11/16/2005 Vol. 2, No. 20

Professional Practice

Advocacy

Chaplain Anne M. Vandenhoeck on the European Union and its impact on chaplains

Editor’s note: As you will see, this article exceeds the word limit. A decision was made to allow this because of the need to provide a more in-depth explanation for our non-European readers, hoping that this will lead to a deeper understanding of what is happening for our European colleagues.

A Challenge for the European Network of Health Care Chaplains

The European Union (EU) has some issues to tackle. Before the summer started, a referendum in France and The Netherlands resulted in a “no”to the proposed constitution. In order to understand what that means, it is essential to know that the European Union is facing a cross road: either it will choose the direction of remaining a free market space or it will become a Community with political power. The Constitution was an important step towards the latter. A “no”vote from the public of two major European players is a sign of an underlying crisis. Specialists refer to two causes of uneasiness by the public: the growth of the European Union and the issue of admitting Turkey. The first reason has to do with the richer countries’fear of having to share resources and wealth with the mainly Eastern European countries, which are eager to become members. An important part of the public feels the Union is growing too fast and that there is a gap between themselves and the EU officials. The second reason has to do with the admitting of a Muslim country to the Union. Political issues, human right issues and freedom of religion play a major role in this discussion. It is also reasonable to state that the “no”vote of the French and the Dutch is a way to revolt against their national governments. It stands without doubt that the European Community has also other impending problems, like its financial plan for agriculture.

In the midst of all this turmoil the European Network of Health Care Chaplaincy (ENHCC) attempts to integrate health care chaplaincy into the structure of the European Union. [1] Father Stavros Kofinas, coordinator of the ENHCC, and I went to Brussels last June to meet with three EU officials: Dr. Weninger, Policy Advisor Concerning Dialogue with Religion, Churches and Humanism and the EU, Dr. Trakatellis, Vice-President of the EU Parliament and member of the Committee of Public Health, and Mr. Schinas, Director of the Office of the Commissioner of Public Health. We were well received and two immediate results were noticeable: 1) The ENHCC became a partner in dialogue of Dr. Weninger, and 2) The ENHCC is negotiating with the Office of the Commissioner of Public Health to become a part of the EU’s ambitious plan on Palliative Care.

Two problems may occur in the new challenges that the ENHCC faces. The first has to do with the political situation of the EU as described above. In case the Union returns to being a free market space, issues like religion and spirituality will not be included. Even when the EU moves on towards a political power, there is a strong current to fight any attempt to include religion, churches or humanism in the structure and workings of the EU. An important part of the EU parliament advocates for a complete separation of “Church and State”stating that the European Union has nothing to do with religion, churches or humanism and thus neglecting the daily life of an important part of the public. [2] The second possible problem has to do with the internal workings of the ENHCC itself. Father Stavros Kofinas, coordinator of the network and representative of the Ecumenical Patriarchate, writes the following in his coordinator’s report:

“Our encounter with the members of the EU has placed the ENHCC on another level of maturation, giving it new challenges and opportunities. We must all ask ourselves if we are ready and willing to take them on. In order to respond to these challenges, it is necessary that we form an even more tightly woven Network, increasing interaction amongst our-selves and responding to the different aspects of the Network in a more positive way.”[3]

Up until now the Network has been a platform for national chaplaincies to exchange and share. The 44 representatives of chaplaincy organizations in 29 countries have been coming together every two years to exchange experiences, challenges and issues of health care chaplaincy. A committee of six members, including the coordinator and the webmaster, prepares the biannual consultations and keeps the Network going in the meantime, providing chaplaincies with information. But in between consultations, it is hard to get responses from the national representatives on occasions that require just that. There are some reasons for that. The main one probably lies in the fact that European chaplaincies are strongly organized per country. Every national chaplaincy organisation deals with its own societal and health care culture and its own religious or spiritual context. National chaplaincy issues take priority over European issues. And although many issues have a common ground, it is not easy to tackle them together.

There is also a language problem that cannot be underestimated. Twenty-nine countries mean at least as many languages, and English, although the official language of the Network, is not for everyone a second language. Another reason might be that chaplaincy issues are by many churches considered to be primarily an internal affair. Last but not least one has to emphasize that the Network is still very young. It was officially formed in 2000 and its constitution was approved at its last consultation in 2004. The new challenges brought to it by the EU contacts demand a growing engagement of the national chaplaincy organizations. It is therefore important that the national organizations are well informed about developments on all levels and find ways of cultivating a firm working relationship between each other and as a whole within the ENHCC.

The next consultation in Lisbon, May 2006, will be crucial in that matter. The theme of the consultation says it all: “Building bridges - Growing hope”. In growing, it will be important for the Network to be aware of the difficulties the EU has encountered: finding its own rhythm to grow both on an internal level and on the level of building bridges to other organizations, enhancing communication between its participants and the Network Committee. This offers a new challenge for all the participants of the ENHCC. Hopefully in Lisbon, the challenge will be met.

[1] Since 1990, representatives of European Chaplaincies have been coming together every two years to exchange their experiences in spiritual health care. In November of 2000, the European Network of Health Care Chaplaincy (ENHCC) was formed at the 6th Consultation that took place at the Orthodox Academy of Crete, organized by the Ecumenical Patriarchate. Based on the “Cretan Declaration”, the Network is the largest body composed of official representatives from all the Christian denominations and chaplaincy organizations of Europe, which provide pastoral care in various health care facilities. The Network aims at mutual sharing and understanding both on a religious, cultural and organizational level. It brings together the various chaplaincy experiences of all the health care systems in Europe. Today 44 organizations from 29 countries are represented in the ENHCC.
[2] A recent example again is the Constitution. Despite long discussions and pressures from religions and churches there is no reference to God in the European Constitution.
[3] The coordinators report of July 8th, 2005. For the full text please go tot our website: www.eurochaplains.org

Do you have thoughts about advocacy you’d like to share with your colleagues? Send an e-mail to info@PlainViews.org.

Education & Research

The Rev. Dr. Jeffery T. Garland on thinking differently about one’s call

The Value of Research That Leads to an Advanced Degree

After completing my Master of Divinity degree at New York Theological Seminary in 1998, I thought that I was finished with the formal classroom setting and actually did not think I would desire to enter a doctorate program. My denomination requires a master of divinity degree in partial fulfillment in order to become ordained. The doctor of ministry degree was something I completed for myself and my ministry. I sensed a need to think differently about my calling and approach to ministry especially because it does not involve being a pastor of a church at this time. My passion and calling in ministry is in the area of hospice and palliative chaplaincy.

As an African American male, my clergy peers have difficulty understanding exactly what I do. Is it possible to perform God’s will at the bedside of a terminally ill patient as their loved ones stand by? Can I feel like I am doing God’s work without wearing a robe or standing behind a pulpit? Not only is the answer yes to all of the above, but it can also be researched and documented as a Doctor of Ministry project.

My ministry in hospice and palliative care began in 1996 when I took clinical pastoral education units at The Healthcare Chaplaincy in New York City. During the next three years I was exposed to a type of ministry outside of the church and one that seems very private at times. Chaplaincy training exposed me to my weaknesses and the weaknesses of those with whom I would later come into contact. After completing the four units of CPE, I chose to go before a board of my colleagues to become a board certified chaplain, a BCC. Looking back I believe going before the Association of Professional Chaplains certifying board for approval taught me a new understanding of what it feels like to be vulnerable and to listen to constructive criticism.

It was at the Theological School of Drew University that I tested my pastoral leadership skills and completed a professional doctoral project and thesis. My dissertation is entitled Hospice and Palliative Care: Educating an African American Community in Newark, New Jersey. My research involved establishing a “Covenant of Churches”with six pastors in Newark, New Jersey communities that had various membership sizes. I explained to the pastors the philosophy of hospice and palliative care and the need to educate African American congregations about end-of-life care issues.

The second stage of my project involved visiting each of the six churches and conducting a six-to-eight hour seminar which included lectures from a medical physician, licensed social worker and a trained volunteer. At the end of each seminar a questionnaire was handed out and feedback was recorded. Lastly, I took the information that was gathered and presented the results to the president & CEO and the executive staff at Saint Barnabas Hospice and Palliative Center. It was my theory that not only the African Americans of Newark, New Jersey needed to be educated, but predominantly corporate white institutions also needed to be educated about the ethos of the communities in which they/we serve.

After numerous revisions and editing, my dissertation passed and I graduated from Drew University in 2004. My project findings and result were submitted to the American Hospital Association 2004 Circle of Life Award committee for innovative projects and it won the Citation of Honor Award.

I strongly encourage all pastoral leaders who are doing great things in ministry to document their research and project thesis. I never considered myself a great writer or great theologian, but I know that God has given me a passion to care for those who are dying. It was my passion for chaplaincy that sustained me through it all and if you have that passion it will do the same for you.

The Rev. Dr. Jeffrey T. Garland, B.C.C., a member of the PlainViews Advisory Board, is staff chaplain at the St. Barnabas Hospice and Palliative Care Center in Millburn, New Jersey, and chairs the multicultural/multiethnic committee of the Association for Professional Chaplains. He received his doctorate at the Theological School at Drew University in Madison, New Jersey, writing a thesis entitled Hospice and Palliative Care: Educating an African American Community in Newark, New Jersey. Chaplain Garland served for five years as a special agent with the Federal Bureau of Investigation. In 1994 he resigned from law enforcement and answered his call to ministry by enrolling full-time at New York Theological Seminary, completed four units of Clinical Pastoral Education and received a master of divinity degree in 1998. He also earned a Bachelor of Science degree in healthcare administration from Nova University in Fort Lauderdale, Florida, his native state. Chaplain Garland is an ordained minister with the American Baptist Churches, U.S.A.

Do you have thoughts about education & research you’d like to share with your colleagues? Send an e-mail to info@PlainViews.org.

Spiritual Development

Faroque A. Khan, MB, MACP on being thankful

A Day of Gratitude and Challenge for American Muslims

Thanksgiving is my favorite American holiday. No denominational strings are attached. It has not been taken hostage by an extravagance of gift giving or the burdens of shopping. Built around the family meal, the feast celebrates the exquisite tension between appetite and its satisfaction.

Legends of Thanksgiving evoke the conflict between white European settlers and the native peoples who welcomed them but, even so, this holiday emphasizes inclusion more than displacement. Generations of varied immigrant groups have identified as Americans by embracing this holiday –and its peculiar menu.

What I love most is Thanksgiving's underlying idea that existence itself is a gift. If the holiday ritual calls for the bounty of culinary excess, it is not to celebrate affluence but to acknowledge the accidental richness of life itself. The multiple desserts are tribute to all that we don't deserve. In taking time away from work, we are remembering that the most precious things are those that we do nothing to earn.

As a Muslim immigrant from Kashmir, I am a part of America's journey. I did not leave my history behind at Immigration's door. Our various immigrant pasts and shared present are wedded in hyphenated names: Arab-Americans, Indian-Americans, Pakistani-Americans . . . or Kashmiri-Americans.

In some parts of the world our differences would be threatening, but in America, we feel enriched. Our differences resonate in our names, language, food, and music. They inspire art and produce champions and leaders. We feel free to disagree. We are a family, and what is a family gathering without debate?

We are thankful for the freedom to speak our minds. We are thankful for the freedom to change our minds. We are thankful for the freedom to chart our lives. We are thankful for the freedom to work for a better world.

Remembering the words of Surah Nisaa (Qur’an 4:97), we thank God for giving us, “a spacious land”of freedom and opportunity, to which Allah has allowed “migration of the weak and oppressed," so that we may live and prosper. This verse describes the experience of millions of arriving immigrants when they first saw the Statue of Liberty, with its inscription penned by Emma Lazarus, a descendant of Jewish immigrants: “Give me your tired, your poor, your huddled masses yearning to breathe free.”

In America, each of us is entitled to a place at the Thanksgiving table.

However, while we thank Allah for all the gifts that have been bestowed on us, we are mindful of the challenges facing American-Muslims.

One out of four of our fellow Americans hold very strong anti-Muslim views. The good news is that when people have access to accurate information and relate to ordinary fellow citizens who are Muslims, their perceptions and stereotypes change dramatically. Our Jihad –our struggle, challenge –is to reach out to our colleagues, neighbors and co-workers.

There are nine principles adopted from the Sunnah (life) of Prophet Muhammad (peace be upon him), which can guide in reaching out with a message of peace, love, tolerance, and mercy:

(1) Take the easier path.
(2) See advantage in disadvantage.
(3) Change the place of action.
(4) Make a friend out of an enemy.
(5) Receive education from wherever it comes.
(6) Don't be a dichotomous thinker.
(7) Do not engage in unnecessary confrontation.
(8) Pursue gradualism instead of radicalism.
(9) Be pragmatic in controversial matters.

These are just some of the principles by which the Prophet of Islam conducted a life of remarkable achievement. We would be wise to follow his example.

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.

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.

Reader Response to
Personal Bankruptcy: A Matter of Money, Not Morality

It is immoral that a catastrophic event like the illness of a child should push a family into bankruptcy. It is equally immoral that "the system" would find it acceptable to push a father to work 90 hours a week to try to make ends meet. The health care system in Canada is not perfect, God knows, but at least people don't have to face financial ruin and devastating shame because of a situation they neither chose nor can control.

Chaplain Mary Holmen
Selkirk Mental Health Centre
Winnipeg, Manitoba, CA

I have, for a long time, contended that the way we do health care in the US has people asking with the spiritual issue "How much do I cost" rather than "How much am I worth". There are legitimate needs for corporations in the face of world competition to lower the "legacy costs" (those expenses that have been passed on from prior contracts with labor). Currently there are more benefit costs in some automobiles than there is steel.

On the other hand, there is a genuine need to balance profitability with the care of employees. Recently WALMART was dinged due to their employee care compared with their competitor COSTCO. My sense is that freemarket and corporate shame or embarrassment will eventually require companies to comply with some kind of healthcare insurance. Last Saturday where I live, WALMART was picketed by people carrying plackards stating, "WALMART, A BAD NEIGHBOR EVERYWHERE". Who would have thought that in spite of what they do to provide low cost items that they would be blasted for using cheap labor overseas and providing no benefits here. I think there is a social movement growing.

George Burn
State College, PA

Personal Bankruptcy: A Matter of Money, Not Morality

The three children of Arnold and Sharon Dorsett are losing their family home in Chapter 7 bankruptcy. [1] Arnold works 90 hours per week earning $68,000 annually. They are frugal shoppers and have good health insurance. But it’s not enough. Their eight-year-old son’s chronic illness is costing them $12,000-$20,000 a year out-of-pocket. Of the myriad emotions engulfing parents of a chronically ill child, the one dominating the Dorsetts is shame. As with most Americans in bankruptcy, shame fuels desire to keep their bankruptcy secret from friends and relatives.[2]

Fifty percent of families in bankruptcy have serious medical problems.[3] Medical bills, job loss, and divorce account for 87% of filings for families with children.[4] Acting on the myth that carefree consumerism reflected in credit card defaults prompts people to seek bankruptcy relief, Congress bowed to the credit industry and enacted draconian new bankruptcy provisions that became effective on October 17.[5]

You have met and will continue to meet many families like the Dorsetts. How can your presence as a spiritual care provider ease their shame and support their struggle to regain financial as well as physical and spiritual health?
Practical tips:

1) Examine your attitudes about debtors in bankruptcy versus everyone else you know who has a mortgage, car payment(s), student loans outstanding, medical bills, and monthly credit card balance –they are all debtors.[6] What distinguishes the former from the latter? Bad moral character, bad money management, bad health, bad weather, bad employment termination, bad divorce judgment, or just bad luck?

2) Encourage your health care institution and health care colleagues to be generous in working out individual payment plans with patients rather than insisting that every patient present a credit card upon receipt of services. Most people work diligently to pay off debts incurred directly to a provider and attempt to meet them even before making their credit card payment. Health care providers need patients! Both need payments applied directly to care providers, not siphoned as interest to multinational financial institutions.

3) Copy the credit counseling information in footnote 7. [7] Give it to patients whose financial worries become part of their discourse with you. [Do not yourself attempt to be a credit counselor, or loan or give money: tend your professional boundaries!]

4) Consider how soliciting credit card pledges to synagogues, churches, mosques and other charitable organizations affects individuals whose financial life is precarious. Are such groups true to their ethics of care and service when, in order to boost their own immediate revenues, they encourage donors to pile more debt onto their credit cards?[8]

5) December Gift-Giving Mania has descended. As providers of spiritual care, offer your patients and colleagues ways to celebrate love and appreciation with gifts of self and service rather than presents purchased on plastic credit.

6) Recognize that each of these suggestions applies as much to you and your family as to your patients and colleagues.

We are all debtors. The margin separating us from those in bankruptcy is only as thick as our luck on a particular day. What would you need from friends and professional creditors to be restored to wholeness should your luck falter? Congress this year gutted all compassion from the constitutional provision [9] to regain solvency through bankruptcy. What can you as a person of faith do to extend grace to those seeking a financial fresh start?

[1] The New York Times, Sunday October 23, 2005, “When Even Health Insurance Is No Safeguard,”front page.
[2] One wonders if they could have saved their home and other personal assets by filing Chapter 13 which is bankruptcy reorganization for real, living, breathing people, offering the same opportunities as Chapter 11 for corporations. Fewer people file Chapter 13, which is more complicated for counsel but provides better relief for many employed debtors.
[3] The New York Times, Monday October 24, 2005. Op-Ed. Professor Elizabeth Warren, Harvard Law School.
[4] Warren, Elizabeth. The Two Income Trap: Why Middle-Class Parents Are Going Broke, Basic Books, 2003, p. 81.
[5] Bankruptcy Abuse Prevention and Consumer Protection Act of 2005 (BAPCPA)
[6] A study released October 12 says seven of ten low and middle income households report using their credit cards as a safety net to pay for car and home repairs, basic living expenses and medical bills. The Plastic Safety Net: The Reality Behind Credit Card Debt in America, Center for Responsible Lending, 10/12/05 at www.responsiblelending.org
[7] www.nacba.com; www.naca.net//resources.htm; www.consumerlaw.org
[8] For the pledger, a credit card is a very different kind of transaction than cash. Paying cash means the money is accounted for, in total, immediately. Using a credit card means the transaction is not complete until the credit card company is repaid not only for the gift but for all other charges on the statement including monthly interest accruals. Most people do not pay off credit balances monthly. Those with least disposable income tend only to pay the minimum charge. If someone pledges $2,500 on a credit card with a 21% annual percentage rate and makes only the minimum payment (usually 2% of the balance owed –but these numbers are increasing in 2006 –or $20 whichever is greater), it will take 40 years and 8 months for the original $2,500 to be repaid. The interest will be $11,894. [$14,394 total of which only $2,500 benefited the religious organization] If that same person gives an additional $20 per month on the same card (and makes no other charges on it and continues paying the monthly minimum), that person would have a perpetually increasing balance and would die owing the credit card company more than the pledges fulfilled to the recipient. Wouldn’t everyone benefit by keeping pledges cash (check) only? Adapted by Peter C. Fessenden, Standing Chapter 13 Trustee, District of Maine from Personal Financial Choices, Trustee Education Network, 2001.
[9] U.S. Constitution, Article I. Section 8

CaseConference

We post an ethical or situational concern that has arisen in a facility where one of our readers works. It has no identifiers included. It gives you only the facts of the case. Then, you can respond to that concern. This is an ongoing dialogue, with comments added as they come in. In the following issue, assuming it has been resolved, we give you the outcome from the facility where the incident took place. Please send any cases that you would like considered for inclusion to: info@plainviews.org

We hope that this new addition will help to inform not only those who are dealing with the issue, but will enable all of our readers to learn from the experiences and perhaps mistakes of others.

PLEASE NOTE: Due to unanticipated continuing responses to both the case and the resolution of the case, added responses can be viewed in the archives. Click HERE.

CaseConference #2 (Responses are posted below the case)

A chaplain was referred to a patient by a surgeon. The patient had just delivered her third child when she was diagnosed with breast cancer. Surgery and chemotherapy followed. Over the next three years the chaplain visited with the patient and her family whenever the patient was at the Outpatient Clinic, offering prayer support, referrals to support services, etc.

One day the chaplain visited the patient. The patient reminded her this was her last chemotherapy session and she wanted to give the chaplain a gift of a pair of earrings “in appreciation for all you’ve done for me. I genuinely love you and am so grateful you’ve been there.”The chaplain indicated that she was touched by the gesture, but wouldn’t be able to accept them. The chaplain was aware of an institutional policy against the giving of gifts to staff by patients.

The patient began to cry and became very emotional, stating, “I didn’t mean anything bad by it. I don’t want to get you in trouble. You’ve just meant so much to me and my family and I wanted to show you how much I appreciate it.”

The chaplain then received the earrings, and thanked the patient. She then contacted her supervisor, who made inquiries with the administration regarding the specifics of the policy and whether there were any exception clauses. The chaplain wanted to honor the institution’s policies, but also wondered if refusing the gift would create harm in the patient. Administration answered that there were not acceptable exceptions to the policy, and the chaplain would need to return the earrings.

Could the chaplain have handled this differently so that the patient would not have been as upset? Is there ever a time that a gift can or should be accepted? Should patients be informed in some way that the hospital has a policy of "no gifts to staff" so that this would not even become an issue?

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Responses to CaseConference #2:

I have been in this situation a few times. My answer is to inform the patient that I cannot accept gifts from patients but it would mean a lot to me if the patient would make a donation to a charity related to the patient's illness, for example, Hospice, cancer research, etc.

Gene Simco
Volunteer Chaplain
Vassar Brothers Medical Center
Poughkeepsie, New York

There is a great line in an old Charles Bronson movie called "Death Wish". The D.A. is about to enter the courtroom to prosecute some murderers. Bronson's words to the D.A. are, "Go in there and do what is right, not what is legal". Need I say more?

Alan Faulkner, BCC,
Medical Oncology Associates of Augusta

There is another option that the chaplain could have considered. It would go something like this: "Ms. [pt name], I am deeply touched by your desire to give me this gift. While we do have a policy in place that prohibits me from receiving gifts, I am also wondering if there might be exceptions. I am willing to go through the appropriate channels and consult with our administration. I think this would be beneficial not only for you and me but also for [institution's name]. Will you please let me make this consultation and contact you later?" Doing this would accomplish a few things. (1) The patient would likely not be so distressed, knowing that at least someone was willing to work with her. (2) Even if the final answer was still "no", both the patient and the chaplain could take solace in having given it their best shot so to speak. (3) There would possibly be an opportunity for the institution (and possibly its ethics committee) to revisit the issue and either clarify the reasons for the policy or define possible exceptions. (4) The chaplain would not have put herself in danger of a reprimand or possible termination.

As to the question, "Is there ever a time that a gift can or should be accepted?", my response is that because we represent the institutions we serve in our professonal practice, the question must be answered by the institution itself. Once a policy has been written, it's not up to the chaplain to decide whether or not to receive a gift. The institution has already made the decision. The chaplain can appeal to the appropriate channels and ask that a policy be reviewed, but accepting a gift when a policy explicitly prohibits doing so is like a quarterback following a different set of game rules than others on a football team. It just doesn't work.

That's my two cents.......will be interested to see other responses.

Mark Pruitt, M.Div., BCC
Staff Chaplain
Department of Pastoral Care
Centra Health
Lynchburg, VA

It seems to me that the chaplain might have acknowledged the patient's desire to symbolize an ongoing sense of connection with the chaplain, and the impending loss of that connection, by acknowledging the depth and intimacy of their journey together. The chaplain could then have affirmed that that experience would, forever, live in the hearts of both persons. The chaplain could then have interpreted the hospital's policy and invited the patient into reflection about a way that they could symbolize the journey that would honour hospital policy.

In the case, as presented, the chaplain (it seems to me) missed the patient's attempt to control her grieving of the loss of connection with the chaplain by giving a gift and also, in her (the chaplain's) anxiety about how to be ethically correct, shifted into a hierarchical place.

John C. Carr, Ph.D., Ch.Psych.
Pastoral Therapy & Education
Edmonton, Alberta, Canada

First, I would coach the chaplain on ways to keep the patient out of the policy discussion. The story indicates that the patient felt guilt by offering the gift and hurt that her gift is turned away. The chaplain might want to explore ways to deal with compliance issues elsewhere. For instance, accept the gift and acknowledge the giver’s offering of thanks. Go to the director and explain the situation and explore possibilities regarding policy. While the question is in the administrator’s court develop a couple of contingencies on what to do next. One idea is to find a close value to the cost of the earrings, buy them and donate the money to the Charitable Foundation and designate it to the oncology fund. Then send a very nicely written thank you note to the patient explaining the action. “Dear Judy, Thank you so much for your gift. I discovered that Truman Medical Center has a policy that disallows me from accepting gifts from patients. I valued your gift so that I donated an equivalent dollar value to our Charitable Foundation under your name and for oncology needs. Every time I wear the earrings you gave I pray for you and hope that each time I see you it will be at Oak Park Mall. Enjoy your days, Roy Ella."

Secondly, I believe the patient telegraphed her intent along the relationship path. As a supervisor (although I don’t have residents for 3 years) I would ask for a case presentation that explored the various times the patient hinted at her intent to give this gift. This would allow the chaplain the opportunity to explore boundary setting, transference, and ideas about when to transfer care to the patient’s clergyperson, if one exists. If the patient has a congregation, Masjid, synagogue, or other gathering of believers then three years is enough time to help the patient bond with her faith community. (I am aware that this is an assumption) The level of intensity that the patient expressed to cause the chaplain to accept the gift indicates to me that a significant level of transference was placed on the chaplain. In turn, my assumption that the same level of reliance of a faith community was not developed.

I am fairly certain that as I read the responses of others I will rethink the above and make adjustments to my opinion, for which I am grateful.

Rev. Roy Sanders, M.Div. B.C.C.
Director Spiritual Care / Clinical Pastoral Education
Truman Medical Center Hospital Hill

Your ethical walk in hospital policy is one that many of us have faced before. As a new pastor I was warned about not accepting a gift, such as after a funeral. If I rejected the gift, the parishoner might be hurt, such as in the case presented. The advice I was given was to accept the gift (which happened to be money), go to a book store or a Christian supply house and buy a book or something that would be valuable to my ministry, and then send a note to the giver explaining to them what was purchased. It ended up being even more appreciated.

However, being a hospital chaplain, the reverse is the norm. No gift may be accepted. I had a couple of thoughts.

1. Perhaps it would have been ethical to accept the gift on behalf of your department and given to a person in need (such was a case that I encountered).

2. Or maybe share with that woman, the greatest gift to you was already given through your ministry to her and her family where no material gift could compare to the sisterhood that was formed.

These are only a couple of ideas that might prove more valuable in the long run. I'm sure there are many ways to adhere to policy and still be faithful to the giver.

Yours in Ministry
Rev. Rick Hope
Chaplain, Methodist Specialty and Transplant Hospital
San Antonio, Texas

Our policy here states that one may not “profit”through receiving a gift. It is clear that occasionally a gift of limited value can be accepted as an expression of thanksgiving.

The chaplain might have suggested that a gift to a pastoral care fund would be appropriate. Or perhaps the chaplain might have expressed great gratitude –suggested that they pray together as a blessing on the earrings and then suggest that the patient keep them as a reminder of their relationship.

However –I believe that policies need to reflect exactly what is expected. If the hospital policy says “no”gifts –then the chaplain needed not to accept them.

If she could have made the policy position clear to the patient indicating that she knew this was probably new information to the patient –she might have suggested that the patient contact the senior chaplain or manager of pastoral care and negotiate an appropriate expression of gratitude.

Kathleen Ennis-Durstine
Children's National Medical Center
Washington, DC

The Ethics Committee at Gillette Children's just finished crafting a policy on gift giving. We struggled with this one for awhile, but concluded that we did not want to create a policy that would preclude the acceptance of small gifts given in the spirit of gratitude or within a cultural framework in which it is customary to share gifts with those who have helped and/or have been one's companions through a significant event. Our policy allows acceptance of gifts under the monetary value of $100 if "the staff member reasonably believes that the patient/family gave the gift without any expectation of special treatment." We
encourage disclosure of such a gift to managers/peers.

I believe our policy leaves room for the "spirit of the law." I also think it is more possible to have such a policy in a small hospital like Gillette.

Helen Wells O'Brien, BCC
Regions Hospital and Gillette Children's Specialty Healthcare
St. Paul, Minnesota

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Reviews

Macky Alston reviews the audio meditation:

Radical Prayer

Spiritual theologian Matthew Fox espouses what he calls “radical prayer,”in this audio series, which he describes as the ability to “magnify …prayer until it becomes a radical response to life from one minute to the next.”He believes that practicing radical prayer enhances an individual’s ability to contribute to the well-being of others and aligns inner life with the welfare of others, both useful tools for chaplains.

His focus is on the mystical teachings of Christianity, many lost and poorly translated, and the bridge between mysticism and science. His discussions range from the physics of interdependence and community to what he calls “deep ecumenism,”or the ability to tap into wisdom that is common to all spiritual traditions.

Matthew Fox also shares insights from teachers such as Lao Tzu, Thomas Merton, Rabbi Abraham Joshua Heschel and the Dalai Lama to guide the listener towards prayer that is “a radical response to life.”He calls for individuals to “make all you do a prayer, in your personal and professional relationships and throughout the cycles of emotions that you experience each day.”

Matthew Fox is the author of numerous books including Passion for Creation, One River, Many Wells, Creativity: Where the Divine and Human Meet and a bestseller Original Blessing. In 1995, he received the Peace Abbey Courage of Conscience Award.

Completed: 2003
Running Time: 7 ½ hours
Distributor: Sounds True

If you are interested in purchasing this 6-CD set, you can do so at the Hartley Film Foundation’s Web site, www.hartleyfoundation.org. Just click on “Masterworks”on the homepage for more information. The cost is $69.95.

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.

Book Review

Chaplain Rozann Allyn Shackleton reviews:

The Last Adventure of Life

Early on, Maria Dancing Heart assures the reader that it is not necessary to read this book from cover to cover. Rather one may use it as a reference, choosing from one of ten general categories, including truth, trust, awareness, hope, and grace. As a reviewer, I chose to read straight through, and my first conclusion is that her advice would be well taken.

Chaplains will find much familiar material in this potpourri of songs, prayers, quotes from the Bible and from other authors both religious and secular. The real strength of this book lies not in these, pertinent though they may be, but in the poetry and prose composed by those who are in the midst of experiencing –or of companioning one who is experiencing –the last adventure of life. One of these individuals, Niah Kinczewski, gave permission for her words to be published “as long as [they] were not edited in any way.”Several of her reflections are included, and they provide poignant personal insight into the dying process.

Dancing Heart clearly intends for this book to be used by other Niahs. In the introductory section she writes, “Trust that you will find the inspiration or support you need …. My hope is that this book will provide you with spiritual material and resources to help you and your loved one face the fears and questions regarding death and begin to work through them as much as you can at this phase of your life.”Unquestionably, there is a wealth of material here, drawn from numerous faith traditions.

If there is a criticism, it is that she has perhaps drawn the circle too wide, encompassing everything from prayers and inspirational writing to physical therapies such as yoga, acupuncture, massage, diet, and chiropractic. It is clear that all the selections were chosen with great care; however, I found the most value in the first person accounts from patients such as Niah who brought me into her world in her own words rather than in the words of others.

The book includes an extensive annotated bibliography with sections devoted to books for caregivers, Web sites, periodicals, music, and video. While chaplains may be familiar with many of the items listed here as well, it does present a valuable resource, especially for those working in extended care facilities or in hospices. With the caveat that chaplains must use its contents judiciously, I consider it a good collection of material –both traditional and untraditional –that is appropriate for use in both formal (ritual) and informal (individual/small group) ministry to the dying.

The Last Adventure of Life, Maria Dancing Heart, (Clinton, WA: Bridge to Dreams Publishing, 2005)
0-9752932-0-6, 318 pp.

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