ask the chaplain

Thanks Calvin. There is a-lot of opining about religion and spirituality with most of the negativity falling on religion and most of the affirmation highlighting spirituality. Actually when it comes to end-of-life care the terms are value neutral with each denoting different things. What therefore is religion? it is the set of practices and beliefs associated with the worship of God. What therefore is spirituality? Although hard to pin down an exact definition a common one is that it is the interior or internal set of experiences and feelings and beliefs that are part of one’s relationship with God.

Studies have shown that there are benefits unique to each, and so those who think that religion is bad simply I’m sorry but you simply do not know what you are talking about when it comes to end of life care.  That said the next question is, What are the benefits of each when it comes to end-of-life care?

As suggested by studies, people who practice religion show a disposition towards readily dealing with ethical questions, with theological questions such as the why of suffering, with the practical aspects of end-of-life care, with the making of wills and medical directives, and with understanding objective truth claims and accepting them.

People who define themselves as more spiritual based and not religious tend to have an easier time with pain control, are more open to non-medicinal practices to deal with pain, do not have extreme faith crises’, are more accepting, are more appreciative of caregivers.

To me the read is that people need both spirituality and religion. We need to be able to avoid the stress of ethical questions, need to have found a path thru the whys and wherefores of suffering, need to adhere to a rock solid faith that is not based on our subjective feelings, and need to take care of our last business dealings with undue anxiety. Yet too we need to have internal self-initiated ways of dealing with pain, need to have sources of spiritual strength not dependent upon our physical condition, do not need to cope with a faith crises as we face death, and yes do need to practice civility to our caregivers.

Rather than see religion and spirituality as competing opposites it is far healthier if envisioned as different sides of the same coin; the coin being a persons relation with the divine. And yes it is very useful to cultivate the side one is weakest in. If all your relation with the divine is about duty you might want to open yourself to the more personal experiential. If all your relation to the divine is about experiential feeling then you need to study open yourself up to objective truth claims. It is not necessarily a comfortable thing to do. After all people drift towards spirituality or religion because of a comfort level with one or the other and cultivating what one is not naturally given toward can take some work. But well worth it in terms of our passage thru life.

There are times when religious precepts and practices will carry you even if your feelings drag you down. There are times your feelings will help you even when those same precepts and practices seem life-less. Be wise and practice both.

Thanks Joseph. The answer is no not necessarily.  Spiritual care of those who are dying includes a wide array of concerns but is always about what brings a sense of peace and courage and fortitude to the one who is facing death.  These may include connecting a person to a church if they need that relation for comfort, but it also can include things like the healing of deep and long-lasting emotional and spiritual wounds, the resolution of interior beliefs that are causing stress, finding a positive sense of self, discovering a lasting sense of dignity and well-being, resolving family tensions, solving ethical dilemmas, reaching a peaceful solution to questions about eternity, experiencing forgiveness, the finding of ways to be not anxious or fearful, the use of prayer as therapy for emotional and physical pain, having one’s story listened to, even taking care of business; all of this and many other things constitute spiritual care for the dying.

Again if a person needs to be connected or re-connected to a church that is what they need and that is well and good. But I do want to add that sometimes well-meaning family members can actually harm a patient by forbidding contact with a church if the dying person desires it. The most common scenario involves onetime Roman Catholics who became Born Again Christians and who at the end of their life feel the need to be anointed by a priest in what were once but no longer are called The Last Rights. I am not Roman Catholic but to my way of thinking whatever a dying person requests they get. There is no room for grinding theological axes at their discomfort. All too often caregivers forget it is not about themselves.

 

 

Thanks for the question. It is a question often asked, either silently or out loud, when one is involved in end of physical life care. People have many pre-conceptions of what a chaplain’s business is and most of them are incorrect, and some of the more incorrect opinions are voiced by veteran end-of-physical-life caregivers!

No spiritual care is not about religion and not just about getting people saved. A chaplain isn’t going to preach to you, condemn you, call you you to reckoning or the like. In fact in most organizations chaplains cannot prostyle although they can give an account of their faith if asked, and they most certainly are able. End of life spiritual care may involve someone’s assurance of salvation but there are a whole lot of other concerns such as the meaning of one’s life, loss of purpose, a sense of diminishment due to disease progression, dignity, dealing with paranormal phenomenon, having a sense of normalcy, having a sense of identity separate from one’s disease, alternative methods of pain control, resolving anxiety about the dying process, forgiving and being forgiven, affirming basic humanity, resolving ethical dilemmas, healing relationship wounds or church wounds or anger at God, developing a positive sense of one’s life, dealing with choices, resolution of ethical concerns, feeling valued by having someone listen, and this is just the short list!

I have prepared a list of twenty questions that generally cover areas of spiritual concern at the end of physical life. It is a pretty good self-evaluation of what might or might not be a concern as someone goes through the dying process. I have found that even very faithful people can have issues that afflict them and cause distress. For example a spirit-filled Christian who believed God has told her she will be healed but she is not and as a result has trouble with her faith.

Or consider the woman who simply needed to make a confession and to hear the words of forgiveness from another human person reiterating the words of Jesus. She was an absolute bear of a patient to her caregivers and friends. She was angry, temperamental, ungracious, unthankful, and inclined to find fault. Each and every physical pain was a major episode. Each and every way her body deviated from accustomed expectations was a crisis. Her disease was a personal affliction sent upon her, although she always stopped short of exact explanation. I got to know her and had several visits that were, to be kind, uncomfortable for me and I was sure uncomfortable for her.

But then  one day she bade me enter her house and seeing me looked at me with an absolutely serious look that was not unkind and blurted out, ” I never told my husband that our second child was not his!”

Needless to say I was stunned and tried not to show it. Sometimes the listener’s reactions can make a persons sin more serious than it is.

We discussed what had happened and at last got to the topic of forgiveness. She wanted her husband to forgive her but since he was long since departed knew that was impossible, although it bothered her. She wanted forgiveness from God but was certain God could not forgive her and especially since it was a sin that had festered for decades. Clearly we had a bit of exploration to do and we did it, and not over the course of weeks but right there in hours of exploration of the Bible because she was a Christian. At last she was assured of God’s forgiveness, but not quite so convinced of her deceased husband’s forgiveness! We discussed the idea of a Great Cloud of Witnesses and discussed the fact that in Heaven there would nothing but forgiveness and at long last she felt that perhaps her husband had, or would certainly forgive her.

The result was miraculous. Overnight she became a wonderful, caring, and loving person. Her physical discomfort greatly diminished and she seldom complained about pain even as her disease progressed. When she died the care staff did genuinely weep.

What accounted for the change? She needed forgiveness. That was it. She needed to hear it from a fellow human person and needed to know the full extent of it in her heart and above all needed to know God forgiveness her. There is one example of the value of spiritual care and for this one woman it meant the difference between dying awash with guilt and feeling acute physical pain and dying with a sense of well-being and with greatly reduced physical pain. There are many such examples. Many such nuances.