Engelhardt’s critiques of “generic chaplaincy” rely on the argument that chaplains are secular; however, professionally certified chaplains must maintain ordination with an ecclesial body. Engelhardt’s concerns are better directed at the academic subfield that supports and trains chaplains: pastoral theology. That field is somewhat guilty of forced ecumenism because it attempts a universal theology rooted in experience and the social sciences rather than the authority of creeds, ecclesial bodies, or traditions. Pastoral theology makes too many sacrifices to the authority of (...) the behavioral sciences without sufficient appreciation for sacramental theology and the spiritual bonds that rituals effect in communities of shared belief. In this model, ritual is reduced to its instrumental value in addressing the emotional needs of patients rather than viewed as efficacious spiritual care. Chaplains should take a holistic approach to theology so that they can better identify the duties and scope of interfaith spiritual care. (shrink)

Appeals to the miraculous are common in healthcare, and arguments about end-of-life decision-making can quickly become theological. Assessments of hope have been recommended within the biopsychosocialspiritual model of medicine, but these assessments fail to account for the theological dimension of hope. Examples of failed assessments include recent efforts in palliative care and classic works, such as On Death and Dying by Elisabeth Kübler-Ross. To adequately address the patient’s and family members’ hopes without patronizing or harming the patient, assessments must be (...) done by a person trained in theology. (shrink)

In the process of professionalization, the American Society for Bioethics and Humanities (ASBH) has emphasized process and knowledge as core competencies for clinical ethics consultants; however, the credentialing program launched in 2018 fails to address both pillars. The inadequacy of this program recalls earlier critiques of the professionalization effort made by Giles R. Scofield and H. Tristram Engelhardt, Jr.. Both argue that ethics consultation is not a profession and the effort to professionalize is motivated by self-interest. One argument they offer (...) against professionalization is that ethics consultants lack normative expertise. Although the question of expertise cannot be resolved completely, the accusation of self-interest can be addressed. Underlying these critiques is a concern for hubris, which can be addressed in certification and the vetting of candidates. Drawing on the virtue ethics literature of Alasdair MacIntyre and Edmund D. Pellegrino, I argue that medicine is a moral community in which ethics consultants are moral agents with a duty to foster the virtue of humility (or what Pellegrino and Thomasma call self-effacement). The implications of this argument include a requirement for self-reflection in one’s role as a moral agent and reflection on one’s progress toward developing or deepening virtuous engagement with the moral community of medicine. I recommend that professionalization of clinical ethics consultants include a self-reflective narrative component in the initial certification and ongoing renewal of certification where clinical ethics consultants address the emotional dimensions of their work as well as their own moral development. Adopting a teleological view of ethics consultation and incorporating narratives that work toward that purpose will mitigate the self-interest and hubris of the professionalization project. (shrink)

Hastings Center Report, Volume 52, Issue 1, Page 12-14, January/February 2022.