The ambiguous role of the chaplain

Acute hospitals are places where boundaries and/or bridges between clinical and spiritual priorities are tested, especially in the decision-making process, such as in multidisciplinary team meetings. In our field site in London, chaplains are part of the end-of-life multidisciplinary team meetings.

During a walking interview, one of the spiritual care practitioners took me to the team room on the oncology ward, where the end-of-life multidisciplinary team meeting takes place. When we left the ward, he said:

“…and that’s where for me, as a chaplain, the prayers I’ve offered or the spiritual life I’ve shared with patients, is shared with the doctors and the doctors share their learning with the chaplains. And it’s an amazing mix in that place. (…) And I happened to be in a meeting where two people had been brought in, both of whom were on the list of Palliative Care, but not on the actual print-out and no one had had the chance to go but they knew the service was needed. And it was chaplaincy that offered the first voice. The first patient experience was the chaplain”.

This quote shows how the chaplain was the first professional from that multidisciplinary team to meet the patient. By becoming an intermediary category, although on the margins, the chaplain then builds bridges between different categories of people, such as clinicians and patients. Interprofessional collaboration among clinical and spiritual staff members has the potential to provide a holistic model of care to make patients’ experience better by overcoming disciplinary boundaries between clinical and spiritual priorities and engaging in a healing process that considers the person as a whole through a biopsychosocial-spiritual care model (Engel 1977).

However, spiritual care can also be perceived as being on the institutional margins of health care and biomedicine, so some participants feel, for instance, that patient consent should be sought prior to allowing chaplains to sit in multidisciplinary team meetings, like the following quote demonstrates:

“Now I have no objection if a patient says, I absolutely want my spiritual advisor to be at my multidisciplinary team meeting. They’re absolutely part of my process of care and getting better. Fine, have him there.  But don’t just have him there, whatever you are”.

Somehow, then, chaplains may not only be perceived as creating bridges through the relations and connections they help to maintain, but also as being ambiguous, in a sort of in-between state (Norwood 2006). Their presence on multidisciplinary team meetings then becomes contested.

To integrate body, mind and spirit, Balbioni et al. propose ‘an open pluralist model’, which ‘provides a way to think constructively about the limits of therapeutic neutrality in the care of individual patients and about the central problem of differing value commitments’ (2014:1596). In this context, ethical professional boundaries are seen important to protect vulnerable patients from undue influence by religious or non-religious health care professionals. These professional boundaries can be protected through multidisciplinary interaction and inetrprofessional collaboration. Chaplains then become instrumental in reminding health care professionals of the importance of considering the patient as a whole and thus the insights they provide through spiritual care become central to an effective decision-making process, respectful of patients’ identity, aspirations and needs.

References

Balboni, M. J., Puchalski, C. M., & Peteet, J. R. (2014). The relationship between medicine, spirituality and religion: Three models for integration. Journal of Religion and Health, 53(5), 1586.

Engel G. L. (1977) The need for a new medical model: A challenge for biomedicine. Science 196: (4286) 129-136.

Norwood, F. (2006). The ambivalent chaplain: Negotiating structural and ideological difference on the margins of modern-day hospital medicine. Medical anthropology, 25(1), 1-29.

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