By Rev. T. Patrick Bradley, MA, BCC
Standard 5. Ethical Practice: The chaplain adheres to the Common Code of Ethics, which guides decision making and professional behavior.
After several years of chairing the NACC Ethics Commission I find that what seems obvious is often much more complex. Take Standard 5: Ethical Practice, “The chaplain will adhere to the Common Code of Ethics, which guides decision-making and professional behavior.” The measurement criteria says that a chaplain “Maintains clear boundaries for sexual, spiritual/religious, financial, and/or cultural values.”
It should be obvious to anyone in our profession that we maintain these boundaries. However, it is easy for these boundaries to blur. Patients become attached and we don’t notice it. Staff members tend to cling to our casual advice. Patients inquire as to what church we are affiliated with and when we preach. Staffers want advice on cultural values of certain ethnic or religious groups. In all these situations, we have to be careful to evaluate how the recipient perceives us. Are our comments being taken as Gospel? Are they taken as directions on what to do? Are our biases being transmitted in our comments? We must remember that some people ascribe an authority, a cloak of infallibility, to us just because we are chaplains.
What are we to do when folks ask if something is morally acceptable when our Catholic religious views differ from the views of that person’s religion? If we are mindful of our boundaries we can navigate these dangerous trails. We can keep on track by being mindful of the authority we are perceived to have.
Although the measurement criteria also remind us that we protect confidential relationships, we develop with patients, confidentiality is a separate standard, Standard 6.
Standard 6. Confidentiality: The chaplain respects the confidentiality of information from all sources, including the patient, medical record, other team members, and family members in accordance with federal and state laws, regulations, and rules.
Just how confidential is our relationship? If a patient reveals to us that he uses street drugs, can we share that information with the medical and nursing staffs? Do we have to inform the patient of our intent and obtain his permission first? Since the revelation was not in the course of a sacramental confession, we can and perhaps should share the information. If the revelation is not pertinent to the treatment plan for the patient, is it necessary to share the information?
State law varies on the question of confidentiality. Some states limit it to clergy; others will have a more inclusive view. As I researched the question in my state, Wyoming, I found that confidentiality is not codified in the state statutes. A friend in the Wyoming Attorney General’s office advised me that I really don’t want to be the first one to take the matter to court. Common law tends to favor the seal of the confessional; however, general clergy privilege varies with the situation and the particular state.
That said, the question of privacy laws is quite different. HIPAA allows for the exchange of medical information among providers. It is my perception that most chaplains tend to maintain confidentiality sometimes to the extreme. Some take the attitude that charting only what is appropriate for the care being received means charting innocuous comments like, “Prayed with patient.” In reality, charting such items as the nature of family dynamics, comments by elderly patients about who comes to visit them and related information can be important to the patient’s recovery.
The only real way to address ethical issues and issues of confidentiality is to make sure we attend continuing education events at which ethical issues are discussed. We also need to keep open lines of communication with medical and nursing staffs. Participating in case conferences and multidisciplinary rounds – and that means participating, not just listening – is another way to share appropriate information with others.
Rev. T. Patrick Bradley is director of pastoral care at Cheyenne Regional Medical Center in Cheyenne, WY.
Read the next article in this series:
Standard 7: Respecting diversity means being cognizant of multiple traditions, calling in others when needed
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