Ms Margaret Naughton:

I thank the committee for the opportunity to be here this morning. I am here to represent the National Association of Healthcare chaplains, NAHC. The NAHC is a professional association whose members serve in hospitals and health care facilities. The purpose of the NAHC is the mutual encouragement and support of its members in ministering to patients, their relatives and staff in health care facilities. This organisation, founded in 1981, is in essence a proven professional support body for chaplains.

What exactly is a chaplain? A chaplain is a person appointed to provide spiritual and religious care to all patients, visitors, staff and volunteers in the health care setting regardless of faith or no faith. A chaplain can be ordained or lay. Chaplains are people of faith who have engaged in the clinical pastoral education programme, a hospital-based experiential programme founded by Anton Boisen to work with and minister to living human documents.

Thomas Moore, in his book, Care of the Soul, wrote:

Modern medicine, on the other hand, is hell-bent on cure and has no interest in the body’s inherent art. It wants to eradicate all anomalies before there is a chance to read them for meaning. It abstracts the body into chemistries and anatomies so that the expressive body is hidden behind graphs, charts, numbers, and structural diagrams.

However, hospitals are not populated by numbers or ailments. They are populated by men, women and children of different ages, classes, creeds and nationalities who all have one thing in common: they are all ill. Charles Vella, a hospital chaplain and priest who has written extensively on the care of the sick, argues strongly that one's suffering is augmented by the humiliation of being thought of as a number on a bed, totally divested of human dignity.

A chaplain works to provide empathy and support to those who find themselves in a health care system increasingly coming under pressure for many reasons. Chaplain address the spiritual and religious needs of the patients they encounter on the wards. By listening with empathy in a compassionate non-judgmental manner, a chaplain provides support for those who are struggling for whatever reason.

It must be remembered that a hospital is a microcosm of society. I mean that all the problems that exist in our society exist also in our hospitals. After all, the problems that people have in their daily lives come with them when they enter hospital.

Consequently, chaplains are faced with the harsh realities of loss, loneliness, addiction, unemployment and so forth when they come into work each day. In a difficult working world, chaplains provide spiritual care and this is done through the quality of their presence, by accompaniment and by companionship. Chaplaincy is about reaching out to those who are distressed for whatever reason. Where death and dying is concerned, the death of a loved one is one of the most intensely painful human experiences any human being can suffer. Not only is it painful to experience but it also is painful to witness, if only because one feels powerless to help. In the context of a maternity hospital, for example, the loss of a baby may be a parent’s first experience of death. The length of the pregnancy has no relation to the depth of grief and sense of loss experienced. In paediatric ministry, chaplains work with parents whose children have been diagnosed with a life-limiting condition. Often and regrettably, death is not the worst thing. There are living deaths in which parents must mourn the loss of a healthy child and learn to live a life full of uncertainty and stress, often with little or support, and to care for a highly-dependent child or young adult, cope with multiple hospital admissions, provide high-dependency home care and care for siblings, as well as to try to maintain their relationship with their partners. In the case of an accident or sudden death, the sense of trauma, disbelief and anguish is enhanced as the death is sudden. The impact is immediate. A person’s life is torn asunder instantly and without warning.

In essence, what does a chaplain really bring to end-of-life care? A crucial element of our training is self-awareness and being challenged to deal with our feelings about our own mortality, fears and anxieties. Having confronted these during our period of training ensures that we are equipped to cope with the vulnerability of those we seek to help in stressful situations and particularly at end of life stage. We all experience the death of a loved one at some stage in our life but the quality of care given to family members around the time of a death - especially when the death is sudden - can and does impact on the grieving process later on. People speak of remembering what the chaplain suggested, did or wore months and even years after the death of their loved one, which is evidence of the impact of the chaplain’s intervention with the family. Chaplains try to ensure that the needs of the patient and family members are met as much as possible. In research recently commissioned by the National Association of Healthcare Chaplains, NAHC, and not yet published, it is clear from the findings that most families expect to encounter a chaplain when their loved one is dying in hospital and actively seek the presence of a chaplain. Chaplains pray with patients and offer to link families of different denominations and faiths with a minister of their own faith when requested or where possible. Chaplains support and accompany families when their loved one is actively dying and during the immediate mourning period in the hospital. Chaplains endeavour to prevent people from dying alone. In the absence of loved ones, a chaplain will sit with a patient assuring him or her that he or she is not alone. Chaplains are trained in debriefing and this is offered to staff who have been affected by workplace traumas and deaths.

In conclusion, I will make our recommendations and closing comments. Working in hospitals is difficult to say the least. It is emotionally fraught and draining. The complexity of illness, the levels of care and the turnover of patients have increased considerably in the last few years. To continue to provide chaplaincy services into the future, we suggest that the Health Service Executive, HSE, embargo be lifted on recruitment in order that more chaplains can be employed. On foot of the reduction in chaplaincy posts in some hospitals, the service has been reduced to a simple "meet and greet" service, which is not acceptable. To die in a public ward is not conducive to dying with dignity. We ask that in every hospital, a single room be made available each time a person is ending their life’s journey. This will ensure that for the patient and his or her family, the end of life experience is a private family one and not one in which a person’s dignity and privacy become compromised.