2014 Clergy Symposium Workshop
The Very Rev’d Nicholas R. Alford
St. Gregory Orthodox Church
A World Health Organization statement describes palliative care as “an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psycho-social and spiritual.” Whereas hospice focuses solely on the dying, palliative care seeks to improve the quality of life and provide comfort to those with serious, chronic and terminal illnesses by taking a holistic approach to the patient’s condition and treatment. A palliative care team will typically include physicians from several specialties, nurses, physical, occupational or speech therapists, as needed, and yes, even clergy. We should be glad to see that even the WHO has observed that there is a spiritual component to treating illness and preparing for death – and we have an integral role in that care.
By definition, therefore, as clergy gathered to consider pastoral care in this context we are addressing issues surrounding serious illness, illnesses which bring mortality into focus, illnesses which make us mindful of death. As Orthodox clergy, we have a radically different perspective on the meaning of life, dying and death from those we find in the world around us. We know that death was not a part of God’s creation. We are created in the image and likeness of God, and created to have communion with God for all eternity. In the Book of Wisdom we read that “God created man for incorruption, and made him in the image of his own eternity”(2:23). But death came into the world by the disobedience of mankind, for as God is the source of all life, turning from God means turning away from life. All that is evil and corrupt in the world seeks to lead us away from God and into bondage to sin and death. Therefore, as St. John of Damascus teaches, death is the result of our own choice and of evil, not a punishment or act of God. Like a wild beast, ravaging and destroying men’s lives, the good and the bad alike are caught up in the destruction we have let loose in the world (The Orthodox Faith, Bk. 2, 28 and Bk 3, 1). Furthermore, death is not the ultimate enemy but now provides a merciful escape from what would otherwise be an eternity of broken-ness and pain in this fallen world. St. Ambrose of Milan, writing after the death of his own brother in the fourth century said, “God did not ordain death in the beginning of things: but He gave it to us as a remedy when that damnable sin brought toil and tears into human life… Deathlessness is no blessing but only a weariness if grace does not transfigure it.”
As Orthodox Christians we know that the purpose of human life is to live in right relationship with God, to give God praise and thanksgiving, to become holy, even as God is holy – in fact we go so far as to say that the whole point of this life is to prepare for death and to prepare to be with God in the life to come. This perspective, so different from that typically found outside the Orthodox Church, should shape our approach to sickness, suffering, dying and death itself. Our work, therefore, begins with teaching, both homiletically in classes and casual conversation, about the faith of our Church concerning these matters. The early Christians knew that death was not a thing to be feared because they fervently desired to live with God. They knew that everything ‘here’ was a potential path to God, depending on the choices they made. They knew the importance of watching and waiting for the coming of Christ. They knew what it meant to die daily to self in order to live with Christ. They knew that an attitude of continual repentance was essential to turn from all that is harmful and unhealthy, in order to return to our true home. As we help people become real Christians, we simultaneously and automatically are helping them to prepare for death.
People, Orthodox and non-Orthodox alike, want to know why there is suffering in the world. They want to know what happens at the time of death. They want to know what happens after death. They want to know what has happened to their departed loved ones. If they have gotten their answers from Hollywood or other aspects of pop-culture, we have much repair work to do. Back in my days in Protestant seminary, during Clinical Pastoral Education, I was frequently chastised by my supervisors for trying to ‘correct’ a patient’s theology. Time after time I encountered people with wrong and harmful notions of God and how He relates to His children: the life-long smoker dying from cancer who wondered why God was doing this to her; the parents of a comatose survivor of a car accident convinced that this was God’s punishment for what they had done; the wife angry at God as she watched her husband waste away. Then after a death has occurred we may hear such things as, “well, she’s an angel now”, “It was God’s will that he died”, or “God took her from me.” We may even hear such things from people who have grown up in the church. While, in the words of Fr. Thomas Hopko, “there is no clear dogmatic teaching of our Orthodox Church on death and what happens when we die” and as Orthodox Christians we are less prone to attempt to define what properly resides in the realm of mystery, we can say much about God’s love and mercy. We know that Orthodoxy is grounded in right worship and right faith. Our pastoral care should begin by bringing people to the truth which has been passed down to us. We know that suffering and sickness and death are all the results of rebelling against God. We know that, while suffering in and of itself is not a good thing, suffering may become a transformative experience depending on how we receive it. We know that the only real healing, be it of body, mind or spirit, comes from God, though he works through his children to bring this about in many ways. We know that Christ wept at the ugliness of death and the tragedy of death, standing at the grave of his friend Lazarus. We know that God destroyed the power of sin and death by taking our death upon himself – filling death with life – even bestowing life on those in the tombs.
After passing on the faith of the Church concerning the basics of the Christian life, our pastoral care for the sick and dying continues with our liturgical ministry. As clergy, we may have a tendency to think that we haven’t ‘done our job’ unless we can relieve suffering and grief, consoling those in difficulty and distress. This is only natural, as we love those who are entrusted to us as our spiritual children and we don’t want to see our children in pain. Here we need to remind ourselves that we are not therapists, as those outside the church understand the term. It’s not our job to make people feel better; it is our job to lead them to God and authentic healing. Following the example of our Great High Priest, we are to offer God to the world and the world to God: “thine own of thine own we offer to thee, on behalf of all and for all.” We are to bring our people to the only One who can truly heal and truly comfort. In practical terms, this means that we are to know our people and share in their lives (in so far as possible). We are to pray for our people, bringing their concerns and needs before God. We offer them the Bread of Heaven and the Cup of Immortality. We call them to repentance and confession, offering words of counsel and pronouncing God’s forgiveness. We tell them of the joy in heaven when a sinner comes to himself, turns around and comes home. We wash them in the waters of baptism and anoint them with the oils of Chrism and healing. We show them signs of God’s Presence and God’s love. We know, after all, that each one of us is dying and that an awareness of this fact is good, healthy and helpful, focusing our attention on the end of life and on the life to come. As we are faithfully tending to our ministry, we are laying a strong foundation by which each and every member of our flocks will be better prepared to face illness and death.
When a parishioner realizes that he or she is facing a life-threatening illness, we move into a new phase of pastoral care. As we pray to be kept from sudden and unprepared death, we know that an awareness of illness and mortality gives one the opportunity to take repentance more seriously, to work to mend broken relationships with God, family or friends, to put things right. The pastor who is trusted may be an integral part, a spiritual guide and friend, during this process. People may seek our direction and need our encouragement to begin and complete difficult emotional work. They may need our help in taking self-examination and confession to a deeper level. They may need a reminder about practical things such as making a will, a living will or advance directive and written funeral plans (especially when family members are not Orthodox). They may need our assurance that they are not alone and will not be alone as they walk through the “valley of the shadow of death.” We proclaim that “God is with us” and that as we live with Christ, so shall we die and rise again with him. We may need to encourage better communication with other care-givers, including doctors, therapists and friends. Rather than keeping a life-threatening illness secret, we should let our people know their responsibility to pray for and care for a brother or sister in need. Particularly, if a person facing death does not have close friends or family, he or she may feel that the church has become their family and only companions in their final earthly journey.
Many times we will also tend to the spiritual needs of family members as they face the illness and mortality of a loved one. They may have great difficulty in letting go and entrusting their beloved to God. We may need to help them know what to expect as an illness progresses. We may need to encourage them towards resolving problems and seeking reconciliation. We may need to help them know how to pray and what to pray for. We may need to encourage them to talk to their loved one who is dying, even when he or she is non-responsive, reminiscing and giving thanks for good times and positive influences. We may need to help them understand when it is time to call for the priest.
When caring for one with a serious illness, it is helpful for a priest to strive to keep a balance between being encouraging and optimistic on the one hand, and being realistic about circumstances on the other. Medical professionals will often diligently try one path of treatment after another and, given the advances of medical science, we know that life can be prolonged almost without end, but at what cost? When the priest is involved in the lives of his parishioners, it is easier for him to give a word of direction here and there, even saying that perhaps it’s time to let go, to stop the extreme medical measures and let things run their course. Many, if not most, people today would still prefer to die at home, surrounded by friends and loved ones than in the midst of the frantic activity of an Intensive Care Unit. We can suggest that consideration be given to Hospice care, when appropriate. We may anoint the sick and bring the Holy Mysteries as food for the journey. We may suggest one last confession of sins. Then when the time comes, whether in the hospital, at home, or in a nursing home, we attend and offer the beautiful prayers of the church at the time of death, prayers which speak to us of the mercy and faithfulness and love of God as He receives His children.
Up to this point I have spoken primarily of caring for those with life-threatening illness, but palliative care may also be offered to those with serious, chronic illnesses. Those who are facing a diagnosis of difficulty, reduced abilities and pain for the remainder of their lives need our care as well, and it may be easy for us to forget the trials they endure every day. We may need to work harder to remember and care for those in these situations. The possibility of depression developing is very real, even suicidal thoughts, as one considers what is to come.
Providing good teaching and a right understanding are essential parts of laying a proper foundation by which a Christian may approach suffering and death in a helpful manner. Our ministry, however, in the midst of suffering or as death approaches is focused more on helping one to be aware of the Presence of God. As we remember the sufferings of Job, we are reminded that Job never received an answer as to ‘why’ so many things happened to him. Rather in answer to his faithful prayers, even as he struggled with all that befell him and struggled with God, (as one commentator observed) “Job received not an answer but the Answerer” and so he was able to declare his hope in God: “I know that my redeemer liveth, and that he shall stand at the latter day upon the earth: and though worms destroy this body, yet in my flesh shall I see God.” As clergy, we need to be present, to listen, to be aware of changes, to suggest that counseling or therapy may be needed, to suggest resources, to remind parishioners of their brother or sister in need.
In our ministry we pray for the sick and the suffering in many ways. We pray for physical healing when it is God’s will, but we also should pray always for repentance and healing of the soul, helping our spiritual children to draw closer to God, whether death is imminent or at some undefined point in the future, all in God’s time. God hears our prayers and it is our privilege to walk with our parishioners as they strive to work out their salvation, with God’s help, with our help, with the help of friends, angels and saints. We know the good news of the resurrection. We know that hope casts out fear. Love and life conquer sin and death. In the words of St. Cyprian of Carthage: “Beloved brothers, with sound mind, with firm faith, with rugged virtue, let us be ready for every manifestation of God’s will; freed from the terror of death, let us think of the immortality that follows. Let us show that this is what we believe, so that we may not mourn the death even of our dear ones and when the day of our own summons comes, without hesitation but with gladness we may come to the Lord at His call.”
PALLIATIVE CARE IN THE PASTORAL MINISTRY: SELECTED BIBLIOGRAPHY
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Barna, J. Mark and Elizabeth J. A Christian Ending: A handbook for burial in the ancient Christian tradition. Manton,
Breck, John. God With Us: Critical Issues in Christian Life and Faith. Crestwood, NY: St. Vladimir’s Seminary Press, 2003.
_______. Longing for God: Orthodox Reflections on Bible, Ethics, and Liturgy. Crestwood, NY: St. Vladimir’s Seminary Press, 2006.
Breck, John and Lyn. Stages on Life’s Way: Orthodox Thinking on Bioethics. Crestwood, NY: St. Vladimir’s Seminary Press, 2005.
“Death, the Threshold to Eternal Life”. On-line article found at www.goarch.org/ourfaith/ourfaith7076.
Engelhardt, H. Tristram Jr. and Ana Smith Iltis. “End of Life: the Traditional Christian View”. Originally published in The Lancet, but on-line at www.csu.edu/clubs/bioethics/Christian.pdf, 2005.
Evdokimov, Paul. Ages of the Spiritual Life. Revised Translation by Michael Plekon & Alexis Vinogradov. Crestwood, NY: St.Vladimir’s Seminary Press, 2002.
Hierotheos, Metropolitan. Life After Death. Translated by Esther Williams. Levadia, Greece: Birth of the Theotokos Monastery, 1996.
Hopko, Fr. Thomas. “Life After Death…Mysteries Beyond the Grave”. Transcription of a talk found on-line at www.orthodoxchristian.info/pages/afterdeath.htm, 1999.
Meyendorff, Paul. The Anointing of the Sick. Crestwood, NY: St. Vladimir’s Seminary Press, 2009.
Morelli, George. Healing, Volume 2: Reflections for Clergy, Chaplains, and Counselors. Fairfax, VA: Eastern Christian Publications, 2011
Muse, Stephen, ed. Raising Lazarus: Integral Healing in Orthodox Christianity. Brookline, MA: Holy Cross Orthodox Press, 2004.
St. Elizabeth Committee. “Resources in Preparation for Dying, Death and Burial”. Booklet from St. Nicholas Orthodox Church (OCA), Portland, OR, found on-line at https://oca.org/cdn/PDFs/Christianwitness/ 2004SaintNicholasChurchResourcesBooklet.pdf, 2003.
Schmemann, Alexander. O Death, Where is Thy Sting? Translated by Alexis Vinogradov. Crestwood, NY: St. Vladimir’s Seminary Press, 2003.
Veronis, Fr. Luke, ed. Lynette’s Hope: The Witness of Lynette Katherine Hoppe’s Life and Death. Ben Lomond, CA: Conciliar Press, 2008.
Westberg, Granger E. Good Grief: A Constructive Approach to the Problem of Loss. Minneapolis, MD: Fortress Press, 1997 (Non-Orthodox, but used by many hospice organizations).