This section is a summary of the experience of a chaplain and hospice worker on the spiritual dimensions of dying. It is rich in observations and suggestions – both for ourselves as we face our dying, and for ourselves as caregivers to loved ones who are dying.
Dying, Yet We Live. Our Response to the Spiritual Needs of the Dying
1988, Anglican Book Store
There is a spiritual dimension to the care we give the dying that is often misunderstood and ineffectually provided.
The author defines “spiritual” as referring to the gift of God’s spirit. It means our openness to God’s spirit, our relationship to God and others, and how we are motivated and sustained by the spirit of God. It involves, therefore, both horizontal relationships – with self and others – and vertical ones – with God. From such a spiritual point of view, the dying person is completing a process that terminates not in death but in the completeness that follows death. (16)
The heart of the spiritual care we need to provide revolves around meaning-making. (18) The ultimate meaning of life for a Christian revolves around God’s desire that we be fully human. (20) Life, then, is about realizing our true potential, discovering what is good and beautiful within life, and growing into mature personhood. (20) The structure of meaning that had given shape to our normal life is being dashed against the wall of death. This can, of course, lead to serious depression and the belief that life is now meaningless. (21)
The search for a new meaning structure must turn inward for the dying. This new orientation toward meaning aims to bring about a re-organization within the person of information already present. One of the dimensions of such new meaning-making for the dying is self-evaluation. This can often take the form of a life review. Such a life review can sometimes make the process of dying more meaningful. Such life review is best done socially rather than merely privately. By helping a loved one make such a life review, we are attempting to help them regain more control of their remaining life. (22)
Our past is still very present. When people develop a healthy respect for the past, they are able to search for integration and completeness. (22) As a person proceeds through this process of looking back, and integrating the events of one’s life, there can be a growing sense of peace. (23) Not so much peace as in tranquility, but as in “shalom,” where things work together in harmony.
In the process of trying to determine the meaning of a particular event, caregivers can help in putting things in a new light. Even painful events can take on new, salutary meanings. (24)
Another way to help find meaning at this stage of life is to remind the loved one of their on-going responsibilities. We must guard against being too overprotective. (24-5) If it is at all possible, the dying one needs to continue being involved in the mainstream of life. By failing to encourage this spiritual activity, we actually treat the loved one as irresponsible and essentially of no use anymore. (25)
One of the best ways to help the loved one continue to find meaning requires that we truly love the dying person. Love is the only way to grasp another human being in the innermost core of his/her personality, to see the essential features and traits that make the person unique. By loving in such a manner, we continue to enable the loved one to actualize him/herself. (28)
It has been shown that those who make the effort to integrate their religious values into their value system are better able to cope with their dying process. (28)
One spiritual service we can offer is to help them answer the serious questions the dying tend to raise, such as what have I done to deserve this? It is important to determine whether the patient is raising a theological issue or just expressing anger at the situation. (34) If the question is clearly theological, we need to be careful to avoid perpetuating traditional answers that have no theological validity – such as the solutions offered by Job’s neighbours. (35) 1. “The Lord gives and the Lord takes away.” 2. “God knows when it’s time to depart.” 3. “God needs her more than you do.” In these, God is represented as a capricious deity arbitrarily giving and taking as it suits that deity’s purposes. The criteria for one’s approach would include whether or not a particular religious belief builds bridges between people rather than barriers, whether it shows concern for the health of personality, whether it provides healthy ways to deal with guilt, whether it emphasizes growth and love rather than fear. (36)
One of the first theological questions is the nature of God: typically, an approach requires that we help the person shed images of God acquired in childhood. In many ways we project on to God those attributes which characterize the authority figures in our lives. These images are usually male, and judgemental, resulting in a relationship of fear. (37) The most important movement for the dying person is from such a judgemental God to a God of love and compassion. (38)
The second most important theological question is theodicy: why would an all-powerful loving God allow such evil? If we believe in an all-powerful God, then God becomes responsible for the evil in the world. One approach has been to see evil that befalls us as punishment. “What did I do to deserve this?” There is also the widespread belief that, in God’s world, the wicked eventually pay and the righteous are rewarded. The Psalms, as well as the Book of Job, are full of this view. The belief that God could intervene in every distressing or evil situation is a dangerous one. (40-1) What is more important than trying to provide an answer (other than the one the author of Job provides at the very end: “if you think running the universe is so easy, you try it!”) is to ask: what might I learn from this situation that would open me more to You? (41) Fundamental to any mature theological position is that suffering is integral to living. We cannot escape suffering, but we can endure it for some purpose. (43) Suffering ceases to be suffering in some way at the moment it finds a meaning. (43) And the best that we can do with a loved one who is suffering is to be with them. (44)
The next theological issue is belief in the next life: 30% of practising Christians do not believe if the possibility of continuation of existence after death. (48) The traditional views of life after death no longer captivate the minds or the hearts of people. Certainly, the traditional notions of heaven and hell have less and less hold on Christians, especially liberal ones. (50) However, as death approaches, the question is almost inevitably raised. There is little that we can know for sure, but our scripture does provide us with sound suggestions. We will not be aimless spirits drifting through space; nor will we be like a drop of water falling into the ocean, being absorbed into the Godhead. We know that we will enter a community, and a community of love, and that, somehow, what mattered to us in our physical form will continue to matter. The bodily resurrection of Christ signifies that in the next life we are promised an existence which will involve personal recognition within a communal life. (51) Because resurrection was preceded by crucifixion, we know that new life can only come upon the death of the old. Thus, the process from one life to the next form requires total letting go. And this is the heart of the spiritual practice of dying.
The notion of “immortality” is not helpful. Immortality is a dream of avoidance, a belief in radical continuity. Death is radical discontinuity. Immortality assumes continuity and therefore does not require radical trust: trust that we somehow manage to get through the radical transformation. (53)
What is the appropriate form of care for the dying? We know that the terminally ill are afraid of abandonment. (57) At the heart of care, therefore, is presence.
More paradoxically, however, is that care requires providing the dying person with opportunities to be a responsible care giver. (58) We provide simple opportunities for the dying to care because otherwise we rob the person of means for any further effective living. By helping people realize that their decision making is important, we are conveying the message that they are still needed, and that they are still worth something in this world. (59) Even helping the person think through what sort of parting gift will the dying one leave this world. Death is sometimes greatly eased when they dying have a sense that they are still able to do something for their loved ones right to the end. (60) One was is to alleviate the guilt of the survivors. Another is for the dying one to give permission to loved ones to express their feelings. Another is to right certain persistent wrongs, to restore broken relationships, to help understand ancient pains, to seek forgiveness, to offer forgiveness. (62-8)
What can caretakers do with the dying one’s claims to psychic phenomena? The reality of these experiences can neither be disputes nor ignored, certainly not dismissed out of hand. While they may “prove” little, they, at the very least, can lead us to realize how little we know about our world, as well as the limits of a materialist scientistic explanation. (73) Near death experiences may not provide us with any concrete proof about the nature of the afterlife, but nor can they be dismissed as mere hallucinations. Moreover, it is clear that our scriptures are full of accounts that are essentially “psychic” in nature. A helpful response to such claims on the the part of the dying might look something like this: How does the experience compare with their experience of God, of the way God communicates with humanity? (80-2) What kind of impact has the experience had on the loved one – anything positive and meaningful? Anything growthful? (83)
What can we make of the “Last Judgement”? Medieval Christianity provided us with gruesome images of what is supposed to await us at the “Last Judgement.” (The “Dies Irae” in the Catholic Requiem mass, especially as interpreted by Romantic composers, is a classic horror tale designed to put the fear of God into the gravest of sinners!) There may well be a moment of reckoning, but it will be a moment when we ourselves see ourselves in our totality, with all the compassion of God. It may be unpleasant, but it will never be vindictive. We shall know ourselves as we have been, plain and simple, and we shall know ourselves with all of God’s love. (82)
What is the role of prayer in the care of the dying? Prayer, when it is offered in the right way, redeems people from isolation. (93) It assures them that they need not feel alone and abandoned. It lets them know they are part of a greater reality, with more depth, more hope, more courage, and more of a future than any individual could have alone. (93) Prayer helps to remind the dying one of the constant presence of God. (95) Prayer can help relieve guilt, can help focus on God’s compassionate love. (95)