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TRANSCRIPT
In this issue:1 Greetings from Wendell
Oman
1 Grace Notes2 Medical Ethics2 The ethicist as mediator 2 The ethicist at the end of life3 The physician/ethicist as
caregiver
3 Hospice Corner4 Meet Chaplain Phyllis Toback 4 In Upcoming Issues
Office for Mission &Spiritual Care
The Office for Mission & Spiritual Care provides spiritual care for patients, their families and associates 24 hours a day every day of the year. The office is open Monday through Friday from 8:30 a.m. to 5 p.m. To contact us, call 708.684.5175. Evenings and weekends, ask for the paging operator and request #2296 for the house chaplain or #2299 for the emergency department chaplain.
Bridges to Our Faith Communities
Advocate Christ Medical CenterHope Children’s Hospital
Office for Mission and Spiritual Care
July/August 2011Volume 2, Issue 4
Bridges to Our Faith Communities
Grace Notes
Ethics is knowing the difference between what you have a right to do and what is right to do. ~
Potter Stewart
What should she do? I once heard a mother lament, “I never thought I would have to make a decision like this.” The choices were not clear or hopeful. Her baby seemed likely to die in either case, but what should she do? And where could she turn for help?
Patients and their families are increasingly confronted with ethical dilemmas in every aspect of health care from who receives care to options of care to advance directives and end-of-life decisions. In the last eighteen months, chaplains at Advocate Christ Medical Center and Hope Children’s Hospital report having provided over seven thousand ethics consultations.
In this issue of Connections, you will read of four Advocate health care professionals who have served in the trenches of ethical decision-making for their entire careers. Helping sort out the best of the good, consulting as a mediator, making the best decisions during trying moments and supporting the journey for the heartbroken are all common experiences for ethicists, chaplains and physicians.
The Office for Mission and Spiritual Care oversees the clinical ethics committees, administrates the consultation process, develops
policies and provides ethics education for the medical staff at Christ Medical Center and Hope Children’s Hospital.
We ask your prayers for wisdom as we consider and provide guidance for those we serve.
Rev. Wendell Oman, Vice PresidentOffice for Mission & Spiritual Care
ConnectionsThis window, near MICU on the fourth floor, portrays Jesus’ guidance in medical decisions.
Grace Notes are readings, poems or quotes from a variety of faith traditions and writers. Each reflection tries to touch on the heart of being human in this world. To receive Grace Notes five
or seven days a week, please click here or contact cmc‑[email protected].
In this issueMedical Ethics:
4 Points of View
Connections - Advocate Christ Medical Center Office for Mission and Spiritual Care July/August 2011 - Page 2
Ed DuBose, Director of Clinical Ethics for Advocate Health Care, holds a Ph.D. in religious studies (with an emphasis on medical ethics) from Rice University and a Master of Divinity from Harvard Divinity School.
During his career as an ethicist, Ed DuBose has been guided by the belief that everyone is good-hearted. “Generally speaking, I assume that we are all motivated by our beliefs of what doing the right thing means. But different points of view exist – for patient, family members, health care professionals. They’re each sincerely trying to figure out the right way to go, and from time to time values conflict,” commented DuBose.
“One of the most common conflicts I see is between the patient’s right to make decisions and the family’s thoughts on what is best for that patient. Then people can start butting heads. Occasionally there is a conflict between what the doctor – who may have seen a thousand similar situations – thinks is best and what the patient wants.
“So, basically, I mediate. I’m not empowered by Advocate or personal belief to resolve issues. I would never do that. I don’t know the right outcomes for each person. If there is a conflict between the family members and the patient, my role is to be sure each person has had a chance to have his thoughts heard. I listen and ask questions so I can tease
out why people take a particular position.”
Most times things can be resolved. “If we can get below the common reaction of ‘I’m right and you’re wrong,’ we often find a common ground -- if people are good-hearted. Then they can come to a decision and move ahead even if that decision isn’t exactly what they wanted.
“Things don’t always go swimmingly well, but if I can help a patient or family move through a bad spot, that makes my work fulfilling.” DuBose added gently, “And there is so much gratitude for helping them move through something.”
Joal Hill, Director of Research Ethics at Advocate Health Care, holds a JD from the University of Tennessee, an MPH from Columbia University and a Ph.D. in medical humanities from the Institute for Medical Humanities in Galveston, Texas.
“Ethicists are not the moral police,” said Joal Hill with a tiny smile. “Everyone is a moral agent, but an ethicist has
expertise in moral reasoning and ethical analysis, so we identify the issues. Ethics is actually a conflict of goods. We can’t achieve all the goods at once, so what takes priority? The role of the ethicist is to help sort it all out.”
Although ethicists consult in a hospital setting for a variety of situations, their help is often needed at the beginning of life if there is a critically ill newborn and at
the end of life. One of the most difficult decisions is turning the corner from aggressive treatment to hospice.
Physicians often delay recommending hospice, and families may delay making a decision. Hospice admission generally is
considered around six months before death is anticipated. The national average for hospice care has been growing, but it still is only about two months. That is a big disparity at an important time in one’s life. Hill said, “I think it’s because Americans have such high expectations of medical professionals. And we’re a youth-oriented society that doesn’t want to recognize each one of us is going to die!”
By choosing hospice in time, a family can have weeks or even months of peace without excessive medical interventions. In addition to
offering an alternative to the intensive care unit, hospice gives
. . . my role is to be sure each person has had a
chance to have his thoughts heard.
. . . key words that hospice patients want to hear and
often need to say:
I love you.Please forgive me.
I forgive you.Thank you.Good bye.
The ethicist as mediator
The ethicist at the end of life
Medicalethics
Nonmaleficence – Do no harm to the patient.
Justice – Serve all fairly.
Beneficience – Do what is in the patient’s best
interest.
Autonomy – Respect a patient’s right to
make decisions.
Connections - Advocate Christ Medical Center Office for Mission and Spiritual Care July/August 2011 - Page 3
people time to say the things they always wanted to say. Hill recalled the key words that hospice patients want to hear and often need to say: I love you. Please forgive me. I forgive you. Thank you. Good bye.
“As ethicists, we always want to respect a person’s decisions, but we can’t always honor them. In some cultures, for example, adult children don’t want their parents to know a diagnosis. We want to respect the family decisions, but when patients are able to make their own decisions, we cannot achieve informed consent unless we tell the truth. That is a potential conflict,” said Hill.
“Parental decision-making for children is another area of complexity. It is right that we give wide latitude to parents to decide what is best for their children, but there can be conflicts here as well. We cannot expect parents to make
decisions in a box. As a parent you consider the impact of events on other children in the family, your marriage and so on. There are times when loving parents make a decision that is understandable in the context of the family, but which the health care team believes is not in the best interest of our patient. Medical codes of ethics emphasize that our primary obligation is to the patient, so this is another area where conflict arises.”
Respect for persons is one of the foundational principles for Western medical ethics, and in the U. S. that usually is understood as individual autonomy. “But respect for a person means that we must respect people who do not want to be autonomous, too. Some think the group or family is more important than the individual, so some patients want to defer their decisions to others. That can make informed consent more complex – but not unachievable.”
Dr. William Adair is Interim Vice President, Clinical Transformation at Advocate Christ Medical Center and Hope Children's Hospital and has served on the Ethics Committee for over 25 years.
Decisions about treatments around the end of life – when to start them, never starting them, stopping them – these are trying moments for patients, families and their
physicians. Withdrawing treatment can be especially difficult, Dr. Adair has found. “While from a logical perspective there is no difference between starting treatment that is withdrawn later and withholding it from the start (not initiating it at all), these alternatives may feel very different.
“I know that when we start a life-sustaining treatment, we all have expectations. We open ourselves to hope, and if that hope is not borne out, it hurts. We think, ‘Maybe it will be okay’ – even if there is just an outside chance. Then our hearts head down that path. If in the end the treatment is not effective, choosing to withdraw it feels more emotionally responsible than never initiating it.
“Think of giving a gift to a someone. The gift has personal meaning to both the giver and the receiver. Taking it back is painful for both – very different from having chosen not to give the gift in the first place.”
Choosing the path of hospice care is often difficult for the physician as well as for the patient and the family. All too commonly, they are ready for hospice while the physician is fearful about initiating the conversation.
“Doctors are sometimes reluctant to have end-of-life
discussions as it may feel like they are abandoning the patient. When there is no longer something to offer that heals or cures, it can feel like there is nothing to offer. They have not yet come to understand that they can still care for patients even when they have nothing left to treat.
“At some point, each of us faces death: our own, a loved one or, for the doctor, one of her patients,” concluded Dr. Adair. “Whatever issues I as a physician have personally regarding death, those issues come up whether I consciously acknowledge them or not. Because of these feelings, doctors
may shy away from these needed conversations. Yet our very best caring is possible when we physicians are aware of our own feelings about death and can empathize with our patients and their families in the midst of some of the most difficult decisions that any of us will ever make.”
Special Memorial Service for Recently BereavedSun., Aug. 14, 4 p.m.Siemers Chapel, Advocate Christ Medical CenterA special memorial service will be held for the hospice and patient families of Advocate Christ Medical Center and Hope Children’s Hospital who have recently lost a loved one. Christ Mission & Spiritual Care and Advocate Hospice join together in leading this service as a comfort for the families they serve. For more information, contact Penelope Gabriele at 630.829.1753.
Hospice CornerAdvocate Hospice ・ 1441 Branding Lane ・ Suite 200
Downers Grove, IL 60515 ・ 630.963.6800
Doctors . . . can still care for patients even when they have
nothing left to treat.
The physician/ethicist as caregiver
Connections - Advocate Christ Medical Center Office for Mission and Spiritual Care July/August 2011 - Page 4
Hope Children’s Hospital
Our new building
The five institutes
Advocate Christ Medical CenterAdvocate Hope Children’s Hospital
Staff Chaplains:Refat Abukhdeir, Moslem MinistriesCathy Arsenault, MennoniteFr. Bill Browne, Roman CatholicMary Anne Cannon, Roman CatholicP.V. Chandy, QuakerFr. Casimir Eke, Roman CatholicChristy Howard-Steele, Christian Richard James, Southern BaptistStacey Jutila, Evangelical Lutheran ChurchMarjorie Kooy, Christian ReformedSr. Peggy Nau, Roman CatholicDavid Safeblade, United Church of ChristTyron Smith, Baptist
Clinical Pastoral Education SupervisorsAngie Keith, Pentecostal
ACPE Supervisory Candidate/ChaplainJanet MacLean, United Church of Christ
ACPE Supervisory Candidate/ChaplainPhyllis Toback, Jewish
ACPE Supervisor/Chaplain
Clinical Pastoral Education Chaplain ResidentsJaroslaw Dabrowski, Roman CatholicDenise Duncan, United Church of ChristMary Johnston, Roman CatholicEliza Leatherberry, United Church of Christ
Secretarial StaffKaren Darr, 708.684.4189
CPE, Ethics Committee, Office of Vice PresidentFran Genender, 708.684.5175
Eucharistic Ministers, the Department, Office of Manager of Spiritual Services
Administrative StaffCorky DeBoer, Christian Reformed
Manager of Spiritual Services, ACPE SupervisorWendell Oman, Evangelical Free Church of America
Vice-President, Mission & Spiritual Care
Advocate Christ Medical CenterAdvocate Hope Children’s Hospital
4440 West 95th Street, Oak Lawn, IL 60453 708.684.8000
Other Advocate Health Care Facilities:Advocate BroMenn Medical Center, NormalAdvocate Condell Medical Center, LibertyvilleAdvocate Eureka Hospital, EurekaAdvocate Good Samaritan, Downers GroveAdvocate Good Shepherd Hospital, BarringtonAdvocate Illinois Masonic Medical Center, ChicagoAdvocate Lutheran General Hospital, Park RidgeAdvocate Lutheran General Children’s Hospital, Pk. Ridge Advocate South Suburban Hospital, Hazel CrestAdvocate Trinity Hospital, Chicago
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To continue receiving Connections, your email address must be current. Please inform us of any changes of email address or other contact information. Email [email protected] or call 708.684.5175.
In Upcoming Issues
Meet Chaplain Phyllis Toback
Once Phyllis Toback began quilting, drawing and firing ceramics, her life was never quite the same.
Eight years earlier, she had earned her Ph.D. in English literature from New York University and had built her career teaching at the college level. “But when I began creating, my images of God and spirituality expanded,” said Toback, who was raised in an Orthodox Jewish family and is now Conservative. “I discovered the Jewish mystical tradition and its commonalities with all other mystical traditions. At the same time, I increased my ecumenicalism.”
Toback had a desire to meet with people one-to-one and journey with those who temporarily needed support. Through a Chicago Board of Rabbis Parachaplaincy course, she earned her certification to visit patients. She then took CPE training, audited courses at
seminaries and acquired a Master of Divinity equivalent. In 1987, Toback was hired as a staff chaplain for Advocate Christ Medical Center.
Ch. Toback serves patients of all religions and acknowledges that there are few Jewish patients at the hospital at any one time. “Certainly I minister to
Jewish patients and their families, but I also have formed good relations with many Jewish doctors. My Jewish ministry is more with doctors than patients.”
She has been vice-chairman of the Perinatal Committee for eight years. “This work was very difficult initially, but we gained experience and set down policy to address all possible situations.
“Sometimes expectant parents find out things are wrong with their babies. Sometimes a mother’s health is at serious risk. These are families that really want these babies. They are heartbroken when they get the news that things aren’t right.”
One particularly agonizing case involved twins known to be joined at the heart. “We contacted doctors all over the country. Then we researched all over the world, but the feedback was consistent. It was painful for us all. We all wanted so much to send that family home with at least one baby,” recalled Ch. Toback.
Today Advocate Christ Medical Center’s perinatal hospice program provides support and counseling for families facing extreme pregnancy complications. Simply having someone there to help them sort things out can offer immeasurable comfort.
“We contacted doctors all over the country . . . Then we researched all
over the world . . . It was painful for us all.
Rev. Bonnie CondonVP, Faith Outreach
Dear Faith Leader –
We at Advocate Health Care recently received a wonderful honor:
For the third consecutive year, Thomson Reuters named Advocate Health Care one of the nation’s top 10 health systems.
This recognition reflects well on everyone associated with our hospitals – our associates (employees), our physicians and our volunteers. Since Advocate Health Care is faith-based, I believe this is also significant for those of us who are faith leaders.
For more than 100 years, Advocate and our predecessor organizations have cared for the health needs of people in our communities. We understand spirituality to be an important part of wellness and healing. We value the unique contributions faith communities make in transforming people’s lives for health and wholeness.
After reading the press release about the distinction Thomson Reuters has once again given Advocate, I felt moved to write to you, a faith leader. This award is in part a validation given to all of us who partner to make certain that the people we are privileged to serve are cared for – physically and spiritually. Thank you for being part of this.
Faithfully,
Bonnie Condon
Link to the Advocate Health Care press release:
http://www.advocatehealth.com/body.cfm?xyzpdqabc=0&id=12&action=detail&ref=89
Link to the Thomson Reuters press release:
www.100tophospitals.com
Rec
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posi
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life,
str
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indo
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sinc
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to m
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the
high
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life
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Aug
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Ther
apeu
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Rec
reat
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Wee
k –
July
10
to 1
6
7-11
Hea
lthy
Com
mun
icat
ion
Pray
er:
Car
ing
God
, rem
ind
me
to a
ppre
ciat
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ose
med
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pro
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each
day
. Am
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ring
dru
gs th
at m
ay b
e da
nger
ous
for
you.
Q: M
y do
ctor
told
me
that
I sh
ould
wea
r a
Med
ic A
lert
br
acel
et, b
ut I
don’
t lik
e th
e w
ay th
ey lo
ok. W
hat a
re m
y al
tern
ativ
es?
A: M
edic
Ale
rt m
edal
lions
can
be
wor
n as
nec
klac
es, w
atch
es
and
even
sho
elac
e ta
gs. T
hey
also
com
e in
diff
eren
t siz
es,
met
als
and
colo
rs, i
nclu
ding
spo
rts
band
s an
d fa
shio
nabl
e be
aded
bra
cele
ts. T
oday
’s w
eare
rs h
ave
a va
riet
y of
goo
d-lo
okin
g st
yles
to c
hoos
e fr
om.
Q: A
love
d on
e su
ffers
from
Alz
heim
er’s
Dis
ease
. How
can
a
Med
ic A
lert
ser
vice
hel
p?
A: A
Med
ic A
lert
tag
lets
law
enf
orce
men
t, fir
st r
espo
nder
s an
d m
edic
al p
erso
nnel
kno
w th
at a
per
son
has
Alz
heim
er’s
and
that
he
or s
he m
ay n
ot b
e ab
le to
effe
ctiv
ely
com
mun
icat
e, e
ven
if co
nsci
ous.
Med
ic A
lert
ser
vice
s ca
n al
so b
e co
mbi
ned
with
a G
PS lo
catio
n se
rvic
e: Y
our
love
d on
e ca
n w
ear
a w
rist
bra
cele
t or
carr
y a
page
r th
at a
llow
s yo
u to
tr
ack
his
or h
er w
here
abou
ts, a
nd th
e M
edic
Ale
rt s
ervi
ce c
an
notif
y yo
u w
hen
your
love
d on
e is
foun
d by
law
enf
orce
men
t or
firs
t res
pond
er s
ervi
ces.
A d
octo
r’s v
isit
usua
lly b
egin
s w
ith a
n in
terv
iew
: The
doc
tor,
nurs
e or
med
ical
ass
ista
nt a
sks
us a
bout
our
hea
lth h
isto
ry a
nd
curr
ent c
once
rns,
then
add
s th
is in
form
atio
n to
our
per
man
ent
file.
The
doc
tor
then
use
s ou
r m
edic
al r
ecor
ds to
mak
e th
e be
st p
ossi
ble
reco
mm
enda
tions
abo
ut o
ur h
ealth
car
e.
But
whe
n a
med
ical
em
erge
ncy
stri
kes
or a
n ac
cide
nt
happ
ens,
we
may
not
be
able
to c
omm
unic
ate
with
firs
t re
spon
ders
or
heal
th c
are
wor
kers
. Str
oke
vict
ims,
for
exam
ple,
may
be
awak
e an
d al
ert b
ut u
nabl
e to
spe
ak o
r un
ders
tand
spe
ech.
Peo
ple
in s
hock
may
lose
con
scio
usne
ss,
and
thos
e w
ith h
ead
inju
ries
may
not
be
luci
d en
ough
to
conv
ey im
port
ant m
edic
al in
form
atio
n to
oth
ers.
Med
ic A
lert
tags
com
mun
icat
e w
hen
we
can’
t. Yo
ur ta
g id
entifi
es y
our
maj
or m
edic
al c
ondi
tion(
s), s
uch
as d
iabe
tes
or
drug
alle
rgie
s, s
o th
at fi
rst r
espo
nder
s ca
n be
gin
trea
tmen
t. O
nce
you
are
at th
e ho
spita
l, st
aff c
an c
all t
he M
edic
Ale
rt
cent
er fo
r yo
ur m
edic
al r
ecor
ds a
nd in
form
atio
n ab
out a
ny
med
icat
ions
you
take
or
whe
ther
you
are
cur
rent
ly
unde
rgoi
ng m
edic
al tr
eatm
ent.
Med
ic A
lert
em
ploy
ees
can
also
con
tact
you
r fa
mily
and
put
them
in to
uch
with
hos
pita
l st
aff s
oone
r.
If yo
u ha
ve b
een
thin
king
abo
ut g
ettin
g a
Med
ic A
lert
bra
cele
t fo
r yo
urse
lf or
a lo
ved
one,
now
is th
e tim
e to
do
it. If
you
al
read
y ha
ve a
Med
ic A
lert
tag,
take
a fe
w m
inut
es to
con
tact
th
e se
rvic
e an
d up
date
you
r m
edic
al r
ecor
ds o
r yo
ur fa
mily
’s co
ntac
t inf
orm
atio
n. Y
ou’ll
pro
tect
you
r he
alth
and
you
r fa
mily
’s pe
ace
of m
ind
by m
akin
g cr
ucia
l inf
orm
atio
n ab
out
your
hea
lth a
vaila
ble
to th
ose
who
nee
d it.
Aug
ust
Is M
edic
Ale
rt A
war
enes
s M
onth
8-11