BioethicsWalk addresses
bioethical issues that chaplains face in their day-to-day work. PlainViews invites
our readers to share their responses
to each BioethicsWalk column,
which will be published in the
following issue. We also invite our readers to submit areas of concern/interest about which they would like Nancy to write.
If you’d like to respond to BioethicsWalk,
please send a comment of no more
than 100 words. You can use the
e-form below (click on "hearing
from you," link) or submit
your commentary to the editors
in the body of an e-mail (or
as a Microsoft Word attachment)
sent to Info@PlainViews.org.
Please put the phrase “BioethicsWalk”
in your subject line. Comments that are too late for the previous issue can be viewed in TalkBack.
We look forward to hearing
from you.
Responses to No Harm Done? (See original article below)
I work in a specialty heart hospital. Doctors often change medicines around, or prescribe new ones for patients when the current regimen doesn't seem to be working. Sometimes the medicine does not provide the relief the physicians and patients hope for. They (docs) don't feel compelled to be held up to the same standard that Ms. Berlinger seems to offer for chaplains. My own doctor has said to me "Try this Rx and see if it helps diminish your symptoms." I learned years ago as a new chaplain to offer grief support materials to families that they could take home with them when they left the hospital with the words, "you may find this helpful, if so read it, use it or share it. If you find that it is not helpful, set it down; maybe it will be helpful to someone else in the family, maybe you will find it helpful at another time. If after some time, a piece of it never seems to help you or others in your family, throw that away." I like to think of the various modalities that complementary medicine offers in a similar way. If it helps, use it; if not, set it aside. It is too easy to become distracted by the prospects for curing, when it is the caring that makes life bearable.
Rev. Susan Weickum, BCC
The Indiana Heart Hospital
Indianapolis, IN
As someone who wears a collar and a hospital badge, I often find that I occupy a place of liminality within the hospital setting--of the institution yet not; independent contractor yet part of the interdisciplinary team; lay person in medicine yet medical staff. It is often a thin line to walk and I try to find a balance between the worlds that is responsive to a family's needs. In the children's hospital where I work I am often asked by desperate parents what kind of miracles I have seen, I give no medical authority to prayer or miracles but I leave room for the family to find hope in both, "I haven't seen the kind of miracle we are asking for for N but I never stop praying for them...sometimes I have to look for other kinds of miracles, like a mom finding the strength to go on for one more day". I also seek to echo the words of the medical team--seeking to support the medical findings while at the same time supporting the family that rejects the picture of reality laid out by the physicians. It is often a balancing act, yet I find that in this place of "neither fish nor fowl" I do my best work. This quasi outsider status also allows me to provide support to medical staff who see in me someone who understands the hospital world yet stands outside of it and allows families who have grown suspicious or angry with the medical staff to continue to seek out my support. This liminality echoes my own theological understanding of being of the world but not subject to the world and also my understanding that the hospital itself as a place of liminality--one enters one way and leaves it another, regardless of outcome. I'm not sure yet how I will leave it.
Reverend Joy Caires
Rainbow Babies and Children's Hospital
Cleveland, Ohio
Thank you for a very thought-provoking discussion. In my opinion chaplains are not only part of the healthcare "team", but also a part of the "team" bringing together the Almighty G-d and the patient. Prayer thus becomes as valid a therapeutic tool as medication and surgery. It is in both of these capacities that the Chaplain does his/her work. Furthermore, in Judaism body and soul are inextricably connected. Thus in the Jewish prayer for the sick we ask for a "healing of soul and a healing of body." In this regard therapy/healing takes place in both parts of the human being. In this context prayer is more than just "provides comfort and relieves stress", it heals the body and forges the connection between the patient and G-d, however the patient understands G-d.
Rabbi Edmund Winter
Pastoral Services and Education
Staff Chaplain
Northwestern Memorial Hospital
Chicago, IL
This particular dilemma should be cause for we chaplains to stop and think about prayer and what we say and believe about it. When I first became a chaplain my belief was simple - that prayer "healed." After much reflection and working with patients and families I have changed my own view on this subject to this: I believe God is present to us. We are surrounded with God's love. Prayer, itself, does not heal but can bring comfort. God does not interfere and if God did then there would be no need for hospitals, doctors and the rest of the health care team. To say that "prayer heals," to our patients is giving a false hope as much as saying "everything is going to be okay."
Joanne Bellaire
Retired Chaplain
Livonia, Michigan
No Harm Done?
Last month, “The Ethicist” column in The New York Times Magazine featured a letter from an anonymous hospital worker in St. Louis who asked several questions about the ethics of performing “healing touch” and “therapeutic touch” on hospitalized patients:
If the practitioners believe these practices are effective, can they tell patients that they are effective even if there is no scientific proof of this?
If the practices seem to make patients feel better, should practitioners withhold information about the lack of scientific evidence, in the interest of the placebo effect?
Columnist Randy Cohen replied that the sincerity of the nurses’ belief did not offer any ethical wiggle room. In a hospital setting, a person may reasonably assume that whatever a health care provider offers as “therapy” meets the same standards as any other therapy the hospital provides. Health care providers cannot lie to patients by telling them that a therapy is “effective” if there is no evidence to support this claim. And making a practice of withholding information from patients, in the interest of the placebo effect or for another reason, undermines patient autonomy: if patients aren’t given all the facts, how can they make informed decisions?
Reading this letter, I was reminded of a conversation I once had with a CPE resident about the ethics of badging. We were talking about what chaplains could, as a matter of ethics, tell patients about the effectiveness of prayer. The resident asked, can I tell a patient that “prayer heals,” if I believe that it does? Do I have to get into the science? Do they even expect that of me – a student, a chaplain?
I felt for this resident. Even as a mere pastoral care volunteer, I’d very quickly learned that one of the ways some – not all – patients use chaplains is for prayer: to pray with, to ask to be prayed for, to provide them with the space or ritual items they need to say their own prayers. Patients and families who rely on prayer themselves expect the chaplain (or the mere volunteer, even) to say “yes” to prayer.
But does it follow that the chaplain should tell patients that prayer “heals” or “works,” mindful that, in the context in which this conversation is taking place, “heal” can sound like “cure,” and mindful that there is no scientific basis for this assertion?
And this is where the badge matters.
A chaplain’s ID badge signifies to patients, families, and other badge-wearers that this person is part of the team and part of the institution: the logo on the building is the same as the logo on the badge. And because the institution that authorizes badge-wearers is a health care institution, any badge-wearer has a responsibility to uphold the well-established ethical principles that differentiate a health care institution from another place of employment. Because the first of these principles, respect for patient autonomy, includes the obligation to give patients accurate information so they can make informed decisions, and because other principles require health care providers to adhere to recognized standards of care in providing treatments that benefit and do not harm patients, health care providers must be mindful that, when they are badged, they are providing “health care,” not just “care.”
The solution is not equivocation: taking off the badge to say “I believe,” putting it back on to say “I know.” Rather, it is awareness of the line between supporting patients’ participation in practices that provide comfort or relieve stress, and endorsing a practice of unproven therapeutic value as if it had therapeutic value.
What do you think?
How do you handle issues like this in your own work, or when you observe practices that seem harmless but whose value is unclear?
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.
.gif){kind=spacer}
.gif){kind=spacer}
