Transcript Document

The Chaplain as Spiritual Guide in
Ethics Consults
2006
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.
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GOAL OF ETHICS CONSULTS
Improve how we provide health care and its
outcome by identifying, thinking through
and resolving of ethical issues.
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Purpose of Ethics Consultations
Ethics is primarily a process of
navigating and negotiating values in
tension
The purpose of Ethics Consultation is to
facilitate good values-based decisionmaking.
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Purpose of Ethics Consultations
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
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The Case
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Chaplain as Spiritual Guide
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
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The Consult Process
What to do
How to do it
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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
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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.
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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.
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CONSULT PROCESS
Ethical
Decision
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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
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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?
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Chaplain as Guide
What are his spiritual issues?
Hopelessness?
Discouragement?
Guilt?
Fear?
What are his religious beliefs?
What is his suffering?
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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
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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?
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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.
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CONSULT PROCESS
Step Four: Identify Relevant Moral Principles
Human dignity,
The common good,
Justice,
Beneficence,
Respect for autonomy,
Informed consent,
Medical futility, etc.
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CONSULT PROCESS
Step Five: Consider Alternate Options
Are the identified goals of treatment appropriate
within this patient’s clinical circumstances?
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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
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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?
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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
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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
•
•
•
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Respect
Compassion
Personal spiritual development
Courage
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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”
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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”
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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”
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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”
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