Wednesday, 26 August 2009

Status and limitations

Have a look at this article by two medical ethicists clearly declaring that hospital chaplains should not have automatic access to every patient or ever to patient notes. I acknowledged the part of my psyche that objected: “Bah! This is just another way of keeping religion in its lowly place.” But it isn’t. We know that there are individual chaplains who feel the need to impose their religion – they’re likely to perceive it as offering a very important service to vulnerable people. Indeed, we probably know of Pagan friends who found a Christian chaplain at the end of their bed offering their services, and how inappropriate that was. That’s an abuse of power.

I remember being fairly pushy myself when it came to having Paganism recognized in hospitals and I’m grateful for the other Pagan individuals and groups who’ve also made it their responsibility. Wherever there are institutions who have a chaplaincy service and who’re likely to have Pagans amongst them then Paganism should be officially represented on the chaplaincy panel, that’s pretty straightforward. That whole debate is about status, primarily the status of Paganism, but also about the status of chaplaincy.

If this is the case then we need to think hard about what chaplaincy is about and what our role is. Chaplaincy seems to me to be about perceiving a person as unique and as part of their own ‘ecosystem’ – relationships, history, hopes and dreams, fears, desires, abilities, the whole kit and caboodle - rather than simply as their diagnosis, and serving individuals and groups so that they can find meaning and purpose for themselves. I really like this quote

Helping, fixing, and serving represent three different ways of seeing life. When you help, you see life as weak. When you fix, you see life as broken. When you serve, you see life as whole. Fixing and helping may be the work of the ego, and service the work of the soul.

Chaplains are not part of the medical team. Although spirituality has a role in wellbeing and health this doesn’t mean that chaplains have the same role as doctors, nurses and radiotherapists. This is no threat to our status: we wouldn’t expect doctors, nurses and radiotherapists to be experts in spiritual care. I know that if I read a patients notes I will form a certain set of beliefs and expectations around those written words, it’s why notes are so confidential and the writing of them always under review. ‘Witty’ shorthand such as ‘FLK’ (Funny Looking Kid) is now recognized as reducing the humanity of the individual and being unethical and unacceptable. So it is that the chaplain – and every other person who isn’t directly concerned with the symptoms and cure of the patient – has no need to know anything about them other than what they see in front of them.

I’d say that the strict adherence to limiting who has access to patient notes is a measure of the quality of care patients receive. I know a very ethical, professional complimentary therapist working in a local mental health hospital who is given access to patient notes. She doesn’t take it but it’s not too surprising that the hospital is well known for the number of patients who abscond.

Certainly, doctors have a godlike status. Nurses are, of course, angels. I’m not sure where in the heavenly hierarchy radiographers might fall but as far as pay and conditions are concerned it’s somewhere above ward cleaners and canteen workers. That’s just the way it is, that’s a matter of society deciding that junior doctors and professional football players should be paid more than experienced nurses and firefighters. Chaplains, well we’re strange altogether, with Deity as our employer and the general public feeling both that they respect us and feel weird around us. For me, that’s just a symptom of our liminality and whilst that’s not always the most comfortable place to be it’s also entirely appropriate. This is not to say that chaplains should be content to creep around being thankful to be allowed into a hospital: that’s to get status and role confused.

Paganism should be given the same status as any other religion. Pagan chaplains should be treated with the same respect that other chaplains are offered, and all chaplains should be treated with the same respect as any other member of the healthcare team. But our role is not to tell people what’s best for them. Neither is it to do things at or to a patient. Although chaplains of all faiths have a responsibility to our gods and the culture of our religions we have a greater responsibility to offer something that other people who work in healthcare cannot: we offer love. We are with patients in a unique manner; we bring the empathy of the professional psychotherapist, the communication skills of mediators, and leadership functions of senior staff. We add a thorough, boundaried and flexible knowledge and understanding of our religion and, on top of it all, the wisdom that whatever a persons religion, spirituality or atheism they are equally worthy of our attention.

High status is lovely but the role of the chaplain is not to compete, it is to Be With people who have requested spiritual input. As long as that is facilitated in a quality manner and chaplains of all faiths are treated respectfully what more do we need, and why?


Oregon Chaplain said...

Greetings from the U.S., Clare --

You might be interested in this Boston Globe article about considering Chaplains members of the medical team:

Clare Slaney said...

Thanks Oregon Chaplain. Reading the comments after the peice I was struck by the atheist person calmly saying that she just didn't want or need a chaplain and that one got in the way of that families distress. The assumption being, of course, that everyone welcomes a representative of a god.

It worries me greatly that chaplains are being invited onto ward rounds - what a dreadful blurring of boundaries and breach of confidentiality.

This will just have to play itself out. It would be good if Chaplaincy would find some principals for itself rather than be dazzled by status offered from on high. :(

Oregon Chaplain said...

Clare, how have you seen chaplains misuse health info they received at rounds? Have you ever seen that information be used in a beneficial manner?

Regarding status, your reply seems to be speaking of a presumed status in the world held by some clergy members of religions that "have all the answers" (compared to religions and spiritual paths that encourage searching). Is that what you're referring to?

Because I believe that each person can access deep wisdom her or himself -- no matter whether the language used is religious, spiritual, agnostic, or atheist -- I see my work as helping people do just that: access the wisdom and and, therefore, comfort.

My first reading of your post had me thinking in terms of a chaplain's status within the healthcare team. I don't think of chaplaincy having a higher or lower status than other members of the health team. Each discipline adds to the potential for healing.

I'm enjoying your blogs. Blessings of the Full Moon.

Clare Slaney said...

Thanks for the questions, Oregon Chaplain.

I, personally, haven’t seen chaplains misuse information received on rounds, because here chaplains have nothing to do with ward rounds. The idea seems extraordinary. In the UK religion is so much less politicised, and whilst this means that Paganism is taken less seriously in general it also means that all religion is treated with a lighter touch.

It seems to be a truth that wherever there is a way for power to be abused, some people will abuse it. As far as I know in the UK, a patient is empowered to decline a planned or unplanned visit from a chaplain and this seems entirely healthy to me. It puts the power in the hands of the most vulnerable person. This system doesn’t always work; I know of a number of cases where a Pagan patient has found a Christian chaplain at their bed and found this very unhelpful. Chaplains who do this are abusing their power.

My thoughts on status do need some clarification. Old-fashioned words like ‘pride’ and ‘conceit’ in a traditional sense seem fitting. What could I gain from learning about the state of a patients’ duodenum? If it’s decided that a patient should not be resuscitated, how can this knowledge help me help the patient? If chaplains start offering their services, whether a patient requests it or not, to people who’ve just been given serious news then we become harbingers of doom and patients begin to fear us.

I can’t see any way in which the principals of chaplaincy can be served by a sense of entitlement. For myself, I value my liminal status in the hospital, where staff treat me with a kind of bemused respect and the power to see me or not is with the patient. At times, a minute minority of individual staff have appropriated that power and I won’t pretend I that I don’t find this infuriating. But it reflects on that individuals way of being and very often serves to bring their other bad practices to light. Something that doesn’t happen when interactions are reduced to tickbox exercises, which is too often what ‘professional’ comes down to. Liminality can often be associated with authenticity, good and bad.

Thanks for the opportunity to clarify my own mind on the matter, and I welcome your thoughts and ideas on better terms than ‘status’ and ‘role’.