Healthcare Chaplaincy: An Unfolding Narrative

Acknowledgements

I begin my words of gratitude by echoing those of the poet John Donne, ‘No man is an island’. In other words, a book like this is the end product of a number of different relationships, connections and processes. While it can at times simply appear to happen organically, I know that a book comes to completion only as a result of the interconnected actions of many.

I would like to begin by thanking the twenty-six chaplains whose narrative is at the heart of this text. It is their honest, authentic and congruent sharing that has helped to give us an insight into the nuances, challenges, joys and sorrows of the chaplaincy ministry. By virtue of their sharing, we now have a body of knowledge that will help in future planning and development of healthcare chaplaincy in Ireland. I offer a sincere word of gratitude to each and every one of them for their sharing, their openness and their trust in me to tell their story, to bring their narrative to life.

I also offer a sincere word of thanks to the Theology and Religious Studies Department at Mary Immaculate College, Limerick, where this topic was originally part of my doctoral studies – in particular I thank my supervisor Rev Dr Éamonn Fitzgibbon, the head of department, and my internal examiner, Prof Eamonn Conway, and indeed my external examiner, Dr Aoife McGrath, St Patrick’s College, Maynooth, for all their insights which have helped me considerably to bring the narrative of the chaplains to life in a meaningful and sensitive way.

I say thank you to my brother-in-law Niall McIntyre and to my friends Mary Clifford and Mary Cahill for assistance with proofing and editing and for listening to a stressed-out theologian at various times in the past four years or so! All the support has been very much appreciated and will never be forgotten. Thank you, too, to Tony Mason, senior commissioning editor at Peter Lang Publishers, who has supported this project and has guided me along in a very helpful, encouraging and professional way. Thank you for trusting in this project.

Introduction

For me, chaplains stand in the gap for all people. As a chaplain I am called to stand in the gap holding a person’s hand and God’s hand so that they can come from where they are to where God wants them to be.¹

I looked for someone among them who would build up the wall and stand before me in the gap on behalf of the land so that I would not have to destroy it but I found no one.²

Following on from over a decade in pastoral ministry I have discovered from personal and pastoral experience that chaplains stand in the gap, in a transitional space, at a crossroads where so many intersections collide and engage. In my view it is a unique ministry because chaplains are tasked with going places where others really don’t usually want to go. They face crisis, challenge and human mess each and every day of their professional and vocational lives. They stand with the pained, the broken, the suffering, the downcast and those who appear to have lost their way. They stand in the gap between light and darkness, hope and hopelessness, joy and sorrow, God and his people. They offer pastoral support to those challenged by the ravages of life, standing firm in the gap with courage and conviction as they do.

This book, Healthcare Chaplaincy: An Unfolding Narrative, is the first of its kind within the Irish context, thus helping to bridge the research gap that has existed to date within chaplaincy. Simultaneously, it sheds significant light on, and provides a groundbreaking insight into, the reality of contemporary healthcare ministry. Here I lean heavily into this experience and process. Therefore, this book shares some of what I have learned from listening attentively and astutely to the practitioners themselves and I offer insight, in a fresh and innovative way, into their reality personally, pastorally and professionally. Theirs is a story worth telling – after all, chaplains ←1 | 2→are professional listeners. But here I offer you, the reader, the opportunity to hear from them and to understand what it is they do, what it is they offer and how they maintain their place in the gap when things can and do become overwhelming.

Framed by the trigger question ‘Do healthcare chaplains need to be people of faith?’, this book will provide significant insight into the role and function of chaplains within a complex and constantly shifting cultural, social and religious demographic. In Chapter 1, I offer a brief historical overview of healthcare chaplaincy in Ireland and in so doing lay the foundation for a succinct overview of clinical pastoral education (CPE) training in Ireland. CPE, a reflective practice methodology, helps chaplains begin the process of knowing themselves more deeply, more authentically and more congruently. For most chaplains, this is their training foundation. This is how they are supported to become congruent instruments of ministry. Chapter 2 is where I begin to explore theological reflection as a methodology, a concept which sits at the heart of the action-reflection-action framework and is a key part of this book and the methodology at the heart of it. I have crafted my own particular style and method of theological ←2 | 3→reflection which I offer to you, the reader, as a means of dialoguing with the chaplains at the heart of this book.

John Swinton and Harriet Mowat have stated that the task of the practical theologian is to ‘excavate particular situations and to explore the nature and faithfulness of the practices that occur within them’.3 In other words, within the research context this translates to a process of excavation, exploration and new learning. Here in this book, I believe that I follow Swinton and Mowat’s vision of the task of the practical theologian in that I offer considerable insight into my own process of excavation into the life and ministry of contemporary healthcare chaplains. This I follow by presenting in an accessible way the fruits of my process of excavation, showing how I have been able to open up a conversation which has long been needed. Finally, I am in a position to suggest some of the areas in need of attention in relation to the chaplaincy profession and indeed to other faith-based ministries also.

I hope that my conversation can trigger other such dialogues within and beyond the chaplaincy world and indeed give you, the reader, some meaningful insight into the reality of living a public role in a time when religion, faith, church has become somewhat countercultural. The qualitative research method which I employed in my study, a reflective practice framework, gave me the opportunity to really help chaplains dig deep, to reflect on pertinent and pressing issues within their ministry and indeed within their lives. I asked the questions which I believed needed to be urgently asked of them. My approach was subsequently justified because of the depth of experience and insight that was shown in their sharing. It is the fruits of this process of excavation that I offer humbly and openly in this book, a book I very much believe is worth reading. As we walk through the journey of the professional listeners, we may find ourselves nudged to reflect in a meaningful way on what is important to us, what gives our life meaning and how we can integrate the strengths and the challenges, the edges and the shadows of our lives in an honest and useful way. Perhaps we may also find ourselves considering how we can become truly congruent, authentic and, most importantly, fulfilled people in a world that brings myriad challenges, especially for people of faith or for those seeking to find faith. I invite you to join the conversation.

CHAPTER 1

From ‘Cinderella Ministry’ to Professional Paradigms – Healthcare Chaplaincy – Humble Beginnings

The Code of Canon Law defines a chaplain as ‘a priest to whom is entrusted in a stable manner the pastoral care, at least in part, of some community or particular group of the Christian faithful, which is to be exercised according to the norm of universal and particular law’.¹ However, for the purposes here, ‘chaplain’ is broadly interpreted as someone who is employed to provide pastoral and spiritual care to the sick and the dying in hospitals and other healthcare facilities, who is endorsed to do so by their faith community, whether male or female, ordained or lay. Pastoral care is a ministry which includes but is not confined to the provision of compassionate presence, authentic listening and faith support in its many facets. The HSE Circular on Roman Catholic Healthcare Chaplains outlines the role of the chaplain as responding to the pastoral need of patients, relatives and staff, and that the chaplain will recognise and value other people’s belief systems in a developing multicultural society.² That said, the term ‘chaplain’ is not without its complexities and is used with some degree of caution. In a Vatican document published in 1997 entitled On Certain Questions Regarding the Collaboration of the Non-Ordained Faithful in the Sacred Ministry of Priests, while it was acknowledged that ‘the lay faithful of both sexes have innumerable opportunities to be actively involved [in ministry]’, nevertheless ‘it is unlawful for the non-ordained faithful to assume titles such as pastor, chaplain, coordinator, moderator or other such titles’³ as this leads to role confusion. There is a somewhat uneasy acceptance of the usage of the term ‘chaplain’, within ←5 | 6→the Roman Catholic tradition at least, for those who provide pastoral and spiritual care in contemporary society despite the clear guidance from canon law around its meaning and function. That said, this is the term used throughout this book for the people who provide pastoral care to the sick, the dying, families and staff colleagues.

‘Faith’ also needs a brief exploration at this point. While the chaplains themselves will progress the conversation in this regard, nevertheless it is important to have a starting point, a lens through which to move the dialogue forward. Here faith is understood, for the most part, within a Christian context. Therefore, it is this understanding which will frame and support the conversation here. In Share the Good News we are reminded of Pope Benedict XVI’s words: ‘Being Christian is not the result of an ethical choice or a lofty idea, but an encounter with an event, a person, who gives life a new horizon and a decisive direction.’4 Faith is an encounter with Jesus. The friends of Jesus became committed to him because ‘they came to know him and his love for them’. They also came to see his commitment to ‘those most in need, his care for the poor, his love for sinners, his ability to change people’s lives by his compassionate presence, his challenging stories, his healing words and works’.⁵ Therefore, faith is about trust, connection, relationship with Christ. His words, his actions, his compassionate presence offer something by way of reassurance, of hope in the darkest of moments. Faith provides a starting point from which we can dig deeper into the existential questions of life.

Healthcare chaplaincy has undergone a significant paradigm shift over the past four decades. Moving from a predominantly clerical model to one which now encompasses male and female, ordained and lay chaplains, the historical development of the ministry in Ireland has been woven with many challenges and difficulties. Chaplaincy has also been impacted by the many societal, cultural and demographical changes which have occurred in Ireland in recent years, some of which will be documented here. In his introduction to a 2015 history of healthcare chaplaincy in Ireland, ←6 | 7→Fr. Tommy O’Keeffe, a founding member of the National Association of Healthcare Chaplains (NAHC), notes that ‘even after Vatican II, hospital chaplaincy in Ireland was a “Cinderella Ministry” given little or no attention by bishops, religious orders or hospital authorities’.6 Importantly, the primary objective here is not to try to determine the extent (or not) to which Fr. O’Keeffe’s assertions are valid but rather to provide a somewhat brief narrative of the historical and social development of healthcare chaplaincy and CPE training in Ireland. The lens through which this exploration will take place is mainly that of the NAHC, the first professional body founded to provide support and fellowship for chaplains in Ireland.

A pivotal moment for healthcare chaplaincy in Ireland was the formation of the National Association of Hospital Chaplains.⁷ Some tentative steps had been taken in 1976, when a number of hospital chaplains from different parts of Ireland met and expressed the need for peer support and training,⁸ and it was (eventually) from the discussions that day that a concerted effort was made to form a national association. The nine priests who came together in 1976 felt that ‘a hospital was increasingly an important field for pastoral care’⁹ but there seemed to be little recognition of this within the wider church context. Five years later, an association was formed to provide professional and personal support to those working within the hospital ministry. Reflecting on such a significant development, Fr. Tommy O’Keeffe wrote:

At this time, chaplains appear to have felt unsupported by the Catholic Church, with the NAHC accusing it of ‘lip-service’.¹¹ Lacking in recognition, training and support, many hospital chaplains were exhausted, and without a platform to share their ongoing concerns felt isolated. As well as exhaustion and a sense of being unsupported, there was a growing sense within the profession that in order to adequately minister to the sick and the dying, a chaplain needed to have appropriate specialised training so that the hospital would no longer be an ‘adjunct’ to the parish.¹² To that end, in June 1980 Fr. Joseph Cahill of the Columban Fathers was invited by the Conference of Major Religious Superiors to organise a programme in clinical pastoral education in Dublin.¹³ In 1981 and 1982, three programmes were held each year, two at St Vincent’s and one at St John of God’s.

On 2 and 3 June 1981 the inaugural conference of hospital chaplains took place at Emmaus Conference Centre, Swords, County Dublin, with a theme of ‘The hospital chaplain today’.¹⁴ A facilitated discussion¹⁵ took place to ascertain whether it would be useful to create an association which would help support chaplains as well as educate interested stakeholders around the role and function of the chaplain. At this conference a consensus to proceed with forming an association was reached. The second national conference of hospital chaplains was arranged for 18–19 May 1982.¹⁶ During this conference, a key development was the introduction of a draft constitution which had been prepared by Fr. Henry Devlin and ←8 | 9→Fr. Christy O’Byrne. Identity had become a key concern for the new association. The following year the predominant theme of the conference was ‘Sacramental care in the hospitals’. A number of important motions were passed at the annual general meeting that year around voting rights and committee membership. At the September meeting of the steering committee later that year, Fr. Tommy O’Keeffe17 outlined plans to assist chaplains to improve their ministry by encouraging reflective practice and appropriate training.¹⁸ Around this time, members of the Irish Hospital Chaplains Association were also involved in determining standards for training and certification of hospital chaplains.¹⁹