Background and aimsFew Polish hospitals have Hospital Ethics Committee (HECs) and the services are not always adequate. In this situation, the role of HECs, in providing, among others, ethical advice on the discontinuation of persistent therapies, may be taken over by other entities. The aim of our research was to investigate, how often and on what issues hospital chaplains are asked for ethical advice in reaching difficult medical decisions.MethodsA survey of 100 Roman Catholic chaplains was conducted, that is, (...) at least 10% of all chaplains currently working in Polish hospitals.ResultsOf the participants, 29% confirmed receiving requests for advice in making a morally difficult medical decision. Receiving this type of request was not conditional on the place of their service, duration of their pastoral mission or HEC membership. The largest group of chaplains (21%) encounter questions concerning the ethical dilemmas associated with discontinuing persistent therapy. Patients and their families most often raise issues related to the methods of birth control, and the medical staff raise the issue of termination of pregnancy—as reported by 9% and 15% of chaplains, respectively. Most of the chaplains asked for help (79%) experience a deficit of specialist knowledge in the area of medicine or ethics.ConclusionsIn order to improve the quality of ethical consultations in Polish hospitals, in addition to further development of HECs, it is postulated to develop a system for bioethical education of chaplains. (shrink)

Polish hospital chaplaincy, because of the unique political and sociological context in which it finds itself, presents a sort of triple beholdenness. It carries particular loyalties to the state, to Catholic doctrine, and above all, it is called to be faithful to the unique suffering person. In this article, I argue that the biggest challenge for Polish chaplaincy resides within the domain of loyalty to the patient, where the profound and immediate need for robust formation of individual Christian conscience (...) through catechesis is needed. Although hospital chaplaincy’s involvement in catechesis and instructing the faithful might not be clearly evident for the reader, nevertheless I prove my point by bringing a story from my practice as a chaplain in one of Poland’s hospitals. (shrink)

This article explores the often-disparate commitments the chaplain has made to both the institutional church as well as the hospital system through the lens of the baptismal rite. As baptism is primarily a religious act meant to initiate new members into the Christian faith and a specific community, the chaplain must grapple with the meaning of baptism in the hospital system, a place of crisis and transient community. It is the numinous presence that binds the chaplain’s disparate commitments (...) together in the liminal space between the clinical and ecclesial within which the chaplain exists. The numinous expands the boundaries of institutions often at odds. The chaplain finds meaning and purpose by bearing witness and remaining committed to this numinous presence that binds. (shrink)

The author, an ordained Lutheran pastor, reflects upon his experiences as chaplain at a small hospital in southwestern Germany (Tropenklinik – Paul Lecher Krankenhaus, Tübingen). Besides its expertise in the treatment of tropical diseases this 100 + bed hospital serves as the referral hospital for terminally ill and dying patients from the local University hospitals and the surrounding area. The experiences at the bedside of such patients with various denominational and religious backgrounds challenged the chaplain to go (...) beyond the confines of any fixed theological system or counseling technique. They made him to discover three essentials as the very basis of such ministry, which he shares in this article. He identifies these as (1) the necessity to realize the situation sober mindedly, (2) the desire to become a companion, and (3) the venture of confident faith, where holding on to any genuine perspective of life is deemed ridiculous. (shrink)

Chaplains often describe their work in health care as “translation” between the world of the patient and the world of hospital medicine. Translators usually work with texts, interpreters with words. However, when chaplains use this metaphor, it describes something other than a discrete task associated with the meaning of words. While medical professionals focus on patients' medical conditions, chaplains seek to read the whole person, asking questions about what people's lives are like outside of the hospital, what they (...) care about most, and where they find joy and support in the world. Chaplains offer a supportive presence that serves to remind patients and caregivers that people are more than just their medical conditions or their current collection of concerns. Some chaplains are skilled at translating patients' experiences and sources of meaning in real time, allowing medical teams to better understand the person they are treating. “Translation” is also defined as metamorphosis. Chaplains provide this sort of translation when they are alone with patients, listening to their deepest concerns, helping them redefine their lives. (shrink)

Volume 25, Issue 2, February 2025, Page 31-33.

“Agent Regret in Healthcare” is a valuable contribution to the field of bioethics, and an insightful application of the concept of agent regret. In this response, I will argue that the authors’ wor...

The notion of hospital chaplaincy raises significant concerns, because it provides for the possibility that the chaplain becomes a generic chaplain rather than a member of a particular faith. Despite these reservations, however, I think that Mennonites should serve as hospital chaplains. Instead of seeing themselves as chaplains to all, though, Mennonites ought to see the service they provide as analogous to relief and development work. This would make Mennonite chaplaincy a form of what Mennonite scholar C. Norman (...) Krause calls “agapeic intervention,” which would allow for the ministry to the sick without requiring genericism. (shrink)

The traditional roles of Christian chaplains in aiding patients, physicians, nurses, and hospital administrators in repentance, right belief, right worship, and right conduct are challenged by the contemporary professionalization of chaplaincy guided by post-Christian norms located in a public space structured by three defining postulates: the non-divinity of Christ, robust ecumenism, and the irrelevance of God’s existence. The norms of this emerging post-Christian profession of chaplaincy make interventions with patients, physicians, nurses, and hospital administrators in defense of specifically (...) Christian bioethical norms and goals unprofessional, because the chaplain is now directed as a professional to support health care services held to standards articulated within a secular morality. These changes are exemplar of the profound recasting of the dominant moral culture with wide-ranging implications for bioethics. (shrink)

Context: Although ethics consultation is commonplace in United States (U.S.) hospitals, descriptive data about this health service are lacking. Objective: To describe the prevalence, practitioners, and processes of ethics consultation in U.S. hospitals. Design: A 56-item phone or questionnaire survey of the "best informant" within each hospital. Participants: Random sample of 600 U.S. general hospitals, stratified by bed size. Results: The response rate was 87.4%. Ethics consultation services (ECSs) were found in 81% of all general hospitals in the U.S., (...) and in 100% of hospitals with more than 400 beds. The median number of consults performed by ECSs in the year prior to survey was 3. Most individuals performing ethics consultation were physicians (34%), nurses (31%), social workers (11%), or chaplains (10%). Only 41% had formal supervised training in ethics consultation. Consultation practices varied widely both within and between ECSs. For example, 65% of ECSs always made recommendations, whereas 6% never did. These findings highlight a need to clarify standards for ethics consultation practices. (shrink)

Context: Although ethics consultation is commonplace in United States hospitals, descriptive data about this health service are lacking. Objective: To describe the prevalence, practitioners, and processes of ethics consultation in U.S. hospitals. Design: A 56-item phone or questionnaire survey of the “best informant” within each hospital. Participants: Random sample of 600 U.S. general hospitals, stratified by bed size. Results: The response rate was 87.4%. Ethics consultation services were found in 81% of all general hospitals in the U.S., and in (...) 100% of hospitals with more than 400 beds. The median number of consults performed by ECSs in the year prior to survey was 3. Most individuals performing ethics consultation were physicians, nurses, social workers, or chaplains. Only 41% had formal supervised training in ethics consultation. Consultation practices varied widely both within and between ECSs. For example, 65% of ECSs always made recommendations, whereas 6% never did. These findings highlight a need to clarify standards for ethics consultation practices. (shrink)

The intimate connection, within Christianity, of theology and ethics is invoked, and the ethical differences between Christian denominations are exposed, as they present themselves inMellon's case studies, in order to call attention to the unsolvable dilemma in which hospital chaplains find themselves, if they understand their role in a merely conciliatory fashion as that of a “comforter, mediator, educator, ethicist, and counselor”. As witnessed by the Calvinist and Anabaptist traditions Mellon introduces, concepts such as “the patient's good” can mean (...) radically different things in these theological contexts. Attempting to merely mediate between such positions in a spirit of merely generic prayer and on the basis of a merely psychological notion of well-being poses a risk to chaplains' spiritual integrity and faithfulness to their mission. (shrink)

In the last two decades, studies on the relationship between spirituality and health have grown significantly in the International literature. In Brazil, the debate on this subject has reached greater visibility since 2009, mainly in the health sciences, with the appearance of the term "spiritual care". In theology, studies on spiritual care in the health care context are still scarce. This paper aims to contribute to the broadening of this reflection. Firstly, spiritual care is approached from scientific publications in Portuguese (...) language. Second, the interdisciplinary spiritual care model is presented as a holistic approach to patient care and consequences of applying a spiritual care model are outlined. The newly defined role of the hospital chaplains, pastoral counselors and spiritual caregivers is also discussed. As a conclusion, the paper mentions the main challenges going along with interdisciplinary spiritual care, especially those concerning the training of health care professionals. (shrink)

In Brazil the relationship between religiosity/spirituality and health has been mainly studied by medicine and nursing. There are few studies on the behavior and beliefs of health professionals and chaplains. This study aims to find out how the dimension of religiosity/spirituality is understood and integrated (or not) by health professionals and chaplains in health care in a hospital in Curitiba-PR. The research method is a quantitative survey, cross-sectional and descriptive. The applied instrument consists of a questionnaire with 35 closed (...) questions and 1 semi-structured question. Participants are n = 100 health professionals: nurses, technicians and nursing assistants, psychologists, social workers, physiotherapists, phonoaudiologists, pharmacists, clinical nutritionists and chaplains. The results indicate that most of these professionals believe that religiosity/spirituality affects health outcomes and they believe it is important to be aware of this relationship. However, only few of them report that they integrate spirituality into their care practice as they lack (in) formation on these issues. We conclude that theology can contribute to a theoretical reflection on spirituality and health, and also to the training of these professionals about the subject, in collaboration with other disciplines. (shrink)

The basics -- The dignity of the human person -- Autonomy, consent, refusing treatment and boundaries -- Ethics and non-autonomous patients -- Confidentiality, privacy, data protection, truth telling and trust -- Ethical issues at the beginning of life -- Ethical issues about babies, children and young adults -- Ethical issues at the end of life -- Dying and death: ethical issues -- Loss, grief and bereavement, burn-out and the wounded healer -- Conscientious objection and loyalties.

Background Encounters of moral distress have long-term consequences on healthcare workers’ physical and mental health, leading to job dissatisfaction, reduced patient care, and high levels of burnout, exhaustion, and intentions to quit. Yet, research on approaches to ameliorate moral distress across the health workforce is limited. Research Objective The aim of our study was to qualitatively explore multi-professional perspectives of healthcare social workers, chaplains, and patient liaisons on ways to reduce moral distress and heighten well-being at a southern U.S. academic (...) medical center. Participants & Research Context Purposive sampling and chain-referral methods assisted with recruitment through hospital listservs, staff meetings, and newsletters. Interested participants contacted the principal investigator and all interviews were conducted in-person. Consent was attained prior to interviews. All interviews were recorded and transcribed verbatim. Research Design Directed content analysis was used to deductively organize codes and to develop themes in conjunction with the National Academy of Medicine’s National Plan for Health Workforce Well-Being. Rigor was attained through peer-debriefing, data triangulation methods, and frequent research team meetings. Ethical Considerations Ethics approval was obtained from the university and medical center institutional review boards. Findings Themes demonstrate that rather than offering interventions in the aftermath of moral distress, multilevel daily practices ought to be considered that pre-emptively identify and reduce morally distressing encounters through (1) the care team, (2) management and leadership, and (3) the health care industry. Strategies include interdisciplinary decision-making, trusting managerial relationships, and organizational policies and practices that explicitly invest in mental health promotion and diverse leadership opportunities. Conclusion Moral distress interventions ought to target short-term stress reactions while also addressing the long-term impacts of moral residue. Health systems must financially commit to an ethical workplace culture that explicitly values mental health and well-being. (shrink)

The essays in this special issue of HEC Forum provide reflections that make explicit the implicit anthropology that our current pandemic has brought but which in the medical ethics literature around COVID-19 has to a great extent ignored. Three of the essays are clearly “journalistic” as a literary genre: one by a hospital chaplain, one by a medical student in her pre-clinical years, and one by a fourth-year medical student who reports her experience as she completed her undergraduate clerkships (...) and applied for positions in graduate medical education. Other essays explore the pandemic from historical, sociological, and economic perspectives, particularly how triage policies have been found to be largely blind to structural healthcare disparities, while simultaneously unable to appropriately address those disparities. Central issues that need to be addressed in triage are not just whether a utilitarian response is the most just response, but what exactly is the greatest good for the greatest number? Together, the essays in this special issue of HEC Forum create a call for a more anthropological approach to understanding health and healthcare. The narrow approach of viewing health as resulting primarily from healthcare will continue to hinder advances and perpetuate disparities. Health outcomes result from a complex interaction of various social, economic, cultural, historical, and political factors. Advancing healthcare requires contextualizing the health of populations amongst these factors. The COVID-19 pandemic has made us keenly aware of how interdependent our health as a society can be. (shrink)

In the healthcare sector, race, ethnicity and religion have become an increasingly important factor in terms of patient care due to an increasingly diverse population. Health agencies at a national and local level produce a number of guides to raise awareness of cultural issues among healthcare professionals and hospitals may implement additional non-medical services, such as the provision of specific types of food and dress to patients or the hiring of chaplains, to accommodate the needs of patients with religious requirements. (...) However, in an attempt to address the spiritual, cultural and religious needs of patients healthcare providers often assume that ethnic minority groups are homogenous blocks of people with similar needs and fail to recognize that a diverse range of views and practices exist within specific groups themselves. This paper describes the example of the Sikh community and the provision of palliative care in hospitals and hospices. Although, the majority of patients classifying themselves as Sikhs have a shared language and history, they can also be divided on a number of lines such as caste affiliation, degree of assimilation in the west, educational level and whether baptized or not, all of which influence their beliefs and practices and hence impact on their needs from a health provider. Given that it is unfeasible for health providers to have knowledge of the multitude of views within specific religious and ethnic communities and accounting for the tight fiscal constraints of healthcare budgets, this paper concludes by raising the question whether healthcare providers should step away from catering for religious and cultural needs that do not directly affect treatment outcomes, and instead put the onus on individual communities to provide resources to meet spiritual, cultural and religious needs of patients. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:"Call me Dr. XXX!"Yilu MaDisclaimers. Names have been changed to protect the privacy of those mentioned.Scheduled to interpret for a Mandarin-speaking woman, I entered the examination room and introduced myself to the neurologist and the patient, who was accompanied by her husband, brimming with smiles and sitting on the edge of the chair."How are you, Katie?" the husband greeted the doctor, using his accented English."Call me Doctor XXX!", the (...) physician returned, her eyebrows knotted with gravity. Immediately, the friendly and light-hearted air in the room froze.This occurred many years ago at a small clinic where I usually went to interpret as a per-diem interpreter. It happened so quickly that I was totally unprepared, and honestly, shocked at the way the physician reacted to the husband. I felt bad for the patient who sat next to her husband without saying anything, being quiet throughout the interactions. She suffered from dementia and was so dependent on her husband. I also felt slightly angry at the doctor's insensitive response to a mere friendly gesture, though seemingly improper, given the conventional power dynamics between the patient and the physician and the way doctors are esteemed in the American medical culture. But the doctor could have reacted to this perceived slight and disrespect with a mere laugh or simply pretended not to have heard it.Even more distinct was the fact the doctor showed her irritation in front of a third party—me, the medical interpreter. I felt she almost directed that to me and right in my face, and yet I felt powerless, helpless, and even embarrassed. I wondered if the doctor would do the same in front of her other colleagues—physicians and nurses. She might have been more diplomatic. Was her rebuke an impulsive reaction or a deliberate projection of her power, putting the husband back into his place? Should I intervene to ameliorate the impact and explain it? What if the doctor became angry with me if I ventured, and would it worsen things despite my good intentions? All these questions were stirring around in my head. Eventually, I decided to mind my own business and stayed in my role. But this episode of her open reprimand and implicit power projection stuck in my mind then and many years after.Over the years, I moved up from a medical interpreter to the Director of the Interpreter Services Department of a major teaching hospital in Boston and worked deliberately to elevate the status of [End Page 151] medical interpreters by educating clinicians about who we are, what we do, what qualifications and trainings we have and the unique roles we play in cross-cultural communication and care delivery. We demythologized medical interpreters' traditionally reductive role of mouthpiece and advocated their full-fledged member role on the care team. Through our regular conversations and dialogues (instead of top-down teaching sessions by clinicians), medical interpreters partner and team up with physicians, nurses, social workers, chaplains, ethicists, residents, and fellows. We learn from one another to foster a culture of collaboration and mutual respect, gradually bringing about a transformation of power dynamics; medical interpreters are valued for their unique roles of language conduit, clarifier, cultural broker and patient advocate. Interpreters now are empowered to ask questions, seek clarification, and advise on care approaches before, during, and after medical encounters with confidence and teamwork spirit.One of the tangible changes that we collectively implemented is that for each patient appointment, we will allocate time for a short meeting between the interpreter and the provider in what we call a "pre-huddle"; the purpose of the quick meeting is for the provider to brief the interpreter about the patient's medical condition and the goal of treatment. The provider will use the opportunity to solicit any input from the interpreter around language and cultural challenges.The interpreter, possibly having worked with the patient before, will provide some background and context if proper and necessary. This simple process change has boosted the interpreter's morale and engagement. Both parties feel comfortable and familiar with each other's roles and moves. By working in such an environment of... (shrink)

This study explores the perceptions of Norwegian nurses who have received assisted dying requests from terminally ill patients. Assisted dying is illegal in Norway, while in some countries, it is an option. Nurses caring for terminally ill patients may experience ethical challenges by receiving requests for euthanasia and assisted suicide. We applied a qualitative research design with a phenomenological hermeneutic approach using open individual interviews. A total of 15 registered nurses employed in pulmonary and oncology wards of three university hospitals (...) and home care in one municipality were recruited. Four themes emerged from the analysis: (1) unprepared for the request; (2) meeting direct, indirect, and nonverbal requests; (3) working in a gray zone, and (4) feeling alone and powerless. The study found that nurses were unsure how to handle such requests due to professional uncertainty about assisted dying. Working in an environment where the topic is taboo made nurses morally uncertain, and some perceived this as moral distress. The hospital chaplain played a significant role in providing support to these nurses. (shrink)

In this volume, leading scholars in ethics, theology, and health care address conscience and how it relates to Catholic health care. Topics addressed include end-of-life care, abortion, and sterilization. The book is particularly useful for ethics boards and chaplains in Catholic hospitals, especially those merging with non-Catholic chains.

In lieu of an abstract, here is a brief excerpt of the content:Being an Interpreter—Beyond LinguisticsPatricia CoronadoInterpreting refers specifically to the process of listening to and analyzing a message received in one language, then recreating the same message and delivering it in another language, all while preserving the meaning. An interpreter should always maintain a professional distance and be neutral to both sides of the conversation. Could I truly walk this line and perform by the book for each encounter?At one (...) of my medical encounters as a Spanish interpreter, I found myself in the midst of a heart-wrenching situation that involved grappling with life and death. No mother ever wants to hear that her baby has a condition that could lead to death either at birth or shortly thereafter. I had the profound experience of witnessing a woman in the final days of her pregnancy come to terms with a devastating reality.Just before I began my duties as an interpreter, I was informed that the baby had a congenital defect in which they would be born without parts of the brain, a condition called anencephaly. If babies with anencephaly are born alive, they usually live only a few hours or days. They have no forebrain or cerebrum (the main thinking structure of the brain), and the remaining brain tissue is often not covered by bone or skin. The baby will be blind, deaf, unconscious, and unable to feel pain.I learned that anencephaly is a serious birth defect, and the cause is not completely understood, but it's believed to be caused by a combination of genetic factors such as mutations or abnormalities, family history of neural tube defects, folic acid deficiency and exposure to certain toxins, medications, chemicals or substances. Hispanic women are more likely than women of other ethnicities to have a baby with anencephaly.During my first session, the medical team had many questions for the mom. For each question, the mother's responses were brief; either a yes or no answer, even when I was acting as a clarifier to make sure there were no misunderstandings. In my head, I thought:• Maybe she is in denial.• Maybe she has faith that a miracle will happen.• Maybe she is just afraid to ask questions.The registered nurse wanted to make sure that mom had what she would need to be comfortable for the day of her delivery. I remember questions like:• Will the baby be baptized?• Would you like to have a priest or a chaplain from the hospital or church?• Would mom or dad cut the umbilical cord?• Do you have a special blanket to shelter the baby? [End Page E10]The mother remained strong and resilient, keeping her emotions inside, at least from my perspective. The meeting was calm.There was a second session in which the medical team invited me to be part of a private meeting to go over key points about this case prior to the delivery. I remember being introduced to the neonatologist, this extraordinary doctor who played a vital role as part of the medical care team.I immediately did my own research about the functions of a neonatologist—a medical professional who manages the care of babies who are born prematurely or with an illness or congenital disability, such as prematurity or congenital malformations (birth defects), among others.I was present on the day of delivery. As I interpreted the emotional complexity of this event, a deep sense of empathy washed over me. I realized I could serve by giving my love through my words, my silence, and my presence. I interpreted for the mom when there were English-speaking care providers, focusing on interpreting for the patient's mom and spouse when needed. I was quiet in the times when a Spanish-speaking care provider spoke to the patient and family. Lastly, I was available—the only person outside of the family who was present during the actual delivery who was not a nurse or doctor—to help interpret and provide support whenever needed.Even with intensely emotional encounters such as this, my commitment to providing support and assistance remained unwavering. I stayed calm, silently praying for the mother and her baby. In an... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Broken Bodies and Healing Communities: The Challenge of HIV and AIDS in the South African ContextEmily Reimer-BarryBroken Bodies and Healing Communities: The Challenge of HIV and AIDS in the South African Context Edited by Neville Richardson Pietermaritzburg, South Africa: Cluster Publications, 2009. 209 pp. $12.00.The township of Mpophomeni, like many communities in South Africa, has been tragically devastated by HIV/AIDS. Christian churches in the region have responded to (...) this ongoing crisis in a variety of ways. In this collection of essays, edited by Neville Richardson, a team of international scholars from various subfields has combined ethnography and qualitative research with theology, with the goal of understanding how Christian churches have responded to the needs of the people of Mpophomeni. This book is the result of a two-year collaborative research project. The title of the book alerts the reader to two major themes of the unfolding narrative: the reality of brokenness, suffering, and sin (individual, interpersonal, social, and ecclesial) and the goal of healing (again, individual, interpersonal, social, and ecclesial). The ten chapters, individually authored, are divided thematically into three sections: Part 1, “Healing and Community: Perspectives from Zulu Culture and Religion”; Part 2, “Caring, Healing and Faith Communities”; and Part 3, “Caring and Community: Training in a Hospital Setting.” As perhaps expected, the authors’ conclusions remain ambivalent. James R. Cochrane explains: “Religion per se is not innocent of breaking bodies, which should always stand as a warning to us. But religion per se is also the source of healing; indeed, in some ways it is all about healing or wholeness, in relation to the sacred” (115). Churches in Mpophomeni have been “protective spaces” (11), “bridging communities” (91), and “broken bodies” that remember and re-member “the broken body of Jesus” (145–51). But communities are also in flux (101) and are sources of discourse that stigmatizes and shames (172).The book presents clearly argued and compelling essays that work independently and could be read or adopted for class as individual essays. The authors approach some of the same difficult questions from different vantage points, methodological foundations, and subdisciplines. For example, in the first two chapters Sidsel Roalkvam and Jone Salomonsen describe the many social problems in Mpophomeni, including poverty, unemployment, gender inequalities, sexual violence, drug and alcohol addiction, and criminal violence. But their [End Page 225] ethnographic research uncovers some of the rituals of healing that help the community to cope, including the practice of communal “strong prayer” (11–15), and uMemulo rite of passage for girls (23–37).However, I wish there were more coherent conversation between the authors of each individual essay. While Richardson explains that the research was collaborative “not only in terms of interaction between the researchers and the community but also among the researchers themselves” (ix), this collaboration between the researchers is not obvious to the reader in the final format of the book. Perhaps another book format would have more fruitfully conveyed this collaborative stance (for example, the inclusion of responses to each chapter or the addition of a roundtable discussion chapter or coauthored chapters).The ethnographic data presented in the third section is particularly rich and challenging for theology, but the authors could have spent more time unpacking, contextualizing, and analyzing the included quotations from patient–chaplain conversations. If, for example, the story of a thirty-three-year-old HIV+ man who allegedly raped a fifteen-year-old girl to give her “a good lesson for her life” so that she will not dress provocatively is “very characteristic of the material” in the study (203–5), much more needs to be said to explain how pastoral care interventions can address the stated “gender inequalities and the drastically different roles of men and women resulting in the vulnerable position of women” (206).The book is a must-read for scholars working on HIV/AIDS and Christian ethics. It could also provide supplemental readings for an undergraduate or graduate course in this area. [End Page 226]Emily Reimer-BarryUniversity of San DiegoCopyright © 2012 Society of Christian Ethics... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:"A Mother's Love"Katie L. GholsonWho is going to teach my daughter about becoming a woman?" S said to me. S was 38 and diagnosed with ovarian cancer. She and her husband were high school sweethearts, and she had a young son and a daughter. She had been told that there was no cure for her cancer, and at the point of meeting her, very little was able to be (...) done to manage her symptoms.As a mother of a young daughter, I was humbled by the question she asked me. Her daughter was 12 and was just beginning to learn about becoming a woman. The anticipatory grief of not having the opportunities to care for one's own children in the crucial moments of their development was devastating to S. Her ability to name what she grieves the most was profoundly sad to me and the other team members who witnessed it.As a palliative care chaplain, I am used to sad and tragic cases, but this one felt different. S and I had [End Page 80] a lot in common. I am also 38, married to my high school sweetheart, and I have a son and a daughter. Of course, it was not just these reasons that I felt a connection to S. It was also the tangible despair I felt when I was with her. As a chaplain, I am trained to meet people where they are and not to hurry them from a place of despair and anguish. I visited with S nine different times and watched the progression of her existential distress. Her distress was not always linear. Some days, it took a backseat and other days, it was front and center, but I was there to be a witness to whatever she was thinking and feeling, and a lot of times, it was inexpressible grief.S did not want to meet with "palliative care" initially. She was terrified of her diagnosis and believed that there were treatments that would give her back the life she desired. She was fierce and determined. S was also religious and believed that there was a miraculous cure for her that would allow her the time she desired to spend with her children and her husband. S was a softball mom and loved to watch her daughter play. While in the hospital, she missed many games, and this weighed on her.Along with being an athlete, S's daughter was very artistic and made S a bouquet of paper flowers. Each flower contained an encouraging phrase. S opened one while I was in her room. She had lost her hair, much of her body weight, and was wearing a hospital gown, but when she opened the flower, her daughter had written, "You are beautiful, Mom." In that moment, two 38-year-old women understood that beauty transcends outward appearances. S was beautiful: her story, her life, and her courage.S loved to walk around the hallway of her unit. I think she felt if she could keep moving, she could stay alive. She was able to take a walk outside a few times while she was inpatient and getting fresh air was very positive to her. These walks not only gave her the ability to widen her environmental space, but they also gave her space to think and consider the difficult situation she was faced with. I accompanied her on one of her walks. It was while we walked next to each other that she was able to finally share with me that she was afraid. She told me that the fear of not getting home, and the fear of death was overwhelming. I find that sometimes people can be vulnerable when they are not feeling interrogated by a medical team staring at them as they lay in a hospital bed. The "normal" activity of taking a walk and being side-by-side humanized the experience and I think S felt that at that moment, she could talk to me human-to-human—like friend-to-friend.When S finally decided to go home on hospice, I collected some legacy project supplies. I went to the hospital... (shrink)

The 1981 Uniform Determination of Death Act (UDDA) established the validity of both cardio-respiratory and neurological criteria of death. However, many religious traditions including most forms of Haredi Judaism (ultra-orthodox) and many varieties of Buddhism strongly disagree with death by neurological criteria (DNC). Only one state in the U.S., New Jersey, allows for both religious exemptions to DNC and provides continuation of health insurance coverage when an exception is invoked in its 1991 Declaration of Death Act (NJDDA). There is yet (...) no quantitative or qualitative data on the frequencies of religious exemptions in New Jersey. This study gathered information about the frequency of religious exemptions and policy in New Jersey that was created out of respect for religious beliefs. Literature and internet searches on topics related to religious objections to DNC were conducted. Fifty-three chaplains and heads of bioethics committees in New Jersey hospitals were contacted by phone or email requesting a research interview. Respondents answered a set of questions about religious exemptions to DNC at the hospital where they worked that explored the frequency of such religious exemptions in the past five years, the religious tradition indicated, and whether any request for a religious exemption had been denied. This study was approved by the Northeastern University Institutional Review Board (IRB #: 16–03-15). Eighteen chaplains and bioethics committee members participated in a full research interview. Of these, five reported instances of religious exemptions to DNC occurring at the hospital at which they worked for a total of approximately 30–36 known exemptions in the past five years. Families sought religious exemptions because of faith in an Orthodox Judaism tradition and nonreligious reasons. No failed attempts to obtain an exemption were reported. Religious exemptions to DNC in New Jersey do occur, although very infrequently. Prior to this study, there was no information on their frequency. Considering religious exemptions do occur, there is a need for national or state policies that addresses both religious objections to DNC and hospital resources. More information is needed to better understand the impact of granting religious exemptions before new policy can be established. (shrink)

It is a mark of arrogance to try to minister in a liturgical or ritual way to individuals of other religions. A hospital chaplain is not a generic brand, all-purpose religious figure capable of fulfilling the religious needs of any. A chaplain should not try to fill in for specific religious ministers, but rather, he should see himself as a human companion to those who need human love and care. In doing this, he can surely be motivated, informed, and (...) sustained by his inner, spiritual life, but should not see himself as replacing the patient's own religious pastor. Excellent examples of how to carry out pastoral duties in pluralist communities come from two contemporary Christians: Mother Theresa and Father Porphyrios. Both of whom remained non-judgmental toward those for whom they cared, while maintaining a strict view of the historical teachings of Christianity and obedience to them. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Right Thing to DoJane RogersIn stark contrast to getting my graduate degree in bioethics in which I discovered that I am inclined to favor an ethics based on my religious beliefs, in nursing school I learned that I had to take my religion out of nursing care. As a bioethics student, I read in my textbook, Bioethics: A Systematic Approach, that “… just because an action is rationally (...) allowed does not mean that everyone agrees one ought to act in that way.” Yet often in nursing I found that we nurses knew what was best for our patients, even if they did not. At least, we believed that we did. This general paternalistic belief spread into every area of the care we gave except for one, and that was religion. [End Page 208]As student nurses, we learned to separate our religion from our care to focus on the patient’s religion or spiritual needs. Our patients should never know of our religious beliefs or even if we had a lack of them. We needed to be completely neutral on all religious issues and focus solely on the patient’s preference. If our patients needed spiritual care, we would find someone to provide it and we would incorporate it into the nursing plan of care. Providing care of the whole patient including their religious needs was the definition of a good nurse. Certainly I wanted to be a good nurse, so I swore I would always include the spiritual needs of my patients as part of my care, while never expressing my own.As fate would have it, as a new nurse I found myself overwhelmed running around just trying to give medications, admit and discharge patients, start IV’s, insert catheters, note doctor’s orders and get my charting done. My time was engaged in trying to calm confused and combative patients, running to grab an emesis basin for a patient to throw up in or answering the phone, so thinking about religion or spiritual care for my patients most of the time amounted to “God help me and my patients get through this shift.” My goal of being a good nurse was starting to look dismal as I realized I had no idea if I could find the time or means and ways to incorporate religion into the care I gave, or if it even mattered if I did.Fortuitously for me, most of my patients never mentioned religion, although at times they did leave some nonverbal clues. I could see a rosary laying on a bedside table or a bible or prayer book next to them in bed. While I would make sure their religious item was always within reach, I remained respectful yet distant in religious matters, never offering any spiritual care or assistance. I was quite accepting of my first Mormon patient wearing the garment under the traditional hospital gown. I was appalled when an unconscious Jehovah Witness patient was nearly given blood. When a minister or priest came to visit, I’d excuse myself quickly so that the work of their God could do what I could not or should not do. Occasionally I was asked by family members to call in a minister or a priest or chaplain and I did that with a great feeling of satisfaction as I was surely providing the spiritual care they requested.Eventually however I did start to indulge in highly spontaneous and random acts of religion. These were always done secretly. The patient or family must never know. Thinking it would help I once covertly gave a patient a special rosary I had with Lourdes water in it thinking it might heal him. I waited to see a miracle. It never came. Despite the absence of that miracle I was still hopeful that perhaps my prayers or another rosary could heal or at least help some of my patients. After all, as a nurse I witnessed lots of healings that astounded me. People I never thought would get better sometimes did anyway.Although I was cognizant that some healing was the direct result of superb medical intervention and excellent nursing care, there were always... (shrink)

Once the post-modern account of individual and cultural identity as creative openness to change is re-construed in terms of a constructivist rendering of the semiotic theory of culture, and once inter-denominational and inter-faith hospital chaplaincy is interpreted on a model of cross-cultural communication which agrees with this theory, chaplains can conceive of their ability to fulfill their mission in offering understanding and help to the client from other faith communities only by explicitly invoking the intervention of the Holy Spirit. (...) The commentary argues that Schneider-Harpprecht’s all too generalized account of that intervention leaves chaplains with no spiritual substance for distinguishing between truely and only apparent pastoral helpfulness. (shrink)

Background Nurses tasked with providing care which they perceive as increasing suffering often experience moral distress. Response to moral distress in nurse wellbeing has been widely studied. Less research exists that probes practicing nurses’ foundations of moral beliefs. Aims The purpose of this phenomenological study was to gain understanding of nurse meaning-making of morally distressing situations, with particular attention to ethical norms, moral agency and resiliency, and nurse religious/spiritual orientation. Design This exploratory study employed semi-structured interviews using open-ended questions. Qualitative (...) data analysis was assisted by MAXQDA software. Participants and research context Nine pulmonary care nurses during COVID-19 in a tertiary care teaching hospital in the northeastern United States. Ethical considerations The study was approved by the IRB. Participants were consented before the study and confidentiality was preserved. Findings/results The study revealed three main themes of meaning-making, rooted in the identity of the “good nurse”: Being true to one’s own values, pursuing ideal patient care (“doing good”), and conforming to/challenging values of the system and culture. Tensions were found between (a) nurse’s own values (b) duty to institutional norms and duty to nurse’s personal code of ethics, and (c) perceptions of institutional support in response to nurse moral distress. Religion was described as a remote source of nurse moral values, among other sources. Spiritual practices were not experienced as sufficient in coping with moral distress at the bedside. Conclusions The study suggests nurses need more opportunities to engage in reflection on their practice and values. The findings also indicate need for accessible institutional supports for nurses experiencing moral distress and strategic use of chaplains in helping with moral distress. Further research is needed on the interplay of nurse spirituality, moral agency, and reflective practice in the face of morally challenging situations. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Buddhist-Christian Dialogue:Moving ForwardThomas Cattoi (bio) and Carol S. Anderson (bio)The San Francisco Bay Area is an interesting location in which to ponder Buddhist-Christian relations. The website UrbanDharma.org lists more than a hundred institutions affiliated with Buddhist organizations—a density higher than in the Beijing metropolitan area. Some of these centers have a clearly ethnic and denominational character, serving a predominantly immigrant population. Some, like many of the Tibetan organizations, function (...) as cultural centers but also attract a considerable Western clientele. Others, like the San Francisco Zen Center or Spirit Rock in Marin County, belong to the first wave of historical Buddhist centers established in the United States in the 1960s and 1970s. A few more are trying to establish new forms of enculturated Buddhist practice that are more suited to Western sensitivities and are only loosely affiliated with the cultures of traditional Buddhist societies. At the Graduate Theological Union in Berkeley, alongside schools training Jesuit priests, Dominican friars, and Protestant ministers of various denominations, the Institute of Buddhist Studies prepares students from different walks of life to work as Buddhist chaplains in hospitals and educational institutions. Buddhism, in its various forms and manifestations, is no longer an exotic import from a little known “elsewhere,” but is part and parcel of the local spiritual landscape.For students and scholars practicing in such a diverse environment, it is perhaps difficult to imagine that for the greatest part of its history, most of Christendom was largely unaware of the very existence of the Buddhist tradition. While Clement of Alexandria and Jerome do mention Buddhism, and references to its practice can be found in the writings of medieval travelers such as Marco Polo, most European Christians lived in a world where the role of the religious “other” was played by Judaism and Islam. It was only in the early modern era, with the beginning of the European colonization of Asia, that non-Abrahamic religious traditions gradually entered the intellectual horizon of Western intellectuals and scholars. Around the year 1740, a French Jesuit named Jean-François Pons (1688–1752), otherwise remembered as a pioneer of Sanskrit studies in the West, came to the startling realization that many of the religious practices that missionaries and travelers had come across in regions as far apart as China, Japan, Nepal, and Mongolia were actually all parts of the same religious tradition. In his correspondence with his fellow Jesuits in France, he coined the [End Page vii] term Bauddhamatham—teaching of the Buddha—to refer to what would eventually be known as Buddhism. In the early years of the nineteenth century, many Sanskrit and Tibetan texts started to be catalogued and translated into the major European languages, bringing about the first encounter between Europe’s intellectual elites and this utterly foreign religious tradition.The nineteenth century also saw the beginning of a more existential engagement with the Buddhism tradition, albeit one that was limited to intellectual elites who were highly critical of institutional Christianity. In his work The World as Will and Representation, Schopenhauer found in Buddhism many echoes of his own philosophical insights. Many of the members of the Pāli Text Society, established in London in 1871, had rejected Christianity and thought they would find in Buddhism a moral framework in a society where the normativity of the Christian tradition had already started to be questioned. At the same time, we also see the beginning of the first comparative studies, where Buddhism and Christianity are compared from a speculative and doctrinal perspective. In 1880, Ernest de Bunsen claimed that if one made an exception for the crucifixion, many of the fundamental moral teachings of Buddhism and Christianity were virtually identical. This was just the beginning of a slew of similar studies.While the Christian churches were initially uninterested or outright skeptical about engaging in dialogue with non-Christian religious traditions, this attitude started to shift in the decades following the Second World War. The Second Vatican Council, for instance, marked an important shift in the Catholic Church’s attitude toward other religions. Before the 1960s, Catholic theology departments did not offer courses on other religious traditions or on interreligious dialogue... (shrink)

There are good reasons for being suspicious of the very concept of ‘a religion’, let alone a ‘world religion’. It may be useful for a hospital administrator to know a patient's ‘religion’ – as Protestant or Church of England or Catholic or Buddhist – but such labels clearly do little more than identify the most suitable chaplain, and connote groupings in the vast and confusing region of ‘religious thought and practice’ that are of very different ranks. By any rational, (...) genealogical taxonomy ‘Protestant’, ‘Anglican’, ‘Catholic’ connote species, genera or families within Christianity, which is in turn a taxon within the multivariant tradition traced back to Abraham. ‘Buddhism’ includes as many variants as would ‘Abrahamism’. Most Abrahamists, traditionally, have been theists, but it is difficult not to suspect that Marxist socialism is an atypical variant which has inherited a linear view of time, a contest between the chosen agents of justice and the doomed powers-that-be, and the prospect of a future in which ‘there shall be no more sea’. (shrink)

A couple and their five‐year‐old daughter are in a car accident. The parents are not expected to survive. The child is transported to a children's hospital, and urgent treatment decisions must be made. Whom should the attending physician approach to make decisions for the child? When such cases arise in, for example, the hospitals where we work, the social worker or chaplain is instructed to use the Illinois Health Care Surrogacy Act as a guidepost to identify a decision‐maker. But (...) in our state and the country overall, the limitations of such statutes leave hospital workers to make a judgment call among friends, family, and clergy who may come forward. While surrogate decision‐making statutes comprehensively address surrogate decision‐makers for adults, a patchwork of laws—permanency statutes, kinship provider statutes, standby guardianship statutes, and, in some cases, surrogate decision‐making statutes—provide variable decision‐making pathways for children. (shrink)

Rather than eliciting behavioral expectations of individuals for an appreciation of organizational ethics, we are focusing on the organization itself and the manner in which distinctive organizational structures assume their own respective behavioral expectations. The hierarchical organizational structure emphasizes obedience while the participative organizational structure emphasizes cooperation. Imposing the ethical virtues of one organizational structure onto another leads to conflict, and that conflict is reflective of a basic injustice which is (indirectly) organizational in cause but (directly) personal in effect. This (...) more conceptual argument is readily identified in the difficulties encountered by pastoral ministers in Catholic hospitals, especially by women chaplains. (shrink)

Bioethical decision‐making in pediatrics diverges from similar decisions in other medical domains because the young child is not an autonomous decision‐maker, while the teen is developing—and should be encouraged to develop—autonomy and decisional capacity. Thus the balance between autonomy and beneficence is fundamentally different in pediatrics than in adult medicine. While ethical dilemmas that reflect these fundamental issues are common, many pediatric physician and nursing training programs do not delve into the issues or offer specific training about how to deal (...) with borderline cases.To meet this need, the Children's Mercy Bioethics Center in Kansas City, Missouri, created a program specifically dedicated to serving practicing, experienced pediatric health professionals. Our students come from various professional disciplines: they are doctors, nurses, social workers, chaplains, lawyers, psychologists, counselors, and hospital administrators practicing in pediatrics. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Searching for Peace in DeathLaura WachsmuthDisclaimers. No funding was utilized for this manuscript. The author, Laura Wachsmuth, has worked at several hospitals. The opinions contained herein are her own. All names have been changed to protect the privacy of the patient and the patient's family.I first met Ellen when she was admitted to the Women and Infant unit on a late spring day in May. She was 27 weeks (...) pregnant and was experiencing intense abdominal pain.As a hospital chaplain, I support patients and their families emotionally and spiritually. Sometimes, this looks like praying with patients; other times, it looks like sitting in quiet because there are no adequate words. Over time, I have developed ways to help me cope with the intensity I witness daily. Still, cases come up that I must grieve. The case of Ellen is one such example.The first time I met Ellen, she was waiting to hear back about her scans and tests. A quick look at her chart and a conversation with the medical team revealed that she was in her mid-thirties. While she spoke English fluently, she had immigrated to the US, and English was her second language. She, along with her husband, Mark, and their young son, had come to the United States on a work visa.After knocking on the door and entering her dim hospital room, I noticed right away what a beautiful person Ellen was, inside and out. Lying in bed, her long dark hair piled up on her head, her slim figure was visibly pregnant underneath her hospital gown. She smiled and gently greeted me. Mark was at her side. Clearly, Ellen was in physical pain, and while she and Mark still hoped the doctors were wrong in thinking she may have cancer, the emotional strain of waiting lay heavy upon them.Ellen and Mark kindly welcomed me and were attentive as best they could as I introduced myself and explained my role as a chaplain. They told me [End Page 75] that they were spiritual, not religious, but welcomed chaplain visits. Both exuded a certain peace and kindness, which was striking considering all they were enduring.As Ellen and her family waited for the results to come back, I waited as well and frequently checked her medical chart, looking for updates. About a week after she was first admitted, the medical team broke the dreaded news: Ellen had stage IV gastric cancer; it was estimated she only had 11 months to live. At this point, the Palliative Care team became involved in Ellen's care, and the chaplain on this team supported Ellen through the shock of her diagnosis and the difficult treatment choices she faced.Originally, the plan was for Ellen to deliver her daughter at 29–30 weeks and then to receive 2–3 rounds of chemotherapy. After further deliberation, however, it was decided that it was riskier to deliver a baby at 29–30 weeks than it was to undergo chemotherapy while pregnant, so Ellen began chemotherapy while still carrying her baby. Her chemotherapy was not a curative treatment, but there was hope it might give her more time.While my role became more peripheral at this point, I continued visiting Ellen. She was often tired or in pain, so I was mindful to keep my visits short. Mark, who stayed with his wife day in and day out, was usually in the room when I came by, and I often inquired after his well-being. Since Ellen and Mark's families still lived abroad, Mark was Ellen's primary support, and needed care and support himself.After two rounds of chemotherapy, Ellen made the decision to stop treatments. She made this decision because she was concerned about the risks of chemotherapy on her baby. It was an agonizing decision, and even after she made it, Ellen turned it over in her mind. During one of our visits, she asked me if I thought she had made the right decision. I told her that I fully supported her, but as I left her room, I wondered if I had done the right thing in affirming her choice. Looking... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:And When May I Cry?Juggling Emotions in Healthcare InterpretingMateo Rutherford-RojasDisclaimers. All names have been changed to protect the privacy of the patient and the patient's family.Baby Oliver had been in the NICU almost since he was born. Oliver was born with a relatively simple congenital problem, which required him to have a routine corrective surgery.Unfortunately, routine surgeries don't always deliver routine results. Due to unexpected complications during the operation (...) and a prolonged lack of blood flow, several of Oliver's tiny organs suffered partial necrosis. It was just a matter of time until little Oliver's life could no longer be sustained with tubes, pumps, liquids, and pain medications. How much time Oliver's tiny body could hold out was unclear—he had days, maybe a week. The care team had already communicated to Oliver's parents, who were still teens themselves, the options that were available. The team provided sufficient medical detail for the parents to understand the logic of the situation. They faced the most difficult decision any parent—past, present, or future—would ever have to make. Before his birth, the parents expected to take little Oliver home, to love and nurture him, and witness him grow well into adulthood. Now, they had two choices. They could either choose to disconnect Oliver from the machines and let him die in their loving arms or watch him fade away, connected to his incubator and accompanying equipment, barely able to touch him through the multiple life-sustaining wires and tubes.The message had been delivered in Oliver's parents' language many times. In fact, every Spanish interpreter on staff had worked with the care team and Oliver's family at some time during their stay. Their ears heard it, but their minds could not comprehend how a routine operation could end like this. It is in these moments that most people rely heavily on their faith, as did Oliver's parents; waiting for God's miracle to happen.Perhaps it was the Chaplain's suggestion that God's miracles are not dependent on medical machines and life-sustaining equipment. Or that perhaps God needs Oliver and knows his family is strong enough to let him go. But at moments like these, religious philosophy and the nature of God do not provide a simple and clear answer. Still, someone has to decide, "Yes, it's time to hold him and say goodbye" or "No, we are not yet ready to let go of our hope."I don't know what the final deciding factor was or when that moment came for these young parents so full of love and hope for their new family. All I know is that I had the tremendous honor and [End Page E6] responsibility of interpreting for the parents and the care team when the gravity of the situation had penetrated all those human mechanisms of self-preservation. Oliver's parents chose to embrace their son, hold him in their arms one last time, and say, "Goodbye, we love you."This situation is not unusual at our hospital. As one of the nation's primary academic children's hospitals, patients come to us for miracle cures or to die in comfort and peace. In this case, what was unusual and touched the hearts of everyone in the room—surgeons, specialists of every organ system, bedside nurses, chaplains, social workers, and yes, the interpreter—was the final message the parents had for the care team. "Please, please, our only wish is that no parent ever have to make a decision like this again, please." We were all shocked and humbled by these anciently wise teenage souls whose hearts were broken, and their primary concern was for every other parent in the world, whom they would never meet—"May they never feel our pain."How I wish their desires had come true. However, soon after the situation with Baby Oliver, I would find myself again in the NICU interpreting the same messages to two other families, though their stories were distinctly different. Unlike little Oliver, the babies in the later cases were diagnosed with genetic disorders that presented little... (shrink)

Background: Black, Asian and minority ethnic groups have a high need for organ transplantation but deceased donation is low. This restricts the availability of well-matched organs and results in relatively long waiting times for transplantation, with increased mortality risks. Objective: To identify barriers to organ donor registration and family consent among the BAME population, and to develop and evaluate a training intervention to enhance communication with ethnic minority families and identify impacts on family consent. Methods: Three-phase programme comprising community-based research (...) involving two systematic reviews examining attitudes and barriers to organ donation and effective interventions followed by 22 focus groups with minority ethnic groups; hospital-based research examining staff practices and influences on family consent through ethics discussion groups with staff, a study on intensive care units and interviews with bereaved ethnic minority families; and development and evaluation of a training package to enhance cultural competence among ICU staff. Setting: Community focus group study in eight London boroughs with high prevalence of ethnic minority populations. Hospital studies at five NHS hospital trusts. Participants: Community studies: 228 focus group participants; hospital studies: 35 nurses, 28 clinicians, 19 hospital chaplains, 25 members of local Organ Donation Committees, 17 bereaved family members; and evaluation: 66 health professionals. Data sources: Focus groups with community residents, systematic reviews, qualitative interviews and observation in ICUs, EDGs with ICU staff, bereaved family interviews and questionnaires for trial evaluation. Review methods: Systematic review and narrative synthesis. Results: Community studies: Organ Donor Register – different ethnic/faith and age groups were at varying points on the ‘pathway’ to organ donor registration, with large numbers lacking knowledge and remaining at a pre-contemplation stage. Key attitudinal barriers were uncertainties regarding religious permissibility, bodily concerns, lack of trust in health professionals and little priority given to registration, with the varying significance of these factors varying by ethnicity/faith and age. National campaigns focusing on ethnic minorities have had limited impact, whereas characteristics of effective educational interventions are being conducted in a familiar environment; addressing the groups’ particular concerns; delivery by trained members of the lay community; and providing immediate access to registration. Interventions are also required to target those at specific stages of the donation pathway. Hospital studies: family consent to donation – many ICU staff, especially junior nurses, described a lack of confidence in communication and supporting ethnic minority families, often reflecting differences in emotional expression, faith and cultural beliefs, and language difficulties. The continuing high proportion of family donation discussions that take place without the collaboration of a specialist nurse for organ donation reflected consultants’ views of their own role in family consent to donation, a lack of trust in SNODs and uncertainties surrounding controlled donations after circulatory death. Hospital chaplains differed in their involvement in ICUs, reflecting their availability/employment status, personal interests and the practices of ICU staff. Evaluation: professional development package – a digital versatile disk-based training package was developed to promote confidence and skills in cross-cultural communication. Initial evaluation produced positive feedback and significant affirmative attitudinal change but no significant difference in consent rate over the short follow-up period with requirements for longer-term evaluation. Limitations: Participants in the focus group study were mainly first-generation migrants of manual socioeconomic groups. It was not permitted to identify non-consenting families for interview with data regarding the consent process were therefore limited to consenting families. Conclusions: The research presents guidance for the effective targeting of donation campaigns focusing on minority ethnic groups and provides the first training package in cultural competence in the NHS. Future work: Greater evaluation is required of community interventions in the UK to enhance knowledge of effective practice and analysis of the experiences of non-consenting ethnic minority families. Funding: The National Institute for Health Research Programme Grants for Applied Research programme. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Patient Self-Determination ActElizabeth Leibold McCloskey (bio)What are the ethics of extending the length of life? We know that we cannot artificially end life (Thou Shalt not Kill), but how about artificially extending life? Is that always good, sometimes good?... In ethics, is keeping people alive the highest good? Should our priority be to keep people breathing?... What does basic religious ethics say about this?(John C. Danforth, letter to (...) the author, 19 August 1989)The Patient Self-Determination Act, signed into law as part of the Omnibus Budget Reconciliation Act of 1990 (OBRA '90) last November, marks the first time that Congress has passed legislation concerning the ethics of life-sustaining medical treatment. The bill was spearheaded by Senator John C. Danforth (RMO), who has a special interest in this area. An Episcopal priest, Danforth was formerly an assistant chaplain at New York's Memorial Sloan-Kettering Cancer Center and now sits as a senior member of the Senate Finance Committee, which oversees Medicare and Medicaid. Although Senator Danforth's legislative initiative was not a result of the Cruzan case, it was in his state of Missouri that the U.S. Supreme Court case involving removal of Nancy Cruzan's feeding tube arose (Cruzan v. Director of Missouri Department of Health, U.S. Supreme Court, 58 LW 4916, 26 June 1990). From his unique vantage point, he felt it was time to craft a legislative response to some of the difficult issues surrounding prolongation of life.The short answer to Senator Danforth's questions about when to artificially extend life is simple enough: people must be free to determine that for themselves. Common law and common sense dictate such a conclusion; living will and health care proxy statutes, enacted in almost every state, codify that right. The Catholic moral tradition teaches that one is not morally obligated to use extraordinary means to prolong life, a tradition shared both by the mainline Protestant and the reform and conservative Jewish community. Yet most people are unaware of their fundamental legal right to make such decisions, and as court cases from Quinlan (In re Quinlin, 137 N.J. Super. 227, 1975) to Cruzan demonstrate, few know [End Page 163] how to make arrangements for this right to be exercised if they become incapacitated.Meanwhile, health care practices are often driven by a denial of death. When Senator Danforth and Senator Daniel Patrick Moynihan (D-NY) introduced the bill on October 17, 1989, Senator Danforth said:More and more it is arguable that we play God by subjecting people to unwanted and sometimes unnecessary treatment, treatment that unnaturally prolongs the dying process. Our health care system has become obsessed with extending life, at times neglecting the caring component of medicine and trampling on the rights of patients.(Congressional Record 1989, 135:5.13566)The American Hospital Association estimates that 70 percent of deaths now occur after a determination to withhold or withdraw medical treatment. Many of those decisions are made without the benefit of an incapacitated patient's views, yet a Harvard study revealed that 95 percent of the population would like to prepare in advance for such decisions. Only 4 percent of hospitals have a systematic method of asking patients if they have an advance directive. Family members confront painful choices in the face of uncertainty about their loved one's wishes and it can be even more painful when a family knows the patient's desires but providers and the courts act otherwise because clear evidence is lacking.The Patient Self-Determination Act is rooted in the belief that people should be given information that enables them to specify the extent of medical treatment they wish to receive should they become incapacitated. The public should be educated about applicable state laws that protect the individual's right to make such choices through the use of an advance directive.The Act moves toward that goal by promoting knowledge of state laws. It requires every hospital, nursing home, home health agency, hospice, and health maintenance organization that participates in Medicaid or Medicare to routinely give all adult patients information about advance directives. Patients will also be given information on the... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:The Achievement of David Novak: A Catholic–Jewish Dialogue ed. by Matthew Levering and Tom AngierChristopher KaczorThe Achievement of David Novak: A Catholic–Jewish Dialogue, edited by Matthew Levering and Tom Angier (Eugene, OR: Pickwick, 2021), 360 pp.The Achievement of David Novak: A Catholic–Jewish Dialogue, edited by Matthew Levering and Tom Angier, brings together twelve essays on various aspects of Novak's thought along with a response to each essay by (...) Novak himself. The topics themselves concern whether Jews and Christians worship the same God, suicide, natural law, Pope Pius IX, justice, the sanctity of human life, and supersessionism. Its contributors include senior scholars as well as those at the beginning of their careers. Each essay, arising from some aspect of Novak's vast corpus, is replied to by Novak himself. These replies are instructive, for they show a great teacher at work, responding with nuance and charity to criticisms and always moving the conversation forward in illuminative ways.Levering opens the volume with a contribution about Novak as a master of Jewish–Christian dialogue, indeed, "the greatest master of Jewish–Christian dialogue who has ever lived" (1). Levering highlights the intellectual pedigree of Novak, whose teachers included Abraham Joshua Heschel, Leo Strauss, Yves Simon, Louis Dupré, and Germain Grisez. Jews are called to live according to the revelation to which they are accountable. Christians are called to live according to the revelation to which they are accountable. Neither Jews nor Christians should hold the other group accountable for their distinctive revelation, but neither Jews nor Christians should hide or minimize what they have to offer to the other.Princeton's Robert P. George interviews Novak, revealing something of the origin story shaping decades of dialogue between the rabbi and [End Page 299] Catholic interlocutors, perhaps the most influential of which was Germain Grisez, Novak's dissertation director in the early 1970s at Georgetown University and a colleague in founding the "new natural law" school, along with George's own dissertation director, John Finnis.Melanie Barrett's essay highlights the importance of natural law, a key theme in Novak's work, for a pluralistic and secular milieu. She cites him saying, "Jews ought to encourage non-Jews to pray in public in order to show how much they believe the world, including the political order, is dependent on God" (48). Such public prayer creates more opportunity also for Jews to express their faith in public.Invoking Gottlob Frege's distinction between sense and reference, Francis Beckwith tackles the question of whether the Trinitarian God is the same God as the God of Abraham. Cassius Clay and Mohammed Ali have the same reference, though different senses. Like Novak, Beckwith believes Catholics and Jews worship the same God.John Berkman returns to the subject of much of Novak's early writing, suicide. Berkman's chapter seeks to explore the similarities and differences between Jewish and Catholic views on the topic. Novak's dissertation exploration of Plato's, Aquinas's, and Kant's views was supplemented by his experience working as a rabbi and hospital chaplain at St. Elizabeth's Hospital in Washington, DC, a facility that specializes in treating mental illness. One of Aquinas's arguments against suicide is that it is contrary to proper love of self. In his response to Berkman's essay, Novak highlights that the command "to love your neighbor as yourself" could mean "as you love yourself" or "as you yourself are loved by God" (118).David Elliot, a former student of Novak's, responds to quasi-Marcionite attacks on the manualist tradition by what might be called the "beige moral theologians" of the 1970s. He highlights Novak's insight that "our terror of God's power is mostly sublimated into our reverence for God's wisdom.... It should reappear only when we are tempted to stand up against God in contempt rather than standing before him in awe" (134).Tom Angier, one editor of The Achievement of David Novak, treats the difference between a more typically Scholastic approach to natural law grounded in metaphysics and Novak's theologically formulated approach. But Novak replies, "I tried to... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:UnbefriendedJean Watson“Can you be a friend to someone who needs one right now?”That probably wasn’t the question that our hospital clinical ethicist asked, though that is what I recall. It sounded like something my mother would encourage me to do. It sounded like something I would like to do. It sounded easy. It was none of that and so much more.Two weeks earlier, a man was found down (...) in his apartment, unresponsive. He had had a stroke. He was hospitalized in our ICU on a ventilator. He had no family or friends to speak on his behalf. Decisions needed to be made. Should he undergo surgery to place a tracheostomy and feeding tube to continue his life?The hospital hired a private investigator who performed yeoman’s work, trying to find someone who knew this man, someone who might be able to share information about his values so that we could act in accord with them. Remarkably, no one was found. The patient had been retired from work for more than a decade. Though he rented an apartment, his landlord did not know him. No family was discovered. No friends came forward nor were identified. No medical records were uncovered. He had not seen a doctor or visited a clinic or hospital in the area until now. He was a solitary person, a human being without close relationships. His apartment was unkempt; beer bottles were strewn about the place.The clinical team requested an ethics consultation. Though the hospital does not have a formal policy for decision making at moments like these, our ethicist is well-versed in a variety of ways these circumstances are handled. Sometimes a treating physician functions as both the attending and a surrogate. This can be fraught with potential conflicts of interest. Unconscious bias could influence one’s thoughts about the value of a life and the cost to sustain it. Sometimes the attending provider presses on with therapies regardless of the likelihood of successful treatment. This choice fails to acknowledge individual autonomy. It fails to weigh the suffering required to live another day. It sidesteps the thorny issues that are discussed everyday between providers, patients, and loved ones.The ethicist gathered a group to serve as informal surrogates for this patient. Three of us agreed to act as friends and decision makers for this man, helping the treatment team determine next steps. The ethicist provided a few rules and much oversight.We met for a family conference. The intensivist and neurologist shared the diagnosis and treatment that the patient had received. They detailed information about the decisions that needed to be made. The patient’s nurse, the social worker, and the spiritual care intern attended the meeting to watch the proceedings and contribute to the discussion. We three, the patient’s friend group, were invited to ask questions. We had some.I am a hospitalist, an internist working in a hospital caring for patients. I have done this work for 25 years. I know the intensivist and the neurologist well. We have worked together, caring for many people over the years. My two surrogate partners were a nurse and a chaplain. The nurse had decades of professional experience, including in the intensive care unit. The chaplain was experienced in her work and comfortable with the challenges that arise in a hospital.The three of us had a robust discussion. I shared what most patients tell me when I ask about resuscitation status. “I don’t want to be kept alive on machines,” or “I don’t want to be a burden.” The ethicist gently reminded us that we were tasked with making a decision on behalf of this person, irrespective of what others would decide for themselves. It was challenging to tease out clues [End Page 10] that could guide us to what this man might choose for himself.Because of the location of his stroke, the patient was not expected to regain consciousness. He had been off sedation for more than a day and had not woken up. For the rest of his life, he would be institutionalized, ventilator dependent, and sustained with nutrition administered via a... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Healing Power of an Ethics ConsultLaura J. HoeksemaOur interdisciplinary team was inhaling and exhaling conflict, frustration, anger, confusion, guilt, and feelings of helplessness as we cared for a 21-year-old woman who was dying. We had regular disagreements about how our team should best care for her. She was receiving hospice care and had complex medical, psychosocial, physical, and emotional needs. She was frequently transitioning between hospice care at (...) home, living with different family members at different times, and hospice care in the hospital due to uncontrolled symptoms. This led to her having an inpatient hospice team made up of me—her physician—and a nurse, social worker, and chaplain and also an outpatient hospice team with a different physician, nurse, social worker, and chaplain. All of us cared for her regularly in our respective settings. Members of the two care teams advocated passionately for what they thought was best for her. At times, team members were advocating strongly for conflicting interventions. Every member of both teams experienced moral distress related to some aspect of her care.How could we move forward in a unified way to provide her with the best care possible when there was uncertainty and disagreement within the teams about whether we were providing her with ethically appropriate care?Several questions arose about her care:• What is our responsibility in protecting a vulnerable patient when there is concern she’s being taken advantage of by others?• How do we address concerns about possible opioid diversion? Was a dying patient not receiving the pain medication she needed because someone else was using it?• How do we address household members smoking in the presence of someone on oxygen?• Do we honor a dying patient’s wish to live in an environment that we’re concerned is unsafe for her and our staff?• When team members receive contradictory information from a patient, how do we develop a common understanding of the situation?• Was it appropriate for our team to spend hours and hours caring for her each day which prevented us from caring for other patients who also needed our support?• What is our responsibility in relation to supporting her family with their financial and legal concerns?We placed an ethics consult to help us think through the answers to these questions and address the intense moral distress of team members. After listening to us share our experiences, the ethicists acknowledged the complexities of caring for her and affirmed that we were doing a good job. This acknowledgment from someone not directly involved in caring for the patient was meaningful. Having colleagues, who weren’t impacted by the emotional intensity of caring for her, empathize with us helped us gain some perspective in the swirling tornado of our emotions.Moral distress was running rampant. Some team members were distressed that we were giving the patient too much autonomy to make decisions they felt put her at risk. Others felt we should restrict her autonomy significantly to protect her. Some were distressed by family members smoking near her when she was on oxygen. Others were distressed that the investment of time in caring for her was so great that we couldn’t care for other patients in ways they deserved. Team members were very passionate about their beliefs about what was right and wrong as we cared for her. [End Page 21]The ethics consultants addressed the conflicting ethical values and helped us feel more comfortable with the plan of care we developed together. We were asked thoughtful questions to help draw out sources of moral distress. We were given new ways of thinking about conflicting ethical values, which helped us understand the underlying reasons for the conflict our team was experiencing. Highlighting the ethical values that were in conflict and helping each of us understand that the specific aspects of her care that we found distressing were related to our personal values, helped decrease the intensity of disagreements and frustration. The ethicist’s ability to share this knowledge with our team was powerful. Our team realized that we weren’t frustrated or upset with each other. We came to understand that because of the... (shrink)