Spiritual Palliative Care A Christian approach to ministry in the valley of the shadow of death

Jesus Christ says: The Spirit of the Lord JHWH is on Me, because JHWH has anointed Me to preach the gospel to the meek, He has sent Me to bind up the broken-hearted; to proclaim liberty to captives, and complete deliverance to the bound ones; to declare the acceptable year of JHWH, and the day of vengeance of our God; to comfort all who mourn; to appoint to those who mourn in Zion to give them beauty instead of ashes, the oil of joy instead of mourning, the mantle of praise instead of the spirit of infirmity so that one calls them trees of righteousness, the planting of JHWH, in order to glorify Himself, Isaiah 61:1-3

WHO1990: “Palliative care is the active total care of patients whose disease is not responsive to curative treatment. Control of pain, of other physical, and of psychological, social and spiritual problems, is paramount. The goal of palliative care is achievement of the best possible quality of life for patients and their families. Many aspects of palliative care are also applicable earlier in the course of the illness, in conjunction with anti-cancer treatment. Palliative care: 1.Affirms life and regards dying as a normal process; 2.Neither hastens nor postpones death; 3.Provides relief from pain and other distressing symptoms; 4.Integrates the psychological and spiritual aspects of patient’s care; 5.Offers a support system to help patients live as actively as possible until death; 6.Offers a support system to help the family cope during the patient’s illness and in their own bereavement. Radiotherapy, chemotherapy, and surgery have a place in palliative care, provided that the symptomatic benefits outweigh the disadvantages. Investigative procedures are kept to a minimum.”

Elements of palliative care (Steiner 2003) 1. Optimal identification of symptoms 2. Optimal relief of symptoms 3. Optimal interdisciplinary teamwork in the care 4. Optimal continuance of care 5. Optimal involvement of patient/family as real partners of the palliative care team 6. Optimal psycho-social support of the patient and family 7. Optimal spiritual support Pneumo-psycho-social care = spiritual care

World view (basic beliefs) + palliative care God Human being Ethics/Values/Norms Truth/Science/Research Health/Disease/Death Vision of palliative care Palliative care in practice

The course in a nutshell Prepared and cared-for care-givers seek to reach six goals via seven points of attention in their care of the dying person

The dying person a Christian perspective 1. Underlying view of man: 1. An integral whole created in image of God, Gen 1, 2 2. Inner person is primary aspect (leaves at death, James 2: 26) 3. Outer person is secondary aspect (will be replaced, 2 Cor 5) 4. At death the inner person is temporarily separated from outer person (rejoined with resurrection body, 1 Cor 15) 2. Care of inner + outer person important, Matt 25: Spiritual care = care of the inner person 4. Care of inner person = focus of this seminar

The dying person: 7 basic spiritual needs 1. Good relationship with God 2. Clear conscience 3. Hope 4. Meaning 5. Purpose 6. Life concluded with no loose ends 7. Prepared for the transition

The dying person over time a Christian perspective Conception Birth Death Second coming Paradise Hades New heaven and new earth Gehenna / Hell

Prepared care-giver: Face own death 1.Present behavior negatively influenced by past experiences? 2.Which feelings surface when you think about your death? 3.Know for sure where you are going when you die? Yes / No 4.Satisfied with ultimate destination? Yes / No 5.If you could choose, how would you like to die? 6.Which way of dying is the most unacceptable to you? 7.Which person most difficult to leave behind when you die? 8.Which things most difficult to leave behind? 9.Adequate preparations regarding your own death and burial? 1.Body / Possessions 2.Job / business 3.Ministry in the church, etc

Cared-for care-giver 1. Care for the care-givers = multi-facetted 1. Self-care: more input than output; re-creation 2. Team member mutual care 3. Team leader cares for team member well-being 4. Care by appointing body, including finances 5. Referred care if necessary 6. Professional group care: e.g. nursing society 7. Local church care 2. Care types 1. Informal: colleagues, friends, family 2. Formal: counselling, coaching, mentoring 3. Non-formal: seminars, in-service training

Six Aspects and Six Goals Aspects Losses Isolation Fear Guilt Emotional struggles Pain Goals 1. Work through the losses 2. Break through the isolation 3. Deliver from fear 4. Deal with guilt 5. Enhance emotional stability 6. Face the pain

A1: Understand their losses and grief 1. Wellbeing / ability to move around / physical self-control 2. External dignity / psychological dignity / mental dignity 3. Bodily strength 4. Identity / control and making of decisions 5. Relationships 6. Work and financial security / social status / possessions 7. Immediate future perspective 8. For not-yet-regenerate: the final opportunity to save their soul from second death 9. Ultimately, loss of own body

Goal 1: Comfort the grieving 1. Point to Jesus – He comforts the weeping, Lk 4: Help them to express their grief 1. Tell you / the Lord about their losses and how that affects them 2. Expressing grief is OK; self-pity leads to bondage 3. Encourage them to let go and say good-bye 1. social / psychological / physical / faith

A2: Understand their isolation/loneliness 1. Dying is an individual process 2. Social factors can contribute 3. Nature of the disease can contribute 4. Can experience isolation even when not so

Goal 2: Break through their isolation 1. Point to Jesus – He restores relationships, 1 John 1: 7 2. Ask ‘help me to understand’ questions 3. Explain own motives 4. Only make promises you will certainly keep 5. Be honest about own limitations / struggles 6. Use psychological ‘judo’ 1. Tell me about the pain behind your anger 2. What do you think is the answer? 7. Ask questions about ‘key words’ 8. Build relationship bridge

A3: Understand their fear 1. The nature and seriousness of the disease 2. The future / re family / re finances 3. Increasing dependence on others / Helplessness 4. Being a burden 5. Being alone, of being abandoned 6. Suffering and pain 7. Humiliation 8. Not being able to cope emotionally 9. Separation from loved ones / from God 10. The unknown 11. Punishment / judgment 12. Losing their mental capacities

Goal 3: Delivery from fear Point to Jesus – He delivers from fear, Heb 2:14-15 Show understanding and identify the fears  Draw a brick wall, each brick is a fear, name them Cast the fears on to Jesus Repent of unbelief where necessary Request Jesus to be Shalom Call on His Name whenever fears assail Involve others to stand with you Build faith; Ps 23; 1 John 4:18.

A4: Understand issues of guilt 1. Who is guilty: You / someone else? 1. who is really responsible? 2. Real / false 1. condemnation: if only…; did you … enough? 3. Guilt is the consequence of breaking a law; it is a judicial state, not a feeling 4. Four types of guilt 1. Personal 2. Social 3. Legal 4. Theological

Goal 4: Dealing with guilt 1. Point to Jesus – He forgives, Mark 2: Show way of repentance, 1 John 1: 9 3. Work towards true forgiveness 1. Transgression: name it; describe impact 2. Seek justice: legal, social, personal, theological 3. Give anger / bitterness / hate to God 4. Let transgressor go; leave vengeance to God 5. Come to God for healing 6. Hold the forgiveness available 7. Practice forgiveness each time it is remembered 4. Then work for reconciliation as possible

A5: Understand their emotional struggles Denial  Rebellion  Negotiation  Restlessness  Anger  Distrust  Despair  Disappointment  Doubt  Criticism  Depression  Bitterness  1. Insight 2. Surrender 3. Acceptance 4. Peace, clear conscience 5. Meekness 6. Trust in relationships 7. Courage, hope 8. Satisfaction 9. Certainty, security 10. Appreciation, gratitude 11. Comforted, joy 12. Reconciliation, forgiveness

Goal 5: Enhance emotional stability Point to Jesus – He is the Shepherd, Ps 23 Identify the struggle Agree on the positive element as the goal Agree on the route to get there Patiently walk the road together Let the suffering person indicate the pace Involve others where necessary

6. Understand whole person pain Transcendent

Goal 6: Face the pain together Point to Jesus – He knows suffering, Isaiah 53 Involve care team which includes the relatives Diagnose  Which of the ten aspects are relevant?  Describe the pain  Determine cause – where does that come from? Treat  Give appropriate treatment to both symptoms and causes

The Seven Points of Attention 1. Communicating eyes 2. Listening ears 3. Wise words 4. Loving hearts 5. Comforting hands 6. Praying knees 7. Serving feet

Point 1: Communicating eyes Mark 10: 21a Heart to heart communication through the windows of the soul Careful observation

Point 2: Listening ears John 4: 7-26; James 1: 19; Job 21: 1-3a Be fully there Ask specific questions

Point 3: Wise words Luke 4: 22a; Proverbs 13: 14; 15: 14; Mark 10: 51; Proverbs 12: 18b; James 3: 17 Be open, 1 John 1: 7 Give true hope, Hebrews 6: 18 Speak truth in love, Ephesians 4

Point 4: Loving hearts Matt 9: 36; 15: 32; Mk 6: 31-34; 2 Cor. 5: 14 Agape love:  Desire, choose and act for highest good Show compassion Luke 7: 13 Build a relationship of trust

Point 5: Comforting hands Mark 1: 41a Gather relevant information Impart comfort Appropriateness:  Approach  Duration  Location  Intensity

Point 6: Prayerful knees Luke 5: 15,16 Pray for the person Pray with the person

Point 7: Serving feet Luke 22: 27b; Mark 6: 30-34; 10: 45. Attitude of service Practical service

Revision: The course in a nutshell The prepared and cared-for care-giver seeks to reach six goals via seven points of attention in his relationship with the dying person

Conclusion Prepared to face your own death? What will change in your involvement? How will it change? Commitment for change