Why Do Patients Refuse to Meet the Hospice Chaplain?

My boss and I had a brief, pleasant disagreement about the title of “chaplain.” She (I hope this is a fair summation) worries that certain hospice patients refuse a chaplain’s visit because of the title.

Could introducing someone as a “chaplain” lead to a closed door?

I think my boss is right. And . . . wrong.

Even though she’s correct 98.3% of the time (please tell her I said that), I wonder if the stumbling block is what a chaplain is perceived to represent. Wasn’t Shakespeare correct in “Romeo and Juliet:” What’s in a name? That which we call a rose by any other word would smell as sweet? Whether the chaplain is Jewish or Buddhist, a layperson or professional clergy, volunteer or paid, they all carry the fragrance (or stink) of . . .

Religion.

Since ordination in 1977, I’ve had various titles: deacon, elder, minister, pastor, associate pastor, senior minister, lead minister, new church start pastor, campus minister, hospice chaplain, and currently a bereavement support specialist. When a new hospice staff member or a grieving family member asks about my background, I’ll mention I’m a United Methodist clergy.

Religious.

Not good? Good? An open door? A closed door?

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What’s the difference between a pastor and a chaplain? Here’s one explanation,

The title of pastor is bestowed on religious leaders in Protestant churches, for example, but a pastor also may be a rabbi, priest or imam. Pastors focus on ministering to those of their own faith or those who wish to convert. Chaplains may be of any faith and typically do not discuss their personal faiths with those to whom they are ministering unless they are asked.

In hospice, a patient must be under the care of a nurse. Other staff, often referred to as the “hospice team”—social workers, home health aides, chaplains, volunteers, and more—provide additional support. While nurses regularly visit, patients (or their health care power of attorneys) can decline contact from the rest of the team. I’ll bet chaplains rank near the top for declines.

Is it the title? I suspect the No chaplain, thank you very much responses are because patients . . .

  • Have their own minister.
  • As atheists or agnostics, they don’t identify as religious or spiritual.
  • May be spiritual, but don’t care for any religious “authority.”
  • Have had no experience with any faith or faith tradition, so why start now?
  • Only wants visits with a like-minded believer.
  • Had negative experiences with religion or a religious leader.
  • Don’t want a priest until the end. Chaplains = last breaths. Avoid a chaplain, avoid death?

Can you think of other reasons?

Though biased, I advocate for saying “Yes” to the chaplain. When there are six months or less to live, every possible hospice resource should be used to make those days meaningful. Nurses will help with medications and management of pain. Social Workers provide emotional support and are knowledgeable about key resources (like Medicare or Veteran’s benefits). Home Health Aides can make a huge difference by assisting patients with simple but essential hygiene.

Everyone has physical, emotional, and practical needs. We also have, I deeply believe, relational/spiritual needs. And that’s a key role of the chaplain in hospice. The Association of Professional Chaplains describes it this way,

Chaplaincy care is grounded in initiating, developing and deepening, and bringing to an appropriate close, a mutual and empathic relationship with the patient/client, family, and/or staff. The development of a genuine relationship is at the core of chaplaincy care and underpins, even enables, all the other dimensions of chaplaincy care to occur. [My italics.]

A good hospice chaplain will never bring in her agenda or traditions. A good hospice chaplain will not share about his faith or to persuade you to follow his way. Whether visiting once or often, chaplains seek to enter into a relationship with you and let you take the lead with your needs. As Chaplain Kerry Egan* explained on NPR’s Fresh Air,

A chaplain should never go in and preach to someone; that’s not our role. Our role isn’t to tell you what to believe. Our role is to say, “What is it you believe and how does that help you — or not help you — in this process, this process of dying, this process of letting go of the life you’ve loved (or maybe have not loved) and coming to some peaceful place?”

But is my boss right? Should we rename the position? She’d contend—and I agree—that some have had lousy experiences with chaplains. A hospital’s chaplain created more rather than less guilt. A police chaplain said the worst thing at the wrong time. An awful past experience does influence any future encounters with those bearing the same title.

So, let’s change the chaplain’s title to . . . what?

Spiritual Counselor? Spiritual Care Coordinator? I’ve read that the military jargon for chaplains is “Sky Pilot.” What about Holy Joe? Or Holy Jane? Padre? Madre? God’s guy or gal?

I can be funny. But this is serious. Titles matter.

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St. Martin and the Beggar, by El Greco

Chaplain” likely emerged in the 4th century from the Latin, cappellani. Christian legend claims that St. Martin, a military leader turned bishop, had once sliced his cloak (cappella) in two pieces with his sword so a poor man would have warm clothing. That half-cloak became a religious relic, taken into battle as a symbol of God’s blessings. When not in use, the relic (and other religious “treasures”) were housed in a chapel. A chaplain was appointed to be in charge of the chapel.

Chaplain and chapel have decidedly Christian and military origins. As the title evolved, a chaplain came to designate an ordained clergy or trained volunteer linked to a particular institution.

Those hazy, venerable origins continue to inform two key parts of the modern chaplain. First, their role was rooted in one person relating directly and personally with another. I hope today’s chaplains symbolically give a “cloak” to those they serve, providing warmth and comfort. Second, every institution—military, hospital, hospice, and more—can be made better when someone is designated to uphold the spiritual side of what it means to be fully human.

What do you think is the best title?

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*Kerry Egan wrote “On Living,” a wonderful book on working with patients as a hospice chaplain. Everyone should read it!

(Hospice vigorously protects a patient’s privacy. I’ll take care with how I share my experiences. Any names used are fictitious. Events are combined and/or summarized.)

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Comments

  1. I would encourage a change in the name to Chaplain & Relational/Spiritual Counselor. I spent many hours listening and trying to help people going through this process. I have waded through it several times myself. It has always been hard. Trying to get through the medical stuff even if you have an understanding of what’s what; when it is your loved one, the process is overwhelming, even soul crushing. Struggling to understand what the next steps are, making choices that may or may not upset family not tasked with making those hard choices can be a minefield. A call from a nurse, a doctor, a case manager, social worker; all giving out information in a calm manner, that you may or may not understand so you are madly scribbling words you will need to look up or ask about later when you can sit and reflect on the totality of all of it all. And you know, before some of the family/friends are contacted you’d better understand what those professionals said, the why and how of every bit of it and then get ready for the questions and statements that will cut you to the bone, or warm your soul and offer you moments of peace and a soft place to fall, because of what they read in some article or heard on TV or someone said or the heads up when they went through ‘it’ and something did not go the way you are talking about. I spent hours and hours listening and I must have said I don’t know but I will try to find out a million times so they could take a breath and a hot bath and maybe catch a few winks. Then a chaplain calls and starts asking personal questions. I would be asked if they had to talk to them? Why did they need to know about my family members? Why are they asking me about my family? I associated right or wrong, the title of Chaplain with emergencies; a crash or a death. However if your entrance into hospice is emergent, the offer of help/support from a relational/spiritual counselor might have been more clear. When they asked personal questions, I was confused and in some cases that attempt at collecting information felt invasive. A stranger (the chaplain) wants to understand the family dynamic? The last thing they need is someone stirring the family pot and this stranger is offering to call people. I understood why they declined. I wished on many occasions I’d had this blog to send them to for the answers I did not have. I’d wished on more than one occasion that someone could have come to talk to members of my church about hospice. One of those subjects we all hope we will never need to understand and I for one regretted not pursuing it before it was my turn.

  2. I work in this role and my title is Pastoral Care Worker, although I still find that this has religious connotations. My work in in a Catholic Hospital but I’m actually Buddhist. I visit all the patients and work non-denominationally.
    I am challenged daily as to how I introduce myself and I’m not sure that we have reached a satisfactory answer yet as to what a suitable title would be.
    I rely on the fact that I can offer a friendly face and a comforting presence and hope that this is enough to engender trust at the most vulnerable of times.
    It seems to work and religion is rarely discussed.
    I actually prefer the title Spiritual/relational counsellor.

    • Thanks, Vivienna . . . maybe our titles will always be a “challenge.” But I so agree with you, being with others and hoping to create trust in the vulnerable moments.

  3. Lots of people want to minimalize the circle of people they communicate with as they travel the terminal road . In LTC facilities they may stop playing bing. It’s our job in hospice to support their wishes.

  4. When a person and their family enter the hospice system, there are so many “new” things they are exposed to and it can be overwhelming. Emotions are understandably abounding. On intake, it would be valuable to calmly sit with everyone to explain services provided by each person in hospice including hospice chaplain. It avoids ever asking the person, “would you like to see a Chaplain”. For example, the hospice I volunteered in has a statement that says:

    “Chaplain”

    Assesses spiritual needs of patient and family

    Provides spiritual counseling or referral to community clergy, with respect to individual’s faith, traditions and spiritual beliefs

    Offers memorial and funeral preparation assistance, including help with planning or officiating at memorial services

    Then leaving this paper with all provider and services information for them to return to after the initial days settle when they can think more clearly. The second sentence is key to clarifying the Chaplain role. This is the person who will help you in anyway should you choose to address spiritual needs. This eliminates assumptions of the Chaplain role and provides a way to help alleviate any previous negative impressions from past encounters with a Chaplain.

  5. Thanks for the helpful article & for posing the question about titles. The official title at my hospice is “Spiritual Counselor,” and yet most employees refer to us as “chaplains.” At a previous job, my title was “Spiritual Care Coordinator” which I found cumbersome to say, and too often it was received with mystified expressions. “Chaplain” is quicker & easier to say, & it is generally received well by veterans. However, the title does often shut out the “unchurched,” those of non-Christian faiths, and those in recovery from bad religious experiences. I have yet to find a simple title that encompasses all we do & which indicates inclusivity. I tend to like “interfaith (or intercultural) chaplain.”

    Perhaps the best approach is to redefine “chaplain” by being our authentic, compassionate selves. When people see that this chaplain is a woman, I have already begun to break down the negative stereotypes of this title (which is balanced by the number of people who are disturbed to see female clergy!). If anyone in this role can get their foot in the door, most patients do welcome a genuinely caring, spiritual companion.

    • Jean . . . thanks so much for reading my “stuff” and responding. The brevity of the title chaplain (even with its possible baggage), does represent an upside. And I agree, when you can get the “foot in the door,” a thoughtful, compassionate, open-hearted chaplain (or whatever title) has a good chance of developing a positive relationship with the patient and family.

  6. I have been a hospice chaplain for many years. I use spiritual counselor or chaplain, depending on the person/situation. Part of the job is navigating the other person’s projection of whatever title is used! The Team also helps people understand the role/purpose of who I am!

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