By David Lewellen
Chaplains may not be professional ethicists, but they can make a role for themselves in ethics consultations.
NACC member Mark Skaja, vice president of mission integration and spiritual care for Mercy Health in Cincinnati, said that many major academic and research hospitals employ ethicists, but chaplains have many of the skills necessary in developing consensus at a formal consultation, such as group facilitation and prior knowledge of the patient and family.
A chaplain is one of the first calls for a formal consult, Skaja said. Knowledge of the family dynamics “may not be an ethical issue per se, but it’s still an issue that has to be dealt with.” Chaplains are also equipped to know about religious and cultural issues that may arise, for instance, with Jewish and Muslim requirements about the body of the deceased, or the beliefs of Jehovah’s Witnesses about medical care — or at least, the chaplain knows the right person to call.
“Chaplains can provide much-needed wisdom in ethical situations that have moral and values concerns,” said Janet Stark, spiritual care manager at Brockville General Hospital in Ontario. “Other members of the team may be proficient at the legal and professional standards of an institution, but a chaplain brings as well, a personal perspective grounded in sanctity of life, autonomy, and faith-based beliefs.”
If the patient cannot speak for himself or herself, Skaja said, “that’s where the documents come into play.” Although living wills and advance directives are more common than they used to be, and some individual cities and hospitals have done a good job of publicizing the issue, it is still far from a majority.
Many Mercy hospitals ask chaplains to help patients and families with the advance directives — not for filling out paperwork, Skaja said, but for putting them at ease and asking questions to guide their thoughts and help them form conclusions.
Being hired as an ethicist usually requires a Ph.D. in the field, but chaplains can certainly learn more and carve out a role for themselves. Stark said, “Difficult dilemmas where there is no best outcome often welcome the support and navigation of decisions from a compassionate chaplain who understands and accepts faith perspectives of the patient and family. Such dilemmas often involve end-of-life decision-making, organ donation, suicide prevention, pre-natal care, etc.”