BioethicsWalk addresses
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Balm in Gilead
Several readers wrote in about last month’s column, on the ethics of comfort, and of making people uncomfortable: I am so grateful for these thoughtful responses (Vol. 4, No. 16). Marty Koontz of Knoxville, TN, suggests while chaplains “should probably not set out with the intent of bringing discomfort to another,” they should recognize that comforting a patient may make someone else uncomfortable, and “so be it.” The chaplain’s ethical obligation is to the suffering patient, rather than to those who refuse to acknowledge this suffering. James Ek of Gilbert, AZ, proposes that an institutional chaplain’s “first ministry” is one of education: A colleague’s discomfort may reflect a lack of understanding of what the chaplain’s role in this institution is, and the chaplain has a obligation to describe this role in ways others can understand. Nancy Cahners makes a similar point, noting that because “ambiguity” over who does what can prevent colleagues from working together in the interest of their patients, chaplains should be candid with themselves about what they alone do, what they do best, and what other services may do equally as well.
All of these comments are relevant to this month’s continuing consideration of medical humanities: how can reading stories shape our moral awareness of what it means to care for those who suffer – or to be the person who suffers? Last month, we looked at Gwendolyn Brooks’s novel March, in which a fictional Civil War chaplain has a commanding officer who does not understand what chaplains do. (Some things never change.) This month, our novel is Marilynne Robinson’s Gilead (2004). The narrator is John Ames, a third-generation Congregationalist minister in Gilead, Iowa, in the 1950s. He is dying of heart disease, and is writing a long letter to his very young son, describing how he spent his life, including “this life,” the life of ministry:
That’s the strangest thing about this life . . . People change the subject when they see you coming. And then sometimes those very same people come into your study and tell you the most remarkable things.
This observation about the peculiar nature of the pastoral role rings true for institutional chaplains as well as for clergy who serve congregations. Americans know how to “use” clergy: for ritual needs, as counselors, as the inevitable go-to community members for everything from meeting space to pandemic planning. When these Americans are sick, the chaplain may represent a normal social relationship that they have in their “real” lives. This relationship may be quite mundane: more coffee-hour than pastor’s study. Having a mundane conversation in a hospital can be a comfort, in and of itself.
(In my own work as a volunteer at a New York City hospital, I have lots of conversations about traffic and the difficulty of finding parking. One woman, nearly in tears while telling me about her sister’s intractable pain, broke off by saying, “. . . and I’m parked at a one-hour meter!” Perhaps chaplains who want to make change should carry quarters.)
And yet, as Gilead’s John Ames points out, some people who may wind up in your “study” someday may not want to talk to you right now, and may always be uncomfortable with what you represent to them: “religion”; “morality”; death; someone whose usefulness is not immediately clear. Sociologist Arthur Frank, a cancer survivor himself, has written about how patients and health care providers are “characters in each other’s stories.” Do your patients, or your colleagues, wonder what you are doing in their stories about being sick, or caring for the sick? Recalling Nancy Cahners’s comments: which health care stories “work” – serve the interests of patients – because there was a chaplain in them? Which stories will probably turn out the same way whether or not this character was present? And which stories should not have chaplains in them?
I welcome your comments, and your stories.
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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