The Value of Circus Clowns: What Clinical Ethicists Can Learn from Chaplains About Credentialing, Standardization, and Professionalization
Devan Stahl, Ph.D., M.Div., Assistant Professor Clinical Ethics, Michigan State University
One of the oldest and enduring analogies for a hospital chaplain has been viewed that of the circus clown (Faber, 1971). Often considered an amateur among experts, but essential for making the “circus” of the hospital system feel like a coherent and unified endeavor, the chaplain-clown never quite belongs within the health-care team, but is fully separate from it either. Today, the analogy of the chaplain has receded under the weight of evidenced-based standardization. Chaplains are now required to constantly prove their worth in the health care team by using the metrics of the hospital system—metrics which have traditionally been foreign to the nature of ministry. Yet, even after professionalization, credentialing, and countless initiatives to measure spiritual outcomes of patients to prove the worth of chaplaincy, chaplains’ job stability continues to be precarious and their roles are frequently undervalued. Attempting to become an act with its own with measurable integrity and worth, chaplaincy has risks losing what makes their presence unique and valuable.
The history of this struggle finds resonance with current proposals for credentialing and standardization amongst clinical ethics consults—proposals that now seem all but inevitable. As new generations of clinical ethicists imagine their future in health care systems, there is much to learn from the history of the professional chaplain. Although many ethicists have a kind of respected managerial role in the clinic the chaplain has rarely received, the chaplain and ethicist share a kind of foreign status within the health care system. The knowledge, skills, and role of clinical ethics consultants is likely to be continually questioned, just as it is for the hospital chaplain, because each struggles to fit into the medico-scientific paradigm used to judge the effectiveness of clinical care. In this presentation, I will explore the critical overlaps between the two groups as they pertain to the challenges of standardization and credentialing. Using my experience as both a hospital chaplain and clinical ethicist, I will explore topics such as ideological diversity, outcomes measurement, training, public visibility, and pluralism as they pertain to both roles. I will argue that there is continuing value in understanding the role of the clinical ethicist as a kind of outsider on the health care team and that clinical ethicist consultants have much to learn from their chaplain counterparts on how to maintain a clown-like status.
One of the oldest and enduring analogies for a hospital chaplain has been viewed that of the circus clown (Faber, 1971). Often considered an amateur among experts, but essential for making the “circus” of the hospital system feel like a coherent and unified endeavor, the chaplain-clown never quite belongs within the health-care team, but is fully separate from it either. Today, the analogy of the chaplain has receded under the weight of evidenced-based standardization. Chaplains are now required to constantly prove their worth in the health care team by using the metrics of the hospital system—metrics which have traditionally been foreign to the nature of ministry. Yet, even after professionalization, credentialing, and countless initiatives to measure spiritual outcomes of patients to prove the worth of chaplaincy, chaplains’ job stability continues to be precarious and their roles are frequently undervalued. Attempting to become an act with its own with measurable integrity and worth, chaplaincy has risks losing what makes their presence unique and valuable.
The history of this struggle finds resonance with current proposals for credentialing and standardization amongst clinical ethics consults—proposals that now seem all but inevitable. As new generations of clinical ethicists imagine their future in health care systems, there is much to learn from the history of the professional chaplain. Although many ethicists have a kind of respected managerial role in the clinic the chaplain has rarely received, the chaplain and ethicist share a kind of foreign status within the health care system. The knowledge, skills, and role of clinical ethics consultants is likely to be continually questioned, just as it is for the hospital chaplain, because each struggles to fit into the medico-scientific paradigm used to judge the effectiveness of clinical care. In this presentation, I will explore the critical overlaps between the two groups as they pertain to the challenges of standardization and credentialing. Using my experience as both a hospital chaplain and clinical ethicist, I will explore topics such as ideological diversity, outcomes measurement, training, public visibility, and pluralism as they pertain to both roles. I will argue that there is continuing value in understanding the role of the clinical ethicist as a kind of outsider on the health care team and that clinical ethicist consultants have much to learn from their chaplain counterparts on how to maintain a clown-like status.