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Lawyers and Chaplains: Re-framers of Change?
Question: What common challenge is faced by a lawyer representing a spouse who does not want a divorce granted and a chaplain ministering to a family member wanting treatment either determined medically futile or which the patient’s legal surrogate says the patient would oppose?
Answer: Both lawyer and chaplain are working with people facing change they didn’t anticipate, initiate or desire. Each is asked to keep alive a source of love, companionship, and identity. Each is sought out for advocacy; each needs to be a compassionate teacher.
Generally, divorces are granted despite the pleadings of the respondent. Grounds may be successfully contested; divorce itself is inevitable. Good advocates get the “best deal” for their clients regarding child contact, support, distribution of marital property, assets and debt. Wise advocates listen patiently to litanies of betrayal, pain, terror and self doubt. They help clients confront change while focusing on strategies for future well being.
Similarly, medical providers are ethically (and legally in most states) obligated to honor a patient’s, or approved surrogate’s, wishes despite family dissent. And, if the treatment sought is determined to be “futile” [1] according to the standard of care, “there is no professional or moral obligation (on the part of medical providers) to offer or provide [it].” [2]
How can advocates help people accept the inevitable death of a marriage or loved one? One way is re framing “futility.” A neurolinguist [3] writes, “Frames are mental structures that shape the way we see the world. …they shape goals…plans…[actions]…what counts as good and bad outcomes….We know frames through language…words are defined relative to conceptual frames….Reframing is changing the way [we] see the world. Thinking differently requires speaking differently” [4]
Advocates can cease terming interventions to preserve life or marriage “futile.” “Futile” implies the patient or marriage must be abandoned, is “not worth” the effort. This challenges the distraught other’s own commitment and values. Wise advocates can identify and re-vision application of those values to the changing context of the person’s life. They can affirm the commitment while acknowledging its outer form is altering. Re-framed, “futility” applies more accurately to fighting the transformation: struggling to preserve a past now well beyond retrieval.
Terri Schiavo’s final days showcased the trauma of a distraught family engaging
lawyers and clergy as advocates to fight a death that courts ruled ethically permissible. Physicians determined life without artificial supports medically impossible in her persistent vegetative state. Death was inevitable.
One wishes the advocates engaged by this family had refrained from engineering personal tragedy into political opportunism. Within their own Catholic tradition, the inevitable change Terri’s parents confronted could have been re-framed into a narrative of resurrection hope. Or more broadly, advocates could have supported her family in learning to accept and adapt to their lives the Compassionate Buddha’s teaching: “the only constant is change.” It’s not about futility at all; it’s about constancy re-visioned.
Footnotes:
[1] “The term futility is now used to cover many situations of predicted improbable outcomes, improbable success, and unacceptable benefit-burden ratios. This situation of competing conceptions and great ambiguity suggests that we should generally avoid the term futility in favor of more precise language.” Beauchamp and Childress. Principles of Biomedical Ethics, Fifth edition. Oxford University Press, 2001, p. 134.
[2] Interpretation of AMA Council on Ethical and Judicial Affairs article in JAMA 268 (1992), in Ascension’s discussion and definition of “futility,” www.ascensionhealth.org
[3] Lakoff, George. don’t think of an elephant! Know Your Values and Frame the Debate, White River Junction, VT,: Chelsea Green Publishing, 2004. p. xv
[4] Cognitive behavioral and biofeedback therapists have long taught clients to articulate the positive action they desire to perform rather than the negative one they seek to avoid.
[5] The court found that Terri’s surrogate, her husband Michael, accurately represented her choice. I wondered during court deliberations if a couple in their early twenties in the early 1990’s had end-of-life discussions. My doubts were put to rest when in private conversation with one of the care-givers, I learned that Michael Schiavo was at that time himself a respiratory therapist. He would have told his wife what he witnessed at work and she would have occasion to say, “not me, never.”
Anne Underwood
has an undergraduate degree in
religious studies, a master’s degree
in rural sociology and a mid-life
law degree obtained after working
over a decade as a college administrator.
She has mediated for the Maine
family courts since 1983. Currently
she serves as an advisor to the
ethics commissions of ACPE, APC,
the CCAR (Central Conference of
American Rabbis), and NAJC, and
consults with a variety of Protestant
faith communities on issues of
power, fair process, and congregational
conflict management. Her articles
on mediation and restorative justice
have appeared in the ACPE News,
The APC News and on the ACPE web
site. Articles on clergy accountability
and judicatory processes are published
by the Alban Institute and The
Journal on Religion and Abuse.
A chapter, “Clergy Sexual Misconduct:
A Justice Issue,” appears in Body
and Soul: Rethinking Sexuality
as Justice-Love
, Marvin Ellison
and Sylvia Thorson-Smith, editors,
The Pilgrim Press, 2003.
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