Outcomes for study
A patient or family member:

​1 - Expresses confusion or dismay at the medical options
2 - Openly discusses an Ethics dilemma 
3 - Participates with family member(s) in an ethics consultation
4 - Communicates having clearly made a medical ethics decision
5 - Demonstrates resignation to the limitations of health care

17 - Ethics Confusion - When deciding what direction to pursue in treatment of a given patient becomes so complex that there is no relatively obvious best option, then medical ethics principles and their application call for the team inclusion of a spiritual clinician to assist the feelings and issues involved. Not claiming to be a professional ethicist if one is not, such a clinician relates primarily to the patient and family, and is also keenly aware of what the treatment team is thinking, what it has done, how it is collaborating, and what directions it eventually pursues. Sometimes the spiritual clinician facilitates the collaboration, advocates for decision making and promotes clear communication. It can be a spiritual clinician who first recognizes patient/family emotions and concerns and initiates a family conference or a facility ethics committee meeting to apply the principles.

        During the early 2000s the medical specialty of palliative medicine has been instrumental in including spiritual perspectives in patient care. As they sought to assuage physical pain, they realized that it is almost

always accompanied by inner suffering of decisional churning, interpersonal conflict, profound fears and religious binds. All of those constitute suffering of the human  spirit. Not accustomed to explore the nature and roots of the difficulties of the soul, palliative care practitioners are increasingly seeking to include experienced and specifically oriented hospital chaplains in their medical ethics deliberations. Many established chaplains are not well versed in ethics deliberating on the edges medical care's limitations. Some can be overwhelmed by the complexity of the sometimes tortuous decisions being considered and the depth of the feelings involved in all of the parties.  To become and remain spiritual clinicians they may need to expand their understanding of and facility with processing cases using the commonly agreed upon ethics principles such as autonomy, beneficence, justice, and maleficence. Already familiar with these as demonstrated in their certification processes, they face the daunting process of integration for regularly working with interdisciplinary teams on ethics cases .