Skip to main content
Markkula Center for Applied Ethics

Appropriate Level of Expertise? (Spiritual Care/Medical Care)

artistic outline of a human brain

artistic outline of a human brain

Case Description: Appropriate level of expertise? (Spiritual care/medical care)

You are the pastor of a Christian church in an economically depressed area hurt by declines in the manufacturing sector. Fifty-five-year-old John, his wife, and two teenage children are active members of the church. In his bi-weekly spiritual directing sessions with you, John has expressed increasing anxiety over the recent buy-out of the factory where he works as a technician by a larger out-of-town corporation. John is the primary income-earner in his family. Although the corporate buyer promised “no personnel changes” for six months pending its structural review, John fears downsizing and layoffs after that. He fears his age and relative seniority on the pay-scale “put a target on my back.” He worries that he would face age discrimination if he had to look for a new job. 

In his session two weeks ago, John said he felt such a sense of doom that it was hard to get up and go to work. A stalwart fan of his kids’ sports teams, he had missed one soccer game because he just felt too weary to go after work. You worried that he might be getting clinically depressed and suggested that he talk to his doctor about his worry and fatigue. He declined, saying he just needs to “carry the crosses put on my shoulders” for the sake of his family. He asked you to pray with him for strength, which you did. 

This session, John says he has something he has to get off his chest. After overhearing a coffee-room conversation of other workers predicting layoffs, John stopped at a bar and had a whiskey after work before running an errand for his wife. You know that John is a former alcoholic who had not previously had a drink in 20 years. He says he just “needed something to get me through the day” and that he won’t drink again. You again recommend that he talk to his doctor; he again refuses. You recommend the church’s Alcoholic Anonymous chapter, but he claims it would be “too risky” to go. He asks you just to continue spiritual directing with him and praying for him. “You are my lifeline,” he says. 

While your pastoral experience leads you to suspect John is depressed and at great risk for full alcoholic relapse, you do not feel qualified to diagnose or address clinical depression, nor to function as a substance abuse counselor. What should you do?

Discussion of Case: Appropriate level of expertise? (Spiritual care/medical care)

Identify ethical tensions:

  • You may feel tension between your role as a spiritual counselor and as a lay mental health resource. What are the appropriate limits of such a lay mental health-supportive role, and of your training? What if your spiritual mentee sees that differently?

  • Autonomy versus beneficence: you may feel torn between respecting John’s desire to keep what he telling you within the confines of spiritual counseling, or risking your pastoral relationship to insist more strongly that he seek additional professional services from which you think he could benefit.

Identify options:
  • Respect John’s wishes. Continue to offer him spiritual counseling and to pray with and for him. Consider asking him to promise to tell you if he has another drink.
  • Encourage John to tell his primary care doctor about his work troubles, “blueness,” and his taking a drink.
  • Talk to John about your view of how God can work through addiction-services and mental health professionals. Offer to refer him to professionals you respect working in those areas, or to help him research referrals. Emphasize you will continue to be his spiritual counselor if he seeks other services.

  • Ask John if you can speak with an addiction and mental health counselor about his situation, without using his name or other identifying details, to see if you can learn any additional ways you could support him.

  • Offer to bring another potentially helpful party to one of your spiritual counseling sessions privately, for example your church Alcoholics Anonymous chapter facilitator.

  • Other?

Practice preventive ethics/systems issues---potential responses:
  • Preach and speak publicly about the socioeconomic, mental health, and addiction challenges in your community, eroding stigma.
  • Participate in mental health training offered to clergy-people through your faith tradition. Encourage such training organizationally.
  • Encourage church or inter-faith clergy organizations in your community to maintain resource lists of local addiction and mental health services, for the benefit of clergy supporting members of their communities facing mental health or addiction challenges.
May 20, 2020