In this issue:1 Greetings from Wendell

Oman

1 Grace Notes2 Medical Ethics2 The ethicist as mediator 2 The ethicist at the end of life3 The physician/ethicist as

caregiver

3 Hospice Corner4 Meet Chaplain Phyllis Toback 4 In Upcoming Issues

Office for Mission &Spiritual Care

The Office for Mission & Spiritual Care provides spiritual care for patients, their families and associates 24 hours a day every day of the year. The office is open Monday through Friday from 8:30 a.m. to 5 p.m. To contact us, call 708.684.5175. Evenings and weekends, ask for the paging operator and request #2296 for the house chaplain or #2299 for the emergency department chaplain.

Bridges to Our Faith Communities

Advocate Christ Medical CenterHope Children’s Hospital

Office for Mission and Spiritual Care

July/August 2011Volume 2, Issue 4

Bridges to Our Faith Communities

Grace Notes

Ethics is knowing the difference between what you have a right to do and what is right to do. ~ 

Potter Stewart

What should she do? I once heard a mother lament, “I never thought I would have to make a decision like this.” The choices were not clear or hopeful. Her baby seemed likely to die in either case, but what should she do? And where could she turn for help?

Patients and their families are increasingly confronted with ethical dilemmas in every aspect of health care from who receives care to options of care to advance directives and end-of-life decisions. In the last eighteen months, chaplains at Advocate Christ Medical Center and Hope Children’s Hospital report having provided over seven thousand ethics consultations.

In this issue of Connections, you will read of four Advocate health care professionals who have served in the trenches of ethical decision-making for their entire careers. Helping sort out the best of the good, consulting as a mediator, making the best decisions during trying moments and supporting the journey for the heartbroken are all common experiences for ethicists, chaplains and physicians.

The Office for Mission and Spiritual Care oversees the clinical ethics committees, administrates the consultation process, develops

policies and provides ethics education for the medical staff at Christ Medical Center and Hope Children’s Hospital.

We ask your prayers for wisdom as we consider and provide guidance for those we serve.

Rev. Wendell Oman, Vice PresidentOffice for Mission & Spiritual Care

ConnectionsThis window, near MICU on the fourth floor, portrays Jesus’ guidance in medical decisions.

Grace Notes are readings, poems or quotes from a variety of faith traditions and writers. Each reflection tries to touch on the heart of being human in this world. To receive Grace Notes five

or seven days a week, please click here or contact cmc‑gracenotes@advocatehealth.com.

In this issueMedical Ethics:

4 Points of View

Connections - Advocate Christ Medical Center Office for Mission and Spiritual Care July/August 2011 - Page 2

Ed DuBose, Director of Clinical Ethics for Advocate Health Care, holds a Ph.D. in religious studies (with an emphasis on medical ethics) from Rice University and a Master of Divinity from Harvard Divinity School.

During his career as an ethicist, Ed DuBose has been guided by the belief that everyone is good-hearted. “Generally speaking, I assume that we are all motivated by our beliefs of what doing the right thing means. But different points of view exist – for patient, family members, health care professionals. They’re each sincerely trying to figure out the right way to go, and from time to time values conflict,” commented DuBose.

“One of the most common conflicts I see is between the patient’s right to make decisions and the family’s thoughts on what is best for that patient. Then people can start butting heads. Occasionally there is a conflict between what the doctor – who may have seen a thousand similar situations – thinks is best and what the patient wants.

“So, basically, I mediate. I’m not empowered by Advocate or personal belief to resolve issues. I would never do that. I don’t know the right outcomes for each person. If there is a conflict between the family members and the patient, my role is to be sure each person has had a chance to have his thoughts heard. I listen and ask questions so I can tease

out why people take a particular position.”

Most times things can be resolved. “If we can get below the common reaction of ‘I’m right and you’re wrong,’ we often find a common ground -- if people are good-hearted. Then they can come to a decision and move ahead even if that decision isn’t exactly what they wanted.

“Things don’t always go swimmingly well, but if I can help a patient or family move through a bad spot, that makes my work fulfilling.” DuBose added gently, “And there is so much gratitude for helping them move through something.”

Joal Hill, Director of Research Ethics at Advocate Health Care, holds a JD from the University of Tennessee, an MPH from Columbia University and a Ph.D. in medical humanities from the Institute for Medical Humanities in Galveston, Texas.

“Ethicists are not the moral police,” said Joal Hill with a tiny smile. “Everyone is a moral agent, but an ethicist has

expertise in moral reasoning and ethical analysis, so we identify the issues. Ethics is actually a conflict of goods. We can’t achieve all the goods at once, so what takes priority? The role of the ethicist is to help sort it all out.”

Although ethicists consult in a hospital setting for a variety of situations, their help is often needed at the beginning of life if there is a critically ill newborn and at

the end of life. One of the most difficult decisions is turning the corner from aggressive treatment to hospice.

Physicians often delay recommending hospice, and families may delay making a decision. Hospice admission generally is

considered around six months before death is anticipated. The national average for hospice care has been growing, but it still is only about two months. That is a big disparity at an important time in one’s life. Hill said, “I think it’s because Americans have such high expectations of medical professionals. And we’re a youth-oriented society that doesn’t want to recognize each one of us is going to die!”

By choosing hospice in time, a family can have weeks or even months of peace without excessive medical interventions. In addition to

offering an alternative to the intensive care unit, hospice gives

. . . my role is to be sure each person has had a

chance to have his thoughts heard.

. . . key words that hospice patients want to hear and

often need to say:

I love you.Please forgive me.

I forgive you.Thank you.Good bye.

The ethicist as mediator

The ethicist at the end of life

Medicalethics

Nonmaleficence – Do no harm to the patient.

Justice – Serve all fairly.

Beneficience – Do what is in the patient’s best

interest.

Autonomy – Respect a patient’s right to

make decisions.

Connections - Advocate Christ Medical Center Office for Mission and Spiritual Care July/August 2011 - Page 3

people time to say the things they always wanted to say. Hill recalled the key words that hospice patients want to hear and often need to say: I love you. Please forgive me. I forgive you. Thank you. Good bye.

“As ethicists, we always want to respect a person’s decisions, but we can’t always honor them. In some cultures, for example, adult children don’t want their parents to know a diagnosis. We want to respect the family decisions, but when patients are able to make their own decisions, we cannot achieve informed consent unless we tell the truth. That is a potential conflict,” said Hill.

“Parental decision-making for children is another area of complexity. It is right that we give wide latitude to parents to decide what is best for their children, but there can be conflicts here as well. We cannot expect parents to make

decisions in a box. As a parent you consider the impact of events on other children in the family, your marriage and so on. There are times when loving parents make a decision that is understandable in the context of the family, but which the health care team believes is not in the best interest of our patient. Medical codes of ethics emphasize that our primary obligation is to the patient, so this is another area where conflict arises.”

Respect for persons is one of the foundational principles for Western medical ethics, and in the U. S. that usually is understood as individual autonomy. “But respect for a person means that we must respect people who do not want to be autonomous, too. Some think the group or family is more important than the individual, so some patients want to defer their decisions to others. That can make informed consent more complex – but not unachievable.”

Dr. William Adair is Interim Vice President, Clinical Transformation at Advocate Christ Medical Center and Hope Children's Hospital and has served on the Ethics Committee for over 25 years.

Decisions about treatments around the end of life – when to start them, never starting them, stopping them – these are trying moments for patients, families and their

physicians. Withdrawing treatment can be especially difficult, Dr. Adair has found. “While from a logical perspective there is no difference between starting treatment that is withdrawn later and withholding it from the start (not initiating it at all), these alternatives may feel very different.

“I know that when we start a life-sustaining treatment, we all have expectations. We open ourselves to hope, and if that hope is not borne out, it hurts. We think, ‘Maybe it will be okay’ – even if there is just an outside chance. Then our hearts head down that path. If in the end the treatment is not effective, choosing to withdraw it feels more emotionally responsible than never initiating it.

“Think of giving a gift to a someone. The gift has personal meaning to both the giver and the receiver. Taking it back is painful for both – very different from having chosen not to give the gift in the first place.”

Choosing the path of hospice care is often difficult for the physician as well as for the patient and the family. All too commonly, they are ready for hospice while the physician is fearful about initiating the conversation.

“Doctors are sometimes reluctant to have end-of-life

discussions as it may feel like they are abandoning the patient. When there is no longer something to offer that heals or cures, it can feel like there is nothing to offer. They have not yet come to understand that they can still care for patients even when they have nothing left to treat.

“At some point, each of us faces death: our own, a loved one or, for the doctor, one of her patients,” concluded Dr. Adair. “Whatever issues I as a physician have personally regarding death, those issues come up whether I consciously acknowledge them or not. Because of these feelings, doctors

may shy away from these needed conversations. Yet our very best caring is possible when we physicians are aware of our own feelings about death and can empathize with our patients and their families in the midst of some of the most difficult decisions that any of us will ever make.”

Special Memorial Service for Recently BereavedSun., Aug. 14, 4 p.m.Siemers Chapel, Advocate Christ Medical CenterA special memorial service will be held for the hospice and patient families of Advocate Christ Medical Center and Hope Children’s Hospital who have recently lost a loved one. Christ Mission & Spiritual Care and Advocate Hospice join together in leading this service as a comfort for the families they serve. For more information, contact Penelope Gabriele at 630.829.1753.

Hospice CornerAdvocate Hospice ・ 1441 Branding Lane ・ Suite 200

Downers Grove, IL 60515 ・ 630.963.6800

Doctors . . . can still care for patients even when they have

nothing left to treat. 

The physician/ethicist as caregiver

Connections - Advocate Christ Medical Center Office for Mission and Spiritual Care July/August 2011 - Page 4

Hope Children’s Hospital

Our new building

The five institutes

Advocate Christ Medical CenterAdvocate Hope Children’s Hospital

Staff Chaplains:Refat Abukhdeir, Moslem MinistriesCathy Arsenault, MennoniteFr. Bill Browne, Roman CatholicMary Anne Cannon, Roman CatholicP.V. Chandy, QuakerFr. Casimir Eke, Roman CatholicChristy Howard-Steele, Christian Richard James, Southern BaptistStacey Jutila, Evangelical Lutheran ChurchMarjorie Kooy, Christian ReformedSr. Peggy Nau, Roman CatholicDavid Safeblade, United Church of ChristTyron Smith, Baptist

Clinical Pastoral Education SupervisorsAngie Keith, Pentecostal

ACPE Supervisory Candidate/ChaplainJanet MacLean, United Church of Christ

ACPE Supervisory Candidate/ChaplainPhyllis Toback, Jewish

ACPE Supervisor/Chaplain

Clinical Pastoral Education Chaplain ResidentsJaroslaw Dabrowski, Roman CatholicDenise Duncan, United Church of ChristMary Johnston, Roman CatholicEliza Leatherberry, United Church of Christ

Secretarial StaffKaren Darr, 708.684.4189

CPE, Ethics Committee, Office of Vice PresidentFran Genender, 708.684.5175

Eucharistic Ministers, the Department, Office of Manager of Spiritual Services

Administrative StaffCorky DeBoer, Christian Reformed

Manager of Spiritual Services, ACPE SupervisorWendell Oman, Evangelical Free Church of America

Vice-President, Mission & Spiritual Care

Advocate Christ Medical CenterAdvocate Hope Children’s Hospital

4440 West 95th Street, Oak Lawn, IL 60453 708.684.8000

Other Advocate Health Care Facilities:Advocate BroMenn Medical Center, NormalAdvocate Condell Medical Center, LibertyvilleAdvocate Eureka Hospital, EurekaAdvocate Good Samaritan, Downers GroveAdvocate Good Shepherd Hospital, BarringtonAdvocate Illinois Masonic Medical Center, ChicagoAdvocate Lutheran General Hospital, Park RidgeAdvocate Lutheran General Children’s Hospital, Pk. Ridge Advocate South Suburban Hospital, Hazel CrestAdvocate Trinity Hospital, Chicago

Share the news! This publication may be copied for use by others if printed acknowledgment of source is included.

To continue receiving Connections, your email address must be current. Please inform us of any changes of email address or other contact information. Email Christ-Mission-SpiritualCare@advocatehealth.com or call 708.684.5175.

In Upcoming Issues

Meet Chaplain Phyllis Toback

Once Phyllis Toback began quilting, drawing and firing ceramics, her life was never quite the same.

Eight years earlier, she had earned her Ph.D. in English literature from New York University and had built her career teaching at the college level. “But when I began creating, my images of God and spirituality expanded,” said Toback, who was raised in an Orthodox Jewish family and is now Conservative. “I discovered the Jewish mystical tradition and its commonalities with all other mystical traditions. At the same time, I increased my ecumenicalism.”

Toback had a desire to meet with people one-to-one and journey with those who temporarily needed support. Through a Chicago Board of Rabbis Parachaplaincy course, she earned her certification to visit patients. She then took CPE training, audited courses at

seminaries and acquired a Master of Divinity equivalent. In 1987, Toback was hired as a staff chaplain for Advocate Christ Medical Center.

Ch. Toback serves patients of all religions and acknowledges that there are few Jewish patients at the hospital at any one time. “Certainly I minister to

Jewish patients and their families, but I also have formed good relations with many Jewish doctors. My Jewish ministry is more with doctors than patients.”

She has been vice-chairman of the Perinatal Committee for eight years. “This work was very difficult initially, but we gained experience and set down policy to address all possible situations.

“Sometimes expectant parents find out things are wrong with their babies. Sometimes a mother’s health is at serious risk. These are families that really want these babies. They are heartbroken when they get the news that things aren’t right.”

One particularly agonizing case involved twins known to be joined at the heart. “We contacted doctors all over the country. Then we researched all over the world, but the feedback was consistent. It was painful for us all. We all wanted so much to send that family home with at least one baby,” recalled Ch. Toback.

Today Advocate Christ Medical Center’s perinatal hospice program provides support and counseling for families facing extreme pregnancy complications. Simply having someone there to help them sort things out can offer immeasurable comfort.

“We contacted doctors all over the country . . . Then we researched all

over the world . . . It was painful for us all.

Rev. Bonnie CondonVP, Faith Outreach

Dear Faith Leader –

We at Advocate Health Care recently received a wonderful honor:

For the third consecutive year, Thomson Reuters named Advocate Health Care one of the nation’s top 10 health systems.

This recognition reflects well on everyone associated with our hospitals – our associates (employees), our physicians and our volunteers. Since Advocate Health Care is faith-based, I believe this is also significant for those of us who are faith leaders.

For more than 100 years, Advocate and our predecessor organizations have cared for the health needs of people in our communities. We understand spirituality to be an important part of wellness and healing. We value the unique contributions faith communities make in transforming people’s lives for health and wholeness.

After reading the press release about the distinction Thomson Reuters has once again given Advocate, I felt moved to write to you, a faith leader. This award is in part a validation given to all of us who partner to make certain that the people we are privileged to serve are cared for – physically and spiritually. Thank you for being part of this.

Faithfully,

Bonnie Condon

Link to the Advocate Health Care press release: 

http://www.advocatehealth.com/body.cfm?xyzpdqabc=0&id=12&action=detail&ref=89

Link to the Thomson Reuters press release:

www.100tophospitals.com

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gs th

at m

ay b

e da

nger

ous

for

you.

Q: M

y do

ctor

told

me

that

I sh

ould

wea

r a

Med

ic A

lert

br

acel

et, b

ut I

don’

t lik

e th

e w

ay th

ey lo

ok. W

hat a

re m

y al

tern

ativ

es?

A: M

edic

Ale

rt m

edal

lions

can

be

wor

n as

nec

klac

es, w

atch

es

and

even

sho

elac

e ta

gs. T

hey

also

com

e in

diff

eren

t siz

es,

met

als

and

colo

rs, i

nclu

ding

spo

rts

band

s an

d fa

shio

nabl

e be

aded

bra

cele

ts. T

oday

’s w

eare

rs h

ave

a va

riet

y of

goo

d-lo

okin

g st

yles

to c

hoos

e fr

om.

Q: A

love

d on

e su

ffers

from

Alz

heim

er’s

Dis

ease

. How

can

a

Med

ic A

lert

ser

vice

hel

p?

A: A

Med

ic A

lert

tag

lets

law

enf

orce

men

t, fir

st r

espo

nder

s an

d m

edic

al p

erso

nnel

kno

w th

at a

per

son

has

Alz

heim

er’s

and

that

he

or s

he m

ay n

ot b

e ab

le to

effe

ctiv

ely

com

mun

icat

e, e

ven

if co

nsci

ous.

Med

ic A

lert

ser

vice

s ca

n al

so b

e co

mbi

ned

with

a G

PS lo

catio

n se

rvic

e: Y

our

love

d on

e ca

n w

ear

a w

rist

bra

cele

t or

carr

y a

page

r th

at a

llow

s yo

u to

tr

ack

his

or h

er w

here

abou

ts, a

nd th

e M

edic

Ale

rt s

ervi

ce c

an

notif

y yo

u w

hen

your

love

d on

e is

foun

d by

law

enf

orce

men

t or

firs

t res

pond

er s

ervi

ces.

A d

octo

r’s v

isit

usua

lly b

egin

s w

ith a

n in

terv

iew

: The

doc

tor,

nurs

e or

med

ical

ass

ista

nt a

sks

us a

bout

our

hea

lth h

isto

ry a

nd

curr

ent c

once

rns,

then

add

s th

is in

form

atio

n to

our

per

man

ent

file.

The

doc

tor

then

use

s ou

r m

edic

al r

ecor

ds to

mak

e th

e be

st p

ossi

ble

reco

mm

enda

tions

abo

ut o

ur h

ealth

car

e.

But

whe

n a

med

ical

em

erge

ncy

stri

kes

or a

n ac

cide

nt

happ

ens,

we

may

not

be

able

to c

omm

unic

ate

with

firs

t re

spon

ders

or

heal

th c

are

wor

kers

. Str

oke

vict

ims,

for

exam

ple,

may

be

awak

e an

d al

ert b

ut u

nabl

e to

spe

ak o

r un

ders

tand

spe

ech.

Peo

ple

in s

hock

may

lose

con

scio

usne

ss,

and

thos

e w

ith h

ead

inju

ries

may

not

be

luci

d en

ough

to

conv

ey im

port

ant m

edic

al in

form

atio

n to

oth

ers.

Med

ic A

lert

tags

com

mun

icat

e w

hen

we

can’

t. Yo

ur ta

g id

entifi

es y

our

maj

or m

edic

al c

ondi

tion(

s), s

uch

as d

iabe

tes

or

drug

alle

rgie

s, s

o th

at fi

rst r

espo

nder

s ca

n be

gin

trea

tmen

t. O

nce

you

are

at th

e ho

spita

l, st

aff c

an c

all t

he M

edic

Ale

rt

cent

er fo

r yo

ur m

edic

al r

ecor

ds a

nd in

form

atio

n ab

out a

ny

med

icat

ions

you

take

or

whe

ther

you

are

cur

rent

ly

unde

rgoi

ng m

edic

al tr

eatm

ent.

Med

ic A

lert

em

ploy

ees

can

also

con

tact

you

r fa

mily

and

put

them

in to

uch

with

hos

pita

l st

aff s

oone

r.

If yo

u ha

ve b

een

thin

king

abo

ut g

ettin

g a

Med

ic A

lert

bra

cele

t fo

r yo

urse

lf or

a lo

ved

one,

now

is th

e tim

e to

do

it. If

you

al

read

y ha

ve a

Med

ic A

lert

tag,

take

a fe

w m

inut

es to

con

tact

th

e se

rvic

e an

d up

date

you

r m

edic

al r

ecor

ds o

r yo

ur fa

mily

’s co

ntac

t inf

orm

atio

n. Y

ou’ll

pro

tect

you

r he

alth

and

you

r fa

mily

’s pe

ace

of m

ind

by m

akin

g cr

ucia

l inf

orm

atio

n ab

out

your

hea

lth a

vaila

ble

to th

ose

who

nee

d it.

Aug

ust

Is M

edic

Ale

rt A

war

enes

s M

onth

8-11