Ministering to patient and person.

As we have been frequently reminded, the spiritual and the medical were once joined in the same figure. Since the days of the Enlightenment, however, the trend has been to encourage a divide between the arts that minister to the body and those that minister to the soul. In so doing, medicine largely has gone the way of the scientific, placing its confidence in objective, evidence-based procedures and an ever-growing multitude of tests, cultures and scans. By contrast, spiritual and pastoral care, guided by emotive signs rather than electronic or biochemical signals, became increasingly "humanistic," looking for the person before the patient. Both medicine and spiritual care have benefited from this separation. However, much like a pair of rival siblings, while a certain degree of distance may be beneficial, complete estrangement is an immature denial of a common heritage, which, in the long run, may prove to be detrimental: both have something to learn from understanding the other's perspective.

As is often the case, the absence of communication has only caused further estrangement between medical care and pastoral care. Many physicians have neither a realistic conception of the nature of modern-day, professional chaplaincy, nor of the training or qualifications of professional chaplains. The role of the chaplain and the (clinical) skills which he or she brings to healthcare often remain unclarified, unqualified and, sadly, underutilized. Nor has such ambiguity been addressed by medical journals, where there is a dearth of articles discussing the chaplain's role as a member of the healthcare team. (1) In these pages of the Southern Medical Journal's Spirituality/Medicine Interface Project, we hope to help revitalize this beleaguered conversation by increasing awareness of the training, standards and education of professional healthcare chaplains.

The standard of spiritual and pastoral care that modern-day professional chaplaincy has set is undeniably high. (2,3) For board certification, chaplains must be trained in a number of fields including theology, pastoral care, psychology and sociology (4); such theoretical knowledge is duly rounded and supplemented by at least 400 hours of clinical pastoral education (CPE), which emphasizes experience as a source of growth. (2,4) Equally important to the development of institutionalized spiritual care is the increasing degree of uniformity, integration and discussion that is growing among the various chaplaincy organizations, often in spite of significant differences in spiritual beliefs and great geographic distances. Such developments are possible largely because the Western conception of chaplaincy is uniquely multi-faithed and multi-cultured in its orientation and builds upon the bond of a shared humanity.

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Yet despite this increased synergy among professional chaplaincy organizations, the scientific dimension needs to be further cultured. While there is much discussion (5-8) about the means and methods for qualitatively measuring the services that chaplains provide, what exactly constitutes best practice is far from being established as protocol, although a consensus is developing. (9) The establishment of such protocols may make chaplaincy more efficient while also reducing chaplain stress. (10) To be sure, there is a desire on the part of many chaplains to augment the scientific dimension of their profession, (5,11) and further integrating the chaplain within the healthcare team is bound to encourage such development.

On the flip side, medical care also has much to learn from its pastoral sibling. Largely due to specialization, medicine increasingly is in danger of becoming a technical field, with physicians--as trained technicians--who are taught to see the patient's body as a hollow machine in need of mere mechanical care and attention. Rather than seeing the patient, it is the disease or illness with which he or she presents that is the true object of attention. As a person, however, the patient's spiritual needs also must be tended: healthcare providers are responsible for the health, wellbeing and (hopefully) eventual recovery of the patient. Indeed, the World Health Organization defines health as not merely the absence of disease but as a state of physical, mental and social wellbeing. (12) It is only in caring and integrating all of the aspects of the patient's being--body, mind and spirit--that genuine healing can occur. (13,14)

Specialization is the natural result of a rapid growth and broadening in conceptual and practical knowledge of a certain field. As with all branches of healthcare, chaplaincy and spiritual care also have been driven to specialization; yet while chaplains may well specialize, the occupation remains focused upon nurturing the growth of the soul at a time of great pain and difficulty (15)--a message of perennial importance for all of healthcare.

In addition to attending to the spiritual needs of the patient, it also is important to remember that, as a person, the patient is a being who exists in relation to others. This understanding lies at the heart of pastoral care, and allows for pain and suffering to be shared and alleviated communally. (16) The human journey is a social one, and not merely because we are social creatures, as Aristotle noted, (17) but also because it is natural for us "to take delight in living together with other human beings," as Aquinas put it. (18) It is interesting to note that Confucian thought, which is also discussed in this issue, (19-21) emphasizes a relational understanding of personhood before one that is constructed upon individual autonomy. While spiritual and pastoral care would certainly do well to learn from medicine's empirical persuasion, Western medical care would do equally well to recall humankind's communal and relational nature: perhaps then the person, rather than the case presentation, also would be seen.

For all its change and growth, medicine--the art of healing--is in many ways still an art, albeit one of an increasingly scientific persuasion. Many patients have benefited greatly from all that science has contributed to medicine and many more will continue to do so. Moreover, it is largely in the achievements of science that humankind can hope to overcome still greater corporeal maladies. However, amid such hype and hope, neither the heart and soul of medicine, nor the who that medicine hopes to heal, should be sacrificed or forgotten. Given the ever-increasing body of knowledge and learning, it is neither practical nor possible for the spiritual and the medical to be once again combined in the same figure. As such, it only makes sense that the two be teamed to treat not diseases but patients--to be reminded of the patient as a person.

References

1. Weaver AJ, Flannelly KJ, Koenig HG, et al. A review of research on chaplains and community-based clergy in the Journal of the American Medical Association, Lancet, and The New England Journal of Medicine: 1998-2000. J Pastoral Care Counsel 2004;58:343-350.

2. Ford T. The development, status, and future of healthcare chaplaincy. South Med J 2006;99:675-679.

3. Snorton TE. Setting common standards for professional chaplains in an age of diversity. South Med J 2006;99:660-662.

4. Common Standards for Professional Chaplaincy. Available at: http://www.professionalchaplains.org/index.aspx?id=207&TierSlicer1_TSMenuTargetID=207&TierSlicer1_TSMenuTargetType=1&TierSlicer1_TSMenuID=1. Accessed May 12, 2006.

5. Gleason JJ. Pastoral research: past, present, and future. J Pastoral Care Counsel 2004;58:295-296.

6. Carey LB, Newell C. Clinical Pastoral Education and the Value of Empirical Research: examples from Australian and New Zealand Datum. J Health Care Chaplain 2002;12:53-65.

7. Broccolo GT, VandeCreek L. How are health care chaplains helpful to bereaved family members? Telephone survey results. J Pastoral Care Counsel 2004;58:31-39.

8. Williams ML, Wright M, Cobb M, et al. A prospective study of the roles, responsibilities and stresses of chaplains working within a hospice. Palliat Med 2004;18:638-645.

9. Handzo GA. Best practices in professional pastoral care. South Med J 2006;99:663-664.

10. Burton L. Chaplaincy is becoming more 'scientific': what's the problem? J Health Care Chaplain 2002;12:43-51.

11. Dodd-McCue D, Tartaglia A. The impact of the Family Communication Coordinator (FCC) protocol on the role stress of hospital chaplains. J Pastoral Care Counsel 2005;59:345-360.

12. Breslow L. A quantitative approach to the World Health Organization definition of health: physical, mental and social well-being. Int J Epidemiol 1972;1:347-355.

13. Association of Professional Chaplains, Association for Clinical Pastoral Education, Canadian Association for Pastoral Practice and Education, National Association of Catholic Chaplains, National Associations of Jewish Chaplains. A White Paper. Professional chaplaincy: its role and importance in healthcare. J Pastoral Care 2001;55:81-97.

14. Kofinas S. Chaplaincy in Europe. South Med J 2006 99:671-674.

15. Cabot RC, Dicks RL. The Art of Ministering to the Sick. New York, Macmillan Co, 1953.

16. Daly CC. The right to life versus the right to live. South Med J 2005;98:851.

17. Aristotle. Nicomachean Ethics. i.1-7.

18. Aquinas T. "Delectabiliter vivere in communi." Summa Theologiae q 114, art. 2 & 1.

19. Tsai D. Eye on religion; Confucianism, autonomy and patient care. South Med J 2006;99:685-687.

20. Lai A. Eye on religion: cultural signs and caring for Chinese patients. South Med J 2006;99:688-689.

21. Visscher C. Eye on religion: understanding the cultural melange in Chinese patients. South Med J 2006;99:683-684.

Conrad Daly, MTH 

From East Tennessee State University, Johnson City, TN.

Reprint requests to Conrad C. Daly, PO Box 70429, Johnson City, TN 37614. Email: [e-mail]