Clinical Bioethics: Ethical Considerations in Pastoral Care of the Sick

When determining the best practices in the ethics of medical care, how can we as Christian healthcare professionals approach helping patients make difficult decisions?

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I really enjoyed this article, and have particularly enjoyed the broad range of articles BL has offered lately. Keep up the good work @HRankin and co!

Medical ethics is such an important topic to get one’s heads around, not least so that we can be compassionate to those in our churches/circles of influence facing gut-wrenchingly tough choices. But also so we can walk alongside them and be a listening ear, sounding board, prayer partner, and provider of encouragement.

I was particularly grateful for Steven’s conclusion:

We might wish that orienting convictions would tell us precisely what to do when we face onerous medical decisions. Instead of providing easy answers they form us into people who see the world through a lens of faith. When we affirm faith in God in the context of medicine, these orienting convictions help us make moral decisions in the context of medicine, and they help us do that in a way that answers Margaret Mohrmann’s question: What difference does it make to be a Christian in the context of healthcare?

Often times, we want ethical issues to be cut a dry and sometimes they can be when we consider them in an isolated, hermetically sealed world of the hypothetical. But when to use John Frame’s language we apply an ethical norm to a situation involving a person (or people) things suddenly get a whole lot messier. Personally, I believe that maturity requires me to acknowledge this mess and tread carefully, with wisdom, humility and compassion. Not blunder it with a one size fits all approach as can be so tempting. Such approaches might make me feel better by alleviating cognitive dissonance and making hard choices seem simple, but they do little to help the person wrestling with the situation they find themselves in.

Better for me to offer to be a fellow traveller through the ethical maze than to claim to be a guide when I may have no clearer idea about where the exit is than they do.

Hmmm… lots to think about.

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Enjoyed the article. As a physician, one problem is communicating the issues involved without being paternalistic. I am on break at a conference where John Walton is speaking, have little time, but one problem with modern medicine is that at times the issues are complex, and it is difficult to inform the patient of the issues without projecting your own bias. At times patients make horrible decisions despite your best efforts.

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can confirm via the stories I hear from my spouse :rofl:

Great observation, @jpm. Do you ever find t that despite the emphasis on autonomy that, when faced with seemingly impossible choices, some patients want you to make a decision for them? Or at least ask, ‘what would you do doctor?’

If so, how does one handle a situation like that? I ask because I can foresee a time in the future when someone might say to me ‘What would you do Pastor?’

Actually it happens quite often when I have a good relationship with the patient. It is at times a difficult question when there are down sides to each approach, and things can go badly no matter what. The typical situation is where further chemo is offered a cancer patient, when it is most likely a futile effort. How do you balance a few more months survival, when the quality of life is poor and it is spent in and out of the hospital rather than at home? My tendency is to go for quality over quantity, but tough to answer for someone else.

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I really did not fully answer your question as to what I actually do, which is explain what I have seen and the possibilities that may arise to give the basis for why I would choose a particular course, and give my honest answer of what I would do, as well as permission and support should they chose another route. Truthfully, I don’t think we know what we will chose until in that situation. I liken it to falling from a cliff, and being given a fishing line to grab rather than a rope. We know it will not hold our weight, and that it will cut into our flesh, but it is hard not to grab it.

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Thanks for coming back and unpacking your answer a bit more. I like your cliff illustration - very true, very helpful.

I also appreciated you taking the time to explain how to answer a question like that. Especially the part about giving permission to disagree. In pastoral ministry when people ask for advice it can be too easy to say in ‘I think you should do X’. And sometimes that’s ok. But the more ethically complex the issue (and so the less clear cut) the more people need permission to disagree and choose a different route. Especially with medical decision. Thanks @Jpm, that’s helpful.

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Respecting privacy is something we can all do. Don’t ever show pictures of hospitalized patients online. Our church has a prayer list, but it isn’t published online. Rather, they include a separate sheet in the print bulletin, and no details are shown. If you must solicit prayer on facebook, use the person’s initials. Never disclose a serious illness like cancer. Remember that potential employers are not allowed to ask about a person’s health status in an interview. Employers would love to have this information; don’t make it easy for them to get it by googling.

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“Let your conversation be always full of grace, seasoned with salt, so that you may know how to answer everyone.” -Colossians 4:6

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