Wednesday, September 27, 2006

More on Catholic Order, Thanks to obadiahslope

Once again obadiahslope responded to my post on arguments from catholic order; and once again, his question brought forth a full-bore reflection and post. From his comment:

Even as you reluctantly say the last rites for "catholic order" I note that progressive bloggers on other sites still vigorously push the argument. It’s advanced for example as a reason to oppose the Kigali statement’s suggestion of a separate structure for the North American conservatives. One bishop per geographical area is an appeal to traditional catholic order, and the catholic impulse to, well, be catholic and not split the church.

Catholic order has at its heart a conviction that bishops are necessary. As an evangelical I lean towards the point of view that they may be useful but they are not necessary. With Hooker I say that they are of the "bonum esse" of the church rather than the "esse" of the church. However the appeal to remaining with those with whom we disagree, in Cantuars "solidarities not of our choosing" remains a strong argument in my view.

It seems to me that your post forms part of a recent pattern among the Episcopalian left of reassessing their views on realignment. Jim Naughton appears to be now in favour of a negotiated split in the US church.

I am surprised that it has taken the left so long to catch on. Both the left and the right may in fact flourish separate from each other. It is the people in the middle who will be distressed I suspect. However I don't expect a US split will be exported. The rest of us don't live with your culture wars, and probably do not want to.

And my response:


Thanks again for this. I always appreciate thoughtful, reflective thought, whether in agreement or not.

"Last rites for catholic order?" Let me think about that a moment.

That certainly wasn't my intent. I'm a pleni esse person myself. I think the Church can’t know what fullness is possible in this world without the historic episcopate to incarnate our sense of continuity of apostolic faith and order. However, to believe that bishops in historic succession are absolutely necessary seems unbiblical. Paul says that no one who accepts Jesus as Lord and believes he was resurrected will be lost. So, while I don't think much of congregational polity (too much risk of "every one did what was right in his own sight;" far greater than any allegations made of the Episcopal Church), I don't claim that congregationalists aren't faithful trinitarian Christians.

Again, my comment is that the arguments from and for catholic order aren't helpful. That doesn't mean that I don't think they're valid. I think a geographic diocese with one bishop is good order (I almost mistyped "god order;" wouldn't that have been in interesting Freudian slip!). I think they have the problems I reflect, but those are matters of the use of the arguments and not of the value of catholic order.

The most difficult reason that the arguments are not helpful now is that reactionaries aren't interested in them. Making those arguments in response to the Kigali statement, which I still believe isn't much interested in catholic order, isn't much more helpful than trying to debate in English in francophone Rwanda. Good order is useful within a communion, and the Kigali statement is about founding a new communion (again, whether it's the fault of reactionaries or progressives is for the moment not the point). If a new communion is established, and they're not in communion with the Episcopal Church, the Episcopal Church would have no more control over their actions than we have over the Russian Orthodox. Now, in North America there are no less than three groups arguing which group has the "purest" Russian episcopate; but the Episcopal Church has no standing to step into that argument.

Now, if there is a new communion, and some configuration of churches in North America is in communion with some group of Global South Primates, and not with the Episcopal Church (and, presumably, not with Canterbury, again considering the tone of the Kigali statement) it appears then they will care about catholic order internally (and thus some struggles I think are brewing between Network churches and Anglican Mission in America [AMiA] churches). But they will, eventually, lose their anxiety about us; and we will, eventually, lose our anxiety about them. The same thing happened regarding the dozen or so "continuing Anglican" churches that have formed and reformed since 1979. (I commend to your attention the “Not in Communion” page of Anglicans Online.)

I have come to reassess my view on the inevitability of realignment. I take them seriously who say, “We can’t continue in communion with the Episcopal Church;” and I trust their commitment to a new vision, as expressed in the Kigali statement and the Hope and Future Conference, and in other settings. I think we (the Episcopal Church, and progressives in general) should be listening to everybody, meaning listening with openness to be changed. I think we should be talking to anybody who’s interested in taking the risk of real conversation, including listening with openness to be changed. I don’t think there’s much point in talking past folks who are no longer interested in conversation. It’s not that I don’t care about them. It’s not that I wouldn’t grieve actions they might take. It’s that, ultimately, I do respect their integrity when they say they’re not interested. There will still be some issues to be resolved, largely at the local level; but that won’t prevent them from following through with their commitments. I appreciate your reference to “solidarities not of our own choosing.” That’s why I have valued the efforts of Bishop Griswold and of Archbishop Williams in pursuit of reconciliation. But, I can’t hold those, choice or no, who see no solidarity.

I have expressed in other settings a thought that perhaps the Global South could allow the Episcopal Church to be the Communion’s “research and development” arm, taking seriously Gamaliel’s warning: “So in the present case, I tell you, keep away from these men and let them alone; because if this plan or this undertaking is of human origin, it will fail; but if it is of God, you will not be able to overthrow them—in that case you may even be found fighting against God!” (Acts 5:38-39) In the venue where I suggested that I was dismissed with scant reflection. However, I still believe it is a reasonable and biblical position. And if, as it appears to me, enough folks have decided they’re no longer interested in reconciliation and are committed to their own path, we progressives and we in the Episcopal Church need to have the faith in God’s providence to take this risk ourselves.

Monday, September 25, 2006

An Alternative to Hegemony in Anglican Arguments

How did I get all the way to here? I’ll get to where here is momentarily; but there is value in the journey, and I also want to share that.

Last Tuesday I received this story from the Episcopal News Service about the redesign of the Theological Education for All website of the Episcopal Church. I found there more resources than I could get a handle on, even with my junk room mind. There are links for schools, articles, programs – all sorts of stuff for lay folk and professionals. Much it is specifically Episcopal and Anglican; but not all of it. It’s worth the time to peruse for things you can use.

From that site I linked to the site of the Anglican Theological Review. ATR is a well-established academic journal within the Episcopal Church. On the site you can read abstracts of articles past and present. You can’t access whole articles, but the abstracts are themselves helpful. The site also has an extensive Resources page.

Which is where I discovered the Journal of Anglican Studies from Australia. This is an interesting journal, offering a different perspective on things Anglican – different, at least, to what parochial Episcopalians sometimes here. The articles are intelligent, but are relatively brief, so they’re eminently readable.

And it’s where I discovered “Conversation: Abandoning the Hegemonic Model,” by Terry Brown, Bishop of Malaita of the Province of Melanesia (Journal of Anglican Studies 2006 4: 113-116). You might be able to read it online here (I found I could from my office, but not from home....).

In light of the current arguments going on in the Anglican Communion, his is an interesting perspective. He is, as he says, “writing from the ‘periphery’, a small island in the midst of a small country in the middle of the Pacific.” Surely this is a Third World setting. At the same time, “having come from a famous ‘centre’, Toronto, but having spent the last nine years on the ‘periphery’, Malaita and the Solomon Islands,” he has some awareness of the view of the world from both perspectives.

In that light, I was struck by his concern with “the fundamental weakness of what might be called the ‘hegemony model’—the power of rich and wealthy forces (whether on the political or theological ‘right’ or ‘left’) to overwhelm small local cultures and make the world into a fundamentally homogenous place.”

“Within this model, there is a ‘purity’ (a traditional culture, a particular form of church life, a language, an ethical code, a way of reading the Bible or a lifestyle, to name but a few) to be defended from a powerful and threatening hegemonic power. Whatever the issue, the model is the same, and often some form of isolation and protection from, if not defeat of the invading hegemonic power is the answer, whether that be political defeat or church excommunication.”

Part of what is striking is his hopefulness for the “small local cultures” to adapt to “hegemonic power.”

“My experience of the Solomons is that people here have (and historically have had) tremendous capacity to resist, adopt, adapt, accept and reject outside influences as they see fit, in incredibly creative ways. Traditional cultures still have tremendous powers of relationship, creativity and reconciliation, both inward and outward. Rather than cultural or religious ‘purity’ as the aim, we need to accept what I would call, ‘loving hybridity’ as the goal, as we move beyond ‘subject’ and ‘object’ to the freedom of persons and cultures to move in the directions in which they wish....

That is not to say that there is no powerful hegemonic control or powerlessness, or even a certain degree of economic determinism, but if people are healthy, if the traditional (and I would add, Christian) culture is fully alive, with good relationships and confidence, with some resources, then people can emerge with very creative ‘impure’ and ‘hybrid’ solutions. And for Christians, this movement towards life-giving creative hybridity should also be a reflection of Christ’s death and resurrection.”

He acknowledges that “Abandoning the hegemonic model (while still regarding it as useful and often even true), one is left with the disorienting experience in which what was once thought to be easily understood is no longer understood.” His response? “The only real anchor is a Christian faith and spirituality that ‘hangs a bit loose’ to any supposedly objective and definitive answer to such questions, though, of course, not descending to unreason.” And what makes it worthwhile? “Our common home in Christ, our heavenly home, partially experienced in the Eucharist and Christian koinonia, is our true goal—such that one must be prepared for disorientation and, indeed, even pleasant surprises.”

I think this is a very helpful perspective. The fact that it comes from someone with history in both the center and the periphery offers perspective that most of us lack in our parochialism. After all, much theology, like politics, is local. In addition, this offers recognition that both (local) cultural and transcultural aspects of the faith can be integral and vital. To each of us in our own “hegemonic” perspective this suggests not only that we might learn something, but that in fact we might be blessed by what we learn.

Certainly, there will be those horrified by the thought of “hybridity,” however “loving” it might be. Each of us, to the extent we are convicted of our “rightness,” will feel some need to defend it. I can hear the cries of “Syncretism!” now. The recent statement from the meeting of Global South Primates in Kigali, Rwanda, with its apparent impetus toward a narrow confessional communion, would seem particularly hostile to such “hybridity.”

At the same time, bath water does need at times to be changed; and the only true necessity is to save the baby. I would argue that in their generations the translation of the truths of the faith into the philosophical frameworks of Neoplatonism and then to Aristotelianism reflected such hybridity. This is implicit for Anglicans in our conviction that people should hear the faith “in a tongue...understanded of the people.” And clearly, if we are to truly embrace a “listening process,” one in which any and all of us are open to and might experience change, this is meaningful. How can I be said to have listened if I am not willing to risk being affected by what I hear?

Americans, including American Anglicans/Episcopalians, can be so very parochial in our opinions. International conversations certainly help expand our horizons, but especially in proportion to our ability to hear voices that really differ from us. Bishop Brown’s suggestion that we return to “conversation” with a new model, challenging our “hegemonic” perspectives and holding up the possibility that “hybridity” can be loving and faithful, and can reflect growth, is refreshing. We will still argue about what in the faith constitutes the baby to be saved. However, perhaps we might do so in an environment of hope, and not in one of defense and doubt and fear.

Friday, September 22, 2006

Catholic Order, Impaired Communion, and Anglican Boundaries

I was reading Fr. Jake Stops the World, specifically his post on the provincial boundary violations of Bishop Frank Lyons of the diocese of Bolivia in the Province of the Southern Cone. I responded, and, among my comments, linked back to my post, “The Church, the Whole Church, and Nothing but the Church.” There I received this comment from obadiahslope, who frequently comments on blogs I read frequently. obadiahslope and I have some points of disagreement, but I always find his comments thoughtful and civil, and usually I find them helpful. He wrote,

When you speak of churches in the anglican communion no longer recognising each other's orders it is a measure of what we have lost. If we accept that TEC or any other province no longer makes a bishop for the "whole" church, then we are acknowledging that we are in some form of impaired communion, surely? One of the stronger liberal arguments has been an appeal to catholic order in my view.

And here is my response:

obadiah, thanks for your comment.

I had been working on a well-thought out response. However, it seems events have superseded the question. The communique from the Global South Primates, meeting in Kigali, Rwanda, and the letter from the meeting in Texas of self-defined “Windsor-compliant” bishops reflect something about “catholic order.”

Let me begin by answering your post specifically in one respect: certainly, we are in some sense in “impaired communion” between various elements of the church catholic. However, this hardly began with the discussions of the last generation within the Anglican Communion (that is, including issues regarding GLBT persons, but beginning with issues regarding women). This sort of “impaired communion” dates to the 11th Century, when the Roman West excommunicated the Byzantine East. It dates earlier to when the orthodox catholic church of the Roman Empire excommunicated the Oriental Orthodox churches; and they proceeded to excommunicate the ancient Church of the East (called Nestorian). All those bodies recognized that the folks excommunicated had, in some sense, the historic episcopate; and even some language that reflected the Creeds (the content of which was received and accepted by the Church of the East in the 6th Century); but couldn’t agree on the interpretation of the content of the faith. We can speculate what it might have meant if the Roman West and Byzantine East had been able to agree to creedal language of the Spirit that “proceeds from the Father through the Son.” There are scholars who suggest that might have been possible. But these churches, each with imperial structure and imperial perspective, if not always connected with an actual empire, couldn’t find that middle ground; and remain divided over the filioque clause to this day.

I don't know that the arguments about catholic order have, in the end, been all that helpful.

  1. I think they support some expectations that themselves ignore our current
    fallenness; for example, that we have some responsibility beyond our own
    choosing to members of the Body that don't recognize us at all (Rome or Moscow, for example) or that we have almost forgotten exist (notwithstanding some recent valuable ecumenical discussions at the Communion level, I doubt most Anglicans/Episcopalians think at all about the Oriental Orthodox churches).
  2. It allows the creation of a hierarchy of one set of ecumenical relations (Rome and Moscow, again) over others that have been recognized has also reflecting catholic order (Utrecht, and Lutheran agreements that are functionally now virtually Communion-wide).
  3. Finally, it makes the issue of "what affects all should be decided by all" seem very one-sided; for example, what should be the appropriate response to the recent agreed paper on Mary? Should the argument for catholic order suggest moving closer to Rome (as the Traditional Anglican Communion seems to desire) and thus accept their definitions? Or, should it move us to argue that by accepting as dogma statements not explicitly grounded in Scripture the Romans have left catholic order? More immediately, if the need for a “listening process” not only affects all but has been decided by all (as the frequently forgotten clause of Lambeth 1998 1.10), what is Nigeria’s responsibility to the communion for the church’s articulated support for laws to deny civil rights not only to GLBT folks, but also to anyone who wishes to discuss their concerns.
  4. Most important, it quickly gets bogged down into the chicken-and-egg argument about who's responsible for breaking catholic order. If churches walk apart, who actually made a turn and when? I will acknowledge I have an opinion on that; but my point here is that we do argue about the question, without really addressing one another.

The Kigali statement has no respect for catholic order, or respects only as a secondary value. Its intent, expressed in the paragraph on an Anglican Covenant and in the paragraph on theological education and shared catechisms, is a communion built around a common confession, with no particular concern for historic episcopate per se. The Texas statement is ambiguous on catholic order. While being “committed to the conciliar character of our Communion,” they distance themselves from actions of their own council, the General Convention. They state, “We recognize the need of some among us for an alternative primatial relationship. This recognition does not weaken our fundamental theological and ecclesial commitments,” without clarifying at all what those fundamental theological and ecclesial commitments might be, much less how those commitments can sustain blurring provincial responsibilities. One denies explicitly and another questions whether an Episcopal bishop can be respected by the whole church, based solely on catholic order or the historic episcopate.

We can find arguments for catholic order attractive; but they presume a level of mutual respect that hasn’t been enforceable by law since the empires fell, and haven’t been respected in 1,000 years. Where churches were tied to cohesive, homogeneous national or cultural groups, it was easy to rely on catholic order. Where those groups overlapped or came into conflict, that respect broke down. Consider, for example, the history of Poland, and the struggles between Rome and Moscow; or of the Balkans, and the struggles between Rome and Constantinople.

Arguments based on catholic order and respect for the historic episcopate as the sign of unity are attractive, but only useful as long as all parties respect catholic order and the historic episcopate. When that respect fails, and especially when it fails among primatial and metropolitan bishops, discussions fail for lack of common terms. That is communion at least impaired, and functionally broken. In one sense, at least in America, and, really, throughout the English-speaking world, we’re long used to that. What Anglican diocese doesn’t overlap with a corresponding Roman diocese, or “continuing “Anglican” diocese? With the first, and even largely with the second, we don’t argue about historic episcopate and catholic order (although we will argue about what is specific to Anglican orders). Communion between Anglicans and Baptists, those children of the Separatist movement, has been broken for generations. Remember that the 17th Century Puritans and Separatists were Anglicans. They also wanted to establish in the new colonies a better church in the Anglican tradition. The biggest difference between the Separatists of the 17th Century and those of the 21st is some continuing commitment among the latter to the historic episcopate. In the loss of respect for catholic order, regarding those with whom they disagree they are largely the same.

So, no, I don’t know that arguments from catholic order are all that helpful. These new developments will only highlight that. The unity of the Body of Christ, which we believe we will know when we see the Kingdom in fullness, is traced with myriad cracks and crevices. Where we fail to see our unity will be found in Christ, and not in shared structures or agreed interpretations of the faith, communion fails; and appeals to catholic order will not prevail.

Tuesday, September 19, 2006

Of Water and the Holy Spirit and Walking the Halls

I spent my afternoon yesterday blessing the hospital.

That's not a self-congratulatory reflection on my work generally. It's a very specific statement: I devoted most of the afternoon walking the halls, in alb and stole, stopping at intervals for prayer, and sprinkling holy water everywhere. Modeled on a house blessing, it's my service for blessing the whole hospital.

It's become something of a tradition. Blessing space was a part of our "received tradition" from the original hospital of our system. The hospital was blessed this way before the doors were opened to patients, and as space has been added or revised, it's been blessed again. But I've also made it a practice to bless the whole hospital at least once a year.

But yesterday was a different facet of the tradition. It has also become tradition to re-bless the hospital before a visit from a survey team, whether from a state health department, or the Joint Commission for the Accreditation of Healthcare Organizations, or a group assessing corporate quality. This last was the occasion for the service yesterday.

If you've read much of this site, you'll know that I'm an Episcopal priest in an Episcopal institution. As an Episcopal practice, this reflects more specifically the Anglo-Catholic, "high church" pole of the Episcopal tradition. Still, it's well within the bounds of the tradition. Indeed, since the implementation of the 1979 Book of Common Prayer and the subsequent revision of the Book of Occasional Services, house blessings specifically, and this form generally, have become more popular.

Certainly, the blessings are popular here. Staff members don't commonly see me in my vestments in their units and offices, and so they take note when they do. For most of our staff, blessing with holy water isn't part of their background. But almost all of them recognize it as prayer to bless the space and the people in it. One result is that folks who would never experience this in their own faith communities take great delight in it. At almost every unit or department someone will say, "Give me some extra, Chaplain. I really need it today!" And I'm happy to oblige. Some are surprised when they get their own individual sprinkle; but they're always pleased.

And many are pleased to see me in places that I don't visit as often. Everybody understands that I spend most of my time on patient units. At the same time, they're happy to see me blessing the boiler room or the lab or the accounting office. Folks in Surgery have the best show: they get to watch me cram my vestments into the disposable coveralls we call a "bunny suit" so that I can go into the sterile zone to bless the operating rooms themselves.

Now, this is not a rigid liturgy. I’m not so very formal about it. Staff people are busy. That would make it hard to assemble a formal procession at all, or even to assemble an ad hoc congregation on each unit. But I also make use of the informality to make stops along the way. It’s a good chance to stop with employees in the midst of things, catching up on personal and family issues. I can’t say I know what’s happening with every “member” of my “congregation;” but then, what pastor does? What I can do is stop with those whose concerns I do know. Since I’m in their space, in places I don’t visit as often, they’re frequently ready to talk, to catch me up on the issues in their lives. And I don’t think the vestments hurt.

The rite has a lot of support from the administration. For one thing, we have a solid record in our short history as a hospital of successful surveys. Now, I don’t want to make claims that make the rite somehow magical. The blessing is entirely a work of the Holy Spirit, and what God does, God does. We work hard as a team to be ready for these surveys, to offer quality work always and to put our best foot forward. But people appreciate the sense of support. And the administration appreciates the way it supports community and morale.

And it is good for morale. Every institution needs rituals for a sense of community, and this is one of ours. People appreciate both the good will of the rite, and also the relaxed and joyful attitude I seek in the process. In any case, the sense of success is palpable. As a former CEO said, “It’s not part of my tradition, and I don’t claim to understand it; but it sure seems to work.”

It’s a lot of walking to bless the entire hospital. It’s also a lot of fun for me. In an institution that claims to be faith-based, and in fact to be Episcopal, it is an act from the Episcopal tradition that seems to be comprehensible at some level to all our people. It expresses a level of good will and of faith both in the presence of God and in the value of the people we bless. Yesterday, I blessed the hospital. Today we had a good survey visit. I don’t claim that I always understand it myself; but it sure seems to work.

Friday, September 15, 2006

Chaplains and Volunteers and Maintenance

In the last post I reflected on the feedback from my colleague, Chaplain Melvin Ray of Greenville, Texas. I responded to his concern about my suggestion that we see chaplains as “advanced practice ministers.” To sum up briefly, I thought his language seemed to separate the practice of ministry in health care institutions from ministry in general, and from our connections and commitments to our faith communities. I say “his language” because I don’t believe he really intended that result.

That said, let me reflect on the end of his message.

“Ill informed administrators, nurses, and physicians (and other health care providers) can not be blamed for misperceptions about our part in the healing art. Yes, volunteer ministers can minister to those believers who desire such help; let the “Pink Ladies” coordinate this. Chaplaincy is a documented clinical intervention accomplished by a highly trained, certified, and well paid health care professional. Chaplaincy should not be entrusted to volunteers.”

I have already reflected here on the difficulty of the label “volunteer,” and how unpaid staff may well have training to provide quality professional pastoral care. Chaplain Ray has been clear on what he’s talking about: “a documented clinical intervention accomplished by a highly trained, certified, and well paid health care professional.” Again, I don’t want to dwell on the issue of “paid.” My colleague who has a board certified chaplain prepared to work unpaid wouldn’t want to refuse the care available on that account; and too many colleagues who are paid would suggest they aren’t “well paid.” No, we’re clear together that his concern is with the interventions of a professional seen as a member of the clinical team with sufficient status to be included in the medical record.

Now, this is a topic on which there can be a good deal of discussion. First and foremost, what are the interventions of chaplain? Certainly they include pastoral presence. They include pastoral listening to patients and/or family members – or active or therapeutic or reflective listening or whatever title for this care is familiar. They include providing appropriate support at bedside for religious practice, whether by providing appropriate rites or scripture or making an appropriate referral. They include theological or “Godly” conversation, pastoral counseling, appreciation of cultural differences, ethical consultation, and sometimes confrontation. They certainly include prayer. Colleagues may offer other answers, although in my experience most would connect with one of these categories.

But just which of those interventions can’t be offered by someone with even minimal training? These interventions are offered frequently by folks other than chaplains: clergy, certainly; but also by family and friends, and by well-meaning strangers. Indeed, in the bedside work of the chaplain I would never want to underestimate the importance of simple presence. I have written before of the experience in which I learned most profoundly the power and importance of sacramental presence. A person with good sense and sensitivity, and some basic instruction in how to “do no harm” spiritually can in fact do some real, tangible good. Families do it all the time; and my reaction is to call them to see the ministry they are offering to those closest to them.

The problem is that each of these interventions can also be misused. I sometimes say that common sense seems an uncommon commodity, and I could say the same thing of good sense and sensitivity. We appreciate that saying that, “If one’s only tool is a hammer, soon every problem begins to look like a nail.” By the same token, we have all known instances where someone comes with good will and a good tool, and no sense or sensitivity. The person who can only pray to expect a miracle for the patient who is diagnosed as brain dead (and, yes, I have witnessed such a thing) only sets up both God and the family for failure. The person whose commitment to her own faith is so fragile and insecure that she cannot respect the faith of another projects rejection and not compassion. The person whose own unrecognized fear is such that he cannot hear the fear of another, cannot walk with person in that, leaves the patient feeling more alone and not less. My colleagues in congregations have been heard to jest that in the structures of the Kingdom they’re in sales. Mine is to say that I’m in maintenance, especially for all the time I’ve spent repairing the harm done by well-meaning and misguided pastoral care. “If one’s only tool is a hammer….”

What distinguishes the trained clinical chaplain is awareness of a wide variety of tools, and the self-awareness and awareness of context to know when and how to use them to best effect. Academic information is part of that: I can provide broader, more appropriate care if I know about traditions other than my own. However, the examined and reflected experience that is the heart of clinical training is also important. It is in that crucible that we learn about our own limitations, and about the limitations of each tool in our toolbox. It is in that process of learning by hearing and by being heard that we gain skill and wisdom to apply the right intervention in the right situation – at our best, as deftly as a paintbrush, and not as bluntly as a sledgehammer. And while charism and vocation are important, they can only take us so far. Any of us with practice can become better listeners, better prayers – better chaplains. It is because we and our predecessors have shown that wisdom and skill that we have a place on the team and in the medical record; and not for the “intrinsic value” of any of those interventions.

But if that is so, that work is too important to leave to “Pink Ladies,” even when the volunteers are visiting like-minded people. (Others will, I’m sure, call into question the identification of “Pink Ladies” here as at best anachronistic, and at worst dismissive and demeaning. I have the highest respect for the many valuable services offered by lay volunteers in many areas of hospital function.) If we are the professionals, with the academic and clinical education and the professional experience to use those tools appropriately, then we are also those with responsibility to supervise those ministries in our institutions. A CPE student could learn a lot about therapeutic listening from a social worker; but he or she could not learn about pastoral presence and listening with a chaplain’s perspective. So we must take responsibility in our institutions not just for what we do at the bedside, but also for oversight of what others might do. That’s not an exact statement. Certainly, we’re not called to interfere in established family or pastoral relationships (although even in the latter case there may be times to step in) precisely because those relationships are established and are not institutional. But if it’s going to be done representing our institutions we should take responsibility as the persons most able to respond. I have suggested that other professions find ways to delegate some of their functions; but they would never delegate supervision of those functions. Indeed, for licensed practitioners those responsibilities are in state regulations: physician assistants must be supervised by physicians and certified nurse aids must be supervised by nurses. So for our work: whether the extenders are volunteers or students, it is for us to establish the standards and to provide the supervision to see that the care is offered so as to benefit the patient. We risk harming patients, and certainly we harm our profession, if we delegate that to others.

Now, I know that we don’t have the opportunity in all institutions. There are many places that don’t understand the value for patients and for the institution of having a certified chaplain who can oversee an institution’s program. But if we establish that as the norm where we can, it will have an effect on the industry as a whole. Even those institutions that will only work with volunteers will recognize the importance of volunteers who show that good sense and sensitivity. They will set expectations and provide training and work only with those who can at least do no harm, and who may well provide care that well serves the patient. Even when we cannot act, we can model the importance of good care, and not simply well-meaning but insensitive care; and the institutions that cannot pay for us will still want to follow our example.

So, if the issue is the quality of pastoral care and support that a patient and family receive, than the question is not at bottom whether the caregiver is paid, but whether the caregiver is carefully selected and adequately trained. Would I like to see a board certified chaplain in every inpatient and residential health care setting? Certainly I would. That would not end the need in many cases to extend our ministries with students and volunteers. It would, however, provide those students and volunteers with supervision and guidance so as to provide those institutions and the patients, families, and staff within them with effective, compassionate, quality pastoral care.

Wednesday, September 13, 2006

The Both/And of Health Care Chaplaincy

I have received another comment in reaction to my article published at PlainViews on volunteers in chaplaincy. Melvin Ray is Director of Pastoral Care for the Hunt Memorial Hospital District in Greenville, Texas. He has clearly read my article, and has strong feelings about my suggestion that chaplains, or at least certified chaplains, are “advance practice ministers.” (You can read his response in full, along with other responses, here.) He writes:

The suggestion is that we think of (and establish) ourselves as “advance practice” ministers/clergy who are extensions of local congregations, and extend our ministry through volunteers.
With due respect to my colleague, I strongly disagree, and offer another view.

It is to the detriment of our discipline when we promote our priority function as advanced religious ministers, as opposed to health care providers whose clinical, medical education and practice finds normal expression in the health care field. Our primary utilization and training is focused on a patient, not a believer (or non-believer). The inability of organized professional chaplaincy to gain full recognition in the health care context is only impeded by resistance to conceive, comprehend, and cast our role in correlation to other disciplines with which we function.

Ill informed administrators, nurses, and physicians (and other health care providers) can not be blamed for misperceptions about our part in the healing art. Yes, volunteer ministers can minister to those believers who desire such help; let the “Pink Ladies” coordinate this. Chaplaincy is a documented clinical intervention accomplished by a highly trained, certified, and well paid health care professional. Chaplaincy should not be entrusted to volunteers.

Melvin does, I think, misunderstand me specifically on one small point. While I believe we can think of ourselves as “advance practice ministers” within the context of ministry, I do not think that makes us “extensions of local congregations.” Rather, within the context of “ministry” broadly understood ours is an “advance practice.”

Let me reflect, though, on his general point. I must say that I have heard comments like Melvin's before. We have asserted that we have a place on the health care team, and many times over the years we've had to fight for it. The model for "a professional" in health care has been the physician, and all the professions practicing in health care, spiritual care included, have embraced such characteristics as advanced degrees, clinical education, continuing education, and peer review. It's no accident that those are significant measures for certification in all the major chaplaincy certifying organizations. Our colleagues at the bedside, and throughout our institutions, are taking the same steps. We’re conscious of that among nurses, but it is just as prevalent among administrators and human resources personnel. We claim our place as professionals in the culture of health care, and these marks of further education and specialization are part of how we fulfill it, and part of how we defend it.

At the same time, that doesn’t take us out of the context or the practice of ministry. I would, of course, disagree that our training and practice are "medical," despite training and experience in "medical" settings. The Master of Divinity degree and clinical pastoral education, the sine qua nons of our practice are still training in ministry. We no more cease to be ministers when we practice in the health care setting than physicians cease to be physicians when they become administrators. School nurses may find their careers in schools and even provide some instruction, but it doesn't make them teachers. The same is true of seminary faculty: their practice may be academic, but they continue to be ministers, ordained or lay.

This is no small point to those same certifying bodies I referred to earlier. In addition to the clinical skills we are expected to demonstrate in that process, we are also required to demonstrate “religious competency,” rooted in specific traditions. The category for that credential is “ecclesiastical endorsement,” and the intent in requiring it is to have someone independent of the certifying body, someone who is qualified to speak to competency within a specific tradition, verify that chaplains bring that “religious competence” to our work in the health care setting. That is not to pigeonhole us into addressing only those with whom we share a similar theological language. It is to acknowledge that we practice and enable ministry in the health care setting, rather than practicing social work or nursing or pharmacy. And we are expected to maintain that endorsement: loss of endorsement results in loss of certification. This will only become more important if, as has been suggested, many certifying groups move to periodic recertification.

I will state again that the normative faith experience of the believer is in the context of the local worshipping community. I also recognize that the local worshipping community is not the context for our practice as chaplains. Although there may be individual decisions to try to work in both contexts, it is not required for our profession, for our ministry; and so I would not say we are “an extension of the local church.” Those are indeed differences that make a difference. However, that doesn’t change our practice from ministry to some sort of generic “health care.” Rather, we are those who provide and supervise ministry in the context of health care. The additional education and training that we pursue for that ministry are part, I believe, of what makes ours an “advanced practice.”

In my own faith community, the Episcopal Church, I have often been heard to make this point. It is important that we participate in our institutions and in our professional organizations. It is also important that we continue to function in our faith communities. As my colleagues have often heard me say, “We need to be visible both as the Episcopalians among the chaplains, and also as the chaplains among the Episcopalians.”

Now, there will certainly be misconceptions on the part of colleagues in health care. Their assumptions will necessarily be shaped by their experiences of ministers in their own, individual normative contexts, good, bad, or indifferent. I agree with Melvin that “Ill informed administrators, nurses, and physicians (and other health care providers) can not be blamed for misperceptions about our part in the healing art.” I believe he would agree with me that educating them beyond those misperceptions is part of our professional practice. In the last century, when health care was primarily directed by physicians, nurses and pharmacists also fought the same battles. (Who directs health care now can be the topic of another post.) I would simply say that they are not wrong to see us as ministers. They are wrong to see us as those ministers with those skills (or lack of them) in those settings.

Now, my expectation is that my colleague Melvin does not really disagree with me on this. He is simply affirming the important differences between chaplaincy and congregational work, even in its pastoral practice. He is also holding up the importance for us as chaplains, and for our professional organizations, to continue to uphold the value of our practice in health care as health care professionals. There is still much work to be done, both in our health care institutions and in our faith groups, to educate about those differences. Still, this is not an either/or proposition. I think it is a both/and situation: we are health care providers, providing, specifically, pastoral ministry to patients, families, and staff; and we are ministers, rooted in our faith communities and extending the concerns of those communities into the world of health care. We lose something of ourselves when we have to fight so hard to claim the former that we lose touch with the latter.

Next post on volunteers: what this, then, has to do more directly with volunteers in chaplaincy.

Monday, September 11, 2006

Day(s) of Remembrance

On occasion I write and share with the staff here at my hospital, a "Word From the Chaplain." These are reflections that seem appropriate to the day or season; and this seemed a very appropriate day for such a reflection. Since, as always, I speak to issues of health care and especially of the care we provide, and to the faith basis of this Episcopal health system, I thought I would also share it here. I hope you find it interesting.

A Word From the Chaplain
September 11, 2006

Today is a day of remembrance. All around us memories are being shared of September 11, 2001, on that day when 3,000 died: where we were, what we were doing, what we expected, what we feared. I was here that day, and I remember that morning, running in and out of the doctor’s lounge to watch, stunned, the televised images of horror. I remember those members of our staff who had someone they believed might be in harm’s way, and how their colleagues picked them up and carried their work, so that they could go home to be with family and wait for news. I remember – but, then, no words can fully convey one person’s experience, much less the many individual perspectives of this shared tragedy.

This remembrance has followed on the heels of another. We have hardly caught our breath from remembering the catastrophe that was Hurricane Katrina, only a year ago beginning on August 29. We watched, stunned once again, the destruction of wind and rain and flood on the Gulf Coast in those days when perhaps 1,800 died. Together we breathed deep in relief when the hurricane passed, thinking the toll was not so great; only to be overwhelmed ourselves, like the levees of New Orleans, when we realized it was not the wind before the storm but the water behind it that would bring the horror. We shuddered again when in less than a month the same coast was struck by Hurricane Rita, taking another 120 lives.

I noted this morning, too, that this followed yet another day of remembrance. Most of you will recall that each year I remember and remark on September 9, when the Episcopal Church and other churches remember those who gave their lives caring for the victims of the 1878 yellow fever epidemic in Memphis, Tennessee, in that summer when 5,000 died. I have written before that I believe we have some fellowship with those Martyrs of Memphis, Episcopalians and other Christians, Jews and others who were not Christian, who gave their lives in their determination to stay and care for others.

Perhaps it seems unexpected to connect these diverse events. They seem so different in cause. What strikes me is how much they have in common. In all three cases death was unexpected and beyond control. It came from the very air. All three involved mass evacuations that for many came too late. And all three affected those who experienced them in ways that shaped generations to come – we know at least that Memphis did, and that we can certainly expect the terrorist attacks of 2001 and the hurricanes of 2005 to do the same.

And all three were marked by those who were willing to come and serve those devastated, even at great risk to themselves. It is for that very service that we remember the Martyrs of Memphis, whom I recall every year as those who gave their lives specifically in providing health care. We know of the many who gave their lives five years ago today, and so many who risked their lives and health that day and for days after. I have visited St. Paul’s Chapel, the Episcopal chapel almost under the World Trade Center towers that miraculously remained after the attack, and that became the center for service to the many police officers, fire fighters, health care providers, clergy, and other volunteers who came to serve at Ground Zero in the days and weeks and months that followed. We have also seen the many professionals and volunteers who reached the Gulf Coast only days after the hurricane, providing rescue and health care and basic needs of living. Indeed, I imagine all of us participated in our own ways to give care or to support care in the aftermath of 9/11 and in the continuing consequences of the Gulf Coast hurricanes.

Too, we have been aware that it is specifically in health care that we recognize how this comes home to us. I recall in the year after the terrorist attacks how we prepared here, with others around the country, for the possibility of weaponized anthrax or of a resurrection of smallpox. Each mass casualty drill since has been based on the possibility of a chemical or biological exposure that might be a terrorist attack – until, that is, this year when we practiced for an earthquake, a disaster as natural and pervasive as a hurricane. We have thought about how we would be at risk giving care, and how those we love might be at risk, whether through disaster at home, or through service abroad. We know that these events, however far away they may seem, have touched us.

I have spoken before of my sense that we have some fellowship when we give and support care with all those others who have also given and supported care. In the Episcopal Church and other Christian communities we speak of “the communion of saints;” but I believe all faith communities and cultures have some language to describe that association with colleagues now and with colleagues who have gone before. In our work here at [our hospital] we share in common cause and common commitment to service with those who have served elsewhere, caring for those sick and injured and devastated by massive disasters, however they occurred.

We speak here of being part of a “faith-based” System, connected with the Episcopal Church. I feel strongly that if being “faith-based” means anything, it means that we see our service in this context: that in the care we provide day to day we share in fellowship with all those who serve and have served, whatever their beliefs, whether more than a century ago in Memphis; or five years ago in New York or Washington or Pennsylvania; or a year ago all along the Gulf Coast. Our daily work, so often taken for granted, shares in the nobility and the value of those acts of grace and heroism, however far away or long ago. To me, that work – your work – in that context is why [our hospital] specifically, and [our system] as a whole, can be “the best place to give care, the best place to get care.”

Saturday, September 09, 2006

Anecdotal Evidence

The headline stood out for me at the bottom of the front page of Friday’s paper: “Severely injured brain still shows responses.” My initial response was, “Oh, [expletive deleted].”

The story is interesting, of course, and pertinent to my practice and experience as a hospital chaplain. You can read it here or here, or any number of other places. A woman in England suffered a traumatic injury to her brain. After five months in a coma she made a transition to a persistent vegetative state. I note “made a transition” because there is a difference between coma and a persistent vegetative state. When examined at the bedside, the patient’s responses to stimuli were consistent with persistent vegetative state. However, when doctors put her through functional magnetic resonance imaging tests (fMRI), her brain showed some response to sounds, and from the evidence it appeared she was responding to specific words. The areas of her brain that responded were those that we would expect to respond in a conscious, thinking person. The suggested interpretation is obvious: that she still had come ability both to hear and to comprehend words and ideas – that perhaps she had some capacity to think. In her case – I emphasize, in her specific case – the bedside examination didn’t give enough information about the function of her brain. Since then it is reported that she has shown some further change, including possible physical responses that could be seen at the bedside, suggesting that she is changing again from a persistent vegetative state to a minimally conscious state.

My initial response was not out of any disappointment for this specific patient or her family. Nor was I concerned about whether or not this was a miracle. I’ve been a chaplain a long time. I believe in miracles, and I think I’ve seen more than my share. Most important, I am not opposed to hope.

However, this person’s individual change, miraculous as it appears, will complicate decisions for many patients and families. Families have difficulty understanding the differences between “coma,” “persistent vegetative state,” “minimally conscious state,” and “brain death.” Indeed, since medicine is as much art as science, individual physicians will differ on diagnosis, based on the available evidence. At the same time, physicians will not disagree that these are specific technical diagnoses, with different characteristics, and, most important, different probably outcomes.

Physicians, too, have awareness of different types of injuries to brains. There are many stories in the literature of people who have recovered from traumatic injuries to the brain. Much more rare are stories of meaningful recovery for patients whose brains went without oxygen for any period of time. The same is true when there have been significant swelling of the brain, or significant atrophy of the brain (loss of brain tissue and mass).

That’s where things get complicated for families. There are cases – rare cases – of patients in comas, even for long periods of time, returning to consciousness and to some level of function. I have not seen nor heard of cases of recovery from brain death. I have certainly had families ask me about coma in patients who are brain dead. I have had to tell a number the same thing: “I believe in miracles. I have seen miracles, and I don’t say there’s anything that God can’t do. I have never seen nor heard of anyone coming back from this.”

Families will want reason to hope. Physicians can give “best medical advice,” basing that on their own experience and on their reading of the medical literature. But families will want reason to hope. Comparisons of this case with the case of Theresa Schiavo have already been made. In fact medically the cases are quite distinct, and the physicians in England have said so. But the image of her parents, holding out for years, against the evidence and against “best medical advice,” will haunt many. Requests for additional tests, and especially for this test, will probably increase. That’s not altogether a bad thing, but it is not likely to change things in many cases.

Should this be news? After all, this is not the result of medical study. It is an individual case. It is anecdotal evidence, if documented better than usual. Who benefits from mass media attention to this? The media outlets, of course: this fits well the adage, “If it bleeds it leads.” But the effect I fear on families and on health care providers will not be a benefit. Patients who are not like this patient will go through tests that tell us nothing new, and that only delay a family in making difficult decisions and entering into grief. Physicians will feel pressed to offer tests that do not benefit the patient, and that add to the family’s expense. This will get attention, but will not change the course of care, or the outcome, for most patients.

And as one whose job includes walking with patients through those difficult decisions, down that path of grief, it will complicate my job. If nothing else, it will add sadness: my own sadness and the sadness of other caregivers as we watch families struggle and delay and hope against hope. And it will add to the sadness of those families, because in the end their loved one is not in a situation at similar to this English woman’s. We will do our best to educate those families, to tell them what we see, to tell them what is our experience and what is in the medical literature. But in the end patients who are already with God, who are simply being held while families struggle, will remain suspended, lost to their families but not gone; not beyond our care, but ultimately beyond our help.

May God bless the woman and her family, and those who care for her. May God bless those few patients whose situations may be sufficiently similar that fMRI can show change. And may God bless the many who will be caught up in hope and delay, wishing that the situation were sufficiently similar when it is not; and all of us who will care for them. These last, I fear, will be by far the majority.

Sunday, September 03, 2006

WIll You Walk Away? (Page 2)

Tonight, thanks to Thinking Anglicans, we learn of this petition to be presented by the Society for the Propagation of Reformed Evangelical Anglican Doctrine (SPREAD – quite a good acronym, as acronyms go) to the Third Global Anglican South to South Leadership Team and Primates Advisory Group. Since this is presented by Bishop Rucyahana, a bishop in Rwanda, and the Primates meet in September in Kigali, Rwanda, perhaps they intend to present it there.

I have skimmed the document, and its intent seems clear. This is a call for a clear break between folks of the Anglican Communion who are more biblically literalist and those whom the petitioners believe are not sufficiently literalist. Since I haven’t read it detail, I’m not going to look for holes in their argument, although I imagine some will find holes, especially questioning just how much biblical literalism is really representative of the Anglican Tradition.

Rather, I am interested in the fact that this document calls for a clear break between a group they call “Anglican,” best represented by Peter Akinola of Nigeria; and two groups, called "Revisionist" and represented by Rowan Williams of Canterbury (and extensively by Frank Griswold of the Episcopal Church) and "Traditionalists/Pragmatists," represented, interestingly enough, by George Carey, retired of Canterbury. The point of the break is whether each group believes “the Church is subordinate to Scripture’s supreme authority.” Revisionists purportedly don’t; and Traditionalists/Pragmatists don’t, or don’t enough.

I have suggested in other venues my thought that both Rowan Williams and Frank Griswold really believe that some form of reconciliation is possible, whatever we might mean by “the highest level of communion possible;” and that that possibility is maintained best by keeping everybody “at the table,” as the phrase has been. I have also suggested that this has another possible consequence: that if reconciliation is not possible, whoever breaks the Anglican Communion, it won’t be us. Yes, the Episcopal Church and the Anglican Church of Canada took steps; but others reacted out of proportion. Yes, Canterbury has seemed to vacillate, or at least to condemn no one; and others couldn’t wait to condemn. But, we’re not the ones who broke the Communion. We can’t be: we’re still at the table, hoping they'll listen. The moral high ground of being the last folks still seeking reconciliation may not be as good as accomplishing reconciliation; but it’s still better than actually turning away. (WHen I was more hopeful I reflected on just this question.)

And this document actually calls for some to turn away, to walk apart. It is a petition: it seeks a new Communion, holding to what it considers true (Reformed Evangelical) Anglican teaching. It asks Archbishop to take up the mantle and lead. It explicitly calls for action now, not waiting for Lambeth or an Anglican Covenant (as understood in the Windsor Document, where it was intended to maintain, once again, “the highest level of communion possible” among existing provinces of the existing Communion) or any alternative primatial or episcopal oversight. (Indeed, they have particular concerns about alternative oversight as “a two-edged sword.”)

This is clear. This calls for decision and decisive action. I will give the authors credit for that. I don’t question that they think they know what they’re saying, or that they mean what they say. I can’t go with them (in any sense of that phrase), but I respect their clarity Many have called for clarity before, especially in the last General Convention. I have always felt the call for clarity was tactical, intended to establish good reasons for breaking the Communion and the Episcopal Church. This document is strategic: “we can’t live with them anymore, and our vision and intent are to walk away. Please lead us where we want to go.”

How this is heard will indeed bring a great deal of clarity It will, first and foremost, put Archbishop Akinola on the spot: will he lead, or will he stall, and risk being marginalized as a leader in the new Communion? If someone leads, who will follow? Certainly, Anglican Mission in America (AMiA) wants this: one of the authors is one of their first bishops. But, which of the Primates will follow? And how will those provinces, those primates, that don’t want to follow react? After all, if they’re not “Anglicans” by the definitions of this documents, they are either heretical “Revisionists” or quisling “Traditionalists/Pragmatists.” This will certainly put Archbishop Williams on the spot, for entirely different reasons. How will he lead in the face of this confrontation? And what if no one leads in either direction?

Unfortunately (I do truly believe it is unfortunate), I do imagine someone will lead, whether Archbishop Akinola or another. I believe that timing this petition to coincide with the meeting of the Primates in Kigali, Rwanda, is intended to incite the walkout, to create the break. This may be the moment when some say, “The highest level of communion possible is no communion at all, and we see no point in staying any longer.” This may be the impetus for some to actually, definitively walk out the door.

And if so many will get what they want. Those who don’t want to live in or with the Episcopal Church and the Anglican Church of Canada (and any church that doesn’t want to anathematize them) will have the break and the leadership they desire. Those at the other pole of the argument, who don’t want to live with the first group, will feel the freedom to follow where they believe the Holy Spirit is leading without having to wait for the slowest to catch up. Those in the middle, whether “mushy” or “fluid,” will see the possibility that the fighting will stop and we can get on with muddling through, being the best and most compassionate Christians we can.

Maybe everybody will get what he wants – well, maybe everybody except Christ.

Friday, September 01, 2006

Volunteers in Chaplaincy: Doing What?

I ended my last reflection on volunteers with the question, “So, what can volunteers do?” For those of us who do call for a high level of quality of care for patients in health care institutions, that is not a simple question. I have suggested that there are a variety of qualifications that we might consider for a person who wishes to volunteer. But, as I have noted, the variety of qualifications simply begs the question.

Or, perhaps it only appears to do so. I say that because the variety of qualifications suggests that volunteers can do what they’re asked to do and trained to do. That is, there are people out there, and perhaps available, who have one or more of the various qualifications I suggested. Granted, there will be more un- or underemployed folks with CPE who might volunteer in major metropolitan areas. I have a colleague who has a Board Certified Chaplain serving on a volunteer (unpaid) basis. However, the other sorts of preparation I mentioned, from seminary courses to education programs for lay ministry, are widely available, and may well reach into small towns. We speak of folks as “volunteers” because we’re not prepared to pay for their service. But that in and of itself doesn’t describe the limits of what a given volunteer, with certain individual talents and preparation, might be able to do. Rather, it clarifies the question from “What can volunteers do?” to “What do we want volunteers to do?”

Two responses, one to the original article and another to the last post, can illustrate this. Barbara Jackman, a Board Certified Chaplain, wrote in response to the PlainViews article, “I've worked too often with volunteers who mean well, but simply don't have the training in communicating, in working with those of other faiths/cultures, or with those in crisis. At times that simply has given chaplaincy a bad name, and affects all of us.” David Fleenor, who has recently entered CPE supervisory training, responded to my last post with reflections from four years working in a hospital as a Patient Representative. His department considered and decided not to use volunteers, even to make initial visits simply to inform patients of the availability of the service.

The reason we decided against using volunteers for this was b/c often during the initial visit the patient would reveal a concern that required immediate attention.

You can see the parallels to chaplaincy. Volunteers might be useful to make initial visits, but what if an immediate need arises that require the sensitivity and pastoral skills of a trained chaplain? The volunteer could make a referral. That is not optimal, however, b/c of the golden moment when a patient takes the risk and finds the courage to reveal his/her anxiety, dilemma, etc. It seems less than a best practice for a volunteer to be in a situation where he says, "You have raised a very important issue. Let me make the chaplain aware of that so she can visit you within the next 24 hours." I guess one could counter all of this by asserting that the chaplain would never know of the patient's need for a chaplain had the volunteer not made an initial visit.

Nevertheless, as a Patient Representative department we were not willing to take the risk of putting an untrained* (unqualified?) person in the situation to deal with what we believed were issues that required our skills.

Both clarify that the issue to be discussed is precisely what we might expect volunteers to do.

And that is a more complex question. The answer will have to be individual to the institution and to the chaplain in the institution. There is a certain level of function that we through our professional organizations have identified with professional practice. That level of function is articulated in the standards for certification of our various professional certifying bodies. While the words and titles are not identical in all our organizations, I believe there are some consistent characteristics described:

  • the capacity to establish and interact in a pastoral relationship based in active listening;
  • to be able to develop that relationship across lines of faith and culture while respecting the faith and culture of the person served;
  • to determine from that interaction a pastoral assessment or diagnosis, and to develop an appropriate plan for spiritual care;
  • to educate other professionals as well as patients about spiritual care and about ethics;
  • to administer a program of spiritual care, and to participate in the administration of the institution in which one serves;
  • to represent in our practice, and to represent our practice to, the faith communities in which we are grounded.
(If I’ve missed something significant I know I can depend on my chaplain colleagues to call it to my attention.)

As I suggested in my PlainViews article, there are many parts of this that we can’t delegate. After all, I can’t delegate doing my budget or orienting new staff to the program. More to the point, I can’t leave it to another to determine a pastoral assessment or care plan. The capacity to function as a professional among other professionals in the institution is a major part of our training. However, it is arrogant to suggest that only we can listen sensitively and establish a relationship, or contribute information toward the assessment. Colleagues Barbara and David have valid points: persons poorly trained and/or poorly supervised can do harm, both to the patient, and to the reputation of the spiritual care program. But if we are Advanced Practice Ministers, as I want to suggest, we are prepared and called to take responsibility for that training and supervision, and for the careful screening that is implicit in it.

I appreciate David's comments regarding "missing the golden moment." I also appreciate his recognition that a referral and delayed response to an issue may be preferable to no response at all. In his comments he makes some comment regarding "legal issues." While always seen as a patient service, patient advocacy and representation are often perceived to have a link to risk management that we in chaplaincy do not share (and that could be the topic of another post). From that perspective, a case not handled may well create less risk than a case mishandled. I would question, though, whether we would share that perspective. Pastoral relationships are not established to solve problems. Generally, pastoral issues may change in intensity but will not change in form with some delay. Moreover, we can address with training the ability of a volunteer to determine urgency and decide just how soon that referral needs to be addressed.

I also think we can fall into an “expertism” about our practice that overlooks or denigrates the importance in pastoral care of simple presence. As an Episcopalian I speak regularly of the importance of “sacramental presence,” God’s capacity to work through material means, including us. Those who would not use sacramental presence would still appreciate the importance of the community of faith, and of the “ambassador for Christ” to represent the faithful concern of that community simply by being there. And any of us can appreciate the existential crisis of isolation, so exacerbated during an institutional admission, which is broken simply by the interest of another in reaching out to us. As I have said before, it has been my experience that people of faith appreciate the concern of people of faith, even if they do not share the same faith. A volunteer with sufficient training to do no harm can in fact often to good simply by being present and interested.

This is a lesson we can learn from our colleagues in congregations. Many of them have seen their role primarily as empowering and overseeing the ministries of others, and not trying to do everything themselves. Many have developed parish visitation programs, reflecting that the call to visit the sick with the love of Christ and the support of the community is a call to all Christians, and not simply to a professional class. As in our practice, they do not want their visitors to assess or treat. Rather, they reflect the love of the faithful; and any information that indicates need for further discussion is faithfully reported. The pastor then has the opportunity to function as pastor or confessor or director, as the situation warrants. So, we have the opportunity to educate and supervise to enable the ministries of others.

I have put this in explicitly Christian language because it is the language that comes to me most readily. I am, after all, an Episcopal chaplain, whether at the bedside or elsewhere. However, I believe this concept will translate well: that representative believers can help us, under our supervision and with our guidance, to demonstrate a caring and compassionate community within our institutions. They cannot do everything, any more than (to follow my PlainViews article) a Certified Nurse Aid can function as a Registered Nurse. They can, however, be present at times and places when the simple limitations of space and time prevent us. They can free us, too, to provide other kinds of care for which we are specifically qualified. If we so “expertize” our practice of pastoral care that we fail to consider how we might enable and support the vocations of others, all suffer: the volunteer stifled from sharing a charism, the chaplain frustrated and exhausted at what couldn’t get done, and the patient who did not experience the representative presence of the community of faith.

Keep watching. There is still more on this to come.