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The limits of the chaplain’s confidentiality

“A woman was in her sick son’s room when she was visited by a chaplain at a civil hospital. She told the chaplain a number of things about herself and her family, including the fact that she was pregnant. The next day she was shocked when a nurse approached him and asked about his pregnancy. It turned out that much of what he had discussed with the chaplain was written in his son’s medical record … “1

Historically, members of the clergy have had a moral obligation to maintain the confidentiality of their parishioners. In recent years, however, people have filed an increasing number of lawsuits against pastors for invasion of privacy arising from the disclosure of confidential information. The result of these lawsuits has led to the recognition that the obligation to maintain confidentiality is not only a moral obligation, but also often a legal one.

If civilians expect their conversations with clergy to be confidential, this presumption is even greater within the military community, where practices such as mandatory drug testing and vehicle searches at gates contribute to increased sensitivity to problems. Of privacy. While religious denominations have their own regulations that guide their clergy regarding information shared in various circumstances, several Instructions, Regulations, and the Manual for Courts-Martial (MCM) contain statutes that protect the confidentiality of communications with chaplains. military.

Protecting our privileged position

The legal protection offered by civilian legal systems and the military system differs considerably. Although military members as citizens of the United States are subject to and benefit from federal and state laws, they are also subject to the UCMJ and other specific military regulations. In certain communications-related cases, military laws and regulations take precedence over civil laws.

According to the Military Rules of Evidence MRE 503 (b) (2), for a communication to be considered privileged, three criteria must be met:

1. It must be done “either as a formal act of religion or as a matter of conscience.”

2. Communication should be made to a chaplain in his role as chaplain or to his assistant in an official capacity.

3. It is the intention of the communicator that the information is confidential.

It is clear that what is important is the intention of the person making the communication and not that of the chaplain. It is also clear that the applicability of the privilege, that is, whether the communication should be considered confidential or not, is determined by the intention of the party and not by where the communication takes place. (for example, chaplain’s office, hospital room, aboard ship, or in the field).

Despite clear policies and regulations maintaining confidentiality by military chaplains, in a recent 2013 survey of naval personnel, 63 percent of 5,049 respondents did not believe their communications with chaplains were confidential, and 65 percent of 2,895 respondents mistakenly believed that Navy chaplains were confidential. required to report certain matters to command. 3

Historical perspective

Before looking specifically at the practice of military chaplains entering patient medical records, it would be helpful to look at how this practice has evolved in recent history.

Hospital chaplaincy as a distinct profession in the United States over the past 20 to 30 years has taken a more proactive stance toward patients, healthcare professionals, and healthcare facilities. Unlike in the past, where patients generally received pastoral visits from clergy representing specific religious groups, today a professional cadre of certified hospital chaplains has evolved who are members of the health care team with access to the medical records of the patients. both to collect information and to make annotations. on your own.

While valuable progress has been made in integrating chaplains more fully into the health care system, some medical ethicists consider charting – making annotations in patients’ medical records accessible others for this specialized chaplaincy as “disturbing” and suggest that there is a need to reevaluate professionals. commitments “to respect and protect the bio-psychosocial integrity of patients.” 4 The evolution of hospital chaplaincy as a profession distinct from congregational ministry has also raised concern among some clergy who view practices such as mapping as a threat to confidentiality that has been a cornerstone of their ministry.

Chaplains, medical records and confidentiality

Although BUMEDINST 1730.2A attempts to balance the hospital’s need for clinical information and the patient’s need for confidential care, paragraph 12b of the Instruction reads: “Patients should be advised that certain information communicated to the chaplain may be shared with other members of the team. treatment. or in a clinical supervision session unless the patient specifically requests that such information remain confidential with the chaplain. “

If military patients presume that what they discuss with hospital chaplains “may be shared” with others unless they “specifically request that such information remain secret,” could these same service members be misled into believing that this also applies? to what they share with chaplains outside of medical facilities? Could these same service men and women question whether what they discuss with their unit chaplains can be shared with their command unless they “specifically request that such information remain confidential”?

Rather than tell patients that their communications with chaplains may be shared with others unless they “specifically” request that such information remain confidential, I submit that it would be more in compliance with SECNAVINST 1730.9 (“Confidential Communications to Chaplains”) To review the BUMED instructions to read, “Information shared with chaplains is presumed confidential unless the patient specifically requests that the chaplain share certain information with other members of the medical team.”

The fact that many patients may be suffering from excessive physical or emotional pain may affect not only their ability to make informed decisions regarding disclosure, but also their ability to “distinguish confidential communications from general pastoral care interventions.” as stated in the current BUMED Instruction. .

Hospital spiritual evaluations

Today, several military hospital chaplains attempt to conduct spiritual assessments of a patient’s cultural, religious, and spiritual beliefs or practices, the results of which are often recorded in the patient’s medical record. Such a practice can be problematic in the military where the privacy of personnel and their families are protected as in the case of SECNAVINST 1730.9, paragraph 4 (h):

Records or notes compiled by a chaplain on his counseling duties are considered “work products” and confidential. As such, chaplains must safeguard such records, in whatever medium or format, that contain confidential communication. When they are no longer needed, these work products will be destroyed.

Unlike the “notes” that a chaplain may take in his office that are later destroyed, the “notes” that a hospital chaplain may record in the process of conducting a spiritual assessment remain a part of the patient’s medical record even after that the patient is discharged. Chaplains who are required by hospital supervisors or administrators to justify their role or “competence” by drawing spiritual assessments can potentially undermine the trust that should exist between clergy and the people to whom they minister. Those who also use the charting system for professional validation, accreditation, or to justify employment, potentially redefine the pastoral visit from disinterested to selfish. Furthermore, it has not yet been established whether healthcare teams benefit significantly from an intake so subjective that it is primarily helpful to the patient.

It could also be noted that spiritual care by the chaplain is not so much an “intervention” (as noted in BUMEDINST 1730.2A, paragraph 13a), or something to “fix”, but rather a relational way of being. Spiritual life is a relational life that involves how the patient relates to others and how he understands his current circumstances in the context of a personal belief system. Because hospital chaplains rarely have long-term relationships with patients who are discharged or die, these evaluations and interventions may not be the most faithful reflection of the person in question.

The role of a chaplain in the healthcare community cannot be underestimated. While metrics are increasingly being used within medical institutions as a method to assess the value and need for professional positions and the number of tickets, there are a host of intangible benefits that a chaplain brings to patient visits. that can never be measured with practices like graphics alone.

Service members and their families deserve the highest assurance that their conversations will be respected and protected. Military chaplains must ensure that their mapping practices do not “cross the line” so that they do not renounce this sacred role that has been entrusted to them during more than two centuries of US naval history.

Lieutenant Commander Gomulka was a staff chaplain at Naval Medical Center San Diego. It was withdrawn in August 2014 after the article appeared in the December 2013 issue of Proceedings published by the Naval Institute Press.

1. Jami Briton, “Hospital chaplains are not required to keep information private,” KCRG-TV9 news report (April 15, 2010).

2. David O. Middlebrook, “Pastoral Confidentiality: An Ethical and Legal Responsibility,” Enrichment Journal (Spring 2010).

3. Lifelink Newsletter, Vol., 2, Number 6, OPNAV N171, June 2013.

4. Roberta Springer Loewy and Erich H. Loewy, “Healthcare and the Hospital Chaplain,” Medscape General Medicine (March 14, 2007).