The Limits of Chaplain Confidentiality
“A woman was in her sick child’s room when she was visited by a chaplain from a civilian 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 taken aback … when a nurse approached her and asked her about her pregnancy, it turned out that much of what she had discussed with the chaplain was written in her 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 laws against pastors for invasion of privacy arising from the disclosure of confidential information. The result of these lawsuits has brought recognition that the obligation to maintain confidentiality is not only a moral obligation, but often a legal one as well.2
If civilians expect their conversations with clergy to be confidential, this assumption is even greater within the military community, where practices such as mandatory drug testing and vehicle gate searches contribute to heightened sensitivity to issues. Of privacy. While religious denominations have their own regulations that guide their clergy regarding information sharing in various circumstances, various 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 the civil legal systems and the military system differs considerably. While service 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 cases related to communications, military laws and regulations take precedence over civil laws.
According to 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. The communication must be made to a chaplain in his or her capacity as chaplain or his or her assistant in an official capacity.
3. It is the intention of the communicator that the information is confidential.
It is clear that it is the intention of the person making the communication and not that of the chaplain that is important. It is also clear that the applicability of the privilege, that is, whether the communication is considered confidential or not, is determined by the intention of the party and not by the place where the communication takes place. (for example, the 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 are required to report certain matters to command.3
Before looking specifically at the practice of military chaplains making entries in patients’ 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, health professionals, and health care facilities. Unlike in the past, where patients typically received pastoral visits from clergy representing specific religious groups, today a professional cadre of certified hospital chaplains has evolved who are members of the entire health care team with access to patients’ medical records. patients both to collect information and to make notes. of theirs.
While decent strides have been made in integrating chaplains more fully into the health care system, some medical ethicists believe that making registries, that is, having this specialized chaplaincy make record entries accessible to others patients’ doctors, is “disturbing” and suggests that there is a need to reassess professional care. commitments to “respect and protect the bio-psycho-social integrity of patients.”4 The evolution of hospital chaplaincy as a profession distinct from congregation-based ministry has also raised concerns among some members of the clergy who see practices such as graphics as a threat to confidentiality that has been the cornerstone of his 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 states: “Patients should be advised that certain information communicated to the chaplain may be shared with other members of the team.” or in a clinical supervision session unless the patient specifically requests that such information remain confidential with 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 remain confidential,” could these same service members be misled into believing that this also applies to what they share with the chaplains? outside of medical facilities? Could these same servicemen and women question that what they discuss with their unit chaplains can be shared with their command unless they “specifically request that such information remain confidential”?
Instead of telling 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 line with SECNAVINST 1730.9 (“Confidential Communications to Chaplains”) to revise the BUMED instruction 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 in 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 it is indicated 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 armed forces where the privacy of personnel and their families is protected, as in the case of SECNAVINST 1730.9, paragraph 4 (h):
Records or notes compiled by a chaplain in his or her counseling duties are considered ‘work product’ and are confidential. As such, chaplains must safeguard such records, in whatever medium or format, that contain confidential communications. When no longer needed, these work products will be destroyed.
Unlike the “notes” that a chaplain may take in his office and which are then destroyed, the “notes” that a hospital chaplain may take in the process of conducting a spiritual evaluation remain part of the patient’s medical record even after that you are discharged. Chaplains who are forced by supervisors or hospital administrators to justify their role or “competence” by recording spiritual evaluations can potentially undermine the trust that should exist between clergy and those to whom they minister. Those who also use the registration system for professional validation, credentialing, or to justify employment potentially redefine pastoral visitation from selfless to selfish. Furthermore, it has not yet been established whether healthcare teams benefit significantly from such subjective intake that it is primarily helpful to the patient.
It might 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 mode of being. Spiritual life is a relational life that involves how the patient relates to others and how he or she understands his or her 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 accurate reflection of the person in question.
The role that a chaplain plays in the health care community cannot be underestimated. While metrics are increasingly being used in medical institutions as a method of evaluating the value and necessity of professional positions and number of tickets, there are a host of intangible benefits a chaplain brings to patient visits that can never be measured with practices like charts alone.
Service members and their families deserve the utmost assurance that their conversations will be respected and protected. Military chaplains must ensure that their cartographic practices do not “cross the line” lest they relinquish this sacred role entrusted to them for more than two centuries of US naval history.
Lt. Cmdr. Gomulka was a chaplain at Naval Medical Center San Diego. He retired in August 2014 after the article appeared in the December 2013 issue of Proceedings published by 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 Bulletin Vol 2 Issue 6 OPNAV N171 June 2013.
4. Roberta Springer Loewy and Erich H. Loewy, “Medical Care and the Hospital Chaplain,” Medscape General Practice (March 14, 2007).