Chaplaincy in Europe.

Abstract: Chaplaincy is organized in Europe in various ways, depending on the cultural, religious, social and governmental aspects which shape healthcare. One of the uniting forces in bringing national chaplaincies together into one united body has been the European Network of Health Care Chaplaincy (ENHCC). Chaplaincy in Europe faces two major difficulties: 1) the professional status of the chaplain within the healthcare community; 2) preserving the patient's rights for spiritual care. These difficulties are described and note is given to how the ENHCC is dealing with them. Finally, special attention is given to how chaplaincy in Europe and the medical community interact and what is needed to bridge the gap between the two worlds of science and faith.

Key Words: chaplaincy, European Union, professional standards, patient rights, networking

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In reviewing the histories of religions and that of healthcare in Europe, one will immediately see that there is a very close correlation between the two, a correlation which shaped a great part of medical care, as well as the culture of Western Civilization. In Ancient Greece, healing took place in the Asclepiad, which was a religious site. Within the Eastern Roman Empire (Byzantium) and the Roman Empire of the West, religious communities established the first organized hospitals that were many times protected by and supported by the state. Four prime examples are those of the philanthropic complex known as "the Basiliada" established by St. Basil the Great in Cappadocia (4th century), the Hospital of St. Sampson (6th century), the Hospital of the Pantocrator Monastery (11th century) in Constantinople, and the Hospital of the Holy Spirit in Rome (8th century). These institutions expressed a very clear attitude about illness and healthcare: that one of the major components of wholeness and health is directly related to the aspect of one's spiritual life and that faith is a basic element of healing.

Today, some of the major providers of healthcare within the European Union are religious institutions. Hospitals, hostels, special care units, and counseling centers are operated and funded by various Faith groups. The person who brings together the dynamics of healing and faith within the healthcare setting is that of the chaplain. Within the European Union, thousands of chaplains serve healthcare settings, offering the spiritual care and guidance that is essential for one's recovery and offering spiritual support to healthcare workers as well.

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Organized Chaplaincy: The Position of the Chaplain

The way chaplaincy is organized within the European Union varies from country to country. One of the reasons for this is due to the fact that there are distinct cultural factors that characterize the national identity of each country. Even though this has changed over recent years due to a trend toward multicultural societies, there are still elements of lifestyles that maintain a national distinction. One of these factors is religion. In most European countries, there are official organizations or associations of the major Christian denominations (Protestants, Catholic). In some countries, there is a primary organization, as in Italy, where the majority of the population is Roman Catholic and in Finland, where the majority are Lutheran. In other cases, the national religious authority (Metropolitan, bishop, etc) directs spiritual healthcare. This is mostly in counties which are primarily Orthodox Christian. In some cases, there are associations which coordinate chaplaincy on a multi-faith and multicultural level. England and the Netherlands are forerunners in this effort.

What determines the placement of a chaplain as a member of the staff of a healthcare institution is greatly dependent on the laws which regulate the health system of each country. In countries which have a predominate religious identity, public healthcare institutions will usually have chaplains of that faith that are either assigned by the religious authority and/or employed by the hospital. In countries that have more of a multicultural character, a chaplain could be employed by the hospital, independent of his/her religious affiliation. With the growth of multicultural societies that are changing the identity of most European counties, there is a growing effort to facilitate more faith groups, which compose a minority of the population, in providing spiritual care to their believers on a more professional basis.

The European Network of Health Care Chaplaincy

Since 1990, representatives of European Chaplaincies have been coming together every two years at consultations to exchange their experiences in spiritual healthcare. The realization that there were common issues, difficulties and differences raised a question that had been breeding for years, from the first consultation held in Berlin to that held in Rome: could the chaplaincies of Europe unite? This formed the main theme of the following historical consultation that took place at the Orthodox Academy on the island of Crete, Greece, hosted by the Ecumenical Patriarchate in November of 2000. The theme of this Consultation, the sixth one since 1990, was: "One United European Community! One United Hospital Chaplaincy?--The Necessity of a European Standard and Association for Hospital Chaplaincy." At the onset of the deliberations, the answer to the question posed in the theme seemed rather simple. It was commonly agreed that the time had come when the Chaplaincies of Europe should come together under some sort of organization. This agreement was also prompted by a growing European Union (EU). The participants initially felt that there were more things that each shared in common than things that separated them. In fact, some of the national Chaplaincies were already "networking" themselves with other national Chaplaincies. There were some initial difficulties, though, in forming a "united" chaplaincy in regards to the underlying different approaches of chaplaincy and the diversity in the spiritualities upon which these approaches are based. In defining these differences and diversities, the main difficulty was not only the theological perspectives of the representatives, but the use of language, the diversity in the meaning of words and meanings as expressed within specific cultural contexts. After much discussion, it was agreed that the European Network of Health Care Chaplaincy (ENHCC) be formed.

Answering the first question as to the name of the organization was relatively easy. The reality of different cultures, national organizational schemes and ecclesiastical structures were too complex to bring together in a central administrative organization. The use of the words "organization" and "association" only added to confusion and misunderstanding. The word "network" was a popular phrase in the European community: something that brings people together by building lines of communication and bridges of sharing and interaction. Thus, the new organization was to be called The European Network of Healthcare Chaplaincy.* Based on the "Cretan Declaration," (1) the Network is the largest body composed of official representatives from all the Christian denominations and chaplaincy organizations of Europe, which provide pastoral care in various healthcare facilities. The Network aims at mutual sharing and understanding both on a religious, cultural and organizational level. It brings together the various chaplaincy experiences of all the healthcare systems in Europe. Since Crete, the ENHCC has had three consultations: Turku, Finland (2002), Dublin, Ireland (2004) and Lisbon, Portugal (2006). Today 42 organizations from 30 countries are represented in the ENHCC. In June of 2005, a delegation of the ENHCC met with officials of the European Union (EU) to discuss the difficulties of chaplaincy in Europe and the importance of spiritual care of the sick. In turn, the EU asked the Network to contribute to a special dialogue concerning palliative care in Europe, designating the importance of spiritual care in this area. It has established official relations with other chaplaincy organizations in the United States of America, Canada, Australia, New Zealand and Japan. Specifically, at the Lisbon Consultation (May 2006) the American Association of Professional Chaplains was represented by its Executive Director, Josephine Schrader, where concrete steps were taken in building a firm bridge of cooperation between the chaplaincies of America and those in Europe.

Concerns Regarding Chaplaincy in the EU

There are two basic concerns that can be sited in healthcare chaplaincy (spiritual healthcare) within the European Union: 1) the professional status of the chaplain within the healthcare community; 2) preserving the patient's rights for spiritual care.

1) The Professional Status of the Chaplain

To become a chaplain, one has to fulfill two requirements: a theological education and a specialized training in a healthcare setting. Practical Theology is the theological reflection on pastoral care and both are taught in theological institutions. Within the framework of pastoral education, clinical experience is required. The way this is done from country to country may vary, depending on the specific approach of theological and clinical education, but there is a common agreement that this is a specific "scientific" field of study, which encompasses all the aspects of healthcare. Therefore, the position of the chaplain is one that has both a theological and "scientific" background, together with a well-grounded clinical dimension. This secures the chaplain's "professional level."

One of the first important matters the European Network faced was to safe-guard the "professionalism" of the spiritual healthcare provider. To do this, the ENHCC adopted the "Standards of Healthcare Chaplaincy in Europe" at the 7th Consultation that took place in Turku, Finland in 2002. These Standards state that chaplaincy provides pastoral services in a variety of healthcare settings, ministering to the existential, spiritual and religious needs of those who suffer and those who care for them. The Standards describe the organization and development of chaplaincy services, the area and activity of chaplains, their education, formation and supervision. There is an emphasis on how Faiths and chaplaincy services can be a vital resource in theological, spiritual-existential, ethical and pastoral matters. Special focus is given to the areas of integrated spiritual development and bioethics. The Standards Document is extremely important in that it gives a point of reference to all who are involved in the area of healthcare in dealing with the spiritual care of the sick. In the pluralistic and multicultural Europe of today, this even becomes a greater necessity. The Standards not only secure the "professional" and "scientific" quality of the spiritual healthcare provider (the chaplain), it also protects patients from unwelcomed spiritual intrusion or proselytising.

The question which must be raised is if the chaplain is accepted within the framework of the public health systems and institutions of the EU and if his/her position is considered as part of the team of healthcare professionals. There is a diversity of how this question can be answered from country to country. Even though most hospitals in the EU have chaplains, in general there is reluctance in viewing them as "healthcare services providers," particularly from the medical staff.

There is another dimension in preventing the chaplain from being included as a member of the healthcare team. Today, the chaplain's position within the healthcare system is slowly facing a crisis because of the attempt to reduce the high costs of healthcare. There is a definite trend to cut salaries and eliminate positions of healthcare givers that are considered as "less important" to the immediate physical care of the patient. Unfortunately, the position of the chaplain is seen in this light.

2) The Patient's Rights for Spiritual Care

In "The Patient's Rights in Europe," adopted by the World Health Organization in 1994, (2) it is clear that "everyone has the right to respect his or her privacy" (1.4) and that "everyone has the right to have his or her moral and cultural values and religious and philosophical convictions respected" (1.5). It is also stated that patients "have the right to be treated with dignity in relation to their diagnosis, treatment and care, which should be rendered with respect for their culture and values" (5.8). Patients also "have the right to enjoy support from family, relatives and friends during the course of care and treatment and to receive spiritual support and guidance at all times" (5.9).

Taking each of these clauses separately, one could interpret them in many ways. Here, there is a definite respect shown to one's privacy, but there is also an acknowledgment of the need and respect for spiritual support and guidance at all times. The misinterpretation of the privacy legislation concerning patients has caused many difficulties in providing the spiritual support and guidance. The same legislation acknowledges as a necessity:

** Professionally trained and recognized spiritual healthcare providers (chaplains) are often prohibited in approaching patients in offering the support and guidance needed.

** In some cases chaplains are not allowed to wear any type of religious dress or show religious distinction, showing lack of respect for the expressions of cultural and religious values.

** Many times, healthcare policy makers, hospital administers and other healthcare providers use "the privacy legislation" to justify themselves in not recognizing chaplains as providers of a specialized "healthcare service," leaving them outside the therapeutic team.

** Chaplains are often not allowed access to database information about the patient. This does not allow the spiritual care provider to share his input with other healthcare providers toward the healing of the patient.

It is necessary that every patient's right to have spiritual care and guidance accessible to him/her at all times be respected and preserved in the EU. The ENHCC has a firm position that this can only be done through an organized chaplaincy that is authorized by a faith community and recognized by the healthcare system. This is one of the issues that has been posed to officials of the EU, an issue that will surely be discussed in the future.

Building Bridges with the Medical Community

What is common in the concerns that are stated above is the need for a close working relationship between the spiritual healthcare provider (the chaplain) and the medical community. This calls for a meeting of two worlds, that of the empirical and that of faith, which "is the substance of things hoped for, the evidence of things not seen" (Holy Bible, Hebrews 11:1). As necessary as it is for doctors to maintain their "scientific" and objective approach in viewing the patient and his or her illness, it is also essential that they do not lose site of the emotional and spiritual entity which contributes to one's personhood, not only that of the sufferer but of their own. In dealing with and treating illness, we as healthcare givers are continually dealing with the issues of life and death, issues which bring us before the tragic part of our own being, which constitutes a reality that we ultimately cannot avoid. Evidence of this is the stress and burn out which healthcare professionals, and particularly doctors, have when caring for the terminally ill. (3-6) In the presence of suffering and death, one could not become completely detached.

There are efforts being made to build a bridge of cooperation between the doctors and chaplains. Although there are only six national chaplaincies (Scotland, Finland, The Netherlands, Italy, Latvia, and Belgium) that have special programs which aid in assisting physicians in dealing with the "spiritual" aspect of illness and death, one of the main tasks of the chaplain is to provide the much needed support to the medical staff. Beyond this, diagnostic tools are being developed to assist in assessing how the spiritual aspect of one's life contributes to illness and to health. This is a tool that can be shared by both professions. There are also specifics of areas of care, such as palliative care, in which cooperation between the medical community and spiritual healthcare providers is taking place. ([dagger])

Such efforts, though, cannot avoid facing a very serious question in terms of how healing is viewed and the direction that healthcare services are taking. Can healing really take place without including the whole person, part of which is the spiritual dimension of the sufferer? This brings on another controversial issue: what is "spiritual"? These two questions must be answered on a parallel level by the medical and religious communities so that dialogue between these two communities can progress and true team work can be practiced in healing the sick.

References

1. Cretan Declaration. Available at: http://www.eurochaplans.org. Accessed March 1, 2006.

2. A Declaration on the Promotion of Patients' Rights in Europe. Available at: http://www.who.int/genomics/public/eu_declaration1994.pdf. Accessed May 5, 2006.

3. Abeloff MD. Burnout in oncology: physician heal thyself. J Clin Oncol 1991;9:1721-1722.

4. Bennet G. The Wound and the Doctor. London, Secker & Warbug, 1987.

5. Vachon MSL. Occupational Stress in the Care of the Critically Ill, the Dying and the Bereaved. New York, Hemisphere Publishing Co, 1987.

6. Whippen DA, Canellos GP. Burnout syndrome in the practice of oncology: results of a random survey of 1,000 oncologists J Clin Oncol 1991;9:1916-1920.

7. Bouwer J. Pastorale diagnostiek. Modellen en mogelijkheden. Boekencentrum, Zoetermeer, 1998.

([dagger]) During the ENHCC Consultation in Lisbon (May 2006), special attention was given to palliative care. One of the future goals of the Network is to open channels in working closer with the EU and medical associations of Europe that are involved with this area of care.

Few men have virtue to withstand the highest bidder.
--George Washington

Stavros Kofinas, DMIN

From the Office of the Coordinator of the European Network of Health Care Chaplaincy and Representative of the Ecumenical Patriarchate of Constantinople, Greece.

Reprint requests to Rev. Dr. Stavros Kofinas, Lycias 3, 17124 Nea Smyrni, Greece. Email [e-mail]

RELATED ARTICLE: Key Points

** Religion and healthcare have always been interrelated since ancient times.

** Chaplaincy is organized in different ways dependant on the cultural, religious social and governmental character of each European country.

** Chaplaincies in Europe are brought together within the European Network of Health Care Chaplaincy (ENHCC).

** The major difficulties which chaplaincies in Europe face are the professional status of the chaplain within the healthcare community and preserving the patient's rights for spiritual care.

** Although there are attempts in cooperating and supporting the medical community by chaplains, many more steps have to be taken to build a firmer bridge of communication and cooperation between the two.

*"Healthcare Chaplaincy" was preferred to "Hospital Chaplaincy" because it was more inclusive of facilities that cared for the sick.