GUIDELINES FOR THE CHAPLAINS' ROLE IN BIOETHICS

College of Chaplains, American Protestant Health Association

1992

This document differs from codes of ethics in its focus on the role of chaplains in clinical settings, particularly within healthcare institutions. Certified chaplains are recognized to be essential members of the healthcare team; they help to identify and integrate the spiritual and moral perspectives of patients with those of other healthcare disciplines to form a holistic approach to bioethics.

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Introduction

Advances in medical science and technology, the evolution of integrated delivery systems, and the changing economics of health care present benefits and ethical dilemmas. Ethical conflicts can arise in the clinical setting and at the organizational level. The obligations of health care organizations include provision of a forum for ethical reflection, a deliberate process for ethics consultation, and persons trained in ethics consultation.

Health care ethics committees may serve three functions: (1) education, (2) consultation, and (3) review and recommendation of institutional policies and procedures. Health care organizations that have a formal health care ethics committee often include a certified Chaplain on that committee. As members of health care ethics committees, Chaplains play a crucial role in health care ethics reflection. Chaplains may be of assistance to health care ethics committees as they discuss the questions of philosophy, theology, spirituality, human values, and morals which are integral to ethical questions.

While some Chaplains have education and/or training in ethics, their roles as Chaplains differ from those of ethicists. Chaplains identify and clarify the patient's spiritual and moral perspectives as essential ingredients in the process of health care ethics reflection. Integration of these perspectives with those of other health care disciplines fosters a holistic approach to health care ethics.

These Guidelines provide primary principles for the effective inclusion of pastoral/spiritual care in the process of health care ethics reflection. While each health care institution has a particular context within which ethical reflection is done, these Guidelines are generally applicable to a variety of health care settings. The Guidelines emphasize pastoral/spiritual care's unique perspective as integral to the ethical reflection process of a health care organization.

Principle I

The health care organization includes a certified chaplain on its health care ethics committee.

INTERPRETATION— A certified Chaplain can make unique contributions to a health care ethics committee. Certified Chaplains have theological education on at least the master's level or its equivalent that includes formal training in pastoral theology and clinical pastoral education.

Guideline 1

Chaplains offer pastoral/spiritual care to health care ethics committee members and to medical and health care professionals involved in health care ethics discussion and consultation.

Guideline 2

Chaplains serve as resource persons to religious/faith group leaders and to the health care ethics committee concerning the spiritual and value dimensions and values of illness and health even if patients or their families have no apparent religious affiliation.

Principle II

Chaplains develop a continuing education plan for themselves and their colleagues that addresses health care ethics theories and approaches related to the spiritual, religious, cultural, and philosophical values represented in persons served by their health care institutions, thus, contributing to the institution's education program.

INTERPRETATION— Certified Chaplains commit to yearly continuing education for themselves in order to maintain certification and serve as resource persons in their organizations' educational programs in health care ethics.

Guideline 1

The Chaplain seeks continuing education in health care ethics and ethics consultation in order to achieve a working knowledge of basic principles, ethical decision-making, current issues, and developing trends.

Guideline 2

Chaplains participate in and serve as resource persons to the organization's health care ethics education program to patients, staff, and community with the goal of providing a forum for discussion of various spiritual and religious perspectives on health care ethics issues.

Guideline 3

Chaplains are included in peer review as the multi-disciplinary team seeks to teach health care ethics theories, principles, and options that apply in specific situations.

Guideline 4

Chaplains contribute as resource persons and speakers in the organization's education programs for patients, health care professionals, and the community.

Guideline 5

Chaplains bring expertise in spiritual, theological, ethical, and moral values to the multi-disciplinary team in the clinical setting.

Guideline 6

Chaplains bring expertise in spiritual, theological, ethical, and moral values to the multi-disciplinary reflection and discourse on ethical issues, dilemmas, case studies, and retrospective reviews.

Principle III

Chaplains participate in the health care ethics consultation services of the facility or organization.

INTERPRETATION— A health care ethics committee may provide the service of consultation to physicians, nurses, administration, patients, and families. Consultation does not take the place of or interfere with the patient-physician relationship. Consultation helps clarify ethical options through reflective discussion in the context of health care ethics principles and good medical practice.

Guideline 1

The Chaplain's role is to maintain contact with the patient and/or the patient's decision-maker(s) during the ethics consultation process.

• The Chaplain may serve as a resource to the health care ethics consultation process, helping to interpret the process and facilitate the patient and the patient's decision-maker's understanding of and participation in the consultation process.

Guideline 2

The Chaplain may assist in facilitating group process.

• The Chaplain may facilitate and be a resource in supporting group process, i.e., consultative process, staff and patient decision-makers' concerns, etc.

Guideline 3

The Chaplain clarifies theological beliefs and values that influence decision-making.

• The Chaplain's function is to identify spiritual, moral, religious, cultural, and philosophical values which influence decisions.
• The Chaplain provides validation and recognition of the importance of personal beliefs, which will help individuals trust the consultation process.
• The Chaplain serves as an advocate for the spiritual values and religious beliefs held by the patient, even when those values and beliefs are not those of the Chaplain.
• The Chaplain assures that the religious, cultural, and philosophic values of the patient are considered during discussion of appropriate medical treatment, even when those values and beliefs are other than those of the Chaplain.

Guideline 4

The Chaplain provides pastoral care to those involved in the health care ethics consultation process.

• Chaplains may provide continuing support to the patient, family, and staff during and following the consultation process.

Guideline 5

The Chaplain serves as liaison with the patient's own clergy.

• The Chaplain is the liaison with the religious community. The Chaplain develops programs and strategies to develop positive relationships with community clergy and other designated religious representatives who visit congregants and may be involved in the decision-making process.
• The Chaplain provides consultations, referrals, professional resources, and educational opportunities for community clergy.
• The Chaplain facilitates the pastoral ministry and the role of community clergy in the decisionmaking process for their congregants who are patients.

Principle IV

Chaplains assist the health care organization in its review and recommendation of policies that have health care ethics implications in the services provided by the organization.

INTERPRETATION— Health care ethics committees are usually responsible for reviewing existing or proposed policies and procedures for the organization, medical staff, nursing staff, etc. As members of the health care ethics committee, Chaplains offer input from their discipline of pastoral/spiritual care.

Guideline 1

Chaplains serve as resource persons for understanding and interpreting faith communities, religious traditions, and belief systems as they might relate to or be affected by proposed policies and procedures.

Guideline 2

Chaplains serve as resource person to staff who have spiritual and religious concerns which arise in the implementation of policies and procedures with ethical implications.

Principle V

Chaplains provide pastoral and spiritual care to those involved in the ethical reflection process.

INTERPRETATION— The ministry of Chaplains includes a wide repertoire of services including pastoral presence, pastoral conversation, pastoral/spiritual care, and pastoral counseling. Experiencing such services, patients, families, health care staff, and employees feel affirmed, understood, and supported in their particular predicament and in their right to have a particular ethical perspective. Those involved in the process can be enabled to explore the relationships of the physical issues of health and illness, psychological dimensions of the situation, i.e., anxiety, fear, trust, etc., and the spiritual issues, i.e., meaning, hope, ultimate concern, and God's presence. Issues vary greatly from person to person depending upon the situation and belief system of the individual. Pastoral/spiritual care offers support for all involved and creates an atmosphere of sensitivity and trust in the context of health care ethics decision-making.

Guideline 1

Chaplains offer religious resources and support from the patient's and family's faith system and community as appropriate.

Guideline 2

Chaplains facilitate the ministry of community clergy and faith group leaders for the purpose of offering support and the opportunity for patients and families to explore the values, beliefs, and meaning inherent in the patient's situation.

Principle VI

Chaplains provide specific evaluation of the process of ethical reflection from a spiritual perspective as well as from a clinical perspective.

INTERPRETATION— Evaluation of the health care ethics reflection process utilized in a case consultation, policy review, or educational event is an important part of quality improvement. Each discipline, including pastoral/spiritual care, has its own perspective and responsibility to contribute to the evaluation process.

Guideline 1

Chaplains have the responsibility to be advocates for patients, families, and health care staff in behalf of their particular spiritual values. The role of the Chaplain is to help ensure that the health care ethics reflection process is as attentive, respectful, and inclusive of patients' values and wishes as possible.

Guideline 2

Pastoral intervention in the health care ethics process is evaluated regularly through peer review and input from a clinically trained and experienced ethicist. The health care organization provides opportunities and encouragement for Chaplains to attend and participate in regional and/or national health care ethics workshops, conferences, and other educational events.

Principle VII

Chaplains provide for alternate coverage of the chaplain's role in the health care ethics reflection process when it is appropriate for the chaplain designated to exclude her/himself.

INTERPRETATION— The Chaplain charged with the responsibility to serve on the health care ethics committee or to participate in the consultation service may withdraw from participation so that objectivity and professionalism can be maintained in the process.

Guideline 1

If the Chaplain does not have adequate knowledge about an issue, particularly a patient's or family's spiritual perspective, the Chaplain seeks consultation or makes an appropriate referral.

Guideline 2

If the Chaplain has a personal relationship with one or more of the significant parties involved in the case being reviewed, designating another certified Chaplain to participate in the ethics process maintains objective and professional integrity.

Guideline 3

Chaplains are familiar with the process for health care ethics consultation in their organizations. When patients with whom they have pastoral relationships are brought to the attention of the health care ethics service for consultation or for education purposes, other pastoral care staff persons or community clergy can be involved when and to the degree appropriate. In this process, confidentiality is maintained.

PRINCIPLE VIII

Chaplains in administrative and managerial roles assist in the identification and consideration of values in matters of the health care organization.

INTERPRETATION— Organizational values and ethics reflect consistency at all levels and in all services of the health care organization. The certified Chaplain who is in an administrative position and/or works at a managerial level has knowledge and experience of health care ethics, organizational ethics, and spiritual values related to the organization.

Guideline 1

Chaplains bring expertise in spiritual dimensions, theological considerations, ethical issues, and moral values to the administrative and managerial teams.

Guideline 2

Chaplains with managerial/administrative responsibilities serve as resource persons to the administrators, board members, owners, etc. concerning the exploration of the spiritual dimensions, theological considerations, ethical issues, and moral values of the health care organization.

Conclusion

Spiritual and religious dimensions of health care ethics issues and dilemmas must be considered and included in the process of health care ethics reflection. The Association of Professional Chaplains provides resources and a Bioethics Committee to assist members of the APC as well as other health care providers to facilitate, promote, enhance, and strengthen the role of Chaplains in this important endeavor.

Approved by the Board of Directors 10/2000