Dialogue: Scrimping on soul services bodes ill for our hospitals

The shortcomings of the health service mean that hospital chaplains have an increased role to play, writes WARREN BROOKBANKS*.

The Government's refusal to increase funding for hospital chaplaincy services, the forerunner of a scaling back of such services nationwide, is a worrying development.

Inevitably, the issue of chaplaincy services raises the vexed issue of the separation between church and state and the justification or necessity of the state continuing to support religious entities in a society which is avowedly secular.

Unlike North America, where the doctrine of separation requires that the civil government cannot subsidise matters of faith, New Zealand has never tried to define limits to the power of the state to assist religious initiatives which might produce benefits of both a religious and a non-religious nature to the public or a section of it.

The chaplaincy service is an expression of the common good, a benefit aimed at the general welfare of all citizens. It offers help to the religious and the non-religious alike. It is a vehicle for expressing the simple truth that most people, in situations of emotional and physical extremity, need and value the support and consolation of other people.

Furthermore, even unreligious people may, when faced with their imminent death or rapidly declining health, turn to God out of fear or simply as a hedge against the uncertainties created by the prospect of death.

Whatever their motivation, for such people a chaplain employed within a hospital setting is a facilitator who might offer such comfort and consolation as the patient is willing to receive, or arrange for the help of other people or agencies able to meet the patient's needs.

As professional ministers and counsellors, chaplains are able to attend to the people needs of patients in a way that the scientific method of evidence-based medicine is not equipped to do.

By virtue of their training, they are able to listen and to empathise with patients in the midst of a social environment that is driven by the necessity to examine, investigate and intervene.

They provide an inestimable service in mediating human compassion and understanding in circumstances of great stress and tension that cannot be measured against the incessant demands of health service rationing.

We need a properly staffed chaplaincy service precisely because the state is unable to guarantee the levels of personal care and emotional support that we might expect of a fully functioning, holistic health service.

We should also reflect on the consequences of a continuing degradation of the chaplaincy service.

Eventually, social workers may replace chaplains as the first port of call for patients wanting someone with whom to discuss their fears and hopes.

But would they be better placed to spend the time and offer the comfort that people in physical, emotional and spiritual crisis are seeking? I doubt it.

The pressure of demands on health care workers, including hospital social workers, is endemic across the health sector. It is unlikely that social workers would have the time or the energy to take on the further demands of a chaplaincy role. Nor are they equipped for such a task.

The essence of giving spiritual counsel is the ability of the counsellor to help the person counselled to look past their immediate fears and apprehensions and to find hope in a source of personal power outside the bounds of a largely impersonal health-care system. This is not a task for social workers.

A new stream of academic writing in the field of medical ethics emphasises the requirement of narrative competence for the effective practice of medicine.

The theory is that clinicians need the ability to acknowledge, absorb, interpret and act in relation to the stories and crises of others.

This is said to be necessary because, despite the outstanding progress medicine has made in diagnosing and treating illnesses, doctors sometimes lack the ability to recognise the plight of patients and extend empathy towards those who suffer.

While this is obviously a desirable quality for practising health professionals to aspire towards, it has long been the essence of the chaplain's task.

Chaplains are professionally trained to bring hope and comfort to the sick and dying.

It is a task that requires the time and patience to listen while the patient recounts his or her story and expresses hopes, fears and dreams.

We would all be much worse off if this valuable humanistic function were to cease to be a part of our health-care system.

It is curious that the Government should be considering scaling back chaplaincy services when public officials are expressing concern at the stress being placed on mental health services by drug and alcohol use, the rise in the incidence of violence and murder and the impact of marriage breakdown and poverty.

Some of the victims of such social dysfunction will find their way into the wards of our public hospitals, requiring the comfort and reassurance of people who care and have the time to spend with them.

One would have thought this was a case for increasing, rather than decreasing, the role of hospital chaplains.

* Warren Brookbanks is an associate professor of law at the University of Auckland.