HOSPITAL/HEALTH CARE CHAPLAINCY

SIXTH NORMAN AUTTON MEMORIAL LECTURE

was delivered by Mrs. Jane Williams
Lambeth Palace, London
6 November 2007


To listen to the lecture please select the link below. http://audio.cofemedia.org.uk/synod/JaneWilliams6November.mp3
alternatively the text of the lecture is further down this page


Mrs. Jane Williams is a visiting Lecturer at King's College, London, Lecturer at the St. Paul's Theological Centre, London and Theological Adviser to the Hospital Chaplaincies Council.

Photo of Mrs. Jane Williams delivering the Norman Autton Lecture
Mrs. Kate Autton presenting Mrs. Jane Williams with the Norman Autton Memorial Chalice.

You don't need me to tell you about Norman. He was a pioneering healthcare chaplain. He worked in all kinds of contexts in the health service, and he wrote very movingly about his experiences and it is his written work that I first came across and, in particular, I think the thread that runs through all of the things that he wrote was his desire to tell the story of the people that he worked with. Lots and lots of stories in Norman's writing and to give dignity and meaning both to those who suffered and those who tried to alleviate suffering. He also wanted to encourage people, whether healthcare professionals or ordinary people not to be afraid of death, not to be afraid of mental illness, not to be afraid of suffering, and not to be afraid of asking hard questions about God and faith in those contexts. 

So there was nothing safe about Norman's ministry, nothing easy about his ministry, although like many a wise guide, he made the path seem safer for others. That is one of the things that as a pioneer he did. 

But on re-reading some of Norman's books, it is clear that there were some solid and unshakeable places in his ministry that can look quite enviable from the shifting sands that healthcare chaplaincy now has to negotiate. Both the church that he represented and the health service in which he worked seemed places, at that point, with much stronger and less-contested sense of self than the ones that we now inhabit. At the heart of Norman's understanding of the work of a healthcare chaplain was his vocation to the priesthood which makes this a particularly proper emblem* and remembrance of him. As I say, I will have to lend it to my husband, I afraid, as I am not ordained. I hope you don't mind that Kate but we promise that we will use it in Lambeth Palace Chapel. His vocation to the priesthood is something that Norman was perfectly clear about. He talked in unambiguous terms about the chaplain as a priest, as one who comes before God with the people on his heart, so that people and God are intimately connected through this incarnational priesthood of the individual. He expected prayer and sacraments to be as much a part of the healthcare chaplain's world as it would be for any parish priest.

He also talked about the health service as a community which had a recognisable shared ethos, and shared values, able to respect the church and be respected by it, as two institutions with a great deal in common, united by a service ethic and an assumption of availability to anyone in the nation. Something that united both the Church of England and the health service.

But now, in the words of some of my favourite theologians, the Beatles, those days have gone and we’re not so self-assured. Neither priesthood nor health service are so easily defined any more. Both feel, a lot of the time, as though they are being undermined from inside and from outside, both face apparently endless criticism, much of it ignorant and petulant, and healthcare chaplains who are in both of these institutions get it from both sides. You are attacked both for your work in the health service and for your representation of the church. I think you sometimes must feel as though you are standing on an earthquake rift and trying to hold it together by trying to put your finger in the ever-widening hole that is opening up to swallow up the world that you inhabit. The Dutch Boy with his finger in the dyke is one thing. A chaplain with your finger in an earthquake is quite another. Bishop Christopher Herbert, in his Norman Autton lecture, identified many of these problems. He asked the question whether there is one community or many in the health service, and concluded, sadly, that the answer is probably many and he then suggested that part of the role of a chaplain in this multi-faceted society is to mediate 'between the mini-narrative of each individual and the confusion, the Babel, which is now the characteristic of society' and I would guess that that description resonates for many chaplains mediating mini-narratives in the Babel of society that we are in at the moment. Talking to you, those of you who are chaplains, very often you meet people at a point where their secure mini-narrative have come unstuck, through illness, through fear, through bereavement, and constantly what chaplains are trying to do is to help people to find the thread of their own narrative again, to feel as though they are the tellers of their own story again, not done to, but actively doing. To find that their meaning and their significance, and their role in their own life stories, has not been ended by illness, even if that illness is terminal.

Chaplains also, of course, help to anchor the mini-narrative of staff not just of patients. Staff whose lives are just as fragmented as those of the patients that they serve. But that suggests that chaplains stand somewhere secure and, as a matter of fact, chaplains too are not immune from the Babel of society. Chaplains' personal stories, too, are often in drift, with no secure over-arching story of priesthood to secure it. Even though chaplains are still very secure in their own sense of calling to the ministry that they perform within the health service, they are aware that their narrative is not convincing or even comprehensible to many of the people that they work with. Chaplains spend far more time simply justifying their existence than is good for any human being to have to do. Like the health service itself, chaplains have to gather data, they have to draw up questionnaires, they have to talk about consumer satisfaction and management practices in a way that sits oddly with the natural language of both chaplaincy and of health care. This is not what most chaplains went into it for, to put it at its most basic, any more than it is what most doctors and nurses went into it for. And so many in the health service, both chaplains and others, are suffering from a kind of institutional depression, borne of overwork, of being misunderstood and having to spend a lot of time doing something they don’t believe in, when the things that they do believe in are crying out to be done, and there is less and less time to do them in.  Forgive me if I am over-stating the case but from my conversations I don’t think I am necessarily. 

Now I am a theologian, not a health care professional, and my interest is directed primarily towards chaplains, though I see many resonances between the experiences of chaplains and that of the health service as a whole. But the Christian chaplain, as a minister of the gospel and as a human person made in the image of God, and so a human person certain of her or his place in God's great story about the world, that is the person I primarily want to focus on today. I hope some of what I say will make sense to chaplains of other faiths and I particularly welcome comments from chaplains of other faiths and from those of you involved in multi-faith chaplaincy work which I am still quite ignorant about but would like to know more about. 

So to start here with anchoring each individual story in God's great story. God's great narrative is to start with God the creator. Christian theology wants to say that the physical world is unequivocally made for goodness and delight. Pain, sickness, and death have no ultimate place in God’s world, and God never, never, wills for any one to suffer. When you are dealing with the inevitable questions of 'why has God let this happen to me?', 'why is the world against me?' - questions that chaplains meet every day, I would guess; I imagine our answer must always be ‘God has not done this and God does not want it’ and in that sense, Christian chaplains can whole-heartedly endorse the health service’s cure-oriented philosophy. God longs for everybody to be well.

But, nonetheless, the reality is that whether God wills it directly or not, pain and suffering, and death, exist and must be endured by every single human being. And the fact that is so must ultimately be God's responsibility, if there really is a God who did really freely choose to create this world, with all its possibilities and its risks, so the patients who ask you 'why is God letting this happen to me?' do have a point which you need to be able to tackle. 

One possible response to this is to concentrate on the inner life, and to encourage a way of living that denies the ultimate reality of the physical in favour of the spiritual. This kind of attitude would say something like 'what happens to your body can produce inner strengths and those strengths are of more value than any minor physical inconveniences' and you know as well as anybody, and better than most, that can be true. That under that kind of pressure people can show that rare quality that is really moving and inspiring. But you equally know, better than most, that suffering and fear can destroy personality and character too, that they are not always conducive to growth and as a Christian theologian I want to say firmly that this kind of spirit/body dualism is, at the very best you can say, sub-Christian. Bodily life, in the Christian tradition, is not something to be endured until we reach our true spiritual state. Bodily life is where we encounter God. It is created by God as the way we are meant to be, and it is lived in by God, directly, in Jesus. Even though we do want to say that the world is not functioning as the creator longs for it to do, God's answer to this problem is not to get rid of the physical creation and to try something less accident-prone but to enter into the physical creation, bodily, and infuse it with his transforming presence. 

In Jesus, we see God, living under the conditions that we live under and remarkably, when you see the Jesus in the gospels, he never says to somebody who comes to him for healing, 'Endure this and it will do you good'. He never says that. He does sometimes see a deeper root to the symptoms of physical suffering. Think, for example, of the story of the paralysed man who was lowered through the roof to whom he says ‘Your sins are forgiven’. But he doesn't stop there, he doesn't stop with absolution. He goes on to heal. 

Here, too, chaplains and the health care service have something in common. Chaplains can endorse the role of spirituality as the health service sees it. The health service like chaplains recognises that the physical and the spiritual are deeply entwined, and must be treated together if healing is to occur. 

But although we are committed to healing and to life, Christians can also walk without fear through the valley of the shadow of death because, thanks to Jesus, we know that God is to be encountered there, too. Jesus does not rescue himself from the real cost of the way the world is. He suffers and he dies, as we all do. In his death, Christians say he is God, taking the most personal responsibility for the price we all pay for God's creation. God shows us that he knows that this price is not negligible, and he knows it is his responsibility, even if it is not his will.

But the cross is not just God suffering with us and saying 'this hurts me as much as it hurts you'. Through the cross comes the resurrection. When all human possibilities are exhausted, God's are not. God's presence with us is never just that of friend and companion, though that in itself is important, and very far from negligible. God is always present also as our creator and our redeemer. In suffering and in death, all those mini-narratives that Bishop Christopher talked about are still part of God's story, and so they are not finished but still living, as God lives. St Paul says that because of Jesus we know that nothing can separate us from the love of God in Christ and that is not a half-hearted promise, but a full-blown assurance about the nature of our creator. Each human life has ultimate significance, woven as it is into the life of God, brought into existence by God, held in existence by God, and so wholly real. Our stories are never ended, but continue to be part of God's reality, and so continue to be part of the world's reality. 

When we say 'God was in Christ, reconciling the world to himself', that reconciliation is not God saying 'there, there', what kind of reconciliation would that be? but God acting to bring the world back into connection with himself. The life that brought the world into being in the first place draws it back into relationship with himself. 

I am not telling you anything that you didn't know - that is a basic Christian doctrine lecture. I am also aware that giving doctrine lectures will hardly ever be required of chaplains at bedsides or in staff canteens. But when the health service tries to unpack what it means by spirituality and which, interestingly, it always admits to be a good thing and, for some patients, even a necessary thing, all the stuff put out by the health service sees some role for spirituality. What it usually means by that word is to do with meaning and significance, as far as I can see. But the problem is that meaning and significance can’t be invented. You cannot give somebody meaning and significance simply by saying this is the meaning and significance department. They have to flow from some kind of recognisable structures, structures in which we find our place and our values and so in which we know our meaning and our significance. For the Christian chaplain, the structure from which all meaning flows and within which we know human life to be infinitely valuable is precisely this doctrine of God that I have been describing.  

Most of the people that you as chaplains work with don’t need to see and understand that structure. You don’t always need to start with the doctrine lecture, just to re-assure you. In fact I would be interested to know how many of you have ever had to start with a doctrine lecture. Most of the people get their sense of being valued and having meaning by the relationships in which they find themselves and as chaplains is one of the most basic things you are doing is to re-establish the reality of relationships which look as though they are being broken by illness, by stress, and working conditions. As chaplains attend to patients and staff, as they build connections between the hospital, or the treatment, and the world around, they are demonstrating significance and meaning, they are embodying and enacting it for those with whom they come into contact. They are giving, what you might say, sacramental form to the belief that each human being is made in the image of God, as they refuse to treat anyone as just an illness or just a job. 

I understand the temptation for chaplains to think of themselves as primarily healthcare professionals. But, if I may,I would like to counsel against it. Please argue with me later if you would like to. The health service does not always really understand what it wants from chaplains, but if it sees the value of chaplains at all, and it does, in nearly all cases it does see the value of chaplains, all of you have borne testimony to the way in which your health service, your trust, welcomes the work that you do, even if it doesn't always know exactly why. It is because the health service sees chaplains providing something that isn't otherwise present and if you don't provide something that isn't otherwise present there really won't be very much point in chaplaincy if you are simply another kind of manager. The health service has lots of managers. What is it that you contribute that nobody else can? I don't know if any of you remember a publication that appeared a couple of times, a very long time ago, it was called 'Not the Church Times' and it was a spoof and I used to love its advert column, in particular, and I particularly remember an advert for, I think, it was for a cathedral chaplain, in which it described the necessary requirements of this chaplain as somebody who was boring, weedy and faithless 'Boring, weedy and faithless clerics required for cathedral chaplaincy'.  

Hospital chaplaincy is not a job for boring, weedy and faithless, clerics. Chaplains need to be better theologians and stronger in their faith than those who work within more recognised church structures. Those who work within parish ministry, not that it is a doddle by any means, but they work within structures that support and understand theology and faith in a way that you don't. I am drawn to see parallels between chaplaincy and 'Fresh Expressions of Church'. What I do for a living is to help train pioneer ordained ministers, who will often be working outside the parish structure and working with those who have little or no contact with the church. You could teach them a thing or two couldn't you - all of you in chaplaincy. They are discovering that that means there is nothing they can take for granted from the people they work with or the organisations that they work in. So their own faith, their own life of prayer, and their own sense of value to God, and to the world, has to come from somewhere else and be sustained from somewhere else.  

Now obviously I am not suggesting that healthcare chaplains are exactly the same as 'Fresh Expressions of Church'. Many of which are overtly evangelistic in a way that I know healthcare chaplains cannot be, and should not be. God does not force himself on the vulnerable, and neither should we.  But many ‘Fresh Expressions of Church’ see themselves as showing people a new way to be human, giving them a chance to belong to, and to experience community again, to experience commitment, to experience trust in ways that a lot of the rest of our society doesn't offer any more. In other words, they are helping people to discover that their lives have meaning and significance. And although many of these new churches, or church-type groups are small, as their number increases, we hope and pray that they will be bringing more and more people to re-imagine not just that small experience of community that they are involved in, but on the basis of that small experience of community, to re-imagine society as whole. This is what we are made for, to be in community, to be committed to each other, to trust each other, to give each other meaning and significance and without that, human beings can't flourish. 

So I think sometimes I have suggested to people that chaplaincy provision in the health service is one of the oldest 'Fresh Expressions of Church' that there is, it invented it before anyone else did. One of the primary motives for 'Fresh Expressions' is the realisation that if people won’t or can’t come to church, then church must go to them and it must be prepared to change. Now as chaplains you have no choice about that at all. Either you are church where you are, or there is no church where you are. You can't say to people outside their normal structures in the health service that they should go to their mosque, or their church, or their synagogue or their temple, because they can't. They are forced to be where they are. This is their context, and chaplains can’t say, ‘go and join your already functioning religious community somewhere out there’ that is not an option. If people are to meet God, and find the significance of whatever experiences it is that they are undergoing while they are in the health service, it has to be here, where they are, or nowhere. 

Similarly, those of you who work in healthcare chaplaincy have no choice about the multi-faith and no-faith context in which you work. You have to work together to meet simple, basic, human need. You can't waste time trying to poach each other's parishioners and in this sense, I think, chaplaincy work has a great deal to teach the wider religious community in Britain. Chaplains work together because the needs of the people to whom they are ministering are the overwhelming context of all they do. Now that ought to be obvious in any religious context but it becomes much less obvious when the need is less obvious. And that is not in any sense to endorse a relativistic, syncretistic approach to comparative religions. It is not in any sense to say that any spirituality will do. On the contrary, I think, from the conversations that I have had, that chaplains of different faiths learn to treat the deepest religious convictions of those to whom they minister as something that must be heard and attended to with the utmost seriousness. This individual, to whom a chaplain is called, often in the middle of the night, cannot find meaning and significance for their own life and death story if they are forcibly uprooted at a time of crisis from all that has given their lives structure so far. So those of you chaplains who work in multi-faith teams carry vital experience for the rest of multi-faith Britain, about how we work together, about how we share responsibility with each other, about proper and respectful attention to each other, without pretending that there are no genuine differences. If the differences between our faiths were unimportant we wouldn't need multi-faith team, would we? If any spirituality would do, why are we working so hard to ensure that each person's religious needs are being met? Any religious practitioner would do if there was no real difference between faiths. To work in a multi-faith team is precisely to affirm that religions are not all the same, and that the best way to explore our differences is to work together for human flourishing. Not to sit down and make theoretical descriptions of the differences between us but actually to look together at what kind of people we are trying to grow, what kind of society we want to be, and how we can actually flourish together. In particular, I would like to suggest that now is the perfect time for chaplains of different faiths to stand together over the need for the religious dimension in healthcare. Muslims need to argue for the rights of Christian patients and staff, and Christians for the rights of Jewish patients, and so on and all people of faith need to work together to prevent the impoverishment of human well-being that comes when faith is side-lined as a second order issue. Spirituality is not some vague, contentless, category which supplies well-being by prescription. It is about each individual human story in relation to others and to the divine. Each individual human being needs to be attended to; why am I telling you this, you know this better than I do, as God attends to each of us, and given a context for their own life, their own pain, their own suffering, which is not just a privatised context but which connects it to others and to God. 

And that means that like those working in pioneer ordained ministry, chaplains need to be very sure about their own faith, and very generous and unaggressive in their relations with each other. Faith communities need to enable their best people to work in this boundary-less and challenging environment, and they need to invest, we need to invest, in training of our healthcare chaplains, and we need to invest in praying for our healthcare chaplains, and we need to try to keep them connected to their own faith communities. This needs to happen both for the sake of the people to whom you minister, but also, if I may make a grandiose claim, for the faith of the future of the human community. Under the kind of pressure that you see every day in your lives, in your work, under the pressure of suffering and of death, we from different faith communities might learn things from each other which will benefit the whole of the human race about how we live and work and pray together.

Inevitably, this will feel very threatening to pretty well everyone concerned, I would guess. Faith communities in this country have a history of good and respectful, distant, relationships keeping a proper distance from each other, so that we don't have to ask hard questions of each other about the truth of the statements we make and about the relationships we want to form. But our world in crisis doesn't really have time for that I don’t think. If we can't work together and learn from each other, without pretending and without patronizing, then we will all end up dead. And there are parts of our secularised world that would quite like to see us killing each other in different faith groups because that helps to discredit religion as a whole. There are, perhaps, more benign but equally pernicious, secular parts of our society that would like to treat all religions as essentially similar quests on the part of individuals for a life-style that suits them, that sees religion as a lifestyle choice like which gym you go to and which brand of apple you buy.

Strange as it may seem, this may be one of the gifts that healthcare chaplains can give to the rest of Britain, under the pressure provided by the people who turn to you in times of human crisis. If chaplains of many faiths can minister together without syncretism, yet working for a common goal, then you have a great deal to teach the rest of us.

In my work with pioneer ordained ministers in the Church of England I have come increasingly to believe that we are now presented with a blessing, born out of a crisis.  Because traditional ways of being church are not reaching many, many, people who long for God, we are being forced to change not our God, we are not changing God, but simply changing some of our structures.  

So can I ask you this question? 'Could the pressures on chaplaincy within the health service be a similar blessing, the fruit of a similar crisis?'`` As I said the health service does pay lip service to the role of 'spirituality' in the overall health of individuals, but it is not the job of the health service to define what spirituality is. The health service as an institutional body is, itself, under immense pressure and looking for its own 'spirituality', its own meaning and significance, and it is hardly in a position to try to define that for others. So chaplains have the perfect opportunity to minister creatively to the institution as a whole and to the individual lives that need to find their meanings in that context, and in the greater context of God and the human community. You are doing pioneering research, you might say, about what human beings need to flourish and how to present the God who made all human beings and loves them all.

To those of you from the Christian tradition I want to say thank you very much from the Christian church in this country for the work that you do on our behalf.  You are church where you are, and for the people you minister to in the times of need, and for all the staff who are also part of your regular parish. The staff who care for them and who often also get very little sense of being thanked and very little sense of their own worth. We, and the rest of the church, are grateful to you, and we don't always remember to say it, and I would like to take this opportunity of saying thank you for being prepared to do this ministry which you do with excitement, with commitment, and with a kind of delight in the opportunities offered that is really engaging to see. What you are doing is ministry on behalf of the whole body of Christ and we have delegated it to you as a church which is part of the ministry that we too need to share in. So I say to you standing here, in Lambeth Palace, please ask from us what you need in terms of support, in terms of prayer, in terms of refreshment, and understanding, and letters from the Archbishop of Canterbury, and anything else that might occur to you and please forgive us that we haven't always offered that kind of support to you in the past. For those of you who have been drawn to chaplaincy because of perceived and experienced sense of the faults and failings in the institutional church, please forgive us, but please do not lose sight of the fact that you, like the rest of the church, are offering people God, you are not offering them the church. We all do that imperfectly and that's OK, because it is not ourselves we are offering, it is our God.

So, if I may, make a plea to you to work at your own faith, your own spirituality, your own community in which you find meaning and significance in relation to others and God. Don't let that inner heart of your calling get hollow or too far from its roots. It must nourish you if it is going to go on nourishing other people. You need to work at your own human and faith nourishing in order to be of any use to others. 

For those of you who are working in multi-faith, multi-denominational teams, please be aware of the valuable, pioneering, nature of the work that you are doing. You are valuing human persons above all theories, and I can't help feeling that the rest of us are bound to learn something about God from your co-operation but, not if you don't tell us about it, not if it all stays within that one context. You are doing work that is pioneering and we, and the rest of the churches, the rest of the faith communities need to hear about it, to learn how you are learning, to learn from the fruits of your experience.

To those of you who are working in what feels, at best, an ignorant and, at worst, a hostile environment for chaplaincy, hang in there. Treat the health service as you would treat a patient mad with pain and fear, and you have all met patients under those conditions. I have been hearing some of the stories over refreshments. I have written down one of those phrases that should have been the title for this lecture 'Patients going bananas'. The health service is equally 'going bananas' in places and it needs you to treat it as you would treat a patient. It needs you now more than ever, and I know that you will be there for it. The results of your chaplaincy work may not be immediately visible any more than the result of any kind of Christian work is immediately visible but there will be fruits from faithful ministry in the health service because God does not waste things. A basic theological belief. What is faithfully given reaps faithful rewards.

If one were to pick one thing that Norman Autton stood for, and I know there are millions that you could pick, one thing that he stood for in chaplaincy was for this kind of fearlessness borne out of involvement when you come to know something you will no longer be afraid of it. This is the time to pick up that legacy, a fearlessness borne out of involvement, and run with it.  This is not a time to abandon it but to give thanks for it and to look to its future.

Thank you.

*Norman Autton Memorial Chalice

This page was updated on 16 December 2008