Following our daughter's death in December of 2003, Phil Pinckard reached out to me with not only a colleague's concern, but the profound sadness that only a another parent who has experienced the loss of a child can know. His willingness to walk with me in the journey of making sense and finding hope out of tragedy was powerful and I am grateful beyond words. Phil's piece on "Organ Donation –a Miracle Out of a Tragedy" gives a powerful witness to the love he has for his son. The passion that both Phil's son Mark and our daughter Sarah had for donation has left me humbled and grateful for the opportunities both our families had to give the gift of life to others as our children so desired. As chaplains, many of us work daily with organ and tissue donation issues, not truly realizing the impact such a decision makes not only for the recipients, but for those willing to make that most precious gift at a time when the world seems to be crashing in around them. My hope is that Phil's article will renew in each of us the passion that Mark and Sarah shared for giving the gift of life through donation, and that as we walk with others who make that choice we realize we are truly walking on holy ground.

Sue Wintz, BCC
Phoenix, AZ

(Editor’s note: As a practice, comments made by PlainViews readers are sent to the author in case the author wants to respond directly to the person commenting. We received this response from Phil Pinckard to Sue Wintz’s comments)

Martha:
Thanks so much for sharing Sue's e-mail. Her sentiments brought fresh tears to my eyes and a yearning in my heart for both Mark and Sarah. I'm convinced that offering the donation option is very much like witnessing: We are charged with responsibility for sharing the story; not for the results. Two weeks ago, while on call at my CPE setting, a 14 year old male was brought to ER, having been fatally wounded in the head. A large caliber bullet was lodged in the center of his brain. Several of us, including the in-house organ donation coordinator, worked with the family. The mom alternated between consent and declining ... and ultimately decided to decline. The in-house coordinator was discouraged, knowing of a 14 year old in our nearby Children's Hospital who will die without a heart transplant. All we can do is faithfully present the options and leave the results to God. Sadly, that grieving mom will never know the comfort that Sue and I share, because we chose to become donor parents!
Blessings,
Phil Pinckard

Is anyone aware of work that has been done on healthcare providers who are engaged in spiritual assessment? It seems to me that in order for them to be able to understand spiritual assessment more thoroughly, they need to participate in some sort of spiritual assessment themselves. If any work has been done in this regard, what was the methodology, results, etc.?
James D. Witherington, Jr.
Chaplain Coordinator
Skyline Medical Center
Nashville, TN

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Re: Establishing a Pastoral Care Department at a Large Metropolitan Hospital, Frederick A. Smith, MD (PlainViews, 10/20/2004, Vol. 1, No. 18)

Dr. Smith's article on advocacy for Spiritual Care is joyful music indeed! I hope that his colleagues in the medical profession echo his enthusiasm and support in this regard. I would like to share with you a note I received from one of our cardiologists this week. I had been in the Coronary Care Unit to visit a patient and could sense that things were pretty hectic. I had a very brief consult with this physician and when I left the unit I sent him an e-mail indicating that I was sending him, the patients and families and staff prayers and spiritual energy. A day later I received back his response:

" Wow!....God is Awesome and so are you!...I don't know why I'm surprised by this, but I know God forgives me for my short memory of His love for us...On Friday morning, just prior to our conversation in CCU, I had a barrage of nurses coming to me, all with bad news about new developments with many patients. I must admit, I was starting to feel a bit overwhelmed and was thinking...I need to get away to a corner somewhere to refocus and pray, but there was NO TIME!...I didn't realize it until late on Friday, as I was going home, but the Holy Spirit must have heard my angst or spirit groaning and sent YOU to CCU to PRAY FOR ME, cuz I couldn't...as my day sped along. After speaking with you I could sense an element of peace that embraced me, tho I never really did get a chance to duck into a prayer "closet" per se. That peace floated me along all day... praise God...and you for having heeded His direction to CCU...Wow!...."

I hope this note is of some encouragement to hospital chaplains everywhere.
Blessings to all,
Diane Bridges, D.Min.
Director of Spiritual & Religious Care
Trillium Health Centre
Mississauga, Ontario, Canada

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Re: Contextual Spiritual Issues in the Medical Treatment Process, The Rev. Larry Austin (PlainViews, 10/20/2004, Vol. 1, No. 18)

In his article "Hospitals are not houses of worship," Larry Austin writes, "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."

A related issue that we have faced is that of requests for baptism of healthy babies. Requests of this nature usually come from parents who have no local church affiliation. Another instance is if extended family members are here from out of town, and the parents request baptism before the relatives have to leave. In either case, my understanding of baptism of a healthy infant is that it belongs in the context of worship, where the child is welcomed into the faith community. The hospital chaplain may be more convenient, but as Larry Austin writes, hospitals are not houses of worship.

In the case of the unaffiliated, our practice is to decline the request, encourage the parents to consider their understanding of baptism, and suggest that they find a congregation. While they may be unhappy with this response, it may ultimately be the motivation they need to explore their own spirituality.

In the case of the parents who are connected to a congregation, we refer them to their clergy person. I relate to community clergy as colleagues, and good professional practice is to avoid triangulation. A number of years ago a chaplain at our hospital agreed to perform the baptism of a healthy baby, only to discover later that he had been used. Their pastor called and told us that he had contacted the family to offer his congratulations upon the birth of their child, and to schedule the baptism education class. The parents told him they didn't need the classes because their baby had already been baptized by the hospital chaplain. The pastor complained that he needed our support, not for us to be undermining his ministry.
This is not suggest, however, that there is nothing we can do for the families of healthy babies. A reasonable alternative in most cases is to offer a ritual of naming and blessing. We gather at the bedside or in the hospital chapel, read scripture, say a prayer of thanks for the birth of the child, and give a blessing to the baby, parents, and other supportive family and friends.

Russell N Myers, D.Min., BCC
Chaplain, United Hospital
St. Paul, MN

I served two hospitals for 17 years and a time of prayer and a time of worship was available for patients, families or staff. Those who chose to come, came. There were invitations but no proselytizing. It is possible to do an interfaith Christian service and, if there is enough of another faith tradition, bring in a rabbi or other clergy to provide it. To me the worship aspect if divided into gathering, Word, Sacrament, and sending (see Marty Haugen and Susan Briehl for this division) focused more on the Word and sending out of the Word. Very rarely –and in concert with infection control- we offered communion. But inviting people into relationship with God through worship was my goal –no different on an individual level of inviting them into relationship with God through prayer. As important as the Eucharist is, the voiced need was for spoken Word and prayer. Sending people out in mission as a patient makes sense when you hear pastoral volunteers say, ‘I got more out of the visit than I gave.’There goal was not to receive more but they often did. Staff in mission, families in mission –all sent out in an environment that is one big mission though broken out into many small individualized ones. I always used confession/ absolution in gathering even though I was in a high percentage Baptist environment for whom formal confession is not often used-at least in West Texas. But it was there as an opportunity to say, ‘I’m sorry”to God each week. In our other hospital –a rehab hospital –I remembering many times as we sung the song, Worthy is Your Name, the verse: “When I fall down, You pick me up. When I am dry You will my cup.”I could think of the struggle patients had in learning to do anything again and the therapists ‘picking them up’as God picked up their spirits. In all twenty years of hospital ministry, worship without including discipleship or regular Eucharist, was an essential part of my ministry.

Dr. Alan Williams, BCC
Pastor
Calvary Lutheran Church
San Angelo, TX

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Re: Bad Theology, Chaplain David Plummer (PlainViews, 10/6/2004, Vol. 1, No. 17)

Plummer is right on target, but he opens a "can of worms" concerning revisions in Political Correctness. I think we have passed the time when we can only make positive comments about prevailing values in minority groups (after all, we are all minorities, depending where you look). Haven't we come to the time when those who are not members of the racial, religious, or other group can raise questions (publicly) about the values evident in other groups that are not helpful to their community or the wider community? (OK, if you ask for an example, let's ask Hispanics whether their lower priority on education is getting them where they want to go when 50% of their kids drop out of high school in public schools –and, yes, while asking the schools to be accountable.)

Or can we get over the sentimentality that argues against racial profiling when we know full well that little old WASP ladies in airports don't really have to be fully searched for weapons; or, conversely, when we know 66% of all car thefts are perpetrated by young black men between the ages of 18 and 25? It is said that the truth will set us free, but why are we so afraid of the truth if it can be balanced by another truth that every one of a certain culture does not necessarily conform to a particular harmful value manifested by a significant segment of that culture? Isn't it time to "speak the truth in love?"

Plumber, it seems to me is on the right tract, but it has much broader implications.

Rev. John Twiname
Life Trustee
HealthCare Chaplaincy
New York, NY

 

The writer asks us to send in our approaches to the so-called "bad theology" towards death and dying often displayed by leaders and members of groups he labels as "Pentecostals and Charismatics."

First, what are his challenge, tact and approach when he sees this "bad theology?" This was not revealed by the author and I, for one, would truly like to know.

Second, bad theology occurs in every religious and even non-religious community, in particular towards death and dying. It is almost always an extremely painful moment for the living who simply want anything but death to occur to their loved one. The fact that Pentecostals and Charismatics make that pain obvious to us in what might seem uncouth or embarrassing ways (prayer warriors, etc.) doesn't make them any more (or the rest of us any less) susceptible to bad theology about dying.

Third, I agree with the author that hospitals everywhere are buckling under the weight of rising costs, particularly in aggressive care for life-threatening scenarios. However, I'm not sure that it's the responsibility of chaplains to address this endemic problem. Nor am I sure it's effective when done on a one-to-one basis. It isn't bad theology that doctors fear, but rather upset families striking back at death through lawsuits. This is what propels them to continue care long after it's clear to them the process is futile.

My own approach as an emergency and intensive care chaplain is to model calm in the face of the chaos that traumatic death represents. This, not corrective speech, seems to help families most when it comes to facing death in some of its more difficult presentations.

Marilyn Morris, M.Div.
Staff Chaplain
Riverside Methodist Hospital
Columbus, Ohio

I was standing in PICU, just after 2:00 A.M., when a well-meaning visitor approached the cubicle. The mother of the dying 5 year old was in deep distress and was channeling all her energy into straightening the bedclothes, checking her daughter’s port, suctioning the child’s mouth. She moved incessantly. When her friend walked in, she was only half focused on what was being said, until the woman blurted, “You have to understand –G-d loves your baby more than you do.”In the shocked silence that followed, I debated whether to strangle the outsider, or escort her from the room. But before I could act, this 5 foot 1 inch mother stretched herself to full height, and began to scream. “How dare you? How could you? Why would you think ANYONE could love my sweet little girl more than I?”

In every CPE class I ever took, we were hammered with the notion that “it’s not About Us –it’s about the patient,”and clearly in the example above, the “bad theology”did nothing to comfort or sustain the mother at a time when she needed it the most. Therefore, in my role as chaplain to the patient and her family, I would have to be the “buffer-in-the-moment,”isolating the woman from her friend with poor judgment.

I have witnessed a good deal of theological rhetoric imposed on patients and staff; some of it I might have agreed with, some has made me livid. The true gauge is the response of the patient. If the pastor/rabbi/imam/priest/laychaplain is self-serving to the detriment of the one s/he is chaplaining, then I would find ways to limit that person’s exposure to patients, in as diplomatic but firm a manner as possible. Sometimes, people hear the platitudes or bad theology in ways I could not imagine, and are comforted by those words. If it works, who am I to judge? If it doesn’t, show the offenders the door.

As a staff chaplain, regardless of the fact that I am both a Jew and a rabbi, I need to serve all the people with whom I come into contact, even those with whom I differ theologically. As a rule of thumb, I aspire “to first, do no harm.”Then each of us, with our own unique gifts, can offer our patients/clients/residents the best of our healing words and rituals, to bring G-d’s presence in the room.

Rabbi Shira Stern, Director
The Center for Studies in Jewish Pastoral Care
HealthCare Chaplaincy
New York, NY

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Re: Healthcare as Context for Theology of Healing: A response to the Bad Theology of some clergy, Chaplain Daivd Plummer and Hospitals are not Houses of Worship, Rev. Larry Austin (PlainViews, 10/6/04, Vol 1, No.17 and PlainViews 10/20/04, Vol. 1, No. 18)    

A scheme for framing the issues raised by Plummer is incipiently present in Austin’s article. Austin adroitly argues that what works in a house of worship may not work in the healthcare context. This holds true for ministry as well as for theology: what makes theological sense in the comfort of a quiet sanctuary may make theological nonsense in the chaos of a health crisis.

For our discussion, two stipulations are important. The first stipulation is that our language must reflect the healthcare context and not the “house of worship”context. Our language will be couched in terms of clinical ethics (autonomy, beneficence, nonmaleficence, and justice) and in terms of contributing outcomes. The second stipulation is that we develop an overarching criterion for evaluating theologies as they apply to various clinical-specific and patient-specific situations.

Respecting autonomy is the hallmark of chaplaincy practice: patients have the right to their beliefs and we chaplains are present to journey with them. Confronting bad theology, however, may require a preference for beneficence, nonmaleficence, and/or justice. Healthcare professionals often favor one of these at the expense of autonomy if the overall consideration points toward some agreed upon health-related outcome. As healthcare professionals, chaplains also have the authority to question patient autonomy if confronted with a non-beneficent and maleficent theology. Our authority, however, must be based on some "agreed upon health-related outcome."

One possible criterion for evaluating a theology is “Does it contribute to the patient’s healing?”This criterion enables us to distinguish the important differences between healing versus curing. We would also be able to support this criterion with our spiritual assessments, as in the following:

Does the patient’s faith include healing?
Does the patient value healing as a desired outcome?
What does this patient understand as constituting healing (in body, mind, soul and spirit)?
Does the patient’s faith function to facilitate healing?
Does the patient’s faith on healing create cognitive dissonance or anxiety in light of the patient’s health-related crisis?
Does the patient’s understanding of healing differ radically with the more probable medical outcomes?
Does the patient’s need for healing also include healing within his or her relationships (with self, God, others, nature, ideas)?
Can the patient’s faith be discussed in terms of clinical ethics?
Can highlighting an ethical principle other than autonomy contribute to the patient’s healing?

Utilizing this assessment, we can discern if the patient’s theology is contributing to the patient’s desired outcome of healing. These categories also provide a significant framework for discussing with patients how their theology facilitates healing in their particular health-related situation.

Chaplains have honed a theology of healing in the crucibles of medical crises. We, more than physicians, local clergy, and academic theologians, must understand what contributes to the patient’s healing from the perspective of theology. Just as physicians know what might work best clinically for a particular patient situation, it is crucial that we discover what works and does not work theologically for any given patient situation.

Mark LaRocca-Pitts, M. Div., PhD.
Staff Chaplain, Athens (GA) Regional Medical Center,
Adjunct Professor in Religion, University of Georgia,
Pastor, Cherokee Corner UMC

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Re: The Authority to Act, The Rev. Stephen Harding (PlainViews, 10/6/2004, Vol. 1, No. 17)

Thank you for your thoughtful, beautiful words regarding both vocation and ordination. I was able to finally describe to my colleagues what it is that I do, and why. They keep trying to put me in their 'job' mode and it's different. When I've used vocation, they say, but you aren't a nun! No, but...this is indeed a calling and it is who I am. It is not a nine to five, monday thru friday 'job.' I thank you for helping me verbalize my vocation. And now your article on ordination strikes a nerve. I struggled with being ordained for over a year and a half, and finally came up with similar thoughts (had help with a spiritual director and a mentor); again some felt ordination meant being called out and 'above' others, as THE pastor, THE reverend, and I was never comfortable with that. For me it did mean saying yes to God and following wherever I was led, even though I preferred to stay and home and do the comfortable things I knew. So, of course, I've been called out to duties I am not comfortable with and have grown because of them; I've been called to places far from family and friends and have learned to truly lean on God and also reach out to others from all sorts of backgrounds and have grown through that. LIfe used to be safe and yes, rather predictable; now it's an adventure and filled with joy.

Pastor Barb Lindeman, M. Div, BCC, CT
Chaplain for Hospice/Community Health
Mankato, MN

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Re: Bad Theology, Chaplain David Plummer (PlainViews, 10/6/2004, Vol. 1, No. 17)

Editor’s note: Because of the incredible response to “Bad Theology,”the Managing Editor decided to print all of the comments in their entirety. In addition, Chaplain Plummer, who has received all of the comments, wanted to respond, and so his comments appear at the end of this section. This is an exciting debate and one that we hope will continue.

You raise interesting questions and even in your raising those questions, I hear the tentativeness of your question and rightly so.

Unhealthy religion is all around us but due to our concern over the rights of the autonomous adult to practice their religion unhindered by Government, we in the religious community are reluctant to confront unhealthy concepts due, I think, in part to the fact that we do not want to be considered biased or bigoted.

The reality is that as we (Chaplains and hospitals) keep silent about these situations in the hospitals, we are in fact allowing patients to be abused by unhealthy religion. We are allowing the patient to be coerced into a course of action due to their anxiety and pain over a difficult situation.

If this type of behavior occurred with any other professional group outside of the religious community we would advocate for the patient and even go to lengths to bar certain people from seeing the patient because they are not helpful or may even be harmful to the treatment process for the patient.

I wrote an article for an Oates On Line conference where I pointed out that in certain circumstances we do limit religion. States can make laws curtailing practices: handling snakes is illegal in 6 or 7 states; polygamy is not allowed by state law; criminal courts limit religious practices if a person performs religious rituals or practices that break laws; and of course civil courts may limit religion by suits against certain practices.

We as a professional organization have a responsibility to monitor our own, and as such we are all responsible for ethical practice of our profession. If we don't do something to help protect patents in the hospital from spiritual abuse, then the only remedial recourse for patients will be to go to court to sue the minister who prayed for the healing and it did not occur.

I for one do not want the courts to begin to make those kinds of determinations for religious/spirituality groups, so I guess it is up to us , is it not?

Larry Austin, D.Min.
ACPE Supervisor, BCC
Director of Pastoral Services
Pitt County Memorial Hospital
Greenville, NC


I too cringe when I hear or see the kinds of responses some ministers and others may express in the time of crisis or death (I count myself as an evangelical as well). Certainly, many of the traditions that I witness are not in line with my theology and I would love to "correct" their thought process. But I have to stop and look at the whole picture. I am with these people for a moment in time. They have an established belief system (whether I agree with it or not) that has sustained them for years. In my view, the crisis event is not the time to provide correction. Trying to educate the clergy members or others who make the statements to make better comments is tantamount to asking them to dump their theology in favor of mine. That approach is probably going to raise animosity and struggle. Truth be told, chaplains NEED area clergy to meet the needs of the people of various backgrounds. Perhaps we can have coffee with them and discuss the differences we hold, but saying their response is not proper for their faith background is a battle I am not willing to wage at the cost of relationship. Mutual discussion can lead to mutual understanding –even if it is understanding we will be different.

Dan Mefford, Chaplain
Heartland Region Medical Center
St. Joseph, Missouri

Thank you Chaplain Plummer for raising the topic of various responses to death. I find that the "bad theology" is not limited to Evangelicals. I have chosen to confront such statements as tactfully and respectfully as possible. At my son's funeral, I asked several people about the meaning of their troubling statements, and after hearing their response, I requested that they not say such things to my wife and daughters. The expression on their face indicated surprise to which I responded, "It's just not helpful." Another colleague, in an attempt to encourage my family referred to us in a letter as "first phase Job's." This was actually frightening to us. After three or four months I did talk to him and expressed how we felt. He attempted to explain and justify, but I just asked him to hear our response. Thanks again for the article. I believe it is possible to confront and educate those with good intentions. Perhaps those who have ears to hear will hear!

Bill Neely, Chaplain
Brooke Grove Retirement Village
Sandy Spring, MD

I am not sure that what you speak of is bad theology or a lack of willingness to be humbled by life. While I personally don't understand the theology, I am hesitant to label it "bad." It seems to me that when I hear this faith understanding being spoken by pastors and friends of the family, there is almost an arrogance that accompanies the words. It's like, we are not here to serve God and to work in God's world, but that God is here to serve us and to do our bidding. I doubt that these pastors preach this on Sunday AM, PM or Wednesday.

In addition, as I have worked with pastors and churches, I make it a point to distinguish between healing and curing. As I have visited with families that want to change the course of life (usually because they are unprepared for the reality of life), as I begin to help them see the difference between these two, I always pray for healing and request curing. I have found that this does not violate their basic faith commitment and they are then open to visit about death as a means of healing.

D. James Stapleford, D.Min.
Director, Spiritual Care and Education
Phoebe Putney Memorial Hospital
Albany, GA

Thank you for allowing the reader to give you feedback on your article...

The first thing I would do is stop calling it bad theology. Those with this type of belief believe that raising the dead and praying for healing is faith. (Faith is the substance of things hoped for evidence of the things not seen.) For these pastors this is good theology.

In our training (CPE & Pastoral Counseling) we are reminded not to lead the patient/client where we want to go, but to allow them to take us where they are.

It is clear to me that these pastors have not explored/discovered their own issues on illness/death & dying. Once they become aware of their own blocks they in turn are open to extend the same to others. They are to busy trying to maintain what they preach on healing alive. I do not even believe that they have asked the question: Why does God heal some people and some people are not? Does He love one more than the other or is one more faithful then the other? God is Sovereign; He can do whatever He wants to, whenever He wants to, in whatever way He wants to. God is God....

So the response to your article would be EDUCATION & TRAINING. I myself challenged my family on issues of life support and asked them if they are doing it for themselves or for the person. As they thought about it they realized that the life support was for them to have their loved one around longer; never was the decision made for the patient.

Lets begin the education & training from where these pastors are. You and I know that it's bad theology. But for them it's good theology.

Your sister,
Rev Luz Celeniar (Lucy) Tirado M.Div. M.A.
Associate Chaplain and ABC of MA clergy...

Thank you for this excellent essay and for reminding us that not one of us is alone in needing to find effective ways to confront "bad theology." I have found that when working with such cultures, one approach is to work with their foundational text, whence cometh their faith and identity. The following essay does not directly address the so dire situation you describe, but it provides an approach:

Faith to Move a Mountain –  Chaplain Mark LaRocca-Pitts

Though you have faith sufficient to move a mountain, do you have sufficient faith to withstand the mountain not moving? The onset of any disease or illness, especially cancer, can create a crisis in one's faith. Questions of "Why me?" or "What did I do to cause this?" or "Why is God doing this to me?, begin to haunt the recesses of your mind and soul. You begin to cast about for any straw that might provide hope of a cure. You hang on every positive word your physician accidentally drops and ignore every negative diagnosis they document. Grief begins to drown you. You go under once, then a second time and then ... then ... a new hope dawns! "Faith is all I need," you exclaim, "if I just have enough faith, God will cure me of my cancer!" And then you set a course to put all doubt behind you, to believe with all your heart, mind and soul, to deny the negative and grapple the positive with all your strength.

And the truth is, God may honor your faith and cure you. But what if you are not cured? What if the cancer continues unabated or even spreads? Do you then jettison your faith in anger, believing that God does not care, or that God does not exist? Or, does your faith grow even more as you realize that faith the size of a mustard seed may be sufficient to move the mountain or to cure your disease, but God requires of you to have an even greater faith: a faith sufficient to live with the mountain not moving. It may not be God's will to cure you. Instead, God may ask you to live with your disease not being cured and yet remain believing in a God that loves you. Saint Paul asked God three times to remove the "thorn" in his flesh, and God did not. Instead, God answered Paul, "My grace is sufficient for thee: for my strength is made perfect in weakness." Yes, you may have faith sufficient to move a mountain, but it takes more faith to continue believing and living when the mountain does not move.

Mark LaRocca-Pitts, M.Div, PhD
Staff Chaplain
Athens Regional Medical Center
Athens, GA

Chaplain Plummer is absolutely correct in his article. I, also, can say this as a member of the "charismatic" community of churches. The most difficult families to attempt to minister to are the ones who have "faith" that their loved one will be healed. Thank you, Chaplain Plummer, for an excellent, and correct, article.

Rev. Frankie B. May
Chaplain
St. Joseph Hospital/Hospice
Augusta, GA

I read with interest your article "Should We Confront and Challenge Particular Cultures?" I am a new staff chaplain at United Medical Center in Cheyenne, WY with previous experience as a Presbyterian pastor. I agree wholeheartedly with you. I confront these issues as well. Usually I begin with a Biblical discussion portraying God as the author of life and death, with death being an integral part of life. I inquire as to the family's intentions to honor God and God's will - and follow that up by stating that we honor God by the way we live and we honor God by the way we die, namely, by honoring the process of death that God has already initiated. More often than not, Christians do want to honor God, but cannot accept the situation facing them. Redirecting the issue away from their personal pain and directing it toward a God initiated process often helps.

Rev. Linda A. Norris
Staff Chaplain
United Medical Center
Cheyenne, WY

I would like to offer my thoughts on this important subject. I wonder if pastors with "bad" theology view the hospital institution as the enemy. If so, they probably feel unwelcome and antagonistic. Could developing a relationship built upon educating community clergy be helpful? In my hospital we have done just that by having Clergy Days in the past, once a quarter, and recently annually. This is a 4-5 hour day where clergy members are welcomed by the chaplain and hospital administration, fed breakfast and lunch, treated with respect, and experience an interfaith ritual and prayer as well as educational material.

One particularly helpful topic, given in didactic format, has been organ donation and transplantation. This has been helpful because it visually shows with pictures of why brain death is real death, even though ventilators keep the organs functioning. Another important topic for clergy has been bioethics and discussing the ethical dilemmas that families and medical staff face when a patient's life is artificially prolonged, and the patient is put through unnecessary suffering. Bioethics has been a sober topic because it has forced the issues to be brought out into the open and discussed. Clergy members have been given a tour of the facilities and helped to understand what codes and some medical terms mean. During these clergy days members of different faith communities have had dialogue with each other about their perspective beliefs, and why. All of these efforts have been helpful in ongoing dialogue.

Though this alone may not solve the problem, it may offer a kind of social pressure that helps clergy members remember that they are accountable, they are seen, and known by their peers.

Reverend Nina Bryant-Sanyika
Director of Pastoral Care & CPE
Mills-Peninsula Health Services
Burlingame, CA

Thank you for an excellent, articulate and insightful article. As a chaplain in a regional community hospital, I have often shared your experiences (this week, in fact). I don't know that I have any answers to the questions you ask, but I do have some reflections and thoughts that I'm happy to share.

I've found it important to encourage the hospital staff to learn to CALL THE CHAPLAIN, CALL US QUICKLY and to think of us as a part of the healthcare team. The tendency has been to think of chaplains as nice religious-types who can say a prayer or two but who are useless if the family/patient already has clergy. We are increasing awareness among our nursing and medical staff that chaplains are healthcare professionals who can sometimes serve as liaison with family, ESPECIALLY when their own clergy are bringing (ahem) challenging theology into play in decision making. Again, the faster we are able to get in and start a relationship with a family the more we are able to help.

Our spiritual care staff (chaplains) also approach families who are clinging to this kind of theologically fixated hope with a great deal of gentle hospitality –we ask if we can get Bibles or oil for anointing, etc. We use language in our prayers that will identify us as allies in comfort and care. We find coffee and cookies and chairs. We gather in portable CD players and recordings of spiritual music that fits their preference (we keep quite a variety). We serve as deacons as well as priests. And an amazing thing often comes out of this - one, or two, or usually more, members of the family quietly begin to approach us with thoughts they are having that are very frightening and that feel (to them) as though they are betraying their loved one and God. They tell us about their struggles of faith in this moment of crisis. Sometimes a family member will even come to us and say something like, "Thank God -–finally here is a representative of the Church who has more that one narrow point of view." We don't teach theology, but we do listen, affirm and encourage. We use the language and stories of the Bible to talk about hope, love and the comforting presence of God –but we do so after we've been invited to do so, and usually it is one-on-one, in very quiet settings. This way we become a support or even a channel for the family to be able to shift some of their theological thinking, but in a face-saving way.

I've also found it helpful to build relationships with area clergy. This can be a real challenge sometimes and I am fortunate in that my boss encourages this and my job description includes liaison with area clergy. I've learned over the years that not all parish clergy are very comfortable in the hospital some are downright scared. (When your theology says you're supposed to be the man or woman with all the answers, the critical care units of a hospital are NOT comfortable places to be, after all.) Many clergy, I've learned, are even a bit ashamed of their own fears and short comings. And, of course, there's that awkward decision we all make somewhere along the road to ordination –when push comes to shove, will we ultimately be defenders of the faith, or proclaimers of grace? Most WANT to do both, but standing in the neo-natal intensive care unit with our arms around the parents of a dying baby, sometimes the limits of human reason require us to choose. Those who choose defending the faith (as their ultimate calling) have the hardest time, and resort to some really bizarre commentary to get themselves through it. While enormously frustrating to me as a chaplain and (I believe) terribly harmful at times to patients, families and staff, I still find myself empathizing even when I want to whack them! And I have found getting to know them outside the crisis moments allows me more creditability and opportunity to confront and challenge in constructive ways. And it reduces the number of times I want to whack anyone...

By the way, this isn't always accepted with open arms. But then, neither is God's love in general.

One more thing –we have quite a bit of theological diversity on our team of chaplains. But we have all agreed that we simply will not be the enemy in these situations. When we can continue to see these families and clergy with the eyes of compassion, we do better. When we get hooked by their anger and pain (and we do, from time to time) we don't. But we keep trying.

Thanks again for your wonderful article. It was most encouraging. I will share it with all our staff and volunteer chaplains.

Peace, grace and blessings be yours,

Cherie Baker
Chaplain and Director of Spiritual Care and Religious Services
Washington County Hospital
Hagerstown, Maryland

I think this is a complex issue, where there is no easy reply. As I'm sure you know, there is no such thing as 'formula' in chaplaincy, just sensitivity to families and patients. I think Jesus had (and has) great reason to be fed up with the whole lot of us; unbelieving, schmoozy liberals on the one hand as well as 'name it and claim it' conservatives on the other. "Bad theology"doesn't just exist in the other person's camp –it belongs in each of ours as well. Just yesterday I worked with a name it and claim it 'faith' pastor whose father is dying at the hospital. Now, this man believes his father is dying prematurely, before his time if you will. And if you think about it there are at least two responses a man of this type may have to this:

1. its the patient's fault, or
2. its due to a lack of faith on the part of those praying (i.e. family, church etc.).

He doesn't think God wants it, but he thinks God will allow it. The eastern traditions have it right, embracing incongruities with both/and solutions rather than the linear, Western either/or thinking which unconsciously controls this man's thought. In this crisis of faith, this man has chosen to explain his father's Parkinson's and lung failure as caused by his father's own negative spirit, and has scripture passages to back it up. So, this leads him to anger at his dad, and he knows its wrong but he can't get out of it. And the saddest part is that he cannot get beyond the place his faith has led him to truly appreciate the miracle his dad really represents. It is possible to do that without losing faith, but expanding theology. But your statement of setting someone straight or "confronting" them on their theology is not the answer. The answer will be found when we work with these people with compassion, love, good questions and presence. Jesus cried with Lazarus' family before he set them straight. We are called to do the same. Thanks for your thought provoking article.

Rev. John H. Brewer, BCC
Pediatric ICU and Oncology Chaplain
Sacred Heart Medical Center
Spokane, Washington

Chaplain David Plummer asks a good question: “Should We Confront and Challenge Particular Cultures?”I have a good answer: “No.”Did you ever hear the joke: “Why should one refrain from teaching a pig to dance?”The answer: “It wastes your time and irritates the pig.”

If the question were: “Should we intervene when injustice is being done?”I would answer: “Yes!”

What’s the difference? In my fourth unit of CPE, I had a 23 year old man brought into the Emergency Department after having overdosed for the umpteenth time. He ended up in the Intensive Care Unit with reams of family visiting. Everyone in the room was praying for a miracle. As a chaplain, I felt my job was support so I prayed too! Their pastor came and he prayed for God’s hand to save this young man. We were in one accord –for a few days.

I have seen some miracles in four years at the same hospital. I saw them before working there. I pretty much expect that God will intervene when and where God has a notion to do so. It’s always been a surprise. Always. This was not one of those times. As the patient “presented,”the staff could see the likely outcome. The family could not. Through all of this, I encouraged the family to look at all possibilities. I try to coach it in the form of “facing our fears.”I’ll say something like: “We can’t be positive if we secretly harbor fear. So let’s talk about it. (Let’s talk about the elephant in the room.) Fear will engulf our life if we don’t face it. Sam (not his real name) made choices. We’re afraid those choices have brought him to this time of trial. If we can’t call him out of the tomb, what’s the next best thing for him?”Etc., etc.

I will never question a person’s faith or theology. I may get them to look at what comes from it, but that may only start the ball rolling toward a more solid theology. Whatever it is, good or bad, theology or philosophy is the essence of what a person is; their sense of ultimate meaning. To challenge ultimate meaning at such a vulnerable time is more than I want to do. I’ve irritated a few pigs in my life and its gotten me nowhere. So I try to work within the bounds of their theology for a win-win situation.

In my little chronicle of events, another area came up where our team will intervene. In this case, the medical staff determined that the man was brain dead. The family was not willing to remove life support. The hospital determined that nothing more could be done so were informing the family that they had to make a decision. The attending physician, neurologist, etc. were called in for a family conference. I was leading an interdisciplinary team called Spiritual Care At Life’s End (SCALE) while the lead chaplain was on vacation. The medical director is on this team and we had discussed the family’s desire to “do everything.”So informed, we “educated”the physicians that they were to be quite clear in their prognosis. The family conference was attended by their pastor as support for the matriarch of the family.

In this discussion, the family referred to the patient’s condition as a coma. They also referred to alternative care facilities as rehabilitation centers. The attending physician, who is usually quite clear and straightforward, started speaking in the same terms, which further confused the situation. Clearly, the emotion and gravity of the loss was affecting everyone in the room. The medical director and I shot some glances at each other and as it was a medical discussion, he stepped in. First, he clarified that he was sorry that the family had to go through all of this strain and stress. Then he qualified that the patient was not in a coma but was, in fact, brain dead. He again apologized for being blunt and for the family’s pain but clarified that he felt it was his ethical, moral, and legal requirement to be forthcoming about the confusion. The attending physician and neurologist confirmed the diagnosis. They asked for questions and left after answering them. I stayed with the mother.

The mother’s theology had not changed. There was anger. There was talk of indifference toward their culture and their religion. I simply reflected and rephrased all that so that they could see it was being heard. And I stayed. I did not negate their position. I did not change mine. I stood with them in their pain, accepted their anger and just loved them. The patient had a twin brother in prison and I worked with his prison chaplain to see if he could be furloughed for a day or two to see his brother. We were declined. We did get a phone call through to their mother at the patient’s bedside. From prison he told his family: “Sam is going to die on a machine and you will waste his strong heart and organs waiting for the prayers to work!”The mother hung up the phone and signed a new organ donor release. They let Sam die the next day.

I don’t know if we could have done better or been more compassionate. I don’t know how one reconciles with the loss of a son whatever the reason. I don’t know what organs were harvested, if any. But I do know that every time the family comes to the hospital for a baby or some health issues, they manage to find the chaplain and fill me in on the family. We may not agree on theology, but we do agree that, for sure, Sam did one thing –he brought us together. It’s funny where blessings come from.

Rev. James D. Ek
SIT/Staff Chaplain
Department of Spiritual Care
Banner Thunderbird Medical Center
Glendale, Arizona

Chaplain David Plummer, when I read your article on "Bad Theology," I laughed because you are so correct in your assessment. Unfortunately, in my earlier years of evangelism, this is what we were taught. Now that I am a chaplain and I have studied the Word of God, l have learned there is a better way. In response to your question regarding confronting and changing that particular culture, it is almost impossible, unless there is a change in the mind set and the teaching. You must realize that many religious cultures have not accepted death and that death is a part of life. In most cases, and I know for a fact, your scenario you presented is taught in many evangelical churches. If they come into the hospital with this mind set, it will be impossible to address. They are on the spiritual warpath and nothing will stop them. The mind set of the leaders must be changed with the proper use of Scripture and they in turn can change the mind set of their congregation. A solution might be to talk to the one in charge of the sick person and try to reason with them. But basically it is a very difficult situation. It would be interesting to know how you found a way to handle the situation. Chaplain Plummer, I applaud you for your honesty and courage in light of the bad theology.

Deborah Heard
Chaplain
Jamaica Hospital
Queens, New York

As an institutional chaplain for over 19 years and being in full - time ministry for 25 years, I haven't experienced what Chaplain Plummer expressed. Our evangelical and Pentecostal ministers have been very supportive in the treatment of patients and working with families.

Have a Blessed Day!
Chaplain Allen Clark
Pastoral Care Department
Hannibal Regional Hospital

My first reaction is that the use of the word "culture" might more accurately be substituted with "subculture." The theology that is being addressed here certainly creates a subculture in some churches. the clash may come with the subculture of certain faith communities is at odds with the hospital subculture, even if we share an American, Virginian, or even Christian culture. The "name it and claim it" approach to prayer is formulaic and is supposed to yield miracles against all odds and in opposition to most medical opinions. It borders on superstition, and thereby can be legitimately challenged as unsound and downright toxic to faith and trust in God. Christians should be encouraged to see death as an enemy that has already been defeated. Accordingly, we don't need to reverse every death that occurs in the community of faith. Perhaps, the best approach is to challenge the subculture somehow, rather than the theology. Belief in prayer doesn't have to translate into seeing prayer as a means for forcing God's hand. Second, as a member of the Ethics Committee, I believe that chaplains
have the responsibility to be advocates for the patient. At times, that may mean "taking on" the family or the pastor.

Challenging the subculture might mean gently pointing out what appears to be ambivalence on the patient or family's part when they are hesitant to take the pastor's suggestions as marching orders. Validating their sadness and reluctance to "say goodbye" to a loved one might build trust in the chaplain so that we can guide them to alternative ways of responding to the situation. We don't have to say that the pastor, or that subculture is "wrong" as we offer additional options. Challenging the pastor should be done in private, if possible, so that he/she is less likely to feel threatened and thereby defensively in need of asserting his/her authority. We can suggest that "marshalling prayer warriors" may be counter to the patient's desire for privacy and confidentiality. They may need to have it explained to them that members of the church are encouraged to pray in their own homes or churches rather that descend "en masse" to the hospital. I am a big proponent of challenging people with the phrase, "I wonder..." As in, "I wonder if the patient's faith is such that they are ready to be with Jesus?" Or, "I wonder when we will know that we should pray for God's peace and for trust in the Lord?" Referring to Romans 8 (If we live, we live to the Lord, and if we die, we die to the Lord; so then, whether we live or whether we die, we are the Lord's.) might be helpful in using the vocabulary of a Biblical faith, without necessarily agreeing with the conclusions of their particular subculture.

Putting this article under the heading of "Advocacy" certainly fits, for when we challenge anyone it should always be in advocacy for patient rights and healthy spirituality. At the end of the day, however, we do well to recognize that a patient, when given the choice between siding with their own pastor or a chaplain who they will never see again, will often go with the "safer" option of choosing the familiar.

Alex Chamberlain, BCC
Staff Chaplain
St. Luke's Regional Medical Center
Boise, Idaho

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To The Responders to “Should We Confront and Challenge Particular Cultures?”

First, I want to thank you for your very thoughtful (and thought-provoking!) comments.  I acknowledge that this topic of assessing and even judging someone else's theology is a very uncomfortable one –one in which chaplains are  usually strictly taught is taboo in a clinical setting.  However, when very real suffering and even harm in several realms is the possible/probable consequence of chaplains' intentional inaction, is it appropriate or even ethical to intervene?  Could it even be considered unkind and unethical for a chaplain to fail to attempt such a palliative intervention?

One thing I realize that I did not clearly communicate is that I do not tell patients and their pastors that they have "bad theology."   That is my own assessment and occasional word choice to healthcare colleagues.  Rather, I attempt to educate using the Socratic Method.   I challenge patients, families, and pastors to examine their own theology.   I ask them about their understanding of God.  They usually espouse the "traditional" Judeo-Christian view (i.e., all powerful, all knowing, loving, etc.).   I then ask them if they believe that God needs the doctors, nurses, medications, and machinery to keep their loved ones alive.  Their answer is consistently "no."  If this is the case, then, I ask why do they not allow God to be God?

I passed the article to my hospital's Critical Care Unit nurse manager (a delightful professional of deep and well-developed faith).  Her lively and clarifying email exchange prompted me to write the following:

From my own theology and experience, I believe that I have seen actual miracles from God.  When God chooses to work a miracle, God “just”sovereignty does it.  Not because God owes it to us, or we are such terrific people, or because we have X amount of faith, or because we get the prayer right.  It is to fulfill God's plans, God's purposes.  God does not need “help”to work a miracle. I think God calls us to do our best medically and then trust the Divine to do what is right.  Sometimes — make that often —as I see happening with families and clergy here, we don't want to do that trust part until we are sure God is on "our" side.  That is why patients sometimes languish for weeks (sometimes months!) before they succumb.  We end up doing "everything" for a patient,  including ignoring and delaying God's call for that person to the end-of-life.  On the other hand, I think that if we as a people of faith were sure that we were on "God's side," we would be much more comfortable with whatever happened. Last, I suspect that it is just a matter of time before the HMO's, Medicare, etc. will not allow patients or their families the "luxury" of demanding and receiving unlimited  futile care. [Indeed, I am aware of three southern states –Texas, Florida, and Virginia –which now have statutes in place that say physicians do not have to indefinitely render care that they consider medically inappropriate.]  Ultimately, healthcare-providing businesses and insurance companies will probably get pretty intrusive or go broke! Maybe we should deal with these issues now, before the crisis?  It is my understanding that other countries think that we are odd in that we allow the patients and their surrogate decision-makers to dictate extreme levels of supportive care to patients who are futile.  Maybe they are correct.

Bottom line:  Of the clinical chaplains I know, most of them would speak up when they see injustices and harm done to the vulnerable –wherever the vulnerable reside. Why are we so curiously silent when the injury stems from a theological root and occurs within our own facilities?

Chaplain David Plummer

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Re: The Challenges of a Multifaith CPE Group, Rabbi Naomi Kalish and The Bad Theology of Some Clergy, Chaplain David Plummer (PlainViews, 10/6/2004, Vol. 1, No. 17)

I want to thank both Rabbi Kalish and Chaplain Plummer for addressing a forever challenging part of our work both as Chaplains and Supervisors. I have recently worked with developing multicultural competencies for CPE Supervisors and Centers. The Task Force interviewed many Supervisors and students. A common concern is feeling silenced when the prevailing view -- whether religious, social, political, etc. -- of the Center or Supervisor is not similar to or accepted by the Supervisor or peer group. Likewise there was the worry of discussing theological views of peers while honestly looking at the problems some types of interventions may cause in our pastoral care work.

Dealing with issues of diversity is inherent in our work. Diversity is there with ethnic, racial and cultural groups, with varieties of religions and spiritual practices, with personally held social and political beliefs, with people of various age groups –the list could go on and on. Helping chaplains learn to be present to others while not feeling threatened or need to act in ways that force patients etc. into the chaplains view point, will take much conversation with students and colleagues. Finding ways to do this is at best a difficult dance and may produce some heated dialogue. It certainly did on our Task Force. However, it was discussion well worth having.

It seems to me that part of what has prevented us from discovering new forms of education and pastoral practice, as these writers suggest, has been our unwillingness to engage these difficult issues. It’s easier to silence the divergent voices rather than honor those traditions with which we disagree and looking to new ways to meet. It is easier to assume we have “the truth”which right thinking people must adopt too. I have always believed our business is helping people stand in the gap when difficult issues surround them. I’m fearful we have failed as a profession to stand in the gap on this issue. I appreciate these two writers for opening the dialogue here. I hope there articles will prompt a lively, honest, and open conversation. Thank you.

John Moody
CPE Supervisor
Honolulu, Hawaii

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Re: Death Has Come to Dinner, The Rev. Susan Wintz (PlainViews, 10/6/2004, Vol. 1, No. 17)

Thank you for sharing your he art.... I see a book in the works and pray that you will continue to receive comfort, healing and joy as your share your story....

Your sister,
Rev. Luz Celeniar (Lucy) Tirado M.Div. M.A.
Associate Chaplain and ABC of MA clergy

Sue's article, written from the heart of a parent and a professional pastoral care giver was so well written.  I thank Sue for sharing her deep feelings of this tragic event in her families life.  Her perspective will help others who will inevitably share similar experiences. Knowing Sue and hearing her story first hand, it is good to see it in print so well written.  Thank you Plainviews for publishing it and for Sue in sharing.

Jim Stephens
Senior Staff Chaplain & Assistant Manager
Spiritual Care Dept
Providence Alaska Medical Center
Anchorage, AK 

As I have grown into my position of Director of Pastoral Care, it has been Sue Wintz who has been an encourager and a constant source of good suggestions and great ideas. She has been so willing to share what she had for the advancement of chaplaincy, especially in the health care setting. All through the last 10 months, my heart has been aching for her and her family at the death of her daughter Sara. Once again she has shared from her heart, her grief experience and opened a window for those of us who have no clue as to what it means to lose a child. I can only imagine the pain this causes, but I pray there is healing too, in sharing. Thank you, Sue, for sharing yourself so deeply and openly. May I be more understanding and compassionate when life calls me to sit with families who experience such a loss. May God continue to bless and heal you and your family.

George H. Richardson, M.Div.
Director of Pastoral Care and Counseling
The University of Texas Health Center at Tyler

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Re: A View from Above, Rev. Joseph Driscoll (PlainViews, 9/15/2004, Vol. 1, No. 16)