This post is by Rob Moll, author of: The Art of Dying: Living Fully into the Life to Come. This post answers a letter question we received last week and posted.
How should the Christian community respond when a member is told he or she has a terminal illness?
This question is of greater importance than ever before, and often we must face it at a time when we are least prepared to answer. As I was researching my book, The Art of Dying, I discovered that Christians have for centuries intentionally practiced their deaths. They meditated upon and prepared themselves for the day they would leave this life. In centuries past, where sudden death was most common, these believers would have greatly appreciated the advanced warning provided by a doctor in the form of a “terminal diagnosis.”
The Physical Burden of Terminal Illness
Before we can get spiritual in our talk of helping people prepare to die, we need to get physical. Our leading causes of death — cancer, heart disease, diabetes, stroke, Alzheimer’s, respiratory disease–are often slow and progressive, and this kind of dying bears with it a unique exhaustion for patient and caregiver alike. Terminal illness doesn’t usually mean the patient has three weeks to live. It may mean the patient has three years to live.
So the first thing for the church to do when someone is diagnosed with a terminal illness is to consider what it means. What is the course of this disease and how much time do we have left? What kind of assistance is this person and her family going to need to get through this period? How can we help in the everyday physical tasks of the dying, allowing them the space to do the important spiritual work that lies ahead of them? Living with a terminal illness is tough enough, but the patient may have two years in which she needs help cleaning the house, getting groceries, visiting the doctor, keeping track of the medicine and the medical bills. Dying is tough work and, often these days, drawn out.
As the patient progresses in illness, the church must also realize just how challenging these years can be for caregivers. I spoke with a widower last year who, a few years after his wife’s death, was still in near tears as he described the 34-foot long bill sent to him from the hospital. He couldn’t explain what it was for and didn’t have the money to pay it. One-third of households, or 66 million Americans, are providing long-term care for a family member. They spend most of their time assisting with bathing, dressing, using the bathroom, and doing housework. The work is tiring, and the financial cost can be crippling. Adding all of this care to the stress of an ordinary life is a tremendous burden. Here the church must stand ready to lend support in physical ways to the caregivers, providing vital respite and encouragement for this arduous task.
Plotting the Course of Dying
With support in place, the patient and his family can be released to turn their attention toward preparing for death. The first step is a very material one: help the terminally ill person write down her end-of-life wishes and her will. A good death–one that survivors feel was meaningful and honorable–is far more difficult when there is intensive medical intervention. The more aggressive the treatment, the more painful and more difficult a death is likely to be. The church can be active here by learning and teaching Christian views of dying well. A study published in the Journal of the American Medical Association found that people died more poorly after being advised by their pastors, mostly because they were urged to pursue more treatment. Instead, the church can promote spiritual faithfulness in anticipation of life with God.
It is important to determine, along with the doctor, what sort of death the patient wishes to have. What is most important, extended life or limited pain and meaningful time with family? Dying at home or with access to the most advanced medical treatments? These are different kinds of deaths. And the church should be present here helping to avoid bioethical troubles and providing a guiding voice alongside the medical choices. As a former hospice volunteer, I’ve seen patients experience the benefit of dying surrounded by family with pain skillfully treated.
Extended life and time with family are not mutually exclusive goals either. I knew a hospice volunteer whose first three patients got better and left the program! One study found that cancer patients lived longer when they joined a hospice program and their cancer was left untreated. The medical benefits of meaningful living and close personal relationships are often as good as any formal health care treatment.
An essential part of these end-of-life discussions also concerns material possessions. In his “Sermon on Preparing to Die”, Martin Luther advised his listeners to draw up a will. Taking care of these earthly concerns allows us to then focus on the image of Christ, Luther says. Jesus did this as well when, from the cross, he asked his disciple to care for his mother. Because arranging our financial and personal affairs always involves other people, including those within the church, it also also provides an opportunity to set our relationships in order.
Offering forgiveness to others, saying goodbye, and completing relationships are important steps in preparing to die. Traditionally, these are considered the “last words.” In the tradition of the “happy death” as practiced by English and American Methodists, people often sought out the words of someone close to death. That much nearer to Jesus, they believed, the dying person’s advice would be that much more spiritually sound. Jesus himself offered final words during the Last Supper, providing instruction and guidance for his disciples to assist them for life without their teacher. I have often wished the church would allow the rest of us to hear what is on the hearts of those who are elderly or dying. We would do well to listen to them.
Saying goodbye requires a willingness to die. One cannot be ready to enter eternity while fighting tooth and nail to keep out of it. The modern therapeutic term for this is “acceptance.” However, I think “willingness” better captures the Christian’s response to what St. Paul called “the last evil.” We need not accept death; it is evil. But, when God calls us home, we do need to be willing, like Jesus in the garden, to take the cup given to us. When the church is present in our end of life choices, has helped to guide our decisions, and given us opportunity to hear from those nearer death, then becoming willing to die won’t be a terribly difficult transition for us. It might become one we’re well prepared for.
A Glimpse of Glory
Willing to die, the terminally ill person may turn her attention away from this life and toward God. As this life gradually fades and the next slowly comes into view, the dying person and others nearby may catch a glimpse of that life to come. People who work with the dying are routine witnesses of the thin boundary between the two worlds. For all Christians, and particularly for loved ones, this can offer a great deal of consolation. However, if a glimpse beyond is common it may not be typical. Even John Wesley, who regularly asked, “Do you see Jesus?” of those who were dying, never expressed a glimpse of eternity on his deathbed.
Preparing to die has long been considered to be a chief duty of the Christian. Such preparation allows us to live this live in view of what is eternal, and what is meaningful in it. The challenges to dying well in the modern age are immense, yet as we work to support those in our congregations on that journey, we too can learn to number our days and in doing, we pray, gain a heart of wisdom.