Ethical boundaries and health maintenance organization (HMO) expectations: who draws the line?

Observes that although HMO expectations continue to expand with an increase of responsibilities for the pastoral counselor, the benefits have not maintained pace with the responsibilities. Asks, "Where and how does the pastoral counselor draw the line of personal limits? When limitations are set, how does the pastoral counselor represent the ethical values of the profession and the religious community?" Argues that there are subjective and objective considerations and judgements needed to test the ethics of where and how such limitations are established.

An adaptation of The Discipline in a clinical pastoral education program. Interview by Larry VandeCreek

The author describes his perspective on providing pastoral care to hospital patients, his search for new ways to understand that ministry, his first contact with The Discipline, and his adaptation of it to the clinical and educational programs at his center. He discusses the need to help clinical pastoral education students to operationalize their ministry and to learn how to identify outcomes that are meaningful to health care decision makers.

Conversion therapy revisited: parameters and rationale for ethical care

Observes that efforts are being made within certain professional counseling associations to oppose and prohibit attempts to modify homoerotic feelings and behavior on ethical grounds. Outlines several factors that can motivate the pursuit of conversion therapy and reviews data that suggest change is a viable treatment outcome. Proposes, based on an analysis of research data, an ethical framework within which conversion therapy can be legitimately practiced.

Racial and gender myths as key factors in pastoral supervision

Explores the various dynamics activated when a black male supervisor and a white female supervisee are part of a Clinical Pastoral Education team. Uses the notion of racial and gender myths as a way to understand such a relationship. Claims that it is exceedingly important to train culture and gender conscious supervisors and that such training can lead to significant racial and gender learnings having implications beyond the CPE context.

The cult of "take" rather than "talk": one pastoral psychotherapist's perspective on psychiatric medication

Examines the use of psychiatric medication in the culture, including the potential pitfalls as well as the clinical, ethical, and religious considerations for pastoral psychotherapists. Uses clinical vignettes to illustrate major issues related to the use and possible overuse of psychiatric medications.

Utilizing a JCAHO review in the education of clinical pastoral education CPE residents

Reflects on how a pastoral care department utilized a Joint Commission review in the education of five pastoral care residents enrolled in their third unit of Clinical Pastoral Education in a medical center. Outlines how residents prepared for the review, the learning opportunities for residents and medical staff, the outcomes, and the recommendations.

What five clinical pastoral education residents discovered from a JCAHO review

Discusses the process one pastoral care department and its five residents used to prepare for a JCAHO review and reports the experience, detailing questions asked and chaplains' responses when they sat in on twenty unit reviews.

Vinegar and oil: are the moral/ethical decision processes by professional prison chaplains superior to hospital chaplains?

Reports research with chaplains from the Federal Bureau of Prisons and the Department of Veteran's Affairs concerning the impact a prison setting or a hospital setting may have in meeting the dilemmas often encountered in the areas or moral and ethical decision making.

Using the family ecosystem model to enhance pastoral care and counseling

Argues that with individual, family, and world issues becoming increasingly complicated, those involved in pastoral care can benefit from using a comprehensive ecological approach to understanding and helping those in need. Suggests that the "family ecosystem model" that emphasizes interactions among individuals/families and their multifaceted environments, including their natural, human-constructed, and human-behavioral environments, can be used to incorporate a holistic view of these diverse issues. Explains and illustrates this approach to family concerns often encountered by pastoral caregivers.

S.C.A.L.E.--spiritual care at life's end: a multi-disciplinary approach to end-of-life issues in a hospital setting

End-of-life care is a hot topic in many hospitals of late, in part due to an aging society, which is forcing health care professionals to address the issue. A culture that places enormous value on youth and avoids the topic of death also contributes to the discomfort many health care professionals feel discussing this topic with their patients and family members. Inpatient satisfaction survey scores at Thunderbird Samaritan Medical Center (TSMC) were very inconsistent on the question of how the institution was meeting the emotional and/or spiritual needs of patients. A staff survey and needs assessment was also conducted regarding end-of-life care, which pointed out communication issues among staff members. All of these factors led to the development of an inter-disciplinary team to examine the issue of end-of-life care at TSMC.

Introduction toThe Disciplinefor Pastoral Care Giving

During the last eight years, the professional chaplains of Spiritual Care Services at Barnes-Jewish Hospital-Washington University Medical Center (BJH) have developed a discipline based, outcome-oriented model for chaplaincy. This article introduces the elements of The Discipline, our development process, the effects on our chaplaincy attributable to its consistent use, and implications for the future. While many of our assumptions about chaplaincy have been challenged, our experience is that a disciplined, outcome-oriented model for chaplaincy has deepened our relationships with patients and significantly increased our integration into the care teams of the hospital. It has also challenged and enhanced our abilities to be emotionally present with patients while also giving attention to the process of the visits and chaplain interventions that contribute to patient healing and well-being.

The public debate on life and death choices: a response from a Jewish hospital chaplain

Addresses the issue of life and death choices from the perspectives of a Jewish chaplain. Explores the tension between the law (Halachah) and experience or story (Aggadah) and the impact of that tension on lives and decisions. Cites persons and situations from biblical material, oral tradition, and modern times which illustrate the human struggle with these disputed issues. Explores different levels of pain and our understanding of and response to suffering. Invites reflection on the range of responses to pain that are humanly possible. Illustrates how meaning in life nurtures the desire to live. Claims this meaning aspect is not adequately addressed in the current dialogue. Focusses on the role of chaplains in listening and responding to persons and in helping to activate the impulse of hope. Suggests ways in which chaplains can be advocates for patients, prophetic voices within communities and institutions, and empowering of the gifts of others.

Judaism, professional intervention, and ethics in long-term care

Discusses spiritual, professional, and ethical approaches to work with an elderly Jewish patient in a nursing home. Addresses the knotty issues of determining decision-making capacity, the refusal of nutrition and hydration, Judaic values pertaining to ending one's life, the role of the spiritual caregiver, the role of the social worker, and the ethical principles of autonomy, beneficence, paternalism, and do no harm.

Life and death matters: toward a sanctity of death

Explores the theology behind the absolute nature of the Sanctity of Life Doctrine, and challenges the doctrine's rigid stance. Presents theological principles that support a sanctity of death ethic. Discusses a hypothetical case to demonstrate how those principles can impact pastoral care.

Assuring professional pastoral care for every nursing home resident

Ministry to persons in nursing homes is built on two mandates: "... He has sent me to bring good news to the oppressed, to bind up the brokenhearted, to proclaim liberty to the captives, and release to the prisoners; ... to comfort all who mourn ..." (Isaiah 61:1-3). The federal government provides the second: "Quality of Life. A facility must care for its residents in a manner and in an environment that promotes maintenance or enhancement of each resident's quality of life" (OBRA '87, Guidance to Surveyors in Long Term Care Facilities, Code of Federal Regulations, Health Care Financing Administration, 1995, section 483.15, F240). This article discusses both the religious and the U.S. political history of caring for the old and frail. It concludes by describing political efforts in one state to increase the quality of that care and pastoral efforts to support the nursing assistants in long-term care facilities.

Structure and provision of services in Black churches in New Haven, Connecticut

Historically, Black (or African American) churches have played a central role as a center of religious and political life and also as a provider of human services and a healing community. This article examined the extent to which African American churches in 1 Northeastern urban environment are involved in the delivery of health and human service programs to their communities. It also explored how comfortable Black clergy are in referring their parishioners to the formal mental health system and identified the actual level of referrals. In addition, the analyses considered the individual and organizational characteristics that predict variations in the levels of support services and the likelihood of referral. Analyses revealed that African American churches deliver a broad range of services to the community. More than two thirds of the clergy feel comfortable in making a referral to a mental health agency or professional, and more than half have actually made a referral. Both service delivery and referral levels varied by several clergy and congregational characteristics. The implications of these findings for research and health policy are considered.

The intellectual foundation of pastoral counseling: a perspective on the future of the profession

Reflects on the intellectual nature of pastoral counseling, compares it with certain aspects of contemporary research in psychiatry and clinical psychology, and offers some observations regarding the uniqueness of pastoral counseling as a profession. Argues that pastoral counseling can offer a truly wholistic view of mental health if (1) its intellectual foundation is developed in theological perspective, (2) continues to integrate its theological dimension with clinical psychology and psychiatry, and (3) evaluates its applied research within the framework of the normative standards of mental health.