EXECUTIVE SUMMARY

Ethicists and chaplains can hold health systems accountable for mission statements referencing “whole person” care and spiritual health. Some approaches to that include the following:

  • Hospitals can ask clinically trained, board-certified chaplains to help develop mission statements.
  • Ethicists can meet with senior administrative staff to monitor the attention given to spirituality.
  • Chaplains can communicate patients’ spiritual needs to clinicians.

Most health systems’ mission statements promise to care for patients’ spiritual health, to respect their values, or address the needs of the “whole person.”

“However, many fall short of meeting this obligation,” says J. Vincent Guss, Jr., DMin, BCC, a clinical ethicist and bioethics professor at Georgetown University School of Medicine in Washington, DC. In Guss’ view, this is because there is no one specifically charged with seeing to it.

“Ethicists and chaplains occupy a strategic position in helping to assure that clinicians, administrators, and allied health professionals maintain faithfulness to these values,” says Guss. He recommends the following approaches:

  • remind hospital staff that spiritual health affects the physical and emotional aspects of healing,
  • meet with senior administrative staff on a regular basis to monitor the attention given to the spirituality of both patients and staff, and
  • ask clinically trained, board-certified chaplains to help develop mission statements. “They are sensitive to the values that different groups of people have, depending upon their religious, ethnic, and philosophical backgrounds,” explains Guss.

Vance Goodman, a chaplain in the cardiac ICU at Children’s Health-Children’s Medical Center in Dallas, says, “If a health system’s mission and values include ‘the total well-being’ of patients, then spiritual health cannot be overlooked.” Chaplains can communicate the religious and cultural needs of patients and their families to the clinical team.

“Chaplains can be advocates and champions for a person’s religious traditions, spiritual beliefs, and cultural customs,” says Goodman. “We help to integrate those things into a treatment plan or daily routine.”

The Joint Commission requires all healthcare organizations to provide adequate care for patients’ spiritual, religious, and cultural needs in conjunction with the medical care they receive. These expectations can be found in the “Ethics, Rights and Responsibilities” section of the standards.

“Beyond that provision, the standards are relatively vague when looking at the ‘Elements of Performance’ to measure or prove that needs are being met,” says Guss.

Regarding metrics for evaluating whether the care is being offered, it is stated that the healthcare organization simply has to set forth its own measurements on how the care is being provided. The Joint Commission doesn’t specify credentials or training that are required. “Nor does it make any statement regarding the kind of support healthcare organizations need to give pastoral care and ethics departments to assure effectiveness,” says Guss.

Clinically trained chaplains and professional ethicists often attempt to fill this role. “But they are often hampered by the place to which they are often relegated in the administrative charts,” says Guss.

Many chaplains who had been department directors have been made managers or coordinators, or staff chaplains, notes Guss. “This reduces or eliminates departmental status,” he says. This leaves many professional chaplains without a significant place at the table when decisions are being made.

Regarding The Joint Commission’s requirements to meet spiritual health needs, Guss urges ethicists to “remind people that lack of [meeting spiritual needs] could result in a citation jeopardizing the organization’s certification.”

Guss says compliance means more than just giving patients ready access to pastors, priests, rabbis, and imams. “A board-certified, clinically trained chaplain is equipped to identify the spiritual needs of patients that untrained clergy or other healthcare practitioners may miss,” he explains.

F. Keith Stirewalt, PA, MBA, MDiv, chaplain for clinical engagement at Wake Forest Baptist Medical Center in Winston-Salem, NC, cautions against having a “checkbox mentality” when considering The Joint Commission spiritual health requirements. “Healthcare systems should place this expectation set into context for every major decision and critical process review,” he says.

At many smaller hospitals, ethics issues are addressed by multidisciplinary or community committees. Many members have not received any formal— or even informal — training or mentoring.

“This situation exists because of the constant financial pressures on healthcare organizations,” says Guss. “Pastoral care departments and ethics services are seen as non-revenue-producing costs centers.” This makes them easy targets for budget cuts.

Guss argues that it’s counterproductive to cut disciplines charged primarily with promoting cultural and spiritual sensitivity. “Research demonstrates that adequate, competent, professional, and consistent attention to the values and spiritual dynamics of patients improves patient care,” he says.

Stirewalt says that rapidly shifting reimbursement policies put healthcare systems on “a never-ending journey of trying to assist margins through expense reduction. Sadly, professional chaplains and reimbursed ethicist positions are attractive targets for expense reductions,” he says.

“While neither discipline directly generates revenue, their worth to the health of patients, families, staff, and the overall institution is significant,” says Stirewalt.

Rev. Barbara Patten, MDiv, BCC, a staff chaplain at Memorial Hospital of Carbondale (IL), says the discipline of chaplaincy’s code of ethics empowers the board-certified chaplain to become “a voice at the ethics table.”

This is only possible if the chaplain’s professional skill set is recognized and valued by the health system, however. “Basic professional trust and respect among the disciplines determines how ethical policies and practices are shaped,” says Patten.

Patten says chaplains have something unique to contribute: They can see the “whole scenario.” This comes into play if staff experience moral distress due to disagreement on the plan of care.

“Another discipline might choose to dismiss the moral distress, focus on the rights of the durable power of attorney, and interpret that an ethics consult is not necessary,” says Patten.

A chaplain could invite staff to discuss their feelings of moral distress. “This becomes a learning moment for all disciplines involved — to return to the health systems’ mission and values statement as the foundation of the ethical process,” says Patten.

While frequently involving prayer, Stirewalt notes that healthcare chaplaincy focuses on healing. This is done through conversation, presence, and exploring values.

“Some healthcare institutions ... see chaplains as theological cuckoo clocks, coming out to pray when the time calls,” says Stirewalt. He sees the chaplain’s role as assisting the health system in respecting patients’ spiritual needs.

“Chaplains and bioethicists have a duty to maintain an ethical voice in the institution, if for no other reason than to remind our institutions of why we do what we do,” says Stirewalt. He recommends the following to bioethicists and chaplains:

  • participate in many hospital committees, especially ones involving patient rights, safety, or the development of new service lines,
  • reinforce holistic, culturally sensitive treatment of individual patients,
  • use their observations and experiences to keep the healthcare institution focused on spiritual health, and
  • “maintain a vigilant lens” on groups who might be marginalized.

“If hospital chaplains are not involved in anything other than occasionally praying for patients, you’re not asking them to do enough — or you have the wrong chaplains,” says Stirewalt.

 

SOURCES

  • Vance Goodman, Children’s Health, Children’s Medical Center, Dallas. Phone: (214) 456-2822. Email: sarah.goodman@childrens.com.
  • J. Vincent Guss, Jr., DMin, BCC, Clinical Ethicist/Bioethics Professor, Georgetown University School of Medicine, Washington, DC. Email: jvguss@gmail.com.
  • Rev. Barbara Patten, MDiv, BCC, Spiritual Services Department, Memorial Hospital of Carbondale (IL). Phone: (618) 549-0721 ext. 64258. Email: Barbara.Patten@sih.net.
  • F. Keith Stirewalt, PA, MBA MDiv, Chaplain for Clinical Education, Division of Faith & Health Ministries, Wake Forest Baptist Medical Center, Winston-Salem, NC. Phone: (336) 716-5811. Fax: (336) 716-5075. Email: fstirewa@wakehealth.edu.