“Where’s the chaplain?” Reflections on Last’s Week’s Washington Post Article

Hannah CreagerChaplaincy, Death and Dying, Hospice

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Last week the Washington Post published an article about death doulas.  I had an impromptu break-out dance session in my office after reading the article.  Why?

I am a chaplain with a nonprofit hospice organization and there was some interesting energy coming from the comments section on this article.   In fact, some of that energy had to do with the subject of hospice chaplainsHospice chaplains!  Can you feel my excitement yet?!

So after thoroughly digesting the comments section, I began to recognize at least three myths about hospice chaplaincy that I think should be addressed. I also thought I should highlight where death doulas fit into the realities of hospice chaplaincy.  I’ve worked as a chaplain in both for-profit and non-profit hospice contexts, so I believe I have enough experience to speak to these myths.  So here’s how I see it:

Myth #1: Hospice chaplains always have time to sit with patients at the end of life.

Nope.  Simply not true.  Would we like it to be that way?  Most certainly!  In fact, we find that we receive beautiful gifts when joining individuals as they take their final breaths.  The reality, however, is that we are members of an interdisciplinary team.  This comes with a lot of administrative duties.  For those of us working for entities receiving government reimbursement, we often find that we have a significant amount of paperwork to keep up with and there are regular medical team meetings to attend.  In addition to making daily visits to patients who can be living miles apart, we are often expected to facilitate memorial services and funerals.  This is something that we have been trained to do, and we are happy to do it, but it takes planning and time.

There’s also this thing called being on-call where we may be getting up in the middle of the night to drive 25 miles to be with a family who have just had a loved-one die.  When there are only a few chaplains to fill the on-call shifts, we can get pretty busy pretty quickly.

With the reality of hospice chaplaincy demands, volunteer death doulas can be a profound boost to the quality and continuity of care of any hospice organization.  Having well-trained death doulas can ensure that someone is there in what can be the most physically taxing moments for the patient and the most emotionally taxing moments for loved ones of the dying.  A study this year showed that one in eight Medicare patients did not receive visits from a doctor, nurse or social worker in their final two days of life.  In a high-demand hospice healthcare world, volunteer doulas have the capacity to fill in these care gaps and to allow for a more peaceful process for both the patient and the caregivers.

Myth #2: Hospice chaplains are better trained than death doulas to handle end-of-life situations.

Let’s clarify this.  Hospice chaplains receive a different kind of training than death doulas.  Most of us have three years of seminary and/or spirituality training of some kind under our belts.  Most (but not all) of us have also gone on to participate in what’s called Clinical Pastoral Education.  This is an intense immersion-learning experience in a clinical setting.  It encompasses group theory work/therapy, an emphasis on self-growth and awareness, and allows for professional certification through an accredited professional organization.  Depending on how you go about the process, certification can take some time to achieve (2 years on average).

Death doulas, on the other hand, are not typically required to take the path of theological studies and intensive clinical training.  This does not mean that all of them haven’t, nor does it mean that they fail to bring years of experience in valuable fields to their work.

Death doulas can receive certification by non-profit training entities.  However, there is no national board or credentialing body for end of life practitioners or doulas at this time.

Chaplains, in contrast, have had national credentialing entities for some time.  Board Certification by the Association of Professional Chaplains has been the gold standard for hiring within the medical community for many years.

What’s the benefit to a national credentialing board?  National credentialing entities provide standards for professional competence and organized methods for addressing violations of codes of ethics.  They encourage and promote opportunities for continuing education so that the professional development is always at the forefront of an evolving medical system.

What’s the benefit of not having a national credentialing board?  It encourages the formation of compassionate communities.  When individuals have easy access to training they are empowered to undertake support of the people close to them.  Professional resources (which may at times be stretched thin) do not always have to be employed when individuals have been equipped with end-of-life knowledge and resources.

Myth #3: Hospice chaplains are scary.

Hospice chaplains actually aren’t ghosts.  We happen to be human beings.  Wearing our spiritual vestments will not hasten your death.  In fact, as hospice workers we uphold that hospice is not about hastening or postponing death in any way.  Sorry, we just don’t have that kind of power.

Most of us claim connection to some kind of higher power in our lives, but that certainly isn’t the case for all of us.  There are actually atheist and agnostic chaplains out there too.  Our certifying bodies are getting much better now about incorporating chaplains with a variety of world and faith views.

Furthermore, those of us who are ecumenically and clinically trained are not going to impose our faith system upon you.  We are going to listen to you and your family members.  We are going to connect you with whatever your spiritual community might be.  Perhaps it is your family, your friends, your co-workers.  We are going to follow your lead and learn from you.

You always have the right to ask us not to visit.  We respect your wishes, and we want you to have a peaceful journey.  If this means not visiting with us that is A-OK.  And, if you would rather see your own spiritual community leaders we completely understand.  Part of our job, in fact, is getting in touch with them on your behalf.

Those of us who have worked in this field long enough know that a deep desire of those facing their final days is to have some sense of control in a process that so often feels like everything is spinning out of control.   We want to bequeath you with the gift of having agency in the time you have so that it may be lived out fully and meaningfully.  Know too, that if you should change your mind at any point along the way, we will be there.

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Hannah Creager is the Chaplain at Hospice House & Support Care of Williamsburg. Hospice House & Support Care of Williamsburg is a 501(c)(3) community supported social model hospice which provides 24 hour care for terminally ill individuals and their loved ones, when dying at home becomes unmanageable. The Hospice House itself is a spacious residence that is a "home away from home" for our guests and their families. Our support care services also include a vigil program, companionship in families' homes and extensive bereavement programs for families throughout our community. Families never receive a bill for any of our services, thanks to the generosity of our community. For more information about Hospice House & Support Care of Williamsburg, or to make a gift, please visit www.williamsburghospice.org or call 757-253-1220.