I am not a pastoral counselor but a pastoral theologian turned medical ethicist. I agreed to write on ethical issues in pastoral counseling because I consider my clinical ethics experience pertinent. Common to medicine and pastoral counseling is the ethical responsibility to treat on the basis of knowledge. It is neither accidental nor deplorable that pastoral counseling is the most medicalized form of ministry.

Pastoral counseling, also called "pastoral psychotherapy;" grows out of an approach to pastoral care that U.S. Protestantism developed in the first quarter of the twentieth century. This approach taught pastors to listen to the people they counseled, rather than just delivering a message from the faith's teachings. Today, many pastoral counselors devote themselves to the private practice of pastoral psychotherapy, marriage and family counseling, or some combination.

In my judgment, professional ethics is as much about uncontroversial commitments embedded and expressed in minute particulars of care as it is about dilemmas. Further, pastoral counseling itself does not just have ethical commitments and issues; it is a profound ethical commitment "to provide and promote theologically informed, spiritually sensitive ...counseling and consultation" (mission statement of the American Association of Pastoral Counselors [AAPC]). This article will review four ethical issues in pastoral counseling: identity; the counselor's responsibility to two traditions-faith and counseling; embedded versus explicit ethics; and the counselor's own stake. My clinical example-always signaled by italics-is a reoccurring problem from my work as a hospital chaplain: Parents' request that a chaplain baptize their dead newborn.

Identity
The identity of pastoral counseling as a profession is an ethical issue, not just an organizational or psychological one, because pastoral counseling must accurately represent the good it seeks to do and its qualifications to do it: How does pastoral counseling differ from the service of appointed leaders of local religious bodies and from secular psychotherapy (and psychiatry)?

Superficially, pastoral counseling may not differ from secular psychotherapy: there is a code of ethics addressing problems like those of psychologists and physicians, and theories, methods, and languages of treatment. In certain ways, it is clearly not like ministry. Local religious leaders and people seeking their counsel may meet at any time, in many locations, at either's initiative, without charge. Pastoral counselor and client typically meet by appointment. in the counselor's office, after referral, at the client's initiative, for a fee.

Pastoral counseling distinguishes itself from secular psychotherapy, by defining itself as ministry and intentionally serving in the context of ultimates. The potentially greater depth, intensity, and duration of pastoral counseling distinguish it from pastoral care in the local religious body.

Seward Hiltner said that three perspectives are always present in ministry: communicating the word (he included administering sacraments), organizing the fellowship, and shepherding persons. Only one perspective is focal at a time. When a minister is counseling, communicating the word and organizing the fellowship are present, but they are in the background.

How does the counselor's attention to one person also communicate the faith's understanding of ultimates? Like the chaplain's caring for family, the counselor's attention. to individual clients expresses God's concern for them. Baptizing, chaplains communicate something about the newborn's place in the community of faith. Not baptizing, they communicate something about relative values proper administration of the sacraments versus inclusion of the dead child.

How does counseling organize the faith's fellowship? Understanding that patients and clients have needs that require special education, churches recognize chaplaincy and counseling as ministry and protect the local religious leaders time and energy for a range of services. Not baptizing, the chaplain adheres to church order. However, does not baptizing best meet the family's needs? Baptizing chaplains place themselves in a ,small way against the church order that authorizes their ministry.

The Two Traditions
Although St. Paul condemned those who would preach "another gospel," pastoral counselors are necessarily responsible to two traditions-faith and counseling. Further, many pastoral counselors view their tradition of counseling as gospel (good news), because they find in "secular" resources what they could not find in their faith until they went outside.

Chaplains honor both traditions by offering a ceremony to name and bless the baby, without offering baptism. Some parents accept this offer, but some still require baptism, forcing the chaplain to choose between the theological and the pastoral traditions.

The two traditions are also evident in the pastoral counselor's guiding values. In terms of ultimates (faith), the counselor is guided by all the values, personal and organizational, that accompany official appointment by a religious body. In terms of daily life (counseling), the counselor is guided by personal values and basic ethical responsibilities of a helping profession: be as good as possible at the work, do not treat beyond your capabilities, seek to do good, avoid or reduce harm, keep confidences, do not take advantage of the client for personal benefit, and so on.

Embedded Versus Explicit Ethics
Professions formulate their ethical commitments in standards, which grow out of, and become embedded in, practice as custom. Custom is one meaning of ethics in the Greek. Ethics as a discipline reviews ethics as standards, looking at codes for over- and under-statements of responsibility, correcting erroneous standards and language, and restating standards that have been altered or misconstrued in implementation. As a discipline, ethics reviews ethics as custom in concrete practice, asking whether established solutions apply in a specific situation or a novel solution is needed. If a novel solution is needed, ethics can help formulate it. Primarily. ethics tests the solution.

Established ethical solutions in pastoral counseling include listening carefully to clients; learning what needs clients are addressing and how they are addressing them; suspending judgment about a client's theological rationales, rationalizations, and expectations: being attentive to the ways one's own concerns may distort one's understanding of the client; and so on. Valuewords, explicit or implied, expose the underlying ethics in these solutions: "better," "good," "superior," "less effective," "responsible." I leave it to pastoral counselors to further explicate embedded commitments, as does the AAPC Code of Ethics, available at http://www.aapc.org/ethics.htm (one of the best codes I have seen).

The purpose of reviewing custom is to revise it where necessary. Standards can be so embedded in practice that they are almost imperceptible, making review difficult. Flag-waving standards (say, being the client's advocate) may be difficult to review, because professional taboos shield them.

For reviewing or revising custom, theological grounding is a conceptual and practical asset. To be reviewed, embedded commitments need to be brought from background to foreground. Further, paraphrasing Reinhold Niebuhr,even as part of the solution, we and our solutions are part of the problem. A theological perspective opens our eyes to harms in our commitments, to overestimating our goodness, and to the "temptation to do good," to overcompensate and do more than reality requires. Mitchell Messer, a Chicago expert in anger management, uses the phrase "good intentions." A good intention is that which does not need to be done. It is always self-serving, counterproductive, and self-destructive. The alternative to good intentions is "real intentions," doing what reality requires.

In some theologies, a chaplain who baptizes a dead baby, yields to this temptation, misrepresenting a truth-baptism is for the living. In other theologies (personal, not formalized), baptizing this infant does what reality requires, expressing the truth that the instruments of faith are for people, in this case, for the grieving. The request to baptize dead babies leads back to ultimates and church order, identifying a need not necessarily for the chaplain to hold the line against the parents but for churches to rethink the meaning of baptism in light of the contexts where it is administered.

Thus far, ethics is about standards and a discipline. Now it becomes a hermeneutic: The parents insist out of responsibility (the operative ethics word) toward their lost child. A refusal to baptize may confuse them, because they base their request on church teaching. Complicating the problem is the fact that no chaplain's theological education provides grounding in every variant of every theological tradition that informs parents.

The Counselor's Own Stake
In a classic version of the joke, "For every problem there is a solution that is neat, simple, and wrong," medical ethics typically focuses exclusively on the patient's well being. But patients are not the only stakeholders. Families are stakeholders. Clinicians are stakeholders. Ethics acknowledges the valid place of each. What is at stake for chaplains is their relationship with their church and themselves. Parents' insistence on baptism forces the chaplain to choose between self-regard and rebellion (or courage).

The four current ethics issues in pastoral counseling discussed here open into other specific issues, because pastoral counseling is an ethical commitment to help people through theologically grounded, spiritually sensitive, competent counseling. As medicine and psychology begin to examine spirituality in health and health care, the theological and spiritual commitments of pastoral counseling equip it to contribute in a new way-through ongoing dialogue with other disciplines about human flourishing.