This is an article by Mark Kolsen. It appears in the current issue of American Atheist magazine, which is sold at Barnes & Noble, Book World, and Books-A-Million bookstores in the United States and at Chapters/Indigo bookstores in Canada. To find a store near you or to subscribe, go to atheists.org/magazine.
In November, ten minutes after walking into a hospital emergency room, I lay on a bed, completely surrounded by medical staff preparing me for a catheter. My left anterior descending artery (a.k.a. the widow maker) was completely blocked, and I needed a stent to restore my blood flow.
Just beyond the staff encircling me, I noticed a middle-aged man wearing a “Hospital Chaplain” sign. (And it was a sign, not a name tag or ID badge. It was about five by eight inches and held around his neck by a string.) When someone asked me about relatives, the “hospital chaplain” offered to call my first mate, and he was the one who took my clothes and valuables and assured me that they would be “safe” during my surgery. And just before I was carted off to the operating room, the chaplain asked, “What denomination of clergy would you like me to call?”
Somewhat surprised, I said that I was an Atheist.
“You want to be an Atheist at a time like this?” he replied.
“Time like this?” For a moment the question baffled me. Should I worry because it’s Friday afternoon, a reputedly bad time to check in to a hospital? Then I snapped to and realized that even though I didn’t think that my life was in danger, the chaplain did. And if I were to die, well…
“Sorry, but I know the science,” I responded with a smile. “Thanks for your help, anyway.” At that, the chaplain slithered away.
Later, as I reflected on my experience, two things struck me. First, the hospital chaplain never offered me non-religious options, such as the secular humanist chaplains now available in the U.S. military. Such options exist elsewhere. In Belgium, “non-denominational institutions have a team of usually Catholic and atheist spiritual care givers.” In 2015, Britain’s National Health Service mandated “equal treatment… of those without a religion in the receipt of pastoral care.” Shortly thereafter, Jane Flint became the first secular humanist hospital chaplain in Great Britain. Her job is to offer “emotional support to terminally ill atheist patients and their relatives.” In the Netherlands, “spiritual caregivers” in hospitals comprise both “humanist” and “non-aligned” chaplains. And in Scotland, with policy guidance from the Scottish Humanist Association, chaplains “are expected to work… with different faiths and those of no faith.”
Chaplains, after all, are not just for theists. There is widespread agreement that all people have spiritual, as opposed to religious, needs. In a recent article for the online journal Philosophy, Ethics, and Humanities in Medicine, Marcelo Saad and Roberta de Mediros define spirituality “as the search for ultimate meaning, purpose, and significance in relation to oneself, family, others, community, nature and ‘sacred,’ expressed through beliefs, values, traditions and practices.” And regarding hospital patients, a recent white paper on ProfessionalChaplains.org states that while serious illness is a biological event, it “frightens patients and isolates them from their support communities when they need them most. Losses such as physical and cognitive capacities, independence, work or family status, and emotional equilibrium, along with the accompanying grief, can seriously impact their sense of meaning, purpose and physical worth.”
Recognizing that sick and terminal hospital patients especially have “spiritual” needs, the World Health Organization (WHO) International Statistical Classification of Diseases and Related Health Problems includes billing codes “for diseases, signs and symptoms, abnormal findings…and for some spiritual interventions.” Here in the U.S, Medicare and Medicaid have agreed to let hospitals claim reasonable costs for clinical pastoral education, and will pay for end-of-life conversations, during which terminal patients can articulate to their providers what kind of medical interventions they do or do not want.
However, unlike other nations, “no hospital is required by law or accreditation fiat to provide pastoral care” in the United States. And, in contrast to the WHO, the National Uniform Billing Committee has refused to provide billing codes for chaplains. Nevertheless, in 2003, the Joint Commission for the Accreditation of Healthcare Organizations said hospitals should “demonstrate respect for patient needs, including the need for pastoral care and other spiritual services.” Hospitals appear to have responded. Although a 2008 study reported that only 59% of American hospitals had chaplains, a more recent study reported that 70% of community hospitals employ chaplains today.
Online, many hospitals advertise “spiritual services.” However, I found none that advertise non-religious — i.e. secular humanist or Atheist — chaplains. This is ironic for several reasons. In metro areas, fewer than half of hospital patients identify themselves as church members when admitted, “hospitals serving primarily pediatric patients… have a higher prevalence of religiously unaffiliated family members,” and the number of non-religious millennials continues to grow.
Atheist chaplains do exist in a few hospitals. But rarely are they paid staff members, despite the fact that chaplains’ services cost very little, and many hospitals advertise their services for no charge. Recognizing the problem — and seeking to increase employment opportunities for their members — liberal theist organizations are training their own chaplains to care for Atheists. Acknowledging that hospitals do not usually hire humanist or Atheist chaplains, one veteran theist chaplain puts it bluntly: “As the number of unaffiliated and nonreligious persons climb, [theist] chaplains become by default the primary spiritual care givers… in a hospital community.”
Not all medical groups are oblivious to Atheists’ needs. According to Toni Van Pelt, nursing home directors have approached the Institute of Science and Human Values for advice on how to meet the needs of their secular residents. Likewise, a recent joint commission report focused on the language, racial, ethnic, and cultural diversity of hospital populations. Cultural diversity, the report points out, includes religious preferences. As non-religious patients increase in number, hospitals must start to recognize that Atheists need staff who share their beliefs.
Theist chaplains, well-meaning as they may be, do not meet Atheists’ needs. Dr. Jason Heap, who has filed suit seeking to become the first humanist chaplain in the military, has trained other humanist chaplains. He says, “If the chaplain with whom you are confiding offers theistic-based reflections or prayers to your existential questions, what practical value does this have in your situation?”
Stephanie Wernek, an Atheist hospital chaplain in Rio Grande Valley, points out she has met “many people under the age of forty who were adamant non-theists. Even in this deeply theistic part of the country, there exist many people who feel silenced and atomized by their lack of affiliation with a religious group that believes in a deity.”
Vanessa Gomez Brake, Director of the Chaplaincy Institute, says, “a need for atheist chaplains exists… [A]t its core, chaplaincy is about taking the sacred out of the church, mosque, synagogue and temple, to bring it to the people, whatever their circumstances.”
In addition to not being offered an Atheist chaplain, my hospital experience raised another issue. Why, I wondered, was a chaplain mingling with the medical team attending to me? I had not requested his presence; like many other people, I felt no need for a chaplain. In fact, upon reflection, his lurking around my body, and his overhearing my conversation with the medical team, was an intrusion into my privacy.
I am not the first to ask this question. As more hospitals employ chaplains, their precise role, especially their access to patient information, is now a subject of contentious debate. Chaplains, supported by some academics, argue that they provide a range of services, making them part of the medical team. Many also reject the assertion of the Department of Health and Human Services (DHS) that health care “does not include methods of healing that are solely spiritual” and that “practitioners that provide solely religious healing services are not health care providers.”
This debate is not just about semantics or chaplains searching for employment. Under the DHS Privacy Rule, chaplains’ access to patient records without a patient’s permission depends on whether the hospital considers them medical providers — and some do. Without your consent, chaplains considered “medical providers” could access information about your general condition, spiritual affiliation, and anything else related to your medical history or treatment. In short, they could know as much as your doctor would about you.
Encouraged by the Association for Clinical Pastoral Education, which is the main accrediting agency for chaplaincy in the U.S., hospital chaplains are already stepping beyond their bounds. “Some chaplains and chaplaincy programs have begun to engage in activities that have ranged from initiating conversations with and perusing the medical records of patients who have not requested their services to suggesting that, because they are chaplains, they be permitted to do ‘spiritual assessments’ on patients whether or not the patients are explicitly informed and agree to this beforehand.” In some hospitals, especially religiously affiliated ones, a chaplain “functions as a full member of the healing team.”
As a result, some academics and doctors are sounding an alarm. Pointing to the fact that members of “healthcare teams” are not equal in education, experience, and status, Roberta and Erich Loewy state that “hospital chaplains are not considered healthcare professionals — either in fact or in principle — and, arguably, not even allied healthcare professionals. Rather, they are considered an ancillary part of the healthcare team that is generally classified under the further, functional descriptor, ‘patient support services.’”
The Loewys argue — convincingly, in my view — that while hospital chaplains may serve some critical functions in the healthcare of patients, “it is a breach of confidentiality to allow a chaplain access to a patient’s medical records unless the patient is fully informed, understands the implications of such access, and either wholeheartedly acquiesces or initiates such a request.” Otherwise, chaplains and doctors may have access to information, including conversations, which patients assumed to be private and confidential.
Moreover, the Loewys believe that chaplains should encounter patients only if patients request their presence because “the unsolicited appearance of a chaplain may range from innocuous — simply embarrassing or uncomfortable — to intrusive or even threatening.” As I think back to my ER experience, their words resonate.
The proper role of hospital chaplains will continue to be debated. Right now, Atheists need to be aware that, like me, you may unexpectedly face chaplains after entering a hospital, especially at your most vulnerable moments. These individuals are likely to be theists. If a hospital considers them to be “healthcare professionals,” they may have access to a lot of information you’d rather not share.
Mark Kolsen recently retired from teaching high school in Wheaton, Illinois. He is an avid fan of the Four Horsemen, the late Victor Stenger, and Ayaan Hirsi Ali. He strives to understand all facets of scientific cosmology and evolutionary biology.
[Hemant’s note: All footnotes and citations for this article can be found in the print edition.]
(Image via Shutterstock)