|Pastoral Care for the Seriously Ill and Dying|
Presbyterian pastor Smith’s ninety-one-year-old widowed father was living alone in the house he and his wife occupied most of their married life when a stroke sent him to the hospital. The pastor drove hundreds of miles to be with him and meet with his own siblings and their families about care for their father upon his release. The discussions were fraught with anxieties about where their father would get proper care and needed assistance, and maintain as much of his independence as possible. It was clear that, although he was recovering well, he could no longer live alone. Family members were overwhelmed with conflicting feelings about their love for their father, their obligations to him, and resistance to the interruption that his needs imposed on their lives and schedules.
Pastor Smith found himself plunged into experiences and decisions common to a growing number of his own parishioners, but about which they seldom seek his counsel. The very real situations that parishioners face often are seen in a context having very little to do with theology and much to do with medical and social services. Nevertheless, common to every concern for those whose loved ones develop infirmities or who enter the dying process, is how best to arrange for loving provision of care: pastoral care ministry. The decisions that result can be a matter of life and death.
Mrs. Johnson was the middle-aged fifth child of her parents and active in her local Presbyterian church. The families of the five children and the parents all lived in different states. When her parents could no longer care for themselves, she was the only child who did not turn a deaf ear to their needs. She moved them into her house where they lived until each of them died. None of the other children made any more than a perfunctory offer attempt to contact them or offer help. Mrs. Johnson’s pastor once expressed amazement that she and her husband were willing to have their lives so interrupted by her parents. But the church made no offer of help.
Mr. Jones’ wife contracted a debilitating illness in her forties. They had no immediate family living in the area but were active members of their local Presbyterian church, where he served as elder and she as deacon. Church members who had known her for years felt awkward around her as it became known that the illness was progressive and terminal. In her last year, until her final weeks of life, Mr. Jones took his wife to church in a wheel chair. She could no longer speak, but she understood everything that was said to her. They felt deserted by their friends and congregation and were alone in their home when she died.
Increasing need for ministry that attends to the end of life
Our society and our churches are increasingly populated with older adults. Our mobile society means that family members often live at great distances from each other, parents separated from children and children scattered even to distant countries. Adult children are called upon to make decisions, or to participate in making decisions, for a parent by means of long-distance phone calls involving medical personnel they have never met to discuss procedures or treatments they know little about for conditions they have only read about. And there is the gloomy reality of widowed parents living and dying alone in institutional care.
The Christian Gospel is about matters of life and death
The decisions at the end of life which are the most difficult, and often the most contentious, almost always are rooted in theology, in the moral and spiritual beliefs of those engaged in the discussions. Often the moral questions and the religious beliefs are submerged but they can account for the tensions and disagreements between families and doctors and among family members themselves.
What does Christian Faith teach about the decisions at the end of life? How are we equipped morally and spiritually as Christians for the practical realities of a parent, spouse, or child who experiences a chronic debilitating condition that gradually erodes our energies or who is suddenly struck with physical incapacitation that overwhelms us? The Bible’s teachings and the model of Jesus’ life, death and resurrection are meant to help us understand and live faithfully in the midst of our own frailties and the experiences with death that we must face ourselves.
Underlying the decisions we face at the end of life are important prior questions of Christian faith that deal with who we are as human beings, how God regards us and how he desires that we regard e3ach other. Lutheran moral theologian Gilbert Meileander once titled an article “I Want to Burden My Loved Ones.” (First Things, Oct. 1991, pp. 12-14) In the article, he considers what it means to belong to a family. He comments that “morality consists in large part in learning to deal with the unwanted and unexpected interruptions to our plans.” He says he tries to teach that principle to his children: “Perhaps I will teach it best when I am a burden to them in my dying.” This matter of the obligations of mutual caring among family members is also a question at the end of life, and it is much akin to the questions of how the church can better care for those in the family of God. Our treatment of the most vulnerable among us is the best indicator of who we are as followers of Jesus Christ.
Also underlying much of the difficulty of end of life decisions are the deeply theological questions of the meaning of suffering and the significance of death. Most of the discussion about issues at the end of life is taking place at medical association conferences, on hospital ethics committees, or in centers for bioethics. One writer remarked several years ago that physicians are becoming the new priesthood. End of life concerns now involve a great deal of what science and medicine can do with and to the human body that is never covered in a seminary course of studies. We in the church know too little about palliative care and hospices, or about the effects of beginning or ending treatments. Consequently it is not surprising that medical personnel are the primary guides in decisions that should be grounded in moral and spiritual beliefs.
The church needs to recover its role in ministry at the end of life
A Gallup poll in 1998 revealed that clergy are among the least sought out for spiritual or emotional support by those facing death. The poll uncovered serious spiritual concerns about dying, particularly among younger adults. More than two –thirds said they were worried about not being forgiven by God, and nearly two thirds said they fear that dying will cut them off from God. It ought to be of enormous concern to us that the church is too often regarded as irrelevant to these discussions and of little help in offering pastoral care.
There is a growing need for pastoral care ministry for the seriously ill and dying in our churches today. Reformed and Presbyterian denominations at every level ought to stimulate local churches to begin a process of study, discussion and development of resources for pastoral care ministry that is faithful to a clearly articulated biblical ethic and responds to the needs of families in our churches.
*The examples in this article are based on actual experiences of Presbyterians.