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Rev. Dr. Walter J. Smith, S.J.

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End Of Life Spiritual Care: A Pathway to Growth and Peace

Posted: 03/15/11 11:51 PM ET

Doug, 81, recently learned that he has end-stage cancer and probably only a few months to live. He's devastated, frightened and feels alone. His wife died two years ago, and he has missed her greatly. He has outlived his siblings and closest friends. His only daughter lives 2,500 miles away; his three adult grandchildren are scattered around the country as well.

Doug finds himself thinking a lot about what he calls "The Big Questions": "What's the meaning of my life? When you add up them up, do my good memories outnumber the failed opportunities and disappointments? What's going to happens after I die? Is there a God? How will I be judged? How will I be remembered by my daughter and grandchildren?"

Larry is 42 and a Wall Street analyst. Work is his life; it's how he defines himself. Everything else has taken a back seat to his career: marriage, family, social relationships. Larry has just learned that he has prostate cancer, and question upon question swirl unanswered in his head. "Is cancer going to cut short or radically alter my life? Will I survive this? Will it destroy my career? I went to Harvard. I've been killing myself on Wall Street for the past 20 years. And for what, to be facing a radical prostatectomy?"

Doug has not been a religious person. Unlike people who are rooted in a faith tradition and community, he feels adrift. He can't turn to and rely upon prayers and rituals, clergy and fellow congregants, all of which might help him find comfort and meaning. And he does not have much of a support network either, apart from some of his Wall Street co-workers.

Samantha is a 38 year old African-American single mother of two who has been diagnosed with Mitral valve prolapse, a heart valve disease that will require surgery. She has been treated for high blood pressure for several years, and suffers from shortness of breath and dizziness. She has chronic swelling in her ankles and has gained a considerable amount of weight since the birth of her second child. Although Samantha's doctors are optimistic about the valve repair and her long-term prognosis, Samantha is pessimistic, believing in a very fundamentalist way that her condition is God's punishment for her free-wheeling lifestyle, which she believes contributed to her first pregnancy that resulted in a still birth. "Am I a good mother? Did I smoke and drink too much when I was younger? Will God forgive me? How will my children get along if I'm no longer here?"

Although each of these people are worlds apart in terms of their life experiences and diagnoses, what's common to them is that a serious or life-altering illness has triggered inner questioning and a search to make sense of life. "Who am I? What's the purpose of my life? Why was I put on this earth?" At their root, each of their questions is spiritual in nature. Spirituality touches the essence of who we are, regardless of whether or not we embrace religious faith or practice.

Spirituality, according to the 2009 consensus conference sponsored by the Archstone Foundation, is "the aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature and to the significant or sacred."

Being unable to grapple successfully with these basic questions of existence can contribute to what may be called spiritual distress. Too often, health care professionals -- appropriately focused on the diagnosis and proposed treatment plans -- pay insufficient attention to the spiritual questions that arise and need to be addressed. People need "spiritual care" as much as they need "medical care."

When our bodies are under assault from disease or illness and our minds are reeling from the threat of disability or death, our spirit is there to hold it all together. And many people can play the role of a spiritual care provider. Spiritual care might come from a spouse, a doctor or nurse, a priest, minister, rabbi or imam, a trusted friend or co-worker. What is required is presence, an ability to listen and understand, and an honest attempt to help a person find meaning -- real meaning -- in their life circumstances.

A person in spiritual distress is usually looking for meaning. A spiritual companion, whoever that may be, must understand this universal need to find meaning and commit to accompanying a patient to find and affirm their own answers from within their own life and experience.

That is what a good spiritual companion does. He or she commits to the journey and becomes a mirror held up to their friend's life, inviting them to look in it deeply and to express truthfully what they see. They encourage their friends to reminisce about events and relationships that have occurred throughout their life and to rediscover legacies, meaning and spiritual strength.

Astute, sensitive spiritual care helps create gentle pathways through which a person might achieve inner growth and peace during critical steps along life's journey until it is finally completed.

If you know a Doug or a Larry or a Samantha, don't be afraid to reach out to them in a gentle way. Recognize that people cope with health crises and grief in their own way and at their own pace. Most importantly, offer to be there for them. Listen to what they say and what they don't say. If your friend is in a hospital, ask if they'd like for a chaplain to visit. I've learned from many years of observation that professional chaplains are particularly able to help people -- regardless of faith or beliefs -- to find meaning and comfort.

Meaning and comfort is what we all need and what we all desire.

 
Doug, 81, recently learned that he has end-stage cancer and probably only a few months to live. He's devastated, frightened and feels alone. His wife died two years ago, and he has missed her greatly.
Doug, 81, recently learned that he has end-stage cancer and probably only a few months to live. He's devastated, frightened and feels alone. His wife died two years ago, and he has missed her greatly.
 
 
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george6090
America can be better
06:34 PM on 03/21/2011
Are we all not individuals? We see death and life as individual as each of us sees ourselves.Right and wrong, subjective, good and bad, subjective, heaven and hell, subjective. Unless you allow yourself to believe what someone or some group tells you what to believe does not make anyone right or wrong. There is now way to know unless you choose it or give your choice to others to make for you. There is no way to win or lose this discussion. The only absolute is our bodies die. After that it is conjecture as to what happens, id anything.
New Yorker
Roman Catholic, Anti-DEATH, Combat Vet, Sinner
12:42 PM on 03/17/2011
If you end up in heaven you can safely assume your life was a success. If you are screaming in agony, surrounded by hideous demons and roasting in unquenchable and eternal fire, you probably didn't make the right choices with your life.

It is all rather simple. God resides in Heaven, sekl God, tell Him you are sorry for your sins and wish to obey Him, and God who is Mercy Itself will give you His presence for eternity, and you will go to heaven where he is.

On the other hand you can imagine God is a myth, a fabrication, not someone of value, and od everything YOUR WAY, and ignore the will of God, you will be sent where God is not for all eternity. God is Not in Hell. You will get your wish.

Either way YOU CHOOSE !
05:15 PM on 03/19/2011
I recall a study some years ago that looked at the attitudes of senior citizens (mostly in nursing homes, as I recall), who were nearing the end of their lives. The results were not that surprising. The Christians among them tended to be at peace and did not have nearly the level of intrepidation about dieing as non-believers. The study also indicated that the black seniors tended to be most at peace as compared to white seniors, the former tending to have a higher percentage of Christians in their ranks.

It should also be noted that the black seniors, in particular, did not tend to fit the mold of "success" by worldly standards. Their peace and lack of fear stemmed from the promises of Christ and the knowledge that their worldly life was as bad as they will ever experience. Whereas the earthly life of non-believers is as good as it will ever get.
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Chaotician101
06:22 PM on 03/16/2011
Hmm, what a interesting assumption you make; that is, that a life has meaning! This is all pretty doubtful unless has used ones life to have meaning to the world or the surviving peoples! To reach for personal meaning; some spiritual purpose for oneself can be a fun, distressing, painful but largely fruitless! Few if any of the "great" spiritual seekers have indicated a successful conclusion from such a quest! A few have reached an accepting accommodation which seems to bring harmony, happiness, and peace; but meaning, I don't think so!
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french queen13
my beloved is mine and I am his
04:23 AM on 03/17/2011
An exclamation mark at the end of every sentence? Please, not needed.

As to whether life has meaning or not, I hope you don't inflict the idea that it doesn't on anyone going through this.
ladyearth
Give birth to your dancing star
08:51 PM on 03/20/2011
My friend, the only meaning life has is the one that one gives it.
01:49 PM on 03/16/2011
I find it very interesting - from my experience it has been that the more religious someone is, the more they seem to fear fear death. Perhaps that is what draws people to religion in the first place, a tremendous fear of dying. I have two friends right now both with terminal brain cancer. One an atheist and one a Catholic. The atheist is at complete calm peace, the religious one is filled with fear and terror.
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naschkatze
A free man creates himself.
08:04 PM on 03/16/2011
I have had that experience too. I used to attend a very small Episcopalian parish in my town made up of older people. Whenever one of them would have a serious health problem, the worship level went up, Bible study and the works, and then when they'd get better, their attendance would go down. I am old too and unchurched now. I never think about dying, just trying to do best with what I have remaining.
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french queen13
my beloved is mine and I am his
04:25 AM on 03/17/2011
I wonder if that is a reflection of the type of religious teaching or experience people have? If someone has had the idea of a place of punishment shoved down their throat, it isn't surprising. Those sort of fears would surface pretty easily, I guess.
02:51 PM on 03/17/2011
Well, people may have been taught the idea of a place of punishment - but the teaching is also that if you accept that religious ideal - YOU are saved. Others may go to the "fiery lake" but the believer is spared and goes to the utopia of a blissful heaven. What's to be so afraid of? I think religion for many is used to blunt an enormous fear of dying. But it doesn't seem to actually work.
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11:51 AM on 03/16/2011
Watching the coverage of the disaster in Japan, I find the demeanor of the Japanese people inspiring What dignity!
What poise!

And there are numerous stories coming out where older people are urging rescue workers to go help the younger people and children, not them.

What generosity!
What deep social commitment!

64-65% of Japanese are non-believ­ers in god.
http://www­.adherents­.com/large­com/com_at­heist.html

Judging by the way Japanese are handling this crisis I would conclude that belief has very little to do with how well one copes with tragedies and crises and impending death and suffering.
01:51 PM on 03/16/2011
Completely agree. Calm. Kindness. No looting. It said on the news that 90% of Japanese consider themselves to be Buddhist. Their actions in this time of such severe crisis makes a tremendous, truthful statement. One we do not see here in America.
10:17 PM on 03/16/2011
I agree.
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Cole 33
If someone asks if you're a God, you, say, YES!
11:09 AM on 03/16/2011
There is a movie that came out not long ago that many overlooked, but was a really good flick called "The Invention of Lying"

It is a "what if" movie, what if we lived in a world where lying didn't exist. The movie followed a guy who "invents lying" , so everyone believes his lies because lying doesn't exist except for him.
plenty of funny scenes using this scenario.

But the most surprisingly poignant scene is when the man is in the hospital with his dying mother, and she's crying and she's scared, scared of dying, scared of the unknown.

And so the man, who can't bare to see his mom so scared, tells her a story, a story of what happens when you die, and it's a beautiful story that comforts her and makes her believe that everything is going to be ok, and that her loved ones long past will be with her. And before she passes she is washed over with a smile and a feeling of comfort and love.

It's a great part of the film, and taps into that need for certainty of the unknown after we die, and a great show of why people feel they need faith, we need to lie, so we can live. but really we don't have to, we just don't know it.
New Yorker
Roman Catholic, Anti-DEATH, Combat Vet, Sinner
11:33 AM on 03/16/2011
Such a deception would comfort one whose life is despicable, and filled with sin and doing harm to others. If, however, a person lived a life of goodness, and doing good, and helping others and not only looking out for himself, he would have a peacful death. God is alive, and He helps us in His own ways. A 'Happy Death' is a great gift from God, not a lie.
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Cole 33
If someone asks if you're a God, you, say, YES!
02:02 PM on 03/16/2011
Such a deception would comfort one whose life is despicable.

it was was his nice mom, not someone who's life is despicable.

regardless of whether you lead a good life, dying is scary, being good doesn't remove you from being scared of dying.

Evil people get peaceful deaths too.

But over all you're missing the point of the scene.
New Yorker
Roman Catholic, Anti-DEATH, Combat Vet, Sinner
10:39 AM on 03/16/2011
Jesuit priests are always so knowledgable, thank you father for your insight, and wisdom. I who have faith, and Trust completely in Our Blessed Lord, despite the many sins of my life, do not fear death. I recognize that is a Merciful and Good God who I seek that would decide my faith. If one is judged by their mother, or one who loved them in this life unconditionally, they would hardly fear that judge. How much more does Jesus, who gave His life in that sorrowful sacrifice just to save us from our sins, love us ? Such is the just judge we sinners must face. He will be merciful to we who show mercy, and good to we who do good, and save souls that no one else would imagine could be saved. Knowing these truths, I feel sad for those who do not know what I know. Would I like to help those poor souls at the end of their life, of course, any decent human would. It is God who must open such a door to us, it is not for us to break down that door. Good people often fail to see that difference.
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stuoverit
"What year did Jesus think it was?"-GC
11:31 AM on 03/16/2011
So if you don't fear death and think you'll have a wonderful life and all, why not commit suicide? I'm not imploring you to do so or trying to be hateful, but honestly, if you relieved believed in eternal paradise, why stick around here? Maybe because you're holding onto life means that you're not really prepared for death...
New Yorker
Roman Catholic, Anti-DEATH, Combat Vet, Sinner
12:27 PM on 03/17/2011
God alone decides when to end our trial in this world, it is sinful to imagine we can make such a choice. My job and yours is to be a servant of God, he tells each of us what he wishes, and we obey. I will live as long as He wishes me to live, not a moment more or less. "May It be Done To Me according to Thy Will O'Lord !" That, is how one assures a happy death. Mnay saints prayed to be released from this life, many times, but they only asked for that 'relief', they knew how sinful it was to imagine it was their choice to end their life. You have life as a gift from God, you are meant to cherish it. Even if I must one day suffer with my life, it will always be my decision that God alone decide when to put an end to my time here on this earth. I look forward to that day for one reason above all others, from then On I will Never Sin Again.
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Roxee
"Feeling" you're right, doesn't "prove" you are.
04:40 AM on 03/16/2011
It's astounding what the religious do to to people who are not religious when they are dying. I should know, I'm an RN, I work in a Catholic hospital and I'm an atheist. Many get asked to take their last opportunity to repent their sins. How distressing it is to have avoided proselytizing religious people all your life only to have them turn up when one is on ones death bed where one can't get away. As Christopher Hitchens says, who us dying from esophageal cancer, he is already got people asking him this. He, one of the most well known atheists on the planet. He adds they ask it as if they are being polite! I often advocate for them when I see a nun or priest heading for their room, although my employer isn't happy with me when I do. Please, if your religious, don't try and "save" people on their death beds. You are hurting their feelings and that's not very Christian.
10:21 PM on 03/16/2011
Keep running interference for those who prefer to be unmolested by the religious. You're doing a good thing.
02:10 AM on 03/16/2011
Reverend Doctor, I very much appreciate articles such as this :) Thank you!!

The fact that you care enough to compose and take your time to share a post here is brilliant. We're better for your work and thought :)
01:14 AM on 03/16/2011
"If your friend is in a hospital, ask if they'd like for a chaplain to visit."

And if he/she says, "No," respect that.

When my dad was dying, he was plagued with a pastor (who meant well) continuing to visit and pray for him even after Dad had asked him not to. He would get into long sessions of what Dad had to look forward to in the "afterlife" and how god had bigger plans for him, all of which made my Dad want to speak his own mind on the subject, but he was too polite.

When I would meet the man at the door and tell him Dad did not feel like company, he would barge right in anyway.

Dad enjoyed visits from friends and family who reminisced with him, or just sat quietly with him. Those folks did him a lot of good in his last few weeks.
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Cole 33
If someone asks if you're a God, you, say, YES!
11:12 AM on 03/16/2011
I had an uncle who was in the same position. He told the priest exactly this. "Sir, I'm going to die soon, stop pushing me into the after life and let me have my time with my family, I have little time with them left"

He was an atheist, and he knew that where he was going wasn't what was important or what he should be thinking about, but that his time here NOW with his family was what mattered.
03:39 PM on 03/16/2011
I admire your uncle. I hope I have his strength of will when the time comes.
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stuoverit
"What year did Jesus think it was?"-GC
11:34 AM on 03/16/2011
The presumptuous nature of believers in general is frustrating. I pointed to the Smith's quote in the post- "Doug has not been a religious person. Unlike people who are rooted in a faith tradition and community, he feels adrift."

With that sentence he makes it clear that regardless of what a non-believer would tell them, he just KNOWS that they are missing something. For me, it is insulting frankly.

And as far as your dad is concerned, I know how you feel. When my father passed, I was inundated with "prayers" from the faithful. While I'm sure they were trying to be nice, being a non-believer is not like being a spiritual invalid.
03:38 PM on 03/16/2011
Yes! That paragraph about "Doug" bothered me. That's what prompted me to write about Dad.

He needs one more example in his post--and that would be the dying person who wants you to keep the prayers and afterlife talk to yourself.
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Bert Dodson
libral gramma
01:03 AM on 03/16/2011
Our culture has great difficulty defining a good life and an even harder time with death. Death is an inevitalble event. Human life has lengthened due to improved sanitation, diet, vacines/prevention and antibiotics, but has it improved? The process of dying has also been extended, IV hydration/nutrition, ventilatiors, dialysis, and so on, none of these eases dying, but they all delay it. There is a shallow, selfcentered style of living that is too commen and much too celebrated. It bleeds over into out politics, and religon, in the way we speak to each other. We have lost empathy, and replaced it with snark. Week are to be abused, the poor to be used, this is the worst of human Darwinism, the strong or rich survive and profit, devil take the hindmost.You can't deal with the utter vulnerability of the dying or those facing death if it is survival of the fittest, illness, dying are weaknesses. It does explain why so often we use extreme measures to squeeze a bit of time, to try and do, say things we should already have said or done. When we learn to live with one another, perhaps we will learn how to die with a measure of dignity.