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.


Susan Palwick said...

Three quick comments on this (I'll probably respond more fully in my own blog):

1. If Chaplain Ray believes that "chaplaincy should not be entrusted to volunteers," he needs to meet some of my patients, such as the frequent visitor to the ED who recently told me, "You're a wonderful chaplain! I hope you never leave."

2. I don't believe that God calls us to confine our ministries to one or another small box. I believe that I'm called to minister all the time, everywhere, although of course this will take different forms depending on context. I'm called to do this not by virtue of professional certification, but by virtue of baptism.

3. I find it significant that the word "God" appears nowhere in Chaplain Ray's comments; nor, indeed, in Chaplain Scott's. If ministry can't be confined to neat boxes, God certainly can't. I simply can't believe that the God who said "the last will be first" would choose to work only through certified specialists.

Marshall Scott said...


I'm sure I would get good results if I actually could ask (point 1), and I agree with you on point 2.

As for point 3: I won't speak for Chaplain Ray on this. However, not all chaplains, much less all patients, are Christians, or even monotheists (or even theists: one can be a good Buddhist, and believe that the question of God is irrelevant; and there are Buddhist chaplains). As a chaplain writing for the broad chaplaincy community, I have to keep that in mind.

Now, "as for me and my house:" by claiming and acknowledging that I am an Episcoplian, I am claiming that my ministry is from God and is rooted in God.

Susan Palwick said...

Hi again! Thanks for the corrections; one of our staff chaplains is Buddhist (so's one of our most devoted and energetic volunteers), and I've worked with any number of non-Christian patients, either people of other faiths or a-religious people.

When I said "God," I was speaking my own language from my own perspective. But I don't believe that compassion or lovingkindness or any of the other values most prized by the world's various spiritual traditions manifest themselves only in certified specialists, either. :-)