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 BioethicsWalk, 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. Comments that are too late for the previous issue can be viewed in TalkBack.

We look forward to hearing from you.

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Responses to Telling Secrets (see article below)

Regarding Nancy Berlinger's request for 'best kept secrets' of a chaplain ... one of which I can say that definitely saves the hospitals and/or institutions a great deal of money. Despite the fact that the Pastoral Care Departments of the world are considered a non revenue department that does not bring in capital...we prevent the possibilities of the hospitals/institutions from monies going out by being sued via the discontent of some patients. Though many patients may not have grounds (and some may) to sue the hospital, physicians, institutions...there still will be lawyer's fees etc that would have to be paid out. This is not to say what may be problematic to the reputation(s)of those involved.

The best kept secret? Is a chaplain with a listening ear, a calming presence and making the right connections for the patient to resolve their issue(s) at hand. This pastoral care to patients can dispel the anxiety they are already experiencing...we (chaplains)redirect the patient(s) to the root cause of their frustrations, anger and most importantly their fears.

Many times throughout my years of ministry have I heard a patient say they "will call their lawyer" or "I am going to sue"...however, when they are allowed to express with any emotion(s) their upset(s) most often...not always...but often times they connect their anger to the fear of not being in control and of the unknown. Therefore, I do my best to get the information they need...and what information is not available...I let them know why and possibly when they will be informed.

Respectfully,
Dr. Sharon Barcham, D.Min., BCC
University of Chicago Medical Center
Chicago, Illinois

 

Here's a reaction from one who shares your alma mater. I am an oncology nurse. I now work as a hospice nurse. I hold both certifications. These two fields have secrets but at least are known entities. My last field is not well noticed.

I am also a Faith Community Nurse--formerly known as Parish Nursing. I run a nursing service in my community for three synagogues: Reform, Conservative and Orthodox. We started ten years ago with a one-time grant from the local Federation. The program is doing well. The synagogues support us to a degree. We are way under-funded. Telling our story is a problem, the same type of problem you relate.

Faith Community Nursing (FCN) has a secrets problem. I think there are at least 15,000 nurses nationally who work in denominational fields and have these same secrets.

Faith Community Nursing is easier to document than chaplaincy because sometimes there are specific technical skills involved. FCN is a non-invasive practice. The practice involves trying to prevent needed health care from falling through the cracks. In my suburban community everyone has doctors. Sometimes five or six doctors. Often five or six or ten medications and more than one pharmacy. There are many cracks. The coordination we are involved in often is confidential. It is hard to fund raise based on confidentiality.

Our population still does not call us soon enough or often enough and certainly does not begin to enable real per hour salaries for nurses.

I have moved from my first profession of teaching English. I have had other professions and degrees. It is interesting that the most useful direction was the one obtained at my first institution: getting things done with others and expressing myself in writing.

Thank you for your work at the Hastings Center.

Jaclyn M Herzlinger, RN

 

Telling Secrets

I’ve never liked the phrase “best-kept secrets,” when used to connote exclusivity, insider access: come to this restaurant or shop, and you get that special service we don’t tell everyone about. It’s our little secret.

Now, some secrets are essential in health care, in the form of patient privacy, confidentiality of records, anonymity of research subjects, and so on. Yet other secrets cause a lot of trouble in health care, if an institution makes a practice of concealing the truth against patients’ interests. Not disclosing mistakes, papering over known problems, and promoting “working the system” rather making it clear how the system works, are examples of secrets that don’t help patients, and may harm them. As philosopher Sissela Bok points out, secrets may be essential at times – but secrets are always part of corruption. So as a matter of ethics, we always have to be clear about whose interests are being served by keeping something secret.

I’ve sometimes thought that chaplaincy has a “secrets” problem, not the kind that leads to corruption, but the “best-kept secrets” kind, where value is associated with concealment. We know that patients and families appreciate this service – but are sometimes surprised that it exists. Among themselves, chaplains can tell wonderful stories about what they do – but then comes the familiar refrain: “Nobody knows we do this.” Granted, chaplains may not have access to the official storytelling channels in their institutions, and the news on a hospital’s home page probably isn’t about the latest advances in spiritual care. But when a chaplain tells me an amazing story about the care provided by her department – sometimes in response to an institutional or community trauma, sometimes as a clinical innovation to improve everyday care – my response is always the same: Please write about this. If nobody knows about this, nobody can learn from it. (And if nobody knows about this, you won’t get proper credit for what you did.)

So I invite you to help me compile the Top Ten Underreported Stories in Health Care Chaplaincy. What are chaplaincy’s best-kept secrets, the situations in which the involvement of chaplains makes a difference in patient care, or in the functioning of a health care team – but that aren’t what comes to mind when an administrator or physician hears the words “chaplain,” “spiritual care,” or “pastoral care”?

One item that might be on this list: chaplains’ involvement with organ transplantation teams, and with donors, recipients, and their families. Chaplains know they do this – but it’s a best-kept secret.

A resource to help you tell your stories inside your institutions: a summary of The Hastings Center-HealthCare Chaplaincy research project, “Professional Chaplaincy and Health Care Quality Improvement.” This is an edited version of our final report to the Arthur Vining Davis Foundations, and describes all project activities and forthcoming publications. You can download a PDF of the summary by going to the project webpage, http://www.thehastingscenter.org/Research/Detail.aspx?id=1212, then clicking on “Summary of Activities” (right below the link to the funder’s website).

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Nancy Berlinger is Deputy Director and Research Scholar at The Hastings Center, an independent, nonprofit, nonpartisan bioethics research institute located in Garrison, New York. Her research interests focus on clinical ethics and include end of life care; ethics in health care chaplaincy; ethics in cancer care; conscientious objection and moral distress in health care; patient safety and the resolution of medical harm; and ethics education for pandemic planners. Broader interests include narrative ethics and medical humanities. Currently, she directs a research project that is revising the influential Hastings Center guidelines on end of life care. This project is funded by the Patrick and Catherine Weldon Donaghue Medical Research Foundation and the Albert Sussman Charitable Remainder Annuity Trust. She recently completed a research project, funded by the Arthur Vining Davis Foundations, which examined how professional chaplains define “quality” within their own practice and profession, and how these definitions correspond to how chaplaincy is represented in the health care “QI” movement and in efforts to advance patient-centered care. 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, paperback 2007) and is currently developing a book project on cancer “survivorship” and the future of cancer care. 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, a longterm care facility; and the editorial board of Medical Ethics Advisor. She teaches health care ethics at the Yale School of Nursing, and 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.