The Chaplain as Spiritual Guide in

Ethics Consults

2006

2

DEFINITION

Ethics Consultation• A service to assist patients, families,

surrogates, health care providers, or other involved parties address uncertainty or conflict regarding value-laden issues that emerge in health care.

3

GOAL OF ETHICS CONSULTS

Improve how we provide health care and its outcome by identifying, thinking through and resolving of ethical issues.

4

Ethics is primarily a process of navigating and negotiating values in

tension

The purpose of Ethics Consultation is to facilitate good values-based decision-making.

Purpose of Ethics Consultations

5

The purpose of an Ethics Consult is NEVER to take away the decision-making power of the appropriate decision makers;

- Patient- Substitute decision-maker- Clinicians- Other

Purpose of Ethics Consultations

6

The Case

7

Spirituality is a focus on the most meaningful aspect of the human person

It connects with

the spirit,the core, the essence of the person

Chaplain as Spiritual Guide

8

The Consult ProcessWhat to do

How to do it

9

CONSULT FEATURES

Identifying and analyzing the the values that are competing

If we can’t honor them all,

which one(s) should we protect/promote?

Facilitating the building of consensus in addressing and/or resolving an issue

10

Characteristics of Ethics Consults

The “product” of the case consultation committee is most often a recommendation with the rationale for the position.

The “model” is Optional-Optional, i.e., referral is optional; accepting and implementing the advice/recommendation is usually optional.

11

CONSULT PROCESS

Facilitating the building of consensus among involved parties by:• ensuring that involved parties have their

voices heard• building morally acceptable shared

commitments or understandings.

12

CONSULT PROCESS

EthicalDecision

Community of

Concern

Facts

Stakeholders

Alternatives

Implementation

13

CONSULT PROCESS

- Gather the appropriate individuals- Gather the relevant data- Clarify relevant concepts/values involved.- Discuss related normative issues- Identify a range of morally acceptable options within the

context- Decide what recommendation(s) to make- Determine implementation plan- Identify necessary education and quality improvements- Document the consult- Evaluate the process and the outcomes

14

CONSULT PROCESS

-Step One: Identify the question(s)

Why was the consult called?

Is this the right question or set of questions?

What are the spiritual issues involved?

Would it make a difference if patient/family

were conscious of those issues?

15

Chaplain as Guide

What are his spiritual issues?

Hopelessness?

Discouragement?

Guilt?

Fear?

What are his religious beliefs?

What is his suffering?

16

CONSULT PROCESS

-

Step Two: Identify the Relevant Facts • diagnosis & prognosis

• goals and values

• oversight regulations & legal issues

•professional standards & codes of ethics

•institutional policies & values

17

CONSULT PROCESS

-

Step Three: Identify the Stake-holders

Who is affected by a particular decision to act?

Who is most affected by a particular decision?

18

CONSULT PROCESS

Facilitating the building of consensus among involved parties by:• ensuring that involved parties have their

voices heard• building morally acceptable shared

commitments or understandings.

19

CONSULT PROCESS

-

Step Four: Identify Relevant Moral Principles Human dignity,The common good,Justice, Beneficence,Respect for autonomy, Informed consent,Medical futility, etc.

20

CONSULT PROCESS

Step Five: Consider Alternate Options

Are the identified goals of treatment appropriate within this patient’s clinical circumstances?

21

CONSULT PROCESS

-Step Six: Arrive at & Justify Recommendation-Take turns expressing individual points of view -Summarize points of agreement -Debate and discuss points of conflict until a decision that

everyone can live with is reached -Provide those who cannot support the recommendation

and/or may be involved in the procedure an opportunity to opt out for reasons of individual conscience -Consider whether the directly intended effect(s) and the

chosen means entailed by the recommendation are consistent with relevant moral norms

22

CONSULT PROCESS

-Step Seven: Review & Follow-up

-Were all parties involved comfortable with the decision? If not, were the provisions for conscience found to be acceptable? -Were individuals with relevant expertise consulted?-Was informed consent obtained prior to implementation? -Were appropriate steps taken to act in a timely manner? -Does this issue require an institutional response? -What learning resulted from this case or issue? -Was the consult properly documented and reported?

23

CONSULTATION COMPETENCIES

SKILLS• Ability to think through values conflicts, Process,

Interpersonal

KNOWLEDGE• Ethical Principles • State laws and regulations • Ethical and Religious Directives for Catholic Health Care

CHARACTER• Respect • Courage

24

CHAPLAIN COMPETENCIESSKILLS

• Ability to facilitate reflection on values conflicts and guide towards resolution and peace

• Process• Interpersonal

KNOWLEDGE• Diverse cultural and religious traditions • Spiritual dynamics in secular language

CHARACTER• Respect• Compassion• Personal spiritual development • Courage

25

CHAPLAIN COMPETENCIES

Guide: “One who shows the way by leading, directing or advising, usually by reason of his (sic) greater experience with the course to be pursued”

26

CHAPLAIN COMPETENCIES

Guide: “One who shows the way by leading, directing or advising, usually by reason of his (sic) greater experience with the course to be pursued”

27

CHAPLAIN COMPETENCIES

Guide: “One who shows the way by leading, directing or advising, usually by reason of his (sic) greater experience with the course to be pursued”

28

CHAPLAIN As Guide in Ethical Dilemmas

Guide:

“One who shows the way by leading, directing or advising, usually by reason of his or her greater experience with the course to be pursued”