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Soins spirituels, aumônerie et soins de santé au Québec

Historically, hospitals in Quebec were built and administered by religious orders. The vast majority of the population were French and Roman Catholic, as were the religious orders that served them. This created a relative homogeneity in the religious practices observed in the province, which was mirrored by the type of spiritual care services provided in health care institutions. Spiritual care providers were known as “aumôniers”, a term often translated as “chaplains”. Although it is true that they fulfilled the same basic role as chaplains in other parts of the country, it has been my experience that the term “aumônier” carries a stronger sense of its Catholic heritage. In these early days chaplaincy services in hospitals were run as autonomous parishes. Priests holding a pastoral mandate from their bishop, while being paid by the Catholic Church, would serve as hospital chaplains. Their role was defined and overseen exclusively by religious authority.

Throughout the 1960s, a period known as the Quiet Revolution in Quebec, the provincial government began to take control of health services. In 1970 Bill 65 was passed ; previously confessional hospitals became government run. Although chaplains continued to be seen as representatives of their respective religious institutions and continued to hold a pastoral mandate from their religious authority, they became government employees who were also required to adapt to the diverse needs of the hospital clientele. By 1975, the government had signed an official document on chaplaincy (Protocole concernant les aumôniers des centres hospitaliers) with the Quebec Assembly of Catholic Bishops, the United Church of Canada, the Anglican Church and the Canadian Jewish Congress. This document stipulated that only priests, pastors and rabbis could be given work under the title of “aumônier” (chaplain).

By the 1980s most health care centres had no official confessional status, but religious authorities continued to have a role in defining hiring criteria for chaplains through the pastoral mandate (e.g. ordination, obedience to the church, moral code of conduct, etc.). An increasing number of women and lay people began to enter the profession and a new emphasis on pastoral care and spirituality emerged. By 1988 the official job title is changed from “aumonier” to “animateur pastoral” or “pastoral animator,” which seems to reflect the changing make-up of chaplaincy services as well and their role in serving increasingly diverse populations.

In 1991 the Act Respecting Health Services and Social Services was adopted (L.R.Q., c.S-4.2). Article 100 states that all health care institutions must ensure services are continually accessible and respectful of the rights of people and their spiritual needs. This law is seen as reinforcing the need for spiritual care services in order to ensure that hospitalised patients can continue to practise their faith. In 2001, the Quebec government published two important documents (Protocole d’entente entre le ministère de la santé et des services sociaux et les autorités religieuses : concernant les services de pastorale des établissements de santé et de services sociaux et Cadre de référence pour l’organisation de la pastorale en établissements de santé et de services sociaux) which lay out the scope of practice of pastoral animators in the province, highlighting the importance of meeting the spiritual and religious needs of patients and their families as well as liaising with various denominations in the community to do so. In 2003, Bill 30 was passed and paved the way for the unionisation of all pastoral animators in the province by 2005.

Unionisation brought many changes to the profession. It helped to streamline the spiritual care services in the province by creating standard salary scales, rules for on-call services, and educational requirements. It also ultimately led to the end of the requirement for a pastoral mandate. Finally, in 2010 the government of Quebec produced a new document (Orientations ministérielles pour l’organisation des services d’animation spirituelle en établissements de santé et de services sociaux) which provides an updated scope of practice for spiritual care providers given the new realities of unionisation and increasing religious diversity. It places an emphasis on meeting the spiritual and religious needs of patients and their families while respecting their individual values and modes of practice. In 2011, the official job title was changed once again, this time from pastoral animators to “intervenant en soins spirituels” or “spiritual care providers.” This has been described as a move to recognise both the increasing diversity among spiritual care providers and the populations they serve.

In 2019, the Quebec government began to undertake a review of spiritual care services, which includes consultations with clinicians and educational partners in order to update its definition of this profession as well as its scope of practice. Early reports suggest this review will focus on standardising the education required to become a spiritual care provider. Although the COVID-19 pandemic has delayed some of this work, a review is expected to be published in 2022-2023.

D 5 mai 2021    AErin LeBrun

CNRS Unistra Dres Gsrl

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