Pastoral Thanatology

The Pastoral Care Giving Provider as an Exquisite Witness

Posted on by Dominick Flarey

What is an Exquisite Witness in Pastoral Care?

Mother Theresa is an excellent example of an Exquisite Witness(Photo by Túrelio)
Mother Theresa is an excellent example of an Exquisite Witness(Photo by Túrelio)
In Pastoral Care, one crosses the line of just merely a provider but also a spiritual friend.  A friend who is there to comfort and reassure the spiritual and emotional element of a patient.  An Exquisite Witness is one who personifies this element of care of the dying.
From a defintion, an Exquisite Witness is a “health care, pastoral, or volunteer care provider  who enters the sacred space between two human souls-having the deepest respect for the yearning, seeking, and wishful hopes of the other to diminish the pain and survive in a new world after a loss.”
Beyond this, an Exquisite Witness is not judged by training but one’s willingness to care for other people and treat them with respect as they face the unknown of death.  St. Theresa of Calcutta comes to mind when one thinks of someone with such deep sancity and care for the sick.
Ultimately when it comes to witnessing, it is jouney where one does not pretend to have all the answers or cures but instead takes the time to sojourn with someone-to listen, observe and follow.
In Pastoral Care Giving, a witness also enters into three dimensions of care.  The first is the heart dimension.  Within the heart dimension, one finds the process of how old personal losses rise to mind when dealing with someone else’s current losses.  Sometimes these memories can affect the caregivers ability to properly witness.  The old memory haunts them so they avoid the current patient, or the old memory prevents the caregiver from focusing on the current pain of an indiviudal.  Caregivers must address the heart dimension of caregiving if they wish to properly care for the sick and dying
The second dimension is the head dimension.  This dimension is one’s knowledge of what grief is and how it applies to certain cases.  One’s experience and education are key elements to the head dimension.
Finally, the third dimension is the hands dimension.  This represents how the care provider acts and performs his or her duties for the patient.  It represents how the witness engages the grieving during their process of mourning.
These three dimensions are key to what we call an Exquisite Witness.  Hopefully as care givers we can all utilize our talents, as Mother Theresa, and help the dying find peace and solitude.
If you are interested in Pastoral Thanatology, please review the program.
(Information for this article was found in “Helping Grieving People-When Tears Are Not Enough” by J. Shep Jeffreys.)
Mark Moran, MA, GC-C, SCC-C

Cultural Diversity in Care Giving

Posted on by Dominick Flarey

Caregivers Need to be Culturally Sensitive to Their Patient’s Needs

As the world has become smaller, interaction with other creeds, cultures and races has become more prevalent in all aspects of life.  Caregiving is no exception as doctors, nurses, pastoral counselors and other caregivers find themselves in direct contact with different cultures who demand and deserve certain care.
Within the area of grief, it is essential, according to John Bowlby, that we understand cross-cultural ideals, especially in grief to better provide the vital care patients need.  Rituals, mourning, and family interaction varies from culture to culture and  health care providers need to respect these particular cultures in their  treatment.  By becoming educated with the basics of religious and cultural ideals a care provider can be better equipped to treat his/her patient.  Yet, before generalizations enter into one’s mind, the caregiver must also realize that there are deviations from the norm and not to expect certain reactions from a particular group merely because of their background.
Unfortunately, they did not teach this in medical school and sadly, it may not have even been considered important but only an after thought.  However, as trained caregivers who aspire to a certain level of professionalism, it is important to be educated in regards to the world and potential patients.

The “House” Syndrome

The lack of bedside manner by many caregivers has given rise to pastoral caregivers to become a crossroad between patient and provider, but the “cultural malpractice” by primary providers still remains a concern.  Doctors and many health care providers seem to care only about the healing of the body or the cure of the disease instead of the treating the entire person.  This “House” syndrome, from the celebrated television drama, is only too many times the norm.  The doctor is more concerned with the puzzle and relates very little to the humanity or cultural diversity of the individual they are treating.
Primary caregivers need to understand the spirituality and the culture of each patient.  This is why it is so important for primary providers to do spiritual assessments of patients.  This can be done by a simple conversation with the patient or with the family.  In this assessment, you can become familiar with how the person views life and what religious affiliations he/she has.  Also in doing this, a doctor can treat the whole of the person.  A patient who is beyond saving, sometimes wants someone to pray with them.  Although doctors need to keep a certain distance to maintain objectivity, there are certain times when praying with a patient may be acceptable, especially if requested or both share the same faith.   Spiritual assessments not only help the doctor become more sensitive to the cultural element of the patient but also enables the doctor to be more than a guy in a “white coat” but also a fellow human being who cares.
If you are interested in Pastoral Care Giving, please review the program.
(Information for this article was found in “Helping Grieving People-When Tears Are Not Enough” by J. Shep Jeffreys)
Mark Moran, MA, GC-C, SCC-C

Who Cares About the Pastoral Caregivers?

Posted on by Dominick Flarey

Pastoral Care for the One Who Cares the Most

My grandmother cared tirelessly for my grandfather and as his health gradually deteriorated he became more needy in his everyday activities.  Fortunately for my grandfather, my grandmother was a nurse and knew how to care for someone who was gradually becoming less and less physically capable.  Her energy level was amazing and my grandfather through the final two surgeries received top notch care and affection.  After my grandfather’s eventual death, my grandmother finally slowed down some herself, almost as if her body knew she no longer was needed everyday.   Still alive, still moving, but now with a cane, my grandmother showed her own pastoral and emotional care for my grandfather through the fulfillment of her vow-“in sickness and health”.
Many primary caregivers are not as energetic or well trained in end of life care as my grandmother, however, even my grandmother showed the tired face and burnout that accompanies caring for a loved one.  This can be twice as draining on someone with little knowledge or training to care for the sick.  The constant pressure and beat of the drum that pushes the primary care giver to doctor visits, prescription and medication study, dosage delivery, feeding, cleaning and the emotional realization that the one you love is going to die soon is overbearing.
Professionals recognize this as caregiver grief.  This type of grief not only affects the primary caregiver emotionally over the loss but it also strips from them the loss of a future and loss of freedom.  The vacation that was once planned by a couple is now forever gone as a faithful wife tends to a crippling disease that is killing her husband.  Or, that special 50th wedding anniversary will not become a reality because one’s wife will not live to experience the 49th one.  In addition, the loss of freedom strips the primary caregiver of the ability to go to the movies, or visit others at a picnic.   Gradually, the vocation of caregiving for their loved one, forces these people to give up on extra curricular activities because the demand of care is so overwhelming.  This was not only the case with my grandmother, but also my other grandmother who also gives up much of her time and energy for care of her husband.  How many times do we see our loved ones becoming burnt out because we will not take that simple step to offer an hour or two of our day?
Pastoral counselors need to let the primary caregivers know that it is alright to be tired and it is alright to take time off.  Pastoral counselors need to emphasize occasional relief through other family members or respite care.  Respite care is available within hospice and can help the primary caregiver have a few days to him or herself.  The National Family Caregivers Association sometimes helps charitably with the fees for hospice in this service.

Most importantly, pastoral caregivers need to let the primary caregiver know that is alright to feel emotions of guilt, resentment and anxiety at times towards the dying loved one.  These are natural emotions and do not mean that one does not love or wish to not care for one’s dying partner or parent.
In fact, after the death of a terminally or chronically ill person, sometimes the primary caregiver is known to have some relief.  Not in a relief that the one they love has died but a relief that they have performed their duty with courage and devotion and that their loved one is now free from suffering.
With these things in mind, who cares about the primary caregiver?–everyone should.
If you are interested in Pastoral Care Education, please review the program.
Mark Moran, MA, GC-C, SCC-C

Pastoral Care and Use of Advance Directives

Posted on by Dominick Flarey

Pastoral Care Giving and Advance Directives

It is important in Pastoral Care to also ensure that the needs of the dying patient are met in full.  This not only involves physical and spiritual support but also helping one fulfill their end desires for themselves or family.  Advance Directives are essential elements in knowing exactly what the dying patient would want or wish if he/she is unconscious or unresponsive in his/her final hours.
An Advance Medical Directive can solve many problems in regards to who takes charger in an event if the person loses consciousness.  It also lays out groundwork for care givers and medical providers to follow in regards to medical treatment with regard to extra-ordinary life sustaining measures and whether to pursue prolongation of life or pursue comfort measures.
These questions can become very confusing if there is no Advance Medical Directive to follow and the care givers, medical providers and family members can enter into a guessing game that can lead to numerous debates.  If there is a Advance Medical Directive, the proper authorities should receive it and utilize it when the path becomes murky regarding ethical or medical decisions.
The Directive itself lists who the patient wishes to be his/her health care representative with alternate choices following if the primary representative is unable to perform his/her duties.  Following this is a list of situations that involve pain and suffering, mental incapacity, physical immobility, physical helplessness, interest of loved ones and potential living situations.
Ultimately the autonomy of the patient is a critical concern in pastoral care.  As long as the requests are within reason, a patient’s rights must be met and listened to.
If you are interested in Pastoral Care Education, please review the program.
Mark Moran, MA, GC-C, SCC-C

Euthanasia: A Pastoral Care Paradox?

Posted on by Dominick Flarey

Pastoral Care and Euthanasia

Many in pastoral care are faced with the dilemma of euthanasia.  Although banned in many states, the right to die movement is a powerful one.  This movement, however, is far from pastoral.  It may paint images of taking someone out of their misery with compassion or ironically tying the words “mercy” and “killing” together, but if one looks beyond this, one will find nothing pastoral regarding euthanasia.
Euthansia is murder.  It is that simple and those who seek to bring Christ to the dying and wish to represent a pastoral element can never condone it.  Euthanais is suicide of despair.  It is the rejection of Christ’s will and cross he has given someone.  Furthermore it is the attempt to make oneself the author of life instead of God.  As a sin of suicide, it shows the active act and the direct willing of death by the agent and requires the assistance of an outside agent to conspire in this taking of life.  With this, it contradicts the laws of life and mocks the oath of all doctors to preserve life.
From a pastoral element,however, one is stricken with the images of such pain and suffering.  Obviously a person in such condition does not deserve harsh criticism for seeking death but to the one thats duty is to preserve and protect is a different story.  While some may be acting out of ignorance in such affairs, it is imperative that care givers realize that true pastoral care is not about ending life but comforting the final phase of it.
In such ways, hospice takes those who cannot survive via ordinary measures into its fold.  These patients do not wish to end their life, but wish to spend the remainder of it as God wills.  Of course, God does not forbid one to find comfort in sickness and sorrow.  In this way, one who seeks death willingly or actively but merely accepts the natural reality of life does not contradicts the laws of God.  From another extreme, as care givers, we cannot forget also that while some piously champion the value of life, they sometimes forget that unnatural prolongation of life or the use of extraordinary measures to preserve life are unneeded and sometimes more burdensome and painful to the dying and his/her family.
It is for these reasons that when one accepts the fact of death, one can with good conscience deny extraordinary measures and know they have not given in to the despair of euthanasia but instead have carried their cross to their own calvary with Christian dignity and heroism.

Pastoral care givers need to focus on making the journey of the dying to their personal Calvary a spiritually and emotionally healthy experience where comfort, love, and support are given instead of despair.
If you are interested in Pastoral Thanatology Education, please review the program.

Mark Moran, MA, GC-C, SCC-C

Hospice and Pastoral Care

Posted on by Dominick Flarey

Hospice and Pastoral Care Giving

For many the choice of hospice is a painful one.  Intrinsic to hospice is the idea that one has given up and medicine can no longer save one’s loved one.  One feels defeat and dismay but the reality is one is freeing him or herself from the bondage of self and accepting the will of Christ.  Pastoral Care Givers have an opportunity to help others accept the final leg of their journey.  They can also help families learn acceptance and find some joy in the final days.  Furthermore, once prolongation of life is no longer the goal, then comfort becomes primary.  This is the essence of hospice.  It accepts the end but allows the person to die with dignity, comfort and consolation.  It is not defeat but victory over denial.  In many ways it is heroic decision for a person to submit his or her will to Christ and prepare for the next world.
Hospice should actually be seen as a pasture for the dying.  The word actually comes from the Latin word, meaning hospitality. With such a warm meaning, it points to a better ending for the dying.  In fact,  88 percent of the dying wish to die in their own home.  Hospice in most cases can make this happen, unless certain critical conditions prevent this.  It was a great joy personally to allow my grandfather to pass away in the comfort of his home.  Fortunately, my grandmother was a retired nurse, but this is not the case for many and hospice gives individuals a chance to die comfort with dignity.
Hospice as a care giving service focuses on the whole human person instead of just the medical condition of a person.  It  has professionals who specialize in physical comfort for those dying of particular diseases but also professionals in counseling and ministry that help one find solace in their final moments.  Although hospice service is only for those diagnosed with six months to live, there are many people who are re-diagnosed and have received care longer.

Hospice Services

Hospice offers four types of care.  The first type of care is routine home care.  Standard services and visits are conducted in this first type of care.  Registered nurses, chaplains, social workers and other care givers can come to the home and check on the patient.  The second type of care is Respite Care.  Within this care, a patient can spend five days with the hospice unit giving the primary care giver the much needed time to relax and refocus.  The third type of care is General Inpatient Care.  This type of care is a continuing care for someone who requires special treatment and care before death.  The final type of care is Continuous Care.  This type of care service allows the patient who is near death to stay home but is cared for by a mobile unit.

These services are critical in fitting a certain person’s needs but also giving the person the spiritual and emotional comfort before death.
If you are interested in Pastoral Care and care for the dying, please review the program.

Mark Moran, MA,  GC-C, SCC-C

The Spiritual Message of Pastoral Thanatology

Posted on by Dominick Flarey

Pastoral Counselors Must Be Like the Good Samaritan

The spiritual message of Pastoral Thanatology echoes with the words of Christ when he said “when you do something for the least of your brethren, you do it for me”.   When a pastoral counselor walks downs the halls of a hospital or nursing home, he or she should see Christ in all the faces of the people.
Christ pointed this out best in his parable of the “Good Samaritan” where only a Samaritan was willing to help an injured man.  Pastoral Counselors encounter Christ in the faces of the suffering on a consistent basis.  Their career becomes a vocational calling.  As ministers, nurses and

counselors they come across the face of the grieving and dying on a consistent basis and can bring joy and consolation to those who have no other to turn to.
In the end, a pastoral counselor will definitely have an opportunity to find Christ in the least of one’s brethren and be able to triumphantly answer Christ that they did indeed help those who were most needy.
If you are interested in the Pastoral Thanatology Certification Program, please review it.

By Mark Moran, MA, GC-C, SCC-C

Pastoral Thanatology and Judaism

Posted on by Dominick Flarey

Judaism and Pastoral Thanatology

As a Pastoral Counselor and Thanatologist, it is important to have a broad understanding of all religious ideals and faiths.  This enables the counselor to pastorally care for the suffering and soon to die in a compassionate way that accommodates the individual.  Christians will not always deal with Christians, so it is important to broaden one’s theological knowledge into all faiths.   We will briefly review some of the primary concepts of Judaism and death to sharpen one’s knowledge in inter-faith dialogue and practice.

Judaism as a non-creedal religion has various interpretations on the afterlife, but the general consensus is affirmation of the next world.  Heaven and Hell again or not clearly defined but within the Jewish circle, most contend that it is a reunification with God and a sharing of happiness with family.  Salvation is based upon a good life on earth that is open to all people.  One does not need to share in the Jewish religion to be saved, but must adhere to a good and moral life to obtain salvation.   Upon death all are judged and eventually share in the resurrection.  Resurrection is believed to be physical if a Traditional Jew, while the resurrection is believed to be only spiritual if one is a Reformed Jew.  These slight differences and no dogmatic declarations leave one with a small variety of differences, however, if counseling a dying Jew, one can rest assured if the Jew is religious, he or she shares in a belief of God and the afterlife.
In regards to burial, the traditional Jew is placed in a simple wooden box casket and clothed in plain white shrouds.  These shrouds are placed upon the deceased after the cleansing prayers.  The funeral itself is divided into two parts.  The first is held at the synagogue or funeral home and the second is held at the gravesite.  Mourning, freedom of emotion and other public expressions are encouraged here as the relatives and friends share in their grief.
As a pastoral counselor this information is important, but most important to the science of Thanatology is the care of the dying.  In Judaism, care for the dying is extremely important.  The person who is dying must be constantly attended to and never left alone.  All of their wishes, even the most minor thirst, must be answered.  Close members of the family consider these to blessed tasks.   Such close care allows the family to express their love but also to give the dying a sense of peace and love.  Once the person has expired, the son or nearest relative closes the eyes and mouth of the parent are closed.  The body then undergoes a ritualistic series of cleansing and purification.
It is important if witnessing the death of a devout Jew to understand these rituals.  While you may not partake individually in these functions, having a solid understanding of them may come to be of service to the family.  It is also important for the dying themselves to feel understood.  Potentially sharing scripture and God’s love can be of great service to a dying Jew.  Remember, if a Theist, there is much Christians and Jews share in regards to the God of Abraham.   Share these precious mutual stories and beliefs of faith that bind Christians and Jews alike.  In the end, that is what will allow you as a Pastoral Counselor to succeed in inter-faith dialogue.

Pastoral Thanatology and Islam

Posted on by Dominick Flarey

Islam and Pastoral Thanatology

Islam while a Monotheistic creed does pose a challenge for a Western counselor.   The Pastoral Thanatologist, however, can meet the needs of the Islamic suffering by covering the general aspects of paradise and a good and just God; a God that is the same and shared by all monotheistic traditions as the God of Abraham.   Still, a slight understanding of Islamic death and eschatology can be of great benefit when counseling a Muslim who is about to die.
Upon approach of death of a Muslim, verses of the Quran are read to remind the person of his faith.   At the moment of death, ritualistic purification is necessary.  These rituals play a pivotal role in Islam and at the moment of death such rituals continue to play an important role.  One such ritual is the washing of the body.  This ritual is conducted by a professional washer who recites part of the Quran.  After completion of this, the body is wrapped in a white shroud and taken to the Mosque.  There a service is conducted with readings from the Quran and other rituals. 

Within 24 hours, the body is prepared for burial.   The body then is laid in a wooden coffin facing Mecca.  Practices such as embalming or preservation or forbidden since the theology of Islam believes the body should return to the ground as quickly and naturally as possible.   During the following months after death, the family continues to pray for the deceased begging for his or her intercession before God.
The Eschatology of Islam contains many common principles with other Monotheistic religions.  The theme of life after death, judgment and resurrection of the body are shared within the Muslim community.  Ideas of reincarnation and other Eastern ideals are rejected.   Upon judgment of the soul, it is either condemned to a life of bliss or life of torment.   Some believe the “fire” can be temporary for purgation while some others are in doubt whether the fire is eternal.  In regards to heaven, Muslims believe it is the reward of the just, but, according to some, can still be attained by those who suffer purgation.   Regardless, all Muslims believe the soul returns to the grave whether to exist in a state of bliss or a state of misery until the end day.  Upon that day, the souls undergo a general judgment and enter into the “garden” of paradise or enters into the “fire”.   Again, the eternal nature of the “fire” is an open debate among Muslims.   Some literalistic Muslims refer to the bridge that must be crossed on that judgment day.  The souls of the just across a wide bridge across the fire to the garden.  They are beckoned by the Prophet, Mohammad.  While the souls of the unjust have a narrow bridge as sharp and narrow as that of a sword.   Upon this day, the souls are finally granted their reward or punishment.
In understanding these slight differences of eschatology and death, Western pastoral counselors can better comfort the grieving and suffering people of the Islamic world.  Whether it be to the one who is about to die or the family that surrounds him or her, an understanding of the Quran and eschatology of Islam would always be appreciated by those in need and anguish. 

By Mark Moran, MA
 

Pastoral Thanatology and Hinduism

Posted on by Dominick Flarey

Hinduism and Pastoral Thanatology

Pastoral counselors or Thanatologists can come into contact with an array of theologies that are not particular to the West.  Many of the Eastern religions are no exception to this.  It is very important for the counselor to be aware of at least some of the theology of these religions, especially in regards to death.
Hinduism is one of the key Eastern religions.  It surpasses Buddhism in age and many of the tenets of Buddhism derive from Hinduism.  There are slight differences regarding the essence of God, the number of reincarnations, and final enlightenment, but the preparations for death have the same essence and core; death is preparation for the next life or enlightenment.  So 

despite the different rituals and slight theological differences both religions share a common theme in regards to how death is viewed.
Hinduism views death as a portal to the next life and eventual enlightenment or reunion with Brahman.   However, the cycles of reincarnation can be endless until that reunification is finally achieved.  Karma determines not only when the cycle of  rebirth will end, but also the quality of life in the next rebirth.  Hence good living and good dying is critical to a Hindu. 
The purpose of the Hindu rites of the dead is to ensure that death is a smooth transition for the deceased and that he or she may attain enlightenment or a good rebirth.  While these rites can last up to a year, most rites only last ten days after the death of the family member.  Prior to death, the soon to be deceased is surrounded by family and read to from the holy texts of the Veda and Bhagavad Gita.  After the initial death, usually a son then cleanses his parent’s body.  Drops from the Ganges River are sometimes applied at the lips.  Following this, the body is wrapped in white.  Within a day or two, the body is prepared for cremation, so that the body may travel to the next life.  The body is also burned as a sacrifice.
During the ten days, the family offers various prayers and offerings to God and also the Brahmins on behalf of the deceased.  While the karma of the deceased will ultimately decide his or her fate, these prayers can be of some benefit.  Finally after the tenth day, the ghostlike period of the deceased ends and on the eleventh day the soul will find enlightenment or a new rebirth; the quality of that rebirth being dependent upon the karma of that person.   Eventually after the soul learns the value of self sacrifice and love, it can claim its reunification with Brahman.
Knowing these theological beliefs and reading the texts of Hinduism can ensure that one who deals with pastoral issues of death can be of help and comfort to someone with these beliefs.  It is not an issue for Western counselors to change their beliefs but to be well informed and a better global care giver to the many needs of other cultures in addition to the needs of the West.
If you are interested in the program, please click here.