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.

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We hope that this 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.

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Case #22 (please see responses below)

The wife of a prominent hospital doctor was admitted with end-stage cancer. In speaking with the patient, she knew that her husband had been reading her chart and felt that her husband wasn't being honest about her prognosis and was hiding information from her. Speaking to her husband, he wanted to 'protect' her from the burden of knowledge.

What role could/should the chaplain play, or should the chaplain not get involved?

How could the chaplain help the patient?

How could the chaplain assist the doctor/husband?

Responses:

If the doctor and his wife have developed a relationship in which he now wishes to hide important information from her, the chaplain should not intervene to alter that. The chaplain might feel that it is better for the wife to know, but that would be injecting his/her own issues into an otherwise private matter.

Naturally, the chaplain should be present for both the doctor and his wife. Both have issues they may need to discuss, and the chaplain can play a critical roll in helping to resolve those issues. If the wife starts to suspect that she is more ill than she has been told, the chaplain can facilitate an exchange between the two spouses in which both are able to discuss the matter openly, and come to a greater resolution of their outstanding issues.

Rabbi Jim Michaels, D. Min.
Hebrew Home of Greater Washington
Rockville, MD

It would be helpful if the chaplain could initiate a conversation with the doctor about the "burden of not-knowing", issues of feeling helpless when there is no knowledge and how "knowing" can actually empower people and make a way for them to be proactive as best they can for the situation at hand.

Alan Faulkner, BCC
Medical Oncology Associates
Augusta, GA

Clearly missing from this situation is the attending physician, whom I assume is not the patient's spouse. Is the husband interfering with the patient/doctor relationship? This is the relationship where the patient should be seeking forthright answers about her prognosis and interference by any third party seems ethically unsound and a potential violation of the patient's rights. The chaplain would want to consider appropriate avenues to address the breach while empowering the patient to get more satisfying information from her attending.

If other hidden material here includes the couple's emotional life, the chaplain could consider an additional and perhaps very different intervention. The chaplain could work to establish a more appropriate and free-flowing expression of intimacy within the couple by helping them shift from their hospital identities as patient and physician to that of life partners. The spouse needs to be restored to a right relationship with the patient, no longer acting as a shadow doctor but simply being present as the husband, and the patient needs to welcome him in that role.

Keith Goheen, Chaplain
Beebe Medical Center
Lewes, DE

The chaplain could encourage the pt to ask her own physician or medical team about her prognosis and related details. The husband-physician is not the attending of his own wife, so that she has the resource of her own attending for details. The pt might share her fear with the attending that her condition might be worse than she has been told.

If the pt is unwilling to relate directly to her attending physician in this way, the chaplain cannot change or fix the dynamic, for better or worse, between husband-physician and wife-pt. Both stand in need of the grace the chaplain can demonstrate, since both have their own experience of grief over the diagnosis and prognosis, regardless of how dire or encouraging it might be.

Rev. Rhonda Cooper, MDiv
Chaplain, Kimmel Cancer Center, Johns Hopkins Hospital
Baltimore, MD

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