Understandings of illness and death in the practice of medicine changed dramatically after the Enlightenment. In the Middle Ages, both had their locus in the liturgical life of the monastery. The sick were the object of the monastic practice of charity, and the practice of charity was inspired by the celebration of word and sacrament. In turn, the care of those who were ill or dying was rooted in an understanding of the Cross, which was a symbol of both death and human finitude. This contextualization of illness and death shaped the configuration of spaces in the monastery, found expression in the ministry and spirituality of the monk-physician, and defined much of what happened in daily life. It also transformed the way in which death itself was understood, which was not seen as the end of life, but as the transition from one life into another.
However, beginning in the late middle ages, death and disease slowly drifted from those liturgical and communal ties, and were located, instead, in the body. From the late eighteenth and early nineteenth centuries until the 1960s, something of the communal dynamic remained, in part, because the physician depended upon the beating heart when announcing that someone had died. The heart—understood, through its rich mythical connotations, as the center of life—kept the event of death connected with the emotional and spiritual life of the person, and with his or her community as well.
But even that place was lost technologically in the late 1960s with the first heart transplant. The heart became a mere “body part,” separable from the person and her community, a machine that could be replaced; and, eventually, death was situated in the brain, where only a physician armed with an EKG could pronounce on the end of life.[i]
In this context both parish clergy and hospital chaplains have worked hard and with varied levels of success to carve out and recreate a sacramental and spiritual space, which our medieval predecessors took for granted. But with the global spread of Covid-19, we have entered a completely new chapter of that history.
Thanks to the provisions of the Hospital Incident Command System which was developed in the 1970s and standardized across the country after 9/11, parish clergy have been forbidden admission to hospitals and – with some exceptions – chaplains have been required to care for patients remotely or at a considerable distance.[ii] So, here we are, in a world that has shifted dramatically yet again.
By inference, the ministries of both chaplains and parish clergy have been judged non-essential. The physical well-being of hospital patients has been judged to be the primary, if not the only concern of the healthcare system. The spiritual needs of the patient have been sidelined. The sacramental has slipped from view, and even an emphasis on pastoral presence and community has slipped from view. Put another way, the materialist worldview that treats the body as a mechanism and its repair as a matter of mechanics has triumphed over any notion that human beings have a soul and that the links between the body and soul might be indissoluble.
It is all but impossible to overstate the significance of this new chapter for the theology and ministry of the church. The way in which we navigate illness and death reveals what we believe about life and its purpose. It reveals how deeply we believe in the sacramental, credal and confessional assumptions that shape our common life. It also exposes how well we understand the ways in which the logic of the Christian faith represents an intricate fabric of assumptions about God and the world in which we live.
Ministry to the ill and dying is imbedded in the ministry of Jesus, who touched and was touched in spite of taboos that were every bit as world-ending in the minds of his contemporaries as any medical dangers that we face. It is imbedded in our theology of the incarnation that holds that in Christ God is with us. It is based upon our conviction that this life and the effort to preserve it is not and cannot be our ultimate value. It is imbedded in the conviction that the journey into God in Christ is framed, deepened, and nourished by the church’s sacraments. It is also rooted in the conviction that we are – as both body and soul – made in the image of God, which is the object of God’s redemptive work in Christ.
Those convictions are not optional, religious niceties. They are, from a Christian point of view, definitional. Until modern medicine severed our connection with God’s ill and dying children, they prompted us to care for one another in the most desperate of circumstances. They led the church and its clergy to risk itself, and – though no one should actively seek it – those convictions have motivated a countless number of Christians to face martyrdom over the millennia. So, to have abandoned those convictions in dealing with the challenges posed by the pandemic without question or conversation is perhaps one of the most stunning and sudden shifts in our understanding of the church and the vocation of clergy in historical memory.
To be clear, I am not talking about clergy behaving in a way that is willfully blind to scientific truth, ignorant of what we know about Covid-19, or in denial about its potential effects. I understand that clergy and chaplains can become a vector for the disease. I also understand that in order to be present to those who are infected, clergy will need protective equipment that has been in short supply. Nor am I talking about the kind of behavior advocated by pastors who have called on their members to attend church services and to behave without regard for what we know about this virus, as if to do so is to pass a test of faith. Such thinking is a magical bastardization of the Gospel.
But to acquiesce to the assumptions latent in the Hospital Incident Command is to make another kind of serious error. What is at stake is our understanding of who we are in Christ, what makes for life in Christ, and therefore, what matters most. At stake, too, is the inevitable grief and moral injury that flows from the policies that we have implemented. Patients, families, chaplains, parish clergy, and hospital staff have all been drawn into a protocol that is designed to ensure physical safety but makes no provision for the cure of souls.
So, how should the church, its clergy and theologians respond?
Chaplains and clergy can continue to forge partnerships with hospitals and healthcare providers. As Rod Dreher notes, “As important as it is for Christians to strengthen their ties to one another, they should not neglect to nurture friendships with people of goodwill outside the churches.”[iii] There are countless reasons that those who are not Christians may well agree with much of what we believe.
For any number of philosophical, psychological and religious reasons, there are many who would find the materialist and reductionistic principles at work in Hospital Incident Command unacceptable. Like so many other untruths, it is obvious that there are good reasons to believe that human beings are more than their bodies; that they require psychological, if not spiritual care; and that people are better off being cared for in a holistic fashion. There are also many beyond the church that will have their own reasons to believe that people should not deal with illness or confront death in total isolation from those who love and care for them. This was clear in any number of specific cases over the last year. Caregivers in every segment of healthcare who were authorized to be in our hospitals weighed in, going beyond the dictates of their professional obligations, to connect with and care for patients confined to our nation’s hospitals.
That said, it is worth remembering that the materialist assumptions behind the Hospital Incident Command made no systematic provision for that kind of care. On the other side of the pandemic, it is also worth bearing in mind that an increasing number of chaplains, like the people for whom they care, are without religious affiliation. Hospitals often insist that that chaplains avoid any kind of clearly confessional, credal or sacramental approach to their ministry; and spiritual care is still not covered by health insurance and chaplaincy programs are, for that reason, vulnerable to budget cuts.[iv]
More importantly, parochial clergy need to remember that people who are confronted with serious illnesses and those who face end of life decisions confront challenges associated with hospitalization with as much or as little as they have been given by their churches. Anyone who has ever cared for people in crisis or for those who love them know that the duress and time limitations that are associated with hospitalization allows little, if any time for reflection.[v] In such moments clergy and chaplains may find that they are able to do little more than affirm the seriousness of the situation in which people find themselves; abandon stained-glass language; avoid broken notions about God; resist lapsing into magical and superstitious assumptions about their faith; offer those who grieve friendship; and expose themselves to the suffering remind them that they are not alone. Only longer struggles allow space for conversation about the way in which people understand illness and death, the difference between cure and healing, or the redemptive purposes of God.[vi]
There is, then, no substitute for catechetical and spiritual formation long before people find themselves in crisis.[vii] For far too long, parochial clergy have neglected this task. Wave after wave of trends in theological education produced clergy who were ill-prepared to provide spiritual leadership for their congregations or basic faith formation, but they were not necessarily to blame. Seminaries tilted in favor of prophetic preaching in the sixties, acknowledging the collective, as well as individual nature of sin. The seventies and eighties brought an emphasis on the value of psychological categories and produced clergy who thought of themselves as counselors. The nineties and early twenty-first century briefly stressed leadership; and now – as elsewhere in the academy – seminaries are emphasizing social justice and community organizing.[viii]
Whatever the value of each emphasis, those trends have encouraged seminarians to think of their ministry in selective and less holistic terms. As a result, when people began looking for an approach to faith formation that drew vital connections between what they believed, the sacraments of the church, and the perennial challenges that they face, they struggled to find clergy who could help them. They looked, instead, to an ever-wider variety of spiritual authorities. They inevitably bought into the false distinctions that are made between the practice of religion and spirituality, and they joined the ranks of the “Spiritual but not Religious” in ever larger numbers.
Not surprisingly, there are now more SBNRs than there are mainline Protestants.[ix] If clergy hope to reverse that trend and prepare people to navigate life in a faithful fashion, they will need to do both basic catechetical work and provide their parishioners with the kind of spiritual direction that will encourage them to approach life in a consciously Christian fashion. The pressures of ministering to a small parish will not excuse them from this task, nor should the luxury of larger parishes with ample resources distract them from it.
But clergy will also need to begin seeing themselves as architects of a counter-cultural church. They cannot afford to see themselves as one of several institutional partners that operate from a shared vision of what it means to be human. Churches will need to challenge the logic of the materialism that dominates our culture. They will need to encourage the baptized to question that logic and, to the extent possible, they will need to press for changes.
If our nation’s response to Covid-19 has taught us anything, it should have taught us that the cure of souls is alien to contemporary notions of health and healing.
[i] For a more detailed description of this argument, see: Jeffrey P. Bishop, Philipp R. Rosemann and Frederick W. Schmidt, “Fides ancilla medicinae: On the Ersatz Liturgy of Death in Biopsychosociospiritual Medicine,” The Heythrop Journal 49(January, 2008): 20-43.
[ii] Rod Brouhard, “Hospital Incident Command System (HICS),” verywellhealth (January 7, 2020): https://www.inquirer.com/health/coronavirus/covid19-mutation-british-colorado-spread-easily-vaccine-20201230.html
[iii] Rod Dreher, Live Not By Lies, A Manual for Christian Dissidents (New York: Sentinel, 2020):174.
[iv] On some of these issues, see: Wendy Cadge, George Fitchett, Trace Haythorn, et al., “Training Healthcare Chaplains: Yesterday, Today and Tomorrow,” Journal of Pastoral Care & Counseling 73 (2019): 211-221.
[v] Such limitations are a function not just of illness or end of life challenges, but are also exacerbated by the strictures associated with health insurance.
[vi] For a longer treatment of my views on those issues, see: Frederick W. Schmidt, The Dave Test, A Raw Look at Real Faith in Hard Times (Nashville: Abingdon Press, 2013).
[vii] On that subject: Frederick W. Schmidt, “The Making of Zombie Theologians: Catechesis, Spiritual Direction, and the Future of the Church,” Patheos (October 6, 2015): https://www.patheos.com/blogs/whatgodwantsforyourlife/2015/10/the-making-of-zombie-theologians-catechesis-spiritual-direction-and-the-future-of-the-church/
[viii] On which, see: Frederick W. Schmidt, “Is It Time to Write the Eulogy? The Future of Seminary Education,” Patheos (March 21, 2011): https://www.patheos.com/resources/additional-resources/2011/03/is-it-time-to-write-the-eulogy-frederick-schmidt-03-21-2011
[ix] “’Nones’ on the Rise,” Pew Research Center: Religion & Public Life (October 9, 2012): https://www.pewforum.org/2012/10/09/nones-on-the-rise/