ABSTRACT
The history of chaplaincy to the sick predates not only the National Health Service (NHS) but modern health care. For most of that time chaplaincy has been linked to the Christian church, and chaplains drawn from its priests and ministers. To understand a chaplain’s perspective on ethical dilemmas, it is important to be alert both to the history and to contemporary practice. Some aspects of this chapter emerge from a Scottish context but its broad outline should be recognisable elsewhere. The superficial cause of change for chaplaincy lies in the context of the altered religious
map of society. As with most Western cultures, Christian dominance in Britain has come to an end through a process of secularisation and the development of a multi-faith society. For chaplaincy these changes prompted the move from a ministry offered by the church to an instrument of spiritual care offered within the NHS. Chaplaincy has also been affected by new understandings of the relationship between
spirituality and institutional religion: ‘believing without belonging’.1 As the perceived importance of the church and of church-going has ebbed, the significance of ‘the spiritual’ in people’s lives has grown. In the response of the healthcare system to the needs of individuals, chaplaincy has been able to point to a distinctive set of skills and knowledge-base which are integral to modern understandings of person-centred care. Responding to the World Health Organisation (WHO) description of health as requiring a
spiritual and compassionate element alongside the physical, psychological and social, the Scottish Government Health Department developed a policy for spiritual care in NHS Scotland.2 In requiring each Health Board to draw up a spiritual care policy it envisaged a spiritual care service which was equitable and accessible to people of any faith and of none. All staff have a responsibility to deliver spiritual care in a broad sense, with the result that the specialist role of chaplains took on a new character. While conscious of being heirs to a long tradition many chaplains perceive themselves as part of a new and emerging profession. This gives rise to some discrete ethical dilemmas. At the heart of contemporary practice lies a judgement about where the chaplain ‘belongs,’
setting the context for the ethical questions which he/she faces. The working context can be described as if chaplaincy were simply analogous to other allied healthcare professions, something many chaplains aspire to. Yet the ‘place’ of the chaplain is one which takes its character not from the institution but from the task: the spiritual care offered both to individuals and to the institution, from a place which may be described as ‘marginal’ or ‘counter-cultural’. The ambiguity in the chaplain’s role sets the context for the ethical dilemmas he/she faces. Perhaps it is implicit in the nature of religious and spiritual care. I consider briefly these two modes of care, and then offer a model of the chaplain’s role: one of accompaniment.
