Capitalizing Hope in Healthcare: Exploring the Future of Hospital Chaplaincy Between Prayer and Profit

Chaplaincy has undergone significant evolution, transitioning from its Christian roots to encompass a wide spectrum of religious and spiritual traditions (Cadge, 2023; Cadge and Rambo, 2022). Within healthcare institutions, chaplains now play an essential role, addressing not only spiritual but also emotional and existential needs alongside medical and psychosocial teams (Alghanim et al. 2021). Despite this development in the scope of spiritual care support, in today’s healthcare landscape, driven increasingly by concerns of profitability and efficiency (American Hospital Association, 2023), chaplains are faced with the challenge of navigating their roles amidst conflicting interests and pressures.

This research examines the multifaceted role of chaplains within healthcare settings, with a particular focus on systemic power in the potential monetization of spiritual care practices. Through qualitative case studies conducted at one of the nation’s largest trauma hospitals, this study scrutinizes examples where chaplains unknowingly collude with institutional power. As an inpatient palliative care chaplain, I explore the delicate influence chaplains hold in fostering therapeutic relationships with patients and their loved ones, while also noting instances where the institution recognizes and exploits this ability for their own gain. This use of chaplains, which I term “capitalizing hope,” is a phenomenon well-known to healthcare professionals, most frequently occurring in family meetings for complex cases. Notably, as a multilingual chaplain, I can attest, and the data supports (Ali and Mark, 2023; Joseph et al. 2022; Lu et al. 2021), that this exploitation appears more frequently in cases involving non-English speaking patients and their loved ones.

With Clinical Pastoral Education (CPE) increasingly emphasizing outcomes-oriented chaplaincy and evidence-based practices (Cadge et al. 2020), there is a rising trend towards monetizing spiritual care interventions. This raises ethical concerns about chaplains being viewed as revenue-generating assets within hospitals, potentially impacting patient access and the integrity of chaplaincy practice. Questions arise: will chaplain services become billable? How would chaplains charge for prayer and other spiritual interventions? What would occur if a patient’s insurance does not cover chaplain services? These are vital and timely discussions among healthcare chaplains and departmental leadership amidst the ongoing professionalization of hospital chaplaincy.

By examining the tension between providing compassionate care and the realities of profit margins within hospitals, this research seeks to deepen understanding of chaplaincy practice and the ethical implications of billable spiritual care. Ultimately, I aim to equip chaplains with the knowledge and tools to navigate their roles effectively while advocating for patient-centered care and the holistic well-being of all patients and their loved ones. Through this inquiry, I seek to contribute to ongoing discussions on the future of chaplaincy training and practice, with the ultimate goal of fostering healing, justice, and dignity within healthcare settings.