December 3, 2008
CRITICAL NOTES ON THE HASTINGS CENTER REPORT BY Ramond J. Lawrence
on a set of essays published in
Volume 38, Number 6, Nov-Dec, 2008.
By Raymond J. Lawrence
(This review is not intended to be exhaustive, but simply to highlight what seems to this writer to be the most useful parts of this collection, and to call attention to weaknesses and errors.)
The essays in this collection are the result of a collaborative undertaking between the Hastings Center and HealthCare Chaplaincy, Inc, of New York City, Gregory E. Kaebnick, Editor. The creation of this collection was funded by the Arthur Vining Davis Foundations.
The title of this Hastings Center collection is “Can We Measure Chaplaincy? A new professional identity is tied to quality improvement.”
The following articles appear in the collection:
”What Are We Doing Here? Chaplains in Contemporary Health Care” by Martha R. Jacobs
“Ethical Grounding for a Profession of Hospital Chaplaincy,” by Margaret E. Mohrmann
“Lost in Translation: The Chaplain’s Role in Health Care,” by Raymond De Vries, Nancy Berlinger, and Wendy Cadge
“Chaplaincy and Clinical Ethics:A Common Set of Questions,” by Martin L. Smith
“The Nature of Chaplaincy and the Goals of QI: Patient Centered Care as Professional Responsibility,” by Nancy Berlinger
The strongest article of the lot is the article jointly written by DeVries, Berlinger and Cadge. This is a seminal piece, every bit worth the price of the issue. This article highlights the critical issues in the chaplain’s identity. It points out that chaplains have a kind of vacuum identity, filling in voids left by other professionals. It points out overlapping identity issues, such as the fact that social workers and chaplains do almost the same tasks. The article also raises the critical question of the process by which a chaplain, as a religious professional, may approach persons outside the chaplain’s own religious tradition. This article sets the parameters of the chaplain’s identity issues, and the issues it sets out are yet quite some distance from resolution.
The Smith piece is also rich. It compares the parallel issues facing both chaplains and bioethicists, each group facing critical identity issues in the modern health care setting. This article, in my view, might spur more chaplains to take on the supplementary role of bioethicist. It would seem to be a natural progression, albeit requiring further study. Truth to tell, every competent chaplain is by definition part bioethicist. One would hope this article might spur chaplains further to develop more serious expertise in this emerging field. (Unfortunately, Smith repeats misinformation put forward in the issue’s lead article about the character of the so-called Spiritual Care Collaborative, and the role of the U.S. Department of Education and Medicare Reimbursement in chaplaincy training, an understandable error since that is not Smith’s field.)
The Mohrmann piece provocatively plays with themes of spirituality, pastoral identity, and the problem of the non-quantifiable character of chaplaincy work. Mohrmann seems a bit too quick in agreeing that chaplaincy is really a new profession, a contention that is very far from resolution.
The Berlinger piece argues, correctly, that chaplains should step up to the plate to support quality improvement, fully aware that this is a hazardous role to play in any institution.
The lead article, the piece by Jacobs is troublesome in a number of respects. It is clearly infected with the HealthCare Chaplaincy agenda, as one would expect from a staff person of that agency.
Jacobs argues blatantly that hospital chaplaincy is “a vocation in its own right,” a claim, even if desirable, is at best premature. She fails to point out that clinically trained religious professionals move easily back and forth between congregational work and hospital work. In what sense this would be seen as changing professions she does not discuss. A great deal more work is to be done if we are going to establish hospital chaplaincy as a distinct profession. The bald claim that it is already one hardly furthers serious discussion and evaluation.
Jacobs also tosses around “spiritual” rather freely, without revealing any clear definition as to what she may be referring to. She offers a lame definition that spiritual “has many definitions, all tend to have something to do with transcendence…” That is not much of a promising start in examining what might be meant by spirituality.
Jacobs writes at length on the subject of what a chaplain does, and the end result is passing strange. She describes countless acts that a chaplain might engage in. Yet for all that, and quite mysteriously, she never quite comes to the point of stating what the chaplain is expected to do, or what the chaplain’s role is. Jacobs tells us that chaplains make themselves available to patients and staff in a variety of ways. Sometime they hang around. Sometimes they help clean up the body of a deceased patient. Sometimes they sit in silence, or they sit on committees, and chaplains, she says somewhat awkwardly, “are genuinely good at death and dying.” But curiously, or should I say astonishingly, she never gets around to stating exactly what a chaplain does, or what the role really is.
More troublesome for us, Jacobs continues the recent drumbeat of the so-called Spiritual Care Collaborative (SCC), repeating the claim that SCC is the organization of the “six major” chaplaincy groups who commit to common standards. This claim is a continuation of HCC propaganda in support of the drive for monopoly on the part of the Association for Clinical Pastoral Education (ACPE) in the field of clinical pastoral training (CPE). That pursuit of monopoly is the hidden agenda of SCC.
It is not clear how the six self-appointed groups got to be the six ‘major’ groups in the field. Certainly they are not major in size. Furthermore, membership in the six overlaps so that virtually every person involved belongs to at least two, and often three of the six, which artificially inflates their numbers.
The claim that the six member organizations subscribe to “common standards” is patently and purposely misleading. The six member organizations have merely agreed to “work toward” elevating their particular organization’s standards to the level of the touted common standards. Furthermore, the common standards themselves are hardly a distinguished or rigorous set of standards. Most notably, they fail to address adequately the critical problem of peer review. In brief, the common standards are to date no one’s standards. The so-called common standards exist purely for vacuous and imperialistic public relations purposes.
Jacobs also repeats the false claim promoted for more than a decade by the ACPE, in its own monopolistic self-interests, that Medicare pass-through funds are contingent on recognition by the U. S. Department of Education. This false claim was made originally by the ACPE in the mid-90s. It was false when it was made and is still false. It keeps being repeated by partisans in support of ACPE’s continued striving for restoration of its monopoly.
It is regrettable that a highly esteemed institution like Hastings has allowed itself to be party to furthering this misinformation, especially in the context of some very useful essays.
Posted by Perry Miller, Editor at December 3, 2008 12:20 PM