Can Chaplains Guide Clinical Decision Making? An Ethical Assessment of Spirituality in the Exam Room

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A chaplain has the ability to participate in difficult clinical conversations and ameliorate conflict.
A chaplain has the ability to participate in difficult clinical conversations and ameliorate conflict.

Medical teams that are willing to engage with and be informed by patients' religious worldviews are able to make clinical decisions more effectively. The chaplain-physician relationship is explored in a personal narrative piece published in the AMA Journal of Ethics.

Rabbi Susan Harris, MHL, director of Chaplaincy at Boston Children's Hospital, described the effectiveness of hospital chaplains as mediators between patients, family members, and practitioners in clinical decision making.

Rabbi Harris described the hypothetical case of an infant newly diagnosed with a fatal, incurable condition. The parents invite their rabbi to the hospital to assist in decision making, per Jewish religious law. The parents do not wish to “prolong suffering”; the rabbi, however, is committed to pursuing treatment and extending the infant's life. The presence of the rabbi makes it difficult for the medical team to act in the best interest of the family, as they are unable to discern which beliefs are the parents' own and which are influenced by the rabbi. Additionally, the parents have a relationship with the rabbi and may feel pressure to adopt his decision model lest they be blamed for choosing the wrong option. Such a dynamic is common and unproductive, Rabbi Harris wrote.

A chaplain has the ability to participate in each of these conversations and ameliorate conflict. Specifically, the chaplain can interface with the parents directly and relay their preferences to the medical team. The chaplain can also educate the medical team about the religious context and implications of the parents' decisions. In this way, the chaplain minimizes third-party influence on decision making and facilitates conversation between the parents and the medical team.

The presence of a chaplain can also aid decision making when the family and its chosen religious counsel are aligned. Rabbi Harris illustrated a further scenario in which the parents wish to prolong their child's treatment even without possibility for recovery. In this situation, the parents enlist their religious counsel as their advocate and otherwise remove themselves from the clinical discussion. In this situation, the medical team may feel morally conflicted, particularly if they cannot reason directly with the parents. A chaplain, Rabbi Harris wrote, could educate the medical team about the cultural nuances behind the parents' decision. Such a discussion could assuage the team's “moral distress” and help clinicians understand and accept the family's reasoning.

The modern hospital houses the intersection of many cultures, religions, and influences. A hospital chaplain, Rabbi Harris concluded, can illuminate these intersections and foster productive discussions between patients, family members, and practitioners.

Reference

Harris S. Chaplains' roles as mediators in critical clinical decisions. AMA J Ethics. 2018;20(7):E670-674.

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