Religions and health

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 May 2021    AErin LeBrun

History of health and religion in Canada

Long before European settlers arrived in Canada with Euro-oriented health services and practices, Indigenous healers and midwives were serving their communities using healing practices, ceremonies, and traditions passed down since time-immemorial based on holistic views of healing and wellness (Wytenbroek & Vandenberg, 2017). Healing and wellness from Indigenous perspectives recognize the interconnectedness of mind, body, spirit, emotion, land and all living things – seeking balance (Calestani, White, Hendricks, & Scemons, 2012; First Nations Health Authority, n.d.). Canada’s colonial history of oppression and dispossession of Indigenous land, community, culture, and language was made possible through both government and religious agendas, resulting in intergenerational trauma and what is now recognized as a cultural genocide (Truth and Reconciliation Commission (TRC), 2015).

In this colonial context, Canadian healthcare services were provided by religious orders and organizations, with hospitals established by religious institutions, mainly Christian. In the post-war period, as national medicare was implemented, hospitals largely transitioned to public funding and government administration. This religious legacy continues to some degree with religious organizations such as the Catholic Health Association providing healthcare services in some jurisdictions.

Reflecting the secularizing trend of the last four to five decades, what was referred to as pastoral or religious care is now spiritual care, offered by those trained in a more standardized and generic approach to spirituality. Spiritual health practitioners (chaplains) have adapted to provide a broad, non-specific form of spiritual care in order to diversify from the original connections to any one religion. Spiritual health practitioners offer an aspect of holistic care that is often neglected within the biomedical model (Lasair, 2016).

Connections between spirituality, health & illness

Immigration has increased Canada’s diversity of religious beliefs. For those who hold religious beliefs, life events and experiences such as birth, sexuality, and death are often inextricably linked with religious perspectives (Bramadat & Seljak, 2009). Spirituality, health, and illness are interrelated to impact health outcomes via three mechanisms: religious/spiritual beliefs; behaviours or practices; and belonging (Taylor, 2020; Litalien, Atari & Obasi, 2021). Healthcare professionals are encouraged to provide person-centred care alongside an equity-orientation approach, which embraces the diverse religious and spiritual beliefs patients may hold and prevents discrimination or racialization (Reimer-Kirkham, 2021).

Current conversations related to health & religion

Current conversations about health and religion in Canada are varied and reflect the issues in broader society, including decolonization and responses to the TRC; Medical Assistance in Dying (MAiD); and COVID-19 responses.

Decolonization. Many of Canada’s oppressive colonizing policies were operationalized by religious institutions, including Catholic and Protestant churches that administered Indian Residential Schools and Indian hospitals (TRC, 2015). Indigenous health and wellness practices such as healing ceremonies were made illegal (TRC, 2015). These policies—as two examples amongst many more—resulted in intergenerational trauma, deep social suffering, and marked social and health inequities for Indigenous peoples. Following the release of the TRC’s report in 2015, and Canada’s formal endorsement of the United Nations Declaration on the Rights of Indigenous Peoples the following year (Government of Canada, 2021), efforts to support cultural resurgence, reconciliation, and healing have gained some ground with guidance from the TRC’s Calls to Action (TRC, 2015). A national reckoning is currently underway across Canada to acknowledge the atrocities of the past, of which religious organizations played a large part. The 2021 uncovering of thousands of unmarked graves of Indigenous children who died at church-run Indian Residential Schools has brought this conversation into every household. Likewise, reports such as those of Turpel-Lafond (2020) in British Columbia and Coroner Kamel’s (Bureau de la coroner Quebec, 2021) in Quebec regarding the death of 37-year-old Atikamekw woman Joyce Echaquan have made undeniable the very present, systemic anti-Indigenous racism within Canadian society that is also pervasive throughout the healthcare system (Turpel-Lafond, 2020).

MAiD. A nation-wide conversation preceded and followed Canada’s 2016 legalization of MAiD (Bill C-14). When this issue was debated before the courts in the 1990s, views of death and suffering remained deeply connected to Christian conceptualizations, reflecting Canada’s traditional Christian history where models of healthcare originated at colonization and throughout much of recent history (Beaman & Steele, 2017). The increasing cultural and religious diversity of Canadian society, where an increasing number of Canadians identify as nonreligious (16.53% in 2001 to 23.89% in 2011; Statistics Canada, 2011), has shifted the conversation from an “understanding of death and dying from a religiously based model to one which is nonreligious” (Beaman & Steele, 2017, p.130). Bill C-14 affirmed an individual’s autonomy and right to choose for themselves the time and place of their death, with legal parameters, marking a move away from legislated religious understandings of death and dying in terms of religious conceptualizations such as ‘God’s will.’

COVID-19. The COVID-19 pandemic has seen Canadian faith groups respond in different ways, some supporting public health measures and offering additional community support (e.g., hosting vaccination clinics), and others rallying around religious freedom and the right to gather outside the parameters of public health orders. This variance is similar to observations from other countries (see Lee, Lim, Xavier, & Lee, 2021). While religion is not specifically named by the Public Health Agency of Canada (2016) as a social determinant of health, it can be closely associated with the determinants of social support and personal coping skills (Lee et al., 2021). Viewing religion as a social determinant of health and as beneficial to health shows how religion may lessen the detrimental impact of the COVID-19 pandemic and thereby minimize disparities amongst minority faith groups (Barmania & Reiss, 2021).

See references in pdf.

D 11 October 2021    AAmy Hildebrand AEmma Strobell ASheryl Reimer-Kirkham

The theme of Covid-19 was chosen for the scientific discussion at the Eurel 2022 Correspondents’ Meeting. Here is the report for Canada.

D 6 October 2022    ASolange Lefebvre