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Case #26 (see below for responses)

A 30-year-old man has suffered a stroke. He will eventually recover and be able to function on his own. His mother, who lives elsewhere, has come to be with him. She wants to take him back to her home to care for him and help him recover. It is clear to the staff that the patient does not want his mother involved in his care and the staff has consented to his wishes, even though he may not have full capacity.

The chaplain has been providing pastoral care to both the patient and his mother and has developed relationships with both of them. The patient's mother asks the chaplain to deliver a letter to her son, explaining her feelings and asking him to consider giving her another chance.

Should the chaplain agree to be the go-between and give the letter to the son (which would involve the chaplain reading the letter to the son)?

What is the chaplain's role with the mother?

What is the chaplain's role with the staff who have "sided" with the son, even though he does not have full capacity?

Responses

We have an age old problem here that many of us will have encoutered in one form or another.

Whilst the Chaplain has a duty of professional courtesy and care to the patient, he has developed a further relationship with the family of the patient, and the same parameters of professionalism are as valid in this regard.

Were it to be me who was approached by the Mother to deliver the letter, I would have no hesitation in agreeing to present her request to her son. However, I would feel duty bound to point out that I would have no hesitatio0n also in offering her any comments that the son wished me to pass on.

There is an absolute in this scenario, that we need to consider the requirements of professionalism and equality to all involved in the situation. It is NOT the role of the Chaplain to be one sided in any way. However, equally it is not within our remit to proffer agreement or dissention with the views or suggestions of any of the parties. Merely to act as an independent advocate, offering equally unbiased opinion and advice to all concerned, whether staff, patient or family.

Rt Rev Dr Barry Rathbone DD(hons) Dip LSR KGCSJ (OM)
Founding Moderator of The International Community of St John the Divine
Abbot of the Oratory of the Holy Knights of St John the Divine

In contrast to Dr. Rathbone, I see my role as primarily serving the patient. I consider my duty to family members secondary because these relationships developed as a result of my connection and service to the patient. For this reason, I would avoid entering a situation where I seemed to serve as the mother's messenger. In my conversations with the mother, rather than agree to carry her message, I would explore with her why she felt unable to communicate to her son directly.

Nancy Cahners
Associate Chaplain,
Hebrew Rehabilitation Center
Boston, Massachusetts

As I read the case it seems that there are several voices that need to be heard: the patient's, the staff's, and the mother's; and as a chaplain I would understand that I have ministry and accountability to all three, but first and foremost to the patient. So what does the patient want here?

If the staff is correct, then even telling the patient about the mother's letter could be upsetting and I would want to remember that, but not necessarily refrain from talking to him about it. In response to the mother, I would tell her that I would be willing to go and ask the patient if he would like to hear the letter and if he does, ask him if he would like her to read it or if he would like me, the chaplain, to read it. I would ask her if she would be willing to read it to him if he wanted her to read it. If she said "no" then there is a point of ministry and discussion. If she said "yes" I would add that I couldn't guarantee that he would want her to read it, and we must abide by his wishes, but that I am glad that she would like to read it.

I would then proceed to ask the patient about the letter and I would abide by the patient's choice. Whatever his choice there is opportunity here for ministry with the mother.

Susan C Schwartz, Chaplain
The Children's Institute of Pittsburgh
Pittsburgh, PA

Since the chaplain has established relationships with both patient and mother, it would be appropriate for the chaplain to deliver the letter. It would also be appropriate for the chaplain to provide spiritual and psychosocial support to mother and son. The chaplain must remain neutral yet supportive.

There are obviously some issues between mother and son prior to the stroke. Hopefully the chaplain could provide some pastoral counseling to provide an avenue for mending the relationship, if indeed there are issues. Otherwise, the chaplain could refer the mother and patient to a therapist and/or clergy of their choosing.

Rev. Frankie B. May, Th.M.
Chaplain, Trinity Hospital/Hospice
Augusta, GA

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