CAPPE at the UHN: An Impediment to Care?
The role of Chaplaincy at the UHN raises some thorny issues with regard to the role of religious care in a contemporary multicultural urban hospital. Two key questions emerge: 1) given that the majority of patients do not enter their faith background on admission, and that the dominant spiritual and emotional paradigm in contemporary urban Canada is psychology, are CAPPE trained Chaplains the optimal choice of care for meeting the spiritual and emotional needs of patients and staff at the UHN?; 2) given that few, if any, religions meet the ethical standards set out by the Canadian Charter of Human Rights and Freedoms, is the UHN ethically compromised by its dependence on (dominantly Christian) religious to manage it’s emotional and spiritual care?
1. Are Chaplains the Optimal Choice of Care for Meeting the Spiritual and Emotional Needs of Patients and Staff at the UHN?
The role of Chaplains is a unique one in the hospital environment. The vast majority of care roles in the hospital are dedicated to dealing with ‘the body’ and, while a patient’s experience of their illness is useful in deriving a description of their symptoms, it is not, in itself, believed to be of the utmost importance. Only Social Workers come close to addressing the needs of patients as expressed by their perception of what is occurring to them, but their role is focused on the necessities of a patient’s social situation and secure discharge. Chaplains then, are, in fact, the only ‘professionals’ who are specifically concerned with the world of the patient’s subjective perception, rather than their objective symptomology.
Elsewhere in contemporary Canadian society ‘mind care’ is the purview of the psychotherapist or counselor. Where a person specifically desires care from someone of their own religious affiliation they may seek that out, but the assumption is that counselors and psychotherapists have the most adequate training to deal with issues of depression, trauma and catastrophe. Why is it then that Chaplains – whose background is, and must be, religious – are serving in the place of such professionals?
Chaplains, whose training is underpinned by religious standards rather than psychological or spiritual standards, are not optimally equipped to be the sole providers of this type of care. Does the care of the ‘mind’ or ‘soul’ simply not matter enough (yet) to Health Care Institutions to persuade them to decisively ensure its standards? The great focus on ‘Patient-Centred Care’ has not translated into a rigorous training and hiring process which is responding directly to the clearly expressed emotional, psychological and spiritual needs of patients and staff.
2. Religious Ethics and the Canadian Charter of Human Rights and Freedoms
Religious affiliation is, according to the standards set out by CAPPE (the only Chaplaincy training organisation that is accepted by Canadian Health Care Institutions*), required to become a Chaplain. This standardisation, set out by an organisation that is around ninety-five percent Christian, leads to a situation which is, in light of the Canadian Charter of Human Rights and Freedoms, highly problematic. The placement of faith-based Chaplains (necessarily trained through CAPPE) to address the spiritual and psychological needs of an exceptionally divers population of patients and staff subjects the UHN to a political, legal and religious quagmire. Canadian Hospitals are understood to be environs under the umbrella of the Canadian Charter of Human Rights, and there are few, if any, religions, which meet the ethical standards outlined in that Charter.
The following ‘situations’ are evidence of an ethical, and, frankly, discriminatory, quagmire at the UHN:
- As of May 30, 2006 there were 11 Chaplains working in the UHN (including Supervisors, Residents and Contractors). All were Christian; all except one were male (the one female being an occasional contractor); and all except two were white. This hardly seems representative of the population present in the UHN, and is, in terms of faith, race, and gender, decidedly unlike any other department at the UHN. This, while not intrinsically discriminatory, certainly raises questions as to principles and standards of hiring and training Chaplains.
- Allowing the Anglican Church and the Catholic Church to pay all or part of the wage of a Chaplain hired by the UHN demonstrates both religious and financial discrimination in that only those faiths with the funding required to support that wage are eligible. Most faith communities new to Canada do not have the financial means to equal the Catholic or Anglican Churches, and so cannot place Chaplains professionally.
- The Catholic Church (along with many other faith groups) explicitly discriminates against gays, lesbians and women, and this is all clearly contrary to the Canadian Charter of Human Rights and Freedoms. The UHN Chaplaincy Services tacitly endorses this by its willingness to contribute to the wages of Catholic Chaplains, as well as allowing Catholic volunteers and ‘novitiates’ to ‘train’ on the Wards of the Toronto Western Hospital.
Are there any other organisations which the UHN hires from which are so clearly, and publicly, contrary to the Canadian Charter of Human Rights and Freedoms? - Admission into CAPPE’s (the UHN’s sole provider of Chaplains and Chaplaincy Training) training program requires, “… documentation of current endorsement or of good standing in accordance with the requirements of his/her own faith tradition.” The need for endorsement from a faith tradition is discriminatory towards those who do not belong to any specific faith tradition. This is further discriminatory to those who, while belonging to a faith tradition, may not be explicitly supported by that faith tradition due to their gender, or their philosophical or lifestyle choices. A Catholic may not receive endorsement, or may have endorsement revoked, if it is discovered that he/she is gay; an individual may lose their endorsement as a result of a change in, or questioning of, their belief system (ie. Sharia Law, Tibetan Buddhist notions of succession, the explicit patriarchy present in many faith traditions, etc.)
- For advancement beyond a basic level of training CAPPE further requires, “evidence of completion of the first year of a theological/religious degree at the master’s level (M.Div., MST, MPS) …” Given that there is no such thing as a theological/religious degree at the master’s level anywhere in Canada in any faith other than the Christian faith (‘Theology’, by definition, assumes that there is one, single, deity) we can assume that anyone who is not a Christian will need to go through a process of ‘Equivalency’. This is religious discrimination.
This Standard is also culturally discriminatory. The Rational-Analytical paradigm of the Western University system which dominates Christian Theology is not necessarily shared as a paradigm of knowledge by other faiths. There is no great role for the objective and critical exegesis of historical texts in most religious traditions.
Some Possible Pathways out of the Quagmire
- The UHN should not pay for Faith-based Chaplains. Faith-based Chaplains, whether they are Catholic, Buddhist or Muslim, serve a specific community of the faithful. Faith-based Chaplaincy should be provided, voluntarily, by the faith group, and should be practiced only with those of their own faith (negating the possibility of in-hospital evangelisation).
- Spiritual and Emotional Care Staff should not be required to receive endorsement from a specific faith group. The majority of the patients entering the UHN do not include their faith tradition in their intake form. In contemporary Canadian society there is an increase in the number of people professing a strong interest and need for spirituality, and yet, simultaneously, a decrease in the number of people professing a religion.
These individuals do have complex systems of belief in God, in human potential, in soul, in growth, but they are not associated with any particular faith tradition. This is a trend which CAPPE, and the UHN, are not addressing, to the detriment of their patients and staff.
The UHN needs to come to terms with whether it is training and hiring ‘Faith-Based Chaplains’ or ‘Spiritual and Emotional Care Practitioners / Counselors’. It is an antiquated notion to equate religiosity with spirituality and it has been more than fifty years since Psychology became the dominant paradigm and symbology which individuals turn to when in distress, and through which they journey spiritually. None of the Classic Psychoanalytical pioneers introduced in the CAPPE training program professed any faith whatsoever: none would receive ‘endorsement’.
- A Graduate-Level Theological Degree must cease to be the standard by which those training to provide Spiritual and Emotional Care are measured. This is a highly specialised advanced degree in a single religion. The Foundational Preparatory Courses required for an MA at Toronto School of Theology are the following: History of Christianity, Theological Foundations, Hebrew Scriptures, New Testament, and Christian Ethics.
A very typical situation that a ‘Chaplain’ in the UHN might need to attend to could be a young man who had a catastrophic health crisis the day before, of no explicit faith background, being taken off life-support in an ICU, with his wife, children and kin in attendance. I ask, very simply, what is the relationship between any of the above research qualifications and the situation the MA in Theology student is being faced with? I’m not convinced that there are any qualifications in evidence that are explicitly related to trauma, grief, counseling or therapy.
Conclusion
My own experience in training and working as a Chaplain in the Neuro, Spinal and ICU Wards of the Toronto Western Hospital unquestionably affirms the need for Spiritual and Emotional Care as part of the multidisciplinary environment at the UHN. The spontaneous gratitude repeatedly expressed by patients and staff, and the sometimes astonishing re-orientations that I was privileged to witness, affirm that the presence of someone whose specific focus is spiritual and emotional well-being can be transformatively healing in ways that can transcend the hospital experience.
The issues faced by patients referred to Chaplains – severe trauma, total debilitation, catastrophe and death – are exceptionally challenging and require a special kind of training, and a special kind of individual. They require facility with a wide variety of belief systems and a strong comprehension of how traumatized people can engage these systems for their own good. They also require strong skills in trauma and grief counseling, both one-to-one and in groups.
Chaplains are, in my experience, very brave people, and frequently succeed in having a tremendous positive influence on those for whom they care. I am not convinced, however, that they have been provided, through their training, with the tools genuinely required to make the best of unbearable situations. The capacity for ‘Spiritual and Emotional Care’ does not require adherence to any one faith, or to any faith at all. CAPPE’s attachment to ‘religion’ severely impedes it’s capacity to attract and train the best possible candidates for this kind of work, and the UHN’s attachment to CAPPE obstructs its capacity to respond to the Spiritual and Emotional care needs of what is, quite possibly, the most culturally divers population of humans ever to grace the planet.
About the Author
Nik Beeson spent a decade working in mental health and palliative care while living in Catholic Christian communities and studying Christian Theology. He was admitted into the one-year CAPPE/UHN CPE Residency in September 2005, receiving his endorsement from the Shambhala Buddhist Meditation Centre of Toronto. He was … surprised … when, halfway through the Residency Program, CAPPE barred him from proceeding because he did not have an MA in Theology.
* Sick Children’s Hospital being, to my knowledge, the only exception.