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On hand when medicine fails

15 April 2009

The latest attack on hospital chaplains ignores what they do, says Terence Handley MacMath

Other gifts? Hospital chaplains are under attack JUPITER

Other gifts? Hospital chaplains are under attack JUPITER

THE MAN who runs the nut stall in my local market knows that I am a hospital chaplain. He looked at me compassionately last week and wondered if I would have a job for long, because “it costs the NHS £40 million to pay chaplains, and they’re going to get rid of them all so people can have chemotherapy instead.”

Full marks to the National Secu­lar Society, then, for the dissemina­tion of information that is almost totally erroneous. It is hard to know how many people, like the nut man, think of chaplains as dispensable; what is true, though, is that the closer you come to suffering, the fewer detrac­tors you will find. Hospital staff are very skilled technicians in modern medicine, but all too often they are too busy, or too vulnerable, or even, sometimes, too clueless to be able to cope when the mortality of the hu­man body prevails over their efforts.

A colleague of mine, who seems to have spent a lot of time recently conducting funerals for babies and caring for women who have had abortions, told me ruefully: “They don’t want you around most of the time; but when something goes wrong, they just melt away and leave you to pick up the pieces.”

THERE are two myths behind the Secular Society’s complaint: that chaplains are merely servicing their own flock, or, if not doing this, they are forcing their religious opinions on vulnerable strangers. For the first, when I review the patients who have wanted most support from me, hardly any of them have been Angli­can, and many of them not discern­ibly Christian.

There was Leila, who gave her religious affiliation as Muslim/ Christian but who seemed entirely innocent of any doctrine of either faith. There were many Jewish patients who were happy to draw spiritual comfort from someone who was not measuring the extent of their religious observance. There were Roman Catholics, often from abroad, with little knowledge of English, who needed the comfort of familiar prayers in the lingua franca of Latin. And there were many who had no emotional vocabulary to handle what they were facing.

As for the second myth, I know of no hospital chaplain who took on the work in order to proselytise. A chap­lain has almost no opportunity to preach, has to deal with all sorts and conditions of people, and will seldom see a patient more than once or twice. When you are confronted by a Hindu woman holding a still­born baby in her arms, or a young man coming to terms with an ampu­tation, there is no place for fancy theo­logical foot­work. People in extremis merely need somebody to hold on to them until they can regain their balance.

Incidentally, there is no cor­relation between a patient’s willing­ness to talk to a chaplain and what he or she wrote in the “Religion” box on admission. Many people now don’t ask themselves what their beliefs are until suddenly it matters. As some­one who works in palliative care, I would hesitate to sum up people’s beliefs until they died — and I would be reluctant to put a name to them even then.

THE IDEA that you can mend an ill person by prescribing the right drug, chopping off the mal­functioning cells, or telling them to live more healthily is held by almost nobody in the caring professions (apart, perhaps, from those in charge of funding). The most important work undertaken in hospitals is to try to help people who are facing physical chaos or despair to reorder their own sense of who they are, why they matter, and what sources of hope they have. This is where healthcare chaplains develop a special expertise. It is not merely psychotherapy or counselling. Chaplains are there to help staff, carers, and patients to integrate their beliefs and lifestyle when facing an uncertain future.

The holistic basis of good treat­ment is being explored more energetically than ever in new tech­niques such as neuro-linguistic pro­gramming and “recovery-based” treatment. Medical professionals are encouraged to treat people in the spirit of the three theological virtues: faith, hope, and love. Faith in patients ensures that we treat them as free people; love for our patients forces us to put aside our own agendas and attend to theirs; and hope and openness to healing — all these are now being taught as learned “programming”.

Key to a good outcome in medicine are an accurate diagnosis and “patient compliance” (a horrid phrase). Medics sometimes fail to spot the religious, moral, and cultural elements that contribute to a condition. Patients often refuse to accept medical interventions that they do not understand. Chaplains will often help to negotiate an acceptable treatment plan that will be willingly implemented, paying due respect to the fears of patients and the seductive confidence of the pharmacologists.

Whatever the secularists might imagine, many clinicians, nurses and health-care assistants, allied health professionals, and support staff are motivated by compassion, and chaplaincy sits comfortably along­side this, not least in the way it counsels the staff in what can be a debilitating profession. The NHS was born out of the Judaeo-Christian belief that God loves his creation. It remains true to this vision.

The Revd Terence Handley MacMath works at the Royal Free Hospital, and was chaplain at the Marie Curie Hospice in Hampstead, north London.

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