While AIHCP offers a Pastoral Thanatology Certification which aims at end of life and death counseling and spiritual care, pastoral care goes beyond merely helping individuals face the crisis of death, but it also stretches out throughout life where multiple pastoral and crisis events occur. Grief counseling, Christian counseling, as well as Stress Management and Anger Management are all key tools to help individuals face the problems of life, but crisis itself involves bandaging the bleeding wound and stabilizing the person emotionally and mentally. A person is crisis is facing a confusing and emotional imbalance that one’s coping strategies temporarily are unable to handle. The following can lead to immediate disorientation, loss of sense, and intense emotional outbreaks associated with sadness, anger, or hopelessness. In essence, ” for an individual, crisis is the perception or experiencing of an event or situation as intolerable difficulty that exceeds a person’s current resources and coping mechanisms (James, 2017, p. 9) “. For some in crisis, foolish decisions can be made, while others, inaction or inability to act can occur. Whether insanity and foolishness or numbness ensue, the person is in dire need of intervention to restore balance, reason and hope. The purpose of the pastoral counselor specialized in crisis intervention is to not only help the person restore that balance but also to give spiritual aid if needed. Chaplains and other on the scene professionals look to help these individuals in crisis find clarity and hope.
Chaplaincy plays a big role in pastoral crisis intervention.
Secular crisis intervention serves the most basic needs of those experiencing trauma or sudden loss. Whether a sudden deceased family member, a violent crime, a national tragedy, or act of nature, individuals need immediate care and assistance in these dark moments. Everly points out that traditional mechanisms of crisis intervention including early intervention, social support, cathartic ventilation, problem solving and cognitive reinterpretation are all essential basics for helpers in crisis (2000, p. 139). In addition, Mitchell looks at some of the most basic needs for those in crisis need through the acronym ASSISTANCE. Mitchell lists the need for Assurance of individuals that individuals, or the government will help in severe crisis. In addition, he lists Security is present and that children and families are safe if they follow directions and guides. Structure refers to order in chaos and the structure provided by others to help again restore order. Information refers to giving individuals in crisis, or part of disaster, the best knowledge and resources for a given crisis or disaster. Support refers to not only financial and guidance, but also mental and emotional support through crisis intervention as well as pastoral guidance. Truth refers to not hiding important information to those victims of disaster or terrorist action but letting them know everything pertinent to a situation to avoid further panic. Action refers to not merely thinking but also helping others in distress, whether it is the crisis counselor working with someone, or others helping a neighbor in need during disaster. Neutralize refers to negating pessimism but pushing forward with optimism and plans. Courage refers the inner resolve of those in crisis, disaster, or terrorist attack to move forward with renewed strength. Crisis and Pastoral counselors can play a key role in implanting this within individuals with words of encouragement. And finally this leads to Encouragement and being positive and pushing positive emotions and ideas with those in crisis but also fellow neighbors. (Mitchell).
Pastoral Crisis Intervention
These basic elements of helping others in crisis are core elements. It is important to help individuals by offering hope but also helping individuals find balance and restoring pre-crisis mental and physical health to help the person find logic and reinterpretation of the event to avoid insanity and inaction. Chaplains and other pastoral care givers who work in disaster sites, or work with police and fire can also offer another element of crisis care referred to as pastoral crisis intervention. When individuals in crisis of a particular faith are receptive, pastoral crisis interventionists whether at a death bed, hospice, sites of violent crimes, accidents, disasters, shootings or other terrorist acts can look to help sooth the soul as well. Everly illustrates various ways chaplains or other pastoral crisis interventionalists can apply pastoral care in crisis. He lists scriptural education, individual and conjoint prayer, intercessory prayer, explaining worldviews, offering ventilative confession, providing faith based support, supplying ritual and sacraments, and discussion of Divine forgiveness and discussions about life and death and the afterlife (2000, p. 140). Within this model it is also important to emphasize perceive reception for utilization of these strategies, which include receptive expectations from the person in crisis for spiritual care, or at least a receptive state of mind that is open to spiritual care, and finally not limiting it only to the person in direct crisis, but being there for other family members, police and rescue, as well as physicians, nurses and other healthcare professionals (Everly, 2000, p. 140).
Potential issues can erupt those for chaplains or other pastoral care givers. It is essential first and foremost not to see oneself as a spreader of the particular faith one adheres to. One is bringing spiritual comfort to those in crisis. Chaplains in hospice or on staff for hospitals, or even prisons, or those who appear on crisis sites are there to serve all people of all faiths. This is why they must be equipped with basic knowledges different religions, ranging from Christianity to Islam to Hinduism and Buddhism, as well as Judaism to even Taoism. In some cases, individuals may be merely receptive to hear a caring voice. Chaplains or those in pastoral care in crisis need to be aware of their role as bringers of peace. If a patient or victim of crisis shares the same faith values, then such issues of universal speech of spirituality can be narrowed down theologically to the faith shared, but when not, some victims may request someone else who shares the same faith, or even wish not to discuss spirituality. Sometimes, it is the duty of the chaplain to find a rabbi, iman or priest for a particular individual if one cannot meet the spiritual needs itself. When reception is not open, chaplains and other pastoral care givers in crisis must respect these wishes to avoid further stress and frustration within the individual. A person who is dying, or in crisis does not need further agitation if spirituality is discussed. Furthermore, chaplains, while present to give peace, are not equipped to offer certain faith based services to other individuals. For example, a minister is not able to offer Last Rites but must find priest, or in other cases, chaplains should not delve into religious practices they are not trained in or go against their personal beliefs. Such subjects should be left avoided or referred to other clergy capable and willing.
Pastoral Crisis Intervention works with receptive individuals looking for spiritual care during crisis.
Everly lists a few issues that can occur in application of pastoral crisis intervention that are important keys for chaplains and other crisis givers need to remember. Among them, he lists failure to listen to the secular needs of an individual. He further lists lack of a proper or structured plan when arriving upon a crisis or death scene. He also points out the the dangers of debating religious and spiritual issues with those in crisis, or attempting to explain theological issues, or preaching to a unreceptive individual, as well as trying to convert someone (2000, p. 141). Obviously these issues are addressed in chaplaincy training and crisis response. Chaplains learn in CPE training that they are present to offer peace not agitation. They are not their to convert but to help with whatever spiritual or emotional need is within the person who is in crisis or dying. Many who are strong within their faith may feel an inner obligation to bring their faith to the individual, but this impulse must be controlled for those who do not seek it or receptive to it. Not everyone will share the same faith, but one is called to serve all individuals and meet the unique needs of those individuals. One does not merely serve one’s own, but serves all common humanity.
In addition, Everly lists some diagnosis mistakes that can be made with individuals in acute crisis that should be avoided. Many times, individuals in crisis can be mistaken as depressed when it is merely grief reaction to loss. Also, chaplains and pastoral crisis interventionists need to be aware of brief psychotic reaction vs intrusive ideation, dissociation vs intrusive ideation as well as acute cognitive impairment vs severe incapacitation (2000, p. 141). Ultimately, many individuals need to be referred later to licensed counselors to deal with longer term issues after crisis. In some cases, the counseling may only need to be at pastoral levels but in other cases, clinical counseling may be required. Chaplains and crisis interventionists are again present to supply immediate emotional and spiritual first aid, much like an EMT who physically stops the bleeding or acute issues, while the nurses and physicians repair the long term damage. Likewise, chaplains and crisis intervention counselors later refer those who have stabilized to the appropriate behavioral health and human service professionals.
Conclusion
According to Evenly “Pastoral Crisis Intervention is the functional integration of pastoral activities with traditional crisis intervention/emergency health services (2000, p. 141)”. With this definition, one can see the important role chaplains play in helping individuals in crisis, whether due to terrorist action, natural disaster, violent crime, sudden death, or even near death in hospice or hospital settings. Chaplains are not to evangelize the Gospel but grant peace and spiritual presence. In some cases, they may be called to find a representative of the person’s faith, other times, they may be working with one of the same faith, but ultimately the goal is to treat all of humanity not only one of a particular faith. In this regard, chaplains must be trained in multi faiths and multicultural counseling competencies to better speak and help others in different faiths. In addition, chaplains are sometimes not even called to discuss spirituality because secular individuals in crisis may not wish to speak about it. Chaplains, especially those on crisis scenes are called to respect the wishes of others and bring calm and restoration of pre-crisis state of mind.
Please also review AIHCP’s Crisis Intervention Specialist Certification and also AIHCP’s Pastoral Thanatology Certification
Please also review AIHCP’s Crisis Intervention Program, as well as AIHCP’s Pastoral Thanatology Program. Both AIHCP’s Crisis Intervention Specialist Certification and Pastoral Thanatology Certification are online and independent study with mentorship as needed. The programs lead to four year certifications for qualified professionals.
Resources
Evenly, G. (2000) “The Role of Pastoral Crisis Intervention in Disasters, Terrorism, Violence and Other Community Crises”. International Journal of Emergency Mental Health.
James, R. & Gilliland, B. (2017). Crisis Intervention Strategies (8th). Cengage
Mitchell, J. “The Meaning of Assistance”.
Additional Resources
“National Hotline for Mental Health Crises and Suicide Prevention”. Naomi. Access here
Davies, B. (2023). “Crisis Intervention: Techniques and Strategies”. NWA Crisis Center. Access here
Cherry, K. (2022). “How Crisis Counselors Help People Coping With Trauma”. VeryWellMind. Access here
“A Chaplain’s Role in Times of Crisis”. (2019). Christian Reformed Church” The Network. Access here
In the complex landscape of healthcare, the role of a healthcare ethics consultant has become increasingly crucial. These professionals navigate the intricate web of moral dilemmas and ethical challenges that arise in medical settings, particularly in end-of-life care. Healthcare ethics consultants play a vital part in ensuring that patient autonomy, beneficence, and justice are upheld while addressing the legal and ethical issues in end-of-life care. Their expertise is especially valuable in hospice settings, where difficult decisions often need to be made with compassion and ethical integrity.
There are numerous standards and codes of ethics in healthcare regarding end of life and hospice care. Please also review AIHCP’s Healthcare Ethics Consultant Program as well as its Pastoral Thanatology Program
The path to become a healthcare ethics consultant involves rigorous training and certification. These experts must be well-versed in healthcare codes of ethics, ethical principles, and the nuances of patient care. They work closely with medical teams, patients, and families to tackle challenging situations, offering guidance on cultural considerations in end-of-life care. This article delves into the multifaceted role of healthcare ethics consultants in hospice patient care, exploring the ethical challenges they face, the legal and regulatory landscape they navigate, and the importance of self-care for those providing such emotionally demanding services.
Healthcare ethics consultants play a crucial part in navigating the complex landscape of medical decision-making, especially in end-of-life care settings. These professionals bring a unique set of skills and knowledge to the healthcare team, helping to address ethical dilemmas and ensure that patient care aligns with ethical principles and legal requirements.
The primary responsibility of a healthcare ethics consultant is to provide guidance on ethical issues that arise in clinical settings. They work closely with medical teams, patients, and families to analyze complex situations, clarify ethical concerns, and facilitate communication among all parties involved. By doing so, they help to resolve conflicts and support decision-making processes that respect patient autonomy, promote beneficence, and uphold justice in healthcare delivery.
Mediation
One of the key roles of a healthcare ethics consultant is to serve as a mediator in challenging situations. When conflicts arise between healthcare providers, patients, and families regarding treatment decisions or end-of-life care, the ethics consultant steps in to facilitate productive discussions. They use their expertise in communication and conflict resolution to help all parties understand different perspectives and work towards a mutually acceptable solution.
The consultant’s role in mediation involves active listening, clarifying misunderstandings, and helping to identify common ground among divergent viewpoints. By fostering open dialog and promoting mutual understanding, healthcare ethics consultants can often help resolve conflicts that might otherwise escalate or lead to legal disputes.
Policy Development
Healthcare ethics consultants also have an important part to play in shaping organizational policies and procedures. They work with hospital administrators and clinical leaders to develop guidelines that address ethical issues in patient care. These policies might cover areas such as advance directives, end-of-life decision-making, or the allocation of scarce resources.
By contributing to policy development, ethics consultants help to create a framework for addressing ethical challenges consistently across the organization. This proactive approach can prevent many ethical dilemmas from arising and provide clear guidance when they do occur. The consultant’s involvement in policy-making also ensures that ethical considerations are integrated into the broader organizational culture and decision-making processes.
Education
A significant aspect of the healthcare ethics consultant’s role is to educate healthcare professionals, patients, and families about ethical principles and their application in clinical settings. They organize and conduct training sessions, workshops, and seminars to raise awareness about ethical issues in healthcare and to equip staff with the tools to address these challenges effectively.
Education efforts might focus on topics such as recognizing ethical dilemmas, understanding patient rights, or applying ethical frameworks to clinical decision-making. By enhancing the ethical competence of healthcare providers, consultants help to create a more ethically aware and responsive healthcare environment.
Healthcare ethics consultants also play a vital role in promoting ongoing professional development within their field. They participate in continuing education programs, attend conferences, and engage in scholarly activities to stay current with evolving ethical issues and best practices in healthcare ethics consultation.
In conclusion, the role of a healthcare ethics consultant is multifaceted and essential in modern healthcare settings. Through their work in mediation, policy development, and education, these professionals help to ensure that ethical considerations remain at the forefront of patient care decisions. Their expertise is particularly valuable in hospice and end-of-life care settings, where complex ethical dilemmas often arise and require careful navigation to uphold patient dignity and respect the wishes of all involved parties.
Ethical Challenges in Hospice Care
Healthcare ethics consultants face numerous complex dilemmas when navigating hospice patient care. These challenges often revolve around decisions to withhold or withdraw interventions, balancing patient autonomy with beneficence, and addressing cultural considerations in end-of-life care. The ethical principles of autonomy, beneficence, non-maleficence, and justice serve as guiding pillars for healthcare professionals in making these difficult decisions.
Withholding/Withdrawing Treatment
One of the most significant ethical challenges in hospice care involves decisions about withholding or withdrawing life-sustaining treatments. Healthcare ethics consultants must carefully weigh the benefits and burdens of continuing or discontinuing interventions. While there may be an emotional difference between not initiating a treatment and stopping it later, ethically, there is no distinction between withholding and withdrawing treatment.
When an intervention no longer helps to achieve the patient’s goals for care or desired quality of life, it becomes ethically appropriate for physicians to withdraw it. However, this decision-making process requires open communication with patients, families, and the healthcare team. Healthcare ethics consultants play a crucial role in facilitating these discussions, ensuring that all parties understand the ethical implications and legal considerations involved.
Artificial Nutrition and Hydration
The use of artificial nutrition and hydration (ANH) in terminal illness, including advanced dementia, remains a contentious issue despite extensive ethical and empirical investigation. Healthcare ethics consultants must navigate the complex landscape of conflicting opinions and evolving medical evidence surrounding ANH.
Recent studies have shown that ANH often provides little benefit to terminally ill patients and may even cause harm. Complications such as aspiration pneumonia, need for physical restraints, and increased respiratory secretions can significantly impact a patient’s quality of life. However, cultural and religious beliefs, as well as misconceptions about ANH, can lead to family resistance when considering its withdrawal.
Healthcare ethics consultants must work to educate patients, families, and healthcare providers about the current evidence regarding ANH in end-of-life care. They must also consider the patient’s previously expressed wishes, cultural background, and religious beliefs when making recommendations about ANH.
Terminal Sedation
Terminal sedation, also known as palliative sedation, is another area where healthcare ethics consultants face ethical challenges. This practice involves the use of sedating medications to induce decreased or absent awareness to relieve otherwise intractable suffering at the end of life.
While palliative sedation can be an effective tool for symptom management, it raises ethical concerns about the distinction between sedation and euthanasia. Healthcare ethics consultants must ensure that the intent of palliative sedation is clearly documented as the relief of suffering, not the hastening of death.
The use of palliative sedation for existential or psychosocial suffering, rather than physical symptoms, is particularly controversial. Some argue that suffering is a dynamic and transforming process that offers opportunities for healing at the end of life. Healthcare ethics consultants must carefully consider the ethical implications of using sedation for non-physical suffering and work to ensure that all other options have been exhausted before recommending this approach.
In navigating these ethical challenges, healthcare ethics consultants must remain committed to upholding the principles of autonomy, beneficence, non-maleficence, and justice. They must work to ensure that hospice care decisions are made in the best interest of the patient, taking into account the patient’s wishes, cultural background, and the most current medical evidence. By doing so, they can help to provide compassionate, ethical end-of-life care that respects the dignity and autonomy of each individual patient.
Cultural Considerations in End-of-Life Care
There are many religious and cultural beliefs that healthcare professionals must be aware of when dealing with the dying as well as ethical obligations to those religious beliefs
Cultural considerations play a crucial role in end-of-life care, as they significantly influence patients’ and families’ preferences, beliefs, and practices surrounding death and dying. Healthcare ethics consultants must be sensitive to these cultural nuances to provide compassionate and culturally competent care. Understanding and respecting diverse cultural perspectives is essential for navigating the complex landscape of hospice patient care.
Religious Beliefs
Religious beliefs often shape individuals’ attitudes towards death and end-of-life care. For many patients, faith and spirituality play a significant role in their perception of and response to the dying process. Healthcare ethics consultants must be aware of how different religious traditions approach end-of-life issues to provide appropriate support and guidance.
For instance, some Buddhist patients may prefer to have a monk pray at their bedside to assist in their journey to the next life. Filipino Catholics might request a priest to administer the sacrament of the sick, seeking forgiveness and strength during their final days. Understanding these religious practices allows healthcare ethics consultants to facilitate meaningful spiritual care that aligns with patients’ beliefs and values.
Those trained in Pastoral Thanatology can better be equipped to understand religious beliefs and other cultural considerations surrounding end of life care. This is especially important for chaplains and those who work in hospice.
Family Dynamics
Family relationships and dynamics often become more complex and emotionally charged when a loved one is facing the end of life. Healthcare ethics consultants must navigate these intricate family structures and help manage expectations and conflicts that may arise during this challenging time.
In many cultures, family members play a crucial role in decision-making processes regarding end-of-life care. For example, in some Asian cultures, the eldest son may be responsible for making end-of-life decisions for his parents. Healthcare ethics consultants must be aware of these cultural norms and work to involve family members appropriately in care discussions and decisions.
Additionally, some families may prefer to provide hands-on care for their dying loved ones as a demonstration of love and support. Healthcare ethics consultants can help facilitate this involvement by working with healthcare providers to educate family members on proper care techniques while ensuring patient safety and comfort.
Cultural Rituals
Cultural rituals surrounding death and dying vary widely across different communities. Healthcare ethics consultants must be knowledgeable about these practices to ensure that patients and families can observe important traditions and customs during the end-of-life process.
For example, some Native Hawaiian families may gather in large numbers, even in hospital settings, to tell stories, pray, and play music for a dying elder. In some Muslim traditions, reciting from the Quran at the patient’s bedside is considered crucial to ensure that the last words the person hears are from their sacred text.
Healthcare ethics consultants can play a vital role in advocating for accommodations that allow these cultural rituals to take place within healthcare settings. This may involve working with hospital administration to create flexible policies that respect diverse cultural practices while maintaining patient safety and quality of care.
In conclusion, cultural considerations are integral to providing ethical and compassionate end-of-life care. Healthcare ethics consultants must continually educate themselves about diverse cultural practices and work to create an environment that respects and accommodates these differences. By doing so, they can help ensure that patients and families receive care that aligns with their cultural values and beliefs, ultimately enhancing the quality of end-of-life experiences for all involved.
Legal and Regulatory Issues
Healthcare ethics consultants must navigate a complex landscape of legal and regulatory issues when dealing with end-of-life care. These professionals play a crucial role in ensuring that patient autonomy, beneficence, and justice are upheld while addressing the legal and ethical issues in end-of-life care. Understanding the legal framework surrounding advance directives, POLST forms, and state laws on end-of-life care is essential for certified healthcare ethics consultants to provide effective guidance to patients, families, and healthcare providers.
Advance Directives
Advance directives are legal documents that allow individuals to express their preferences for medical care in case they become unable to make decisions for themselves. These documents are crucial tools for healthcare ethics consultants to understand and interpret patient wishes. The two most common types of advance directives are living wills and durable powers of attorney for healthcare.
There are many legal documents that need understood and applied during hospice care. Healthcare ethic consultants have a strong understanding of these documents and their application
Living wills specify the types of medical treatments a person would or would not want to receive in certain end-of-life situations. They may address issues such as the use of life-sustaining treatments, artificial nutrition and hydration, and pain management. Healthcare ethics consultants must be well-versed in interpreting these documents to ensure that patient autonomy is respected.
Durable powers of attorney for healthcare allow individuals to designate a trusted person to make medical decisions on their behalf if they become incapacitated. Healthcare ethics consultants often work closely with these designated agents to help them understand their role and make decisions that align with the patient’s values and wishes.
POLST Forms
Physician Orders for Life-Sustaining Treatment (POLST) forms are another important legal tool in end-of-life care. These forms, which may also be known as Medical Orders for Life-Sustaining Treatment (MOLST) or other similar names depending on the state, are medical orders that specify a patient’s wishes for end-of-life care.
POLST forms differ from advance directives in that they are completed by a healthcare provider in consultation with the patient or their surrogate decision-maker. These forms are typically used for patients with serious illnesses or frailty, for whom death within a year would not be surprising.
Healthcare ethics consultants must be familiar with POLST forms and their legal status in their state. They play a crucial role in facilitating discussions between healthcare providers, patients, and families to ensure that POLST forms accurately reflect the patient’s wishes and values.
State Laws on End-of-Life Care
State laws governing end-of-life care vary widely across the United States, and healthcare ethics consultants must have a thorough understanding of the legal landscape in their jurisdiction. Some key areas of state law that impact end-of-life care include:
Requirements for advance directives and POLST forms
Surrogate decision-making laws
Laws regarding the withdrawal or withholding of life-sustaining treatments
Physician-assisted death laws (in some states)
Healthcare ethics consultants must stay up-to-date on changes in state laws and regulations to provide accurate guidance to patients, families, and healthcare providers. They also play a crucial role in helping healthcare institutions develop policies and procedures that comply with state laws while upholding ethical principles.
In conclusion, healthcare ethics consultants must have a comprehensive understanding of the legal and regulatory issues surrounding end-of-life care. By navigating these complex issues effectively, they can help ensure that patient autonomy is respected, beneficence is upheld, and justice is served in end-of-life decision-making processes.
Self-Care for Hospice Care Providers
Healthcare ethics consultants and hospice care providers face unique challenges in their work, often dealing with emotionally taxing situations and ethical dilemmas. The demanding nature of their roles can lead to compassion fatigue, burnout, and emotional exhaustion. To maintain their well-being and continue providing high-quality care, these professionals must prioritize self-care and emotional support.
Compassion Fatigue
Compassion fatigue is a common experience among those working in palliative care settings. It is defined as a state of exhaustion and dysfunction resulting from prolonged exposure to compassion stress. Healthcare ethics consultants and hospice care providers who work in pastoral thanatology are at high risk of developing compassion fatigue due to their constant involvement with suffering patients and their families.
Symptoms of compassion fatigue may include emotional exhaustion, cynicism, and reduced personal accomplishment. It can impact job satisfaction, patient outcomes, and lead to professionals leaving the field. To combat compassion fatigue, healthcare ethics consultants should be aware of its signs and take proactive steps to address them.
Burnout Prevention
Burnout is a form of cumulative work-related stress characterized by emotional exhaustion, cynicism, and reduced personal accomplishment. It is closely related to compassion fatigue and can have significant consequences for both the healthcare ethics consultant and the patients they serve.
To prevent burnout, healthcare ethics consultants should:
Establish a healthy work-life balance
Set clear boundaries between work and personal life
Practice mindfulness and stress-reduction techniques
Engage in regular physical exercise and maintain a balanced diet
Seek support from colleagues and supervisors
Organizations play a crucial role in burnout prevention by providing a supportive work environment, manageable workloads, and opportunities for professional development.
Emotional Support
Emotional support is essential for healthcare ethics consultants and hospice care providers to maintain their psychological well-being. This support can come from various sources, including colleagues, supervisors, and professional counseling services.
Healthcare organizations should implement formal support systems, such as:
Regular debriefing sessions after challenging cases
Access to employee assistance programs
Peer support groups
Mentorship programs
Informal workplace support is equally important. Cultivating a culture of openness and understanding among team members can help healthcare ethics consultants feel supported and valued in their roles.
Self-care activities are crucial for maintaining emotional well-being. These may include:
Engaging in hobbies and personal interests outside of work
Practicing relaxation techniques such as meditation or deep breathing exercises
Seeking spiritual or religious support, if applicable
Maintaining strong personal relationships and social connections
By prioritizing self-care and emotional support, healthcare ethics consultants can enhance their resilience, maintain their compassion, and continue to provide high-quality care to patients and families facing end-of-life decisions. This approach not only benefits the individual consultant but also contributes to better patient outcomes and a more ethical healthcare system overall.
Conclusion
Healthcare ethics consultants play a vital role in navigating the complex landscape of hospice patient care. Their expertise in addressing ethical challenges, cultural considerations, and legal issues has a significant impact on ensuring compassionate and ethical end-of-life care. By facilitating communication, mediating conflicts, and promoting patient autonomy, these professionals help create a more ethical and patient-centered healthcare environment.
Please also review AIHCP’s Healthcare Ethics Consulting Program as well AIHCP’s Pastoral Thanatology Program
To wrap up, the work of healthcare ethics consultants is crucial to uphold ethical principles in hospice care. Their ongoing efforts to educate healthcare providers, shape policies, and provide emotional support contribute to better patient outcomes and a more robust ethical framework in healthcare. As the field continues to grow, the role of these consultants will remain essential to address the ever-changing ethical landscape in end-of-life care.
What are the key ethical principles to consider in patient care? The fundamental ethical principles in nursing include autonomy, which is the right of individuals to make their own decisions; beneficence, which involves promoting good actions; justice, ensuring fairness and equal distribution of resources; and nonmaleficence, which is about avoiding or minimizing harm.
What are the recognized ethical principles in palliative care? In palliative care, the universally recognized ethical principles are autonomy, beneficence, nonmaleficence, and justice. These principles are acknowledged both in Eastern and Western cultures, though their application and emphasis may vary across different settings.
What ethical considerations should be made for patients at the end of their lives? When cure is not possible, physicians must assist patients in determining their most valued interests and help them make tough decisions regarding the balance between quality and quantity of life. This includes deciding on the interventions to accept and determining when to decline life-sustaining efforts.
What is the role of a healthcare ethics consultant in hospice care? Healthcare ethics consultants (HCEs) aim to identify and support the appropriate decision-makers in healthcare settings. They promote ethically sound decision-making by facilitating communication among key stakeholders, fostering understanding, clarifying and analyzing ethical issues, and providing justifications when making recommendations.
Additional Resources
Akdeniz, M. et. al. (2021). “Ethical considerations at the end-of-life care”.SAGE Open Med. 2021; 9: 20503121211000918. Published online 2021 Mar 12. National Library of Medicine. Access here
Mohanti, B. (2009). “Ethics in Palliative Care”. Indian J Palliat Care. 2009 Jul-Dec; 15(2): 89–92. National Library of Medicine. Access here
Stol, I. (2018). “Ethical Dimensions of Caring Well for Dying Patients”. AMA Journal of Ethics. Access here
Code of Ethics (2024). National Association for Homecare and Hospice. Access here
In the field of pastoral thanatology, compassionate care plays a crucial role in supporting individuals through the final journey of life. This article explores various aspects of pastoral thanatology and its application in providing empathetic and supportive care to those experiencing loss and grief. From therapeutic relationships to specialized training in grief counseling, each section delves into essential practices for promoting healing and resilience in the face of loss.
How healthcare professionals relay terminal diagnosis or death of a loved one is lacking in many medical facilities and it is important to improve these skills
Key Takeaways
Authenticity and support are key in therapeutic relationships for promoting individual strengths and goals.
Navigating loss with supportive guidance is essential for coping with grief and bereavement.
Insight into anticipatory grief and traumatic death is crucial for understanding bereavement.
Utilizing personalized interventions and active listening can help address stuck points in adapting to loss.
Diverse approaches like hypnotherapy, spiritual counseling, and pet loss grief support offer compassionate care for individuals coping with loss.
Exploring the Role of Pastoral Thanatology in Compassionate Care
It is important to note, many healthcare professionals lack a bed side manner that is conducive helping patients face death. Many find it difficult to discuss death, or tell family members a loved one is going to die. Many physicians and nurses look to avoid or designate an individual to be the bearer of bad news. Many see it as a failure and not as an opportunity to further treat the patient also from an emotional standpoint. It is essential that healthcare professionals have an understanding of death and how to properly communicate it with patients and family.
It is also equally important that healthcare facilities become better equipped to handle end of life diagnosis or death news. Protocols should exist, as well as special designated areas to discuss sensitive news. Preparation of how the news is delivered, as well as preparation for emotional responses of patients and families need addressed. Hospitals and other health facilities should have a clear protocol and plan and place to help grieving families deal with bad news and death.
Too many healthcare facilities do not have protocols or plans in place to deliver terminal diagnosis or death news to families or patients
Studies in Pastoral Thanatology and Kubler-Ross five stages of dealing with terminally ill patients is an excellent starting point. AIHCP offers certifications and education for healthcare professionals to better be equipped to handle end of life issues in medical facilities. Those certified in Pastoral Thanatology can help the grieving better learn of terminal diagnosis and be better equipped to help them deal with the news. With better communication, proper vocabulary, preparation, empathy and a safe place to discuss, horrible news can be delivered in a less traumatic way.
Authenticity and Support in Therapeutic Relationships
In the realm of pastoral thanatology, the therapeutic relationship is the cornerstone of compassionate care. Trust, honesty, and a commitment to growth are pivotal in creating a supportive environment conducive to healing and transformation. The authenticity of the caregiver in these relationships is not just beneficial but essential, as it fosters a space where individuals can express themselves without judgment and embark on a journey of self-discovery.
Authenticity in the caregiver-patient relationship
Trust and honesty as foundational elements
Commitment to personal growth and collaboration
The process of reframing unhealthy thought patterns and shifting the inner narrative is a critical aspect of the therapeutic journey. It is through this collaborative effort that individuals can confront the concerns of life and develop practical strategies for change.
A compassionate and dedicated approach, which integrates traditional psychotherapy with holistic perspectives, allows for the customization of techniques to the individual’s unique challenges. This personalized method supports the path to healing and personal growth, providing a safe space for exploration and the expression of thoughts, feelings, and challenges.
Promoting Individual Strengths and Goals
In the realm of pastoral thanatology, the emphasis on promoting individual strengths and goals is paramount. The therapeutic journey is tailored to honor the personal, emotional, cultural, and spiritual needs of each individual. This approach is not only client-centered but also strength-based and goal-oriented, aiming to empower clients to navigate their needs within a safe space.
We need to enhance our ability to respond to people’s individual wishes so that we can provide quality and respectful care.
Clients who are self-motivated and have clear goals often face challenges that are exacerbated by mental health issues. It is crucial for them to identify their strengths and weaknesses and be willing to engage in the process of growth and change. Openness to new coping strategies and ways of thinking can facilitate learning and growth, leading to the achievement of health and wellness goals.
The following list exemplifies common goals that clients may wish to pursue:
Reduce anxiety or depression’s impact on daily life
Improve interpersonal well-being and communication
Identify treatment or occupation-related recommendations
Enhance intra-personal understanding and self-esteem
Each goal is approached with a holistic and strengths-based perspective, ensuring that the care provided is attuned to the unique challenges and aspirations of the individual.
Navigating Loss with Supportive Guidance
In the realm of pastoral thanatology, the journey through loss is not one to be undertaken alone. Supportive guidance is a cornerstone of compassionate care, providing a beacon of hope and direction amidst the tumult of grief. Navigating the complexities of loss requires a multifaceted approach, where the bereaved are met with empathy, understanding, and practical strategies for coping.
Healthcare professionals certified in Pastoral Thanatology from AIHCP can better deliver bad news to patients and family with empathy and professionalism
The role of the thanatologist is to act as a guide, offering a safe and nonjudgmental space for individuals to express their grief.
By promoting authenticity and supporting individual strengths, the thanatologist fosters a therapeutic relationship grounded in trust.
Personalized interventions are tailored to each person’s unique experience of loss, ensuring that the support provided is as effective as it is compassionate.
In this supportive role, the thanatologist empowers the bereaved to identify and utilize their own strengths and resources. This empowerment is crucial in helping individuals adapt to their loss and find a path forward.
The ultimate goal is to help survivors on their journey towards recovery, equipping them with the tools and understanding necessary to embrace their grief and emerge with renewed purpose.
Understanding Bereavement through Hospice Social Work Experience
Insight into Bereavement
With 16 years of experience as a Hospice Social Worker, the depth of understanding in bereavement has expanded significantly. This experience encompasses a range of areas including anticipatory grief, traumatic death, and the loss of health. Bereavement is not a uniform experience; it varies widely among individuals and can manifest as grief anxiety or difficulty with life transitions.
Bereavement is a deeply personal journey, and the role of a Hospice Social Worker is to provide a supportive presence, guiding individuals through their unique process of grief.
The therapeutic approach in grief therapy is to offer short-term, goal-oriented support. It involves a variety of strategies and techniques from different therapeutic practices, all aimed at meeting grievers where they are. This personalized approach ensures that each individual’s experience is validated and that they receive an impactful learning experience.
Grief is the natural response to loss, and it is important to recognize that it does not have a set timeline. The process of adapting to loss involves reaching certain healing milestones and addressing any stuck points. Active listening and personalized interventions are crucial tools in assisting individuals to cope with their loss.
Focus on Anticipatory Grief and Traumatic Death
Anticipatory grief and traumatic death present unique challenges in the realm of bereavement. Anticipatory grief, the mourning that occurs when a death is expected, often involves a complex mix of emotions, including fear, sadness, and even relief. Traumatic death, on the other hand, can lead to sudden and overwhelming feelings of shock and disbelief.
In addressing these forms of grief, it is crucial to tailor therapeutic practices to the individual’s experience. A Hospice Social Worker, with years of experience in grief counseling, brings a depth of understanding to these sensitive areas. The therapeutic journey may include a variety of strategies, such as:
Cognitive-behavioral techniques to manage grief anxiety
Narrative therapy to process the story of loss
Mindfulness practices to cope with emotional pain
The goal is to provide a supportive and impactful learning experience that acknowledges grief as a natural response to loss, without a set time limit. Healing milestones are achieved by meeting grievers where they are, utilizing active listening, and offering personalized interventions.
Certification in specialized areas such as Complicated Grief Treatment and the Grief Recovery Method enhances the ability to support those navigating these difficult waters. The integration of various therapeutic practices ensures that each individual’s path to coping is both respected and facilitated.
Utilizing Therapeutic Practices for Impactful Learning
In the realm of pastoral thanatology, the application of different therapeutic practices is crucial for meeting grievers where they are, facilitating a journey of self-discovery, and fostering an impactful learning experience. The therapeutic process is not a one-size-fits-all; it is tailored to the individual’s unique path through grief, which is a natural response to loss without a prescribed time limit. The therapeutic journey involves a partnership with clients, guiding them to reframe unhealthy thought patterns and shift their inner narrative towards healing.
Continuous education and self-reflection are imperative for caregivers to remain attuned to the evolving needs of those they serve. This commitment ensures that the therapeutic environment is one where survivors feel understood, respected, and valued. The ultimate goal is to empower individuals by helping them maximize strengths and improve well-being through appropriate therapeutic recommendations. AIHCP and the American Academy of Grief Counseling offers an in-depth program in Pastoral Thanatology for healthcare professionals and those in ministry.
Navigating the Complexities of Grief Therapy
Short-Term Therapy with Clear Goals
In the realm of grief therapy, short-term interventions are designed with the intention of providing immediate relief and a clear path forward for individuals grappling with loss. The focus is on establishing attainable goals that align with the client’s personal strengths and desired outcomes.
Short-term therapy often employs evidence-based practices such as cognitive-behavior therapy (CBT), mindfulness, and solution-focused brief therapy. These modalities are chosen for their proven efficacy in helping clients to manage symptoms of grief and to foster resilience.
The therapeutic journey in short-term therapy is a collaborative one, where the therapist and client work together to identify areas of strength and weakness, and to develop strategies for coping and growth.
Clients suitable for this approach are typically self-motivated and have clear objectives that may be hindered by their emotional state. The table below outlines common goals and the corresponding therapeutic techniques that may be utilized:
Client Goals
Therapeutic Techniques
Reduce anxiety and depression
CBT, Mindfulness
Improve daily functioning
Solution-Focused Brief Therapy
Enhance self-esteem
Strengths-Based Approaches
Foster personal growth
Mindfulness, Matrix Model
By setting clear goals and employing targeted techniques, short-term therapy can provide a structured yet flexible framework for individuals to navigate their grief and begin the healing process.
Meeting Grievers with Various Techniques
In the realm of grief therapy, the diversity of techniques available to practitioners is as varied as the individuals seeking support. Grief is the natural response to loss, and it manifests uniquely across different people. To address this, therapists employ a range of strategies, each tailored to the specific needs and circumstances of the griever.
The therapeutic journey in grief counseling is not a one-size-fits-all process. It requires a nuanced approach that respects the individuality of each person’s experience with loss.
Some of the techniques used in grief therapy include Narrative Therapy, which offers the right combination of structure and flexibility to meet grievers wherever they’re at in the messy, nonlinear grieving process. Additionally, practices such as Complicated Grief Treatment and EMDR (Eye Movement Desensitization and Reprocessing) are utilized to help individuals process their emotions and adapt to their new reality.
Narrative Therapy: Helps individuals re-author their life stories after loss.
Complicated Grief Treatment: Addresses prolonged grief disorders with targeted interventions.
EMDR: Aids in the processing of traumatic memories associated with loss.
Each technique is a tool in the broader therapeutic toolkit, designed to confront and process emotions in a way that is both compassionate and effective.
Embracing the Natural Response to Loss
Grief, as a natural response to loss, encompasses a spectrum of emotions that individuals must navigate through. It is a deeply personal journey, one that does not adhere to a prescribed timeline or set of stages. The process of grieving is unique to each person, and as such, therapeutic approaches must be flexible and responsive to the individual’s needs.
Whether chaplain, clergy, or healthcare professional, all should be trained in how to listen and be empathetic to needs of the dying at an emotional level
The goal of grief therapy is not to hasten the bereavement process but to provide a supportive space where individuals can express their emotions and learn to adjust to life without their loved one.
Therapists employ various techniques to meet grievers where they are, recognizing that grief does not simply ‘go away’ but rather, we evolve in our relationship with it. Below is a list of common therapeutic practices:
Active listening and empathic presence
Personalized interventions tailored to the individual’s coping style
Assignments that encourage reflection and processing of emotions
Education on the nature of grief and its impact
By embracing grief as a natural part of life, therapists can help individuals find a path forward, acknowledging the pain of loss while fostering resilience and healing.
Specialized Training and Certification in Grief Counseling
Complicated Grief Treatment
Complicated Grief Treatment (CGT) is a specialized therapeutic approach designed to address the unique and persistent form of bereavement known as complicated grief. This condition is characterized by an extended grieving period and the inability to progress through the typical stages of grieving. Trained experts in CGT aim to guide individuals through a structured process that helps them confront the loss and gradually reduce the symptoms of grief that interfere with daily living.
The treatment typically involves several components:
Establishing a therapeutic relationship and setting a safe space for sharing.
Identifying and confronting emotions and thoughts related to the loss.
Developing coping strategies and tools to manage intense emotions.
Working on personal goals and finding meaning after the loss.
Complicated Grief Treatment is not a one-size-fits-all solution; it is tailored to meet the specific needs of each individual. The process is collaborative, with the therapist and client working together to create a path toward healing.
By engaging in CGT, individuals can learn to adapt to their loss and move forward with their lives, while still honoring the memory of their loved one.
AIHCP offers an online and independent study Grief Counseling Certification, as well as a Pastoral Thanatology Certification for qualified professionals.
Personalized Interventions for Coping with Loss
In the realm of pastoral thanatology, personalized interventions are pivotal for individuals coping with loss. Each person’s grief journey is unique, and thus requires tailored strategies that resonate with their specific needs and circumstances. Personalized interventions may include a variety of therapeutic techniques, each chosen for its potential to facilitate healing and growth.
Active Listening: Creating a space where individuals feel heard and validated.
Homework Assignments: Encouraging engagement with the therapeutic process outside of sessions.
Complicated Grief Treatment: Addressing prolonged and intense grief reactions.
EMDR (Eye Movement Desensitization and Reprocessing): Aiding in the processing of traumatic memories associated with loss.
Personalized interventions are not a one-size-fits-all solution; they are carefully crafted to support individuals in recognizing and honoring their unique paths through grief.
The efficacy of these interventions is often enhanced by the practitioner’s ability to identify and address ‘stuck points’—specific areas where an individual may struggle to adapt to loss. By utilizing tools such as active listening and specific therapeutic practices, caregivers can assist in moving past these hurdles, fostering a sense of progress and hope.
Healing Milestones and Personalized Interventions
Addressing Stuck Points in Adapting to Loss
In the journey of grief, individuals may encounter stuck points that hinder their adaptation to loss. These are moments or areas where the bereaved feel unable to move forward, often trapped by persistent thoughts or emotions. Addressing these stuck points is crucial for healing milestones to be reached.
Active listening and personalized interventions are key in assisting individuals to navigate through these challenging junctures. By employing specific tools, caregivers can help the bereaved to cope and gradually adapt to their new reality.
The process of adapting to loss is not linear and requires a tailored approach for each individual. Therapeutic practices, such as Complicated Grief Treatment and EMDR, are designed to meet grievers where they are, offering impactful learning experiences that acknowledge grief as a natural response to loss. Certified specialists in grief recovery are equipped with a variety of techniques to facilitate this process.
Survivors embarking on the path to recovery benefit from a supportive environment that encourages exploration and expression of their grief. This support is essential in transforming their relationship with loss, allowing for a gradual and healthy adaptation.
Utilizing Active Listening for Healing
Active listening stands as a cornerstone in the process of healing, particularly in the context of pastoral thanatology. It involves a full presence and attentiveness to the bereaved, fostering a safe space where their feelings and thoughts can be expressed without judgment. Active listening is rarely taught to those in pastoral roles, yet it is crucial for facilitating healing milestones and addressing stuck points in adapting to loss.
The practice of active listening extends beyond mere hearing. It requires the listener to engage with empathy, reflecting and clarifying the speaker’s message, and withholding personal judgments or advice unless solicited. This approach not only validates the individual’s experience but also empowers them to explore their emotions and thoughts more deeply.
The journey of grief is unique to each individual, and active listening honors this by tailoring support to the person’s specific needs and story. It is an act of self-care for the bereaved to seek out a listener who can truly hear them, and it is a powerful step in the healing process.
By utilizing active listening, pastoral caregivers can help individuals find their own path to healing, using evidence-based practices and a mind-body connection. The goal is to assist in a healthy and emotionally intelligent manner, allowing the client to put in the necessary work to heal themselves, with the support of therapeutic techniques when needed.
Tools for Coping with Loss
In the journey of adapting to loss, individuals often reach a point where traditional coping mechanisms may no longer suffice. Developing a toolkit of strategies is essential for those seeking to navigate the complexities of grief. These tools are not one-size-fits-all; they must be tailored to the individual’s unique experience and needs.
Effective coping strategies may include a combination of reflective practices, such as journaling or creative expression, and active approaches like structured problem-solving or physical activity. It is crucial to recognize the value of each tool and its potential impact on the healing process.
Journaling to process emotions
Creative outlets like art or music
Structured problem-solving techniques
Physical activities to release tension
Mindfulness and relaxation exercises
Embracing a variety of coping tools can empower individuals to find their path through grief, transforming their relationship with loss into one of growth and understanding.
Diverse Approaches to Supportive Care
Hypnotherapy and Meditation for Healing
In the realm of pastoral thanatology, hypnotherapy and meditation emerge as powerful tools for facilitating deep healing and self-discovery. Hypnotherapy, by accessing the subconscious, allows individuals to explore and reframe unhealthy thought patterns, while meditation fosters a mind-body connection essential for self-attunement and emotional regulation.
Hypnotherapy can address trauma and depression-related disorders.
Meditation promotes relaxation and stress management.
Both practices encourage a holistic approach to healing.
Embracing these modalities within compassionate care can significantly enhance the therapeutic journey, offering a path to rewrite one’s narrative towards a more peaceful acceptance of loss.
The integration of these techniques into grief therapy is not only about symptom relief but also about empowering individuals to navigate their journey with greater resilience and understanding. The evidence-based practices of hypnotherapy and meditation contribute to a more profound healing process, acknowledging the cultural, spiritual, and environmental factors that impact an individual’s experience of loss.
Spiritual Counseling for Emotional Support
Spiritual counseling offers a unique dimension to emotional support, particularly in the context of grief and loss. It integrates the individual’s belief system into the therapeutic process, providing a holistic approach to healing. This form of counseling can be especially comforting for those who draw strength from their spiritual or religious convictions.
Healthcare professionals need to be trained better to not only professionally deliver bad news, but also be able to supply emotional and spiritual support as needed, and if they cannot, have someone on staff who can do so at a professional and competent level
Spiritual counseling can help individuals find meaning and purpose during times of loss.
It may involve practices such as prayer, meditation, or rituals that are significant to the person’s faith tradition.
Counselors trained in this modality are skilled at navigating the intersection of emotional distress and spiritual beliefs.
Spiritual counseling respects the diverse belief systems of individuals and aims to provide support in a manner that aligns with their values and worldview.
The effectiveness of spiritual counseling is often reflected in the way it helps individuals reconcile their inner emotional turmoil with their spiritual understanding. By doing so, it can facilitate a more profound sense of peace and acceptance.
Pet Loss Grief Support for Compassionate Care
The loss of a pet can be a profound and deeply personal experience, often equated with the loss of a human loved one. Pet loss grief support is an essential aspect of compassionate care, acknowledging the significance of this unique bond. It is important to explore compassionate tips on coping with pet loss to find solace and honor the memory of the beloved companion.
Recognize the depth of your loss and allow yourself to grieve.
Create a memorial or ritual to celebrate the life of your pet.
Reach out to support groups or counseling services that specialize in pet loss.
Engage in self-care practices and maintain routines to help navigate through grief.
Grief is the natural response to loss, and it doesn’t have a time limit. Grief doesn’t go away completely, but we change our relationship to it.
By addressing the emotional needs with sensitivity and understanding, individuals can move through their grief with the support of specialized interventions and therapeutic practices tailored to pet loss.
Exploring the myriad of ways to provide supportive care is essential in today’s diverse healthcare landscape. Our website offers a wealth of resources and certification programs, including the esteemed Pastoral Thanatology Certification, to enhance your knowledge and skills in this vital field. Whether you’re a healthcare professional seeking to expand your expertise or someone interested in the spiritual and psychological aspects of end-of-life care, we have something for you. Don’t miss out on the opportunity to elevate your practice and make a meaningful difference. Visit our website now to learn more and register for our courses.
Conclusion
In conclusion, the field of pastoral thanatology plays a crucial role in providing compassionate care to individuals facing the final journey of life. Through the expertise and dedication of professionals like myself, who are trained in various therapeutic practices and techniques, grievers are supported in navigating the complexities of loss and grief. The emphasis on authenticity, empathy, and nonjudgmental support creates a safe space for individuals to explore their emotions and find healing in the midst of bereavement. As we continue to embrace the challenges of loss and transition, the integration of personalized interventions and specialized tools offers a holistic approach to coping with the inevitable changes that life presents. Ultimately, pastoral thanatology serves as a guiding light, illuminating the path towards acceptance, healing, and resilience in the face of loss.
Please also review AIHCP’s Pastoral Thanatology Certification which can help aid those in ministry and healthcare better serve the needs of the dying
AIHCP offers an online certification program in Pastoral Thanatology. The program is online and independent study and open to qualified professionals seeking a four year certification in Pastoral Thanatology. Healthcare professionals as well as clergy and those in active ministry are excellent candidates.
Frequently Asked Questions
What is pastoral thanatology and its role in compassionate care?
Pastoral thanatology focuses on providing compassionate care to individuals navigating the final journey of life and coping with loss. It involves supporting individuals in a safe and empathic environment, encouraging authenticity, and guiding them to cope with loss.
How does hospice social work experience contribute to understanding bereavement?
Hospice social work experience provides insights into bereavement, anticipatory grief, traumatic death, and other aspects of loss. It emphasizes short-term therapy with clear goals and utilizes various therapeutic practices to offer impactful learning experiences.
What are the key components of grief therapy in dealing with loss?
Grief therapy involves meeting grievers with different techniques, embracing the natural response to loss, and setting clear goals for short-term therapy. It focuses on helping individuals adapt to loss and cope with grief effectively.
What specialized training and certifications are beneficial for grief counseling?
Specialized training in complicated grief treatment, certification as a grief recovery method specialist, and personalized interventions are valuable for grief counselors. These certifications enhance the ability to provide personalized support for coping with loss.
How can healing milestones and personalized interventions aid in coping with loss?
Healing milestones and personalized interventions help address stuck points in adapting to loss. Active listening and specific tools provided in therapy sessions assist individuals in coping with grief and moving towards healing.
What are some diverse approaches to supportive care in grief counseling?
Diverse approaches such as hypnotherapy, meditation, spiritual counseling, and pet loss grief support offer emotional and compassionate care for individuals experiencing loss. These approaches provide additional tools for coping and healing.
How does grief counseling support individuals in navigating the complexities of loss?
Grief counseling offers guidance and support to individuals experiencing the complexities of loss. It helps them understand and cope with grief, navigate the emotional journey, and develop personalized strategies for healing.
What are the benefits of utilizing therapeutic practices in grief counseling?
Therapeutic practices in grief counseling offer a range of techniques and strategies to meet individuals where they are in their grief journey. These practices provide a supportive and impactful learning experience, helping individuals process their emotions and cope with loss effectively.
Additional Resources
“Delivering Bad or Life-Altering News”. FRANKLIN J. BERKEY, DO, JOSEPH P. WIEDEMER, MD, AND NICKI D. VITHALANI, MD. (2018). American Family Physician. Access here
“Death in the hospital: Breaking the bad news to the bereaved family”. Naik, S. (2013). National Library of Medicine. Access here
“Dying Well-Informed: The Need for Better Clinical Education Surrounding Facilitating End-of-Life Conversations”. Sutherland, R. (2019). National Library of Medicine. Access here
Communicating a terminal prognosis in a palliative care setting: Deficiencies in current communication training protocols”. Wittenberg-Lyles, E., al etc. (2008). Science Direct. Access here
Healthcare unfortunately sometimes sees patients as win or lose. Was the patient saved or cured or did the patient die is the common judge of success. Death, disease and incurable ailments though are part of life and healthcare should not see the death or survival of an individual as a grading process of competence. While all measures and standards of care should be performed and addressed properly, sometimes patients die or cannot be cured and the end result should not be seen as defeat in healthcare. Instead healthcare professionals must be able to extend themselves to another level of care that looks to treat the entirety of the human person who is dying. When the person who is terminal receives the best care that reduces physical and emotional discomfort, then a healthcare professional can truly say they succeeded. Success should be graded on giving the best that is available both physically and emotionally.
Unfortunately, not all healthcare professionals are equipped with training to give bad news to patients and family
Many physicians and nurses are not well versed or well trained to give bad news though to the terminally ill or able to communicate the death of a loved one to a family. Instead, many times, it is handled very sterile or avoided at all costs. Elisabeth Kubler Ross began to turn the table in the 1980s on this sterile and numb approach to communicating death. It, however, involved an entire re-understanding of life and death, medical success vs medical failure and a better understanding of helping those in grief. Of course, this led to Elisabeth Kubler Ross’s famous 5 stages of grieving, which mistakenly were applied to grief in general, when they were designed to retrace reactions of the terminal ill to death. Denial, anger, sadness, bargaining and ultimately acceptance became the norms of grief reaction and they mistakenly became seen as fixed, sequential stages, instead of reactions of the terminally ill to bad news. They still serve as foundational pieces of emotions associated with loss and can be utilized in helping those in healthcare to react to the emotional response to death and loss itself.
Since the turn of the century, the need of grief counseling, pastoral counseling and training in giving bad news to patients has increased. While many healthcare professionals still lack bed side manner, the push to train and certify, and prepare others through module training programs has increased. Healthcare facilities are starting to see the need of trained professionals who can deliver the necessary news in a solemn and professional manner.
Terminal diagnosis is difficult to communicate and requires training to properly tell patients
In regards to this, those trained learn a variety of grief theories about loss, crisis intervention, and communication skills. In many cases, the patient or family is already in a sense of anxiety due to the wait and emotions are tense. Caregivers should be prepared for a myriad of emotions that can erupt when a bad diagnosis, or death is revealed. Understanding the situation, being calm, and allowing the individuals to express initially is key.
While many caregivers would rather keep it simple, detail is important. The family or person will have numerous questions. A facility should have a quiet and private place to be able to aid the family in digesting the news. Questions will emerge and answers should give the most up to date factual information regarding the situation. In some cases, crisis intervention and emotional support will be required, but one should not limit information. Information should be given as the family is able to digest it. A later follow up meeting may be needed to allow the family to grieve until they are able to ask more logical questions. Hence communication of diagnosis is key but also an understanding of the family system and the emotional response. Each experience will be unique and require adjustment in how it is presented. Silence, or avoidance however is never the answer.
The article, ‘Delivering Bad News to a Patient” by Monden, K., et. al. takes a closer look at question system employed by Rabow and McPhee. The article states,
“Rabow and McPhee also proposed a model for delivering bad news called ABCDE: A, advance preparation; B, build a therapeutic environment/relationship; C, communicate well; D, deal with patient and family reactions; and E, encourage and validate emotions”
Monden, K., Gentry, L., Cox, M. (2016). Delivering bad news to patients. Baylor University Medical Center. 29(1). 101–102.
Within the context of terminal diagnosis, the bad news could be shocking to those present but it could also be divisive. Some family may wish to keep things a secret, or others may enter into a state of denial, while some may optimistically seek next step solutions. It is essential to understand the state of shock the family is in and to accurately give the diagnosis, statistics and courses of option.
Giving bad news requires finding a quiet place and the patience and understanding of human reaction to loss
Within immediate death, some family may want more details, while others may fall into silence. Others my need crisis intervention, coping advice, or the aided in relaxing from the traumatic news. Again, training modules with case studies can help prepare healthcare providers with better methods to alleviate the pain and better aid the family in hearing the horrible news of the death.
While some healthcare professionals are naturally better at helping families emotionally, there still must be a continued emphasis on training. Many families leave without any emotional support, confusion, and lack of full information regarding the death or the terminal diagnosis. This only compounds the trauma and emotional stress. Hence it is important that training be applied to all staff. It is fine to have one particular staff member who is more emotionally able to communicate bad news, but sometimes, it is still essential for the primary care giver to be able to answer questions and help those in distress.
AIHCP offers a certification in Pastoral Thanatology that aids professionals in learning more about caring for the terminally ill as well as being better equipped to communicate difficult diagnosis or news. The program equips professionals with knowledge on grief counseling as well as care for the terminally ill. It also equips the professional with information on death itself and multiple cultural, pastoral and religious beliefs related to death. The program is online and independent study and open to qualified professionals seeking a four year certification in Pastoral Thanatology. While many chaplains take the program, it is highly encouraged that nurses and other healthcare professionals also learn more about pastoral care of the dying and giving bad news.
Reference
Postavaru, G., McDermott, H., Biswas, S., Munirm, F. (2023). Receiving and breaking bad news: A qualitative study of family carers managing a cancer diagnosis and interactions with healthcare services. Leading Global Nursing Research, 79(6). 2211-2223. https://doi.org/10.1111/jan.15554
Coyle, N. , Manna, R., Shen, M., Banerjee, S.M, Penn, S, et. al. (2015). Discussing Death, Dying, and End-of-Life Goals of Care: A Communication Skills Training Module for Oncology Nurses. Clinical Journal of Oncology Nursing 19(6). 697-702.
Monden, K., Gentry, L., Cox, M. (2016). Delivering bad news to patients. Baylor University Medical Center. 29(1). 101–102. Access here
Additional Resources
“How can doctors share bad news with patients?”. Beresford, L. (2017). Medical News Today. Access here
“Delivering bad news: Helping your patients retain dire details”. Augnst, H. (2009). Contemporary Pediatrics. Access here
Death is as common and as natural as birth but death discussion is always avoided till its usually too late. With death being a reality, the more we discuss it, the more we can understand it but also the connections we have with others and their thoughts and desires. Talking about death does not illustrate a morbid fascination but recognizes a reality that time is precious and we must enjoy the time we have with our loved ones. No next day is ever promised. Unfortunately, many fear this topic or wish to deny it.
Discussion about death while alive is healthy and needed. Please also review AIHCP’s Pastoral Thanatology Certification
The article, “If death happens to us all, we should probably talk more openly about grief” by Dinah Lewis Boucher discusses the impact of losing someone and the long mental process to learn to live without that person. Boucher states,
“Three years after my husband died, his toothbrush remained in our family’s toothbrush holder. It didn’t make any sense, of course. He didn’t need it. But there it stood, three toothbrushes altogether. Our daughter’s, mine and his. It was a visual representation of how I wished for it to be. But our family was down to two. People say time is a great healer, and the pain of grief changes — over time. But if we aren’t active in the process of grieving, some say it may not change so much. “
“If death happens to us all, we should probably talk more openly about grief”. Boucher, D. (2022). ABC News
Whether we discuss death or not, it will come to our loved ones and eventually ourselves. The process will always be difficult since the lost of a loved one is so intense due to attachments and love. The brain does not respond well to such change. The neural networks need to realign to the new situation and past memories can haunt. The adjustment period is only adjustment. It is not a recovery but a realignment to new realities. Those who do their grief work and avoid complications within the process still remain sad but are able to move forward in a healthy way and find joy in the world despite the loss and the pain associated with it.
Thanatophobia is an intense fear of death and the dying process. It can prevent one from discussing the issue of death itself
Hence, discussing death while others are alive is important to understanding the needs of our loved ones and their wishes. It allows one to express emotions now instead of when it is too late. It is recognizing that everyday is not guaranteed and that time goes by fast. It helps one also understand the inner thinking and wishes of the loved one and what the loved one would want for us if he/she passed away. Concretely sharing these moments instead of speculating what ifs after death can alleviate future suffering.
The phobia of death can paralyze an individual into a state of inaction during life. It can prevent a person from expressing love the day of instead of when its too late. It can make one unprepared and not ready for the loss of a loved one. It is hence important to embrace the reality of life which includes death and express fears or anxieties associated with it to others. One will discover it is not a morbid discussion but a a discussion that is very real and an opening to emotional connections that will not be there one day.
Moving Forward
After acknowledging death with loved ones, one will understand spiritual and emotional sides of the loved one that one may not have known before. There may also exist a greater peace if something occurs knowing each other’s feelings and not being left to wonder what one would think or do after they passed away. When death is discussed, one discovers not only religious beliefs, but also how one would deal with particular situations when one is gone. One is hence better able to handle situations or execute legal decisions with more certainty and confidence instead of guesswork.
Trying to introduce this much needed conversation can at first be difficult and maybe even awkward. One does not merely begin the conversation with death itself but it is gradually implemented from such topics of legacy, the future, desires, or religious thoughts. The death of a celebrity can be an excellent introduction to the topic as well.
We only have so much time alive to discuss death with others. It is far better to discuss and understand feelings about this event while alive
While death is naturally feared because of its unknown aspects, death discussion takes away the taboo element of it and helps individuals discuss and better understand implications of it. It allows one to also be better prepared for one’s own death from all financial and spiritual concerns. Many individuals today pre pay for funeral expenses, urns and cemetery plots. This is not pessimistic or morbid planning but real and true planning for eventual reality. Live everyday and stay healthy, but do not allow one’s fear of speaking about death to become a pathology.
Some suffer from a mental pathology of Thanatophobia or the fear of death. This is more than a natural fear of the unknown but a topic that physiologically upsets the person to such an extent that the topic causes extreme anxiety and physical reactions such as higher heart beat or blood pressure. While some may have been exposed to something traumatic others can merely develop this fear. If the fears and reactions persist for longer than six months, then professional help may be needed. Therapists usually utilize cognitive behavioral therapy to help understand the phobia as well as exposure therapy where individuals are gradually under the guidance of a counselor are exposed to concepts of death.
Conclusion
Death discussion can seem taboo or morbid but it is a healthy discussion that recognizes reality and life itself. Pastoral Thanatology is the field of care where individuals in ministry help others prepare for death, as well as, help others deal with the death of a loved one. Chaplains, ministers and others in Human Service fields need a strong training in Pastoral Thanatology to better help individuals deal with death issues.
Please also review AICHPs Grief Counseling Certification as well as its Pastoral Thanatology Certification and see if it meets your academic and professional goals
AIHCP offers a four year certification in Pastoral Thanatology. Qualified professionals can earn the Pastoral Thanatology Certification and apply the knowledge and training to their own ministries and help others face and cope with the reality of death. The program is online and independent study. After completion of the core courses, one can apply for a four year certification.
Additional Resources
“Thanatophobia (Fear of Death). Cleveland Clinic. (2022). Access here
“Thanatophobia (Fear of Death) Explained”. Fritscher, L. (2023). VeryWellMind. Access here
“We Need to Talk About Death”. Beaumont, A. (2017). Psychology Today. Access here
“Talking About Death With Family: 7 Tips to Start a Dialogue”. Vasquez, A. (2022). Cake. Access here
The two most important events in life is birth and death but the later is rarely spoken about. Individuals fear and dread death and avoid the existential topic as much as possible, but death talk is important. This important discussion helps focus individuals to the reality of life and that days are precious. This discussion helps prepare others express feelings and put financial and inheritance matters to rest. It allows the deceased to have his or her wishes known for funeral and burial. Yet, despite the healthy discussions that the topic of death brings, it is still avoided as if the topic itself will bring about the existential event.
Death is a healthy discussion. Please also review AIHCP’s Pastoral Thanatology Certification and see if it meets your professional goals
Individuals dread and fear death so they hope to avoid, dismiss and ignore it. It can only happen to others not oneself and the mere discussion seems morbid too many. Yet this important discussion is critical and taboos, fears, and myths about speaking about death need to be removed from society. Death talk itself is healthy. Many in Pastoral Thanatology ministry minister to the dying but the topic of death has been avoided and even when dying is occurring, no family or friends know how to broach the subject. This leaves the dying person very much alone. It is healthy to discuss death in the prime of life as well at the final moments.
The article, “If death happens to us all, we should probably talk more openly about grief” by Dinah Boucher looks at why many fear discussing death or even talking about the pain associated with death of a loved one. She states,
“Identity rupture is a common response to loss, Professor Gill Straker and Jacqui Winship explain.’ For sure, it affects our identities. Our sense of ourselves is intricately associated with our sense of ourselves in relation to others. So when we lose a really important person in our lives, our identity has to kind of shift and change to adapt'”.
“If death happens to us all, we should probably talk more openly about grief”. Boucher, D. (2023) ABC News. Access here
Hence, whether it is about one’s own mortality or losing a loved one, the fear and pain of the subject can paralyze one from speaking about it or trying to understand it. This can be unhealthy for the grieving as well as unhealthy for those who fear any discussion about the event of death. Death itself or when someone dies cannot be swept under the rug but needs to be discussed and understood in order to have a healthier understanding of it as well as the ability to heal.
The Importance of Having End-of-Life Conversations
End-of-life conversations are crucial for several reasons. Firstly, they allow us to express our wishes and preferences for our own end-of-life care. By discussing our desires in advance, we ensure that our loved ones are aware of our choices and can honor them when the time comes. Additionally, these conversations provide an opportunity for us to clarify any misunderstandings or misconceptions about our preferences, preventing potential conflicts or disagreements among family members.
Secondly, end-of-life conversations foster emotional and psychological well-being. They can help alleviate anxiety and fear surrounding death by providing a platform to openly express concerns and emotions. By addressing these concerns, we can find comfort and support, allowing us to cope with the inevitable reality of our mortality.
Lastly, having end-of-life conversations enables us to support and comfort our loved ones. By sharing our thoughts and wishes, we provide them with guidance and alleviate the burden of making difficult decisions on our behalf. These conversations also encourage open communication within the family, fostering deeper connections and understanding during a time that can be emotionally challenging.
Common Challenges When Discussing End-of-Life Topics
Despite the importance of end-of-life conversations, there are common challenges that can arise when discussing these topics. One challenge is the discomfort or fear associated with discussing death. Many individuals find it difficult to confront their mortality or to acknowledge the possibility of their loved ones passing away. This discomfort can hinder open and honest communication, making it challenging to have meaningful conversations.
Due to fear of death, or seeing death as a morbid topic, many death talks are postponed till it is too late.
Another challenge is the cultural or societal taboo surrounding death. In many cultures, death is seen as a morbid or forbidden topic, leading to a lack of awareness and understanding about end-of-life matters. This taboo can create barriers to open dialogue, preventing individuals from expressing their wishes or seeking the necessary support and guidance.
Additionally, differing perspectives and beliefs within families can pose challenges. Family members may have varying opinions on end-of-life care, leading to potential conflicts or disagreements. It is important to approach these conversations with empathy and respect, acknowledging and validating differing viewpoints while working towards a shared understanding.
Benefits of Having the ‘Death Talk’
Despite the challenges, having the ‘death talk’ offers numerous benefits. One of the significant advantages is the peace of mind that comes from knowing that our wishes will be respected and honored. By discussing our end-of-life preferences, we can ensure that our values and beliefs are upheld, providing a sense of control and dignity during our final days.
Another benefit is the opportunity to strengthen relationships and deepen connections with our loved ones. End-of-life conversations allow for intimate and vulnerable discussions, fostering trust and understanding among family members. These conversations can create a safe space for emotional expression and support, ultimately strengthening the bond between individuals.
Furthermore, having the ‘death talk’ can alleviate the burden on our loved ones. By openly expressing our wishes, we provide clarity and guidance, reducing the stress and uncertainty that can arise when making difficult decisions on behalf of someone else. This proactive approach ensures that our loved ones are equipped with the necessary information and can focus on providing comfort and support during our final moments.
Key Elements to Consider Before Having End-of-Life Conversations
Before initiating end-of-life conversations, it is essential to consider certain key elements. Firstly, it is important to reflect on our own values, beliefs, and desires regarding end-of-life care. Taking the time to understand our own wishes allows us to articulate them clearly to our loved ones. This self-reflection also helps us identify any fears or concerns that may arise during the ‘death talk,’ enabling us to address them proactively.
Secondly, it is crucial to choose the right time and place for these conversations. Finding a comfortable and private setting can create a safe space for open and honest dialogue. It is important to ensure that all participants feel at ease and are free from distractions, allowing for focused and meaningful discussions.
Thirdly, considering the preferences and needs of our loved ones is vital. Each individual may have their own unique approach to discussing end-of-life matters. Some may prefer direct and straightforward conversations, while others may require more time and gentle guidance. Being sensitive to these preferences can facilitate effective communication and ensure that everyone feels heard and understood.
Strategies for Initiating End-of-Life Conversations
Initiating end-of-life conversations can be challenging, but with the right strategies, it can become more manageable. One effective approach is to start the dialogue gradually. Begin by mentioning the importance of discussing end-of-life matters and expressing your own willingness to have these conversations. By framing it as a shared responsibility, you create an environment that encourages participation and collaboration.
Another strategy is to use open-ended questions to prompt discussion. Instead of asking yes or no questions, ask questions that invite reflection and personal experiences. For example, you can ask, “Have you ever thought about what kind of care you would like to receive towards the end of your life?” This approach encourages deeper conversations and allows for a more comprehensive understanding of each individual’s thoughts and wishes.
Active listening is also crucial when initiating end-of-life conversations. Give your loved ones the space to express their thoughts and emotions without interruption. By truly listening and validating their feelings, you create an atmosphere of trust and respect, facilitating open and honest communication.
Tips for Effective Communication During End-of-Life Discussions
To ensure effective communication during end-of-life discussions, it is important to keep certain tips in mind. Firstly, use clear and concise language. Avoid using medical jargon or ambiguous terms that may cause confusion. Instead, opt for simple and straightforward language that is easily understood by all participants.
Active and empathetic listening is another essential tip. Give your full attention to the speaker, maintaining eye contact and providing non-verbal cues that show you are engaged in the conversation. This active listening fosters trust and encourages individuals to share their thoughts and concerns openly.
Respecting differing opinions and beliefs is also crucial. End-of-life discussions can bring to light varying perspectives within a family. It is important to approach these differences with empathy and understanding, acknowledging that each person’s perspective is valid. By creating a non-judgmental environment, you encourage open dialogue and prevent potential conflicts.
Addressing Fears and Concerns During the ‘Death Talk’
During the ‘death talk,’ fears and concerns may arise for both the initiator and the participants. It is important to address these fears and concerns openly and honestly. By acknowledging and validating these emotions, you create a space for individuals to express their anxieties and seek reassurance.
Talking about one’s death has many benefits. It helps one realize that time is limited on this realm
One common fear is the fear of loss and separation. End-of-life conversations can bring to the surface the reality that our loved ones will not be with us forever. It is important to provide emotional support and reassurance, emphasizing the importance of these conversations in ensuring their wishes are respected and their legacy is honored.
Another fear that may arise is the fear of burdening loved ones with difficult decisions. Assure your loved ones that by discussing end-of-life matters, you are lightening their burden and providing them with guidance. Emphasize that these conversations are an act of love, enabling them to focus on providing comfort and support rather than making challenging decisions.
Resources and Tools for Navigating End-of-Life Conversations
Navigating end-of-life conversations can be made easier with the help of various resources and tools. One valuable resource is advance care planning documents. These documents, such as living wills and healthcare proxies, allow individuals to legally document their preferences for end-of-life care. They provide a clear framework for decision-making and ensure that our wishes are known and respected.
Another helpful tool is the use of conversation starters or discussion guides. These resources provide prompts and questions that can facilitate end-of-life conversations. They offer a structure for the dialogue and can help individuals articulate their thoughts and preferences more effectively.
Additionally, there are numerous organizations and support groups that specialize in end-of-life care and discussions. These organizations offer educational materials, workshops, and counseling services to guide individuals and families through these conversations. Seeking support from these resources can provide additional guidance and reassurance.
Seeking Professional Support for End-of-Life Discussions
In some cases, seeking professional support can be beneficial when navigating end-of-life discussions. Palliative care teams and healthcare professionals trained in end-of-life care can provide guidance and facilitate conversations. They have the expertise to address medical concerns and can offer advice on treatment options and symptom management.
Therapists or counselors specializing in end-of-life issues can also provide emotional support and facilitate communication. They can help address any unresolved conflicts or emotional barriers that may arise during these discussions. Seeking their assistance can promote a more open and constructive dialogue among family members.
Conclusion: Empowering Yourself and Your Loved Ones Through Open Dialogue
Having end-of-life conversations may seem daunting, but they are crucial for our own well-being and the well-being of our loved ones. By openly discussing our wishes, concerns, and fears, we empower ourselves and our loved ones to make informed decisions and provide the necessary support during end-of-life care. Remember to approach these conversations with empathy, respect, and active listening. Utilize the resources and tools available to navigate these discussions, and don’t hesitate to seek professional support when needed. By embracing open dialogue, we can ensure that our end-of-life journey is guided by our own wishes and preferences, providing comfort, peace, and a sense of dignity for ourselves and our loved ones.
Those engaged in Pastoral Thanatology ministry can help others broach the subject of death and help others understand it
Call to Action:
Start the conversation today. Take the first step towards having end-of-life conversations with your loved ones. Begin by reflecting on your own wishes and desires, and then find a comfortable setting to initiate the dialogue. Remember, open and honest communication is key to empowering yourself and your loved ones through this journey.
Please also review AIHCP’s Pastoral Thanatology Certification and see if it meets your academic and professional goals. The program is online and independent study and open to qualified professionals seeking a four year certification in Pastoral Thanatology
Additional Resources
‘Death talk’, ‘loss talk’ and identification in the process of ageing”. Karen West and Jason Glynos. (2014). Cambridge University Press. Access here
“End-of-Life Stages Timeline”. Angela Morrow. (2023). VeryWellHealth. Access here
“The Taboo of Death”. Mark Whitmann, PhD. (2019). Psychology Today. Access here
“What Is Thanatophobia?”. Team VeryWellHealth. (2023). VeryWellHealth. Access here
“Death anxiety: The fear that drives us?”. Maria Cohut, PhD. (2017). MedicalNewsToday. Access here
“Facts to Calm Your Fear of Death and Dying”. Ralph Lewis. MD. (2018). Psychology Today. Access here
In addition to the many painful emotions associated with a terminal illness of a loved one, there are also numerous decisions that need to be made for his or her future. Whether an aging parent, or a young child, and anything in-between, the difficulty in helping the loved one through this final phase can be difficult.
Beyond the emotional pain of dealing with a terminal diagnosis of a loved one also involves numerous medical and legal decisions. Please also review AIHCP’s Pastoral Thanatology Program
One needs to start considering possible therapies and treatments but also quality of remaining life versus quantity of days. Should one remain in a healthcare facility with treatments unproven or accept the inevitability of death and find joy in the final days of life? These decisions are not easy and especially made harder when the person is unable to make choices regarding their own health.
Please also review AIHCP’s Pastoral Thanatology Certification and see if it meets your academic and professional goals. The program is online and independent study and open to qualified professionals seeking a four year certification in Pastoral Thanatology
Grief experts have labeled the term Disenfranchised Grief to be a type of grief that is hidden due to fear of ridicule, or a type of loss that is not recognized or belittled by others because to others it is outside the range of societal norms or perceived as insignificant. Types of examples can be the loss of a pet, or particular loss that is extremely painful but personal but not acknowledged by society. Another example would be the pain of an individual who may be a boy friend or girl friend who may have lost someone in High School. While the family receives the bulk of the sympathy, the Highschool boyfriend or girlfriend may find themselves on the outside looking in. Another example of Disenfranchised Grief pertains to suffering from a stigmatizing disease. Still others who lose a loved one within the LGBTQ community may find a stigmatizing view towards their particular loss. All of these losses are ways society attempts to control how one grieves or what is worthy of grief itself. These type of constraints are an issue that Grief Counseling attempts to unbind in counseling sessions. Acknowledging the loss and grief is key and making awareness to others that these losses matter.
Many individuals are expected to react to grief in a quiet and private way. Please also review AIHCP’s Pastoral Thanatology Certification
Society attempts to control grief in other arenas as well. Not just merely in what is worthy of grief, but also in how one should grieve in public. Societal norms and standards of public display in the West seem to find contempt in outward expressions of grief. The discomfort of others witnessing a sobbing mother, or a hysterical child grieving the loss of a parent seem out of control and socially awkward. “What’s Your Grief” takes a closer look at this attempt to censure public displays of grief in it’s article “What is Suffocated Grief”. The term labeled “Suffocated Grief” refers to situations where other standards attempt to moderate grief expression. The article states,
“It wasn’t until years later, sitting in a conference listening to Dr. Tashel Bordere, that I realized it was more than that.. I heard the phrase ‘suffocated grief’ for the first time, a term she coined. She explained that for some, their expression of grief is not simply unacknowledged or stigmatized, as in disenfranchised grief, but it is punished. As she described normal grief reactions being penalized, all those calls to security flashed in my memory.”
“What is Suffocated Grief”. Whats Your Grief. December 21st, 2022. Whats Your Grief
Hence even if a grief loss is seen as within the norms of societal grief reaction and not disenfranchised, it still may fall under societal condemnation in regards to reaction to the loss and how that reaction is perceived in public. This literally takes grief bullying to a whole new level and can cause larger issues for the griever.
Many within societal norms see outward expressions of grief as uncomfortable or not acceptable in public
Grief reactions are not universal. Various cultures and faiths all grieve differently to a particular loss. One standard of expression or mourning cannot be held higher to another. Mourning as a public reaction to loss is the primary target of Suffocated Grief. The prevailing society sets the standards and rules for what is perceived as appropriate. When encountering loss, one’s reaction within a society must meet those societal standards of duration or extremity. When one travels off the path of “proper” reaction then that person is perceived as odd or temporarily insane. The discomfort for others is the primary issue. Individuals sometimes do not know how to respond to a particular emotion of others. Some individuals become uncomfortable or embarrassed when confronted with raw human emotion. Hence, hospitals, facilities and nursing homes will noise regulations or removal of individuals from a particular patient or ICU room when human emotion becomes to raw and visible.
Where is Grief Suffocated?
Suffocated grief unfortunately can be seen in many medical facilities. The ICU can become a very stressful place and the outward mourning of someone who may have passed may cause a considerable upheaval to the point of removal from the facility. Noise and crying in public can be perceived as threatening. Individuals who express themselves in the moment of extreme distress are seen sometimes as insane or out of control. While precautions need to be taken to protect everyone involved, such outward displays of mourning are usually frowned upon in the West.
The same is true within schools. Many minority children who experience more loss than white counterparts are sometimes held to a higher standard when expressing the same loss. They are not permitted to express themselves and when they do, it is seen or perceived as aggressive.
Suffocation of grief is especially seen in the work force. Many positions have little to no paid bereavement leave. Instead individuals are forced to return to work while grieving and expected to maintain composure and professionalism.
It seems, once the final shovel of dirt has been thrown over the grave, everyone should become silent and move on with life without expression.
Better Training
Understanding Suffocated Grief is important because it opens one to the pain of others. It is a sign of empathy to realize others are suffering. Instead of turning away, one needs to open arms. Pastoral Care and better training in grief are definitely needed in the caring professions. Medical professionals and nurses need to become better trained in the reactions of grief. A less sterile response to the needs of family experiencing a loss need to be implemented. How medical professionals discuss death and how they reveal these things can play large roles in helping others experience the bad news in a more quiet way. When these basic decencies are not met, individuals are more likely to be angry or devastated by a loss and display more outward mourning.
These feelings need to be respected within a safety net that prevents physical harm to oneself or damage to property.
Conclusion
Mourning or outward expression of grief within society is a very subjective thing. Cultures differ across the world. One way of reacting to loss should not be sanctioned by another community. Instead, others should be able to express grief and have the time to express grief without fear of ridicule. Healthcare professionals should receive training in helping others when reactions to grief and loss are experienced.
Alan Wolfelt lists a number of Bill of Rights for Mourners that cannot be taken away. One is to express oneself uniquely during loss and another is to experience “grief bursts” without fear of societal condemnation or grief bullies. It is important to grieve and express if one feels the need to do so.
The American Academy of Grief Counseling offers both a Grief Counseling Certification and also a Pastoral Thanatology Certification for qualified professionals in ministry, counseling and the medical fields. The programs are open enrollment and independent study. If interested, please review AIHCP’s Grief Counseling and Pastoral Thanatology Programs.
Additional Resources
“Disenfranchisement and ambiguity in the face of loss: The suffocated grief of sexual assault survivors.” Bordere, T. (2017) Family Relations: An Interdisciplinary Journal of Applied Family Studies, 66(1), 29–45. APA. Access here
“THE MOURNER’S BILL OF RIGHTS”. Alan Wolfelt. December 21st, 2013. TAPS. Access here
“The Ways We Grieve”. Ralph Ryback, PhD. February 27th, 2017. Psychology Today. Access here
“What to Know About Disenfranchised Grief”. WebMD Contributors. October 25th, 2021. WebMD. Access here
It is terrifying to be diagnosed with a terminal illness or to discover a close family or friend discovers such a terrible diagnosis. There are many existential reactions to such a proclamation. Individuals respond differently to such a thought. Finally death becomes a reality and how one deals with this reality determines one’s final chapter of life. This video reviews the many aspects and reactions that accompany a terminal diagnosis.
Please also review AIHCP’s Pastoral Thanatology Certification and see if it meets your academic and professional goals. The program is online and independent study and open to qualified professionals seeking a four year certification in Pastoral Thanatology.
Upon a worrisome visit to the doctor, eventually in one’s life, one will come to the grips of existential crisis, where one must deal with a life or death illness, or hear the terrifying words, that one is dying. For some, these words come earlier in life, for many, later, and for some, death can come like a thief in the night. Those who are granted the ominous warning are given a blessing and a curse. A blessing to prepare oneself and others, to put things right and affairs in order, but also a curse in knowing the clock is fearfully clicking to a deadline that is unavoidable. Please also review AIHCP’s Grief Counseling Certification.
There is a myriad of emotions and feelings that one goes through when a terminal illness is announced. An existential reality of one’s own finite nature is made rawly known to the intellect. What was once considered an abstract but real concept suddenly becomes personal and intimate. One comes to the conclusion that death will concretely and definitely happen. It is no longer a future imaging of how but becomes a concrete concept of now and here. Please also review AIHCP’s Grief Counseling Courses
A terminal diagnosis brings oneself to one’s final chapter in life. It is a scary time but there are ways to face death. Please also review AIHCP’s Grief Counseling Certification
How one perceives life and existence itself plays a large role in the existential dread of this bad news. Levels of fear and anxiety are measured and varied in regards to one’s own existential beliefs. Someone who is profoundly convinced of life after death and molded by an undying faith, may feel a sense of fear, but also a sense of hope and reward, while one who holds empiric and only observable phenomenon as a basis for existence, may feel a deeper dread of creeping into nothingness. Some individuals are less attached to the temporal reality and are able to sense a stronger sense of purpose and peace beyond the observable world. Those of this deeper faith, whether rightly placed or not, will react quite differently to the bad news of approaching death than one of lesser or no faith.
Fear of the unknown still exists even if in the smallest grain to the faithful. So naturally, the evolutionary push to exist when challenged will spring forth within the soul a type of fear. The fear of the unknown still exists for those of faith, but the levels of fear that may surround one who is terminally ill, differs greatly in intensity. One of faith upon the announcement of bad news will definitely still feel a sense of fear and be forced to reckon with the unknowable. This type of fear is a natural reaction. Since one’s conception, the urge to exist is programmed within the body. The urge remains a strong driving force.
For those facing death, a general fear may also be replaced with a more acute fear of the now. Fear of sharing this news, or keeping it to oneself. Fear of the disease itself and what this particular disease may do to one’s body during the final phases. Oneself may fear the pain, the treatments, the side effects and quality of life or even the fear of leaving family and children without one’s guidance and protection. Obviously these are grounded fears to one who has come to a firm acceptance. While initially one may be swarmed with questions and options, one may soon find oneself consumed with collecting as much information about the disease or condition, understanding pain management or reviewing various extraordinary measures to preserve life. Understanding the enemy can sometimes qualm some fear and even give a glimpse of hope. One finds oneself with more power over fear when one faces the enemy across oneself. Some individuals face the enemy, while others choose to live in fear and hide from it. One in the end accepts how they will face death, either with a strong will, or a broken one. Accepting death but facing it with a strong will despite fear is the true definition of courage.
Due to this natural fear of death, even among the most spiritual and religious, one when faced with this terrible thought will undoubtedly deny it. Elisabeth Kubler Ross who worked with the terminally ill observed this natural human reaction to reject bad news initially. Something so frightful at first refuses to be processed by the brain. Bad news is met with an equally powerful rejection of it. As one receives this bad news then, one will probably initially reject the sentence of death. How long this reality takes to sink in may differ among some. Some may seek additional medical opinions, until all options are removed. Others will proceed with elaborate alternative therapies in hope of a cure. For some, hope can be a evolutionary device for survival. It definitely is not something to rejected but when hope blinds oneself to such an extent that is masquerading as denial, then it can become problematic to oneself and prevent oneself from dealing with the reality of death.
Death itself is a process that many run and flee from. Evolution to survive engrains this feeling into oneself. Yet, if one stops and realizes that death is a process one must face, then maybe one can allow oneself the process of dying properly. Many cultures value a good death. A good death is as part of life as birth. Dying well, handling oneself well and maintaining dignity is critical to the last chapter. Long term denial strips one the opportunity to handle affairs, repair relations, prepare the mind body and soul and live the final chapters. So, absolutely, upon terminal diagnosis, one will feel fear and denial and this is OK. What one does not wish to continue to entertain is a long term denial. Hope should not be squashed, but denial should not be masked as hope either.
Oneself may think if one ignores the horrible diagnosis that it will go away. For this reason alone many in denial, may keep a terminal diagnosis as a secret from friends and family. One will ignore checkups and important procedures and postpone wills and other critical business at hand. These types of secrets are part of denial at its core. Oneself may feel as if one is sparing others grief, but this type of internalization of bad news only denies the reality and creates less time for others to express love and accept reality.
Following this diagnosis, other emotions may erupt within oneself. As Kubler Ross points out in her famous stages of grief, one experiences far more than denial upon the initial announcement of bad news. One will experience also a range of emotions with the first minutes or days or weeks or months. Anger is a powerful emotion that may erupt. One may find oneself angry at God, or others. One may feel one’s life has been stolen or cut short. Others may become jealous of others who were granted better health. Again, in grief, one cannot deny these initial feelings, but understand them and see where this anger comes from. While one may feel like they may be treated unfairly, one cannot allow anger to turn into envy and become caustic within one’s very being. There is little time left with a terminal illness and negative emotions and negative energies while acknowledged should not be permitted to fester, unless one wishes for the soul to also suffer with the body.
With the lamenting of death, some will feel greater melancholy. How long one grieves the impending loss of life, like fear itself, varies upon the spiritual nature and resilient nature of oneself. One should clearly come into contact with the sadness of loss of one’s physical life, but again, like anger, it is important to evaluate the emotion within its proper degree. Some may go into a deep depression or no longer wish to live. Oneself may recede to the shadows well before the date of death. When sadness of this level overtakes oneself, then one must realize that the diagnosis is now taking more life than it originally took before. The intense grief is taking what is left. It is stealing the final days of sunshine, family memories and expression of love.
With such deep emotions, sometimes it may be good to express these feelings. Some may find solace in their family and friends, but others may feel a fear to cause them more pain. While this is noble, in many ways, family and friends wish to help one carry this cross. Oneself should not feel isolated to the point where one has none to share the fear and emotions of dying. An additional option is finding others in support groups or other social venues where others of like diagnosis can meet and share emotional fears and acute physical symptoms. A good balance between sharing with family and other like diagnosed individuals can play a great tool in helping one face the emotions of one’s diagnosis.
Kubler Ross pointed out that many may also bargain. As if one has a final say with the grim reaper, oneself may feel the need to negotiate with the angel of death. This sense of powerlessness is lessened with bargaining and creates an illusion as if oneself can negotiate the final days. Oneself may ask, if I can only have an extra year, or have only this procedure instead the other procedures. This illusion of power and control over death is merely another way oneself may try to create one’s own ending. Instead of focusing on “ifs”, oneself should focus on the realities and what can be done within the time given. Less time bargaining and more time doing is a far better way to accept the angel of death.
How will you face the angel of death and one’s own existential reality when the time comes? Please also review AIHCP’s Grief Counseling Certification
Upon this terrifying news of one’s own impending death, one can react in a multitude of ways, intellectually and emotionally, but while no emotion is initially to be ignored, there is clearly a better way to face death. It is up to you, the person facing the terminal illness, how you will face the final chapter in your life and no-one else but you can author that chapter.
If you would like to learn more about death and dying, or about AIHCP’s certification programs in Grief Counseling and Pastoral Thanatology, then please review AIHCP’s online programs. The Grief Counseling Certification and Pastoral Thanatology Certification Programs are both online and independent study and open to qualified professionals seeking a four year certification.
Additional Reading
Elizabeth Kubler Ross Stages of Dying. Please click here
