Presentation to the Joint Committee on Health and Children-Public Hearings on End of Life Care.
My name is Margaret Naughton and I am here today representing the National Association of Healthcare Chaplains (N.A.H.C). The N.A.H.C is a professional association whose members serve in Hospitals and Healthcare facilities. The purpose of the N.A.H.C is the mutual encouragement and support of its members in ministering to patients, their relatives and staff in healthcare facilities. This organisation, founded in 1981, is in essence, a proven professional support body for chaplains.
So what is a chaplain?
A chaplain is a person appointed to provide spiritual and religious care to all patients, visitors, staff and volunteers in the healthcare setting regardless of faith or no faith. A chaplain can be ordained or lay (standards for Hospitals and Palliative Care Chaplains, UK 2006). Chaplains are people of faith who have engaged in the Clinical Pastoral Education programme, a hospital based experiential programme founded by AntoinBoisen to work with and minister to “living human documents”. As Thomas Moore in his book Care of the Soul has written:
Modern medicine is hell bent on cure…It wants to eradicate all anomalies before there is a chance to read them for meaning. It abstracts the body into chemistries and anatomies so that the expressive body is hidden behind graphs, charts, numbers and structural diagrams.
But hospitals are not populated by numbers or ailments. They are populated by men, women and children of different ages, classes, creeds and nationalities who all have one thing in common, they are ill. Charles Vella, a hospital chaplain and priest who has written extensively on the care of the sick argues strongly that one’s suffering is “augmented by the humiliation of being thought of as a number on a bed, totally divested of their human dignity”.
A chaplain works to provide empathy and support to those who find themselves in a healthcare system that is ever-increasingly coming under pressure for many different reasons. A chaplain addresses the spiritual and religious needs of the patients that they encounter on the wards. By listening with empathy, in a compassionate, non-judgemental manner a chaplain provides support for those who are struggling for whatever reason. It must be remembered that a hospital is a microcosm of society. What I mean here, is that all the problems that exist in our society exist also in hospitals. After all, the problems that people have in their daily lives come with them when they enter into a hospital. So a chaplain is faced with the harsh realities of loss, loneliness, addiction, unemployment and so forth when they come into work. In a difficult working world a chaplain provides spiritual care and this is done through the quality of their presence, by accompaniment and also by companionship. Chaplaincy is about reaching out to those who are distressed for whatever reason. Where death and dying is concerned the death of a loved one is one of the most intensely painful human experiences, any human being can suffer. Not only is it painful to experience but it is also painful to witness, if only because we feel powerless to help. In the context of a maternity hospital for example, the loss of a baby may be a parent’s first experience of death. The length of the pregnancy has no relation to the depth of grief and sense of loss experienced. In paediatric ministry chaplains work with parents whose children have been diagnosed with a life-limiting condition. Very often and regrettably, death is not the worst thing. There are ‘living deaths’ where parents have to mourn the loss of a healthy child and learn to live a life full of uncertainty and stress, often with very little or support to care for a highly dependent child/young adult, cope with multiple hospital admissions, provide high dependency home care, care for siblings and try to maintain their relationship with their partner. In the case of an accident or sudden death the sense of trauma, disbelief and anguish is enhanced as the death is sudden. The impact is immediate. A person’s life is torn asunder instantly and without warning.
So in essence what does a chaplain really bring to end of life care?
1)A crucial element of our training is self-awareness and being challenged to deal with our feelings about our own mortality, fears and anxieties. Having confronted these during our period of training ensures that we are equipped to cope with the vulnerability of those we seek to help in stressful situations and particularly at end of life stage.
2)We all experience the death of a loved one at some stage in our life but the quality of care given to family members around the time of a death (and especially when the death is sudden) can and does impact the grieving process later on. People speak of remembering what the chaplain suggested, what the chaplain did, what the chaplain wore, months and even years after the death of their loved one, evidence of the impact of the chaplain’s intervention with the family. Chaplains try to ensure that the needs of the patient and family members are met as much as possible. In research, recently commissioned by the N.A.H.C and not yet published, it is clear from the findings that most families expect to encounter a chaplain when their loved one is dying in hospital and actively seek the presence of a chaplain.
3)Chaplains pray with patients and they also offer to link families of different denominations and faiths with a minister of their own faith when requested or where possible.
4)Chaplains support and accompany families when their loved one is actively dying, during the immediate mourning period in the hospital.
5)Chaplains endeavour to prevent people from dying alone. In the absence of loved ones a chaplain will sit with a patient assuring them that they are not alone.
6)Chaplains are trained in debriefing and this is offered to staff who have been impacted by workplace traumas and deaths.
Recommendations:
Working in hospitals is difficult to say the least. It is emotionally fraught and emotionally draining. The complexity of illness, levels of care and the turnover of patients have increased considerably in the last few years.
In order to continue to provide chaplaincy services into the future we suggest that the HSE embargo be lifted on recruitment so that more chaplains can be employed.
With the reduction in chaplaincy posts in some hospitals the service has been reduced to a ‘simple meet and greet’ service which is not acceptable.
To die in a public ward is not conducive to dying with dignity. We ask that in every hospital, a single room be made available each time a person is ending their life’s journey. This will ensure that for the patient and their family the end of life experience is a private family one and not one where a person’s dignity and privacy becomes compromised.