Events

Lunch will be provided. RSVPs are not required, please email Anna Adelman with any questions

Case

Mr. J is a 59-year-old man with metastatic pancreatic cancer admitted with sepsis, worsening liver failure, and escalating pain despite maximal medical management. ICU and palliative teams agree he is unlikely to survive this hospitalization. Oncology estimates “days to a short week,” assuming he survives the current infection.

A respected elder in his small Pentecostal congregation, Mr. J declares to every clinician, “I am not dying; God told me I will walk out of here,” and requests that the team “do everything” including CPR, intubation, and dialysis “until the Lord heals me.” His wife echoes this: “Withdrawing treatment would be giving up on God.”

During rounds, the medical team describes Mr. J as “in total denial” and “not getting it,” noting in the chart that he “lacks realistic understanding of prognosis. Yet, he accurately repeats the oncologist’s statistics and key medical facts. Nurses, who have developed a close bond with him, express moral distress at continuing aggressive interventions they see as prolonging suffering without benefit.

The palliative care physician leads another family meeting, explaining gently that “we are at the end of what medicine can do.” Mr. J listens respectfully and replies: “Doctor, I hear you. But medicine is not my final authority—God is.”  He also quotes Christian scripture about faith moving mountains, signaling that his resistance is not grounded in misunderstanding, but in a theological worldview.

The medical team requests a chaplain “to help break through his denial and get him to accept hospice.” The chaplain accepts the consult but clarifies with the team that spiritual care is not persuasion toward a specific medical outcome; it is exploration of meaning, hope, and spiritual distress.

In the room, the chaplain finds Mr. J surrounded by church members, with prayers focused on “claiming healing” and “rebuking death.” The chaplain begins simply: “When you say you know you will walk out of here, what are you hoping for most deeply?”

Mr. J talks for nearly an hour about his identity as a spiritual leader, his responsibilities to his congregation, unfinished hopes for his grandchildren, and his belief that God is glorified when believers stand against discouraging medical predictions.

Ethics Discussion Questions

• Is it ethically problematic to label someone as “in denial”? What assumptions or biases can this label conceal?
• How do we distinguish between cognitive misunderstanding and existential or  theological non-acceptance?
• Is there a point at which honoring a patient’s religiously grounded hope becomes complicity in causing harm? Who decides where that point is?
• What ethical obligations do clinicians have to understand or at least respect a patient’s faith perspective when it shapes treatment requests?
• How might a theological stance (“God will heal me”) function differently than a misunderstanding of medical facts? Should they be addressed differently?
• How should teams appropriately use chaplains in goals-of-care conversations?
  What are the risks of using chaplains as persuaders rather than explorers?
• Should clinicians ever challenge the theological premises that underlie a patient’s decision-making? If so, when? If not, why not?
• How can teams address clinicians’ moral distress when providing treatments they consider non-beneficial or medically ineffective?
• How can an ethics lens help turn a conflictual case (“hess fighting us”) into a collaborative one (“we’re aligning treatment with his values”)?
• What ethical principles support the reframing of hope from cure to comfort?
  What constitutes an ethically meaningful “good death” in a case like this from a patient’s standpoint? From the family’s? From the team’s?

FEATURING PANELISTS

Moderator
Matt Norvell
Clinical Manager for Spiritual Care and Director of RISE, JHH

Panelists
Naomi Madaras
Pediatric Chaplain, JHH

Ignatius Okoye
Catholic Chaplain, JHH

Kim Henson
Family Advocate Chaplain, JHH

Sally Miller
Manager of Clinical Pastoral Education Programs, JHH