• Can a county hospital hire a full-time chaplain who is paid with tax revenues? Yes, concluded a federal appeals court in a significant decision. A county hospital in Iowa hired a full-time chaplain in 1984 after a volunteer chaplaincy program proved inadequate to meet patients’ needs. Fifty percent of the hospital’s inpatient population were in a psychiatric ward, and many of these patients had been committed involuntarily and were not free to leave at will. The hospital also confined prisoners who were referred to it for treatment or evaluation. The chaplain’s duties included calling on patients prior to surgery, being available for counseling in intensive care and surgery waiting rooms, visiting patients who requested a visit, and conducting worship services and a Bible study class for patients who chose to attend. The court concluded that the act of hiring the chaplain did not violate the first amendment’s “nonestablishment of religion” clause, since it served a valid secular purpose, did not have a primary effect of advancing religion, and did not unduly entangle church and state. The court emphasized that the hospital practiced a “wholistic” approach to medicine, which recognizes that a patient’s overall health and recovery is based on spiritual as well as physical and emotional conditions, and accordingly that spiritual needs must be addressed in the lives of patients who express an interest. Such an approach, concluded the court, constituted a permissible “secular purpose” and precluded a finding that the primary effect of the chaplaincy program was the advancement of religion. The court emphasized that the chaplain “avoided proselytizing” and engaged in no “direct advancement” of religion by “inculcating any religious belief or practice.” The court further held that “the chaplaincy is a permissible accommodation of at least some patients’ free exercise [of religion] rights. There was evidence that a large percentage of patients were prisoners or had been involuntarily committed … in the psychiatric ward. Such restrictions constitute a state-imposed burden on the patients’ religious practices that the state may appropriately adjust for.” The court permitted the chaplain to counsel with outpatients and with the families of patients, but prohibited the chaplain from engaging in religious counseling with hospital employees (secular counseling with employees was permitted). Finally, the court ruled that (1) the chaplain could not review the medical records of any patient without that person’s consent, (2) the chaplain could wear a name tag and park in a reserved lot, (3) the hospital could use an admissions form that permitted patients to list their religious preference, and (4) the practice of conducting optional religious services was permissible. Carter v. Broadlawns Medical Center, 857 F.2d 448 (8th Cir. 1988).
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