Saturday, February 11, 2012

Chaplaincy Care: A Human Right?

This week the leadership of the Church of England met in General Synod.  While most folks were watching other issues (notably, progress toward ordination of women to the Episcopate in the Church of England), they did address other issues. Notably, they passed this motion:

That this Synod, mindful of Our Lord’s ministry of healing and his charge to his disciples to heal the sick in his name:

    (a) affirm the ministry of all who promote health and wholeness in body, mind and spirit, and, recognising in particular the role of chaplains in the NHS as an expression of the Church of England’s commitment to minister to all in the community, whether as patients or healthcare workers, call upon Her Majesty’s Government to ensure that chaplaincy provision remains part of the core structure of a National Health Service committed to physical, mental and spiritual health;

    (b) call upon Her Majesty’s Government to apply as the test to any proposed changes to the NHS whether they are best calculated to secure the provision throughout the country of effective and efficient healthcare services provided free at the point of delivery and according to clinical need;

    (c) commend the work of mission agencies and the networks of the Anglican Communion in embodying the churches’ contribution to health and wholeness and promoting fairer sharing of health resources worldwide.

This resolution was based on the background paper, “Health Care and the Church’s Mission: Report from the Mission and Public Affairs Council.”  (You can find the motion and the link to the report as a part of this  report at Thinking Anglicans.)The reason for the paper is provided in the Introduction:

The NHS is currently undergoing the most thorough revision and reconstruction in its sixty year-old history. The NHS that emerges from this process will shape the delivery of healthcare in England for decades to come. It is, therefore, appropriate for the Church to look at the current and prospective state of healthcare delivery in England, focusing on particular areas of interest and concern that are pertinent to the Church’s healing ministry and mission.

This paper is worth the time of any of us in chaplaincy, and especially for those of us who are Episcopalians and Anglicans. For one thing, it provides a discussion of spiritual care and its importance in health care generally, and in the National Health Service in particular. It includes this remarkable statement: “Delivery of spiritual care is the responsibility of all professionals in a multi-disciplinary healthcare team, but on the grounds of care, efficiency and human rights, it is essential that chaplains continue to play a central frontline role in ensuring that appropriate spiritual and religious care are extended to all patients, clients and staff.”

The reference to human rights is one that perhaps many of us might not have addressed. The paper makes reference both to the European Convention on HumanRights, and to “The Declaration on the Rights and Responsibility ofIndividuals, Groups and Organs of Society to Promote and Protect UniversallyRecognized Human Rights and Fundamental Freedoms” of the United Nations. The conclusion reached by the Mission and Public Affairs Council based on human rights is similar to that many in the United States have reached based on civil rights: that patients in the hospital are functionally not free, and that to protect their rights to religious expression it is necessary to make a positive provision for spiritual care.  As the report states,

This requires the NHS not only to allow freedom of religious belief and practice, but also to take all reasonable steps to promote such freedoms, enabling patients, clients and staff to express and to practise their beliefs. While these rights have to be set alongside other rights, such as those associated with privacy, the NHS has, nonetheless, an obligation to promote rights associated with religious belief and practice.

In this light, they review information from a survey of National Health System patients admitted in 2009 and 2010.

In 2009/10, there were 14,537,712 hospital admissions in England. An analysis of the ‘Picker Inpatients surveys’ between 2007 and 2009, indicates that, on average, 22% of hospital patients identified belief as being ‘an issue’, with 17.7% of patients wishing to practise their religion while in hospital. 2.1% of patients, however, reported that their beliefs were not fully respected and 2.9% were not able to practise their religion as they had wished. Using the 2009/10 NHS statistics, this translates into absolute figures of 3,198,297 patients for whom belief was ‘an issue’. 2,573,175 patients wished to practise their religion while in hospital, but 305,291 patients did not have their beliefs fully respected and 421,594 patients were not able to practise their religion as they had wished.

So, in 2009 and 2010 there were more than 14 million admissions. Perhaps 20 per cent would say that belief was “an issue,” and/or that they wished to practice their faith while admitted. Of those more than 14 million, two percent felt their beliefs were not respected; and almost three percent were not able to practice their religion. The report notes that, while the percentages might seem small, they represent more than 400,000, and perhaps more than 700,000 admissions. (I grant that the higher number is unlikely, with an expectation that there is a great deal of overlap between these two groups. It remains that even the smaller number represents a large number of dissatisfied patients, and just within England’s National Health Service.)

The report then notes what provision the National Health Service has made:

This hospital population was served by some five hundred ‘whole-time-equivalent’ chaplains who made approximately one million patient-visits between them. Chaplains also attend to the needs of critically ill patients and neonates who were not surveyed, as well as to families and staff, and many serve on ethical committees or manage bereavement or other services. Given this workload, it is fair to say that the NHS may already be close to failing to fulfil its human rights obligations. Five hundred whole- time-equivalent chaplains is a tiny contingent, compared with the 140,897 doctors, 417,164 nurses and 44,661 managers employed in a National Health Service workforce that totals almost one and a half million. (Emphasis mine)

In the United States, at least, a discussion framed by freedom of religion (and often by freedom from religion) seems to overlook that meeting the spiritual needs of hospital patients (like the military and prisoners and others who are functionally not able to freely exercise their beliefs) requires this positive provision. This report approaches the issue from the other direction, from the perspective specifically of protecting those rights. The Church of England is concerned that the National Health Service may be failing in adequately protecting human rights. One wonders whether in the United States where hospital care is not systematized, much less national, we’re also failing by that measure.

As I said, the paper is worth our time to review. It is of course interesting to hear how the Mission and Public Affairs Council has understood the importance of and provision for chaplaincy within the National Health Service. Beyond that, though, it can provide us with a different perspective from which we might analyze how well we are and aren’t doing in our own context.


Erp said...

One thing to consider is does the NHS chaplaincy reflect the religious makeup of the patients including those who consider themselves humanists or non-theistic or Muslim, etc.? Or is it overwhelmingly Anglican despite the low number of active Anglicans in England.

Marshall Scott said...

Erp, I don't have the statistics to answer your question. However, my impression from information from international conferences, etc, is that it's overwhelmingly Christian, I don't know that it's overwhelmingly Anglican. That's certainly the case in the United States and Canada. That's partly because historically most folks in the United States have identified as Christian; but it's more because chaplaincy is only a recent addition to models of ministry for rabbis and imams (although they're catching up and their numbers are growing among chaplains).

I think the paper focuses on the professionalism of chaplains as the primary resource, if you will, instead of shared faith tradition. After all, as a professional chaplain I'm committed to supporting each patient and family within his/her/their own tradition, as best I can. Basic support and listening knows no specific faith tradition; and as I need to I'm happy to reach for them the resources they need. I can't "be all things to all people;" but I can be respectful, supportive, and informed of the resources available.