DALLAS--The Rev. Patrick Moran prefers prayers with a personal touch. So for nearly 40 years, he prayed for the sick by name at every Mass. Then, a few months ago, he reluctantly stopped. Now, the Minnesota priest simply offers a general prayer "for all those who are sick."

His actions are the result of an emerging debate over medical privacy that some church and legal experts predict will change the way prayer is conducted in public worship and on prayer chains and prayer hotlines.

With prayer so central to faith, the avenues for it are seemingly endless. Books on prayer are best-sellers. Conferences led by prayer superstars are sell-outs. Internet chat rooms and prayer e-mail chains abound, full of names of people who are suffering from a variety of diseases.

But with computer technology making it possible to share data more easily than ever before, Americans' concern about protecting their privacy, especially medical records, has made it a pressing legal and social matter.

"It's a very sensitive pastoral issue," said Moran, 67, pastor of St. Elizabeth Catholic Church in Gary-New Duluth, a small, northeastern Minnesota community. Kathy Kunes fields sick calls at St. Elizabeth Ann Seton Catholic Parish in Plano, Texas, where she's a secretary.

"Many times people want the priest to know what's wrong, but they just don't want it being made public," she said. "Usually, that's when it's something like prostate cancer, breast cancer, a stillborn birth, or drug problems. It's very painful."

Some churches get permission from ill members before going public with prayer requests. Others say that's not necessary. After all, who wouldn't want prayer? "People voluntarily join churches," said the Rev. Larry Burton, president of the Association of Professional Chaplains in Schaumburg, Ill. "They expect the care of each other and to pray for one another.

"The trouble is," he said, "the culture has changed, and there are new ways to communicate. We have a heightened sense of privacy and a heightened opportunity to violate privacy."

Even getting consent may not solve the problem entirely. Sometimes in worship or in Sunday school, members are invited to spontaneously offer prayers. What happens if they disclose that a neighbor, a friend or someone outside the church suffers from depression, alcoholism, or drug addiction?

Or when information is put on an e-mail prayer chain without the subject's knowledge? After the shootings at Wedgwood Baptist Church in Fort Worth, Texas, last September, an e-mail circulated nationally requesting prayers and chronicling what happened at the church, only some of which was true, according to the Baptist Standard.

Can churches be expected to monitor every prayer?

Probably not, Burton said. Still, he insists that churches need to do more to protect people's privacy.

"It's about how to respect your brothers and sisters," he said. "I may not want you to know my business. I may not want you to know I have prostate cancer. But I still want prayer. Once you announce it from the pulpit or put it in a prayer e-mail or on a bulletin board, you can't control it."

Instead of suing, members who feel their privacy is compromised are more likely to leave their church, according to Twila Brase, president of the Citizens' Council on Health Care, a national health care policy organization based in St. Paul, Minn.

"They might sue if the ramifications of the disclosure were such that it affected their insurance or their employment or because they felt it created a stigma," she said.

Brase believes that medical privacy is more of an issue in urban congregations with thousands of members than in smaller family-type churches. "When it's just a small, close-knit circle, people are more willing to have information shared," she said. "But in a big congregation, there may be reasons why they don't want certain people to know their medical conditions. Maybe their employer is in the church. Or estranged family members. Or an insurance agent. Think about someone battling depression or alcoholism."

A few months ago, Norma Power of Dallas was told that she had breast cancer. She called her pastor at NorthPark Presbyterian Church who, with Power's permission, announced her situation in worship and added her name to a prayer chain.

Power, 71, who doesn't have family in the city, appreciated the support. "I would get cards from people at church," she said. "When somebody saw me, they would give me a hug. As a result, I didn't feel so isolated."

But mostly, she was comforted by the prayers. "I believe that prayer works. And I have all these people who are praying for me."

The Rev. Sally Brown, an associate pastor at NorthPark, said the church is careful about how much information it discloses to the congregation when a member is ill.

"We don't want to embarrass people or upset folks," she said. "We have to realize that illness is a very personal thing, and there are times even when you have someone dying, that they won't even let their friends come and see them. That's a thing we have to honor."

In a few weeks, the first-ever national standards to protect medical records is expected to be finalized by the U.S. Department of Health and Human Services. The standards, designed to safeguard patients' privacy, will apply to medical records created by health care providers, health plans, and health clearinghouses.

The standards don't directly apply to churches. But because many hospitals have begun limiting the information they disclose about patients, even to clergy, churches are beginning to consider whether they, too, ought to put more stringent rules into place.

"A pastor has to balance the lines of confidentially against what a patient may or may not have consented to make public," said Patrick Souter, who teaches health law at Baylor University in Waco, Texas. "You have a blurred gray area as to whether there is liability or not."

The evolution in thinking about medical privacy happened slowly, Souter said, but snowballed as family doctors gave way to managed care. "With managed care, you have a lot of eyes looking at medical records. People are a lot more concerned about confidentiality."

The proposed federal standards would enhance protections provided by state laws. In circumstances where the federal rules and state laws are in conflict, the stronger privacy protection would prevail.

"It raises all kind of difficulties for how a church community can offer solace without getting in a legal situation where a person doesn't want it known that he's sick," Moran said.

A few years ago, Moran could walk into any hospital in the Catholic diocese of Duluth and ask for a list of Catholic patients. He could study their medical charts and find information about their diagnoses. After his visits, he would enter his own notes describing the sacramental care provided.

"Learning everything you could about a patient before seeing them could help a priest anticipate their spiritual issues," Moran said. "But the hospital's desire to protect the patient's privacy is a good thing, too."

Today, at many hospitals around the country, the only clergy allowed access to patients' data often are hospital chaplains. Moran no longer writes in charts but relays information to a nurse for documentation. In fact, patients must grant permission before he's even notified that they've been hospitalized. "We're trying to respect the privacy issue, yet be attentive to the spiritual care needs," said the Rev. Joseph J. Driscoll, executive director of the National Association of Catholic Chaplains in Milwaukee, Wis. "At the time of admission to the hospital, we ask the question, 'Do you want your pastor notified?' By doing that, we're getting patient consent. But you still have the frustration of clergy who want to visit their sick but don't know who's there." The Rev. Bob Shortall said that most of the ill people he ministers to want prayer, but not everybody wants to be identified. In those cases, he says a public prayer for "special intentions."

"When people are sick, they want their faith community to pray to God with them for recovery or health," said Shortall, a priest at St. Elizabeth Ann Seton Catholic Parish in Plano. He also ministers to people with AIDS in Dallas. The Rev. Billy Abbe believes handling medical privacy issues are a matter of common sense.

"The Lord knows our needs," said Abbe, pastoral care and senior adult pastor at the Christian Life Assembly of God in Carrollton, Texas. "If he knows why a person is sick, there's no reason for me to blab it to the congregation." But naming the sick in worship or in church bulletins is so common that pastors often get criticized if they fail to mention someone, said United Methodist Bishop William B. Oden of the North Texas Conference.

"Once it's started, it's difficult to stop," he said. "Because the prayer for the ill sometimes becomes a community bulletin board for the church. And, of course, just listing names of the sick in a bulletin whets the appetite for wanting more information, but usually out of concern and not because people are nosy."

That's why Moran opted to stop identifying everyone altogether, even though some people wanted to be named.

"It can create hurt feelings to name some and not name others," he said. "Some take offense that the name is mentioned. Others take offense that the name isn't mentioned. I don't want to create divisions. You have to make a pastoral decision."

Thyra Rukovina was among the first to confront Father Moran about the change. Rukovina, 82, said as long as she can remember, the sick had been listed in the church's bulletin.

"It seems strange that everybody worries about being sued," she said. "But I think we understand why things had to change. People are lighting a lot more candles in church to say their private prayers. That's what's important. People know that they aren't forgotten."

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