We post an ethical or situational concern that has arisen in a facility where one of our readers works. It has no identifiers included. It gives you only the facts of the case. Then, you can respond to that concern. This is an ongoing dialogue, with comments added as they come in. In the following issue, assuming it has been resolved, we give you the outcome from the facility where the incident took place. Please send any cases that you would like considered for inclusion to: info@plainviews.org

We hope that this new addition will help to inform not only those who are dealing with the issue, but will enable all of our readers to learn from the experiences and perhaps mistakes of others.

PLEASE NOTE: Due to unanticipated continuing responses to both the case and the resolution of the case, added responses can be viewed in the archives. Click HERE.

CaseConference #15 (See responses below)

A group of teenagers appear at the ED with a friend who is unconscious. The police, having been called by the ED, arrive shortly thereafter. Over the course of the next several hours, each teen is interviewed by the police as they try to figure out what happened. The unconscious 17-year-old has alcohol in his blood, indicating that he had been drinking. The ED staff are having a difficult time stabilizing and rousing the teen. He appears to have a head injury as well as a high content of alcohol in his blood. The Chaplain has been called to the ED to help with the family of the injured teenager. At one point, the chaplain sits with two of the teenagers who have yet to be interviewed by the police. They begin to tell the chaplain about “what happened.” The story they tell is somewhat unbelievable – and the “facts” change as they tell their story.

If the staff believes that the truth of what happened to this injured teen might save his life, what is the chaplain’s role with the other teens?

What if the two teens have knowledge that could benefit the injured teen but don’t want to reveal it? They are keeping information from medical staff because it might cause a problem for them. Who is the chaplain protecting?

What is the chaplain’s obligation to these two teenagers? Should the chaplain let the teens know that telling the truth would be in their best interests or just listen to them?

What is the chaplain’s responsiblity vis-à-vis telling the police about his/her "suspicion” that the teens are not telling the truth?

Responses:

The question which precedes all others is, Was it ethical to call the police to the ED?

The Emergency Department is there to provide medical care for the patient. The medical needs of the patient should be of highest priority. The teens who were present should be questioned by the medical staff, in order to gather information needed for patient care. By calling the police, the ED staff put patient care at risk.

After providing emergency care for the patient, if the staff believed a crime had been committed, the police could have been called.

Martha Lindley
Community Chaplain
Harborview Medical Center
Seattle, WA

As a chaplain who is committed to the spiritual care of those to whom I am called I would feel obligated to encourage these teens to speak the truth. I would ask them to imagine themselves in their friend’s position and ask, “What would be your hope for and expectation of your friends?” And I would ask them to accept their responsibility in helping to save his/her life. In offering spiritual support to these teens I am committed to their spiritual well-being. That means that if there is need for confession and forgiveness I would listen but I would also encourage and support that process, helping them to recognize that forgiveness does not let them off the hook in terms of responsibility and culpability. Rather, I would remind them that confession and forgiveness frees them to do the right thing on behalf of their friend. I would offer to be present with them, if they wished, while they spoke to the medical team about what happened.

It is the chaplain’s role to be present to and to listen to those who are in spiritual distress. One way to do that is to help them to find their way through this maze of what has happened and how they should respond. Fear of getting in trouble versus telling what happened to save a friend’s life is a powerful spiritual conundrum and the chaplain is the person who can help these young people walk through it.

I would also inform these young people of my obligation to tell the medical staff any information I have that would save this patient’s life, or impact his/her care. Since these teenagers had not yet spoken to the police I am a little unclear as to what I might do. In my hospital, I would speak with the social worker (who would also have been called and is our designated liaison to the police) about the discrepancy in stories so that s/he could be aware of this. I would also encourage the teenagers to be truthful and brave. Again, I would offer to be present with them when they spoke to the police and if they accepted that offer I would inform the police of this request. I would not convey information to the police.

Doreen Duley, BCC
Director of Pastoral Care
Children’s Hospital of Alabama

The role of the chaplain on the interdisciplinary team is called into question in Case #15. As I read the case material, I did not find that role to be very clear. In our department we work very hard to be clear about our roles on the team. In times of stress, these things can become clouded. So, it must be well rehearsed in the mind of the chaplain. At times it helps to know what WE ARE by being clear about who WE ARE NOT.

In this case, the chaplain clearly is not a detective or any other kind of police. He is not one of the physicians who is trying to save the young man's life. He is not a legal counselor for the teenagers. The case report clearly stated that,"The chaplain has been called to the ED to help with the family of the injured teen." That was the chaplain's role; yet no more mention was made of it in the report. Helping with the family traditionally means being a compassionate, non-anxious, presence who assessed and responded to their resulting emotional/spiritual needs and concerns. It involves living with them in the moment of their pain and conflict. The role of chaplain as I understand it does not primarily involve being a problem solver or affecting immediate change. The chaplain is not the patient representative. The authority by which we do the wonderful work that we do is "pastoral authority", and that is ascribed to us by those in our care. What authority did those teens give to the chaplain? Perhaps the chaplain was a representative of their image of God, or a holy person who knew right from wrong in all matters, or a father confessor who could be trusted with the horrible truth. Is it worth taking the chance of abusing that authority to coerce the whole story out of them? I think not.

In the end the job of the detective was done by a detective. The physicians did their best. Charges were filed against the offenders. The chaplain needs to fulfill the sacred role trusted to him/her. Staying in the role described in this case could present further complications including being forced to give a deposition or giving testimony in court which only further compromises our role.

Stan Dunk M.Div., BCC
Director of Pastoral Care
Fort Hamilton Hospital
Hamilton, Ohio

Please check the archives below for comments made about the last CaseConference.

Send your comments about CaseConference to info@PlainViews.org.