayer explicitly calls for “only one chalice on the Altar”(2) because this symbolism is so central to our identity and liturgy. References to this “cup” run through the language of both rubric and prayer, because the iconography of the cup is powerful. Early Christian art portrayed the cup held by an angel to collect the blood and water streaming from the wound in Christ’s side, and one of the most potent symbols of Western Christendom has been the Holy Grail. The Cup of Blessing has been a major focal point of symbolic reflection; and we recall the fact that the return to its common usage was a hard-won victory for the reformers. We believe the sacramental significance of a common cup receives even more emphasis in our time because we do not normally drink from common vessels; this is a potent and robust reminder that this is no ordinary meal, but is, in fact, an anticipation of the Heavenly Banquet. We are unwilling to surrender the sacrificial quality of this tradition because drinking from a common cup is a sign of trust, fellowship and commitment.

Second – we do, nevertheless, respect the knowledge of medical experts, who advise the consistent employment of rational measures to secure communal safety. The Anglican Church of Canada produced an excellent overview which summarized scientific studies when the AIDS pandemic occurred and was subsequently followed by the emergence of SARS. We encourage anyone seeking more information to read their material, but to very briefly summarize the major points, we want to cite the most salient and at the same time list some important recommendations for usage in our diocese:

• There is very little risk in the use of a common cup if a clean purificator is used appropriately. This means wiping both the outside and the inside of the lip of the cup, with a clean part of the purificator, each time the cup is administered. It is suggested that more than one purificator be readily available for the chalice bearers in larger congregations.
• It is imperative that Eucharistic ministers have clean hands when administering the bread. It is suggested that the lavabo be of an adequate size to accommodate some soapy water in which the hands can be truly cleansed and then rinsed by the pouring of additional water. The use of an alcohol hand sanitizer is also recommended.
• Intinction by the communicant is strongly discouraged. If communicants have a personal preference for this manner of receiving the Sacrament, it should be only the clergy, who have utilized the lavabo, who intinct the host.
• When intinction is the preferred method of receiving Communion the priest or deacon should take the wafer directly from the ciborium, not the communicant’s hand, to avoid introducing that person’s germs into the chalice.
• Silver has a mildly antimicrobial effect which is beneficial but it is not sufficient without the above-mentioned precautions.
• Receiving the Sacrament “in one kind” has always been, and continues to be, an acceptable alternative for communicants. While we promote the use of the common cup, we also want to offer this option for those who prefer it since it too has ancient precedent in our spiritual life. Indeed this entire message is designed to retain our inclusive community with its rich heritage of commonality.

The Peace

The common practice in most congregations is that members of the congregation greet each other with a handshake, or even an embrace. This is a prime opportunity for the spread of germs.

Holding Hands During the Lord’s Prayer

In some of our congregations the recitation of the Lord’s Prayer at the end of the Prayer of Consecration is an occasion when hands are held, offering yet another opportunity for the transmission of germs. It is noteworthy that this takes place after the priest has ritually cleansed his or her hands at the customary time of ablution.

The Sharing/Passing of the Consecrated Host

On special occasion in some congregations, and more commonly in others, the custom exists of passing bread (pita or otherwise) from one communicant to the next. Not only is this extremely unsanitary, it is explicitly contrary to the directions of The Book of Common Prayer.

Specific Recommendations:

In General

If the Celebrant or any of those assisting in the service feel ill, they should excuse themselves from worship that Sunday. The same holds true for members of the congregation who do not feel well; they should excuse themselves from attending Church that Sunday.

The Common Cup

We strongly recommend that all those responsible for congregational life and worship use this occasion as an opportunity to:

• re-enforce sound Eucharistic teaching, with a special focus on the unifying symbol of the chalice,
• reassure the faithful that, though mindful of this serious concern, there are options and prudent measures that are, and can be taken, to reduce the risk of infection,
• offer refresher instructions on the basics of receiving Communion (with special emphasis on guiding the cup to one’s lips by holding the base of the chalice – not by placing one’s hands on the bowl of the chalice itself). There should be special emphasis on the protocols around intinction: ideally the consecrated host should be taken directly from the ciborium by the minister administering communion, intincted and then presented to the communicant,
• review and amend altar guild procedures (especially as they have to do with ablutions and the provision of hand cleansers for the Celebrant and those administering Communion,
• review and amend instructions for the ministers of Communion especially as regards the cleansing of their own hands, the proper use of a purificator and the practice of intinction.

The Peace

This should be reviewed by each Congregation. Graceful provision should be made for those who do not wish to have direct physical contact with their fellow worshipers either because of their vulnerability to infection or their concern about their own state of health.

Holding Hands during The Lord’s Prayer

This practice should be reviewed by each congregation where it is practiced. Graceful provision should be made for those who, because the state of their own health, do not wish to have that level of physical contact with their fellow worshipers.

The Sharing/Passing of the Consecrated Host

This is a highly unsanitary practice that is theologically insipid, contrary to the Canons of the Church and therefore, contrary as well to the Book of Common Prayer. It is not a practice to be encouraged. Therefore, this is an inappropriate practice and we are asking congregations not to do it.

1 American Journal of Infection Control: Volume 26(5), October 1998 (pp 538-539) – “RISK OF INFECTIOUS DISEASE TRANSMISSION FROM A COMMON COMMUNION CUP”
2 BCP, page 407