Conscientious objection of providers, moral distress, patient adherence, and difficult or noncompliant patients all are situations where chaplains can be of help, says Steven Squires, PhD, vice president of mission and ethics at Cincinnati-based Mercy Health.

“Chaplains can be great mediators in intractable clinical conflicts, getting to life and purpose issues with greater ease than many healthcare providers,” he adds.

Yet when healthcare teams are concerned about medical ethics dilemmas, chaplains often are the team members who are involved last, according to Angelika A. Zollfrank, BCC, manager of spiritual care at Yale New Haven Hospital (CT). Here, Zollfrank shares some common reasons for this:

• A hospital may not have adequate staffing to allow for chaplains to be as visible as other healthcare providers.

Chaplains often cover many units, effectively taking responsibility for the spiritual care of 70 to 100 patients and families at any given time, notes Zollfrank.

• Medical teams, with the exception of palliative care, tend not to include the chaplain in their daily team structure.

“Chaplains might find such integration into the team takes time that they would rather spend in direct patient care,” says Zollfrank.

• Clinicians sometimes are concerned that chaplains will impose their values on the team.

“This preconceived notion may be fueled by the clinicians’ spiritual or religious beliefs, or lack of such belief,” says Zollfrank. In reality, chaplains’ training enables them to support others in their beliefs and values — even when those beliefs and values are different from their own. “Chaplains offer crucial support to clinicians and families alike,” says Zollfrank.

• Chaplains vary widely in their training.

Some have received formal education in medical ethics, while others learn on the job. Some are members of ethics committees, others are not. “Sometimes interns in spiritual care and chaplain residents cover a clinical area and they are just beginning to learn about medical ethics,” says Zollfrank. In other cases, service lines enjoy the constancy of a professional chaplain who is a known and trusted member of the team.

“All these factors can present challenges for medical teams to think consistently of the chaplain as a resource in cases of moral distress, moral uncertainty, or ethical dilemmas,” says Zollfrank.

As highly skilled communicators, chaplains bring unique competencies to medical ethics issues, says Zollfrank. This allows them to pick up on the underlying motivations, concerns, and coping abilities of families and surrogate decision-makers.

“Chaplains are often an effective bridge between the world of science and healthcare on the one hand, and the world of faith and nonmedical values on the other,” says Zollfrank. Community clergy are typically unfamiliar with medicine and healthcare. In contrast, professional chaplains are healthcare team members who are supportive of families in crisis.

“Often, the dynamics of grief play a crucial role in medical ethics decision-making,” says Zollfrank. Clinicians have a sense of urgency when medical interventions become more burdensome than beneficial. In contrast, chaplains understand the emotional and spiritual processes that families go through.

Zollfrank has found it helpful to hold a huddle ahead of provider-family meetings to clarify the roles of everyone involved. “Often, it is useful to have the chaplain process with the family or surrogate decision-maker, outside a caregiver-family team meeting,” she says. Zollfrank sees the following as important roles for chaplains:

• Helping with end-of-life decision-making. “For many people, dying is a spiritual and not a medical process,” she explains.

• Counseling patients and family using knowledge of what is ethically permissible in different religious communities.

• Collaborating with community clergy to ensure continuity of care beyond the hospital stay.

• Bringing spiritual, religious, and cultural sensitivity to medical ethics issues.

“Chaplains are good at communicating that while medical care can become burdensome, healthcare providers and medical teams never stop caring,” says Zollfrank.

SOURCE

• Rev. Angelika A. Zollfrank, BCC, Manager, Spiritual Care, Yale New Haven Hospital (CT). Phone: (203) 688-7036. Email: angelika.zollfrank@ynhh.org.