Spiritual Care at the End of Life
For all people, life is a gift from God. Life is given as the opportunity to meet God in friendship and love; life is the journey to God; and the goal of life is to live with God forever. Baptism has set the Christian on this pilgrimage of faith into an explicit and personal relationship with Christ who is the Way, within the Church which is the community of fellow pilgrims. The life and death experience of Jesus reveals that God has entered every aspect of human life, especially suffering. For the Christian, as natural life draws to an end, the goal of eternal life with God should be clear and the hope of its attainment should be evident. End of life is generally a time that spirituality and religion assume a heightened significance. It is an opportunity to deepen one's relationship with God. However, the physical, emotional and spiritual crises that characterize death can affect the Christian in many ways. Pastoral ministry to the dying Christian is essential to provide the assurance and the confidence that faith offers to the person and his or her family at this time.
Spiritual Care of the Dying
The focus of ministry at the end of life will be to develop what began at Baptism so that it fittingly culminates at the moment of death, namely full communion with Christ who is our Life. This ministry is exercised in personal, prayerful and sacramental experiences. This ministry is personal, since the personal bond with Christ and his Church is experienced through a variety of vital relationships: spouse, children and grandchildren, extended family, friends, neighbors and various pastoral ministers. These relationships manifest Christ's abiding presence to the dying person. This mystery is palpable; it is tangible. The pastoral minister can play an important role with the patient and the family by offering a simple catechesis about the personal mode of Christ's presence in the ordinary network of human relationships. Then, with every touch, Christ is touching the person too; with every word of comfort and love, Christ is also speaking to the person; with every tear shed, Christ is moved with compassion for this person and his or her loved ones.
The listening and companionship of the pastoral minister are spiritual gifts. The person might need to express spiritual pain such as feelings of abandonment, anger, fear, guilt, remorse, etc. He or she can be assisted to name spiritual strengths such as hope, trust, forgiveness, love, inner peace. Spiritual conversation can help a person let go of limiting ideas of God (One who punishes. One who tests, etc.) and can reinforce positive images of God.
Ministry to the dying will also be prayerful and sacramental because prayer is the ordinary means by which we experience and deepen our union with God and experience God's loving assistance for living; and, for us as Catholic Christians, prayer reaches its fullness in the sacraments. In these ways, and in all relationships, Christ is laboring for the ultimate well-being of the dying person, the family and the Church.
Prayer with and for the dying person is invaluable and takes many forms. It may be as simple as prayers of acclamation such as, "Jesus, have mercy on me!" or the regular praying of the Lord's Prayer and the Hail Mary. Holding the Rosary might be important. This is also a time when the pastoral minister can help the person and loved ones safely express their deep thoughts, feelings, concerns and affections through the form of spontaneous prayer.
The pastoral minister can gently assist persons by asking questions such as: What would you like to say to God? What do you most need from God at this time? Are there regrets you wish to express? For what are you most thankful? Prayer can point to the steadfast love and compassion of God. It can affirm God's forgiveness. It can also express lament. Suggestions that invite people to consider what they most need from God at this time can lead to silent prayer and then to shared prayer and, finally, to a prayer that gathers all of this together. The "Spirit praying in us", as St. Paul describes it, is often experienced in wordless moments by patient and loved ones alike, when the Lord's loving presence is simply felt and savored.
While Christian prayer begins with human experience, it necessarily moves toward the further immersion of the person's experience in the experience of Christ. As the moment of death approaches, the Church and the dying person's loved ones and friends are found praying that this passage through death will end in the victory of the resurrection. Likewise, Christ is present as forerunner and guide, to lead this person for whom he shed his blood. Though it is a deeply personal time, it is naturally a time of communion. The personal expression of love, "letting go" and hope can be expressed poignantly by spontaneous prayer, by texts from Scripture and the Commendation of the Dying in the Pastoral Care of the Sick. These approaches to prayer may also be helpful if it is necessary to withdraw life support.
The proclamation of Scripture, as a presence of Christ's experience, is always appropriate. For some, the repeated proclamation of one significant verse or text will be most consoling. For others, the familiar and comforting images of Psalm 23, or the urgent longing expressed by Psalms 42 and 63, or the profound personal trauma and desire of Psalm 130 will articulate their thoughts and affections. The proclamation of the Gospel is always helpful. It might be the Beatitudes in Matthew 5:1-12, or the compassionate invitation of Christ in Matthew 11:28-30 ("Come to me"), or the life giving power of Christ in Luke 7:11-17f (raising of the widow's son). It should certainly include the proclamation of his passion and resurrection: the agony in the Garden, Luke 22:39-46; the promise of paradise, Luke 23:42-43; Jesus' final commendation of his spirit, Luke 23:44-46; the shared gift of the resurrection, John 20:19-22. All of these texts invite further communion with Christ and deeper immersion in his Paschal experience.
Because the goal of all ministry at the end of life is oriented toward communion with Christ, the Sacrament of Viaticum sets the tone of the ministry to the dying. They should, as often as possible, receive Holy Communion and then, especially, Viaticum when death is near. The Eucharist is the primordial sacrament of Christ's passage from death to life and of our passage with him.
Every effort should be made to facilitate frequent sacramental communion for the dying. The presence and generosity of so many Extraordinary Ministers of Holy Communion in various settings (hospital, nursing care facilities, parishes) should make this possible. The Sacraments of Penance and Anointing of the Sick should be offered to the dying person at appropriate times and in a sensitive fashion. The continuous rite of these three Sacraments can be given in situations when death is coming unexpectedly and imminently. As much as possible, the Sacraments should be celebrated communally with the person's loved ones and friends. They should also be celebrated when the dying person is able to receive maximum psychological, as well as spiritual, benefits from them. At a time when priests are less numerous, the celebration of the Sacraments must be seen as their primary ministry. While planning these celebrations is always desirable, ministry to the dying is often needed at unexpected times. This requires the selfless availability and generous flexibility of priests to provide the pastoral care that they alone can offer.
Apart from the sacraments, which are the primary means of ritually caring for the sick and dying, other rituals might be utilized. Rituals provide an awareness of the presence of God in every situation. The pastoral minister can encourage and provide rituals. Among the possibilities are those contained in the Pastoral Care of the Sick, chapters Six and Seven: Commendation of the Dying and Prayers for the Dead. There are other prayers in the Book of Blessings for the elderly and for sick adults and children that would be appropriate in various circumstances. Catholic Household Book of Blessings, issued by the Bishops' Committee on the Liturgy, provides some resources in Part III: Times in Life: Blessings of Family Members. Blessings, accompanied by gentle touch of the person, are important.
For some dying persons, it would be helpful to provide music as prayer, either songs or hymns that express the abiding care of the Lord and the comfort of his grace. It may also be helpful for some to have instrumental music playing to relax them, dispose them for prayer and to minimize their fears and anxieties.
Care of the Family
As the person is in the last stages of dying, the focus of pastoral ministry begins to shift to the family. When death arrives, the ministry focuses almost exclusively on the family and the minister becomes a presence of Christ and his comfort to them. Later, when others have taken up the ministry to the bereaved, reflection on the experience of this person's death can become a form of prayer, and a means of strengthening grace, for the pastoral minister who will be called upon to offer this ministry again and again.
Perhaps these words from the Pastoral Care of the Sick can fittingly conclude these Ministry Notes: "The Christian community has a continual responsibility to pray for and be with the person who is dying. Through its sacramental ministry to the dying, the community helps Christians to embrace death in mysterious union with the crucified and risen Lord, who awaits them in the fullness of life." (Pastoral Care of the Sick, #163) The journey of faith, begun in Baptism, has brought the dying person to the threshold of death. Christ has accompanied this person and will not abandon the dying person at death's door, but always remains faithful to his promise: I am with you always (Matthew 28:20). Christ's abiding presence is accomplished by grace and manifested through the Church in her members, ministers, sacraments and prayers. As Christ continues to guide the person through death to eternal life, the Church continues to express her faith and hope in him, and her love for him and for the faithful departed by prayers and the rites of the funeral liturgy. The Christian life gives constant witness that life and love are stronger than death.
These Ministry Notes were prepared by Rev. John Sassani, Director, Office of Spiritual Development, in collaboration with Kelly Dunn, Director, Office of Parish Outreach Ministries/Health Care Ministry.