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6/20/2007 Vol. 4, No. 10

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.

 

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.

 

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.

 

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.

 

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

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6/20/2007 Vol. 4, No. 10
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Professional Practice
Dr. Brent Peery: family presence during codes
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Advocacy
Archbishop David Mike Jacobs: Nigerian and African chaplaincy
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Education & Research
Rev. Fr. Anselm Amandikwa: enabling Nigerians to perform their expected duties
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Spiritual Development
Rev. Jonathan Scott: weathering the unexpected
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BioethicsWalk
Nancy Beringler, M.Div., Ph.D.: being present in the grey area
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LongView
Harold G. Koenig, M.D.: the integration of theologians into health research
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