Challenges of Chaplaincy

Their commitment to physical and mental recovery puts chaplains trained in Clinical Pastoral Education (CPE) in a challenging position. Many in both medical and religious institutions view hospital chaplains as inhabiting the space between clinician and religious officiant, between medicine and religion. While the American Hospital Association in 1967 described hospital chaplains as a "necessary part of the hospital's provision for total patient care," hospitals rarely provided funding or space for chaplaincy programs; in some hospitals, chaplains did not have access to phones or even desks.¹ Despite the consistent support of organizations like the American Medical Association, with Rev. Dr. Paul McCleave at the head of its Department of Medicine and Religion in the 1960s, many people still questioned what the role of a chaplain should be in a medical context.

In 1954, 66.7% of hospitals in the United States reported having chaplaincy service, but by 1966 that number had fallen to only 41%.²

Hospitals themselves were among those that scrutinized the purpose of hospital chaplains. Sociologist Wendy Cadge found that as hospital costs continued to rise steadily, chaplains and other employees considered non-essential struggled to prove their worth to the medical establishment. While veterans' hospitals have required a staff chaplain since 1945, there were no regulations that required hospitals to have chaplains on staff.³ Budget cuts and the gradual disassociation of formerly religious hospitals with particular traditions throughout the nation deeply affected hospital chaplains. In 1954, 66.7% of hospitals in the United States reported having chaplaincy service, but by 1966 that number had fallen to only 41%.⁴ To survive as a profession, hospital chaplaincy needed to adapt, stay relevant, and prove that a CPE-trained chaplain was still an integral part of a patient's health care plan.

Throughout all America, there is a new recognition, on the part of many, of the concept that man is a whole being. He is physical, he is spiritual, he is mortal, and he is social in his total health . . . The faith of the individual patient is a vital factor in total health. The patient must be treated and cared for within the scope of that faith . . . There needs to be greater understanding between the physicians and all faith groups as to the requirements of those faiths relative to patient care.⁵
—Rev. Dr. Paul McCleave

Due in part to persistent education initiatives, the medical institution began accepting religion more and more as decades passed. In 1975, medical texts began to include religion as a critical part of hospice care.⁶ By 1980, 58% of hospitals reported having some form of chaplaincy service available to patients.⁷ Despite a growing acceptance of the chaplaincy work in hospital settings, the profession continued to struggle with issues of identity. These continued into the 1990s as hospital chaplains questioned whether they were members of a health care team or of the clergy. Some chaplaincy leaders urged hospital chaplains to embrace a more clinical perspective, but many were reluctant to move in this direction, lamenting the medicalization of their work.⁸ Even by 1998, when consultants were brought in to assist with the merger of the Association of Mental Health Chaplains and the Protestant College of Chaplains, the greatest single issue they identified as facing hospital chaplains was the struggle with identity.

Are chaplains first of all ministers called by God, therapists trained by experts, or theoreticians trained in dialogue? As chaplains, which relationship is (or should be) of greater importance: the relationship with the church that sets them apart to minister or the relationship with a professional organization that certifies technical competency? Is the key to carrying out a chaplain's stated mission proficiency in therapeutic technique or spiritual commitment or both? What is the more basic identity for a chaplain: the pastoral/spiritual calling or clinical/therapeutic competence?⁹
—Consultants on the merger of the Association of Mental Health Chaplains and the Protestant College of Chaplains

Today, hospital chaplains continue to wrestle with these questions. As the profession moves increasingly toward an interfaith model, chaplains are assigned to hospital units and provide their services to patients regardless of their religious backgrounds.¹⁰ The field has also become more unified in terms of education and the responsibility of chaplains to draw on "traditions of spirituality that contribute to the healing of the body, mind, heart and soul."¹¹