The Greek philosopher Heraclitus maintained that the only constant is change. Most of us understand this idea of universal flux but continue to find it destabilising. This was my experience over 15 years as a healthcare chaplain at Palmerston North public hospital.
Hospitals are theoretically secular workplaces, but now heavily infused with Māori culture and tikanga. This brings forth questions of identity, allegiance and role for chaplains as spiritual, religious and cultural definitions become increasingly blurred.
In this article I briefly outline the history of hospital chaplaincy in Palmerston North, including my own involvement, the current situation for chaplains in the spiritual and pastoral care team then note the broader chaplaincy engagement with government. The developing picture of religion in New Zealand is described alongside increasingly contested definitions of secularity and religion. Throughout I comment on some chaplaincy challenges before reflecting on a possible way forward.
Background
Chaplains have been in Palmerston North Hospital since the 1950’s, originally representatives from St Mary’s Catholic and St Peter’s Anglican churches who visited members of their denomination and sometimes loitered with intent to visit others.
A more organised situation has been in place since 1972 when a group of churches negotiated with the Ministry of Health (MoH) to secure funding. This group eventually became the Interchurch Council for Hospital Chaplaincy (ICHC) made up of nine member Christian churches and continues to hold “..the chaplaincy service contract with the Ministry of Health (MoH)..”, [1] which is funded about 50/50 between ICHC and MoH. “All ICHC salaried staff and volunteer lay people are practising Christians..”, [2] and are allocated Health New Zealand honorary staff status.
This means that all public hospital chaplains are Christian and contracted to provide spiritual support to “..all people regardless of their religious denomination, faith orientation, belief system, ethnicity, gender, or sexual orientation”. [3] However, the MoH, “..has not reviewed or revised the obligations to meet the religious, spiritual and pastoral needs of the population since the contract was initiated..”. [4] This situation will likely demand attention once the results are available from the national project currently researching spirituality in New Zealand healthcare. [5]
My situation
I was employed as a chaplain by ICHC at Palmerston North hospital in 2011. By then I had been an Anglican priest since 2003, having worked in school and military chaplaincy with a background including health promotion and change management.
It was immediately obvious to me that unlike my previous embedded chaplaincy experience, hospital chaplains were marginal to the health system, unable to access patient notes or attend multi-disciplinary team meetings where health professionals interact and collaborate about patient care. The Pae Ora Māori health team also faced these difficulties.
At that time, there was an obvious link between Māori and Christianity, evidenced by Christian prayers on the walls of Te Whare Rapuora, a building with offices and marae style accommodation. Today, all those prayers are gone and the link to Christianity is more nebulous, although one chaplain who is Māori has moved from ICHC to being employed by the Pae Ora Māori Service. The spiritual care team works collaboratively with this chaplain who is included in our weekly reflective practice/supervision.
Like the international situation, I found spiritual care to be “..a greatly misunderstood practice at both conceptual and practical levels”.., [6] including the not unreasonable belief that chaplains were about religion, given that we were employed by an exclusively Christian organisation, whilst the population was becoming increasingly non-religious.
This reality was reflected in the 2018 census figures with Christian dropping from 69% in 1991 to 37%, with non-religious growing from 20% to 48% in the same time frame. [7] Trends that are irreversible as shown by the 2023 census figures with Christians at 32.3% and no religion rising to 51.6%. [8] However, New Zealand is also becoming more religiously diverse illustrated by a public service study that showed their staff associated with “..133 religious categories..” nearing the 157 that the public reported being connected to in the 2018 Census. [9]
As part of exploring the situation, I presented Hospital Chaplaincy Beyond Religious Control at a 2013 conference, where I pointed out that, “..the Christian religion I represent has become so irrelevant to the greater percentage of the New Zealand population that it’s now a stumbling block in my job as a hospital chaplain..”. [10]
My questioning led to some organisational challenges for me, which led to me being directly employed by Health New Zealand MidCentral as spiritual care coordinator, which means being professional lead for the chaplains, including weekly reflective practice and ad hoc supervision.
Despite these complications, significant gains were made through the interdisciplinary MidCentral Spiritual Care Advisory Group (SCAG) creating a spiritual care policy with, “..a clear expectation that it is the responsibility of all staff to provide spiritual care..” and seeing “..health professionals as generalists and members of the Pastoral/Spiritual Care Team as specialists..”. [11] This grew out of our 2016 Transforming Spiritual Care Strategy, which aimed to have spiritual care recognised, “..through a renewed understanding of spirituality as an integral part of care”. [12] We also did research and published two academic papers. [13] [14]
This work escalated the organisational understanding of chaplains as professionals, which eventually led to becoming part of multi-disciplinary teams (MDT) and permission to write in patient notes, one of only two chaplaincy services in the country to gain this routine access.[15] The Māori health team were also recognised in this way. Both teams also continue to receive referrals from family members or community groups.
The reality for chaplains
Healthcare chaplains must learn quickly that professional spiritual care is not about representing a faith or spreading our beliefs. Instead, we see spirituality as how people understand “..ultimate meaning, purpose, and transcendence, and experience relationship to self, family, others, community, society, nature, and the significant or sacred”. [16] This may be “.. expressed through beliefs, values, traditions, and practices..”, [17] which may, or may not be from a religious tradition.
Reality beckons when chaplains realise that “..within health care, these are all aspects of our humanness that can easily be overlooked or downplayed”.., [18] which makes it crucial to develop their ability as professional reflective listeners. Not activated by unfamiliar traditions, beliefs and practices that may appear to contradict one’s own. Nor to be tempted to share one’s own beliefs to bond with a patient, family or staff member. Instead, our individual spiritual perspective is a crucial grounding or backbone but must not intrude into the therapeutic encounter. A professionalism that requires constant reflective practice and can be considered “..a secular practice which utilizes religious forms of knowledge to assist the aims of secular state-funded healthcare”. [19]
Current situation
Given how much effort goes into this professionalism, questions are now arising for chaplains in an apparently secular hospital system where Māori spirituality has a pre-eminent position. All formal occasions are blessed or otherwise sanctified by Māori protocol, but hospital chaplains are not routinely invited unless Māori staff are unavailable. Even then, the assumption often is that Māori waiata, karakia and whakatauki will be utilised rather than Christian, or any other religious /spiritual input.
Meetings and other gatherings are also affected. For instance, senior nursing meetings begin and end with karakia. Student nurses bookend study days with karakia despite minimal engagement. National online meetings are opened with karakia, often with the admonition, “let us pray”. No other options are offered despite an influx of overseas staff and in Palmerston North, a significant number of nurses from Kerala, India.
An exception is the SCAG group. There we encourage the person rostered to begin and end the meeting with something that has spiritual relevance to them. A wide variety of offerings have been made but it is hard to hold that practise given the universal pressure to use Māori protocol.
In terms of patient care, Pae Ora staff access Māori patients through knowing their ethnicity from hospital lists. This mirrors the method some chaplains use to access patients through the religion or denomination they identify with. In other words, using a collective identity, which leans directly into religious care, “..given in the context of shared religious beliefs, values, liturgies and lifestyle of a faith community..”. [20]
Although arguments abound in the public square about whether Māori is a religion, Manuka Henare is clear. “Māori religion is a belief in spiritual beings, and is both a way of life and a view of life. lt is found in rituals, ceremonies, religious objects, sacred places and sites, in art forms and carvings, in songs and dances, proverbs, wise sayings, and riddles, in the naming of people and places, in myths and legends, and in customs, beliefs, and practices.” [21]
As an experienced hospital chaplain, it is clear to me that Māori religion is embedded and sanctioned by Health New Zealand, which is effectively the State. So, a decade after I suggested the need for hospital chaplaincy to move beyond religious control, the situation has subtly shifted. Now the state appears to have a religion that expects at least token submission or adherence in apparently secular workplaces.
However, this religion also has additional political implications because it is interwoven with the Treaty of Waitangi. This may reflect an international trend where secularity has moved from “..narrating religious decline into a political project involving negotiating between competing actors..”, and “..has emerged as a key concern of the modern nation-state in the attempt to implement political sovereignty”. [22]
Van der Krogt suggests that the situation we are facing is “Māori religiosity” and promoted “..precisely because it is an integral part of the living culture of the indigenous people..”, although noting that this, “..comes disconcertingly close to state-sponsored religion”. [23] He adds that although the New Zealand Bill of Rights Act (NZBORA) gives a “..general guarantee of religious freedom..” only “..Māori spiritual values are protected under the Treaty of Waitangi Act and its ramifications in other legislation”. [24]
As already noted this results in Māori protocol taking prime position in the hospital, completely eclipsing all other religious and spiritual traditions. This leaves the existing Christian chaplains in an awkward position, having a contracted role to provide spiritual care to patients and staff but effectively marginalised in official undertakings.
To add to the political confusion for chaplains, over 400 Christian leaders recently published an open letter expressing their opinion about the proposed Treaty Principles Bill, which they are entitled to do. But then they called on, “..all Members of Parliament to do everything in their power to not take this Bill to Select Committee..”, [25] which seems to suggest an undermining of the democratic parliamentary process.
One of the signatories was Archbishop Justin Duckworth who suggested that the Treaty aligns with Christian unity and that David Seymour’s view that everyone has equal dignity based on the “..core Christian principle of imago dei..” was “..at odds with te Tiriti..”. [26]
There is dissonance here for chaplains who are charged with listening to and encouraging people to speak their own truth, whatever that may be, often in the face of significant suffering. And further, Anglican chaplains may feel pressure to align with the bishop’s view as church leaders have the power to certify whether a person is suitable for a chaplain role without reference to any objective standards.
Notwithstanding individual chaplain views about the Treaty, colonisation, spirituality or religion, we are working in an even more liminal space than usual. Treading increasingly blurred lines between what is deemed secular, political, cultural or religious. Needing to be aware that “..although Christianity has been profoundly influential in New Zealand public life, and deeply entangled with the state..”, life has changed beyond recognition with one outcome being that “..religion is increasingly unbounded, with potentially far-reaching effects..”. [27]
None of this would surprise Heraclitus. Neither would it surprise a former Bishop of London, Edwin Sandys, who at the 1571 opening of parliament wanted to implement godly laws to secure “..conformity in religion most essential to civil peace..”. [28] His view aligned with Sir William Cecil intolerant of religious indifference, believing that freedom from tyranny would come from laws to establish “..constancy and conformity of true doctrine..”. [29] But as always, true doctrine is determined by the people with power.
What now?
Every hospital chaplain’s expertise develops and shifts over time through education, individual spiritual journeys and life events. Significant is being immersed in a hospital in a constant state of flux. Although it took time, my development was enhanced by being forced out of the church, dealing with the pain of that in supervision and analysis and developing an independent process of reflecting on hospital chaplaincy.
I conclude that New Zealand hospital chaplaincy is at a crossroads. By maintaining its exclusive Christian stance, it remains religiously partisan, often marginalised because of role confusion and financially unstable through inadequate funding. Continuing this way could risk government funding being withdrawn as it was in the Canadian province of Saskatchewan, in part justified because “..government could not be in the business of funding ‘Christian theology’ in public healthcare..”. [30]
However, the nuanced historical, theological and organisational connections between Christianity and Māori, along with the growing influence of the Kīngitanga movement led by the Catholic Kuini Ngā Wai Hono i te Pō and diplomatically supported by Anglican clergy, may forestall, or further complicate this.
I argue that increasingly blurred boundaries between spirituality, religion and culture necessitate the development of spiritual care as a secular profession, “..a professional practice integrating secular and religious forms of knowledge with the intent of practicing a universally applicable form of care”. [31] Without this separation, chaplains will be increasingly conflicted in terms of role and allegiance, which “..hampers their collaboration with other healthcare professionals..”. [32]
In line with this, my experience reflects a Dutch study that observes healthcare chaplaincy moving away from mainly focusing on patients, towards education and support of staff. This is where my gains have been made as staff appreciate the care taken of them and support to keep developing their compassionate presence, despite the pressures they face. The Dutch further suggest that there is room for “..being involved in ethics and policy making..”, [33] which I support if chaplaincy can develop as a robust, reliable source of ethical and philosophical wisdom.
This needs separation of church and state, a robust national training process that includes learning about world religions, the philosophy of religion, ethics, narrative and psychotherapeutic techniques and much more. It will require investment in and redevelopment of the existing professional chaplaincy organisation and commitment to ongoing research. In other words, we must grow up and leave home.
My cursory glance at history shows that blurring spiritual, religious, cultural and political boundaries is nothing new. Chaplains, at the forefront of listening to individuals talk about what rises to trouble them, must keep listening with an open mind and heart, knowing that “sacredness cannot be identified with any one culture, and no single tradition has a monopoly on the sacred. The world is already infused with the glory of the sacred; sacredness does not have to be imparted by a spiritual race or a metaphysical language”. [34] Heraclitus may be smiling.
Bibliography
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———. “Losing Our Religion Could Reinvigorate Faith in Healthcare.” Sande Ramage, 30 July 2017. https://spiritedcrone.co.nz/losing-our-religion-could-reinvigorate-faith-in-healthcare/.
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Swinton, John, Sarah Mullally, and Jason Roach. “Spiritual Care in the NHS.” Pages 233–48 in Spirituality and Psychiatry. Edited by Andrew Powell and Christopher C. H. Cook. 2nd ed. Cambridge: Cambridge University Press, 2022. https://doi.org/10.1017/9781911623311.017, https://www.cambridge.org/core/books/spirituality-and-psychiatry/spiritual-care-in-the-nhs/1326FC7A50410B6A5100A5D304D4EEEA.
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[1] Colin Woodhouse, “A Private Universe: What Does Spirituality Mean and Is Appropriate Support Being Provided for People in Hospital?” (University of Canterbury, 2024), 28, https://hdl.handle.net/10092/106988.
[2] Woodhouse, “A Private Universe,” 29.
[3] “About,” Ichc, n.d., https://www.ichc.org.nz/about.
[4] Woodhouse, “A Private Universe,” 63.
[5] “Spiritual Care in Healthcare,” Spiritual Care in Healthcare, n.d., https://www.spiritualwellbeing.nz.
[6] Simon Lasair, “Spiritual Care as a Secular Profession: Politics, Theory, and Practice,” Journal for the Study of Spirituality 8 (2018): 5, https://doi.org/10.1080/20440243.2018.1431022.
[7] Woodhouse, “A Private Universe,” 20.
[8] Georgina Campbell, “Losing Faith: More than Half of the Population Has No Religion,” NZ Herald, 5 October 2024, https://www.nzherald.co.nz/nz/census-data-nz-more-than-half-of-the-population-has-no-religion/YT2KJBSTQNBDTPVDHJYHNALIZA/.
[9] “Public Service Census – Religion,” Te Kawa Mataaho Public Service Commission, n.d., https://www.publicservice.govt.nz/research-and-data/workforce-data-diversity-and-inclusion/workforce-data-religion.
[10] Sande Ramage, “Hospital Chaplaincy beyond Religious Control?,” Sande Ramage, 27 October 2013, https://spiritedcrone.co.nz/hospital-chaplaincy-beyond-religious-control/.
[11] Jacqueline Tuffnell, “Healthcare Chaplaincy and District Health Board Spiritual Care Policy in Aotearoa NZ: Review and Recommendations,” Journal of Religion and Health 62 (2023): 8, https://doi.org/10.1007/s10943-022-01728-w.
[12] Sande Ramage, “Losing Our Religion Could Reinvigorate Faith in Healthcare,” Sande Ramage, 30 July 2017, https://spiritedcrone.co.nz/losing-our-religion-could-reinvigorate-faith-in-healthcare/.
[13] Sande Ramage, Barry Keane, and Richard Egan, “‘Spirituality Matters’: Reflections on a Chaplaincy Championed Spiritual Care Initiative in a New Zealand Cancer Ward,” Health and Social Care Chaplaincy 6.1 (2018): 62–81, https://doi.org/10.1558/hscc.32493.
[14] Richard Egan et al., “Spiritual Care: What Do Cancer Patients and Their Family Members Want? A Co-Design Project,” Journal for the Study of Spirituality 8 (2018): 142–59, https://doi.org/10.1080/20440243.2018.1523073.
[15] Tuffnell, “Healthcare Chaplaincy and District Health Board Spiritual Care Policy in Aotearoa NZ,” 6.
[16] Christina Puchalski et al., “Improving the Spiritual Dimension of Whole Person Care: Reaching National and International Consensus,” Journal of Palliative Medicine 17.Number 6 (2014): 3.
[17] Puchalski et al., “Improving the Spiritual Dimension of Whole Person Care: Reaching National and International Consensus,” 5.
[18] John Swinton, Sarah Mullally, and Jason Roach, “Spiritual Care in the NHS,” in Spirituality and Psychiatry, ed. Andrew Powell and Christopher C. H. Cook, 2nd ed. (Cambridge: Cambridge University Press, 2022), 234, https://doi.org/10.1017/9781911623311.017, https://www.cambridge.org/core/books/spirituality-and-psychiatry/spiritual-care-in-the-nhs/1326FC7A50410B6A5100A5D304D4EEEA.
[19] Lasair, “Spiritual Care as a Secular Profession,” 5.
[20] “National Guidelines for Spiritual Care in Aged Care (Digital Copy) – Meaningful Ageing Australia,” n.d., 8, https://meaningfulageing.org.au/product/national-guidelines-for-spiritual-care-in-aged-care-digital-copy/.
[21] Manuka Henare, “Tapu, Mana, Mauri, Hau, Wairua: A Māori Philosophy of Vitalism and Cosmos.,” in Indigenous Traditions and Ecology. (Harvard Press for the Center for the Study of World Religions, Harvard Divinity School, 2001), 199.
[22] Geoffrey Troughton and Philip Fountain, “An Insecure Secularity? Religion, Decolonisation and Diversification in Aotearoa New Zealand,” The Round Table 112.5 (2023): 529, https://doi.org/10.1080/00358533.2023.2268932.
[23] Christopher J. van der Krogt, “New Zealand: Religion as Culture in a Secular State and a Pluralist Society,” Studies in Interreligious Dialogue 25/1 (2015) 68–91 (n.d.): 84, https://www.academia.edu/14519065/New_Zealand_Religion_as_Culture_in_a_Secular_State_and_a_Pluralist_Society.
[24] Krogt, “New Zealand,” 84.
[25] “Open Letter from 440 Christian Leaders on the Treaty Principles Bill.,” Common Grace Aotearoa, n.d., https://www.commongrace.nz/common-grace-actions/churchleadersletter.
[26] Thursday, September 19th, and 2024, “A Bishop Explains How Support for the Treaty Aligns with Christian Unity,” n.d., https://cathnews.co.nz/2024/09/19/a-bishop-explains-how-support-for-the-treaty-aligns-with-christian-unity/.
[27] Troughton and Fountain, “An Insecure Secularity?,” 531.
[28] Alexandra Gajda, “‘A Wall of Defence unto This Realm’: William Cecil, Conformity and the Protestant State in Early Elizabethan England*,” The English Historical Review 139.596 (2024): 596, https://doi.org/10.1093/ehr/cead215.
[29] Gajda, “‘A Wall of Defence unto This Realm,’” 596.
[30] Lasair, “Spiritual Care as a Secular Profession,” 5.
[31] Lasair, “Spiritual Care as a Secular Profession,” 6.
[32] Renske Kruizinga et al., “Enhancing the Integration of Chaplains within the Healthcare Team A Qualitative Analysis of a Survey Study among Healthcare Chaplains,” Integrated Healthcare Journal 4.1 (2023): 4, https://doi.org/10.1136/ihj-2022-000138, http://access.portico.org/stable?au=pjbcg1kknfn.
[33] Kruizinga et al., “Enhancing the Integration of Chaplains within the Healthcare Team A Qualitative Analysis of a Survey Study among Healthcare Chaplains,” 1.
[34] David J. Tacey, Re-Enchantment: The New Australian Spirituality (Pymble, N.S.W.: HarperCollins, 2000), 151.
