 12/15/2004
Vol. 1, No. 22
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Professional
Practice |
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Chaplain
Jeff Lancasater on changing
the way we look at Do Not Resuscitate
situations
Allowing
Natural Death
Chaplains
have been talking about an
interesting change in language
known as AND (Allow Natural
Death), as an alternative to
DNR (Do Not Resuscitate). While
my knowledge of how this idea
started is incomplete, I believe
Rev. Chuck Meyer did groundbreaking
work prior to his death, and
others have implemented a change
from DNR to AND. I gratefully
acknowledge their creative
and visionary work. This article
describes the results of research
into communication issues around
end-of-life care as a backdrop
to implementing AND. Our hospital
decided to review the protocols involving
DNR orders and advance care
directives. The
review included representatives
from many different disciplines,
including nurses, administrators,
social workers and chaplains.
Our
findings revealed how both
families and caregivers often
misunderstand DNR to mean the
withdrawal of care, or the
abandonment of a dying person.
AND does not change the protocols
of medical care, but may reduce
some distress associated with
this misunderstanding.
AND
also represents coming to grips
with the fact that death is
a natural part of every life.
Just as the hospice movement
improved the quality of care
for terminal patients by starting
from a philosophical understanding
of the inevitability of death,
so ‘Allow
Natural Death’holds
promise of a more balanced
approach to deaths that occur
in the acute setting.
American
culture leads people to believe
they have a God-given right
never to face death. Within
this grief-avoiding culture,
bringing up the possibility
of death feels contrary to
the hospital’s
mission of healing. Here is
the paradox: we recognize the
patient’s
right to participate in their
care, but without a mechanism
to facilitate good communication,
patients may experience heightened
confusion, fear, and lack of
support. By not communicating,
patients and families may experience
more distress at the time they
most need emotional and spiritual
support.
In
a national survey, 68% of patients
stated they wanted their physicians
to discuss the use of life
sustaining treatments, but
only 6% had opportunity to
do so. [1] Another
study indicated physicians
are no more accurate in predicting
the resuscitation preference
of patients than would be expected
by random chance alone. [2] Families
are also unreliable sources:
their decisions largely failed
to correspond with the patient’s
wishes when patients who survived
resuscitation were later interviewed.
Clearly, our culture of denying
death leads many patients to
undergo treatments without
their wishes being known. Neither
physicians nor families provide
a reliable measure of assurance
that the care given represents
the patient’s
wishes.
Another
barrier to communication is
dissonance about role. Nurses
and physicians over the course
of time may differ on the goals
of treatment. Ideally, those
views should be communicated
in a professional manner across
disciplines, but nurses struggle
at times to voice their professional
judgment without appearing
to stand in judgment of the
physician. How to address those
differences is a source of
significant stress for the
nurse.
Liability
issues also play a role in
our non-communication. To minimize
risks of liability, physicians
may order tests and initiate
treatments that are medically
unnecessary. According to the
Texas Medical Association,
fear of lawsuits drives 50%
of physicians to order invasive
procedures more frequently
than the physician believes
is medically warranted.
AND
holds promise as a tool to
improve communication with
patients and families. Chaplains
work in sensitive environments
with professionalism and skill
and are uniquely qualified
to facilitate communication
in this most difficult area.
By broaching this difficult
subject before the crisis of
a resuscitation attempt, AND
can provide all who stand by
a dying person an opportunity
to learn from the patient and
to make treatment decisions
that respects their values
and autonomy.
[1]
Lo B, McLeod GA, Saika G:" Patient
Attitudes to Discussing Life
Sustaining Treatment." JAMA.
1985; 253:2236-2239. Also cited
in AMA Guidelines on DNR, p.
3.
[2] Uhlmann, RF, Pearlmann RA, and Cain, KC: "Understanding of Elderly
Patients Resuscitation Preferences by Physicians and Nurses." West
J Med. 1989; 150:705-707.
Jeff
Lancaster, BCC, is Director of
Pastoral Care at Texoma Medical
Center in Denison, Texas, where
he has served since 1999. He
is endorsed with Cooperative
Baptist Fellowship and was ordained
in 1980. He received his M. Div.
in 1981 and D. Min. in 1990 from
Southwestern Baptist Theological
Seminary. He enjoys sailing,
gardening and playing with his
three dogs.
Do
you
have
thoughts
about
professional
practice
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like
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Advocacy |
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The Rev. George Handzo looks at
the world of Chaplaincy from a different
perspective —it's about trust
A
View from Portland (In Response
to Father Joe Driscoll)
I am thankful to my
colleague, Fr. Joe Driscoll for his
expansive and challenging vision
statement (A View from Above, #16).
I certainly agree with Joe on the
final goal —to make professional
pastoral care and counseling more
available so that more people who
are sick and suffering receive the
support they so need and deserve.
I also agree with Joe that we do
need foundational statements and
agreements that we can all affirm
and which speak with one voice —especially
to external audiences —about
who we are. The new common standards
for certification and common code
of ethics are major steps forward.
Common standards of practice including
assessment documents should be next.
However, in general, I would plot
a somewhat different means to the
same end. Everyone who knows me is
well aware that I intensely dislike
flying, or even high buildings. More
importantly, my time in pastoral
care leadership has convinced me
that any kind of “top down”approach
as suggested by Joe’s one building
in Washington is not the way to go.
Because of the kind of people we
are, personally and professionally,
any successful pastoral care and
counseling movement must be built
on relationships of collegiality
and mutual trust on a very individual
level. That is, it must come up from
the trenches. My ideal advocacy program
would be certified chaplains, empowered
by their national associations through
training, marketing materials and
research, working together at the
local level to raise the awareness
about professional pastoral care
through face-to-face meetings in
individual institutions.
I believe that the greatest stumbling
block to this reality is our continuing
mutual distrust. Even within our
individual tribes (associations),
we don’t trust each other very
much. The new common standards and
code of ethics which Joe Driscoll
helped to bring about have correctly
been trumpeted as major weapons in
our battle to establish ourselves
with external publics as a true profession.
However, a largely unrecognized and
maybe even more valuable benefit
is that they invite or even, I would
argue, impel those associations that
affirm them to open up to each other
and share the most intimate and closely
guarded inner sanctums of our individual
tribes —certification committees
and ethics grievance processes.
From a completely dispassionate
viewpoint, having common standards
should mean that there is no reason
why our certification processes cannot
be completely transparent to one
another. However, certification is
hardly a dispassionate business.
They are the heart and soul of who
we are as individual associations.
The common standards and codes of
ethics have given us an unprecedented
opportunity to build mutual trust.
If we can admit each other into our
individual Holy of Holies, just maybe
we will find that we can trust each
other on this most precious ground.
Just maybe we will find that those
from other associations will treat
our processes, values, traditions,
and particularities with the same
respect that we do.
The question is do we, individually
and collectively, have the will to
lay aside our fears and insecurities
as we do every time we step across
the threshold into a new pastoral
care encounter, and encounter each
other as pastoral care professionals
in this new way. On November 7th
in Portland, Maine, the door officially
opened. My hope is that we can all
walk through, certainly with fear
and trembling, but also with great
anticipation for the new relationships
that await us. And once we learn
to trust each other, the horizons
are unlimited indeed.
The Rev. George F. Handzo is The
HealthCare Chaplaincy’s director
of clinical services and institutional
relations. He has spent nearly three
decades in the field of multifaith
clinical pastoral care. A certified
healthcare chaplain and Lutheran Pastor,
the Rev. Handzo served as president
of the Association of Professional
Chaplains (APC) from 2002-2004. He
also served until recently as chair
of the Council on Collaboration, which
is comprised of the six major pastoral
care organizations in the United States
and Canada.
Do you have thoughts about advocacy
you’d like to share with your colleagues?
Send an e-mail to info@PlainViews.org.
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Education & Research |
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Linda Smith, RN on rediscovering
the healing power of
Bible Oils
Sent
to Heal and Anoint
(The following article
is based on a presentation
given at the 2004 Annual
Conference of the Association
of Professional Chaplains)
Why should chaplains
be interested in anointing?
Is it only symbolic or
is there any real healing
in the oil that is used?
In the scriptures they
weren’t using cooking
oils!
Throughout history,
people have created rituals
to celebrate, bless and
heal. “Anointing”meant
they would touch with
oil an individual, group,
sacred objects or even
their homes to signify
that a sacred connection
to God was being made.
It recognized the coming
together of the physical
world and the spiritual
world. Oil became a symbol
of the healing power
of God breaking into
the lives of people.
It was a sign of a unique
blessing that was healing
and sustaining. There
are over a 1,000 references
in the scriptures to
the use of oils but only
one formula given to
Moses for the people.
It contained Myrrh, Cinnamon,
Cassia and Calamus. Many
today believe it was
used to protect the Israelites
from a plague. Modern
science shows these oils
contain either immune-stimulating
or antiviral compounds
or both.
There were oils esteemed
as holy—frankincense,
stacte, onycha, galbanum,
and spikenard. Other
oils include those from
scented barks and resins,
flowers, roots and seeds.
We find references to
aloes, pine, fir, cedarwood,
cypress, hyssop, myrtle,
and Rose of Sharon.
To be anointed with
sacred oil in Old Testament
days was a sign of great
favor. When Jesus came,
he said he was God’s
anointed one. During
his ministry, he was
anointed several times
and taught his disciples
how to use aromatic oils
and then sent them out
to both heal and anoint.
Oils played an important
part in healing during
the early years of Christianity.
Christians privately
used oil, ointments and
salves that had been
blessed by the priests
for physical and spiritual
healing. There was a
strong belief among Christians
concerning possession
by evil spirits. Demonic
spirits are repelled
by their smell. They
fervently prayed, laid
on hands and anointed
all those who were sick
in body, mind and spirit. “Are
any among you sick? They
should call for the elders
of the church and have
them pray over them,
anointing them with oil
in the name of the Lord.”James
5:13
If anointing for healing
was so powerful, what
happened to it? Within
a few hundred years,
it was associated only
with the forgiveness
of sins and public penances.
Eventually it was taken
from the laity and given
to the priesthood who
anointed only the seriously
ill combining it with
absolution for sin. After
the reformation, anointing
and laying-on of hands
fell into disfavor not
to return until modern
times.
In the letter of James
to the church at Jerusalem,
the practice of prayer,
the laying-on of hands
and anointing with oil
is described as Christian
duty. Each act of anointing
opens us to the possibility
of receiving God’s
favor—God’s
healing grace. When we
take the very essence
of the plants, the essential
oils, and breathe them,
rub them on our bodies
or take them within,
we accept the gift of
blessing from God. We
are reminded that through
anointing, God has set
his seal upon our hearts.
So how can chaplains
incorporate healing oils
in pastoral care settings?
First—become knowledgeable
about the healing abilities
of therapeutic essential
oils. The Healing Touch
Spiritual Ministry program
(www.HTSpiritualMinistry.com)
offers a course called
Sent to Heal and Anoint
in its curriculum. I
recommend that you use
only therapeutic quality,
not perfume-grade, oils.
Just because an oil says
it is from the “Holy
Land”does not mean
it is a therapeutic grade,
especially if it is in
a clear vial. HTSM offers
policies/procedures to
guide you in the use
of anointing oils. Anointing
for healing is not the
same as “sacramental”anointing
performed by Roman Catholic
or Episcopal priests.
It is, however, an anointing
well within the duties
of a chaplain.
Linda
Smith RN, MS, HNC, CHTP/I
is a holistic nurse with
a passion. A former Catholic
sister, she is now president
of Healing Touch Spiritual
Ministry, Inc., an organization
with the goal of restoring
healing to Christianity.
She is the author of three
books including Called
Into Healing, Reclaiming
our Judeo-Christian Legacy
of Healing Touch and
most recently, Healing
Oils Healing Hands, Discovering
the Power of Prayer, Hands
On Healing and Anointing.
She has a private practice
in healing in Arvada, Colorado
and teaches courses on
healing throughout the
U.S. and Europe.
Do you have thoughts
about education & research
you’d like to share with
your colleagues? Send
an e-mail to info@PlainViews.org. |
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Spiritual
Development |
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Chaplain
Mark L. Allison on a
day when all present
looked to the Divine
together
A
Chaplain's Prayer
(The
Managing Editor received
this story and prayer
from Chaplain Mark
L. Allison, who is
still serving in Afghanistan.
The event that he is
writing about occurred
on Monday, September
5, 2004 at Jik-dalek,
Afghanistan.)
The following
prayer (as best I can
recall it) was offered
before an open-air assembly
of approximately 50 local
Afghani’s…all
men and young boys, including
the village elders, local
militia leaders, the
doctor and the mullah/school
principal at the remote
village of Jik-dalek
located on the eastern
side of Afghanistan near
the border with Pakistan.
We landed at this remote
village in two Army Chinook
helicopters loaded with
pallets of donated goods
from Utah to distribute
to the locals. Accompanying
me were 38 American soldiers
and a native born Afghani
interpreter who has long
lived in America but
who has now returned
to help his countrymen.
After the frenzy of
the goods distribution
and the announcement
that the American Military “Mullah”was
going to pray, most of
them instantly chose
to kneel upon the ground
and clasped their hands
together in an attitude
of reverence and attention.
Seated before them on
three chairs was myself
flanked by the mullah
on my right and the village
doctor on my left. In
contrast to the preceding
noise and commotion of
the goods distribution,
the public mood instantly
changed to sacred and
worshipful.
With the aid of the
American hired interpreter
Shah, I began to pray
in a deliberate sentence-by-sentence
manner to allow time
for accurate word-by-word
interpretation for the
people. It was a very
special experience to
be among and pray for
these severely impoverished
and humble people who
showed me, an American
and a Christian Chaplain,
the utmost respect. When
I concluded, the mullah
(Mohammed I’Yoob)
prayed a short prayer
in the native language
of Dari followed by the
doctor (Dr. Maroop) who
requested he too be allowed
to pray. Their prayers
included expressions
of gratitude to God for
the Americans who had
come to help them rebuild
their country and establish
peace. It is my belief
incalculable good was
accomplished that day
through this experience
of practical assistance
and prayer.)
Heavenly Father, the
God of all people…of
Afghans and Americans
Today as Muslims and Christians we pray together and express thanks and ask
your blessings.
We pray for the people
of this village…the
men and women and all
who live here…may
they be blessed.
We pray for the children…the little boys and little girls; especially
those who are sick or injured
May they be comforted and healed.
We pray for the local
leaders, the elders,
who have the responsibility
to govern, may they
be blessed with wisdom
in their duties.
We pray for the mullah that he will be blessed in his important responsibilities.
We pray for the doctor that he will be blessed with “healing hands”and
skill to bring comfort and relief.
We pray for this land
that it will produce
crops of vegetables
and fruits.
We pray for the whole country of Afghanistan and that the upcoming elections
will provide for a future of freedom…and that peace return to this
land.
May these items provided
today of clothes, shoes
and food be remembered
as gifts of friendship
between Americans and
Afghans.
These blessings we
ask together this day
in the name of the
God of Abraham, Isaac
and Jacob, and of Mohammed
and Jesus.
Amen.
Chaplain Mark Allision,
is a Board Certified Chaplain
and a clinical member of
the ACPE. He is the Chaplain,
Director of Spiritual Care
at the University of Utah
Hospital and Medical School
. Mark was an active military
chaplain from 1986-1995,
was a Marine Corps Reservist
from 1995-1998 and currently
serves the Utah Army National
Guard. He received his
MA in Marriage and Family
Therapy and was a hospice
chaplain as well as a bereavement
and grief counselor. He
is ordained a High Priest
in the Church of Jesus
Christ of Latter-day Saints
and is Commissioned as
an officer and chaplain
by the Department of Defense
as a Military chaplain.
Do you have thoughts
about spiritual development
you’d like to share with
your colleagues? Send
an e-mail of any length
to info@PlainViews.org. |
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EthicsWalk |
EthicsWalk addresses
spiritual care as an ethical
enterprise. It explores why
relationships between spiritual
care providers and those
they serve need protection,
and examines what that protection
entails. PlainViews invites
our readers to share their
responses to each EthicsWalk column,
which will be published in
the following issue.
If
you’d like to respond to EthicsWalk,
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 “EthicsWalk”
in your subject line.
We look forward to hearing
from you.
Bounded
Intimacy
Codes
of Ethics and work place
policies are external guides
to professional conduct.
What are the internal guides?
How does one discern them?
How are one’s
abilities and vulnerabilities
used to assist those in one’s
care?
Power
between giver and receiver
is always imbalanced during
professional care. Fiduciary
(trust) duty requires the
giver focus the relationship
to benefit the receiver.
Ethics codes and policies
are deontological. Deontological
requirements must be balanced
with the teleological realities
of individual care receivers.
Professional judgment and
personal discernment can
never be replaced by rules.
But the anarchy of personal
desire is not an acceptable
alternative.
That
said, is there a concept
to guide how one shares the
self that enriches one’s
professional persona? Literature
in social work, psychology
and ministry suggests “boundaries”[1]
may.
Websters
Dictionary defines
a boundary as “something
that sets a limit.”Ethicist
Rev. Marie Fortune says, “Boundaries
are a means to attend to
our relative power and
vulnerability in any relationship
without doing harm.”Boundaries
promote the ethical values
of beneficence, non-maleficence,
autonomy and respect for
persons.
Aspects
of chaplaincy relationships
implicating boundaries are:
1. Intimacy: emotional, spiritual, sexual;
2. Friendship: is mutuality in relationship ever possible between professional
care provider and receiver given the latter’s heightened vulnerability?
3. Finances: should a care-giver ever borrow/loan money from a client/patient?,
be trustee for patient’s funds? Accept gifts or money?
4. Information: gathering more than is needed? Disclosing inappropriately?
5. Confidentiality: failing to know what must be shared? Failing to warn
patient of requirements to share? Chattering on the elevator? Sharing
with one’s domestic partner?
6. Promises: of more than can be delivered by the care giver’s
own skill or role, the program; the institution within which the relationship
occurs.
Are
boundaries boarders which
separate a spiritual care
giver, from those served?
Or, are boundaries points
of contact at which people
meet, but which allow the
provider safely to maintain
enough separation to focus
on the other’s
best interests rather than
on the provider’s
own needs or the other’s
inappropriate requests?
Observing
boundaries need not remove
warmth. Miriam Greenspan
of the Stone Center says, “Boundaries
do not mean ‘detached
neutrality,’boundaries
need to be about passionate,
but trustworthy engagement.”Enmeshment/friendship
at one end of the spectrum
or “power-over”professional
hierarchy do not define the
full range of appropriate
relationships.
Some
ethicists [2] invite recognizing
moments in the middle range –which
occur more frequently and
safely as the professional’s
skills and experience increase.
Boundaries may be navigated
for the other’s
benefit and in consultation
with a supervisor or mentor.
Professional care relationships
should not coexist with personal
ones. However, once the professional
relationship terminates and
time passes, friendship may
occur when initiated by the
care receiver [ except for
psychotherapist-client relationships
which remain forever professional].
Boundaries
insure space for the unique
intimacy of a pastoral relationship
in which neither person has
to worry, wonder or fantasize, “where
are these special encounters
going to lead?”The
answer is assured: on a sacred,
companied journey with the
Holy One.
[1]
Useful discussions found in: Sex
in the Parish,
Lebacqz, Karen and Barton,
Ronald. Westminster/John Knox,
1991; Ethics
and Spiritual Care,
Lebacqz, Karen and Driskill,
Joseph. Abingdon Press, 2000; At
Personal Risk,
Peterson, Marilyn. Norton,
1992; The
Abuse of Power: A Theological
Problem,
Poling, James Newton. Abingdon
Press, 1991; Boundary
Wars: Intimacy and Distance
in Healing Relationships,
Ragsdale, Karen Hancock. The
Pilgrim Press, 1996; Sex,
Priestly Ministry, and the
Church,
Sperry, Len. Liturgical Press,
2003.
[2]
Ethics professors Karen Lebacqz
and Ronald Barton, among others.
Anne
Underwood has an undergraduate
degree in religious studies,
a master’s degree in rural
sociology and a mid-life
law degree obtained after
working over a decade as
a college administrator.
She has mediated for the
Maine family courts since
1983. Currently she serves
as an advisor to the ethics
commissions of ACPE, APC,
the CCAR (Central Conference
of American Rabbis), and
NAJC, and consults with a
variety of Protestant faith
communities on issues of
power, fair process, and
congregational conflict management.
Her articles on mediation
and restorative justice have
appeared in the ACPE News,
The APC News and on the ACPE
web site. Articles on clergy
accountability and judicatory
processes are published by
the Alban Institute and The
Journal on Religion and Abuse. A
chapter, “Clergy Sexual Misconduct:
A Justice Issue,” appears
in Body
and Soul: Rethinking Sexuality
as Justice-Love,
Marvin Ellison and Sylvia
Thorson-Smith, editors, The
Pilgrim Press, 2003.
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Reviews |
Macky Alston reviews
the film This
Far By Faith
This
Far By Faith
This Far by
Faith explores
the heart and soul
of African-American
faith in six hours
of dramatic storytelling
that chronicles
religion in the
Black experience
from the days of
slavery to the
battle for equal
rights. For pastoral
caregivers, this
comprehensive and
in-depth series
provides an engaging
resource for education
and inspiration.
The series covers
the evolution of
African-American
religious thought
and G_d as a Negro,
then journeys from
the rural South to
the industrial North
through the stories
of gospel music pioneer
Thomas A. Dorsey
and urban church
activist Cecil Williams.
The second half of
the series focuses
on Jim Crow and the
civil rights movement,
the paths of those
African Americans
who find spiritual
fulfillment outside
of Christianity and,
finally, an interfaith
pilgrimage from Massachusetts
to Senegal via New
Orleans and the Caribbean.
It’s noted
in the series that
in many African cultures
there is no word
for G_d, because
G_d is in every thing
and every place.
As we enter the 21st
century, This
Far by Faith leaves
open the question
of whether Black
churches can retain
their centrality
in the struggle for
equality and dignity
in this country.
Macky Alston is
the director of Auburn
Media, a division of
the Center for Multifaith
Education at Auburn
Theological Seminary
committed to supporting,
cultivating and promoting
powerful, engaging,
balanced and responsible
media on religion,
spirituality and ethics.
He is a graduate of
Union Theological Seminary
and an award-winning
documentary filmmaker.
This Far by Faith is a co-production
of Blackside, Inc., and The Faith Project, Inc.
produced in association with The Independent
Television Service
Completed: 2003
Running Time: 360 Minutes
Producers: W. Noland Walker, June Cross, Leslie D. Farrell, Valerie Linson,
Alice Markowitz, Lulie Haddad
Executive Producer: June Cross
If you are interested in purchasing this film,
you can do so on the Hartley Film Foundation
Web site at www.hartleyfoundation.org. Just click
on “Masterworks”on the homepage for
more information. The cost for the six-part VHS/DVD
series is $199.95.
Do you have thoughts about reviews you’d like
to share with your colleagues? Send an e-mail
to info@PlainViews.org.
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