6/20/2007
Vol. 4, No. 10
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|
Professional
Practice |
Dr.
Brent Peery on
family presence
during codes
Families
at Codes:
A Beneficial
Practice
“Stop!
Just stop it! He
has suffered enough.”
These
words were from
the son of a patient
who was undergoing
cardiopulmonary
resuscitation (CPR),
administered by
the code team of
a large academic
trauma hospital.
He was in his father’s
hospital room when
his father suddenly
had a cardiac arrest.
The code team was
called, including
the chaplain on
duty, who responded
very quickly. As
the rest of the
team worked with
focus, skill, and
haste to restart
the patient’s
heart, the chaplain
stood with the
son in the corner
of the room and
attended to his
emotional and spiritual
needs. Ten minutes
into the code,
the son tearfully
asked the team
to allow his father
to die in peace.
They complied.
One by one the
team members gathered
their equipment,
expressed their
condolences to
the son and exited
the room. The chaplain
remained to support
the son as he expressed
the mixture of
grief and gratitude
that comes after
the death of one
long-loved and
lost.
This
personal experience
is one of many
that illustrate
why I support our
hospital’s
policy of allowing
family members
to be present at
codes. This policy
is in accord with
the American Heart
Association Guidelines.
The Guidelines
cite research demonstrating
a variety of positive
outcomes from the
practice, including
compliance with
family wishes,
family value of,
and comfort from
being present for
their loved one’s
final moments.
It also assists
in families’grief
adjustment. These
Guidelines conclude, “Thus,
in the absence
of data documenting
harm and in light
of data suggesting
that it may be
helpful, offering
select family members
the opportunity
to be present during
a resuscitation
seems reasonable
and desirable.”[1]
There
are other reasons
for allowing families
to be present.
It helps them make
decisions that
are reality-based
regarding the treatment
of a family member.
Many people have
their notions of
CPR formed by what
they see in fictional
media where CPR
is performed briefly
and almost always
successfully. In
reality, codes
are violent, lengthy,
and only successful
a minority of the
time.[2] Family
members need to
understand what
they are requesting
for their loved
one.
I
have seen families
experience peace
after a death,
knowing that great
effort had been
expended by the
treatment team
to prolong their
loved one’s
life. Conversely,
preventing families
from being present
during codes can
create or enhance
mistrust of the
treatment team
(i.e. “What
are they hiding?”).
At
codes in our hospital,
the chaplain on
duty (we have 24/365
in-house coverage)
locates any family
immediately upon
arrival at the
scene of the code.
If the family wants
to stay in the
room, the chaplain
helps to ensure
that the family
is out of the way
of the code team
and attends to
their needs allowing
the rest of the
team to focus on
the patient. Some
families choose
to remove themselves
from the situation.
There have been
requests to watch
from the hallway
outside the patient
room. Some choose
not to be present
and move to a waiting
area down the hall.
In these cases,
the chaplain has
remained with the
family and periodically
returned to the
scene of the code
to acquire updates
for the family.
Chaplains,
by being present
with the family
during a code,
can enhance the
care of patients
and families. They
can explain the
benefits of family
presence at codes,
and facilitate
the healthy experience
of this practice
by supporting the
family and helping
them to understand
what is happening
to their loved
one.
What
are other chaplains’experiences
when family members
are present at
codes? Do you think
that it has been
helpful or harmful?
How have the doctors/staff
dealt with the
family being present?
Does your hospital
have a policy?
Does it include
the presence of
the chaplain?
Footnotes
[1] “2005
American Heart
Association Guidelines
for Cardiopulmonary
Resuscitation and
Emergency Cardiovascular
Care.”Part
2: Ethical Issues.
IV-9. Supplement
to Circulation.
2005; 112: IV6-IV11.
[2] Robert Wallis, MD, stated in the May 2007 Memorial Hermann Healthcare
Clinical Ethics and Palliative Care Newsletter, “The currently
accepted rate for in-hospital CPR survival by adults is only 15% for observed
and essentially nil for unobserved arrests.”Though there are numerous
variables that affect outcomes, a survey of current medical literature reveals
no studies with a survival rate until discharge of greater than 42%.
Brent
Peery, D.Min.,
BCC, is chaplain
manager for Children’s
Memorial Hermann
Hospital in Houston.
Brent is an ordained
Baptist minister,
endorsed by The
Cooperative Baptist
Fellowship. He
is husband to Karen
for over twenty
years and father
to Garrett, Brooke,
and Anna. He is
profoundly grateful
for the joy and
meaning that his
family, faith,
and work bring
to his life.
Do
you have thoughts
about professional
practice you’d
like to share with
your colleagues?
Send an e-mail info@PlainViews.org.
 |
|
Advocacy |
Archbishop David Mike Jacobs on Nigerian
and African chaplaincy
About
Nigerian and African Chaplaincy
This was received by the
Managing Editor from the Chaplain-Chief
in Nigeria. It arose from a series of e-mails
between the Archbishop and the Managing
Editor.
Shalom! Thanks you for your
e-mail, I am delighted to know and understand
that you want to have us as a contact in
Nigeria. May God continue to bless you.
Please find here the write-up on my work
in Nigeria and Africa in general. I have
a global apostolic ministry calling which
gives me the opportunity to have access to
train Christian leaders from all denominations
in Nigeria and Africa.
As an Inter-denominational and International
ministry, I train, equip, develop, nurture
and mentor Christian leaders all over the
continent of Africa; ordaining those who
qualified and have sure calling into the
five-fold ministries:
a. Apostolic ministry
b. Prophetic ministry
c. Evangelistic ministry
d. Pastoral ministry
e. Teaching ministry
This thereby strengthens the churches and
equips their leaders for ministry.
As a man who has a global Apostolic Ministry
calling, I operate a mission outfit whereby
Christian missionaries are trained, identified
and sent on missions.
Our organization has a mission's training
department called Open Academy of Missions
where mission courses are offered from undergraduate
to Doctoral level courses.
We also undertake short term mission programmes
for busy executives, Christian leaders who
cannot leave their duty post, ministries
and churches for much longer. We also put
together mission conferences once a year.
The Global Chaplaincy Corps is the Chaplaincy
arm of our ministry where chaplaincy practice
goes beyond the church setting and as a pluralistic
nature is non-denominational in scope and
is offered to people who have the specialized
calling into pastoral care, pastoral giving
and chaplaincy practice. We offer, at the
Global College of Chaplains, the following
courses:
A. General Chaplaincy courses
1. General Basic Chaplaincy course (6 months duration)
2. Advance Diploma General Chaplaincy course (6 months duration)
3. Supervisory Chaplaincy course (9 months duration)
B. Specialize Chaplaincy courses
1. Specialize Basic Chaplaincy course (6 months duration)
2. Specialize Advance Diploma Chaplaincy course (6 months duration)
3. Specialize Supervisory Chaplaincy course (9 months duration)
C. Lay Chaplaincy Courses
1. Basic Lay Chaplaincy course (6 months duration)
2. Advance Diploma Lay Chaplaincy course (6 months duration)
3. Supervisory Lay Chaplaincy course (6 and 9 months duration)
Our organization is called International
Association of Pastoral Care-givers and Chaplains
(IAPC3) and produces professional journals
on a quarterly basis for practicing chaplains.
We solicit and obtain articles from practicing
professional chaplains from all works of
life. This publication can be obtained from
us on demand at P. O. Box 3702 Ikeja, Lagos,
Nigeria, West Africa or E-mail: evangelicalpentecostalism@yahoo.com.
NB: We have decided to train professional
chaplains as well as lay chaplains who will
be able to assist the professionals with
ministry to the general public and humanity
where the professionals will not be readily
available or in enough numbers to go about
their duties. Courses of training for these
grades of chaplains can be obtained upon
request.
We also undertake to prepare chaplains in
specialized areas such as:
a. Traumatic events
b. Post-traumatic events
c. Violence
d. Crises
e. Health care delivery
f. Prisons
g. Maritime sector
h. Community
i. Marriage and family
j. Law enforcement and their communities etc.
In our leadership development programme,
we train people in an outfit called Global
Leadership Institute in partnership with:
Leadership Training Ministry, Canada. Strategic
Global Assistance Inc., USA, and other organizations
that are called into the same ministry with
us to develop National and International
Christian leaders in organizational leadership
development and management skills. We offer
courses from the basic level to Doctoral
level.
We also have a theological outfit called
The Open Christian Theological Seminary,
where theological trainings and courses are
offered to those Christian leaders in Africa
who have ventured into ministry without adequate
training and preparations.
Our slogan is to reach them where they are,
as they are, and prepare and equip them adequately
for better effectiveness and performance.
We also provide the needed theological experience
and exposure for the chaplains we train to
make it easy for them obtain International
recognition and certification.
We believe in networking with professional
colleagues, other professionals and ministries
who are favourably disposed to us and our
ministry calling as cross-trained chaplains.
We believe and share the views of the United
Nations resolutions of seeking global assistance
for the development of our national leaders
and even continental leaders.
We are therefore open to all and sundry
who are favourably disposed to have an input
into what we are doing in this part of the
world.
May you remain eternally blessed as you
consider assisting, collaborating and co-operating
with us in this assignment knowing fully
well that we are from the 3rd world nations.
Archbishop David Mike Jacobs is the Chaplain
Chief in Lagos - Nigeria, West Africa.
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 |
Rev. Fr. Anselm Amandikwa on enabling Nigerians
to perform their expected duties
What
Chaplains Should Know about Nigerians
I am a Nigerian who is presently residing
in America. My experience as a chaplain this
year has highlighted how connected effective
chaplaincy is to people's cultural, religious
and ethnic world views. According to research,
there are three major areas where differences
are particularly manifested: "Communication
of 'bad news'; locus of decision making;
and attitudes towards advanced directives
and end of life care."[1] With this
in mind, I want to offer a few basic ideas
related to these aspects from a Nigerian
cultural perspective.
To begin, communicating critical diagnoses
directly to a Nigerian sick person is culturally
inappropriate. Medical professionals should
communicate “bad”news to family
members who then decide the best way of conveying
it to their sick relative.
Who makes decisions in these critical moments?
Americans emphasize the autonomy of the sick
person –but, Nigeria is a family-oriented
cultural community. While the autonomy of
the individual is recognized, family relationships
usually determine personal behavior and decisions
in sadness –and in joy. Nigerian families
prefer to take care of their unwell loved
ones at home. The following assertion by
Harley, et al, is true of the Nigerian situation: “Family
members often make sacrifices to care for
relatives. Families provide care, pain management,
and protect the patient. Although they may
lack knowledge, caregivers gain satisfaction
and pride from providing care ….”[2]
Nigerian families hope for recovery and
divine intervention until the last moment.
We expect a medical team to continue treatment
until all interventions and/or financial
resources are exhausted. Chaplains should
not be surprised when relatives –often
the eldest in the family –make all
of the decisions. This makes family –or
Nigerian community –support essential.
Nigerians rarely rely upon a durable power
of attorney or complete advanced directives.
Traditional norms of most Nigerian communities
are organized in ways that specific family
roles are culturally designated. Depending
upon their position in the family, children
know their responsibility to their relatives;
the same applies to relatives and their children.
The local community holds its members accountable
in the performance of these roles. One invokes
community anger when not performing one’s
expected duty.
Moments of sickness or danger of death are
inappropriate times to talk about wills.
Discussions about “who gets what”while
the owner is alive –whether sick or
elderly –is considered disrespectful
and selfish. Further, it is equated to a
death wish and as such, is highly offensive.
Traditional laws of inheritance are embedded
in the cultural norms of the community. Often
this is based on how each loved one either
cared for the deceased while alive or contributed
towards the burial.
Last but not least, it is a dignifying honor
for Nigerians to die in their homes amid
their loved ones. Nigerians strongly believe
in the relationship between the living and
the dead and so, would prefer to be buried
in their hometown among their own people.
Nigerians living far away from home are worried
about what will become of their corpse after
death.
One extremely important pastoral intervention
that a chaplain can provide to an unwell
Nigerian –or one who is suffering the
ravages of ageing –is to connect that
person to other Nigerians within the community
at-large.
Footnotes
[1] H. Russell Searight, et al. “Cultural
Diversity at the End of Life: issues and
Guidelines for Family Physicians.”AAFP, 2005. http://www.aafp.org/2005/515.html.
Accessed 4/3/2007.
[2] Haley, W.E., & Bailey, S., (1999). "Research
on family care giving in Alzheimer’s
disease: Implications for practice and policy." In
B. Vellas & JL Fitten (Eds.), Research
and Practice in Alzheimer’s Disease Volume
2. (pp.321-332). Paris, France: Serdi Publisher.
Rev. Fr. Anselm Amandikwa, B.Phil., M.A.
Theology, M.A. Rel. Ed., is a Catholic Priest
of the Claretian Missionaries, Province of
Nigeria and a resident chaplain at The Healthcare
Chaplaincy in Manhattan, NY. He serves as a
parochial vicar at St. Michael’s Church
and as an interfaith chaplain at St. Mary’s
Center, both in Manhattan. His bachelor's degree
in philosophy is from the Pontifical Urban
University in Rome; his masters degree in theology
from Duquesne University, Pittsburgh, and his
master’s degree in Religious Education
from Fordham University, where he is currently
a doctoral candidate. Ordained in 1993, he
has served in as pastor, teacher, Catholic
Campus Chaplain, seminary formator, and as
the secretary of his province in Nigeria. He
hopes to go back to Nigeria after his studies
to take up a chaplaincy and parish pastoral
work.
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 |
Rev. Jonathan Scott on weathering the unexpected
The
Changes that Weather can Bring
“Boy, it’s surprising
weather! I never would have expected this.”
So began the conversation with
the patient by the window. The weather is
a common bond for all of us, a safe entry
into a shared experience that establishes
some general connection. As an important
part of our New England setting, the weather
impacts our decisions to go out or stay in,
to spend time peering out windows at snow
or time out walking in gardens. The weather
when you read this will doubtless be different
than the weather that warms the still green
lawns in the start of January.
The conversation started with the weather, but it went towards the surprise
and the unexpected. For all of us are also connected with the experience of
not knowing what tomorrow holds, of having plans changed at the last minute.
We are bound together by the unexpected. On this particular day, the patient
wanted to talk about the surprise of a terminal illness, of finding herself
in the hospital rather than her home, of facing a totally different future
than the one anticipated before her diagnosis. This sickness had snuck up on
her, catching her unprepared, abruptly taking her out of one season in her
life and placing her in another.
We cannot control the weather. We end up
taking whatever comes and making the best
of it. Sometimes it is easy to adapt ourselves
to changing circumstances. Sometimes we simply
grab a jacket out of the closet on a cold
day and go out and continue on our merry
way. But other times we are completely derailed
by fierce storm or bitter cold, and long-established
plans are temporarily or permanently shelved.
We cannot control the diagnosis. We end up
accepting the results of tests, and accept
the need to adjust to changing circumstances.
Many times we simply follow the healthcare
advice, take our medicine and return to good
health. But other times the illness is more
serious and the options are limited to making
the best of a bad situation. We cannot control
the course of the terminal illness, but we
can control our response to it.
This patient wanted to talk about how her
life was unexpectedly changed. She wanted
to express the anger and frustration of loss.
She wanted to talk about ways to somehow
make each day count. It ended up being a
very personal conversation, full of questions
and confusion and faith and intentions. In
the journey together, we remembered supports
from her religious tradition and from past
days of grace. The visit ended up with her
hope that, whatever she faced, the God in
whom she believed would love and sustain
her. We had started out our visit with the
unexpected weather. We ended our visit exploring
how she would weather the unexpected.
Rev. Jonathan Scott, BCC, is an ordained
American Baptist pastor who served churches
in Connecticut, Massachusetts and Rhode Island
before becoming a chaplain at Day Kimball Hospital
in Northeastern Connecticut. He and his wife
Sally are the proud parents of three teenager
children.
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 |
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 BioehicsWalk,
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.
We look forward to hearing
from you.
Being
Present in the Grey Area
For the past seven years, I’ve spent
a lot of time hanging out with professional
chaplains. I got curious about this profession
when I was working on a research project
at The Hastings Center on the ethics of patient
safety. At the time, I was also doing my
M.Div. and the Center was my field education
site. My ordination-track classmates were
immersed in CPE, so I heard a lot about chaplains:
about supervisors, verbatims, being sent
to the morgue on your first day at the hospital,
supporting grieving parents as they decided
whether to withdraw life support from their
son after a car accident left him with castastrophic
brain injuries....
When The Center's research project took
up the issue of disclosure, I figured that,
if I looked into it, I’d find chaplains
involved in disclosure. Weren’t my
classmates, even as CPE students, in the
room for all those “difficult conversations”?
Surprise! Once I began to get to know and
talk with professional chaplains about their
place within the health care hierarchy, and
about their professional culture’s
knowledge and beliefs concerning medical
error and its aftermath, I developed a much
more nuanced, more clinically grounded, understanding
of chaplains and chaplaincy, and of the barriers –some
institutional, some self-imposed –that
stood between chaplains and involvement in
improving health care, in this case, by honoring
the ethical obligation to disclose mistakes.
I learned that chaplains shared some of
the same worries and believed some of the
same persistent myths as physicians and nurses –if “we”tell
the truth, if “we”apologize,
we’ll get sued. I learned that chaplains,
because of their uncertain –and unreimbursed –status
within healthcare institutions, sometimes
preferred to “fly below the radar,”by “being
present”to patients and families but
invisible to decisionmakers, a problematic
decision that worked against their inclusion
and involvement in improving policy and practices.
I learned that some chaplains more readily
identified with the clinicians involved in
adverse events than with the injured patients
and their families. I learned that other
chaplains were deeply distressed by their
inability to be present to injured patients
and their families, if their institution’s
practice was to quarantine these patients
and families in “legal”or “risk
management,”as threats, rather than
as, perhaps, the most vulnerable persons
in the system.
As these conversations continued and as
I made fewer faux pas, I learned
more about how chaplains did encounter the “grey
area”of ethics, beyond the particular
issue of medical error. I learned that many,
perhaps most, professional chaplains serve
on ethics committees; that some serve on
IRBs; and that the ones on the IRBs seemed
to be having more fun. I learned that most
professional chaplains can recite the “Georgetown
mantra”–Beauchamp and Childress’s
four principles of biomedical ethics –but
that, for some, this was “bioethics.”I
learned that time-pressed chaplains may have
few on-the-job opportunities for the challenges
(and pleasures) of thinking about and discussing
cases and theories; about what the “least
worst”course of action may be in a
particular situation (in health care, there
is often no “best”course of action),
and what steps can be taken to translate
ethical reasoning into ethical policy to
guide ethical practice.
I also learned that chaplains don’t like reading about chaplains. But
I don’t believe that, or would never have agreed to write this monthly
column on bioethics, for chaplains.
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.
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|
LongView |
Harold G. Koenig, M.D., on the integration
of theologians into health research
Center
for Spirituality, Theology, and Health:
Past, Present, and Future
When I came to Duke University
Medical Center in 1986 as a geriatric medicine
fellow, I was viewed as a bit odd because
of my research interests in religion, spirituality
and health. In the previous year that I had
spent as a family physician in Springfield,
Illinois, however, I had cared for many older
patients and frequently heard them discuss
how important religious faith was in helping
them cope with their illnesses. This prompted
me to conduct a small research study examining
life satisfaction, death anxiety, and religious
involvement that found that persons who prayed
more and used religion to cope had higher
life satisfaction and less death anxiety.
This was truly exciting, since it confirmed
my clinical impressions. From then on, I
knew that research on spirituality and health
is what I wanted to do. However, it took
about 10 years at Duke to learn how to conduct
research, complete some studies, and get
some papers published before I could convince
my mentors that this was an area worth pursuing
as an academic career.
In 1995, I started the Program on Religion,
Health and Aging within Duke’s Center
for Aging and Human Development. Dr. Harvey
Cohen, Dr. Linda George, Dr. Dan Blazer,
and Dr. Keith Meador, were mentors and colleagues
who supported me and enabled this to happen.
Bear in mind that this was a time when religion
was not something that physicians studied
and certainly didn’t make a career
of. The study of spirituality and health
was known as the “anti-tenure”factor
in those days. Three years later, though,
with the help of Dr. David B. Larson, my
colleagues and I were able to secure a 5-year
grant from the John Templeton Foundation
to start the Center for the Study of Religion,
Spirituality and Health in 1998. Our focus
at that time was to conduct research, publish
papers, write grants, and run a post-doctoral
educational program. The Center during the
next seven years would be very productive,
conducting at least a dozen research studies
and publishing close to 100 research papers,
along with dozens of books on religion, spirituality
and health.
In 2005, though, it became evident that
the Center needed to do more than just conduct
research and run a post-doctoral research
program (although research would continue
to be the Center’s strength and core).
By this time, the field was beginning to
grow rapidly due to the accumulation of a
critical mass of research and increasing
interest within mainstream medicine and nursing
of addressing these issues in clinical care.
There were enough interested academic researchers
and scholars now in the field so that it
was ready to move to an entirely new level.
Furthermore, this was happening not only
in the United States, but also in the United
Kingdom, Europe, Canada, and Australia, where
small groups of researchers and clinicians
were beginning to show interest in developing
programs in this area.
Up until then, clergy had not played much
of a part in our Center, its research, or
its educational programs, since this was
largely a medical center initiative. While
there was some collaboration with pastoral
care when that department had a director
of research in the early 1990’s, after
that person left the collaboration could
not be sustained. In 2005, it became evident
that if the religious community were ever
to seriously buy into what scientists were
doing, they needed to be more involved in
this research. Faith communities –because
they represent the people and the patients –have
the real power to make a difference in society
and health care. Furthermore, the absence
of theological input into the research and
the clinical applications meant that a vital
component was missing from this research
that scientists without theological training
simply could not provide.
At that time, many clergy and theologians
were not fully embracing the research that
was coming out, and were looking a bit askance
at doctors and nurses who were trying to
address the spiritual needs of patients.
What were these health care professionals
doing addressing issues that they had no
training or expertise in? What were scientists
doing trying to prove (or disprove) the value
of religious faith and practice? Up until
then, theologians had not typically been
involved in the research, in the development
of religion/spirituality measures, or in
the interpretation of the results. Instead,
it was those who had training in research
-- psychologists, sociologists, physicians,
nurses and public health researchers –who
were carrying the field forward.
Therefore, in the later part of 2005, I
invited Dr. Keith Meador –both a psychiatrist
and a theologian with academic appointments
in both Duke medical center and Duke divinity
school –to join me as co-director of
the Center. To emphasize the role that theology
would play, we changed the Center’s
name to the Center for Spirituality, Theology,
and Health (CSTH). The difference from the
earlier Center for the Study of Religion,
Spirituality, and Health would be that we
would now include a focus on theology by
involving theologians into the design and
interpretation of the Center’s research
and in its educational programs. There were
other changes in the Center that Keith and
I dreamed about, including a number of groundbreaking
initiatives that would require major grant
funding to get off the ground. We were successful
in obtaining initial support for these initiatives
from the John Templeton Foundation.
Beginning in January 2007, these initiatives
included a program to award grants to conduct
research on spirituality, theology and health
(STH), the development of a world-wide STH
membership society, the formation of a community
of senior scholars, an annual national/international
conference at Duke University, and further
development of the Center’s educational
programs.
The request for research proposals (RFP)
is the first in what we hope will be a series
of grant programs that the Center will run
for the John Templeton Foundation. The current
RFP seeks to award grants to elucidate how
involvement in the religious community (attendance,
worship, altruistic and caring activities)
influences individual and community health.
The goals are to document effects on health
(where health is broadly defined), clarify
the biological, social, psychological mechanisms
involved, and interpret what the findings
mean for the individual, congregational,
and community health. We will be awarding
seven $200,000 grants to outstanding research
proposals that target these goals.
The STH membership society is open to all,
including researchers, clinicians, and others
with interest in this area –academic
or non-academic -- and will be worldwide
in scope. Members of STH networks in Europe,
Great Britain, Canada, Australia, and Brazil
are being recruited to join the society,
which charges a modest yearly membership
fee ($75) for a number of benefits. These
benefits include a monthly STH e-newsletter
on grants, new research findings, and events
in the spirituality and health field; reduced
tuition for the annual Duke conference; access
to the membership directory (which will have
the names and contact information for society
members); access to the proceedings from
yearly Duke conference; and access to senior
investigators for mentorship and advice.
All major health disciplines have a membership
society to help persons make connections
and learn about what others with similar
interests are doing, and we believe that
having such a society in spirituality and
health will significantly advance the field,
by promoting dialogue, research, and scholarship.
The deadline for letters of intent is July
15.
Our community of scholars (COS) consists
of 12 leading STH researchers and scholars
coming primarily from the United States (although
including non-US scholars) and primarily
from Duke and surrounding universities. Each
month we invite one national STH scholars
from outside of Duke to provide a lecture
and engage with Duke scholars on the key
issues facing the field of spirituality and
health. The purpose of the COS is to serve
as a leadership core to create a research
network, develop collaborative research projects,
write consensus reports on controversial
issues in STH, mentor young investigators,
and raise financial support for research
and networking.
The Center also conducts a number of educational
programs. First, as noted above, there will
be an annual national-international conference
at Duke focused on research, scholarship,
and networking in spirituality and health
(1st conference to be held in April 2008).
This will serve as the annual meeting for
the STH membership society, and will not
only involve presentations by renowned STH
researchers and scholars, but also provide
young investigators with an opportunity to
present their research and receive feedback
from peers and senior colleagues. Besides
the annual conference, the Center continues
to hold research and clinical workshops during
the summer. Five-day intensive research workshops
are open to persons from all educational
levels interested in conducting research
in the area of STH, and are designed for
both senior and junior researchers. The clinical
workshop is for clinicians from a wide range
of health specialties who want to integrate
spirituality into patient care in a compassionate
and sensitive manner.
The work of the Center described above is
particularly relevant to pastoral counselors
and chaplains, who are the primary spiritual
care providers in health settings. The research
and clinical programs are ideal for chaplains
and will prepare them to both conduct research
and help educate other health professionals
about their role and the role that faith
plays in health and illness. The Center is
a liaison organization of the Association
of Professional Chaplains. For those who
want to know more about our Center and its
initiatives, go to our web site at http://www.dukespiritualityandhealth.org.
Harold G. Koenig, MD, MHSc, completed his
undergraduate education at Stanford University,
his medical school training at the University
of California at San Francisco, and his geriatric
medicine, psychiatry, and biostatistics training
at Duke University Medical Center. He is board
certified in general psychiatry, geriatric
psychiatry and geriatric medicine, and is on
the faculty at Duke as Professor of Psychiatry
and Behavioral Sciences, and Associate Professor
of Medicine. Dr. Koenig is co-director of the
Center for Spirituality, Theology and Health
at Duke University Medical Center, and has
published extensively in the fields of mental
health, geriatrics, and religion, with over
300 scientific peer-reviewed articles and book
chapters and over 35 books in print or in preparation.
Do you have thoughts about long view you’d
like to share with your colleagues? Send
an e-mail of any length to info@PlainViews.org.
 |
|
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.
We
are always looking for cases. Please send
any cases that you would like considered
for inclusion to: info@plainviews.org We
will ensure that it is stripped of any
identifiers. For further guidance about
how to write up a CaseConference, please
refer to the CaseConference Archives, Vol.
4, No. 3 "How to Submit a Case for
CaseConference." (Click HERE)
We
hope that this 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.
Case #20 (see responses below)
Isaac was 14, the only child of older parents.
At 12, he was diagnosed with an aggressive
form of cancer that was wrapped around his
spine at the base of his brain. After a year
of chemotherapy and radiation treatments,
which left Isaac weak and sick, the cancer
was not diminished in any way.
At 13, surgery was performed to remove as
much of the tumor as possible, which now
was wrapped so tightly around his spine that
it was affecting his limbs and causing great
pain. The surgeons were unable to remove
all of the tumor.
Within a few months, the tumor grew so much
that Isaac lost the use of his left arm and
could no longer walk unassisted. Oncologists
at his hospital told Isaac’s parents
that , medically, there was nothing more
to do; they said Isaac had, at best, a few
months to live. The parents refused to share
this information with Isaac. A palliative
care team was brought in to assist the family.
Isaac asked the palliative care physician
if he could see the most recent CT scans
of his tumor. His mother adamantly insisted
he shouldn’t see them. Nonetheless,
the palliative care physician arranged for
him to see the scans and the palliative care
team arranged for his beloved friend and
neighbor and her also beloved dog to be with
Isaac as he viewed the scans.
With the dog on his lap, the neighbor at
his side, and his parents and the palliative
care team present, in a private conference
room at his hospital, Isaac listened intently
as the palliative care physician carefully
showed and explained the CT scans to Isaac.
Isaac asked if more chemotherapy or radiation
would help. The doctor explained that these
treatments had been unable to stop the tumor’s
growth. Isaac asked if more surgery could
be done to remove it. The physician explained
that the tumor was too deeply connected to
the spine to be removed. For a few minutes,
Isaac sat quietly with an inward gaze. Then
he asked, “So what do we do now?”
The physician answered that now Isaac should
spend time deciding what he most wanted to
do in his life and find ways to do them.
Within the next few days, Isaac decided he
wanted to go home, to spend time with his
neighbor and her dog, to eat a favorite meal,
to finish a poem he’d been writing
before this hospitalization, and to tell
a girl in his class that he loved her. He
wondered if she would kiss him just once.
He wondered what beer tasted like and asked
his Dad if he could try one when he got home.
Within two days of going home, Isaac was
convinced by his parents to go to another
children’s hospital where they begged
for treatment for him. He was enrolled in
a toxicity study, a drug trial designed to
test dosage limits for an experimental treatment.
He died in hospital two weeks later.
What would the chaplain's role be with Isaac?
With his family? With the hospital staff
at the first hospital? What about the staff
at the second hospital?
What ethical issues are present here?
What can be learned about the needs of
children in hospitals from Isaac’s
story?
Responses
I recognize the difficulties of privacy
here, the responsibility of a parent for
a minor, and yet the emotional maturity of
this 13 year old. While I don't think the
parents could ever have fully acceded to
Isaac's wishes, a family meeting with the
chaplain present as moderator might have
been helpful. Were Isaac's wishes truly heard
by his family? Did he go to the final treatment
to please them? Where was the chaplain in
this story?
Judy Novak, M.Div., NACC Cert
Cudahy, WI
Please check the archives
for comments made about previous CaseConferences.
Send your comments about CaseConference
to info@PlainViews.org.
 |
|
Reviews |
Sarah
Masters reviews the film
Soul
Searching: The Journey of Thomas
Merton
The voice of author, social
activist, poet, and monk Thomas Merton, who
died suddenly at the age of 53, resonates
in the recently released documentary Soul
Searching: The Journey of Thomas Merton.
Award-winning filmmaker Morgan Atkinson
traces Merton’s spiritual path from
boozy jazz clubs in New York to the Abbey
of Gethsemani in Kentucky, where Merton lived
in relative isolation as a Trappist monk
for close to 30 years. The camera captures
monastery life and the beauty of nature so
influential in shaping Merton’s spiritual
quest.
Over time, Merton agitated for more and
more solitude, all the while, paradoxically,
emerging as a public figure. As many Chaplains
are aware, Merton first gained fame with
his autobiography, The Seven Storey Mountain,
which described his conversion to Catholicism
and his decision to take vows as a monk.
He wrote: “I seek to speak to you,
in some way, as your own self. Who can tell
what this may mean? I myself do not know,
but if you listen, things will be said that
are perhaps not written in this book. And
this will be due not to me but to the One
who lives and speaks in both.”
Soul Searching is a meditation
on Merton’s life as seen through the
eyes of Merton’s friends and Merton
scholars. Their observations provide insight
into his internal struggles, as he questioned
his faith, discovered certainty, then questioned
again, and grew into what many have called
a “spiritual giant of modern times.”
In his role as a public figure and social
activist, Merton wrote frequently about war
and the nuclear arms race until he was silenced
by his superiors. They told him that he could
only address issues concerning peace. His
missives about war, the arms race, and peace
are quoted in voiceover narration with comments
from those who knew him best. This film is
an intimate portrait of this courageous and
prescient man.
Completed: 2007
Running Time: 67 Minutes
Director: Morgan Atkinson
If you are interested in purchasing this
film, you can do so at http://www.amazon.com/s/ref=nb_ss_b/104-0028722-6007167?url=search-alias%3Daps&field-keywords=soul+searching+the+journey+of+thomas+merton.
The cost of the film is $30.00 for a DVD.
Sarah Masters is the Managing
Director of the Hartley Film Foundation,
a non-profit foundation dedicated to cultivation,
support, production and distribution of
the best documentaries and audio meditations
on world religions, spirituality, ethics
and well-being.
Book
Review
Rev.
Suzanne Hope Graham reviews
Walking
With Grief –A Healing Journey
“Grief when it comes,”writes
Joan Didion in The Year of Magical Thinking, “is
nothing like we expect it to be.”Well,
yes and no. We react profoundly and instinctively
to our losses immediately after they occur
and are usually only able to reflect and
make connections much later. Those who have
endured the death of a spouse or child can
nurture the raw wound for quite some time
before allowing it to begin to heal. We possess
that pain and hold it close and, sometimes
it seems, only give it up reluctantly. Then
we begin our own journeys toward renewed
wholeness, albeit changed forever.
Walking With Grief –A Healing
Journey, although a slim book, is
a generous gift from both Nanette Geertz,
who wrote the poem, and Annette Ierardi,
who illustrated it. Nanette Geertz, a congregational
pastor, lost her daughter, Jennifer, suddenly
at the age of 19. This was written sometime
after Jennifer’s death. Later, Nanette
herself died of breast cancer.
This poem is her search to make sense and
give meaning not only to the life and loss
of Jennifer, but to her own sadness. She
looks for connections with the world around
her and finds Jennifer’s essence and
her own consolation there: “kitten,
do you know where my jennifer is? no, but
you may use my playfulness to remember her
laughter”and on another page, “sunrise,
have you seen my daughter? no, but today
is a new day for loving her still.”She
is able to put Jennifer in the continuum
of creation, with all God’s creatures,
with those who have been, are now and are
yet to come. That is what we want for those
we have lost, too. The generosity of Nanette
Geertz is that she gently leads us there.
Her world is filled with what is in ours:
rain, stars, wind, a budding tree. She shows
us that we can find our own comfort through
her words and not only understand her journey,
but deepen the dimensions of our own. She
reminds us to look around, make connections,
and remember.
The reproductions of Annette Ierardi’s
paintings are on a par with those found in
museum catalogues. They are original and
thought provoking and add immensely to the
text. At the back of the book, there are
three pages of interesting notes about the
paintings and an additional four pages for “notes,
reflections, or poems.”
This is a valuable book for individual reflection
and would be extremely useful as a jumping
off place for discussion and sharing in bereavement
groups.
Walking With Grief –A Healing
Journey –Poem by Nanette Geertz,
Illustrations by Anne Ierardi. Healthsigns
Center, Inc., 408 Main Street, Yarmouthport,
MA 02675; Website: amifinearts.com,
pp 40.
Rev. Suzanne Hope Graham received her
M. Div. from The General Theological Seminary,
is an ordained Episcopal priest in the Diocese
of New York, and is an associate at Grace Church,
Nyack, New York. She works as an associate
chaplain at Westchester Medical Center and
White Plains Hospital, and has applied to the
Association of Professional Chaplains for certification.
Do you have thoughts about these reviews
you’d like to share with your colleagues?
Send an e-mail to info@PlainViews.org |