Wednesday, September 2, 2009

The Chaplain's Role in Advance Directives

A good chaplain friend from Nebraska has sought our help and I intend to provide some from my perspective.

He asked in part, “Is it right to initiate an end of life planning discussion with a person whether or not the person has indicated a desire to talk of such matters?”

Now, I’ve never been a chaplain, nor have I been lying as a patient in a hospital bed in recent history. But my admiration for what it means to be a chaplain in a healthcare institution leads me to opine that chaplains could ask almost anything and I would treat the question respectfully—maybe not answer it, but I would presume his/her right to ask it.

So let’s talk specifically about advance directives. In the admissions process, the patient has been asked if he/she has one. Whether the answer is yes or no, the chaplain not only has the privilege but the obligation to follow up on the patient’s answer.

Patients from 18-88 (and beyond) need to have this discussion, and who better than an unhurried chaplain. So I argue that beneficience obliges the chaplain to open the discussion, thus contributing to the patient’s welfare.


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Blogger Practical Bioethics said...

From George Flanagan:

As in all things chaplainesque, our goal is to allow the patient to determine the agenda for the visit. This is central to the role of the chaplain.

If the chaplain is a good listener—I prefer the Rogerian model—she/he is amazed at the concerns brought to the conversation by the patient without prompting, frequently leading to end-of-life concerns and conversation.

Perhaps it won’t be in the first visit but rather in the second or third. Patients in hospital beds are thinking about life and the end of life at some level.

It’s unavoidable in that setting.

Chaplains are ready to be engaged by the patient in an end-of-life conversation, and in that case, the chaplain may quite appropriately ask if the patient would like to make some decisions in written form now.

If “yes,” we proceed. We can trust that the idea of AD has been presented to the patient somewhere in the admitting process; deciding to have the conversation is the patient’s elective (sometimes the patient asks the chaplain specifically about end-of-life planning and advance directives).

Now, I may ask permission to leave a tri-fold brochure with the patient as part of my exit for his/her later interest and reading, and it should contain information regarding whom to contact, inpatient or outpatient, if/when the patient is interested in initiating or continuing that conversation.

But I am clear that my agenda as a chaplain is not to lead the patient to complete an advance directive. My agenda is to listen and to be initiated by the patient in whatever it is she/he is struggling with at the moment I walk in the door.

I want to encourage the patient as he/she talks about end-of-life concerns, and I am ready to offer the AD as a tool that can be helpful.

The ethical obligation to ensure that patient’s are aware of their right to make their own health care decisions is the medical center’s. The chaplain is further committed ethically to being there on the patient’s terms, to be a minister to the patient in his/her pressing need.

It calls for discernment and balance.

Chaplain/Integrated Ethics Program Officer
VA Medical Center
Kansas City, Missouri

Wednesday, September 02, 2009  

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