Medical Ethics Advisor relies heavily on feedback from readers to guide the content of the newsletter, and we always welcome comments and suggestions on topics of interest to you.

Following our inclusion of an article on the role of patients’ spirituality in their medical care, we received a letter from Chaplain Steve Pyle, director of pastoral care at Baxter Regional Medical Center in Mountain Home, AR.

Chaplain Pyle made some insightful comments about our article and included suggestions that we intend to incorporate into future articles on the topic of patients’ beliefs and their health care.

Letters and suggestions about articles we’ve published or topics you would like to see can be sent to Managing Editor Jayne Gaskins at

Dear Editor:

I serve as the director of pastoral care in the hospital in which I serve. As a board-certified, professional chaplain, I want to thank you for the article in Medical Ethics Advisor, October 2004 issue, titled "Patients’ spirituality: Should it play a role in their care?"

I am especially thankful for the paragraph recommending referring to a chaplain.

I would like to make some observations, however:

First, you recommend "calling in a hospital chaplain, if the patient agrees, is one resource for meeting patients’ spiritual needs." A professional, board-certified, clinically trained chaplain is a member of the health care team, as any ancillary department. I would recommend making the referral if there are triggers about spiritual distress in the same way the physician or nurse would make referrals to, say, respiratory therapy if the patient is having breathing difficulties. The physician or nurse wouldn’t say, "I see you are having breathing difficulties. Would you mind if I contacted respiratory therapy?"

My point being that we are not talking about a member of the area clergy coming from the outside into the hospital. Asking permission for such a referral is appropriate. However, we are talking about a member of the health care team who specializes in assessing and addressing spiritual needs of the patient. The physician and nurse certainly can do a simple spiritual screening, but not a spiritual assessment.

Second, there is confusion between "faith" and "spirituality." It is reflected in conversations in society in general and in your article, in specific. Faith and religion are one of several components that can make up a person’s spirituality. Spirituality is that which gives life meaning, offers a sense of self-worth and purpose — that which is transcendent and helps one cope with life. Even an atheist has spirituality — he/she derives strength from somewhere — it may not be religion, but it is from somewhere, and the question that needs to be asked is, "How is that working for you, right now?" Whether one is religious or not — how are their coping resources handling the crisis at the moment? A professional, board-certified chaplain is uniquely equipped to handle that issue in depth. As your article stated, the physician and nurse often don’t have the time to "hear the patient’s story," but the chaplain does. It is not unusual for the chaplain to have a pastoral conversation with a patient and never have "religion" come up, yet they may talk about spiritual issues.

I mentioned "spiritual triggers about spiritual distress." Glenn Sackett, a board-certified chaplain, has defined spiritual suffering [as follows]:

"Spiritual suffering has a parallel to physical pain; it is a warning that something destructive is occurring or that an injury has occurred. This would be an injury to, or an assault on one’s spirit. Likely causes would be:

  • Unmet spiritual needs (love/belonging, meaning/purpose, reconciliation/freedom from guilt/shame, hope/hopelessness).
  • Conflicts related to spiritual beliefs.
  • Unresolved spiritual issues (guilt, grief, shame, alienation, despair).
  • Collapse of a spiritual/world view."

Charles Barley, another board-certified chaplain, has defined spirituality as a continuum:

  • Spiritual strength: Healthy belief system that helps them cope well with one’s life setting and relationships.
  • Spiritual concerns: Experiencing mild stress/anxiety, yet has a moderate to high level of spiritual resources and coping skills intact.
  • Spiritual distress: Experiencing some loss of balance/harmony in life, which includes personal and or relational problems in one or more areas of their lives.
  • Spiritual despair: Characterized as feeling like life is meaningless, socially and spiritually alienated, low self-worth, and is experiencing deep hopelessness and possibly depression.

There is much discussion out there, in society in general, and in medical circles, about spirituality. The great thing is that there is a resource that is available and trained to deal with these issues. The professional, board-certified chaplain brings much to the table and needs to be utilized as the resource he/she is.

With kindest regards,

Stephen Pyle
Director of Pastoral Care
Baxter Regional Medical Center
624 Hospital Drive
Mountain Home, AR 72653
Phone: (870) 508-7750