Importance of End of Life Training

Dr. Saul Ebema

Patient #1 had just been diagnosed with a terminal brain tumor when I first met him. At 42 years old, he was still a young man with two children aged eight and six years. I met his wife by the bedside trying to comfort him. His two children had been taken to his parent’s home to keep them away from the sadness that had engulfed the home.

He was the sole bread winner in the home, and a man of strong faith. Before this diagnosis, he was active in his Methodist church and was a member of the worship team. The tumor had metastasized, making him more disoriented. But he spoke about his faith in God and his love for his wife and children.

He seemed at peace with his situation but his wife was not. “Why would God allow this to happen to my husband?” she asked. I looked in her eyes and saw the pain. “He is such a good man and doesn’t deserve this;” she continued with tears rolling down from her eyes.

I held her hand and offered emotional support to help reduce anxiety and spent about two hours with them. It was a good initial visit. As I was leaving the house, Patient #1 asked me to call his pastor and ask him to visit them. The wife provided the pastor’s phone number. I called the pastor and updated him on the situation and he accepted the invitation to visit.

Three days later, I got a call from the pastor. He said he had visited patient#1 and the family but felt completely overwhelmed with the situation to be of any help to them. He asked whether I would be able to follow up with the patient and family for ongoing spiritual support instead of him. I agreed to follow up and the pastor was very appreciative.

For the last four years, I have heard from about 50 to 75 different pastors who expressed the same concerns as patient#1’s pastor. They all said that they felt overwhelmed and inadequate to provide spiritual support to the dying and their families.

From my experience as a hospice chaplain, there is a growing need for pastoral counseling in times of terminal illness, death and bereavement. Recent research also indicates that a growing number of people, especially Christians seek and value spiritual support at the end of life.

In Park Ridge, IL, I conducted an interview study involving family members of people who died under hospice care due to terminal illness in 2015-2016 and found that spiritual care at the end of life was important to those family members. The people I interviewed reported higher ratings of the deceased’s quality of life and peace throughout the dying process as a result of receiving spiritual support from their pastors, hospice chaplains or faith communities.

The importance of religion and spirituality at the end of life and the relatively low response from clergy to help meet these needs led researchers at the Institute of Medicine to raise questions about the training ministers receive. Two researchers, Doka and Jendreski, suggested that the clergy’s lack of education about end of life care and grief was an obstacle that prevented them from being of greater solace to the bereaved.[1]

Hospice chaplaincy’s training focuses on the development of core counseling competences essential in the area of pastoral care to the dying and their loved ones. Most patients with a diagnosis of a terminal disease often look to ministers and religious figures for guidance and support. But many ministers do not always feel comfortable participating in such end of life situations. The lack of knowledge in understanding end of life issues and the cultural fear of death make religious leaders feel inadequate to serve in their unique calling as pastoral caregivers. Craig Younce said it best,

I believe that the ministers, who have paid the price of disciplined study and training leading to competency in providing pastoral care to the dying, will experience the joy that comes with the realization that he/she has been an instrument through which God has brought comfort to another human being.[2]

It is reasonable to suggest that in every worship service, Pastors from their pulpits will see a troubled husband who has lost his wife due to death to cancer, a husband who has admitted his wife under hospice care due to a terminal illness, a young man deeply depressed by the death of his grandfather, a couple grieving the death of a child. These distressed church members will “often trust the very fabric of their lives to the counseling skills of their religious leaders.”[3]

The reality is that many religious leaders and people lack training in one of the most vital aspects of ministry, counseling the terminally ill and the bereaved thereby, making them incompetent pastoral caregivers.

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[1] Charles Asp et al., “Spiritual Care at the End of Life. Journal of Health Progress 9 (2004): 1- 9.

[2] Craig L Younce, “The significance of Developing Core Counseling Competencies in Pastoral Care Ministry” (DMin diss., Liberty Baptist Theological Seminary, 2011), 4.

 [3] Ibid., 5.

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