Ministry to the Terminally Ill

A few months ago my brother died in a hospital in Chicago. He was only fifty. His basic illness was emotional and spiritual, not physical. He had a great need to be recognized and accepted, to be a somebody, to feel satisfaction as a bread-winner, husband, and father. When in his late forties it became evident that he would not succeed in any of these, he began to die more rapidly.

My brother was an alcoholic. But this form of slow suicide which he had practiced for twenty years or more seemingly was not fast enough for him. Last July during one of his “benders” he told me he had cancer. I know this was only his own idea, not that of a doctor, and I didn’t take him seriously. But when he underwent exploratory surgery last August, his prediction turned out to be true. The diagnosis was the death sentence he wanted. Statistically he had a 30–40 per cent chance of “beating the rap.” But deep down within him, in the psychic processes we call the unconscious, the “death instinct” had taken over.

One day he talked frankly to me about his death: “Dying is the best thing that can happen to me. Will you say a few words over me when I’m gone? Tell them I lived a rough life and didn’t amount to much.”

The ministry of a pastor to a terminally ill patient can be considered in two ways, as a person-to-person relationship and as a symbolic ministry.

Religion—which is for me centered in the Gospel of Christ—is best communicated in a face-to-face relationship, I feel. Religion that remains isolated in words, concepts, doctrines, strikes me as cold and distant. My ministry as a pastor, then, is to incarnate (imperfectly, to be sure) those theological truths of God’s love, understanding, and acceptance.

This person-to-person ministry includes the following personal expressions:

1. Listening. To listen well is hard work, but it is very important for a pastor. I listened to my brother’s review of his life. A bad-conduct discharge after fourteen years in the Navy, divorce, dissatisfaction, failure to be a father to his son—this was a part of what came pouring out.

2. Understanding. Could I sense what it was like to be in my brother’s shoes? Could I feel a part of the body reduced to eighty-five pounds, with an open wound in the abdomen? Could I sense something of the failure he had experienced? Could I begin to understand what it was like to work up to a fairly good job and then time after time end up at the bottom?

3. Acceptance. This is the crucial part of any relationship. Am I acceptable just as I am to the other person? I am opposed to pastors or religious groups who push toward conversion without showing acceptance of the person as he is.

The key to acceptance of my brother was my seeing myself in him. I could accept his prodigal ways because I too was a prodigal. Accepting myself became the key to accepting him.

A person who cannot accept himself and deal realistically with his own guilt is ill fitted for a pastoral ministry. How can he possibly accept others in their guilt, if he has never accepted his own?

4. Reality confrontation. At times during my brother’s illness he thought he was nearly well and was going home. My discussions with the doctors were enough to convince me that this would probably never happen. Although I too had trouble accepting this, time and time again I gently tried to bring this fact home to my brother. “I want you to get well, but you may die.” He always liked my frankness. He did not like “doctor talk” that brought about false hope.

5. Support. This is the reassurance, the encouragement, that each of us needs when the going is rough. Often my brother felt like screaming out between pain shots. It was more than he could stand, he thought. How would he make it through the lonely hours of the night? The doctors and nurses and I all tried to work together to provide this support he so desperately needed.

6. Hope. The hope I tried to communicate had two sides. One part of it was for now. I hoped he would recover and have a chance to live the satisfying life he had never lived before. I grasped at little improvements along the way—an increase in appetite, in alertness—and communicated this hope to my brother, the hope that he would live. This may seem like a paradox. How could I do this and yet also confront him with the fact of probable death? I don’t know. Somehow I managed to hold these two together.

The other hope I tried to communicate to my brother, a hope that I believe he accepted, was hope in a God who loved and cared for him.

The second part of the pastor’s ministry is the symbolic side. By this I mean that he is a representative of God, religion, the Church. What he represents is largely determined by persons to whom he ministers. It is up to the pastor to meet the patient at whatever image of God he holds and help him work through toward the concept of a God of love. Many people under the stress of illness see God as a stem punisher. The pastor needs to communicate a God of love, not only in what he says but also in what he does. His symbolic ministry includes anything he does to help the patient draw upon religious resources.

Prayer is the most common religious resource. My brother tended, at first, to look upon prayer as a way of stemming the tide of illness—almost as a form of magic. In another stage of his illness, he used it to help him face the pain, to hold himself together. The most touching way he used it was to offer his life, his soul, to God. His prayers here reflected acceptance of death and surrender to God.

The sensitive pastor prays selectively. He does not always pray with every patient, nor does he always pray the way a patient desires. His prayers should have elements of comfort, reality, and hope all bound together, if possible.

Scripture is another important resource. The pastor needs to select passages carefully to meet the need of the patient. My brother saw himself as the prodigal son of Luke 15. The comparison fit, and it helped him feel accepted by God.

The pastor should have selections of Scripture ready in his mind. Portions like the Twenty-third Psalm still bring comfort.—HAROLD R. NELSON, director of pastoral care, The Swedish Covenant Hospital, Chicago, Illinois.

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