Chaplains can help with ultimate issues

National Catholic Reporter, Jan 19, 1996 by Gustav Spohn

It was six years ago, but for Fr. Joseph Driscoll, he memories are still vivid. After all, it's not every day a physician accuses a priest of helping someone commit suicide.

The doctor wanted to perform a tracheotomy on an 84-year-old woman. Mary, so he could wean her off the hospital ventilator that kept her alive.

When Driscoll walked into her room. Mary motioned for a writing pad and, in shaky scrawl, wrote, "What does God want me to do?"

Driscoll, a parish priest at the time. held Mary's hand and listened as she wrote and gestured. He assured her that she could morally refuse a further invasive surgical procedure. At the end of an hour she scribbled, "I have lived my life arid I have enjoyed my life. I do not want to be a burden to anyone. I am ready to go to God."

He gave Mary his blessings and, at her request, called the doctor to explain that she had decided against living with a hole in her throat and wanted to be removed from the ventilator, knowing full well she would probably die.

Mary and her family were at peace with the decision, Driscoll said, but "the physician - he could not deal with it at all. He said he would not meet with me and oil the phone said to me that, as far as he was concerned, it was tantamount to suicide."

For Driscoll and Mary's family, that story has a happy ending. Through Driscoll's stubborn intervention with physicians, nurses, legal and administrative officials, Mary's wish was eventually granted. She died a peaceful death two days after the ventilator was shut off.

Not all patients are so lucky, according to a recent, widely publicized study on care of the terminally ill.

The study, funded by the Robert Wood Johnson Foundation and involving 9,105 patients, documented an alarming lack of attentiveness to the wishes of the dying by medical professionals - such as physicians not understanding, in 80 percent of the cases, whether their patients wanted to be resuscitated if their hearts stopped and a failure to routinely monitor patients' pain.

More disturbing, perhaps, was the study's conclusion that even intervention by specialty trained nurses - intended to encourage better communication between physicians and patients - failed to make a difference.

Frequently, though, interveners in end-of-life situations are religious workers like Driscoll - certified chaplains or visiting priests, nuns and pastors - and they were only incidentally included in the study.

The spiritual dimension

Their effectiveness has never been the subject of a major examination, but only thing is clear: Men and women of faith are increasingly drawn into deliberations about treatment decisions as technology allows more and more patients to be kept "alive" through mechanical means - forcing questions about what constitutes life, when to extend it and when to end it.

"There's a growing recognition on the part of clinicians to permit and invite into the decision-making group people who deal with the spiritual dimension of persons," said Sr. Jean deBlois, senior associate for clinical ethics at the Catholic Health Association, based in St. Louis.

According to deBlois, most of the ethical dilemmas that arise in health care settings involve end-of-life issues like whether to begin or withhold life-sustaining intervention, such as use of mechanical ventilators, or questions about donation of organs for transplant.

"You can probably save just about everyone's one's life,' she said. "But the question is not can you. The question is should you."

Rick Erickson, a Catholic layman who is director of pastoral care at St. Mary's Health Center in St. Louis, said, "It seems like this is one of the areas that is pretty well recognized as a spot for chaplain's intervention, the end-of-life kinds of issues."

Erickson, a chaplain for two decades, said chaplains often become "translators," in two directions - from patient. to physician and physician to patient. Sometimes, he said, disagreements that appear to be unresolvable conflicts over tough ethical questions turn out to be simple misunderstandings.

He recalled the case of a young man with AIDS where the family and physician were at odds over treatment, the family wanting to prolong his life while the doctor saw continued treatment as futile.

After intervention by one of Erickson's chaplains, it became clear that the question was not about keeping a dying patient alive indefinitely.

"It turned out that it was important to the family that the patient was alive for one more birthday," said Erickson. "Once that communication was clarified between the physician and the family, plans were put in place about how that could be best done with the family around; and the birthday was celebrated, and care was gradually backed off and the patient died pretty easily."

More data needed

There are doubters, though, and others who point out that more data are needed before the effectiveness of people like Driscoll, deBlois and Erickson an be measured.

"It seems to me they wouldn't necessarily be any better at doing this than would nurses or social workers or just other doctors, for that matter,' said Daniel Callahan, president of the Hastings Center, a New York ethics think tank. "There's no special reason to think they would have any particular skills in doing that type of thing."