What Are the Ethical Issues in Missionary Member Care?
Short & Simple Summary
Ethical codes have been around for thousands of years, but applying them to issues raised by new technologies is not simple. The fact that professionals from many different disciplines provide missionary member care and the fact that the missionary member care providers often live in a different country than the missionaries receiving the care make the ethical issues even more complex. There is no way anyone can give a meaningful short and simple summary. Here are the topics covered in this chapter.
Ancient Codes
Recent History of Missionary Member Care Ethics
Professional Association Ethics
Ethical Issues Raised by New Technologies
If you want more detail and links to other sources, read on.
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When dealing with questions of morality, right and wrong, people usually consult some code of ethics. These may be codes that originated in antiquity or codes that originated in the 21st century.
Ancient Codes
Although all member care people would look at both, Pastoral Care people may be more likely to look to the Scriptures while mental health people may be more likely to look to the Hippocratic Oath.
The Israelites had the books of the law in Old Testament times. The Ten Commandments as stated in Exodus 20 and Deuteronomy 5 and written in the 2nd Century B.C. are excellent summaries of what was considered right and what was considered wrong centuries ago. The first four of these commandments referred to relationships with God and the last six were relevant to relationships with other people.
In the New Testament, when Jesus was asked which commandment was the greatest (Matthew 22:35-40), he replied by quoting Deuteronomy 6:5 which summarized the first four commandments—one’s relationship to God. Then he added Leviticus 19:18 which summarized the last four commandments—one’s relationships to others. Christians today call these the Great Commandments. These Old and New Testament commandments still provide the basis of Judeo-Christian ethics.
Preaching on the plain in Luke 6, Jesus quoted that second great commandment after presenting a series of blessings and woes, he said, “Do to others as you would have them do to you” (v. 31). This is often called the Golden Rule. Paul quotes it as well in Galatians 5:14. This Golden Rule is found in many cultures and religions and is a good guide to relating to others.
When it came to ethics related to helping others, especially in the medical field, the ancient Greeks looked to the Hippocratic Oath from the 5th Century B.C. The classical version of this oath includes five points. After noting that he was making his covenant before all the gods and goddesses and promising that he would provide free medical instruction for his own children and for his teachers’ children, Hippocrates said he would do the following.
· Benefit the sick and do no harm.
· Not assist in, or even suggest, suicide or abortion.
· Not use the knife (surgery), but leave that to men who did so
· Do no intentional mischief, no sexual relations with patients
· Hold what he saw or heard in confidence.
He ended by hoping to enjoy life and be honored if he kept the oath, and he would accept the opposite if he transgressed it.
http://www.pbs.org/wgbh/nova/body/hippocratic-oath-today.html .
Few, if any, doctors today are asked to take this oath. Today (postmodern world) most medical schools write their own versions of the “Hippocratic Oath.” Thus, there are many such oaths today. The classical one would be acceptable to most missionaries today if they substituted “God” for “all the gods and goddesses,” but that would probably not be acceptable to most medical school graduates.
Recent History of Missionary Member Care Ethics
New books about member care in general, and codes of ethics in particular, for those serving in member care have appeared at about the turn of each decade.
Around 1990. The first major member care book was published shortly before 1990. Helping Missionaries Grow: Readings in Mental Health and Missions (1988) edited by Kelly and Michele O’Donnell and published by William Carey Library has one chapter about ethics. Chapter 44, “Some Suggested Ethical Guidelines for the Delivery of Mental Health Services in Mission Settings.” This chapter discusses the following ethical issues.
· Responsibility
· Professional Competence
· Personal Values and Legal Standards
· Confidentiality
· Client Welfare
· Relationships with Other Professionals
· Psychological Assessment
This book is available free at https://sites.google.com/site/membercaravan/test/helping-ms-grow-book.
The second major member care book appeared shortly after 1990. Missionary Care: Counting the Cost for World Evangelization (1992) edited by Kelly O’Donnell and published by William Carey Library also has one chapter about ethics. Chapter 19, “Ethical Concerns in Providing Member Care Services.” This chapter presents a case study which discusses the following ethical issues
· Organizational Responsibility
· Confidentiality
· Counselor/Consultant Competence
· Use of Testing
· Personal Values and Legal Standards
This book is available at https://sites.google.com/site/membercaravan/test/mc-counting-the-cost-book-.
Around 2000. Ethics in missionary member care became a major topic at the turn of the century. Two overall codes of ethics appeared in different countries on different continents. Two more major books also appeared about the same time.
The Code of best practice in Member Care developed by the Evangelical Fellowship of Canada was published in 2001. This code, arranged in six sections around different aspects of life, is good for people in other countries as well. It is at http://www.worldevangelicals.org/resources/view.htm?id=59 Member Care Guidelines also appeared about this time in the UK. These guidelines for good practice in member care are developed around 11 core values and are available from Global Connections at http://www.globalconnections.co.uk/resources/codesandstandards/membercareguidelines. Missionary member care workers are urged to read these codes, both available free of charge. They will at least make the workers aware of ethical issues they face.
Doing Member Care Well: Perspectives and Practices from Around the World (2002) edited by Kelly O’Donnell and published by William Carey Library has one chapter on Ethics. Chapter 26, “Best Practice Guidelines,” presents summaries of both the Canadian and UK guidelines above. These guidelines are much broader than the ones given a decade earlier which were primarily for mental health professionals counseling someone.
Enhancing Missionary Vitality: Mental Health Professions Serving Global Mission (2002) edited by John R. Powell and Joyce M. Bowers published by Mission Training International contains a section titled “Ethics and Professional Standards” containing four chapters.
· Chapter 51. Ethical principles for mental health work with missionaries
· Chapter 52.Excerpts from professional codes of ethics
· Chapter 53. The use and misuse of psychological assessment in missionary candidate evaluations
· Chapter 54. Professional use of the internet: Legal and ethical issues in a member care environment
Around 2010. A decade later Global Member Care, Volume 1: The Pearls and Perils of Good Practice (2011) by Kelly O’Donnell was published by William Carey Library. This book contains a section titled “Ethics/Human rights in Member Care: Developing Guidelines in Mission/Aid.” This section contains four chapters as follows.
· Chapter 9. Encountering Ethical Member Care
· Chapter 10. Pursuing Trans-Cultural Ethics
· Chapter 11: Extending the Foundations of Good Practice
· Chapter 12: Resources for Good Practice
This book is the most complete resource for ethics a decade into the 21st century. Many of the ideas in this book were part of O’Donnell’s 2009 Integration Symposium at Fuller Theological Seminary and they are available for download free at http://www.fuller.edu/Academics/School-of-Psychology/Integration-Symposium-2009.aspx
Guidelines for Good Practice in Member Care also appeared about this time in New Zealand. These guidelines for good practice in member care are based on the core values of the Global Connections document in the UK and are organized around 10 topics. This document is available at http://www.missions.org.nz/images/guidelines%20mc%2017%20july%202012.pdf .
For those who have access to a library which has interlibrary loan, a list of books, chapters, and articles in printed form is available at
http://www.missionarycare.com/dbListArticles.asp?TOPICID=37 .
Professional Association Ethics
Professionals from various backgrounds are involved in providing member care. Those professionals know their own codes of ethics; however, some readers considering entering member care may be interested in what these codes say. Here is a list of the most common ones.
· American Association of Pastoral Counselors Code of Ethics http://www.aapc.org/about-us/code-of-ethics.aspx
· American Association of Marriage and Family Therapy Code of Ethics http://www.aamft.org/imis15/content/legal_ethics/code_of_ethics.aspx
· American Psychological Association Ethical Principles of Psychologists and Code of Conduct http://www.apa.org/ethics/code/index.aspx
· Christian Association for Psychological Studies Statement of Ethical Guidelines http://caps.net/about-us/statement-of-ethical-guidelines
· National Association of Social Workers Code of Ethics http://www.socialworkers.org/pubs/code/code.asp
· American Psychiatric Association Ethics Resources and Standards http://www.psychiatry.org/practice/ethics/resources-standards
Ethical Issues Raised by New Technologies
By the turn of the century it had become obvious that the digital revolution, especially the Internet and all it makes possible, raised new issues related to missionary member care in the areas of physical and mental health. Few questions were raised about a radiologist interpreting an X-ray or MRI from the other side of the world. But what about a psychiatrist diagnosing depression via email? What about a counselor providing therapy via Skype? Clearly technological advances were far ahead of current ethical codes and existing laws.
Telehealth is most relevant to missionary member care, and it includes such things as telephone, interactive videoconferences (such as Skype), email, texting, instant messaging, bulletin boards, websites, social media (such as Facebook), chat, and anything else that may be invented. Telehhealth is used in the United States to serve people living in remote areas where there is a lack of professionals to meet needs. Of course, it can also be very useful to meet the needs of missionaries around the world.
During the first decade of the 20th century professional associations and legislative bodies wrestled with the ethical and legal implications raised. This is a constantly changing area, so anything written at this time may well be out of date as soon as next month. Any search engine will result in dozens of websites with current information. The Telehealth Resource Center at http://www.telehealthresourcecenter.org/legal-regulatory and the Center for Telehealth and e-health law at
http://ctel.org/ will give you a start.
A good introduction to telehealth in counseling and psychology is in the June 2011 Monitor on Psychology published by the American Psychological Association at
http://www.apa.org/monitor/2011/06/telehealth.aspx. Just as different professional associations have different general ethical codes as noted above, so do they have different positions on telehealth. Likewise, different states and nations have different laws regarding telehealth. Because I taught psychology for 35 years and live in the state of Kentucky, I am including links to those below—readers can find links relevant to them through search engines.
In July 1012 The American Psychological Association posted a draft of “Guidelines for the Practice of Telepsychology” inviting public comment. This link may no longer work when people read this book, but a search for the final draft will be able to be found with a search engine.
http://apacustomout.apa.org/commentcentral/commentcentralPDF/Site26_Telepsychology%20Guidelines%20Draft_July2012_posted.pdf. This APA document gives eight guidelines.
· Competence of the psychologist
· Standards of care in the delivery of telepsychology services
· Informed consent
· Confidentiality of data and information
· Security and transmission of data and information
· Disposal of data on information and technologies
· Testing and assessment
· Interjurisdictional practice
The last guideline refers to the fact that different states (and different countries) have different laws—and the missionary member care provider is responsible to obey the laws of both. This brings us to the issue of state laws about telehealth. Mental health professionals may find that it is illegal for them to provide mental health care for someone in another state—that they may lose their licenses in their own state if they do.
For those who would like to see an example of a state law, this link leads to “Telehealth and telepsychology” in Kentucky http://www.lrc.ky.gov/kar/201/026/310.htm. This document is divided into five sections.
· Definitions
· Client requirements
· Competence, limits on practice, maintenance and retention of records
· Compliance with federal, state, and local laws
· Representation of services and code of conduct
Like other things in missionary member care, the ethical issues are very complex. Because the missionaries receiving the care and the professionals providing the care are often in different countries, the complexity increases greatly because of the interaction of the differences.
Note to the reader: If you have suggestions about other things that would better answer this chapter’s question, please email those to me at ron@missionarycare.com. In that email please tell me three things: (1) what you believe needs to be included, (2) links to relevant websites if available, and (3) how it better answers the question “What are the ethical issues in missionary member care?” I plan to periodically update and expand the book with these suggestions.