Caring for the Terminally Ill

ACE Class, Mt Carmel BP Church

By Pastor Daniel Chua

18 September 2010

Opening Question

• If someone who is terminally ill were to ask you, “What is it like to die? Does it hurt?”, how would you answer?

• Exercise: share your reflections with the one seated next to you.

Introduction

Death is intensely personal and a very isolating experience, foremost to the dying person and to his

family as well. Therefore, the importance of the consistent and supportive presence of pastoral

caregivers among them cannot be overstated.

It is a must in order to support them through the ‘crisis of death’ where the dying is facing the loss of relationship, meaning, self-worth and hope.

And these losses bear on their faith.

Introduction

The pastoral caregivers are there to show concern and care for the part of the body of Christ that is

suffering and serve to ‘visibly’ remind them of God’s abiding loving care.

The pastor alone cannot provide such level of consistent pastoral care. Therefore, if the ministry to the dying can be structured into a ministry involving both the pastor

and the laity, the ministry will be more holistic, encompassing and reliable.

Theological Basis

God sets the benchmark: God is our shepherd through life as well as through “the valley of the shadow of death” (Psalm 23). He is one who does not abandon us and gives us confidence (Heb. 13:5-6) even amidst our ‘crisis of death.

Pastor takes the lead: As shepherd over God’s church, the pastor is a shepherd of souls even in the presence of death and loss.

Theological Basis

Members join in caring:Furthermore, we are the body of Christ that minister to one another’s needs (1 Cor. 12:24-27). Considering the emotional upheaval the dying has to live with, they have a special need of our special concern and when they appeal for our pastoral mercy, it must not be in vain.

When one part of the body of Christ is suffering, our compassion for them drives us to heed and attend to their call for help. And by ministering to them, we can help the dying to maintain a right relationship to God, for death does not have the last word but the grace of God does (Rom. 6:23).

# 1: To mediate the presence of God is to be present with the dying person and attending to him with

a care that originates from the love of God.

People need to feel that God still loves them and the pastoral caregiver can communicate God’s love through his presence and care-giving.

# 2: To offer support to the person to affirm and appropriate the promises of the gospel is to hold before

the person’s and his family’s consciousness “the essential heart of the Christian gospel:

that Christ died for our sins, that the love of God does not end on the cross but rejoices in the hope of the

resurrection, that grace makes perfect our weakness” and they “can trust the same goodness of God revealed in Jesus will be present in the world to come, and that

God will not give us a trial greater than we can endure.”

Four Fears of the Dying

“In Christ, we can be freed from the fear of annihilation because the Bible teaches us that death does not end it

all. We can be freed from the fear of the unknown because Christ speaks to us from beyond the grave. We can be freed from the fear of damnation because Jesus offers us an abundantly forgiven life. We can be freed

from the fear of being alone because the Good Shepherd leads his sheep through the valley of the

shadow of death.”

Jeffrey Watson

# 3: To offer companionship and counsel or guidance to deep spiritual concerns and questions is to be present to

the person, listening and speaking. Death is intensely personal. For the dying person, death is a very isolating

experience for he becomes “aware that even though others are present, only he or she is dying.” He can feel

isolated, abandoned and unsupported..

Therefore, companionship is the ministry of offering the dying person someone he can reliably “hold on to,

someone he can talk with confidentially, someone who lends him support.” He is offered consolation and comfort which comes through our supporting

presence with them.

“If the dying cannot rely fully on the faithfulness of those who come to help them, their sense of being alone

becomes even more acute.”

The spiritual concerns and questions of a dying person arise out of their “pain” amid the ‘crisis of loss,’ that is anticipatory and already occurring –

the loss of relationship and separation from significant persons,

the loss of meaning, the loss of self-worth and

the loss of hope.

Loss of Meaning, f/n 17

“Part of the spiritual struggle is to find meaning in this experience, even as health is being diminished. Death

with dignity is death with meaning. Human beings find it very difficult to encounter death unless some way is

found to link it to meaning. …

It is not at all uncommon for people in the context of approaching death to ask questions. Some of the

questions … asked are “What is it like to die?” “Where is God in this process?” “Has my life been significant?”

“How does God deal with people who haven’t done all they should?” “What is it like to be with God?”

Loss of Self-Worth, f/n 18

“In a society that highly prizes vitality, illness can be very demeaning and dying the ultimate indignity.

One of the spiritual needs of the dying person is for affirmation of self-worth. …

Spiritual care offers the assurance that one can die with an intact sense of self-worth.”

His “pain” needs to be attended to and given meaning. The pastoral caregiver must bear in mind that people are unique and “Each person’s season of anticipatory

mourning (grieving prior to the death in awareness of the coming value loss) has its own pace and internal timing.”

Also present are the worries of being a current burden to his family and the impending impact of his death on his family.[1] There can also be issues of guilt, regret, anger and denial that need may need to be addressed. Therefore, the pastoral caregiver will need to listen carefully and accurately to what is being said in order to respond with “well-chosen scriptural wisdom personally expressed in the language of one’s own experience, enriched with compassion, sincere thanksgiving, and the courage to face reality.”

[1] Paul Irion reported that “‘What is my illness doing to my family?’ is a relatively common query, especially from younger and early middle-age patients who still have dependent family members.”

It is important to note that the pastoral caregiver’s mode of counsel is one where the dying recipient is

“experientially ahead of the pastoral guide.”

Therefore, it serves us well to acknowledge our lack of experience and to “listen carefully to the unparallel

expertise of those who are dying.”

The times “of approaching death and bereavement are exceptional opportunities for spiritual growth.”

This is God’s doing.

• In facing death, others find a growing capacity to love and to express love…

• Also, the dying person may want to resolve some unfinished business “of disruptions in relationships, of failures to maintain earlier commitments, of estrangement from earlier values of faith.” They want to express their regret and to seek some kind of restoration…

# 4: To perform priestly functions of administering sacraments is to offer “Holy Communion when asked, and to encourage its being when appropriate.” When needed, the ministry of word and Holy Communion can bring “a well-timed message” of God’s forgiveness to address the feelings of guilt in the penitent dying person

# 5: To offer practical help and support to cope with the crisis speaks of offering encouragement and help for the person to attend church worship and meetings, allowing him to be connected to the community of faith as long as he is able to. The dying person can feel vulnerable and powerless…(he) needs to be able to feel a measure of control over his life…

The family of the dying person is affected by his or her approaching death. Therefore, they are to be ministered to in the areas discussed above from the perspective of

a family of the dying. There will be disruption to the family due to the “redistribution of responsibilities and a shifting of authority roles with the family structure.” And because of these changes, family members may react

with discomfort, anger, frustration, anxiety and joy.

The guilt felt by family members who are not able to provide home care to the dying family member or who

botch the job can lead to breakdown in familial relationships, even in loving families.

Therefore, pastoral ministry to the family is sensitive to providing the space for the feelings to be expressed and

discussed among the family members.

Members of the church can help meet the needs of respite care, help with household duties or provide companionship for a member of the

family who is feeling stressed.

The pastoral care to the dying includes the conducting of the funeral for him. Request for

planning of the funeral should be initiated by the person or principal caregiver in his family.

The ministry to the dying will also necessarily involve bereavement aftercare for his family. Some statistics show that bereaved families received a considerable

amount of care in the first two weeks following the death of the family member. However, after these initial two weeks, it seems like care has fallen of ‘a cliff’ and they

are expected to ‘get on with their lives.’

The pastoral care-giving visits to the family prior to the death should be continued after the death, to support

the family in their mourning.

Summary

# 1 Death is intensely personal & lonely

# 2 The patient & family needs consistent support

# 3 This support should involve pastor & church community

# 4 Be with the dying; they need to know God still loves them

Summary

# 5 Help the dying to affirm the unchanging promises of the gospel

# 6 Offer constant companionship & timely counsel to their concerns & questions

# 7 Expect conversations on questions of significance: What is it like to die? Where is God in all this? Has my

life been significant?

# 8 Deal with issues of guilt: Am I a burden to my family?

Summary

# 9 Assist if the dying wishes to resolve unfinished business: restoration of broken ties, unfulfilled promises,

etc

# 10 Allow the dying to have some measure of control over his life

# 11 Discuss funeral matters when the dying or his family is ready

# 12 Care for the dying person’s family too, including bereavement aftercare

Other Tips

• Let the patient tell his story, be patient, non-judgmental

• Ask questions instead of always giving advice

• Be willing to touch the patient

• Share God’s Word, but be brief. His attention span is short. Pray for the patient

Remembering…

• Kerwin Chua, NPC• Nessie + Edwin, NPC• Mrs Ong, multiple sclerosis• Teh Chun Wai, bone cancer• Jessie Heng, cancer• Ng Wan Sing, cancer

Final Questions

• What is a dominant lesson you have learnt in caring for caring for the terminally ill?

• Are we ready to develop a church-wide ministry of caring for the terminally ill? What are the steps we need to take?