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Can anyone hear your prophetic voice?: the ethics of speaking up
You can learn a lot about what’s going on in health care in a state by talking with chaplains at their state meetings. In states with ageing populations, we talk about chaplaincy in long-term care, nursing homes, assisted living. In states with younger populations, we talk about chaplaincy in ob-gyn and pediatrics. In states with changing demographics, we talk about the challenges of providing chaplaincy services to newer community residents, who may bring different religious, cultural, and economic factors into the mix, and of balancing their needs with the needs of longtime residents.
During one such discussion, a chaplain, sitting in the back of the room, mentioned the “prophetic voice” he and his colleagues brought to their work. I was curious: How was this chaplain using his prophetic voice as a health care professional? I needed examples. “Well . . . . I’m on the ethics committee.” With that, everyone in the room turned around in their seats. “We’re all on the ethics committee – that’s just filling a seat at a table!” They had a point.
The “prophetic voice,” in seminary shorthand, is that voice that calls attention to social injustice and holds society accountable for its care or neglect of its most vulnerable members: the widow, the orphan, the stranger at the gate. Acute-care hospitals are perhaps the one institution in American society recognizably organized in these terms: in principle at least, the stranger at the gate (or in the ambulance) will be taken in and cared for. We know that this is not always how it works. We know about the 46 million uninsured. We know that our health care system is not organized in ways Isaiah would approve of. And we know what we are called to do when we call ourselves health care professionals: to align ourselves with the best interests of those who suffer, and to work to improve the quality of their health care.
Simply being a health care professional, or a member of a particular profession, is not a guarantee that we will do this every day. It is easy to substitute “I’m on the ethics committee” for “In practice, I speak up for patients’ best interests, and whenever I learn that care is organized in ways that do not serve patients’ interests.” And there are chaplains who will say, isn’t justice-seeking the patient rep’s job? Isn’t my job to “be with” the patient and family, to help relieve their suffering through my presence and my skills?
Shirley Otis-Green is social worker and palliative care specialist at City of Hope National Medical Center near Los Angeles. Her mission is to encourage the “being with” professions in health care – chaplains, social workers, psychologists – to find their prophetic voices, to speak up for patients. Otis-Green runs a training project called Advancing Clinical Excellence (ACE), which is funded by the National Cancer Institute. According to the project’s website, participants will be trained “to become more effective role models and advocates for enhanced palliative, end-of-life and bereavement care within their institutions and disciplines.” These advocates are not meant to be lone voices crying in the managed-care wilderness. ACE is committed to transprofessional education, to teaching participants how to work as interdisciplinary palliative care teams and to collaborate as advocates for better care.
In this vision of advocacy, “being with” entails the ethical obligation, “being for.” Speaking up is part of the job, and will be until all patients have access to high quality palliative care when they need it. The ACE Project’s vision challenges chaplains working in all areas of health care to think about the ethics of speaking up – and of keeping silent.
For more information about the ACE Project, visit: www.cityofhope.org/ACEproject
Nancy Berlinger is Deputy Director and Research Associate at The Hastings Center. Her research interests focus on clinical ethics and include end of life care; ethics in health care chaplaincy; conscientious objection and moral distress in health care; and patient safety and the resolution of medical harm. Her broader interests include bioethics issues in cancer care, narrative ethics, and medical humanities.
As Deputy Director, she manages the Center’s organizational capacity-building initiative, Bioethics and the Public Interest, which has received major support from the Ford Foundation.
Berlinger is the author of After Harm: Medical Error and the Ethics of Forgiveness
(Johns Hopkins, 2005), which will be released in paperback in fall 2007. She serves on the ethics research group of the Joint Commission, the ethics faculty of the American Society of Healthcare Risk Managers (ASHRM), the bioethics committees at Montefiore Medical Center, Bronx, New York and at Richmond of New York, and the editorial board of Medical Ethics Advisor
. She is a frequent presenter at grand rounds and other ethics education programs for health care professionals. She volunteers on the Chaplaincy Service at Memorial Sloan-Kettering Cancer Center in New York City.
She is a graduate of Smith College and holds the Ph.D. in English Literature from the University of Glasgow and the M.Div. in Christian Ethics from Union Theological Seminary.
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