The Role of Medical Professionals in Spiritual and Contemplative Care:
In our research, we feel that there are two critical insights gained from the wider CPE program in the United States:
- the religious professional must undergo an inner transformation in becoming a chaplain so as to be able to listen deeply and be totally present for a patient,
- the chaplain’s role extends beyond caring for the patient and their family to the surrounding medical professionals, who also struggle emotionally, mentally, and spiritually in their work.
In the former, embodied Buddhist meditation can be an important tool in developing these essential abilities of chaplaincy. Indeed, numerous Buddhist chaplains have remarked that chaplains from other faith traditions have asked them for instruction in meditation. The aforementioned chaplain from the New York Zen Center for Contemplative working at Mt. Sinai Hospital explains that:
Within the pastoral care departments at hospitals, we are experienced, seen, and recognized differently, sometimes affectionately being called ‘Zen-terns’ (Zen+intern). When we arrive at these departments, it is obvious that we are embodied in a certain way and bringing our contemplative practice with us. Many members of theses pastoral care departments are also hungry for this aspect of meditation, both as part of their own practice as chaplains in the hospital and also as part of something they could possibly offer to patients. I receive requests all the time to teach meditation to the members of these departments and to have it incorporated it into their program of pastoral care.
In keeping with the CPE injunctions to never seek to convert and with Buddhism’s non-theistic orientation, when a chaplain from another faith studies meditation, the goal is not for them to become Buddhist. On the contrary, they become an embodied Christian, an embodied Jew, etc., which helps them to get their religious training from their head down into their heart, and even into their gut, so they can then see ways to communicate their faith without relying just on the terms and concepts of their tradition.
In terms of the latter, there is the task of caring for medical professionals, like a patient, when they suffer from secondary trauma, burnout, and moral distress. However, medical professionals themselves need to embody some of the basic skills of the chaplain, especially deep listening and presence. A number of CPE program founders and directors whom we met had important insights into this issue:
- Chris Brown, the Manager of Clinical Pastoral Education at the Department of Spiritual Care & Chaplaincy at Johns Hopkins Hospital, explained: “If I were a patient, I would want a physician to pause and understand that my spirituality is important. This is where “active listening” comes in, because when a patient is talking, a doctor or caregiver needs to look them in the eye and free their thoughts from trying to complete the patient’s sentence. They may recognize that the situation is out of their domain and refer it a chaplain. Even so, I would be looking for a physician to be engaged with my suffering and to realize that at that moment my spirituality is important. Holistic care is knowing you are a physician but that you are also a human being and making a human connection is spiritual care. In this spiritual care department, we are trying to provide a complete model for the doctors in “active listening”. I would hope that anyone on our interdisciplinary team would be able to recognize that there is more to the patient than just the physical. This is very important, because there are other hospitals with no spiritual care department or CPE programs, whose patients need this kind of care.”
- Ty Crowe, Director of the Department of Spiritual Care & Chaplaincy at Johns Hopkins Hospital and a teacher in the Shadhiliyya Sufi Order, explained further that: “Everyone needs to participate in spiritual care, so we do education for the nurses and some physicians, and for other professionals in the hospital. They are encouraged to be compassionate and to listen for places where someone’s spirituality may come up. Yet we also want them to know the limits of their abilities. Most of them are afraid of talking about spirituality, because they think: 1) ‘This will take too much time.’ 2) “What if the patient’s faith is different from my own? 3) ‘What if the patient starts talking about things I have no understanding that may endanger our doctor-patient relationship?’ It is in the last situation that they should make a referral to a chaplain. Part of our role is actually having an influence on the educational institutions, like the schools of medicine. There are a number of good medical schools that are developing presentations, workshops, and simulation cases to expose their residents to spirituality, but we have discovered that there are no such joint clinical programs with chaplains. We think this kind of program has potential to develop.”
- Koshin Ellison, co-founder of the New York Zen Center for Contemplative Care, spoke about this from the Buddhist perspective: “We were just approached by the medical school of a major medical center that wants specifically Zen training, as they already have experience with mindfulness meditation. They want to train their attending physicians, who are the ones who have to train the new medical interns and other professionals in the unit. They want something more than just mindfulness. Thanks to MBSR, everyone now knows that meditation and mindfulness is a best practice. That is now standard knowledge, but these people are scientists and they want to know where this mindfulness comes from. They also want to know about the ethics, which is a new and important jump. We are also teaching this at the University of Arizona Medical School and at the Houston Medical Center. There is a desire now to learn Buddhist ethics, wanting to know what meditation is rooted in.”
A comprehensive “contemplative care” training for medical professionals that goes beyond just teaching meditation is the specialty of Rev. Joan Halifax and her pioneering Being with Dying Professional Training Program in Contemplative End-of-Life Care (BWD) course established in 1996 by her Upaya Zen Center. She explains that:
[After examining the clinician’s worldview], the second area we work with in exploring how we can transform the clinician is related to contemplative interventions—in other words, we teach them meditation. We call them “contemplative interventions” as a skillful means, because when you say “meditation,” it produces resistance in most medical settings. Our focus in these reflective practices or contemplative interventions is on the cultivation of insight, mental stability, and compassion … We endeavor to help clinicians understand that there are beneficial outcomes to these contemplative strategies, including attentional and emotional balance, cognitive control, and resilience … Through these contemplative interventions, one can develop mental flexibility, insight, and metacognition, which means you are able to reframe experiences in ways that are prosocial.
The third area they work in is the confronting of moral distress and the development of character, as also seen in the growing work of the New York Zen Center for Contemplative Care.
In this way, we can see the growing swath of the chaplain’s role: from caring for the patient and their family, to caring for the other professionals and clinicians with whom they work as a team, and finally to the widest level of caring for the institution in which all this takes place. Rev. Halifax’s programs offer a significant emphasis on systems care and “transformation of the institution”, including Upaya’s own Buddhist Chaplaincy Program that trains individuals to work in a wide area of social fields beyond just medical environments. She explains that:
Our vision of chaplaincy operates on many different levels. Because you cannot separate the patient from the clinician, the clinician from the community, or beings from the institutions themselves, we have used a systems-theory approach for both our Buddhist Chaplaincy and Being with Dying training programs … We feel that a systems perspective is the only viable one. Individual clinicians can go through a deep change in how they approach their work, but the institutional demands create a moral conflict within them and within how they can approach their work. Therefore, you cannot look at things in isolation. Everything is interconnected—as Buddhism teaches. We also have a very strong emphasis on neuroscience, direct and structural violence, and ethics, relationship, and communication. In this way, our training, especially the chaplaincy program, is basically in socially engaged Buddhism.
Go to: Part 5: Shifting from the Individual to the System
 Halifax, Joan Jiko. “Being with Dying: The Upaya Contemplative End-of-Life Training Program” in Buddhist Care for the Dying and Bereaved. pp. 209-28.
 Halifax. Buddhist Care for the Dying and Bereaved. pp. 216-18.
 Halifax. Buddhist Care for the Dying and Bereaved. p. 227.