Scottish Association of Chaplains in Healthcare, SACH Soundings 14 June 2003

In May 2003 the Association of Hospice and Palliative Care Chaplains (AHPCC) met at the Hayes Conference Centre in Swanwick for their annual 3 day conference which this year focused on Ethical Issues at the End of Life.
The main conference sessions were by Alastair Campbell and David Cook, both gifted speakers and well experienced in the complex field of medical ethics. The sessions were inspiring. It was disappointing that Professor Baroness Finlay of Llandaff (a ‘peoples peer’) was unable to be present due to a House of Lord’s commitment, however her influence had a profound impact on the conference by raising our awareness of the Patient (assisted dying) Bill, to be presented in the house of Lord’s on 6th June. None of the delegates had heard of the Bill. Baroness Finlay noted that no objections had been received in the House of Lords, and suggested that given the significant experience of hospice chaplains and the depth of understanding we would have of the issues we might consider a response.
At first reading the Bill seemed thought through and practical, especially when you focused your mind on the recent experiences of Motor Neuron Disease patients going to a Switzerland to end their lives. However, on closer reading serious questions needed to be asked and explored.
In addition to their topics of Virtue Ethics and How People Make Hard Decisions, Alastair and David both led us through an exploration of Euthanasia and the main arguments for and against, the arguments around sanctity of life, the slippery slope and the experience of the abortion legislation.
There was a general feeling that the Patient (assisted dying) Bill had serious flaws and that the conference should prepare a response and press statement based on our wide experience of caring for patient, the families and staff.
The main concerns were that the Bill was based on a few difficult and well publicised cases rather broader principles. The main criteria centred around ‘unbearable suffering’ which was ill-defined and was the sole responsibility of the doctor to judge. What if the root of the suffering was psychological or spiritual, why the doctor and not a multidisciplinary team to decide? There was a concern too that it significantly changed the relationship of the doctor to the patient and the rest of the care team. Even the doctors ‘conscience clause’ was compromised since the doctor was required to refer on to another doctor who would carry out assisted dying. It was felt that the bill placed too much pressure on patients who could be made to feel it was the right thing to do for their family, and there was a strong feeling that the experience and provision of palliative care was a significant alternative and brought a wealth of experience in this difficult area.
The conference was careful not to use the arguments of Sanctity of Life or the experience of the Abortion Act in its statement. Although both are relevant arguments it was felt they would be seized by the media and would polarise the discussion and overshadow the more important comments and criticisms being made.
The other significant feature of the conference was the launch of the associations Standards for Hospice and Palliative Care Chaplaincy. There are 7 standards: access to chaplaincy service, spiritual & religious care, multidisciplinary team working, staff support, education & training, resources, and chaplaincy to the unit (institution). The standards also come complete with a comprehensive audit tool and suggestions for different types of audit.
The Scottish influence on the standards is strong and was warmly if not enviously welcomed by the conference. The standards include the relevant chaplaincy and spiritual care components of the now mandatory NHS Quality Improvement Scotland(QIS) Specialist Palliative Care Standards, which all hospices have to meet, and also draw on the Spiritual Care in the NHS Guidelines (NHS HDL 2002 76) and definitions.
The standards were piloted in 12 hospices prior to being published and were unanimously adopted and launched on 20th May 2003. All UK hospices will receive a copy of the standards, and all chaplains who are members of the AHPCC. Copies are available from the secretary of the Scottish branch of the association:
Rev Tom Gordon, E-mail
tom.gordon@mariecurie.org.uk
Aside from these two significant elements of the conference it was good to meet colleagues from throughout the UK and to see how hospice and palliative care chaplaincy is developing. It was also encouraging to realise how far ahead of the field Scotland is in terms of the development of chaplaincy and spiritual care. Small is beautiful was a phrase used to describe our experience and offered as the main reason for the speed at which we are able to move and agree things in Scotland.

David Mitchell
Scottish Representative
AHPCC

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