Ethical grounding for a profession of hospital chaplaincy.

Hospital chaplains do not have a monopoly on the spiritual care of patients, just as teachers do not have a monopoly on teaching. Spiritual care of the ill and dying--compassionate and thoughtful attention to a patient's explanations of suffering, yearnings for transcendence, constructions of meaning, expressions of faith or loss of it, reliance on prayer or ritual, bafflement, fear, hope, or any of the many other possible manifestations of spirituality in crisis--has long been within the domain of good nurses and good doctors. Nevertheless, spiritual care is the primary and arguably the sole focus of chaplains' work, and just as we recognize a teaching profession even though "nonprofessionals" also teach, we can justifiably recognize hospital chaplaincy as a profession that specializes in spiritual care of patients--and then turn to the task of specifying the defining criteria for the profession, including its ethical grounding and governing tenets. As chaplains acknowledge, physicians, nurses, and other clinicians may--and often do--offer patients "spiritual" care that attends to the deep questions of meaning, purpose, and connection to others that arise during a serious illness. (Although some patients may frame their questions in religious terms, it should be noted that "religious" is not a synonym for "spiritual," but rather describes a sizable subset within the category of the spiritual.) The difference between chaplains and other clinicians is that chaplains are specialists in spiritual care; it is what they do, rather than part of what they do. Chaplains tend to distinguish themselves and their work from clinicians who also offer spiritual care by referring to what they do as "pastoral" care. But for this distinction to represent a salient difference, it will have to be explained. One way of understanding the distinction would be to regard spiritual care as only vaguely or incidentally (if not tendentiously) religious, whereas pastoral care hones in on the specific religiousness of the patient. This understanding would highlight a potential difficulty lurking for an avowedly "interfaith" profession in its use of the term "pastoral," a word closely tied to the Christian tradition's fondness for shepherd imagery. Alternatively, is the spiritual care provided by clinicians a form of screening only, perhaps with some empathic connection added, and are chaplains then the professionals equipped to take the conversation further, into realms of assessment and some analogous sort of therapy? Adept practitioners of ancient moral philosophies, such as Stoicism and Epicureanism, understood and often referred to their teaching as therapy. They seem to have considered their therapeutic task to be identification (diagnosis) of the student/patient's specific "disease"--his particular erring thoughts and bad habits--followed by provision of appropriate bracing, life-altering theories and methods intended to redirect and heal the supplicant. (1) If chaplaincy seeks to be something more or other than a form of palliation, then an analysis of the ways in which the practice is and is not intended to be therapeutic may be useful for elucidating professional goals and methods. It is also the case that a language of therapy will affect, for good and for ill, the communication bridge of translation and interpretation that is sometimes necessary when justifying the presence of clerical professionals within a secular health care institution. Thus, one fundamental challenge for the nascent profession of chaplaincy is to assert that which not only defines but also distinguishes the kind of care provided by trained and certified chaplains. Theologian John Cobb's admonition is relevant here: The pastor's task is to be present with and to "hear" the sufferer, to let the parishioner know that expressing fear, anger, and loneliness is acceptable. I do not dispute the validity of this approach, which in many cases is no doubt the best one possible. …