Loewy Roberta Springer, Loewy Erich H
Bioethics Program, University of California, Davis, USA.
MedGenMed. 2007 Mar 14;9(1):53.
Many chaplains and most chaplaincy programs in the United States--with encouragement from their accrediting organization, the Association for Clinical Pastoral Education (ACPE)--have begun to assume a more proactive stance toward patients, healthcare professionals, and healthcare facilities. Some chaplains and chaplaincy programs have begun to engage in activities that have ranged from initiating conversations with and perusing the medical records of patients who have not requested their services to proposing that they be permitted to do "spiritual assessments" on patients--in some instances whether these patients have been explicitly informed and have agreed to this beforehand. Moreover, many chaplains and chaplaincy programs have begun to assume that chaplains are full-fledged members of the healthcare team, complete with access to patients' medical records both to gather information and to make notations of their own. It would appear that such novel activities are being justified by a questionable set of claims and assumptions that includes: (1) the claim that chaplains have a spiritual--as opposed to purely religious--expertise that entitles them to interact with patients and/or significant others (even those who have not requested a chaplain)--presumably without in the least compromising patient autonomy or the confidentiality of the patient/healthcare professional relationship; (2) the assumption that the terms "spirituality" and "religiosity" mutually entail one another; (3) the claim that the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) mandates "spiritual assessments" (which it does not); (4) the assumption that chaplains are full-fledged members of the healthcare team; and (5) the claim that chaplains must, therefore, be permitted access to patients and patients' medical records both to gather information and to make notations of their own. We consider such claims and assumptions disquieting, and suggest that it is high time we revisit the terms "chaplaincy," "healthcare professional," and "member of the healthcare team" in reassessing what our professional commitments to respect and protect the bio-psycho-social integrity of patients require.
在美国，许多牧师以及大多数牧师关怀项目——在其认证机构临床神职教育协会（ACPE）的鼓励下——已开始对患者、医疗保健专业人员和医疗机构采取更积极主动的立场。一些牧师和牧师关怀项目已开始参与各种活动，这些活动范围广泛，从主动与未请求其服务的患者交谈并查阅其病历，到提议允许他们对患者进行“精神评估”——在某些情况下，无论这些患者是否事先已得到明确告知并同意。此外，许多牧师和牧师关怀项目已开始认定牧师是医疗团队的正式成员，有权查阅患者病历以收集信息并自行记录。看来，这些新奇的活动是基于一系列可疑的主张和假设而被合理化的，其中包括：（1）声称牧师拥有精神层面而非纯粹宗教层面的专业知识，这使他们有权与患者和/或重要他人互动（即使是那些未请求牧师服务的人）——大概丝毫不会损害患者的自主权或患者/医疗保健专业人员关系的保密性；（2）假设“灵性”和“宗教信仰”相互包含；（3）声称医疗组织认证联合委员会（JCAHO）要求进行“精神评估”（其实并非如此）；（4）假设牧师是医疗团队的正式成员；以及（5）声称因此必须允许牧师接触患者及其病历，以便收集信息并自行记录。我们认为这些主张和假设令人不安，并建议现在是时候重新审视“牧师关怀”、“医疗保健专业人员”和“医疗团队成员”这些术语，以重新评估我们尊重和保护患者生物心理社会完整性的专业承诺要求。
