Muslim doctors in Catholic hospitals: a challenge for the Christian profile?

3.1 With regard to the first profile level: based on the Christian foundation of faith

According to the physicians interviewed for the study, the different conceptions of God Christians and Muslims have do not present a challenge in day-to-day hospital life. It is striking that none of the Catholic physicians describe their Christian understanding of God in all its complexity: compared to Muslims, Catholics explicitly fail to say anything about the Trinity of God. When all statements by Catholics are taken into consideration, the understanding of God as Father, Son and Holy Spirit does however become apparent. Muslim doctors on the other hand speak explicitly about the Trinity and explain that Jesus is unthinkable for them as the Son of God because of God's omnipresence and immortality. The Christian image of man is unknown to most Muslim as well as Catholic physicians, only a minority can comment on it at all. The Muslim interviewees do, however, know how to talk about their own religious image of man. Both Catholic and Muslim physicians say that they have common values on the basis of similar views of God and man, which are substantiated by common norms and ethical standards. The interviewees say that they have a common mission of practiced charity, even if it is based on different contexts: Bible and Quran.

3.2 With regard to the second profile level: living within the Catholic Church

None of the doctors interviewed had searched specifically for a Catholic hospital as an employer: they found them because of the proximity to the applicant's home or to their family. During their job interviews, Catholics were hardly ever asked about their faith, some of the male Muslims were questioned on the topic while female Muslims were always asked about issues of their faith. It seems that for Catholics simple church membership is enough of a precondition for their employment, whereas the personal identification with faith and church does not play a role. Female Muslim physicians were always asked about the headscarf, no matter whether they wore it or not. If Muslim women wanted to wear headscarves in a Catholic hospital, this had to be approved within the organisation first. Muslim interviewees are aware that they are not allowed to promote their own faith in Catholic hospitals. The hospitals included in the study showed a high degree of openness towards the employment of Muslims: the physicians who were interviewed did not see any issues as to the employment of Muslims in Catholic hospitals, as long as Christian faith was practiced within the institution, and also was represented recognisably and appropriately to the outside world. At the time of the interviews, the church employment law had not yet been revised. One Catholic perceived the older version as restrictive – other persons did not even bring up the topic during the conversation. It became obvious that the Muslim staff who were interviewed were not informed about their limited career opportunities in Catholic hospitals. Catholic physicians also have varying views in this regard.

3.3 With regard to the third profile level: credible and perceptibly Christian culture

Many of the interviewees do not know the mission statement of their Catholic hospital. Those who know it cannot find anything positive in it, because in reality they experience economic pressure, performance pressure, lack of information, lack of appreciation as well as shortage of personnel, time and workspace, all of which lead to stress, work overload, excessive demands and diminished quality of care for employees. Muslims as well as Catholics worry that church hospitals are becoming increasingly similar to non-faith institutions. Therefore, as a result of the dwindling presence of Brothers and Sisters belonging to the Christian order in ecclesiastical hospitals, some doctors have recognised that the implementation of a Christian culture is now a secular task. A head physician expresses the hope that this task might be taken on by the nursing staff, rather less so by physicians.

In everyday life doctors do not have time to talk about religion and faith. Doctors primarily recognise Christianity in tangible things like crosses, pastors or the celebration of Holy Mass. Muslim interviewees do not associate their work as medics with their own faith; their focus is on professionalism. Some of the interviewed Catholics and Muslims see the beginnings of interreligious understanding in helping people. Respondents also reported that Muslim women who wear headscarves experience positive as well as negative reactions from patients. They also have to do more to prove themselves in everyday medical life than doctors without headscarves. Therefore, Muslim women with headscarves say that they need a good deal of self-confidence so that they do not find themselves cornered by comments or forced into a defensive position. Overall, the headscarf was not a problem in the hospitals included in this study. There were no women wearing burqa.

Catholics are unsure whether or how Muslims practice their faith at work. One Catholic interviewee saw it as a potential problem if a Muslim physician decided to participate in Friday prayers without finishing all his work first. None of the interviewed Muslims consider praying in public an option which is why a majority of Muslim physicians pray in the doctor’s room – also because Muslim prayer rooms are not always available. Even if they are, doctors are often not aware of them. It is a great challenge for Muslim doctors in hospitals to practice the Ramadan because fasting has negative effects on work performance. A Catholic doctor in charge of the rota reacts with understanding and allows a Muslim colleague to work half days at the weekend.

The interviewed physicians state that their focus is on satisfying patients' needs, including those who are poor and not insured. For Catholic doctors a holistic approach to medicine is important in which social, religious and pastoral aspects also play a role. Physicians report of vacant pastoral positions as well as extensive pastoral tasks, therefore it is often difficult for them to find a person to speak to. This is seen as a significant shortcoming with regard to the Christian profile of the hospital. They also talk about the lack of specific pastoral care for Muslims, meaning that this role is occasionally taken over by Christian pastoral staff, doctors or family members. A Catholic palliative physician is of the opinion that all occupational groups in the hospital are also pastoral workers. A Muslim physician, however, feels that this task is beyond him.

4.1 With regard to the first profile level: based on the Christian foundation of faith

The answers given by Catholic physicians about their understanding of God give rise to the following questions: is the Christian view of God too complex to be discussed easily? Or do issues arise from the fact that, as the Würzburg study realised, one in ten Caritas employees rejects the idea of a personal as well as non-personal image of God (Ebertz & Segler 2016)? Are Christians not able to talk about God because the necessary knowledge and vocabulary have been lost? Or are there other reasons? The habilitated theologian Joachim Wiemeyer demands that “even non-Catholic employees [...] have to know (cognitively) something about the Catholic faith in order to be able to deal with Catholic clients accordingly” (Wiemeyer 2016: 85–86, own translation of the German quotation). With regard to the result that Muslims already know many aspects of the Christian image of God, one has to ask what else they need. When physicians were asked about the Christian concept of man in this study, Muslims and Catholics were equally speechless. The reasons given were a lack of debate about the topic as well as lost religious context. Is it not also possible to assume that many people’s relationship with the faith of the church has become a selective one, because they no longer perceive and accept certain parts of the truth of faith as plausible (Ebertz & Segler 2016)? For the medical director of the Association of Catholic Clinics, Theodor Königshausen, this points to a fundamental issue:

the question arises [...] whether the inalienable positions of the Christian view of man in a Catholic/Christian hospital, on which base the institutions justify their right to exist, can still be guaranteed in a plural society (Königshausen 2016: 15, own translation of the German quotation).

A possible solution might be to create spaces in Catholic hospitals where the Christian understanding of man, God and values could be discussed with others. The results of this study show that the number of common values is extensive, therefore Christians and Muslims form a community of values. The Central Committee of German Catholics underlines this in 2012:

The similarities in the image of man, in the understanding of God and in ethics clearly show that Christians and Muslims also have a common mission in and for society, for the well-being of all people, individuals as well as the whole community (Zentralkomitee der deutschen Katholiken 2012: 13, own translation of the German quotation).

4.2 With regard to the second profile level: living within the Catholic Church

A Muslim doctor reports that it is not easy for Muslims to pursue a career in Catholic hospitals. Catholic physicians confirm this point of view: Muslims can only become senior physicians but not head physicians in German Christian hospitals. Neither Catholic nor Muslim physicians are certain whether this is actually the case. This prompts the question whether Muslims are familiar with church employment law and their career opportunities (Ari 2010). Do employers talk about these issues openly and transparently? A study by the Technical Universities in Berlin and Dortmund, in which more than 100 Christian hospitals participated, demonstrates that 72 percent of hospitals filled leadership positions with staff who identify with Christian values (Osterloh 2016). A study by the Caritas Association in Münster comes to the conclusion that “formal characteristics, such as church membership of employees, are of minor importance for the Christian profile of the hospital” (Caritasverband für die Diözese Münster e.V. 2015: 6, own translation of the German quotation). The so-called Brussels Circle, an association of 13 non-profit social and health economic institutions from Caritas and Diakonie, is convinced that church membership becomes a condition that can hardly be fulfilled with regard to the manifold secularisation tendencies in our society (Haas & Starnitzke 2015). Although they see church affiliation as a fundamental cornerstone that cannot be given up, they also associate challenges for the acquisition of employees with it. In times of pluralisation and secularisation, they plead in five theses for the abolition of the formal criterion of church membership as a basic condition for employment, and advocate instead a “pluralistic religious openness” and a “togetherness in diversity” with simultaneous “religious pluralism of conviction” (Haas & Starnitzke 2015: 52–53. 56, own translations of the German quotations). Christian identity is thus not primarily maintained by the person, but by the organisation. Their vision:

The company formulates this understanding of itself towards all employees and expresses the clear expectation that they should reflect the company’s ethos in their actions. In doing so, it explicitly accepts not only the various personal views of the people supported by the company, but also those of its own employees. Conversely, despite all the plurality of personal convictions, employees explicitly and bindingly acknowledge the confessional bond of the company and thus the appropriate conduct expected of them (Brüsseler Kreis 2015: 23, own translation of the German quotation).

Could this be a viable approach for church hospitals? The German bishops are convinced of the added value that Muslims and other believers can bring to Catholic institutions: “In justified individual cases, charitable institutions therefore employ non-Christian employees with their own migration backgrounds and find that this enriches their work” (Die Deutschen Bischöfe 2014: 27, own translation of the German quotation).

4.3 With regard to the third profile level: credible and perceptibly Christian culture

Respondents of these and other studies experience that framework conditions at work are not conducive to the implementation of a Christian ethos by physicians. They see this as a contradiction to the mission statement. Theologian Hans Hobelsberger (2016) is convinced that the mission statement loses its affirmative and orientating function, is ultimately regarded as an ideological value, and can even have a counterproductive effect. The excessive focus on economic profitability also leads to the fact that the Christian view of man is in danger of getting lost because under these circumstances, pauses, attention, listening, appreciation, etc. can no longer be guaranteed. Further studies confirm this and see this development increasingly as a consequence of the introduction of DRGs (Deutscher Ethikrat 2016). In the Würzburg study, employees are convinced that a spiritual profile can only succeed if the organised Caritas does not ignore the work on the quality of interaction between the helpers and their addressees, which is what Caritas should be based on after all (Ebertz & Segler 2016). Suitable framework conditions also play an important role in enabling an exchange about faith and religion at work. However, the Muslims questioned report that they understand religion as a private matter and that their own faith does not play a central role in helping others. This is not surprising since they were told in their first interview with the employer that their Muslim faith must not be lived publicly at the hospital. Nevertheless, Muslim as well as Catholic interviewees experience that they share the same basic attitude and practice charity. This shows that, in terms of their day-to-day actions, they focus on common goals. This can be affirmed with Dorothee Steiof, who is convinced that “people can act in the spirit of the gospel, even if their motivation for this service comes from another faith orientation or world view” (Steiof 2016: 160, own translation of the German quotation). For Ottmar Fuchs such action is an action “with the Church in favour of a certain common goal, which the Church understands from its identity as a concrete expression of the Kingdom of God” (Fuchs 2009: 268, own translation of the German quotation). For Fuchs, this is not an appropriation but an ability to form alliances for the Kingdom of God and for human beings. How can this common idea of aid be made successful in terms of serving others – especially regarding spiritual care: a Muslim physician reports that there is no provision of pastoral care for Muslims. One idea is that Muslim physicians can do this job, but one Muslim physician indicates that this task is beyond his capabilities. A study of Turkish physicians shows that “the majority of medical staff (84.4 %) [...] rarely or never ask about spiritual/religious concerns of patients or their families” (Kuseyri 2018: 37, own translation of the German quotation). The chairman of the Catholic Hospital Association of Germany, Theo Paul, says that doctors do not need to be able to practice pastoral care, but they have to be sensitive to it (Paul 2017). According to results of a study by Volker Meißner (2014), there are just isolated model projects of Muslim pastoral care: the treaties between the states of Hamburg and Bremen and Muslim organisations from the year 2013 created a basis on which religious facilities in hospitals of both states could be developed. This could send a signal to other federal states to follow suit. Carla Amina Baghajati, the women's representative of the Islamic Religious Community in Austria, provides a rather more sobering assessment:

We are still only able to speak about the issue in the subjunctive because in reality we are still a long way away from any kind of institutionalised Muslim pastoral care in hospitals in the German-speaking area, even if the need for it is undisputed (Baghajati 2014: 239, own translation of the German quotation).

It therefore seems that the question of how pastoral care for Muslim patients and staff can be ensured remains unanswered. There is also another important question: how can the use of headscarves be handled across all Catholic hospitals, since attitudes can vary from one hospital to another? In some hospitals female Muslim doctors are allowed to wear headscarves (Meißner 2014), but in other hospitals the wearing of headscarves is forbidden. In an interview with the French daily “La Croix” on 16 May 2016, Pope Francis spoke out against such a ban and for the freedom to express one’s faith: “If a Muslim woman wants to wear a headscarf she must be able to do so, just like a Catholic who wants to wear a cross” (quoted from the Katholische Nachrichten Agentur 2016, own translation of the German quotation). Does this also apply to Catholic hospitals?