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Whose business?

By Robert Clark.

...Is any among you sick? Let him call for the elders of the church; and let them pray over him, anointing him with oil in the name of the Lord: and the prayer of faith shall save him that is sick... James 5:14.

Yes indeed! But what then should we make of the outsized banner headline in the Church Times of 2nd June 1995, following lead stories in the Sunday press of the previous week?

HOSPITAL BAN ON VISITING CLERGY

A new ban on local clergy seeing patients lists and visiting the wards...

Has something so dramatically changed in our society that in some way and for some reason, the National Health Service (NHS) now feels the need to protect its patients from the churches?

This question has both 'yes' and 'no' answers, and it is vital that every official representative of any church, congregation or group visiting any hospital, or indeed any sick person in their home, should now be fully aware of the importance of confidentiality and privacy for the benefit of all patients.

Let us first look at the 'yes' and try to identify some of the reasons behind it.

Circumstances and attitudes have changed and are changing in our society. Among the more welcome and positive developments is the increasing concern of the NHS for the total well-being of its patients. The Guidelines (HSG[92]2) issued by the Department of Health to all NHS hospital trusts in 1992, when read alongside the Patient's Charter, highlights the importance for each and every trust to provide all patients of all faiths, all races and all traditions with ready and easy access to the spiritual and religious care which is appropriate to the particular history and needs of the patient.

Such formal recognition of the importance of 'spiritual and religious care' is a significant advance in our liberal democratic society and should be warmly welcomed by all faith communities. In most hospital trusts there is now the provision of a team of officially selected and appointed hospital chaplains. These are people who are specially trained for work with patients, staff and relatives in the complex world of the modern hospital setting. In the case of the larger religious traditions the chaplains are contracted and paid by the NHS for their work. All major faith communities and minority groups as well as the main Christian traditions are included among the lists of Official Chaplaincy Appointments to the Trusts.

In many instances the provision of official Christian hospital chaplains as full members of the hospital/trust staff pre-dates the introduction of the NHS in 1948. The recent more formal arrangements with all faith communities, together with a remarkable increase in numbers (now 350 whole-time and about 1800 part-time hospital chaplains) has come about as the result of management changes in the NHS linked with a changed understanding of the significance and value of spiritual and religious care for the total wellbeing of the patient. With a better trained and selected total chaplaincy of all traditions, the NHS has set new standards and duties for all staff chaplains which include undertaking more responsibilities in the work-place in the interests of both patients and employing trusts.

The many developments now taking place in the range and potential of modern medical skills and treatments, together with the use of communication technology - computer records and the like - have been accompanied by an increased awareness in society as a whole that individual people and patients need privacy and confidentiality if they are to be free to act autonomously and talk openly and honestly to health care professionals as they seek help and treatment at an early stage in their illness. The provision of that security must in the long run be in the best interest both of the patient and of our society as a whole. The attempt to bring it about has focused greatly increased attention on the need to protect confidentiality and safeguard patient privacy.

Health care today is highly complex and has considerable knock-on effects in many aspects of a person's private life. Everybody who works in the hospital setting, including all hospital chaplains, must be aware of the need to safeguard the proper interests of all patients. Thus it must follow that all staff are bound by a proper professional discipline regarding confidentiality and patient privacy. This is not only a matter of good professional practice; it is also a matter of law, and all NHS staff (again, chaplains included) can be dismissed for a breach in the regulations.

In 1994, the Department of Health issued a consultation document, 'Confidentiality - Use and Disclosure of Personal Health Information'. Section 4.29, 'Information about Religious Affiliation', reads thus:

HSG(92)2 advises that hospitals should, when registering patients, record religious persuasion where the patient is willing to disclose this. This information may be passed on to the appropriate hospital chaplain or religious leader where that person is a member of staff, unless the patient has refused permission for this. Information about a patient may not be passed to any religious organisation or its members outside the NHS without the patient's consent.

Put in very general tems for our purposes, the law amounts to this:

The very fact that a person is a patient is itself private confidential information.

It must remain confidential until the patient agrees otherwise.

The patient alone has the right to say who may be told what and when.

People not professionally involved in the care of the patient do not have any right to know. This includes family, friends, employers, neighbours, clergy, ministers and fellow members of faith groups.

There are a few notable exceptions to this rule in the case of notifiable infectious diseases, children, and very serious criminal offences, but these few exceptions would not cover clergy, ministers, and official hospital visitors.

Perhaps a few recent examples of local practice and professional standards which have failed to be up to the highest expectations of the NHS, society and the law, will serve to highlight the pastoral implications of this problem.

The economic recession of recent years has meant that many employers large and small are unwilling to employ those who they think may have a bad sickeness record now or in the future. For example, when a manager of a small Midlands company attended a service at his local church and heard the prayers, using the full name, for a person in the town who was, in the words of the Bidding, 'seriously ill and needing further major investigations', he mentioned his genuine concerns for the sick person to the company personnel officer. Rightly or wrongly the sick person came to the view that the only reason for having been made redundant in the down-sizing of the company a few months after his/her return to work, was that the company might have to pay for very expensive sickness payments in the changed arrangements of National Insurance, which would be financially to the company's disadvantage - a serious matter in the light of the recession. When detailed inquiries were made, it became clear that the name had been put on the prayer list not at the request of the person concerned but in response to information given by a 'concerned member of the church' who had picked up the news while visiting her husband who happened to be in the same ward. The prayers of the faithful greatly disadvantaged both patient and family in this case!

Another recent example is that of a concerned minister. Having been told of the serious illness of a lady's husband, and from the best possible motives, he made a home visit. Regrettably the information had come not from the patient, but from an 'official sick visitor' in the congregation. This visitor had made an official visit to another patient in a distant hospital who happened to be in the same ward as the husband. The visitor had recognised the husband/patient as a member of the congregation, and had gone straight back to tell the minister that this man was in hospital for cancer tests. The fact that her husband was in hospital at all was news to the wife, and came as such a shock when the minister told her, that her already fragile mental and nervous condition gave way to a total breakdown leading to her immediate admission to the local acute psychiatric clinic. It transpired that her husband, aware of his wife's delicate condition, had arranged to 'go away on business for a couple of days' rather than worry her with the truth that he was to undergo preliminary cancer investigations. In law he was entitled to expect that the fact that he was a patient was itself confidential information. He had the right, whatever others might think of his approach, to protect his wife in what seemed to him the best manner possible. His caution seems to have been justified by the fact that she required prolonged treatment following disclosure of his real situation. Thinking that the breach of confidentiality was made by the hospital, he began legal proceedings against the health authority, which he withdrew only when the true source of the breach was identified. Both husband and wife are now alienated from all worshipping communities.

Additional examples can be cited in cases of HIV and AIDs patients. Regrettably these conditions give rise to strong and often irrational adverse and confrontational attitudes in the judgments of many in our society, Christians included. Once confidentiality about a patient's condition is breached, there may be and often are major damaging results for patient and family in relation to employment, insurance and bank accounts, pension schemes and mortgages. A moment's reflection will confirm that it is not only in the best interests of the patient but also of society as a whole, that privacy and confidentiality are fully respected. Only then can patients be expected to come forward in time to receive the treatment and counselling which they and their families need and which is in the interests of the community as a whole. Terminations, mental illness, genetic counselling and a whole host of other conditions could be listed; for all alike, it is imperative that the health care professional can provide privacy and confidentiality, so that vulnerable, sick and troubled people may feel secure in seeking help, information and care.

As the Law and the NHS attempt to set standards which will ensure for everyone the best possible climate of security in which to make the right choices for themselves their families and society, it seems wholly right that they should expect the understanding and support of all faith communities which above all else are concerned to speak of the meaning, the dignity and the purpose of humankind.

We have taken some space to show how and why some thing have changed. The 'no change' part of our answer arises out of the simple theological truth that God does not change and therefore the individual and collective responsibilities of his people in their relationships with their fellows do not change. In the changing medical, technological, social and legal situation of our complex society, there remains the duty of the church, ministers and the faithful people of God, to pray and care for the sick and those who are involved with them. But we do need to look at what are the most appropriate and professional ways of providing that care and witness.

The concern of all faithful people for any who are sick, together with those close to them, must surely be governed by these basic principles which will need to be worked out in each particular case:

In the name of God, to care:

1. In practical ways, to care for the individuals for whom we have some particular personal responsibility;

2. As members of any faith groups, to have a special concern for those of our own community by responding to patients' requests for services, prayers, visits, or appropriate practical help.

3. As taxpaying members of a society which provides for care through the organised and publicly regulated Health Care agencies, to take our share of the responsibility for influencing the attitudes, the provision and the value judgments of that society.

4. Always in all circumstances in relation to all people, to provide pastoral care and concern in ways that do not add to the strain, pain and stress of vulnerable sick folk.

What does this amount to in the contemporary practice of pastoral care?

1. When a person is sick or in hospital, providing they have told the minister, the official church visitors and friends of the situation, then visits should be made of right and of duty in the name of the faith community.

2. For patients in need of any services of the church while in hospital, it is the privilege and duty of the officially appointed hospital chaplain to perform them or arrange for them to be performed.

3. Clergy, ministers and any official faith community representatives should alert the hospital chaplain with the names and needs of those who have made their requests known.

4. Hospital chaplains should be points of reference and the means of contact for patients expressly requesting visits and services from local churches.

5. Particular care and discipline must be exercised to ensure all requests for names on prayer lists do have the express agreement of the named person.

Always remember

...Is any among you sick? LET HIM CALL for the elders of the church; and let them pray over him, anointing him with oil in the name of the Lord: and the prayer of faith shall save him that is sick... James 5:14

Additional Reading:

Dictionary of Medical Ethics DLT 1981

Health Respect: Downe and Calman. OUP 1995

The Value of Life: Harris Routledge 1994

Religious Ethics and Pastoral Care: Browning Fortress 1984

Confidentiality - Use and Disclosure of Personal Health Information: DoH Consultation Document 1994

Robert Clark is Chief Executive of the Hospital Chaplains' Council and Chaplain to the Queen.