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 #7 (see responses below)

A mother, father and their 12-year-old son appeared for an appointment with an ENT (ear, nose and throat) physician. The family stated that the reason for the visit was their son’s “voice box” was closed; he did not speak. They informed the physician, “The Holy Mother of our Church sent us to you, because you can open the voice box and make my son speak.”

After realizing the boy was autistic, the doctor shared the psychological and neurological nature of the condition with the family. Still the family pressed him to do a CT scan and X-ray study, saying it was foretold that the problem with the voice box would appear on the scan. The studies were ordered. Results of the study were negative, no lesions or abnormalities were apparent.

The results were reported to the family. A few days later the mother, father, the Holy Mother, and priest of the church had an appointment with the doctor. They asked to see and review the X-ray and CT results. The doctor carefully took time to explain how he had read the studies and the reports of the radiologist. He shared the films with those gathered.

The Holy Mother then pointed to a specific slice of the CT films and remarked that she was told by God that in this place he would find a “perisicula” that God would help him to remove and the boy would speak.

The physician knew of no such abnormality. He informed the family that in keeping with his medical oath to do no harm, he could not operate seeing there was no lesion, growth or visible blockage.

The doctor called the chaplain for advice on how to respect this family’s strong religious convictions without compromising his professional integrity.

What might the chaplain do to support the physician?

How could the chaplain assist the family?

Responses to CaseConference #7:

First, this doesn't sound like an issue of ethics as much as how to support a Dr and family. Secondly, the chaplain could spend time listening to the Dr explain her/his understanding of a "perisicula." According to my search through my Webster's Medical Desk Dictionary and the ever present Goggle I found no such term. What does the physician understand the HM to say? This chaplain would want to hear the physician's story that makes this case problematic. This chaplain would want to provide the supportive listening and pastoral conversation to the Dr thoroughly enough that the person wearing the title can process his/her own theological, personal, and historical story and possibly find personal healing.

Finally, after hearing the person/Dr the need for a chaplain to interact with the family may not be necessary. If the physician still want chaplain support this chaplain would arrange a meeting with the family, HM, and Priest to listen to their story. I wouldn't do much by way of convincing or explaining; I would simply state the obvious. "It is against medical practice to perform a surgical intervention when there is nothing to be gained." I am sure the group will move to another physician and another and so on at the expense of this young person. Ultimately my job will be to put the son on my prayer list, possibly never to be removed.

Rev. Roy Sanders, M.Div. B.C.C. Diplomate in CPE Supervision
Director Spiritual Health / Clinical Pastoral Education
Truman Medical Center Hospital Hill

What makes this case a matter of ethics as well as a matter of spiritual care is exactly the physician's concern about being asked to perform a procedure that he sees no medical reason to perform. I see at least two possibilities: 1) I would wonder with the physician if there might be additional tests/scans that could be done that could reveal something that cannot be seen with the scans available; or perhaps the physician could suggest that he perform scans at intervals of several weeks, in the event the "perisicula" is too small to be seen at this point. The cost of such diagnostic imaging may be prohibitive, however, and thus not a tenable solution. The physician's concern not to perform invasive surgery for no visible problem should be respected, and supported with the family.

But another tack that could be taken is: 2) to offer other doctors (psychologists), in conjunction with spiritual care providers, who may be able to address the autism, and thus "remove" the "perisicula" from the boy's voice box. It seems that a good religious history and spiritual assessment, in addition to psychological assessment, would be useful in this case.

Rev. Beth Collier, MDiv, ThD, BCC
Coordinator Chaplain
Alexian Brothers Medical Center
Elk Grove Village, IL

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

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