By Stacey Kusterbeck
At recent chaplaincy and clinical ethics professional conferences, M. Jeanne Wirpsa, MA, BCC, HEC-C, program director and clinical ethicist at Northwestern Memorial Hospital’s Medical Ethics Program, noticed a new trend. More chaplains were being asked to serve in formal clinical ethics roles at their institutions. Additionally, many chaplains — Wirpsa included — were seeking professional advancement in the field of medical ethics. “This trend emerges at the same time as the field of clinical ethics is maturing,” observes Wirpsa.
Some ethicists voiced concerns that chaplains would impose their own beliefs and values on patients, families, or clinicians when serving in the ethics consultant role. In Wirpsa’s experience, this is an unfounded concern. “Chaplains are trained to bracket their own beliefs and values, probably moreso than many other clinicians who wind up doing ethics consultations,” she says. “Self-awareness and respect for diverse worldviews is a core part of chaplaincy training.”
As for clinicians, many are skeptical about chaplains’ ability to do ethics work. “At some hospitals, the perception of chaplains was as nice people and good communicators — not experts in medical ethics. I was concerned about the deleterious impact that having underqualified persons representing the profession of clinical ethics would have on its reputation,” says Wirpsa.
Wirpsa and colleagues conducted a study to learn more about the experience of chaplains working in the clinical ethics field.1 The researchers surveyed 337 chaplains about the roles chaplains were currently occupying in clinical ethics committees and programs, and how chaplains prepared for those roles. Some key findings:
- Almost 60% of chaplains indicated they had adequate knowledge to function in their clinical ethics role. About one-quarter (26.7%) indicated they were “very” well-prepared. However, 12.5% thought their education was “somewhat” lacking, and 1.2% thought it was “very” lacking.
- About 8% of chaplains were certified as healthcare ethics consultants (HEC-C).
- Most (85.5%) chaplains did not receive any formal compensation for ethics work and stated that it was considered as part of their role or duties.
- Chaplains served in a variety of roles in clinical ethics programs. Most (61.5%) served as a member of the ethics committee. About one-third of chaplains served as the chair or co-chair of the ethics committee.
- Most (64%) chaplains had not received formal education in clinical ethics, beyond what they received in Clinical Pastoral Education (CPE).
“The training in CPE is not for ethics work but, rather, for how chaplains can support ethical decision-making in their role as chaplains and meet the chaplaincy code of ethics,” explains Wirpsa.
Few CPE Programs offer robust ethics training. “The religious ethics knowledge chaplains bring to the role would therefore be gained from taking a course or two in seminary — that is, specifically about Christian ethics rather than medical ethics or ethical frameworks of other religious traditions,” says Wirpsa.
In free text comments, chaplains reported knowledge gaps in documentation of ethics consults, hospital policies, and relevant laws and regulations. Chaplains reported wide variation in their level of training, involvement in ethics work, and whether their ethics role was voluntary or paid. One chaplain stated, “I had no idea what I was doing. I had no training in CPE, grad school, seminary, or on the job.” Another stated, “For at least the first year while I was serving on the ethics committee, I didn’t understand my role or how I could best contribute.” When serving in the role of ethics consultant, chaplains reported confusion about what “hat” they were supposed to be wearing.
Some chaplains noted that their involvement in ethics work came about because ethics positions got cut. One stated, “When my organization cut the position of director of ethics, that work fell to me as lead chaplain.”
Chaplains also were asked what in their training or identity gave them a foundation to do ethics work. Chaplains identified communication skills — active listening, nonjudgmental responses, facilitating conversations, and ability to build trust and rapport. “Chaplains are uniquely positioned to contribute meaningfully and competently to ethics work because of their core competencies in communication skills, understanding of nonmedical aspects of care, and ability to suspend judgments to hear competing ethical perspectives,” says Wirpsa.
As the field of clinical ethics continues to mature as a profession, paying attention to the core competencies of the people doing this work will become increasingly important. “Hospital leaders also need to recognize that clinical ethics is a highly specialized and advanced field of care, in its own right, and take responsibility for ensuring quality in this team,” says Wirpsa.
Based on the findings, the authors recommend that ethicists provide the following education to every chaplain involved in clinical ethics work:
- orientation and guidance on their role on the clinical ethics committee;
- the vocabulary of clinical ethics;
- the frameworks used to resolve ethical dilemmas;
- ethical frameworks/guidelines related to specialty areas of care such as transplant ethics or surgical ethics);
- relevant regulatory statutes and consensus statements of medical specialties;
- the “how to” of the ethics consultation process: gathering information, speaking with key stakeholders, identifying the ethical question, applying moral reasoning, documenting in the chart, and following up with the team to provide education and support for moral distress.
Chaplains can be excellent partners in ethically difficult situations in the intensive care unit (ICU), according to Alexia Torke, MD, MS, a research scientist with the Indiana University Center for Aging Research at Regenstrief Institute and director of the Daniel F. Evans Center for Spiritual and Religious Values in Healthcare at Indiana University Health. In the ICU, families ask questions such as, “Why is this happening to my family member?” or “Why is this happening to me?” “Chaplains are the experts in supporting families through these difficult times,” says Torke.
Torke and colleagues conducted a literature review of research on the role of chaplains in supporting ICU families, but found very few studies.2 “The ICU is one of the places where chaplains are most active, and where families clearly have needs. Yet there is very little empirical research about this experience,” says Torke.
Sometimes, clinicians perceive religion as a barrier to good decision-making. For example, a family member may want to continue life-sustaining treatment because of a particular religious belief. “However, many people rely on their faith to cope when a patient is unlikely to recover and may be facing death. Ethicists are very familiar with the role that religion often plays in medical decision-making,” says Torke.
Chaplains can provide religious or spiritual support while, at the same time, meeting the family’s emotional needs and assisting with decision-making. “They often know things about the family’s point of view that no one else on the team has heard,” says Torke.
If ethicists see that religious or spiritual concerns are affecting decision-making, having a chaplain meet with the family can be very helpful. Families may have misconceptions about the chaplain’s role, however. Some assume chaplains are only there to pray with people or comfort families when the patient dies. “Chaplains certainly do these things, but they come from a variety of faiths and can support people who are atheists or have no religion. Sometimes, rather than telling the family that a chaplain will be coming, it is better just to ask the chaplain to stop by. They are very good at introducing themselves,” says Torke.
Stacey Kusterbeck is an award-winning contributing author for Relias. She has more than 20 years of medical journalism experience and greatly enjoys keeping on top of constant changes in the healthcare field.
References
1. Wirpsa MJ, Redl N, Lieberman K, Springer K. The expanding role of United States healthcare chaplains in clinical ethics. J Relig Health. 2024;63(6):4486-4511.
2. Torke AM, Varner-Perez S, Burke ES, et al. Improving outcomes for ICU family members: The role of spiritual care. J Palliat Med. 2024;Oct 4 doi: 10.1089/jpm.2024.0165. [Online ahead of print].
Many are skeptical about chaplains’ ability to do ethics work. M. Jeanne Wirpsa, MA, BCC, HEC-C, program director and clinical ethicist at Northwestern Memorial Hospital’s Medical Ethics Program, and colleagues conducted a study to learn more about the experience of chaplains working in the clinical ethics field.
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