Book Review: Chaplaincy in Hospice and Palliative Care

July 04, 2018 1 Comment

Reviewer: Barry McGrath^[i]

Karen Murphy and Bob Whorton (eds.),
Jessica Kingsley Publishers, 2017

 

Chaplaincy in Hospice and Palliative Care states in its preface that it is a collection of writing which ‘explores the many aspects of chaplaincy to all those with life limiting and life threatening illness’. The premise of the book is sound and inspiring: that we are going to embark on an exploration of ministry within a very particular and critical context—that of people dying and ministry to them via chaplaincy.

The forward, written by the grandly titled Baroness Finlay of Llandaff, establishes the parameters of the importance of chaplaincy, while also laying the foundations for the rest of the book’s perspective on chaplaincy—that it is crucial, and provides a presence for people at a fragile phase of life.

The book is divided into three sections: attempting to locate the work of the Palliative Care Chaplain; reflecting theologically on the role; and thirdly, a very personal section presenting diverse perspectives on Palliative Care Chaplaincy, in the aptly titled, ‘Who are we?’ There are also some appendices of creative writing and poetry.

The book attempts to show the reader the work of chaplains and the challenges they face in their day to day practice. And it does give a sense of the complexities of working within a system where chaplains need to tread carefully, so they don’t upset the moral and spiritual sensibilities of a culture which is presented as decidedly post-Christian. And yet, in the delicate footwork that they are engaged in, there is a sense that chaplaincy has moved into a nebulous spirituality which is keen to be the supporting glue in a hospice setting. This fuzzy ambience of the role verges on hagiography at times, where the chaplains are the spiritual social workers who just need to be emotionally aware, and to be people who have ‘wrestled with life’s big questions’ (p20).

Obviously, these are challenging times for chaplains who are working in public institutions within a culture where the declaration of Christian truths and other religious truths seems passé, or at least relevant only to a small boutique faith community. The attempt to prove that chaplains are very worthwhile, and that they have a place at the multi-disciplinary table in palliative care, is a thread which runs throughout the book. The chaplains want to sit alongside the health professionals as equals, and yet this book keeps on placing them in a very loose position where they seem to be people who are ‘just there’, without any clear role. They speak of having a ‘spirituality of presence’, but it is never really explained what this very broad type of spirituality actually represents.

The book focuses the practice of chaplaincy on listening. The Chaplains are listeners, but they are certainly not to be speakers of their faith tradition, unless they are specifically asked to articulate their faith. This almost hidden spirituality means that what is on the surface is a fuzzy, emotional spirituality which seems to have more emotional content than any doctrine or truth component. Perhaps when a culture silences spiritual voices we end up with this sentimentalising of the role of the chaplain.

The authors are often at pains to stress that they are not there for religion, nor, it seems, for God. They are there for the patient. This is a laudable goal, and yet when a Christian chaplain declares, ‘for this patient, God was not the answer in his search for peace’ (p34), it projects Christian ministry into a netherworld where anything goes as long as it is quiet, and calm and has an ambience of peace.

In the last ten years there has been much written in palliative care circles about the significance of spiritual care for the well-being of patients.  The book embraces this ‘spirituality’ where the chaplain, as one of the contributors expresses it, ‘has focused on finding ways to help people attend to what is meaningful’ (p38). It is such a broad goal that it is little wonder that some of the writers do delve into the question of whether you need to really come from any particular faith tradition to be a chaplain, or just to be open to people’s search for meaning. Perhaps the future, if this slim volume is any indicator, will see chaplaincy move from the preserve of faiths and world religions to the sphere of facilitating a ‘quest for meaning’.

In the chapter entitled ‘Many Faiths, No Faith’, the contributors state that ‘spiritual care is attentiveness to everything in a person’s life that gives meaning and purpose or enables them to transcend their physical existence and limited lifespan’ (p42). The chaplain, according to this chapter, would attend to matters of life and death, and I was left wondering what the chaplain’s job actually is in a palliative care setting? The breadth was breathtaking, with ‘escorting patients to their last Premier League match or new Star Wars film’ and ‘tracking down a Polish-speaking, gay-friendly Roman Catholic priest’ (p43) being a few of the activities described. The chaplain becomes an everything, and I wonder how far that is from becoming a nothing.

Perhaps the book’s strength for me was that it challenged me to consider why you would have a chaplain in a hospice at all? What purpose do they serve? As someone who was a palliative care chaplain, I recognize the need for sensitivity in being a Christian voice in a place of such gravitas. And yet, I don’t think the answer is to be merely a warm human contact person who is sojourning with those who are dying. One thing which challenged me on the role of the chaplain was the claim (quoting Swinton and Pattison) that the chaplain was to attend to the ‘restoration of the patient’s humanity’ (p105). I wonder if this exalted view of the chaplain’s role and the denuded spirituality where the faith tradition seems to get second billing to emotion, does not actually mean all that much!

Even the chapters which avowedly engage in theological reflection seem not to do much reflecting on theology at all. They reflect on context, and on tradition, and on culture (all important aspects of theological reflection), but are very thin on biblical content. A quote from Stephen Pattison suggesting that ‘for many chaplains an overt theology is problematical’ (p82) is illuminating.

If theology and articulating faith are so problematic to the chaplain’s role, one does have to question what the role of chaplains in the 21^st Century public health systems is. The scope of their work as presented is so loose, that I wonder if other health professionals see it as spiritual diversion therapy. Are chaplains morphing from professionals of their religion to spiritual social workers? While the intent of this book seems to be to prove that chaplains really are worthwhile, for me, as I read, this was the very thing called into question and I was left with more questions than answers.

 

[i] Barry McGrath is the Manager of Health Services Chaplaincy for Anglicare. For the perspective of Christian chaplains working in Australia, see Case Quarterly vol. 44 ‘Soul Care’ (2016).

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