Those whose vocations take them into the world of healthcare on a daily basis are well aware that it is an active and bubbling moral cauldron. Personal, professional, administrative, and societal decisions are loaded with passion and quandary.
Although hospitals tend to be the most public places where moral issues erupt, all who provide services, receive services, and pay for services confront problems. Hospital chaplains are deeply involved in this crisis.
Is there a healthcare crisis? Yes, there is; but the dimensions of that crisis are not unlike the proverbial blind men describing the elephant.
- It is a public health crisis. Issues include access to preventative (“wellness”) resources for uninsured, quality of water and air and general population trends toward obesity.
- It is a professional crisis for physicians and nurses. Both groups have very high dissatisfaction rates with their employment conditions. Long-term trends include serious concerns about maintaining an adequate supply of these professionals as the population ages.
- It is a financial crisis. Healthcare generates 13.4 percent of the Gross National Product annually, the largest single portion of the economy. Cost increases are astounding. Who can pay? What should we not pay for?
- It is a scientific crisis. Knowledge of the body, its illnesses and possible treatments expands daily. Both medicine and nursing have strong emphasis on developing “evidence-based practices,” but perhaps only 20 to 25 percent of current practice actually reaches this standard.
- It is a moral crisis. End-of-life care, beginning-of-life care, emerging genetic treatment technologies present new quandaries for how Christians can be faithful. Issues of justice and the common good are difficult to understand, much less resolve.
Christian witness and ministry take particular interest in this cauldron. Healing of the sick, compassion for the injured and justice for the oppressed are core expectations of the prophets and of Jesus.
This mission has been engaged in many ways, not the least of which was the denominationally owned hospital building ministry of the 20th century.
Although church-affiliated hospitals now have, at best, a distant relationship to institutions that bear their name (Roman Catholic hospitals are mostly an exception to this generalization), the missions of care and healing remain. Faithful physicians and nurses continue to respond to such needs with deep vocational commitments.
Hospital chaplains also embody part of the church’s ministry. How does the healthcare crisis affect their ministries?
Seventy years ago spiritual care of the sick was the responsibility of churches, although a few church associations were beginning to place chaplains in medical institutions. Today chaplaincy is a semi-autonomous profession. Chaplains have ties to their faith traditions but employed by hospital systems.
Jesus’ words about money apply here: where your treasure is, there will be your heart also. All healthcare system issues impact chaplaincy. Here are a few of the dangerous ways:
- As hospital administrators make financial adjustments in order to remain viable, they carefully evaluate expenses that receive little to no reimbursement from payers. Chaplaincy positions are frequently targeted.
- As payers decide what they wish to reimburse they are increasingly using the phrase “evidence-based practice.” Chaplains (like most clergy) have deep suspicion of external, physical measures of their value and thus have seldom engaged in such research. In scientific terms, chaplains have not demonstrated value.
- The patient care mix is changing rapidly. Hospitals are moving toward high-tech intensive care needs, while most chronic and lower acuity problems are dealt with as outpatients. Relational ministry is more difficult with those who are extremely sick. Chaplains have not made great strides toward outpatient and home-care ministries.
But crisis also offers opportunity. What are some of the opportunities that chaplaincy is engaging?
- Workplace spirituality is recognized in both religious and secular realms as core to employee satisfaction and effectiveness. Some chaplains are reforming their ministry to focus on employee spirit and wellness.
- Medical and social scientific research is demonstrating some connections (surprising to some) between people’s spirituality, religious practices and healthcare issues. Some chaplains are reforming their practices to support physicians’ and nurses’ efforts to apply this new knowledge.
- Current hospital practices discharge patients for care at home with more complicated conditions. Some chaplains are working with churches to shift their “care of the sick” from hospital visitation to sustaining at-home visits.
- The complex ethical issues of modern healthcare show no signs of abating. Some chaplains have developed expertise in both clinical and organizational ethics and are thus highly valued within their healthcare systems.
Chaplains have always offered a ministry that placed them “betwixt and between.” Today is no different. The dangers and opportunities for this ministry require resiliency, courage and imagination. Churches who support these ministers certainly remain in the compassionate tradition of “visiting the sick.”
Steve Ivy is vice president for values, ethics, social responsibility, and pastoral services of Clarian Health Partners in Indianapolis, Ind. He is a member of First Baptist Church of Indianapolis (ABC).