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The Boundaries of Chaplain Confidentiality
“A woman was in her sick child’s room when a chaplain from a civil hospital visited her. She told the chaplain several things about herself and her family, including that she was pregnant. The next day she was surprised when a nurse came to her and inquired about her pregnancy. It turned out that much of what she had discussed with the chaplain was recorded in her child’s medical record… ” 1
Historically, members of the clergy have had a moral obligation to maintain the confidentiality of their parishioners. However, in recent years, 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 recognized that the duty to maintain confidentiality is not only a moral duty, but often a legal duty as well.2
If civilians expect their conversations with clergy to be confidential, this assumption is even greater in military circles, where practices such as mandatory drug testing and gate vehicle searches foster heightened sensitivity to privacy concerns. Although religious denominations have their own rules that guide chaplains regarding information shared in various settings, various instructions, regulations, and the Courts-Martial Manual (MCM) contain statutes that protect the confidentiality of communications with military chaplains.
Protecting our privileged position
The legal protections offered by the civilian legal system and the military system differ significantly. Although military personnel are subject to and benefit from federal and state laws as citizens of the United States, they are also subject to the UCMJ and other military-specific regulations. In some cases involving communications, military laws and regulations take precedence over civilian laws.
According to the Military Rules of Evidence, MRE 503(b) (2), three criteria must be met for a communication to be considered privileged:
1. It must be made “either as a formal act of religion or a matter of conscience.”
2. Communications should be made with the chaplain on duty as chaplain or his/her assistant on official duty.
3. The communication provider intends to keep the information confidential.
Clearly, it is the intention of the communicator, not the chaplain, that matters. It is also clear that the applicability of the privilege, that is, whether or not a communication is considered confidential, is determined by the intent of the party, not the location of the communication. (eg, in the chaplain’s office, in a hospital room, on a ship, or in the field.)
Despite clear policies and regulations ensuring the confidentiality of military chaplains, in a recent 2013 survey of Navy 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 personnel chaplains are like that. obligation to report certain issues to the team.3
Before looking specifically at the practice of military chaplains in making entries in patients’ medical records, it is useful to look at how this practice has evolved in recent history.
Hospital chaplaincy as a distinct profession in the United States has taken a more proactive approach to patients, health care professionals, and health care facilities over the past 20 to 30 years. Unlike in the past, where patients usually received pastoral visits from clergy representing certain faith groups, today there has developed a professional circle of certified hospital chaplains who are members of the health care team who have access to patients’ medical records for both information gathering and recording. own.
Although worthy strides have been made to integrate chaplains more fully into the health care system, some medical ethicists view charting, ie, the annotation of patients’ medical records so that this specialized chaplain can access others, as “disturbing” and suggest that it is necessary re-evaluate the specialist. a commitment to “respect and protect the biopsychosocial integrity of patients.”4 The evolution of hospital chaplaincy as a profession distinct from parish ministry has also raised concerns among some clergy who believe that practices such as charting threaten the 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 with the patient’s need for confidential care, Instruction 12b states: “Patients should be advised that certain information communicated to the chaplain may be shared with other members of the treatment team. or clinical supervision session, unless the patient specifically requests that such information remain confidential to the chaplain.”
If military patients assume that what they discuss with hospital chaplains “may be shared” with others unless they “specifically request that such information be kept confidential,” those same service members may be misled into believing that this applies also to what they share with chaplains. outside medical facilities? Could these same service men and women question that what they discuss with their unit chaplains can be shared with their team unless they “request such information to be kept confidential”?
Rather than telling patients that their communications with chaplains may be shared with others unless they “specifically” request that such information remain confidential, I believe SECNAVINST 1730.9 (“Confidential Communications with Chaplains”) would be better revised by BUMED instructions to read. , “Information shared with chaplains is considered 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 suffer from excessive physical or emotional pain may affect not only their ability to make informed decisions about disclosure, but also their ability to “separate confidential communication from general pastoral care interventions”, as stated in the current BUMED instruction. .
Hospital mental evaluations
A number of military hospital chaplains today attempt to conduct spiritual assessments of a patient’s cultural, religious, spiritual beliefs or practices, the results of which are often recorded in the patient’s medical record. Such practices can be problematic in the military where the privacy of personnel and their family members is protected, as in SECNAVINST 1730.9 §4(h):
Notes or notes made by the chaplain in the course of his or her consulting duties are considered “work product” and are confidential. As such, chaplains must safeguard all such records, whether or not they are confidential. When these work products are no longer needed, they will be destroyed.
Unlike “notes” that a chaplain may take in his office, which are later destroyed, a hospital chaplain’s “notes” of a mental evaluation may remain in the patient’s medical record even after the patient is discharged. Chaplains who are pressured by supervisors or hospital administrators to justify their role or “competence” by creating a spiritual rating chart can potentially weaken the trust that exists between chaplains and the people they serve. Those who also use the charting system for professional approval, accreditation, or to justify employment may be redefining pastoral attendance from selfless to selfless. Furthermore, it remains to be determined whether medical healthcare teams benefit significantly from such highly subjective admissions that primarily benefit the patient.
It may also be noted that the chaplain’s spiritual care is not so much an “intervention” (as stated in BUMEDINST 1730.2A, paragraph 13a) or something “fixable”, but more of a relational type. Spiritual life is a relational life that includes the patient’s relationships with others and how she makes sense of her current circumstances in the context of her personal belief system. Because hospital chaplains rarely have long-term relationships with patients who are being discharged or dying, these assessments and interventions may not be the truest reflection of the person in question.
The role of the chaplain in the healthcare community cannot be understated. Although metrics are increasingly used in medical settings as a method to measure the value and necessity of professional positions and the number of billets, chaplaincy provides many intangible benefits to patient attendance that can never be measured by practices such as charting.
Service members and their families deserve the utmost confidence that their communications will be respected and protected. Military chaplains must carefully ensure that their charting practices do not “cross the line,” lest they betray this sacred role that has been entrusted to them for more than two centuries of U.S. Naval history.
Lt. Commander Gomulka was the staff chaplain at Naval Medical Center San Diego. She retired in August 2014 after an article appeared in the December 2013 issue of Proceedings, published by the Naval Institute Press.
1. Jamie Britton, “Hospital Chaplains Don’t Have to Keep Information Private,” KCRG-TV9 News Report (April 15, 2010).
2. David O. Middlebrook, “Pastoral Confidentiality: Ethical and Legal Responsibility,” Journal of Enrichment (Spring 2010).
3. Lifelink Newsletter, Vol 2, Issue 6, OPNAV N171, June 2013.
4. Roberta Springer Loewy and Erich H. Loewy, “Health Care and the Hospital Chaplain,” Medscape General Medicine (March 14, 2007).
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