Can the efficacy of a profession that focuses on spiritual care be measured in any way?
I have a particular interest in one such profession, that of healthcare chaplain. I should say at this point that I am not, and never have been, a chaplain. However, I have represented the UK Bahá’í community’s governing body, the National Spiritual Assembly, on one of the UK’s healthcare chaplaincy bodies, the Multi Faith Group for Healthcare Chaplaincy (MFGHC), since its establishment in 2002 – and before that, from 1998, on the Multi Faith Joint National Working Party, the MFGHC’s predecessor body.
I am also one of the two members of the National Spiritual Assembly’s Chaplaincy Team, which is responsible for recruiting and training Bahá’ís who wish to serve as healthcare chaplains in the National Health Service – but not as chaplains in the Bahá’í community itself, since the responsibility for pastoral care resides with the community’s local and national elected Assemblies.
Hospitals in the UK’s National Health Service (NHS) offer chaplaincy as one of their services for patients. The salaries of chaplains employed whole- or part-time by NHS Trusts are paid from the Trusts’ publicly provided funds, as are the costs of administering chaplaincy and spiritual care departments in hospitals and other healthcare settings.
The NHS, like other health services and providers, requires that the treatments it offers are evidence-based. This requirement also increasingly applies to the work of healthcare chaplains.
This raises questions about the relationship between religion and science in this particular context. Chaplaincy has been seen as a quintessentially religious exercise, and the impact of chaplaincy interventions are often intangible and immeasurable, as I shall show. However, no NHS service can be exempt from the requirement to produce evidence of its efficacy, so chaplains and chaplaincy researchers are having to ask themselves such questions as: What kind of evidence can be adduced to show that patients and staff benefit from interventions by chaplains? What kind of interventions should chaplains be offering if their work is to be effective. To put it bluntly, does the work of chaplains help patients get better? And does it help NHS clinical and other staff function better?
It also raises a question about what would count as evidence in this context.
Chaplaincy in the NHS
Before we can measure the efficacy of the work of chaplains, we need to know what it is that chaplains actually do.
Chaplaincy has been a part of the NHS since its inception in 1948. It was assumed before the NHS came into being and in the early years of the health service that chaplaincy was a good in itself and that it needed no external justification. However, as Heather Mowat notes in her substantial and informative review of the – admittedly limited – research literature on chaplaincy effectiveness (Mowat, H., The Potential for Efficacy of Healthcare Chaplaincy and Spiritual Care Provision in the NHS (UK). Aberdeen: Mowat Research Ltd, 2008), UK society has changed considerably since 1948 and the NHS with it.
The NHS is a public service aimed at providing basic healthcare for all as a result of taxes raised through national health insurance. The NHS is a major focus of political policy for all the main parties. The relationship between investment, resource allocation, professional practice, professional power, measurable outcomes and patient voice and votes is part of the picture of the NHS. The NHS is both subject to, and influencer of, the political winds and moods of the UK. Arguably it is a barometer for wider social and cultural relationships. (Mowat 2008: 13)
The increasingly multicultural and multifaith make-up of UK society has led to demands for greater equality among the diverse populations and elements now resident in the UK. Governments have responded by putting legislation on the statute book to outlaw discrimination and to ensure that public authorities treat people equally.
The growth of individualism has also reshaped the health service. When the NHS came into being, just after the end of the Second World War, British people were inured to collective provision of services. As the decades have passed, though, individualism has come to rule the roost and “patient choice” has become a mantra for governments of all stripes. This, linked with a parallel growth in interest in spirituality (as distinguished from religion) has inevitably had its impact on chaplaincy, notably with respect to the development of chaplaincy provision by faith communities who had not previously been involved.
So what do chaplains do?
For many, the stereotyped view of a chaplain is of a priest (male, of course) who comes onto the hospital ward, administers holy communion to the church-goers, gives a blessing and departs. It’s a long time since that stereotype from the time when chaplaincy was assumed to be a good and (in England) to be the preserve of the Church of England has born any relationship to the reality.
The NHS careers website has this job description:
NHS chaplains offer a service of spiritual care to all patients, their carers, friends and family as well as the staff of the NHS. The spiritual dimension of life expresses purpose and meaning. “The spiritual dimension evokes feelings which demonstrate the existence of love, faith, hope, trust, awe, inspirations; therein providing meaning and a reason for existence. It comes into focus particularly when an individual faces emotional stress, physical illness or death”– Narayanasamy, 1999.
Healthcare chaplaincy occupational standards define the work as that which “enables individuals and groups in a healthcare setting to respond to spiritual and emotional need and to the experiences of life and death, illness and injury, in the context of a faith or belief system.”
The work of the chaplain embodies the spiritual, pastoral and religious care associated with these needs found in the healthcare setting.
Chaplains are an integral part of healthcare teams and provide a service to patients, their carers and families. The role of chaplains is focused on the spiritual and religious domains, the way these relate to health and wellbeing, and how they can enable people to cope with the challenges and transitions that accompany illness, injury and suffering. This means that chaplains are highly experienced at supporting people with a wide range of pastoral issues and concerns. They also have an understanding of the clinical procedures that patients undergo and the work of other healthcare professionals.
As challenging as these descriptions show the role of chaplaincy to be, Ann Ulanov issues a challenge (Ulanov, A., The Space between Pastoral Care and Global Terrorism. Scottish Journal of Healthcare Chaplaincy 10:2, 2007, p. 12) to chaplains working in an increasingly plural and fractured world:
You who see struggle and sorry in your work as chaplains, who witness the fragility and strength of people reaching for new life in the midst of their old life crumbling around them … see remnants.
She [Ulanov] challenges chaplains to act as witnesses to the moment, to hold more than one story or version of events in order that others can learn to do the same and to make links and connections in order to encourage globalism and tolerance. She calls this remnant consciousness. Her view is that chaplains are called to work with this remnant consciousness in order to encourage global perspective which is the only way forward. The alternative is to have a rigid “one story” tyrannizing as the whole story….
Ulanov is making a case for healthcare chaplaincy in the context of more fractured and less “religious” society [than was the case when chaplaincy was assumed as a good]. (Mowat 2008:15)
Provision of religious care for patients who practise a religion no longer meets the needs of a society that is declaring itself to be more interested in spirituality than religion.
Hospital chaplaincy therefore is now increasingly concerned not only with serving and supporting those with specific religious beliefs and practices but also those with no religious beliefs and practices. (Mowat 2008:15)
Here, as in other aspects of life in the 21st century, relativistic post-modernism is playing its part in shaping what can and cannot be said and done in the name of chaplaincy. No kind of fundamentalism is acceptable inside the portals of the NHS.
For a balanced and illuminating Bahá’í perspective on transcending the dichotomy between fundamentalism and relativism in the context of knowledge and truth, it is well worth reading Chapter 5 (“A Problem of Knowledge”) in Paul Lample’s excellent Revelation and Social Reality (West Palm Beach, Fla., Palabra Publications, 2009, pp. 161–189). Mr Lample makes the following points that would seem to be highly relevant to chaplaincy in the 21st century, especially in light of Ulanov’s challenge:
Knowledge that is nonfoundational is intimately tied to language, justification, intersubjective agreement, and relations of power; it is not something that stands apart from human beings. It is ever-evolving. It is tied to experience and is sensitive to context… The human enterprise is, then, the never ending investigation of reality, the search for truth, the quest for knowledge, and as important, the application of knowledge to achieve progress, the betterment of the world, and the prosperity of its peoples. (Lample 2009:173 Emphasis added)
Language, intersubjective agreement and justification are at the heart of chaplaincy practice, of the way chaplains relate to and interact with patients, other chaplains, their faith communities, and management; chaplains must now justify – to themselves, to the patients, to their faith communities, to the NHS – what they are and what they do; and, inescapably, they stand in relations of power with respect to others.
A suitable metaphor of nonfoundational thought is standing on a raft. There is no anchor for knowledge, so change is a constant. With the generation of new insights and new beliefs, it is necessary to regularly alter some essential elements of understanding – to replace pieces of the raft. However, we cannot revise all aspects of our knowledge at the same time – we need some reliable piece of the raft on which to stand to replace other parts. (Lample 2009:174)
In any case, whatever the merits of relativism in addressing metaphysical concerns, it is nonfoundationalism, not relativism, that most closely correlates with the Bahá’í teachings on knowledge when dealing with the contingent world. A nonfoundational approach to knowledge, like relativism, recognizes the legitimacy of different points of view and the limitations on certainty. Unlike a relativistic approach, however, it permits judgments about inadequacy or error. (Lample 2009:177–78)
To be continued next week …..
This is first part of the 9th in a series of blogs on the unity of science and religion and its applications by Barney Leith, a member of the UK Bahá’í community and its National Spiritual Assembly. For more of his blogs, see http://barneyleith.com on Posterous.