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 Process What 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 Ethical Decision 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 COMPETENCIES SKILLS 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”