EthicsWalk addresses
spiritual care as an ethical enterprise.
It explores why relationships between
spiritual care providers and those
they serve need protection, and
examines what that protection entails. PlainViews invites
our readers to share their responses
to each EthicsWalk column,
which will be published in the
following issue.
If you’d like to respond to EthicsWalk,
please send a comment of no more
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We look forward to hearing
from you.
Editor,
We in the United States are now coming up to the time of the civic holiday of Thanksgiving. In the weeks ahead we will either participate in programs which address, or we will literally speak of the many blessings we know, and how thankful we are in terms of physical comfort, and/or sufficient food on our tables, shelter from life’s storms, and/or, hopefully, good health.
We chaplains or pastoral counselors, or simply we readers of PlainViews in America or beyond, would be neglectful in our words of appreciation were we not to include in our reasons to give “THANKS” the ongoing wisdom we read monthly, penned by Lawyer/Ethicist Anne Underwood who writes the “Ethics Walk” section of this fine electronic magazine.
As she noted in her first column, (PlainViews Vol.1, No. 12) “Ethics is a process of making decisions about what course of action is moral in a given situation. Ethical dilemmas arise when there is more than one normatively human response for the situation and the responses conflict.”
Anne has helped her readership to understand and appreciate the delicate balances in such areas as privacy/confidentiality and need to know/greater good, and she has helped readers to examine their own limits by “establishing, tending, mending, and navigating boundaries in the work of chaplaincy and spiritual care.”
In a recent column, she drew a wonderful parallel between Lawyers and Chaplains in terms of reframing change. As she wrote, there are cases where both lawyers and chaplains “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.”
Thank you, Editor, of adding this feature to PlainViews, and thank you Anne Underwood for your ongoing walks through the thorny thickets of the world of ethics.
David J. Zucker
Director of Spiritual Care
Shalom Park
Aurora, CO
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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