 10/20/2004
Vol. 1, No. 18
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Professional
Practice |
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The
Rev. Stephen
Harding on authority –one’s
own and the community's
Authority
Must Be Shared
Earlier,
I wrote about
the authority
that results
from being ordained
(See issue #17
Professional
Practice). In
addition to the
authority that
comes from G-d,
there are two
other sources
of authority –one
from within oneself,
and one that
the community
gives. I write
this time about
the authority
that comes from
within.
When
I supervised
chaplain interns
at the hospice,
we would invariably
have a conversation
about authority –theirs.
As a result of
these conversations,
which never failed
to move me, I
eventually discovered
the biblical
Greek word for
authority: exousia [1].
I understand exousia to
consist of the
prefix ‘ex’–‘out
of’, and ‘ousia’–‘substance’or ‘essence’.
Authority for
me comes, in
part, out of
one’s own
essence or substance,
and that, for
me, is linked
with responsibility:
I have the authority
to act because
I as priest and/or
man, am responsible
for preserving/changing/advancing/taking
care of whatever
situation I am
in.
Looking
more closely
at my own authority
in my vocation
as priest, I
have authority –which
is different
than power (dynamis in
biblical Greek –‘force’) –in
the situations
in which I am
responsible to
G-d, responsible
to myself, and
responsible to
others. As a
Hospice Chaplain,
my authority
to act grew out
of my responsibility
to help the person
die well, as
defined by that
person. This
sometimes took
the form of being
the conscience
for the multi-disciplinary
team providing
care, sometimes
being the patient
or family’s
advocate, sometimes
helping the physicians
to change the
medical goals
of care, and,
sometimes, being
with the person
as they died.
The
other source
for authority
is that which
the community
gives one. Because
of who I am and
because of my
relationship
with G-d, part
of my function
is to be a vehicle
through which
other people
can deepen their
own relationships
with the Divine –to
pray the space
- and so, in
a sense, part
of my authority
is given to me
by the community
that I am in
to continue to
deepen my relationship
in G-d and to
function as priest
in their community,
whatever that
hospital, institution,
or parish community
may be.
In
the hospital
the patients
and staff give
me the authority
to be their Chaplain.
There is an implicit
relationship
as soon as I
walk in the room:
They are my congregants,
and I am their
priest for as
long as they
are in the hospital.
Without their
consent, I have
little authority
to act. When
I talk with parishioners,
they give me
the authority
to listen, respond,
pray, and bless.
When I’m
with members
of the Fire Department,
they give me
the authority
to bless them,
bless the apparatus,
and to keep them
in my prayers.
In
my vocation,
because my authority
comes from three
sources (G-d,
from within myself,
community), my
authority cannot
help but be shared –because
I must remember
and recognize
that I am in
a multivalent
set of relationships
that permits
me to function
as a conduit
for G-d.
[1]
Matthew 21:23-27;
Mark 11:27-33;
Luke 20:1-8 (NRSV);
Young’s
Analytical Concordance,
22nd American
Edition, Revised,
Eerdmans, Grand
Rapids, 1970,
p. 63.
The
Reverend Stephen
Harding, S.T.M.,
BCC, is an Episcopal
Priest serving
as the Chaplain
for the Department
of Pain Medicine
and Palliative
Care at Beth Israel
Medical Center
in New York City,
a HealthCare Chaplaincy
partner. He is
also the Priest
Associate for the
Healing Ministries
at the Church of
the Epiphany in
Manhattan.
Do you have thoughts
about professional
practice you’d like
to share with your
colleagues? Send
an e-mail info@PlainViews.org.
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Advocacy |
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Frederick A. Smith, MD, on establishing
a pastoral care department at a large
metropolitan hospital
Persuading
a Budget-Balancing Administrator
to Invest in
Non-Revenue-Producing, Full-Time Clinical Chaplains
Dennis Dowling is a
well-known hospital administrator
who measures by results, and whose
compliments must be earned. So I
was moved and gratified when, one
year after its inception, he called
me on my direct line to thank me
for my role in helping to bring Clinical
Pastoral Care and its director, The
Rev. Jon Overvold, to North Shore
University Hospital in Manhasset,
New York.
Bringing clinically trained chaplains
to North Shore didn't seem like a
slam-dunk idea when the directors
of social work and volunteer services
first identified it as a pressing
need in early 2000. When they spoke
to Mr. Dowling, he reasserted the
hospital's longstanding policy that
chaplain services were a responsibility
of the religious organizations in
the community, and not something
the hospital should pay for.
As a physician interested in the
interface between religion and medicine,
I joined these and other advocates
in an ad hoc effort to make the case
that the hospital should hire a full-time
CPE-trained chaplain. Our written
proposal described specific vignettes
to illustrate how many in-patients’spiritual
needs could not possibly be met by
clergy not prepared for cross/un-traditional
spiritual counseling, including:
•Religious people following
religious traditions different
from the faiths traditionally dominant
in our community and hospital;
•Individuals whose anger, doubt, guilt or other experiences put them in
ambivalent tension with their faiths of origin;
•and patients indifferent or hostile to "organized religion" who
nonetheless wrestle with existential/spiritual issues of meaning, value, relationship,
and remorse.
The proposal elicited no immediate
response from administration. But
about six months later, its advocates
were invited to an administration
meeting with The HealthCare Chaplaincy
representatives. Despite Mr. Dowling’s
aversion to out-sourcing, he was
impressed enough to ask us to phone
numerous hospital administrators
in our area, who were almost uniformly
enthusiastic about the benefit that
The HealthCareChaplaincy’s
clinical-chaplain staffing had brought
to their organizations.
With self-conscious chutzpah, we
proposal writers pushed beyond our
initial recommendation for a single
chaplain, and requested two. To our
surprise, Mr. Dowling decided on
budgeting for three positions, including
a certified ACPE supervisor to extend
the program’s reach.
Pastoral Care at North Shore has
come a long way since then. Having
concluded two sessions of training
CPE interns, our three-member pastoral
care department has added to its
training program two paid residents
and an ACPE-supervisor-in-training
for 2004-5, with the full support
of hospital administration.
No doubt there are patient-care
advocates at other hospitals who,
like us, have been only faintly hopeful
that they can persuade a budget-balancing
administrator to invest in non-revenue-producing,
full-time clinical chaplains. What
can we recommend to them?
First and foremost, do some gentle
and respectful education:
1) Explain the difference between
clinically trained chaplains and
regular clergy who do not have
this training, whether they are
in the hospital all the time or
not.
2) Demonstrate very specifically
how the lack of such clinical chaplains
•leaves a large number
of patients in the cold with
respect to spiritual care;
•makes it almost impossible to effectively identify and manage spiritual
conflict and suffering on the wards;
•forfeits opportunities both to enhance compliance with standard medical
care, and to enhance healing that goes beyond mere physical cure;
•and deprives health care workers and administrators of a unique source
of comfort and spiritual support when they too suffer from daily losses and threat
of burn-out in the hospital.
•(But don’t threaten a citation on the next JCAHO review; such threats
tend to get an administrator’s back up.)
Second, be prepared to do the leg
work, make the phone calls, and document
the experiences of administrators
who support clinical pastoral care
departments at other institutions.
Third, point out the benefit to
the hospital itself in increased
appreciation from patients, families
and community, and in improved morale
for clinicians whom trained chaplains
have helped to fill in that too-often-missing
wedge (or substrate?) in the circle
of healing —the spiritual and
existential comfort of faulty mortals
who, overtly or covertly, fear the
suffering, separation and extinction
threatened by physical illness.
Frederick A. Smith, MD, is Senior
Associate Chief of the Division of
General Internal Medicine at North
Shore University Hospital (Manhasset,
NY), where he is involved in care of
both insured and indigent patients,
and teaches residents in medicine.
He has precepted a course on “Spiritual
and Palliative Medicine,”and
has lectured on the epidemiological
and clinical literature about the effects
of religious observance on health.
With the Rev. Frances Carr, then-director
of pastoral care for Hospice Care Network,
Dr. Smith led a workshop on physician-chaplain
collaboration at the 2003 EPIC meeting
in Toronto.
Do you have thoughts about advocacy
you’d like to share with your colleagues?
Send an e-mail to info@PlainViews.org.
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Education & Research |
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The Rev. Larry Austin
on contextual spiritual
issues in the medical
treatment process
Hospitals
are Not Houses of
Worship
Research on spirituality,
religion and faith has
been on an explosive
developmental trajectory
for the last few years. “Spirituality’s
meanings and definitions
depend upon the training
and experience of the
people who do the writing,”[1]
which should lead to
one immediate contextual
concern for theologically-oriented
writers. Authors such
as Boisen, Oates, Young,
Cabot, Gerkins, Hitlner,
Klink, Dunbar, Wise and
others—all familiar
names to chaplains—are
rarely mentioned by secular
writers. [2] Thus the
debate over spirituality
in medicine makes agreement
on even simple functions
and definitions problematic.
Contextual [3] issues
of community and institutional
ministry are equally
important in the function
and practice in ministry.
There are numerous issues
to consider but in the
brief format of this
article only a few can
be mentioned. Consider
the following:
 Hospitals
are not houses of worship,
perhaps the most simple
and complex issue of
all. The ‘house
of worship’has
as its basic purpose
the worship of a deity,
and the making of disciples.[4]
To make disciples of
one’s faith,
many religious organizations
expect faith members
to attract members
to their particular
faith even if they
belong to another tradition.
Hospitals
have an altogether
different contextual
goal; treatment of
the patient. Treatment
may be curative or
palliative. Individual
Departments of Pastoral
Services along with
professional pastoral
care organizations
[5] adhere to a very
strict code of ethical
behavior that prohibits
evangelizing and proselytizing
of patients in the
hospital complex.
A second contextual
issue is, in Christian
traditions, the baptism
of Infants, which for
some is a cherished church
tradition. The child
is born and brought before
the congregation and
baptized into the fellowship
of the religious faith
group. Even those of
the Anabaptist tradition
perform child blessings
or dedications to ensure
the congregational recognition
of the child and family
in the life of the particular
church.
In the hospital the
call to baptize an infant
often has more to do
with the grief of parents
and staff over the loss
or death of an infant,
than the baptism into
the membership of a specific
church. [6]
Community clergy are
leaders of a specific
denominational group
and the majority of their
function centers around
the leadership of worship.
The hospital chaplain
is also clergy, but works
as an employee in an
institution, which may
be secular. The chaplain
has specialized skills
and training and works
to deliver pastoral/spiritual
care. Many chaplains
lead worship in hospitals
but spend the great amount
of their time and energy
in pastoral care and
its related functions.
The community congregation
is made up of people
who are mostly a homogeneous
group of believers of
a similar faith. If you
visit a Baptist church
you will find mostly
Baptists there. In the
Hospital, religious affiliation
varies a great deal and
there is much more of
a religious heterogeneous
mixture.
The practice of the
sacrament of the Eucharist
in the hospital has lately
been under scrutiny,
not from religious authorities,
but from hospital Infection
Control Committees. The
sacrament practice in
the church may be debated
theologically and managed
according to practice,
meaning, value, participation
method and other issues.
It is only in the context
of the hospital that
infection control committees
manage or may even limit
the practice of the sacrament.
Contextual issues in
spiritual care abound
and they affect the function
and practice of ministry
in ways we are just beginning
to explore. Many of those
contextual expectations
and practices are unconscious
but serious discussion
and reflection is needed,
if we are to envision
a valid and unique chaplaincy
for the 21st Century.
[1] Frank Moyer, Chaplaincy
Today, July August 1998.
[2] Larry Austin, Spirituality Rediscovered, Guest Editorial, Journal of Pastoral
Care and Counseling,
[3] Special appreciation is noted here for Mark Larocca-Pitts for his reflections
and discussion on the pastoral care list serve on context and Chaplaincy.
[4] Church is used in this paper as basically an Evangelical Christian representation
but may have implications for other faith groups)
[5] ACPE, Association of Clinical Pastoral Education, APC, Association of Professional
Chaplains; AAPC, American Association of Pastoral Counselors; NACC, National
Association of Catholic Chaplain; NAJC, National Association of Jewish Chaplains.
[6] Note: The author acknowledges that these are not universally held practices.
The
Rev. Larry Austin , D.Min.,
is a Board Certified Chaplain,
ACPE Supervisor; and serves
as the Director of Pastoral
Services of Pitt County
Memorial Hospital, University
Health Systems of Eastern
Carolina in Greenville,
NC.
Do you have thoughts
about education & research
you’d like to share with
your colleagues? Send
an e-mail to info@PlainViews.org.
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Spiritual
Development |
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The Rev.
Barbara Crafton on the
experiment of group spiritual
direction
Group
Spiritual Direction –How
Did It Go?
Editor’s note:
Rev. Crafton wrote
a two-part article
in issues 1 & 2
of PlainViews about
starting Group Spiritual
Direction –a
new area of exploration
in spiritual direction.
Here, Rev. Crafton
writes about the outcome.
It was an experiment
in response to a need:
can people's need for
spiritual direction be
met through the creation
of a consistent, committed
group facilitated by
one spiritual director?
Will the result of such
dilution of the experience
lead to "spiritual
direction" no longer
being an accurate term
for it?
The HealthCare Chaplaincy in New York City offered an experience in Group Spiritual
Direction, and about 25 people responded – too many for one group, so we offered
two. Participants were asked to commit to attending the six sessions in the
first period. The format was always the same: brief introductions, an hour's
presentation and discussion of some topic relating to spiritual growth chosen
beforehand – journaling, prayer discipline, dream analysis, confession, centering,
and many other topics – and then a 45-minute "peer pairs" experience:
the group breaks into pairs (never the same pair twice in a row) and practice
intensive listening and thoughtful responding by turns. A brief closing prayer
ends the evening, promptly. The entire exercise takes two hours.
Very early, three who were unable to commit to the six months revealed that
fact by disappearing, leaving two committed groups of people who came to know
each other well and to enjoy a deep level of sharing and peer support. The
structure seemed to work well in accomplishing two things one wants from spiritual
direction: actual transmission of information and encouragement in spiritual
practices, and the incomparable gift of another listening heart.
At the end of the six months, enough people from the two groups wanted to continue
the experience that we decided to combine the two groups into one – a risk,
since considerable bonding had occurred in each. But the structure, familiar
to both groups, provided a sufficient bridge into the new group configuration.
The new combined group is the same size as each of the two previous groups,
twelve people.
One clergyman attended a session of one of the groups, finding it a good model
for him. But he also found himself unexpectedly inhibited by his Orders – unfree,
in a way, to speak his mind, and expressed the wish that there were a similar
group for clergy only. We are at this time setting about creating such a group,
which will meet at a church in Westchester County.
The good? More people find a place of mutual support and exposure to the wisdom
of the spiritual life as transmitted throughout the history of the faith. They
learn a listening technique useful in any setting. A close-knit community is
formed.
The bad? There is less suggestion of specific prayer practices for specific
people's needs than there would be in classic one-on-one spiritual direction.
Though the group practices a policy of strict confidentiality, there are times
when a closer confidentiality with one spiritual director is needed.
The test? Of the members of the group, twelve in number, three are in classic
spiritual direction as well. All the others seem, for the present, to be meeting
this need through the group.
The Rev. Barbara Crafton
is a spiritual director,
an author, and director
of The Geranium Farm, an
organization dedicated
to providing innovative
ways to support people
in their spiritual journeys.
Do you have
thoughts about spiritual
development you’d like
to share with your colleagues?
Send an e-mail of any
length to info@PlainViews.org. |
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EthicsWalk |
EthicsWalk addresses
spiritual
care as
an ethical
enterprise.
It explores
why relationships
between
spiritual
care providers
and those
they serve
need protection,
and examines
what that
protection
entails. PlainViews invites
our readers
to share
their responses
to each EthicsWalk column,
which will
be published
in the
following
issue.
If you’d
like to
respond
to EthicsWalk,
please
send a
comment
of no more
than 100
words.
You can
use the
e-form
below (click
on "hearing
from you," link)
or submit
your commentary
to the
editors
in the
body of
an e-mail
(or as
a Microsoft
Word attachment)
sent to Info@PlainViews.org.
Please
put the
phrase
“EthicsWalk”
in your
subject
line.
We look forward to hearing
from you.
Professional
Power:
Claim
It,
Own
It!
Ethics
codes and
work place
polices
encourage
recognition
and responsible
use of
professional
power.
Religious
professionals
especially
must be
ever mindful
of power
imbalances created
by the
expectations
and realities
of ministerial
relationships. Fiduciary
duty requires
ministers
act solely
in the
best interest
of persons
in their
care.
Fiduciary
duty applies
to the
treatment
of another’s
financial
concerns,
private
information,
employment
issues,
emotional
needs,
psychological
state,
sexual
desires,
or religious
quest. Professionals
who transgress
their duty
in one
area often
transgress
other areas.
Their problem
is handling
power responsibly.
Power
does not
exist in
a vacuum.
Power is
relational,
and in
itself,
is neither
good nor
evil, but
morally
neutral.
Most adults
possess
some degree
of personal
power,
with varying
manifestations,
in most
relationships.
Among
adults
in family
and friendships,
there is
mutuality
of power.
Each person’s
power,
although
different,
balances
that of
the other.
While people
defer to
the knowledge,
expertise,
or skills
of friends
or family
in some
aspects
of life,
those same
relatives
or friends
defer to
them in
other aspects.
There is
mutuality
of need
and reciprocity
of response.
Power differentials
shift within
situations
but remain
overall
in balance.
In
professional
relationships,
the balance
is upset. There
is, hopefully, “mutuality”of
consent
to the
relationship.
But there
is not
mutuality
of access
to information
about each
other:
the physician
does not
bear her
chest for
the patient
to examine;
the lawyer
does not
open his
financial
records
for the
client
to review.
The professional
has the “power”of
expertise
and the “power”of
knowing
the other
person
in ways
which are
not reciprocal.
In
addition
to real
power differential,
most people ascribe power
to the
professional
whether
or not
the professional
has actual
power in
a given
encounter.
This is
particularly
true for
clergy
and other
ministers
of all
faith traditions. Numinosity is
the kind
of “transcendent,”“connected-to-the-Divine”power
ascribed
by laity
of all
faith traditions
to their
ministers
or religious
teachers
and leaders.
“I
don’t
feel
all-powerful.”“I’m
an over
burdened,
multi-tasked
employee
of a
giant
health
care
provider,
and anyway,
I regard
everyone
as my
equal.”
Ethicist
Marie Fortune
says the
legacy
of liberalism
is the
denial
of power
and power
differentials
by those
who have
it. The
person
with power
earnestly
proclaims, “this
relationship
is based
on mutuality,
equality.”But
who sought
whom for
guidance?
If money
is exchanged
for services,
who is
paying
and who
is being
paid? The
chaplain
is paid
for contact
with the
patient;
not the
reverse.
Acknowledging
power differences
inherent
in chaplaincy
relationships,
allows
people
safely
to form
and sustain “spiritual
bonds,”while
being mindful
of the
here-and-now
realities
of power
imbalance.
Two
ethical
questions
emerge:
-
How
does
one recognize,
own,
value
and use
wisely
one’s
power
while
remaining
fully
human
and non
arrogant
in a
professional
relationship? and,
-
How
does
one use
one’s
own needs
and abilities
to benefit
and compliment
the needs
and abilities
of the
other?
These
questions
introduce
the issue
of “boundaries,”to
be discussed
in the
next EthicsWalk.
Anne
Underwood
has an
undergraduate
degree
in religious
studies,
a master’s
degree
in rural
sociology
and a mid-life
law degree
obtained
after working
over a
decade
as a college
administrator.
She has
mediated
for the
Maine family
courts
since 1983.
Currently
she serves
as an advisor
to the
ethics
commissions
of ACPE,
APC, the
CCAR (Central
Conference
of American
Rabbis),
and NAJC,
and consults
with a
variety
of Protestant
faith communities
on issues
of power,
fair process,
and congregational
conflict
management.
Her articles
on mediation
and restorative
justice
have appeared
in the
ACPE News,
The APC
News and
on the
ACPE web
site. Articles
on clergy
accountability
and judicatory
processes
are published
by the
Alban Institute
and The
Journal
on Religion
and Abuse. A
chapter,
“Clergy
Sexual
Misconduct:
A Justice
Issue,”
appears
in Body
and Soul:
Rethinking
Sexuality
as Justice-Love,
Marvin
Ellison
and Sylvia
Thorson-Smith,
editors,
The Pilgrim
Press,
2003.
|
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|
Reviews |
The
Rev. Stephen Harding
on authority –one’s
own and the community's
Authority
Must Be Shared
Earlier,
I wrote about the
authority that results
from being ordained
(See issue #17 Professional
Practice). In addition
to the authority
that comes from G-d,
there are two other
sources of authority –one
from within oneself,
and one that the
community gives.
I write this time
about the authority
that comes from within.
When
I supervised chaplain
interns at the hospice,
we would invariably
have a conversation
about authority –theirs.
As a result of these
conversations, which
never failed to move
me, I eventually
discovered the biblical
Greek word for authority: exousia [1].
I understand exousia to
consist of the prefix ‘ex’–‘out
of’, and ‘ousia’–‘substance’or ‘essence’.
Authority for me
comes, in part, out
of one’s own
essence or substance,
and that, for me,
is linked with responsibility:
I have the authority
to act because I
as priest and/or
man, am responsible
for preserving/changing/advancing/taking
care of whatever
situation I am in.
Looking
more closely at my
own authority in
my vocation as priest,
I have authority –which
is different than
power (dynamis in
biblical Greek –‘force’) –in
the situations in
which I am responsible
to G-d, responsible
to myself, and responsible
to others. As a Hospice
Chaplain, my authority
to act grew out of
my responsibility
to help the person
die well, as defined
by that person. This
sometimes took the
form of being the
conscience for the
multi-disciplinary
team providing care,
sometimes being the
patient or family’s
advocate, sometimes
helping the physicians
to change the medical
goals of care, and,
sometimes, being
with the person as
they died.
The
other source for
authority is that
which the community
gives one. Because
of who I am and because
of my relationship
with G-d, part of
my function is to
be a vehicle through
which other people
can deepen their
own relationships
with the Divine –to
pray the space -
and so, in a sense,
part of my authority
is given to me by
the community that
I am in to continue
to deepen my relationship
in G-d and to function
as priest in their
community, whatever
that hospital, institution,
or parish community
may be.
In
the hospital the
patients and staff
give me the authority
to be their Chaplain.
There is an implicit
relationship as soon
as I walk in the
room: They are my
congregants, and
I am their priest
for as long as they
are in the hospital.
Without their consent,
I have little authority
to act. When I talk
with parishioners,
they give me the
authority to listen,
respond, pray, and
bless. When I’m
with members of the
Fire Department,
they give me the
authority to bless
them, bless the apparatus,
and to keep them
in my prayers.
In
my vocation, because
my authority comes
from three sources
(G-d, from within
myself, community),
my authority cannot
help but be shared –because
I must remember and
recognize that I
am in a multivalent
set of relationships
that permits me to
function as a conduit
for G-d.
[1]
Matthew 21:23-27;
Mark 11:27-33; Luke
20:1-8 (NRSV); Young’s
Analytical Concordance,
22nd American Edition,
Revised, Eerdmans,
Grand Rapids, 1970,
p. 63.
The
Reverend Stephen Harding,
S.T.M., BCC, is an
Episcopal Priest serving
as the Chaplain for
the Department of Pain
Medicine and Palliative
Care at Beth Israel
Medical Center in New
York City, a HealthCare
Chaplaincy partner.
He is also the Priest
Associate for the Healing
Ministries at the Church
of the Epiphany in
Manhattan.
Do you have thoughts
about professional practice
you’d like to share with
your colleagues? Send
an e-mail info@PlainViews.org. |
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