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Care of the Whole Person: The role of Hospital Chaplains · Health Ethics Podcast

0:08
Speaker 1: Welcome to Health Ethics, a series of conversations with leading
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Speaker 1: experts about ethical considerations associated with health and healthcare, both
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Speaker 1: locally and globally. I am Brian Pilkington, Professor of Bioethics
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Speaker 1: in the Department of Medical Sciences at the Hackensack Meridan
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Speaker 1: School of Medicine. This series, like its predecessor, which focused
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Speaker 1: on the COVID nineteen pandemic, relies on the idea that
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Speaker 1: challenging ethical issues are best addressed by folks from diverse
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Speaker 1: backgrounds practically reasoning together, and complements the Health Ethics series
0:41
Speaker 1: with its panel of leading experts from medicine, nursing, politics, economics, philosophy,
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Speaker 1: and the law. Thank you and enjoy the episode.
0:59
Speaker 2: Welcome to the he Health Ethics podcast. My name is
1:01
Speaker 2: Brian Pilkington, and I am Professor of Bioethics at the
1:04
Speaker 2: Hackensack Marineian School of Medicine. It is my great pleasure
1:08
Speaker 2: today to be speaking with doctor Robert Klitzman, who is
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Speaker 2: Professor of Psychiatry at the College of Physicians and Surgeons
1:15
Speaker 2: at Columbia University as well as at the Joseph Manman
1:18
Speaker 2: School of Public Health and the program director for the
1:22
Speaker 2: Master of Science and Bioethics also at Columbia. He co
1:25
Speaker 2: founded and for five years co directed Columbia University Center
1:29
Speaker 2: for Bioethics and directed the Ethics and Policy Corps for
1:32
Speaker 2: the HIV Center there for ten years. He's published over
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Speaker 2: one hundred maybe scientific journal articles, nine books, and numerous
1:40
Speaker 2: chapters on critical issues in bioethics, including genetics, neuroethics, HIV prevention,
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Speaker 2: research ethics, and the relationship between doctors and patients. Doctor
1:51
Speaker 2: Klitzman has received numerous awards for his work, including fellowships
1:54
Speaker 2: from the John Simon Guggenheim Foundation, the Russell Sage Foundation,
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Speaker 2: the Commonwealth Fund, and the Ackefeller Foundation, just to name
2:01
Speaker 2: a few. He's a member of the Empire State stem
2:04
Speaker 2: Cell Commission and served on the US Department of Defense's
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Speaker 2: Research Ethics Advisor Board, as well as being a Distinguished
2:11
Speaker 2: Fellow of the American Psychiatric Association, a member of the
2:15
Speaker 2: Council on Foreign Relations, and a regular contributor to The
2:18
Speaker 2: New York Times and CNN. I'm a big fan of
2:21
Speaker 2: doctor Clinton's bioethics work, as you'll tell from our conversation
2:24
Speaker 2: I Hope and his book The Ethics Police. I think
2:27
Speaker 2: is an especially poignant and powerful one. Today we will
2:30
Speaker 2: be discussing his new book, Doctor Will You Pray for Me? Medison,
2:33
Speaker 2: chaplains and the Healing of the Whole Person.
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Speaker 1: Bob, thanks so much for being here. I really appreciate it.
2:39
Speaker 3: Happy to be here.
2:40
Speaker 1: So I'm a big fan of a lot of your work.
2:43
Speaker 1: I was a big fan of ethics Police. You've written
2:45
Speaker 1: a ton What motivated you to write this book about
2:48
Speaker 1: chaplaincy in particular?
2:51
Speaker 3: So I wrote this book for a few reasons. One
2:54
Speaker 3: is a personal reason, and then several of professional reasons. Personally. Unfortunately,
3:00
Speaker 3: on nine to eleven, my sister died. She worked at
3:03
Speaker 3: the World Trade Center and was at her office and
3:07
Speaker 3: called her best friend at eight thirty in the morning,
3:09
Speaker 3: and no one ever heard from her again, and we
3:12
Speaker 3: had no body. She just disappeared. It's as if she
3:15
Speaker 3: just evaporated. And it was a very difficult time for
3:19
Speaker 3: many of us in New York and in the country,
3:21
Speaker 3: in the world. But I was struck that no one
3:23
Speaker 3: else I knew had a family member who was lost,
3:26
Speaker 3: and I had to go and register with the FBI
3:29
Speaker 3: as a missing person. We had to decide we have
3:32
Speaker 3: a memorial service. Again, we had no body. Would we
3:36
Speaker 3: have a grave site for her? Will we put anything
3:38
Speaker 3: in it? What would we do? We eventually emptied out
3:41
Speaker 3: her apartment and had just burst her belongings. And as
3:45
Speaker 3: I said, it was a very hard time. And first
3:47
Speaker 3: I wondered why me, why us? Were sort of thoughts
3:51
Speaker 3: that came to me. And then also I found that
3:55
Speaker 3: after that, after a few weeks of doing all that,
3:58
Speaker 3: my body just gave out and I just who wanted
4:00
Speaker 3: to lay in bed and I thought I had the flu.
4:02
Speaker 3: I felt like I had the flu, had hurt to
4:04
Speaker 3: move my body. I didn't want to watch TV or
4:07
Speaker 3: go to movies or see movies or read, etc. And
4:11
Speaker 3: friends said, well, this is grief, and I said, no, no,
4:13
Speaker 3: I have the flu. And I was a psychiatrist, But
4:16
Speaker 3: of course I realized eventually that they were correct. And
4:19
Speaker 3: I was struck how much I didn't understand what it
4:22
Speaker 3: was like to be a patient, to have to go
4:24
Speaker 3: through grief, to have to and how much it's a
4:27
Speaker 3: bodily experience or can be. And a lot of physicians
4:32
Speaker 3: I know say that half the patients they see or
4:35
Speaker 3: whatever percent actually come in with complaints but actually have
4:39
Speaker 3: no physical cause of the complaints where it's quote all
4:42
Speaker 3: in their head. They come in complaining of aches and pains,
4:45
Speaker 3: and this hurts, and that hurts. And we tend to
4:47
Speaker 3: look down at patients like that as somaticizing. But I
4:50
Speaker 3: realize how much, especially given how much we know now
4:54
Speaker 3: about how much depression is a biological process and anxiety, etc.
4:59
Speaker 3: That this was very much a bodily experience. And so
5:02
Speaker 3: I was struck how little I knew. And then I
5:05
Speaker 3: went to my temple I'm Jewish, but also church to
5:09
Speaker 3: a Buddhist service where we walked around and rang bells,
5:13
Speaker 3: and none of it really lifted my spirits speak until
5:18
Speaker 3: I was sitting in Central Park one day and the
5:21
Speaker 3: wind was waving, was below the grass which was waving,
5:25
Speaker 3: and the trees are waving, and I realized that nature
5:27
Speaker 3: somehow goes on, that even though I'd had this great
5:30
Speaker 3: loss in my life, nature continues, and that was very reassuring.
5:34
Speaker 3: And after that I became interested in how other physicians
5:38
Speaker 3: go through serious problems and what they learned, what they unlearned,
5:44
Speaker 3: what they now knew they didn't before. So I got
5:46
Speaker 3: anih funding and wrote a book called When Doctors Become patients,
5:49
Speaker 3: and I interviewed seventy five physicians around the country who
5:52
Speaker 3: became patients themselves. When I asked them, what do you
5:56
Speaker 3: now know or what have you learned since being a
5:59
Speaker 3: patient with serious illness that you did not know beforehand?
6:03
Speaker 3: Patients used to say to me, doc, would you pray
6:05
Speaker 3: for me? And I'd go, yeah, yeah, whatever, and I'd
6:08
Speaker 3: poop poot. And then I became a patient with a
6:10
Speaker 3: serious illness and didn't know if I'd survive. And I
6:13
Speaker 3: realize how much existential and spiritual and religious issues are important,
6:17
Speaker 3: but I have no training to do with them. So
6:20
Speaker 3: I also got interested giving that in the past few
6:23
Speaker 3: years our country has become increasingly polarized politically but also religiously,
6:28
Speaker 3: and there are huge debates about religious issues and healthcare,
6:31
Speaker 3: from abortion to rights of LGBTQ people, etc. So I
6:37
Speaker 3: was curious where do patients come down now at the
6:39
Speaker 3: end of life, given that we have a wide change
6:42
Speaker 3: in the religious landscape of America, increasing their people who
6:46
Speaker 3: are evangelical on the one hand, and on the other
6:48
Speaker 3: hand we have people who are spiritual but not religious,
6:51
Speaker 3: or who believe nothing in particular or just unaffiliated. What
6:57
Speaker 3: does this look like for patients. As I began to
7:01
Speaker 3: get interested in this area, I realized how much chaplains
7:04
Speaker 3: are the ones who really deal with these issues. And
7:07
Speaker 3: I've been fortunate to work with some wonderful chaplains at Columbia,
7:10
Speaker 3: particularly on the ethics committee of the hospital, and I
7:14
Speaker 3: began to realize how much they really have insights and
7:17
Speaker 3: really are sort of in the trenches with these issues.
7:19
Speaker 3: So I decided to interview them, and what I found
7:22
Speaker 3: was startling and it really surprised me in many ways,
7:25
Speaker 3: and so that's what led to the book.
7:26
Speaker 1: First off, I'm very sorry to hear about your sister,
7:29
Speaker 1: though I do appreciate you revisiting it, because I know
7:32
Speaker 1: lots of folks listening to the podcast, and we have
7:34
Speaker 1: a bunch of medical students who do and so thinking
7:37
Speaker 1: through research projects with them. There's an ancillary benefit to
7:40
Speaker 1: having someone sort of, you know, pulling in from your
7:42
Speaker 1: own experiences, I think is very helpful for them. Can
7:46
Speaker 1: you say more? I mean, you detail us in the book,
7:49
Speaker 1: but a little more about the profession of chaplaincy if
7:53
Speaker 1: it is probably a profession, but chaplains do an exceptional
7:57
Speaker 1: amount of work. Chaplains are in many hospitals, not all hospitals.
8:01
Speaker 1: Can you sort of talk us through what chaplains do
8:04
Speaker 1: and the benefits of chaplains?
8:06
Speaker 3: Yeah, so great questions. So chaplains are an evolving profession,
8:09
Speaker 3: and I would call them a profession. So increasingly in
8:14
Speaker 3: recent years, chaplains are becoming bored certified. It used to
8:19
Speaker 3: be a number of years ago where in hospitals chaplains
8:21
Speaker 3: were often voluntary clergy from the community. So I remember
8:24
Speaker 3: when I was a medical intern, might occasionally see a
8:26
Speaker 3: rabbi and a yamica or a priest with a collar,
8:30
Speaker 3: and they operate in some different world like we've never
8:32
Speaker 3: talked to them or never interact. In fact, at one point,
8:36
Speaker 3: I remember I had a young patient who was had
8:40
Speaker 3: metastatic cancer and was dying basically, and first she was
8:44
Speaker 3: very hopeful about new treatment, so they began to fail her.
8:47
Speaker 3: And she was very Catholic, and she had a card
8:50
Speaker 3: with a picture of Jesus at the foot of her bed.
8:52
Speaker 3: And as time went on, she was getting worse and worse.
8:55
Speaker 3: So I said to my resident at one point, should
8:57
Speaker 3: we call a priest? And he looked at me if
9:00
Speaker 3: I was said, should we call the voodoo doctor, like,
9:03
Speaker 3: what do you care? Like that's kind of nonsense, like
9:06
Speaker 3: it's irrelevant. And eventually I didn't do anything. But eventually
9:10
Speaker 3: priests actually came on his own and she sort of
9:12
Speaker 3: actually perked up quite a bit and I realized she
9:14
Speaker 3: I mean, she died unfortunately shortly thereafter, but I realized
9:18
Speaker 3: the priest gave her something that I didn't or couldn't
9:21
Speaker 3: at that time as an intern. So so chaplins, though, have,
9:26
Speaker 3: as I said, increasingly become and I think I said
9:29
Speaker 3: something about what chaplains do by the way, also, and
9:32
Speaker 3: I'll come back to that, but chaplins increasingly your board certify,
9:36
Speaker 3: which means that they go through very rigorous training and
9:39
Speaker 3: practice and supervised work where they have training in basically
9:44
Speaker 3: psychotherapy as well as and how to help patients across beliefs.
9:49
Speaker 3: So chaplaincy is now really an interfaith, non denominational profession.
9:54
Speaker 3: One chaplain I interviewed for the book said that chaplaincy
9:58
Speaker 3: is really a post religious profess at this point, that
10:01
Speaker 3: it is able to help people whether they are evangelical
10:04
Speaker 3: or atheist or agnostic or nothing in particular, or a
10:07
Speaker 3: Buddhist or you know, one of the major faiths, et
10:11
Speaker 3: cetera in various degrees. And I should say that at
10:14
Speaker 3: this point about seventy five percent of hospitals do have chaplains,
10:19
Speaker 3: about a quarter do not. Among those that do have chaplains,
10:22
Speaker 3: though some are still voluntary chaplains and they can do
10:26
Speaker 3: a lot of good. One problem with that is they
10:28
Speaker 3: often know only about their own faith, So if they're Catholic,
10:31
Speaker 3: they really only know about Catholicism, if they're Jewish they
10:35
Speaker 3: may only really know about Judaism. And also they are
10:38
Speaker 3: not trained specifically to work in medical environments, so they
10:42
Speaker 3: may not know what a stage two versus a stage
10:45
Speaker 3: four cancer is, for instance, Whereas chaplains increasingly know about
10:50
Speaker 3: medical symptoms and work in hospitals and so begin to
10:53
Speaker 3: understand how those kinds of things, for instance, can have
10:56
Speaker 3: very different meanings that otherwise may all sound the same.
11:00
Speaker 3: What's a stage two versus a stage four whatever? So
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Speaker 3: chaplains basically work on helping patients find meaning and purpose
11:10
Speaker 3: and hope and connection, and regardless of what their beliefs are,
11:15
Speaker 3: they pray with patients, which could be very powerful. They
11:20
Speaker 3: give support, spiritual support, existential support also with patients' families,
11:25
Speaker 3: who are often going through very difficult times. It might
11:27
Speaker 3: be moms dying or my child's dying, whether a child
11:30
Speaker 3: is an infant or five or seven years old or
11:33
Speaker 3: twenty five years old, so families are often going through
11:37
Speaker 3: a difficult process. Staff also go through difficult existential challenges. So,
11:43
Speaker 3: particularly during the COVID pandemic, staff are really getting burnt out,
11:46
Speaker 3: and chaplains often were the only ones there on the
11:49
Speaker 3: ground to provide a space to talk to to staff
11:53
Speaker 3: about it. So one chaplain, for instance, I interviewed, said
11:56
Speaker 3: that during the COVID pandemic, she insta tutored chocolate rounds.
12:01
Speaker 3: She said, well, there are grand rounds. So I started
12:04
Speaker 3: chocolate rounds and I'd go around to the staff with
12:06
Speaker 3: a box of chocolate and say, I'm doing chocolate rounds today.
12:09
Speaker 3: Would you like a chocolate? And staff would inverbably say
12:12
Speaker 3: I'd love a chocolate, And she'd say, well, and by
12:15
Speaker 3: the way, how are things going? You know, what's been
12:17
Speaker 3: going on? You know? And the person would say, well,
12:20
Speaker 3: you know, we had three deaths yesterday and I have
12:22
Speaker 3: two patients today I think are not going to make it.
12:24
Speaker 3: And what's that like? And how you doing? And just
12:26
Speaker 3: talking about it often helped in chaplains and other things
12:29
Speaker 3: as well. During that one Ward, for instance, had a
12:34
Speaker 3: lot of losses in the chaplain during the COVID pandemic,
12:37
Speaker 3: said well, let's create a wreath. And she put pieces
12:40
Speaker 3: of paper out and told the staff everyone should write
12:43
Speaker 3: down if they'd like a name of someone they've lost,
12:46
Speaker 3: either a family member or friend or patient, and put
12:49
Speaker 3: the leaf on the reef, and soon the wreath was
12:52
Speaker 3: covered with names. And when the COVID pandemic went down,
12:56
Speaker 3: she was going to take this off the wall, and
12:57
Speaker 3: people said, no, no, leave it here in the nursing station.
13:00
Speaker 3: And it really is a reminder of what we've been through.
13:02
Speaker 3: And I think that demonstrates the kind of healing of
13:06
Speaker 3: a certain type that chaplains can do. And the books
13:10
Speaker 3: filled with stories of the specific things chaplains do. They
13:13
Speaker 3: also mediate between patients and families and staff. So one
13:18
Speaker 3: other story in the book, for instance, is there was
13:21
Speaker 3: a young man who was in an accident and had
13:24
Speaker 3: wanted to be a organ donor and the family was
13:27
Speaker 3: fine with that, and he was unfortunately soon brain dead.
13:30
Speaker 3: Just machines keeping him alive, and the surgeon said, okay,
13:33
Speaker 3: we're going to roll him into the operating room and
13:36
Speaker 3: will harvest the organs terrible word. And the family said, well,
13:41
Speaker 3: can we be there when our son dies? And the
13:43
Speaker 3: sergeant said absolutely not, because it's going to be in
13:46
Speaker 3: the operating room and you'd have to gown up and
13:48
Speaker 3: you know, you'll get emotional, and we really have to
13:51
Speaker 3: harvest the organs as soon as possible. And then the
13:54
Speaker 3: family was sort of thinking, well, maybe we won't agree
13:56
Speaker 3: to have his organs donated if this is what it's
13:59
Speaker 3: going to be, and if we can't be there, so
14:02
Speaker 3: and they were at loggerheads whether or not now he
14:04
Speaker 3: would donate the organs or not, or the family would
14:06
Speaker 3: let the organs be donated, and the chaplain said, well,
14:08
Speaker 3: let me talk to everyone. The chaplain arranged the family
14:11
Speaker 3: would gown up in sterile gowns and go to the
14:13
Speaker 3: operating room for just three minutes and be there and
14:16
Speaker 3: then leave. And the surgeons said okay. So when the
14:19
Speaker 3: son was rolled in, the chaplain said of the mother,
14:23
Speaker 3: does your son have a favorite song? Did he have
14:25
Speaker 3: a favorite song? And the mother said yes, amazing grace.
14:29
Speaker 3: So they all sang amazing Grace, and the surgeons joined in,
14:34
Speaker 3: the nurses joined in, everyone joined and sing and everyone
14:36
Speaker 3: started to cry. And then at the end of three minutes,
14:39
Speaker 3: a family left and the mother then took the chaplain's
14:42
Speaker 3: head and said, thank you so much. We got to
14:44
Speaker 3: sing my son into heaven. And I think that's a
14:47
Speaker 3: very moving story to me. That also shows the kind
14:50
Speaker 3: of work chaplains can do. Whereas here they were now
14:54
Speaker 3: organs donated which could save other people's lives that may
14:57
Speaker 3: not have happened otherwise had it not been for this
15:00
Speaker 3: sort of simple but sensitive intervention. So those are the
15:04
Speaker 3: kinds of things chaplains can do, and in terms of
15:08
Speaker 3: helping to mediate, helping to have discussions about between within families,
15:14
Speaker 3: between family members and patients, etc. Other things. It was
15:18
Speaker 3: a man who came in with an abdominal pain and
15:21
Speaker 3: other chaplain told me and had a million dollar workup
15:24
Speaker 3: and they found nothing. And a few months later he
15:26
Speaker 3: came back with abdominal pain and again had a million
15:29
Speaker 3: dollar workup, and again they found nothing. And then several
15:32
Speaker 3: months later he came back with abdominal pain and the
15:35
Speaker 3: chaplain said, well, let me talk to him. And the
15:37
Speaker 3: chaplain said, when did the pain start? And he said, well,
15:40
Speaker 3: January nineteenth, twenty twenty, what happened then? Will my wife
15:44
Speaker 3: died and no one had asked him sort of what
15:47
Speaker 3: the context was in which his pain started was just
15:50
Speaker 3: always had the pain for three years or whatever it was.
15:53
Speaker 3: And again it shows how chaplains have time often to
15:57
Speaker 3: get to know patients and find out things that and
16:00
Speaker 3: medically useful and important. And with that patient he then
16:02
Speaker 3: got psychotherapy and never came back to the hospital with
16:06
Speaker 3: that complaint. So I think it shows the power that
16:09
Speaker 3: chaplains he has and how it can help us as patients,
16:13
Speaker 3: as providers, et cetera. At the same time, unfortunately, chaplains
16:17
Speaker 3: are very marginalized, so they're underfunded, they're often under resourced,
16:20
Speaker 3: et cetera.
16:21
Speaker 1: All the cases, all the stories are poignant, and I
16:24
Speaker 1: was actually going to try to take you to the
16:26
Speaker 1: point that you just went to. Given the great work
16:29
Speaker 1: that chaplains can do, and the story just I mean,
16:33
Speaker 1: saves this person in the hospital the system millions of
16:36
Speaker 1: dollars in the future. But chaplains are not reimbursed, right,
16:39
Speaker 1: their services aren't reimbursed for so this is there we
16:43
Speaker 1: have to pick up. I want to ask you a
16:44
Speaker 1: little bit about their work relative to the work of
16:48
Speaker 1: other folks. So I see how given the existential crises,
16:52
Speaker 1: religious crisis, spiritual crises that often face folks when they're
16:55
Speaker 1: in challenging health situations, your description of the chaplain's work,
16:59
Speaker 1: it's a great fit for this right the time. The
17:01
Speaker 1: chocolate rounds perfect story. You mentioned that they have training
17:05
Speaker 1: in psychotherapy, and one of the stories that, I mean,
17:08
Speaker 1: the Amazing Grace story is just I actually read that
17:10
Speaker 1: twice when I was reading the book. Is a wonderful
17:13
Speaker 1: instance of mediation. I often think of mediation as a
17:16
Speaker 1: clinical ethics consultation practice. I often think of psychotherapy as
17:20
Speaker 1: something that psychiatrists do. Any reflections, further thoughts about chaplains
17:27
Speaker 1: and how they exist in these different tasks spaces. How
17:30
Speaker 1: are they getting in fights with ethicists? Is there a
17:32
Speaker 1: war over turfs or any reflections on that.
17:34
Speaker 3: Yeah, So those are great questions. So Unfortunately, hospital systems,
17:39
Speaker 3: or most hospital systems I've seen, are very fractured, fragmented,
17:42
Speaker 3: under huge strains at the moment. Under you know, they're
17:45
Speaker 3: facing cutbacks. There hospitals that are closing, there's reimbursement issues,
17:50
Speaker 3: They're being gobbled up by larger healthcare systems that could
17:53
Speaker 3: lead to strains and layoffs or the nursing shortages, etc.
17:57
Speaker 3: So medical staff, doctors and nurses often have to spend
18:02
Speaker 3: a lot of time on computers entering information into electronic
18:07
Speaker 3: medical records and have less time to sort of sit
18:10
Speaker 3: and just run and talk to patients and get to
18:12
Speaker 3: know patients. So I think that chaplains fill in the void,
18:17
Speaker 3: so to speak, in words, they fill in the gaps
18:19
Speaker 3: like they're just not enough ethicists to go around for
18:22
Speaker 3: clinical ethics consults if only there were. And also ethics
18:26
Speaker 3: consults occur generally when they're specifically called for by someone,
18:31
Speaker 3: whereas chaplains will go around the ward, they'll just say
18:34
Speaker 3: to the nurses on the ward, you know, hey, anyone
18:36
Speaker 3: I should speak to today, And let's say, well, missus
18:39
Speaker 3: Stone or missus Jones or mister Tom whatever is having
18:43
Speaker 3: some issues or whatever. So they're much more on the
18:46
Speaker 3: ground there in a way that ethicists are not, and
18:50
Speaker 3: sort of an ongoing basis waiting to be called. For instance,
18:52
Speaker 3: I mean sometimes people call the chaplain, but often chaplains
18:55
Speaker 3: will just sort of be part of the staff on
18:57
Speaker 3: the ward and so available so I think that I
19:02
Speaker 3: haven't seen turf wars. If anything, I think that ethicis
19:07
Speaker 3: I've seen on ethics committees for instance. Really feel that
19:09
Speaker 3: chaplains have a lot to add and in terms of
19:11
Speaker 3: mediation also yes. I think one issue though, is that chaplins,
19:15
Speaker 3: as I said, get some training really quote counseling more
19:18
Speaker 3: than psychotherapy per se. But I think they're related and
19:21
Speaker 3: they don't get explicit training in mediation, and I think
19:25
Speaker 3: they should. So what I think is that chaplains do
19:28
Speaker 3: a great job. I really think they're unsung heroes in
19:31
Speaker 3: the hospital systems in which you work today. But I
19:33
Speaker 3: could think that many of them could also up their game.
19:36
Speaker 3: So I think they could even do more and more
19:38
Speaker 3: explicitly take on some of these roles. Get training in mediation,
19:42
Speaker 3: for instance, because a lot of them are sort of
19:43
Speaker 3: de facto doing it but not having specific training. I mean,
19:47
Speaker 3: they tend to be wonderful people who are very sensitive, caring, compassionate.
19:53
Speaker 3: Many have had prior careers doing something else. They've worked
19:56
Speaker 3: in the music industry, or they've worked in theater, a
20:00
Speaker 3: million other things, that worked in business and then or
20:02
Speaker 3: law and then sort of had a I'll say a calling,
20:05
Speaker 3: or realize that this is something meaningful for them. Many
20:08
Speaker 3: of them have had a personal loss in their life,
20:11
Speaker 3: maybe a family member died and it was a very
20:13
Speaker 3: difficult period for them, and they realize that there's a
20:16
Speaker 3: need for chaplains, or they sort of played a certain
20:19
Speaker 3: role for friends or family and realize that this is
20:22
Speaker 3: something that was very ratifying to them in doing in
20:25
Speaker 3: a way they can help other people. So I think
20:28
Speaker 3: social workers could do some of this for sure. Social
20:31
Speaker 3: workers in hospitals today, I think, unfortunately, are forced to
20:35
Speaker 3: spend most of their time doing discharge planning, arranging for insurance,
20:39
Speaker 3: arranging for a hospital bed or a long term care
20:42
Speaker 3: facility BET or a nursing home bed, or making sure
20:45
Speaker 3: that there is someone at home or a home health
20:47
Speaker 3: aid to help the person patient when they get home.
20:51
Speaker 3: Psychiatrists could do a lot of this work too, but
20:53
Speaker 3: are in short supply and hospitals and generally often get
20:56
Speaker 3: involved on them when there's a crisis, if a patient
20:58
Speaker 3: becomes violent or clearly psychotic, and then focuses on medication.
21:03
Speaker 3: So I think chaplains sort of filling these voids in
21:06
Speaker 3: a very important way.
21:07
Speaker 1: It's really helpful and their sort of nimbleness, right, an
21:11
Speaker 1: addressing variety of existential concerns makes them a really good
21:14
Speaker 1: fit for this. I want to stick with the sort
21:17
Speaker 1: of professional the profession of chaplaincy, maybe the professionalization of chaplains,
21:23
Speaker 1: and it's a bit of a pet project, but I
21:25
Speaker 1: have interest in bioethics and in how clinical ethicists have
21:28
Speaker 1: become professionalized. Right, everybody's the HGC dash see credentials are
21:32
Speaker 1: not many do? And so for board certified chaplains. And
21:37
Speaker 1: as someone who's sort of spoken with many chaplains, you've
21:39
Speaker 1: run this study, is this a good move? Would you
21:43
Speaker 1: like to see all chaplains boards certified? Are there? Is
21:47
Speaker 1: that not the right kind of question? The word chaplains
21:50
Speaker 1: do is amorphous enough. It's a benefit if you have
21:53
Speaker 1: some training in this particular way. Any reflections on the
21:57
Speaker 1: sort of professionalization of this much needed field.
22:00
Speaker 3: Yes, I think that professionalization is a good thing for
22:04
Speaker 3: chaplaincy because it encourages them to get board certify, which
22:08
Speaker 3: means they get training. As I mentioned earlier, not just
22:11
Speaker 3: in their own faith tradition, whatever that may be, but
22:14
Speaker 3: in others as well, including people who have a lack
22:17
Speaker 3: of a faith tradition. They may be humanist or secular,
22:20
Speaker 3: or atheist or agnostic. So I think that's important. And
22:24
Speaker 3: I think also as part of their training, getting specific
22:28
Speaker 3: skills in counseling, for instance, is something that could be
22:30
Speaker 3: very helpful for them having supervision. And it's hard work.
22:34
Speaker 3: I mean, it's you know, a lot of chaplains work
22:37
Speaker 3: in hospices, for instance, and probat to care. The people
22:39
Speaker 3: who often need chaplains the most are those who are
22:42
Speaker 3: really facing death and dying in a very real way,
22:45
Speaker 3: and that's hard work. And so I think helping people
22:48
Speaker 3: develop the skills to be able to do this kind
22:51
Speaker 3: of work. I know when I train in psychiatry, you know,
22:54
Speaker 3: patients express anger, patients get mad at you, patients reject you.
22:58
Speaker 3: And being able to sort of deal with and realized
23:00
Speaker 3: what's in the patient's best interest is very important. One chaplain,
23:05
Speaker 3: for instance, told me a story that he visited a
23:09
Speaker 3: patient and knocked on her door and said, Hi, I'm
23:11
Speaker 3: from the Chaplaincy Service and she put up her arms
23:15
Speaker 3: and a cross and said, you are anathetomy. Get out.
23:18
Speaker 3: My religion is CNN. I believe in the facts and
23:22
Speaker 3: in politics. And he was much taken aback and didn't
23:24
Speaker 3: know what to do and left. But then he thought
23:26
Speaker 3: about it, and he was pained by that, but he
23:29
Speaker 3: says it she was also a feisty but really a
23:32
Speaker 3: very lonely woman. No one was visiting around the ward
23:35
Speaker 3: she was dying, and so he went back the next
23:37
Speaker 3: day and knocked again on the door and said remember me,
23:41
Speaker 3: and she went yeah, And he said, I know that
23:44
Speaker 3: your religion is CNN, but what do you think of
23:46
Speaker 3: what's going on in the world today politically, And they
23:49
Speaker 3: ended up having a conversation and they ended up developing
23:51
Speaker 3: a close bond, which was very helpful for her given
23:54
Speaker 3: that she was there alone in the hospital with really
23:56
Speaker 3: no one to talk to, and addressing her own fears.
23:59
Speaker 3: And so I think that that shows how being able
24:04
Speaker 3: to deal with that kind of rejection or anger at you,
24:08
Speaker 3: and a lot of people are also angry at God
24:10
Speaker 3: and they're anger at you and they don't want to
24:11
Speaker 3: see a chaplain because they're pissed off at the world
24:14
Speaker 3: and they're dying or you know, these are difficult conversations
24:17
Speaker 3: to have, and so people having explicit training I think
24:20
Speaker 3: can help that. Said, there is a debate on how
24:23
Speaker 3: to assess chaplains. In other words, one stumbling block for
24:27
Speaker 3: that is that chaplains are not yet reimbursed. As you
24:30
Speaker 3: mentioned earlier. They are reimbursed in the VA system and
24:33
Speaker 3: the Veterans Administration system, but otherwise they're not directly reimbursed patients.
24:38
Speaker 3: Is part of Medicare. The hospitals would get a certain
24:42
Speaker 3: amount of money. They'll get x amount of money for patient,
24:46
Speaker 3: which includes paying for the lighting and the electricity and
24:50
Speaker 3: the heating, and the staff and the janitors and the
24:53
Speaker 3: nursing staff and the chaplains, but not a specific line.
24:57
Speaker 3: And so a lot of hospitals under fund chaplains. As
25:00
Speaker 3: I mentioned, a quarter of hospitals have no chaplains. And
25:02
Speaker 3: I think one issue one reason for that is which
25:05
Speaker 3: comes up with ethicist two or has in the passes?
25:08
Speaker 3: How do you assess them? Where if you say you
25:10
Speaker 3: want a profession, how do you know if someone's worthy
25:13
Speaker 3: of being in the profession? What kind of standard should
25:16
Speaker 3: you have to say? Okay, now, yes, you are now
25:18
Speaker 3: part of the profession. You are a professional. And there
25:21
Speaker 3: have been efforts to quantify what chaplains do, and you
25:24
Speaker 3: can imagine that's difficult. I've argued, and I arguing in
25:27
Speaker 3: the book that as opposed to just measuring how many
25:31
Speaker 3: times do you pray with a person? Did you pray
25:33
Speaker 3: with a patient this week? How many times? And that's
25:36
Speaker 3: what chaplains do? Or did you help with the devands directive?
25:39
Speaker 3: The chaplains will do a lot of other activities, and
25:41
Speaker 3: that I think narrative explanations qualitative data helps us understand
25:47
Speaker 3: what chaplains do in a way that legitimizes what they do.
25:50
Speaker 3: There was an effort to show quantitatively that patients who
25:55
Speaker 3: saw a chaplain then had higher satisfaction scores after left
26:00
Speaker 3: the hospital or their family report to higher satisfaction, and
26:03
Speaker 3: the first study showed, look, here is proof that chaplains help.
26:08
Speaker 3: But then subsequent studies show that there was not a relationship.
26:11
Speaker 3: And part of that, of course, is that people who
26:13
Speaker 3: are more likely to see chaplains are more likely to
26:15
Speaker 3: be facing death and dying. So you had more patients
26:19
Speaker 3: who were dying saw chaplains. But then if you ask
26:21
Speaker 3: the family a few months later, on a satisfaction scale
26:25
Speaker 3: of one to five, how is your experience in the hospital, Well,
26:28
Speaker 3: if your mother died in the hospital, you may not
26:30
Speaker 3: say five it was a great experience I recommended for everyone. Right.
26:33
Speaker 3: You may so the satisfaction scores may not correlate with
26:38
Speaker 3: whether or not you saw chaplain because the person may
26:41
Speaker 3: be dying and maybe difficult and et cetera. But I
26:45
Speaker 3: think that Therefore, I think qualitative methods can convey the
26:49
Speaker 3: importance of chaplains, and I try to do that in
26:51
Speaker 3: the book.
26:52
Speaker 1: The book doesn't well. I found the argument persuasive, both
26:56
Speaker 1: because chaplains are able to fill in in these different
27:00
Speaker 1: TSK spaces, given the need that you illustrated well, with
27:03
Speaker 1: changing demographics relative to different kinds of religiosity and spirituality,
27:08
Speaker 1: it seems like a good fit. And the point you
27:10
Speaker 1: made earlier about chaplains also being available to practitioners in
27:14
Speaker 1: the hospital, right, I mean it's I mean, it just
27:17
Speaker 1: seems like it's a it's a slam dunk case in
27:20
Speaker 1: them anyway. And this goes to I think the end
27:24
Speaker 1: of the title of the book, Healing of the Whole Person.
27:26
Speaker 1: If we think about holistic care, right, this response to
27:30
Speaker 1: existential challenges and angst is a good fit. So I
27:34
Speaker 1: want to turn a bit to bioethics and doing bioethics
27:37
Speaker 1: and You've written a ton in this space and done
27:39
Speaker 1: a lot of work, and so I was wondering, Actually,
27:41
Speaker 1: it picks up on your point about qualitative research about
27:45
Speaker 1: the power of narrative and bioethics. So lots of bioethicists
27:48
Speaker 1: or fans of narratives, some aren't, and I guess is
27:51
Speaker 1: a bit personal. One of the challenges I occasionally run
27:54
Speaker 1: into in chatting with future physicians in ethics sessions and
27:58
Speaker 1: classes is there's more It sounds like that they're more
28:01
Speaker 1: interested in the quantitative pieces and some of the narrative
28:04
Speaker 1: work is less persuasive. So I mean, I really think
28:08
Speaker 1: of this book as a masterclass and how beneficial and
28:11
Speaker 1: important narratives are. To that end, if you want to
28:14
Speaker 1: comment on that and help me persuade some medical states
28:18
Speaker 1: of the importance of narrative great or is there a
28:20
Speaker 1: story or two, maybe one you haven't mentioned yet, which
28:23
Speaker 1: you really found to be powerful when you're writing the book.
28:27
Speaker 3: Yeah, so let me answer each of those are great questions.
28:30
Speaker 3: So let me just say about the role of narrative.
28:32
Speaker 3: I think that overall in healthcare it's important to have
28:36
Speaker 3: both quantitative and qualitative approaches. So I think that each
28:41
Speaker 3: play important roles, so you can imagine, you know, heart disease,
28:45
Speaker 3: experience with the drug or whatever. You know. Knowing the
28:49
Speaker 3: statistics is important. The problem is that for a lot
28:52
Speaker 3: of areas it's very difficult to quantify what the phenomenon
28:59
Speaker 3: are for various reasons. So if you look at you know,
29:03
Speaker 3: patient's grief or whatever it is, or loss of meaning,
29:08
Speaker 3: or people's regret about their surgery they've had, or regret
29:12
Speaker 3: about medical decisions they've made, those are it's harder to
29:15
Speaker 3: quantify certain subjective phenomena, is one, and I think narrative though,
29:21
Speaker 3: can explain things that the numbers can't and therefore plays
29:26
Speaker 3: an important role. So in this case, the quantitative data
29:30
Speaker 3: on chaplains says things like, well, eighty percent of the
29:34
Speaker 3: time the chaplain prays with the patient, or forty percent
29:37
Speaker 3: of the time or whatever. Percent of the time, thirty
29:39
Speaker 3: percent of the time they deal with advanced decisions you
29:42
Speaker 3: know about goals of care discussion. But that doesn't tell
29:46
Speaker 3: you the first of all, the advantage of qualitative data
29:49
Speaker 3: is it often discovers phenomenon that the quantitative data didn't
29:55
Speaker 3: pick up because the quantitative data didn't ask about it.
29:57
Speaker 3: Is one. So a little examples. So I earlier did
30:01
Speaker 3: a book called Am I My Genes? Confronting Fate and
30:05
Speaker 3: Family Secrets in the age erogenetic testing, And there wasn't
30:09
Speaker 3: much work at that time on disclosure of genetic conditions,
30:13
Speaker 3: and various issues came up. So I interviewed people at
30:16
Speaker 3: risk of Huntington's disease, and I said, well, let me
30:19
Speaker 3: tell you what to People would be concerned, Well, there's
30:21
Speaker 3: privacy decisions, but a number of patients told me, well,
30:24
Speaker 3: I don't care about that. The big issue I face
30:27
Speaker 3: as a person with Huntington's is should I have children?
30:30
Speaker 3: Should I not have children? Should I get married? Should
30:33
Speaker 3: I not get married, because then that way avoid having tools.
30:36
Speaker 3: Should I screen my embryos to prevent the Huntington's mutation
30:40
Speaker 3: from passing on to my children if I have them?
30:42
Speaker 3: And if I decide to abort my fetuses or discard
30:47
Speaker 3: embryos because they have my mutation? What am I saying
30:50
Speaker 3: about the value of my own life? So these are
30:52
Speaker 3: profound questions that no one had asked about. No one
30:54
Speaker 3: had asked you know, what do you think of? What
30:56
Speaker 3: are your reproductive decisions like or how what are you
30:59
Speaker 3: struggling with that or what is that like? But if
31:01
Speaker 3: you talk to people, you find things out that ended
31:03
Speaker 3: up being important. Similarly, I did a book years ago
31:07
Speaker 3: called Being Positive The Lives of Men and Women with HIV.
31:10
Speaker 3: That was one of the first books to or scholarly
31:13
Speaker 3: works to also look at research look at women with HIV.
31:16
Speaker 3: This is I started this in the early nineteen nineties,
31:19
Speaker 3: and when I asked people what were the biggest decisions
31:22
Speaker 3: or difficulties they faced with HIV being HIV positive, A
31:26
Speaker 3: lot of them said, well, telling people, do I tell
31:28
Speaker 3: my wife? Or I told I told my wife, but
31:31
Speaker 3: I haven't told other chicks I sleep with, Or well
31:34
Speaker 3: I told I tell people, quote I tested negative, but
31:37
Speaker 3: that was two years ago, and don't tell them I
31:39
Speaker 3: tested positive three months ago. And so no one had
31:43
Speaker 3: looked at issues of disclosure of you know, do I
31:45
Speaker 3: tell my family? Do I tell my coworkers? And these
31:48
Speaker 3: are the issues he were struggling with. And then I
31:50
Speaker 3: sort of got NIH funding and did a whole study
31:53
Speaker 3: on that. So the qualitytive research found phenomenon that people
31:58
Speaker 3: were experienced that no one was dealing with. And of
32:00
Speaker 3: course then people need help. But should I disclose what
32:03
Speaker 3: do I do? What do I do in terms of
32:05
Speaker 3: safer sex? If I do or don't disclose the words,
32:07
Speaker 3: it helps identify what problems are that are out there.
32:10
Speaker 3: So I think that that's an advantage of qualitative research
32:13
Speaker 3: in ethics and other areas. Is it's as opposed as saying,
32:17
Speaker 3: let me think in my head what the issues are
32:18
Speaker 3: going to be, And this is will including a questionnaire.
32:21
Speaker 3: Being outside the situation, I might not know what the
32:23
Speaker 3: real issues are the major issues are that people are
32:25
Speaker 3: facing the situation. It can also show the quantity, the extent,
32:31
Speaker 3: the range of issues. As I mentioned, so various examples
32:36
Speaker 3: of even what to say how to train people. So,
32:38
Speaker 3: for instance, one chapter in the book and these are
32:41
Speaker 3: getting your second questions of some examples of the stories,
32:44
Speaker 3: said that he was visiting a grizzly old guy who
32:47
Speaker 3: was dying, who is still alive, and said, you know,
32:49
Speaker 3: what's the purpose of my life? I've been a mean
32:51
Speaker 3: son of a bit. I haven't talked to my kids
32:52
Speaker 3: in years. You know, I regret it. I feel terrible
32:55
Speaker 3: about it. You know why am I even still here?
32:58
Speaker 3: What's the point am I staying alone?
33:00
Speaker 2: Live?
33:00
Speaker 3: At this point? And so the chaplain who was standing there,
33:03
Speaker 3: picked up a piece of bread from the patient's plastic
33:06
Speaker 3: meal tray and said, let's talk about bread. For instance,
33:09
Speaker 3: it's been bread amazing, think about it comes from the earth,
33:12
Speaker 3: it's a natural product. It gives us nutrition. Jesus said,
33:16
Speaker 3: He's the bread of life. Maybe the purpose of life
33:19
Speaker 3: is not to accomplish great things, but to just focus
33:22
Speaker 3: on the present and to enjoy the things we have
33:24
Speaker 3: and appreciate the things we have, etcetera, etcetera. And the
33:28
Speaker 3: patient kind of brightened and respond to that, and then
33:31
Speaker 3: it changed his attitude and his outlook. So I think
33:34
Speaker 3: there are things that that, for instance of that story
33:37
Speaker 3: conveys about not just helping a patient, but what it means.
33:40
Speaker 3: And so from that you could see how you know
33:43
Speaker 3: what the specific lesson is and how to sort of
33:46
Speaker 3: apply it and make it sort of real in the
33:48
Speaker 3: moment with a patient. Another example, there was a young
33:52
Speaker 3: boy who was dying of a terrible disease and his
33:55
Speaker 3: mother had gone all over the country of different hospitals
33:58
Speaker 3: trying to get treatment and nothing worked, and he was dying.
34:01
Speaker 3: And when the chaplain came and wanted to talk to
34:03
Speaker 3: the mother, she would put literally put her fingers in
34:07
Speaker 3: her ears and go la la la lah lah, I
34:08
Speaker 3: can't hear you. And the chaplain finally was able to
34:11
Speaker 3: talk to the mother and said, you know, I think
34:14
Speaker 3: it's important you talk to your son about what's going on.
34:16
Speaker 3: And said, no, I don't want to talk to him,
34:18
Speaker 3: you know, I don't want him to think anything's wrong, etcetera, etcetera.
34:21
Speaker 3: So finally the chaplain encouraged the mother, and after a
34:24
Speaker 3: while the mother was able to say to the sun,
34:26
Speaker 3: you know, honey, I think the medication isn't working. And
34:30
Speaker 3: he immediately said, oh, yes, mommy, I know I'm going
34:32
Speaker 3: to die. But at my funeral, I don't want people
34:35
Speaker 3: to bring flowers. I want them to bring stuffed animals.
34:37
Speaker 3: And afterwards, I want you to take the stuffed animals
34:39
Speaker 3: and bring them to the ward and give them to
34:41
Speaker 3: all the other kids here, to Sally and Jane and Tommy.
34:44
Speaker 3: And he had an all things figured out in his mind,
34:47
Speaker 3: but he knew that she couldn't hear it, the mother
34:50
Speaker 3: couldn't hear it, and so he had not said anything,
34:53
Speaker 3: and the mother was taken aback, and when he died,
34:56
Speaker 3: she brought had stuffed animals at the funeral, not flowers,
35:01
Speaker 3: and brought them to the ward, et cetera. The other
35:03
Speaker 3: thing he said at one point after that was he said, Mommy,
35:06
Speaker 3: I see angels in the room. And she was terrified,
35:09
Speaker 3: like what do I do? Like she was freaking out
35:11
Speaker 3: me And but the Chaplins are let's talk about it.
35:14
Speaker 3: And the kids said, yeah, but mommy, they're good angels.
35:18
Speaker 3: They're here to help me. So I think Chaplains are
35:20
Speaker 3: a people of religious thoughts. As I said when I
35:22
Speaker 3: when my sister died at nine to eleven, I found
35:24
Speaker 3: myself wondering why me? So we often think why me?
35:27
Speaker 3: I think this is an unconscious, impulsive kind of reaction
35:32
Speaker 3: when bad things happened to us. So people are feeling
35:35
Speaker 3: these things, and religious thoughts come up. Spiritual thoughts questions
35:38
Speaker 3: about the universe, where we fit in the universe, where
35:41
Speaker 3: we fit in the cosmos, What's the purpose of life?
35:44
Speaker 3: What's the meaning of life? These are age old questions
35:46
Speaker 3: that people wrestle with, and I think that to quantify
35:50
Speaker 3: this is hard. Whereas I think, particularly for educating doctors
35:54
Speaker 3: and providers nurses, Chaplains to hear the stories as a
35:57
Speaker 3: way of realize the important into these issues and connecting
36:01
Speaker 3: and finding way into this set of issues. So I
36:04
Speaker 3: think narrative is very important. It's not the only way
36:08
Speaker 3: to go. I think we also do the quantitative. But
36:10
Speaker 3: I think it's I think they're yin yang. I mean,
36:12
Speaker 3: I think they're part of the equation and certainly for research,
36:17
Speaker 3: but also for teaching and for practice, it's important. And
36:20
Speaker 3: I should say I think it's also because we evolved
36:23
Speaker 3: telling stories before we had written language, before we've written numbers.
36:27
Speaker 3: We had thousands of years that tens of hundreds of
36:30
Speaker 3: thousands of years of telling stories, and so we evolved
36:33
Speaker 3: with telling stories. We didn't evolved with statistics and numbers.
36:36
Speaker 1: Yeah, I mean this is I think it's a powerful argument.
36:39
Speaker 1: It's it's preaching a choir because I'm I'm on board
36:43
Speaker 1: and think you know about human beings in many ways
36:45
Speaker 1: as storytelling animals. To borrow the famous philosophical phrase, but yeah,
36:49
Speaker 1: this is a bit I mean, really helpful and frame
36:51
Speaker 1: it in terms of quantitative and qualitative research. Yeah, that's
36:56
Speaker 1: that's excellent. I'll get you out one last question, the
37:00
Speaker 1: obligatory AI question, And I think it's a good fit
37:02
Speaker 1: in some ways in stark contrast to the sort of
37:05
Speaker 1: rich narrative that you were just weaving. Or are there
37:08
Speaker 1: tasks that chaplains do which you believe in the future
37:12
Speaker 1: may be replaced by some artificial intelligence system or chatbot
37:18
Speaker 1: or could they? I've seen I mean, I'm not a psychiatrist,
37:21
Speaker 1: I'm not a clinician, but I've seen moves for artificial
37:25
Speaker 1: intelligence being incorporated into into psychiatry being suggested to be
37:29
Speaker 1: incorporated into psychiatry in different ways, sometimes due to a
37:31
Speaker 1: lack of insufficient workforce, and all these kinds of things.
37:35
Speaker 1: Could AI help us with these existential quandaries.
37:39
Speaker 3: The great question? So within the wide range of topics
37:43
Speaker 3: at chaplain's address, from very religious ones to spiritual existential ones,
37:49
Speaker 3: are just more psychological ones. Let's talk about politics, you know,
37:53
Speaker 3: the case of the woman who believe in the CNN.
37:55
Speaker 3: I think there are for some patients when there are
37:58
Speaker 3: not enough chaplains around that sophisticated I'll say chat bots
38:02
Speaker 3: who would potentially help some patients, particularly if they're lonely,
38:05
Speaker 3: have known to talk to, so that's a possibility, and
38:09
Speaker 3: particularly also if there is no staff around. The caveats
38:12
Speaker 3: on that are and sore, and for Alzheimer's there are
38:16
Speaker 3: and for young children there are various I'll call them chatbots,
38:19
Speaker 3: you know, whatever the AI that talks to you know,
38:21
Speaker 3: how you doing today, Sally? And you know for patients
38:24
Speaker 3: with Alzheimer's, they could remind people to take pills. Have you, Jane,
38:27
Speaker 3: have you taken your pill today? You know, let's have
38:29
Speaker 3: a conversation. What do you want to talk about? I mean,
38:31
Speaker 3: it could keep people. And we know that with Alzheimer's
38:34
Speaker 3: and early Alzheimer's that stimulation is important and social interaction
38:38
Speaker 3: is important. Unfortunately, even though we know that there's a
38:40
Speaker 3: lot of people with early Alzheimer's who live by themselves
38:43
Speaker 3: or by themselves, have no social interaction, can't get out
38:46
Speaker 3: of the house or whatever where people ignore them or
38:49
Speaker 3: they're nursing home. So is it as good as human interaction?
38:52
Speaker 3: Absolutely not. Is it better than nothing in some situations? Yet?
38:56
Speaker 3: And again what the it is? So I think we're
38:58
Speaker 3: talking about profound, ultimate questions about the meaning of life.
39:02
Speaker 3: A chat box, I think is not going to be
39:05
Speaker 3: really able to do that well, and arguably perhaps shouldn't.
39:08
Speaker 3: I think you need a certain authenticity. But for other
39:12
Speaker 3: kinds of conversations early Alzheimer's Let's talk about something. What's
39:17
Speaker 3: your favorite book? What do you like about? Let's talk
39:19
Speaker 3: about a movie. What's your favorite movie? What can I
39:21
Speaker 3: tell you about the movie? Did you know that the
39:23
Speaker 3: star of that movie? Whatever? You know has three kids
39:28
Speaker 3: and lives in wherever, or also do this, or also
39:31
Speaker 3: has a singing career or something. So it's a way
39:33
Speaker 3: of engaging someone. I think though whenever I actually last time,
39:37
Speaker 3: I was having a change of plane reservation and the
39:41
Speaker 3: website didn't work, so I couldn't do on the website,
39:44
Speaker 3: and so I called the airline company and they said,
39:47
Speaker 3: you know, of course you get an automatic message you'd
39:49
Speaker 3: like to talk to a chatbot. So whenever I've talked
39:51
Speaker 3: to talk to a chatbot on whether talk making reservation
39:55
Speaker 3: or something, it's invariably anything more complicated than the most
40:00
Speaker 3: basic stuff you need to talk to someone. But the
40:02
Speaker 3: basic stuff. You know, what time does the flight leave
40:05
Speaker 3: for Miami? You know that'll tell you the eleven o'clock
40:08
Speaker 3: fight from McGarty, What time does it get to Miami?
40:10
Speaker 2: Dat?
40:10
Speaker 3: It could type if you said I want to change
40:12
Speaker 3: a ticket, but whatever it is, forget it. So I
40:15
Speaker 3: think that suggests that AI can help with basic stuff,
40:20
Speaker 3: but more complicated stuff is just not there yet.
40:23
Speaker 1: The existential weight of some of these conversations, I mean
40:26
Speaker 1: new frames it in terms of authenticity, which sounds exactly right.
40:29
Speaker 1: I mean there's the soon to be certain human features
40:32
Speaker 1: which might push it and remains to be seen. Remains
40:36
Speaker 1: to be seen, but that I'll let you go on
40:39
Speaker 1: that one. Thank you so much. It has been a
40:40
Speaker 1: really interesting conversation about a phenomenal book. Everyone. Thanks for
40:44
Speaker 1: tuning into the Health Ethics Podcast. I'm Brian Pilkington and
40:47
Speaker 1: I'm speaking with doctor Robert Klitzman, who is the author
40:51
Speaker 1: of Doctor Will You Pray For Me? Medicine, Chaplains and
40:54
Speaker 1: Healing of the Whole Person. Thanks so much, Bob, I
40:56
Speaker 1: appreciate it.
40:57
Speaker 3: Thank you.
40:59
Speaker 1: This podcast here is a production of the Health Ethics Lab,
41:02
Speaker 1: and I am grateful to colleagues in the Department of
41:04
Speaker 1: Medical Sciences, the IHS Library, and the Hackensack Bridy in
41:07
Speaker 1: the School of Medicine for making this collaboration possible. To
41:11
Speaker 1: learn more about our work or to engage with the
41:13
Speaker 1: series content, reach out to me Brian Pilkington at Brian
41:17
Speaker 1: dot Pilkington at hmh N dot org.