Pastors and ministry leaders are often well-trained to care for people’s eternal well-being. However, they often feel ill-equipped to shepherd people as they make important decisions at the end of their physical lives. New Wine, New Wineskins and Multnomah Biblical Seminary will host a forum on this subject titled “Supporting Parishioners in Critical Health Care Decisions” on Wednesday, October 23rd at Multnomah University in Portland, Oregon. In this seminar, a palliative care physician who is an ordained minister will provide concrete advice and resources for pastors and ministry leaders about how to prepare their congregants both practically as well as spiritually for the end of mortal life. He will be joined by a panel that includes two pastors, a licensed counselor, and an estate attorney. The keynote presenter is Rev. Dr. Robert Macauley, the Cambia Health Foundation Endowed Chair in Pediatric Palliative Care, School of Medicine, Oregon Health and Science University. I reached out to Rev. Dr. Macauley to ask him some questions pertaining to the event. Here are the questions and his responses:
Paul Louis Metzger (PLM): Dr. Macauley, you operate in two domains: one as a medical doctor specializing in palliative care, and the other as a minister specializing in soul care. What are a few insights and concerns that a medical doctor brings that inform critical health care decisions? What are a few insights and concerns that a minister brings to bear on the same subject? How have these two spheres intersected or possibly even collided on this subject in your experience?
Robert Macauley (RM): These are great questions. As a physician, I’m well-versed in the probability of certain outcomes. Part of my job is to help patients and families understand what to expect based on the decisions they make. I am also acutely aware of the burden of having to make those decisions, so as much as possible I try to understand their goals and values and frame recommendations based on those. As a priest, I think I have come to be at peace with not being able to “fix” things. My role is to companion families on an incredibly difficult road, and to reassure them of God’s presence. In that respect, my priest side helps compensate for the “fix-it” nature that we physicians tend to have, and my physician side helps inform what we cannot reasonably hope for based on science, although this does not take into account the possibility of divine intervention which often comes up in my conversations with parishioners and with patients.
PLM: Does recognizing the sanctity of life require a Christian to do everything possible to prolong their lives, regardless of suffering or burden? Might there be times when medical technology is standing in the way? If so, how does one make that determination?
RM: I strongly believe the answer to the first question is No. As Christians, we believe that earthly life is only a small fragment of our entire lives, when you take eternity into account. And while earthly life is a gift from God and therefore demands respect and honor, I do not believe that we are obligated to make it last for as long as conceivably possible. There are times when the burdens of continued treatment—which can include pain and other forms of suffering—are so great, that we can faithfully focus more on comfort and quality of life, than on quantity. I am often reminded of an old joke. It tells of a person who is in a ship wreck and is treading water in the middle of the ocean. He prays that God will save him. Soon a helicopter comes by and offers to pluck him out of the water, but he refuses because he is waiting on God to save him. Then a little while later a ship happens by and offers to pick him up, but he refuses for the same reason. Eventually he drowns and when he appears before God in heaven, he asks God why, after he had exhibited so much faith, God didn’t do anything to save him. God in turn asks him, “If you really wanted to be saved, why’d you say no to the helicopter and boat I sent?” One could easily change the thrust of the joke to imagine a critically ill patient whose kidneys have shut down (so goes on dialysis) and who can’t breathe on his own (so is put on a ventilator), who asks God why God hasn’t done anything to ease his suffering. To which God might respond, “I’ve been trying to bring you home, but you keep saying yes to things like dialysis and ventilators.”
RM: I think there are 2 big reasons why clergy are not as involved in end of life decisions as they could be. One is that they may not feel prepared, given that the medical environment is a foreign one. The other is that they view their role as a spiritual comforter rather than counselor or advice giver. Studies have shown, however, that the end result of this is that clergy often end up overestimating the possible benefit of certain medical interventions, and also end up endorsing whatever decision the patient has arrived at, without recognizing that the patient may be looking for spiritual permission to make a very different decision. I would advise clergy to establish relationships with the medical establishment so that they could be more informed about some basic medical decisions that patients often face, and that they would be bolder in engaging patients on a spiritual level about what God expects of them in such situations.
PLM: What are some of the most important things a pastor or ministry leader can do in helping those entrusted to their spiritual care prepare for the end of life?
RM: First, I’d recommend being open about the fact that we will all die, and not just in an eternal salvation sense. Part of being a good steward of what we’ve been entrusted with is to make informed and thoughtful decisions about the end of our lives, and in the process, we end up taking care of those whom we love, who are spared having to make those decisions themselves. This includes naming a health care surrogate and sharing one’s goals and values with that person. Those goals and values will frame brave decisions about what treatments will prolong life, and which ones only serve to prolong death.
PLM: What closing thoughts would you like to share with our readers? Are there any resources to which you would draw their attention? Thank you for your time.
RM: A great way of helping patients address these critical questions is to use resources that are widely available, like Five Wishes (www.fivewishes.org). Opening conversations in a group setting—especially when a medical professional is present to offer context and perspective—can help people feel supported. Moreover, speaking from the pulpit about what a “good death” looks like from a Christian perspective can be a huge help.
After the talk, a panel of two pastors, a clinical psychologist, and a lawyer will respond followed by a time of interaction with those in attendance. The panelists are Pastor Tom Schiave, Gateway Church, Portland, Oregon; Pastor Jim Sequeira, Cascade View Covenant Church, Vancouver, Washington; Dr. Kristen White, Director, Master of Arts in Counseling, Multnomah University, Portland; and Attorney Justin Curtiss, Landerholm, P.S, Vancouver.