 |
|
|
.gif) |
 4/21/2004
Vol. 1, No. 6
 |
|
Professional
Practice |
| |
The Rev.
Martha R. Jacobs on the
importance of Advance
Directives
The
Importance of Advance
Directives
Terry Schiavo
has been in a coma (some
say a persistent vegetative
state) in a Florida nursing
home, brain damaged and
supported by a feeding
tube, since 1990. Her
case has created a level
of awareness in the U.S.
not seen since the celebrated
cases of Karen Ann Quinlin
and Nancy Cruzan first
raised the consciousness
of the need for advance
directives. As the United
States Supreme Court
ruled in 1990, individuals
have a right to self-determination,
but they need to tell
someone what their wishes
are before they become
incapacitated. Most
states responded by allowing
the creation of Living
Wills, documents in which
individuals can stipulate
what medical treatment
they want or do not want
to receive.
My experience
is that in most cases,
unfortunately, the provisions
of a Living Will do not
cover every contingency.
They have sometimes been
overruled by ethics boards
when the patient did
not clearly state his
or her wishes in a particular
situation, such as when
not to resuscitate. Or,
families and/or medical
care givers resist carrying
out the patient’s wishes
as stated in a Living
Will. In New York and
Missouri, the standard
is higher than a Living
Will in that you must
actually name someone
to make your healthcare
decisions for you. This
“Health Care Proxy,”
only takes effect if
the person cannot make
decisions for him/herself.
Even if not required
by law, I believe more
patients should name
a Health Care Proxy,
and take the time to
discuss with that person
their wishes regarding
resuscitation, artificial
hydration and nutrition,
respirators, and other
life-prolonging treatment.
This removes the ambiguity
surrounding a Living
Will and gives one person—who
knows the patient’s wishes—complete
legal authority in medical
decision making.
The problem
with all of these directives
is that most people do
not want to talk about
the possibility that
they might die. Some
people think that when
they sign a Living Will
or a proxy that they
are “jinxing” themselves
and that they surely
will die soon. Not to
make light of this thinking,
but each of us is going
to die at some point
in our life. Further,
death is rarely spoken
about, even from the
pulpit. This shows a
lack of clarity even
for clergy on this issue.
Imagine how our congregants
must feel about this
when we, who are supposed
to have a “closer” relationship
with G-d, can’t even
talk about death, other
than on Good Friday (if
then).
As a chaplain
I am often puzzled by
the desire of people
to stay alive for as
long as possible. Is
it the fear of death?
Is it the fear of not
knowing whether or not
they will go to heaven?
The paradox for me is
that some people say
that when it is their
time, “G-d will take
them.” Being hooked up
to machinery that prolongs
ones life, in my opinion,
is not letting “G-d take
them.” People want to
hold out for miracles.
Miracles happen with
and without respirators.
If we believe in G-d
and, for some religions,
some sort of life after
death, then why are we
afraid to die? Our bodies,
which I believe were
created by G-d, were
not created to live forever;
our bodies deteriorate
and so do our minds.
We were clearly not created
to outlive our physical
bodies.
It is a
real quandary for me
as a chaplain. I have
been trained to put my
own views aside when
families are looking
for guidance. I often
watch families struggle
with trying to make decisions
for their loved one who
is clearly dying, having
never had a conversation
about what their loved
one wanted. It makes
me wonder if we are really
helping humanity with
all of the mechanical
means we have for keeping
people alive, sometimes
well beyond even what
is humane.
I know
that there is no easy
solution to this dilemma.
As long as people feel
the need to live longer
and longer and are fearful
of death, this will continue.
Our role as spiritual
care givers should be
to help individuals accept,
if not embrace, the idea
that eventually they
will die. Naturally,
as chaplains we need
to have accepted that
for ourselves as well.
We need to speak out
in our hospitals, nursing
homes, pulpits, and our
personal lives to ensure
that people complete
advance directives so
that their wishes can
be honored at the end
of life. Families deserve
to savor any remaining
time with their loved
one and not spend that
precious time fighting
over whether or not to
prolong life by artificial
means.
The Rev. Martha R. Jacobs,
BCC, is the Managing Editor
of PlainViews. She
is an APC Board Certified
Chaplain and is currently
pursuing her doctorate of
ministry, focusing on the
attitudes of clergy around
death and dying.
|
 |
|
Advocacy |
| |
|
Chaplain Jane Mather on HIPAA and
Empowering the Patient
HIPAA
– Empowering the Patient
Recently the enactment of the new HIPAA* regulations with regard to privacy
have added an extra and troubling burden to the delivery of spiritual care.
Those compelled to implement the privacy laws struggle to reconcile the conflicting
obligations of providing patients with access to spiritual care while simultaneously
protecting their right to confidentiality.
There are numerous places where
the concerns about HIPAA have been
carefully explained and the various
“rules” and “players” defined.
The negative ramifications of HIPAA
are frequently documented, not
just by those involved in the effort
to deliver spiritual care, (who
seem to have taken a heavy hit
by the changes brought about by
HIPAA) but by many others impacted
by the cumbersome changes. There
are still misinterpretations of
HIPAA being applied in healthcare
facilities that impinge on the
rights of patients, clergy, and
chaplains, and those still need
to be addressed. This short essay
should not be seen as an effort
to negate those concerns, but rather
to offer another perspective.
The intention for HIPAA has been
to insure privacy for each person
rendered vulnerable to unwarranted
exposure by either well-meaning
or unscrupulous practices involving
patient information. Implementation
of these protective changes has
shaken up the way things “had always
been done” with and for patients.
The results have been somewhat
disorienting, but change is almost
always disorienting. If that inherent
discomfort were removed from the
equation, HIPAA – as it relates
to spiritual care services – is
actually all about empowering,
not just protecting patients. The
new rules return to patients the
right to take charge in a way and
at a time when there is very little
autonomy allotted them! What “had
always been done” involved clergy
having the freedom to visit patients without patients
having the opportunity to gracefully
decline. There were many scenarios
in which the pastor/patient visit
in the hospital proved awkward
and disquieting for patients, but
since the rules of the hospital
and the rules of pastoral propriety
favored visitation, patients had
little choice.
In the hospital setting, patients
are accustomed to sacrificing their
right to making small choices once
they’re admitted. Other than what
to have for breakfast and the right
to leave without being treated,
patients have few opportunities
to exercise autonomy or control
(and sometimes even breakfast is
prescribed). Consequently, the
lack of autonomy with regard to
a pastoral visit was consistent
with the rest of the hospitalization.
Spiritual care was provided during
clergy visits, so both clergy and
hospital had fulfilled their obligations,
but at what cost? The new changes
may result in the loss of unsolicited,
but possibly salutary pastoral
contact, but the reward is that
HIPAA returns some modicum of autonomy
to the patient during their care.
If HIPAA were fully understood,
supported and implemented, pastoral
visits would still occur – but as
a result of the patient’s request
and at a time of his or her choosing.
Rather than pastors, priests, and
rabbis routinely initiating visits
to very sick patients – patients
who may or may not be comfortable
while under-dressed, over-medicated,
or following embarrassing surgeries
– clergy can now respond to the
parishioners' defined needs and
at a time when they might really
be open to the spiritual content
of the visit.
It seems to me that patients’
being empowered to say when and
whether to be visited by their
clergy has a distinctly positive,
even spiritual value – a reminder
that despite whatever physical
vulnerability brought them into
the hospital, they are still able
to exercise functional free will
and moral agency. Empowerment strengthens
overall outcomes and the conscious
involvement patients take in their
own healing processes. It may be
a stretch to attach such lofty
results to HIPAA’s convoluted legalistic
rhetoric, but each time I distill
it down I’m left with the same
basic answer – HIPAA’s shift in
control from the hospital and the
pastor to the patient has the potential
to be a good thing!
* The U.S. Health Insurance and
Portability Act (HIPAA) which took
effect in April 2003 established
privacy standards that provide
patients with access to their medical
records and more control over how
their personal health information
is used and disclosed. For more
information visit http://www.os.dhhs.gov/news/facts/privacy.html
Chaplain Jane Mather, a member
of the PlainViews Advisory
Board, is director of pastoral care
at Winthrop-University Hospital,
a HealthCare Chaplaincy partner institution.
Seeking a more diverse ministry,
Chaplain Mather came to New York
from Spokane, Washington, where she
last served as manager of pastoral
services for Empire Health Services,
a two-hospital, 475-bed system serving
two trauma centers. A Roman Catholic
lay person, Chaplain Mather is a
member of several professional organizations
including the National Association
of Catholic Chaplains and the Association
of Clinical Pastoral Education.
 |
|
Education & Research |
| |
|
Imam Ramadan Zakat writes
about his pilgrimage
from CPE
student to CPE supervisor
My
CPE Pilgrimage—From
Student to Supervisor
As an imam, spirituality
has always been a big
part of my life. But
my pilgrimage into
CPE began when my cousin
Donald died from AIDS
in 1996. I needed some
answers and, at the
time, just reading
scripture was not enough.
I was also working
part-time as a security
guard for Rap stars,
a bail enforcer, and
an alcoholism counselor.
After my cousin died,
I talked to friends.
One of them told me
about CPE. He said
it would force me to
confront my deepest
emotions.
When I enrolled in
CPE, I thought I was
there to learn to teach
patients religion.
I approached the process
as a doer rather than
a learner. But I soon
I opened my mind to
being a student, and
I began to realize
it was a very different
experience, one I knew
I needed.
Intense daily interactions
with others in the
hospital raised personal
questions: How do I
understand God to work
in the world? What
family traits, what
old hurts do I bring
to my ministerial relationship?
How is my past repeated
in the present? How
easy is it for me to
accept criticism? Eight
months after my cousin’s
death, I was working
on an HIV/AIDS unit
(a placement I chose),
and constantly dealing
with my own emotions.
I worked with five
wonderful CPE supervisors
at The HealthCare Chaplaincy
who, each through their
own gifts, helped me
to learn from my emotional
reactions and to grow
in my ministry. They
changed my life and
my work so much, that
it inspired me to think
about becoming a CPE
supervisor myself.
The Prophet Mohammed
spoke very highly of
teaching— it’s an obligation
in Islam, to teach
all people, even those
outside the Muslim
religion. I enjoy helping
people explore; I learn
from the students as
much as they learn
from me.
There are only two
board certified Muslim
chaplains in the world—myself
and Al Hajji Yusuf
Hasan. There are no
Muslim supervisors.
My becoming certified
will help me to attract
more Muslims and African
Americans to the field
of CPE. The ideas used
in CPE are often foreign
to many African Americans
who do not readily
talk about their feelings
openly. But I believe
they will be receptive
with the right kind
of education. CPE encourages
people to speak honestly
about what they’re
feeling, and through
that process become
more able to be present
for others.
This September I was
granted candidacy status
by the ACPE Eastern
Region Certification
Committee to become
a CPE supervisor— a
difficult challenge.
I couldn’t have done
it alone; the support
I received from my
supervisors and colleagues
are what made this
first step possible.
I am the first Muslim
to take this path.
Anytime anyone takes
a new course, there
will be bumps and bruises.
But because of where
this path leads – for
me and for my community
– there is no question
that I will stay the
course. And I know
my friends and colleagues
will be there to help.
Imam Ramadan Zakat
is a supervisory resident
at Beth Israel Medical
Center, a HealthCare
Chaplaincy partner institution.
He was granted candidacy
status by the ACPE Eastern
Region Certification
Committee and, when fully
certified, will be the
first Muslim CPE supervisor
in the world. |
 |
|
Spiritual
Development |
| |
|
.gif) Vicki Polin, MA on remembering
to exhale
Remembering
To Exhale
Don't you just hate it when you're upset, and someone tells you to take a
deep breath and exhale? I know for myself that used to be the last thing
I wanted to hear. I remember thinking yeah right, what is breathing going
to do! But, remembering to breathe is just one of the many things we can
do when we're feeling badly. I've learned that if I don't exhale, I begin
to lose control of my life. By just remembering to breathe in — and OUT
— I can do just about anything.
When we are surprised, shocked, panicked, stressed, or have flashbacks —
we automatically inhale fast and deep, but usually forget to exhale. After
several years of keeping our breath inside, our feelings also build up and
we begin to feel stuck. When this happens we begin to feel like we can't
do anything.
Why is it so important to breathe? When you stop breathing, your brain stops
receiving oxygen. When that happens, you can't think clearly, and you can't
solve problems. I know for myself when I can't solve problems I start to
feel stuck, helpless, unable to move beyond the point that I'm at.
If you stop and think about it there are several types of breathing. One
is the kind women learn in Lamaze classes. They teach mothers-to-be to reduce
labor pains, with two short breaths out, and one long, deep breath in. Remember,
the key concept to relieving pain is breathing out. This is true for both
physical and emotional pain.
When we are about to take a test at school, for a job, confront someone about
something that bothers us, we may take a deep breath in, but how many of
us remember to let it go? I wonder how many deep breaths are stuck inside
each and every one of us. How many of the feelings attached to those breaths
are also stuck inside us? I also wonder how many of us develop stress-related
illnesses because we forget to let go of our breath. Breathing in and out
can help us think more clearly, and alleviate stress and anxiety. Paying
attention to our breath can also help bring us back to the here and now,
when we are having flashbacks, or when we are frightened by a memory and/or
thought.
I think the two most important things about breathing is that we all know
how to do it, and it’s free. You don't have visit the doctor to get a prescription
to breathe. We are born already knowing how and when to breathe. I've never
heard of anyone overdosing from taking slow, long, deep breaths and then
exhaling slowly. I don't think I've ever heard of anyone dying from it either.
So the next time someone reminds you to breathe, remember he or she is trying
to help you learn to live.
Vicki Polin is the
executive director of
The Awareness Center
- The International
Jewish Coalition Against
Sexual Abuse/Assault
(JCASA). For more
information visit http://www.TheAwarenessCenter.org
© Vicki Polin, MA, ATR, LCPC
|
|
|
|
| | |
|
| |
.gif){kind=spacer}
