Page last updated at 13:34 GMT, Wednesday, 8 April 2009 14:34 UK

The value of hospital chaplains

By Daniel Sokol
Medical ethicist

Hospital ward
Hospitals can be tough places

The National Secular Society has called for an end to NHS funding for hospital chaplains, arguing the £40m annual cost could be better spent. But a medical ethicist argues they play a key role.

The patient, a middle-aged woman, arrived in A&E complaining of a severe headache.

She spoke in a voice both soft and filled with terror.

So sudden and painful was the headache that she woke up in the middle of the night and vomited several times.

A CT scan revealed a brain haemorrhage, a blood vessel had ruptured in her brain.

More often than not, doctors are strangers at the bedside

After reviewing the scan, a doctor told the patient that the neurosurgeons were on their way.

The A&E was in full steam, with dozens of patients waiting to be seen.

"Is there anything else you need?" asked the doctor, at the end of the three minute consultation.

The answer was short: "Just pray for me".

Lonely wait

These words could easily have been ignored or met with a sympathetic smile, but a colleague had the insight to call the hospital chaplain.

As a non-believer, I was sceptical of pastoral care

Although a busy emergency department is a hub of activity, it can be a long and lonely wait for patients.

The chaplain kept the patient company at a time when she needed it most.

The doctors and nurses were too busy to spend more than a few minutes with each patient.

The patient was tearful and frightened, aware that blood was leaking into her brain and that the outcome was uncertain.

The chaplain soothed and comforted the patient, praying with her.

It is hard to overstate how helpful that chaplain was to the patient and the clinical team.

As a non-believer, I was sceptical of pastoral care.

My experiences as a hospital ethicist have changed my views.

Holistic care

Pastoral services can make a world of difference to some patients, relatives and healthcare staff.

At times, the patient is not viewed as a person but a disease or a constellation of symptoms

Modern healthcare struggles to provide holistic care.

There are too many patients and too few healthcare workers. Consultations are expeditious.

At times, the patient is not viewed as a person but a disease or a constellation of symptoms, shuttled efficiently from one specialist to another.

More often than not, doctors are strangers at the bedside.

And while many clinicians have a wonderful bedside manner, others are less socially gifted, feeling more at ease in the technical aspects of their job.

Hospital chaplains can usually spend more time with patients and contribute to the ideal of a holistic approach to patient care.

The patient feels valued as an individual.

Important expertise

Furthermore, chaplains possess expertise in dealing with emotionally distressing situations.

In another instance, the clinical team decided that aggressive care was no longer benefiting an elderly patient with bowel cancer.

She was dying. We called the family to discuss the decision to withdraw life support and provide 'comfort care'.

The presence of a hospital chaplain in that poignant family meeting was invaluable.

When the clinical team left the room, the chaplain stayed behind and prayed with the distraught family.

in a healthcare system that can appear like a giant, impersonal factory, removing another element of humanity and compassion will be a regrettable loss

When the life support was removed a few hours later, the chaplain was also present.

I have no doubt that, without her, it would have been much harder to communicate the decision to the family, withdraw care, and help the relatives cope with their loss.

In this last case, the family agreed with the medical team's suggestion to withdraw life support.

In some situations, however, there is disagreement between clinicians and patients and their relatives.

Parents, for example, may object on religious grounds to let their terminally ill son off the ventilator until the bitter end.

In these tragic situations, all parties suffer, not least the clinical team who may feel that they are torturing the patient.

Huge help

In these cases, a hospital chaplain from the relatives' own faith can be immensely helpful.

when deciding whether to reduce funding for hospital chaplains, we need to ask ourselves if this will cause more overall harm to patient care than good

The chaplain can clarify the religious positions on the issue, dispel misunderstandings, and reduce tensions between parties.

Of course, some patients will not budge from their deep-seated religious convictions, but in some cases chaplains will reveal solutions to hitherto intractable disagreements and avoid the use of the courts (a most welcome result for all, especially cash-strapped NHS Trusts).

There is a need for more research on the activities and value of hospital chaplains.

However, not all that is valuable can be captured by the usual research methods prized by the scientifically-minded.

It is difficult to measure intangible benefits such as the comfort given to the terrified woman with the brain haemorrhage.

As in any intervention, when deciding whether to reduce funding for hospital chaplains, we need to ask ourselves if this will cause more overall harm to patient care than good.

While I do not know how much harm will result from fewer hospital chaplains, I have little doubt that in a healthcare system that can appear like a giant, impersonal factory, removing another element of humanity and compassion will be a regrettable loss.

• Daniel Sokol is a medical ethicist at St George's, University of London, and Director of Applied Clinical Ethics at Imperial College London. www.medicalethicist.net



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