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At my nearest church on weekend Masses the deacon or an EMHC goes out at the start of communion to distribute anyone who should not have to get up and stand in line (an organized body of ushers provides practical support for this I think). So I expect we would still need to have a thoughtful protocol for distribution if we used the altar rail since the people here who currently cannot move from a pew once they are in it will not simply cease to exist.

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This is not a problem. The ushers simply open the gates and the priest/Deacon goes out to those who need that. And people who can approach but can't kneel simply stand at the rail. An ordinary part of distribution with the rail.

The rail is not there to exclude. It's there to encourage a norm of reverential reception and to be a symbol of heaven approaching the earth. Even those who can't kneel will benefit from the norm.

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