Ethics, Politics, and Religion in Public Health Care: A Manifesto for Health Care Chaplains in Canada.

Health care chaplaincy positions in Canada are significantly threatened due to widespread health care cutbacks. Yet the current time also presents a significant opportunity for spiritual care providers. This article argues that religion and spirituality in Canada are undergoing significant changes. The question for Canadian health care chaplains is, then: how well equipped are they to understand these changes in health care settings and to engage them? This article attempts to go part way toward an answer.

Ethics in pastoral care and counseling: a contemporary review of updated standards in the field.

This article reviews ethical responsibilities that must be considered when engaging in pastoral care, counseling, and psychotherapy. It discusses important contemporary issues counselors will want to contemplate in pursuing a high quality of care in their counseling practices. Examples and case studies are provided. Readers will be able to: Understand the function of ethical standards in the practice of counseling Be able to differentiate between pastoral care, pastoral counseling, and pastoral psychotherapy and their ethical implications Understand the importance of identifying one's limitations in counseling situations and how to proceed under such circumstances. Understand the need for pastoral counselors to attain the necessary credentials for practice in the area of counseling they intend to undertake. Become aware of the legal requirements when engaged in a counseling relationship.

A psychospiritual, family-centered theory of care for mothers in the NICU.

Weighing less than three pounds four ounces, very low birthweight infants account for 1.4% of births and 46% of infant deaths in the U.S. Mothers of these infants often endure significant suffering while witnessing their children struggle for life. By examining their psychological and theological needs, and drawing on a mother's lived experience, this article develops a psychospiritual, family-centered theory of care to aid chaplains in providing spiritual care to mothers in the NICU.

Bioethical issues and health care chaplaincy in aotearoa New Zealand.

This paper summarizes survey and interview results from a cross-sectional study of New Zealand health care chaplaincy personnel concerning their involvement in multiple bioethical issues encountered by patients, families and clinical staff within the health care context. Some implications of this study concerning health care chaplaincy, ecclesiastical institutions, health care institutions and government responsibilities are discussed and recommendations presented.

The 'methodic' exploration of the ethical and pastoral dimension in interaction: the cycle of encounter.

Social competence can be understood as the capacity to interact with each other. As such, it is the acquisition and optimization of an interior attitude that transcends technique; it is a way of loving and doing justice to one another. A scheme is presented to explore the ethical and spiritual dimensions of the pastoral counseling process. Ethics is both an objective discipline and a relationship. Relationships are built during qualitative encounters that build respect and construct religious meanings. All encounters share this process. This article explores the logic of ethical dynamics with particular focus on pastoral counseling encounters.

Ethical issues in case study publication: "making our case(s)" ethically.

As chaplains develop richly detailed case studies for publication, ethical questions about case study construction and publication are emerging. Concerns about seeking patients' permission to publish material about them suggest additional questions and raise broad confidentiality and privacy issues. Confidentiality-related practices in health care and psychotherapy provide the most extensive guidance for chaplains, but healthcare chaplaincy has roots in religious and professional traditions with distinct notions of confidentiality that deserve consideration. Single case studies do not appear to be "research" requiring informed consent, yet their publication exposes patients to some risk of harm. Obtaining the patient's/"case study subject's" permission to publish, disguising non-essential information, and allowing the patient to review the case study can mitigate the risks. Striking a balance between protecting patients and providing sufficient detail to make case studies useful is a central ethical challenge of case study publication.

Research report: a grounded theory description of pastoral counseling.

Historically, clerical paradigms of ordained ministry have defined pastoral counseling. However, these fail to describe pastoral counselors in the complex social, theological and medical contexts in which they now work. This study asks the question: How do pastoral counselors in clinical practice describe what is uniquely "pastoral" about the counseling they offer clients? Grounded theory was used to propose a preliminary description and an intermediate theory of how pastoral counselors interpret "pastoral." Eighty-five pastoral counselors were selected for the study over a four year period using criteria to assure maximum variation. Interviews and pastoral identity statements were collected and coded, and theoretical models were organized using NVIVO, a computer assisted qualitative design and analysis software (CAQDAS) package. Results suggest that pastoral counselors share some common ideas regarding "pastoral identity" and clinical practice. How pastoral counselors interpret "pastoral" is highly context sensitive and varies widely.

Defining and advocating for spiritual care in the hospital.

A definition of spiritual care and attention to the scientific literature can strengthen the advocacy efforts of hospital funded chaplaincy programs. Adapting Pargament's work, spiritual care is defined here as giving professional attention to the subjective spiritual and religious worlds of patients, worlds comprised of perceptions, assumptions, feelings, and beliefs concerning the relationship of the sacred to their illness, hospitalization, and recovery or possible death. Results from the scientific literature are then presented in response to four advocacy related questions: 1) How do hospital decision makers and chaplains perceive the experience of hospitalization, 2) Does a need for spiritual care exists; is it relevant, 3) Who can best provide spiritual care, and 4) Are chaplain visits helpful? This definition and advocacy material can be useful when decision makers review the funding of spiritual care.

Progress in ethical decision making in the care of the dying.

Practitioners in critical care have made a significant progress in caring for dying patients in critical care by taking advantage of the suggestions from their professional groups. Progress has been made in responding to and controlling patients' pain. Major initiatives from the Joint Commission and the American Pain Society have helped direct this improvement. Palliative care consultations as well as ethics consultations have improved symptom control in the critically ill. Issues of consent have been problematic for dying patients in critical care especially in the area of discontinuing therapies. But, better policies related to advance directives have been developed to ensure good care. Spiritual care has received more attention, and now chaplains are recognized by the Society for Critical Care Medicine as integral to the critical care team. The American Association of Critical-Care Nurses has been a leader in improving end-of-life issues and continues to spearhead many projects to improve end-of-life care.

Do pastoral counselors have a duty to report clergy sexual abuse done by their clergy clients?

What does a pastoral counselor do when a clergy client reveals that he or she has been sleeping with a parishioner? Does the counselor have an ecclesiastical duty to report this offense to a church official; or does the pledge of confidentiality trump any disclosure? Some ecclesiastical bodies require their clergy to bring knowledge of these offenses to church authorities. Does this requirement apply to pastoral counselors? The authors have been confronted with these questions in their ministry of pastoral counseling and have struggled with producing a faithful, professional response. Along the way they have not received clear direction from judicatories or professional organizations. This article is the authors' attempt to answer the questions raised above as well as to challenge professional and ecclesiastical bodies to confront more forthrightly the dilemmas these situations cause for pastoral counselors who seek to protect the welfare of the Church as well as protect the pledge to maintain confidentiality.

Health care chaplains and their role on institutional ethics committees: an Australia study.

This paper presents the results of the largest Australian pastoral study concerning the perceptions of health care chaplains about their involvement on hospital research ethics committees (also known in some contexts as institutional ethics committees). Survey results from over 300 Australian health care chaplains indicated that nearly 90% of chaplains believed there was merit in chaplains serving on hospital research ethics committees, yet only a minority (22.7%) had ever participated on such committees. Data from in-depth interviews is also presented exploring the reasons for the lack of participation and the varying opinions regarding the role, appropriateness, and value of chaplains on ethics committees. Some implications of this study with respect to chaplaincy, hospital research ethics committees, health care institutions, ecclesiastical institutions, and government responsibilities are discussed.