The Chaplain as a Member of the Multidisciplinary Team- An Ethical Risk?
Janet Young, Mary-Lou Martin, Rosemary Garside,
Sandra Berzaitis-Smith, Kathy Carlin,
Chaplains have been an integral part of the clinical team
Debate about whether chaplains should be part of the clinical team in mental health
Potentially conflict between the needs of the client, the team & spiritual care provider
Should there be standard guidelines related to this issue?
How does the chaplain meet clients’ spiritual needs?
How can clients benefit from spiritual care & how can any harm be avoided?
Should chaplains protect the confidentiality of clients’ personal information?
Should chaplains be expected to disclose clients’ information to the clinical team & vice versa?
Should chaplains document & have access to the client’ s casebook?
What happens to inter-professional collaboration when one party does not share information?
What is the duty of the chaplain who has a client disclose to them a risk of harm to self or others?
What is the responsibility of the employer in this situation?
The search for the sacred. A conscious striving to move beyond isolation and self-absorption to a deeper awareness of interconnectedness with the self, other human beings and the transcendent. (Catholic Health Association of Canada 2000, p. 102)
The expression of spirituality through traditions, rites and practices usually within the context of an organized faith. (The Catholic Health Association of Canada, 2000, p. 100).
Spiritual & Religious Care
The activity of chaplains, community clergy, faith leaders and laity in helping persons to discover and deepen life and give expression to their spirituality and/or religion.
(The Catholic Health Association of Canada, 2000, p. 102)
Reasons To Include Spirituality & Religion In Mental Health Services
Reflection of consumer self-understanding
Facilitation of recovery
Enhancement of cultural sensitivity of services
Positively related to psychosocial well-being
Barriers To Spirituality
History of mental health treatments
Confusion & fear about the meaning of spirituality
(Longo & Peterson, 2002)
Confidentiality is a quality of human communication that protects a person’ s right to privacy by fostering trust between the care provider and the person receiving care. Confidentiality excludes unauthorized persons from gaining access to information concerning the person receiving care, and requires that people who have such information refrain from communicating it to others
(The Catholic Health Association of Canada, 2000, p. 94)
What measure are in place?
Do clients have the right to expect & assume that chaplains will not disclose personal information?
Are their limits to the bounds of confidentiality
Should the chaplain only disclose information as authorized by the client
Protection of Privacy
Every person has the right to privacy. This includes privacy of personal information, confidentiality, and freedom from the unwanted intrusions of others in their immediate situation. This privacy must be carefully respected by care providers in their professional and informal conversations .Exception to the right of privacy must be clearly justified by those claiming them. Exceptions may be justified in situation where the right to privacy is limited by the dematnd of the common good.
(The Catholic Health Association of Canada, 2000, p. 33)
Free & Informed Consent
Perspective Of The Chaplain
Role of Chaplain?
Touchstone in crisis
Officiator at celebrations
Communicator of bad news
Clients Describe Chaplains
Pastor, Reverend or Minister
Community Faith Leaders’ Expectations
Keeper of confidences
Always compassionate will no time restraints
Someone to show your best side to
Representative of what has wounded/ rejected in the past
Connection with the Divine
Masters Degree in Theology/Pastoral Counselling
Specialist in Clinical Pastoral Education with CAPPE/ACPEP
Code of Ethics
Faith Group Endorsement for Institutional Ministry
Multifaith Training and Evaluation
Chaplain’ s Perspective
Oversee Spiritual Care at CMHS
Place & Mentor Students
Support Volunteers & Community Clergy
Provide Crisis Support for Staff
Provide Education on Spirituality
Subject to PHIPA & Hospital Policies & The Ontario Human Rights Code regarding Creed
Work Within the Recovery Model
Member of the Ethics Committee
How Can A Chaplain Minister To People Of Other Faiths?
Some chaplains may, in fact, agree that religiosity is merely one expression of spirituality yet claim that, because all patients are spiritual beings, they should routinely be visited by a chaplaincy service because chaplains have “special expertise” in all matters spiritual.
Leowy & Leowy (2007, p. 53)
Being a person of faith exposes one to what is held in common with other faiths e.g. moral values, choices, worship, prayer, limitations, aha moments, community, etc.
Values That Promote Care Sensitive To Culture
Equality: All persons are equally, fully human, equally deserving of positive regard.
Mutuality: Human beings are relational beings who are fully alive in reciprocal exchange
Integrity: All persons are responsible individuals capable of thinking their own thoughts, feeling feelings, choosing options.
Additional Values That Promote Care Sensitive To Faith
Humility: Always being open to one’ s own fallibility
A Sense of Wonder: Taking delight in the unexpected and new as well as recognizing the beauty and grace revealed in everyday life.
This strategy does not call for the healthcare provider to become an expert in cultural minutae Ideally, being appropriately cognizant and responsive to cultural issues should not be thought of as reaching a òcompetency’ so much as engaging in an ongoing process of honing and applying skills for self-awareness and for respectful recognition of the unique perspective each patient brings to the clinical encounter.
(Hunt, 2001, p.1882)
Can A Chaplain Provide Counselling?
CAPPE Code of Ethics
supports disclosing information for necessary treatment, ..for the safety of any person or as required by law. Otherwise disclosure requires client permission.
Members are subject to the law in their jurisdiction.
The code also deals with knowing the limits of one’ s expertise and working with and making referrals to other professionals whenever it is in the best interest of those being served.
The practice of psychotherapy is the assessment and treatment of cognitive, emotional or behavioural disturbances by psychotherapeutic means, delivered through a therapeutic relationship based primarily on verbal or non-verbal communication.
(Pychotherapy Act, 2007, p. 118)
Should A Chaplain Keep A Client’ s Confidentiality?
..we suspect that most patients assume that chaplains in the healthcare setting operate on much the same principles as do clergy — if I confide in my clergyperson, I can expect strict confidentiality (unless, of course, what I have confided places another at risk). I assume that a chaplain is also bound by that strict confidentiality unless I am explicitly told otherwise.
(Loewy & Loewy, 2007, p.53)
CAPPE Code of Ethics
No clear guidance
It requires that we enter chart notes
there is judgment required as to what is necessary to communicate for the benefit of the client.
(CAPPE, 2007, p. 118)
Perspective Of The Consumer
My Story -My Journey
My mental health
My profession -occupational therapist
Sensitivity to religious values: practice of personal devotion and prayer. Relating to one’ s spirit and higher consciousness as distinct from one’ s earthbound body and nature
Perspective Of The Recreational Therapist
Therapeutic recreation is a process that utilizes treatment, education & recreation participation to enable persons with physical, cognitive, emotional &/or social limitations to acquire &/or maintain the skills, knowledge & behaviours that will allow them to enjoy their leisure optimally, function independently with the least amount of assistance & participate as fully as possible in society.
Recreational Therapists’ Intervention
What is meaningful to the person
Goals are based on the person’ s expressed needs
Standard assessment tools specific to spirituality
Therapeutic Recreation (TR) Issues
Therapeutic recreation may not be supported as treatment
Spirituality is incorporated into TR practice
TR has commonalities with other professions
Complimentary service between TR & chaplaincy/spiritual care
Common experience connecting us
Search for meaning & purpose
Connectedness & hope