BioethicsWalk addresses
bioethical issues that chaplains face in their day-to-day work. PlainViews invites
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Who's the Boss?
Ask chaplain-managers what they would like to improve about the management of chaplaincy as a health care service, and they often say: “It would be great for me have the same boss for more than a year.” A supervisor who understands what chaplains do, or is willing to learn what they do, would be a luxury for some managers. For now, they just want to stop being transferred from vice president to vice president, from box to box on the organizational chart, sometimes for reasons that have nothing to with supporting and improving the delivery of health care services.
This isn’t mere organizational-chart griping or status anxiety on the part of chaplain-managers. It can be a burden to keep breaking in new bosses, particularly if there is no institutional understanding of what high-quality health care chaplaincy is or aspires to be –
a problem that “medicine” and “nursing” do not have – and if the differences and commonalities between chaplaincy and other supportive services – social work, mental health, even clinical ethics – are not being explained in clear, consistent ways across the institution. And' because organizational ethics in health care is concerned with the systems that deliver good care, or are a barrier to it, how an organization supports or hinders the work of health care providers is an ethical issue. Time spent on defending one’s turf is time lost to patient care.
One chaplain-manager thinks she and her colleagues need to aim higher: “Are any chaplains vice presidents in their institutions?” This manager believes that, at a certain point in the evolution of a department, the manager has to give up the “bedside” in lieu of the “team” and the “committee,” so chaplaincy is a stakeholder in the evolution of clinical services and in the institution itself. What do you think? I know one chaplain who is also a vice president – are there more of you out there? Does your supervisory relationship support the delivery of chaplaincy services, and if so, how does it work?
One new tool that may help chaplain-managers educate their supervisors and colleagues will be published next week in the Hastings Center Report and online – the essay set from The Hastings Center’s recent research collaboration with Healthcare Chaplaincy and researchers at Rush University Medical Center. Details to follow in PlainViews later this month.
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.
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