A Clergy Guide to End-of-Life Issues

Martha R. Jacobs, A Clergy Guide to End-of-Life Issues (The Pilgrim Press, 2010).
A Book Review by John Vlainic

This book is intended for local church pastors, with the goal of helping to orient them to some of the basic questions and issues involved in end-of-life care

The attached Table of Contents tells you of the scope of the book. I will here highlight a couple of things and end by stressing that you NOT MISUSE THE BOOK.

Her section on “OUR OWN DEMONS” is very important. I have come to think that so much of the hurt and ineffectiveness in care of the dying and their loved ones could be remedied if the caregivers (including pastors) were much more in touch with our own mortality. This section begins:

“Clergy have a responsibility to help congregants with many difficult decisions throughout life. One of the most difficult for us (as well as for our congregants1) is about end of life, how we want to die and what we hope to accomplish before we die.

If we don’t face our own demons with regard to death and dying, we cannot empower our congregants to face those most difficult-to¬-face decisions. Decisions about how one wants one’s life to end are individual decisions that need to be made, when possible, through a process of discernment. In addition to their religious beliefs, people have financial and familial concerns as well as the desire to be pain-free. No one can or should make decisions about end-of-life issues quickly and without prayerful discernment.

. . . . As clergy, we are not always willing to practice self-care. It is one of the hardest things for us to do. Unfortunately, when we don’t prac¬tice self-care, our boundaries can get wobbly and our minds get easily distracted; burn-out and compassion fatigue are nearby—waiting to pounce. It is just as important to prepare for self-care as it is to pre¬pare to preach, deal with a budget meeting, or perform other clerical duties.

. . . . When dealing with those who are dying, it is particularly important to practice self-care. While you may begin to feel more comfortable when you are with those who are dying, it is still draining and you need to be aware of your own feelings toward the person who is dying. Perhaps it is a parishioner with whom you had a long-time relationship that was meaningful to you, or one with whom you always disagreed. In both cases, it is important that you be present to that person and to his or her family and also be present to yourself and your own need to grieve.”

She then shares from her own story.

“I thought that I was very good at self-care, that God had given me the gift of being able to “handle anything” and then continue on with the rest of my day. I would “give it up to God” when I would walk out of the room or after seeing the family off the ICU or to their car. Little did I know that the residual was building up in me. Then 9/11 happened, and I spent a great deal of time at Ground Zero with the rescue and recovery workers. Again, I thought that I was doing just fine — “giving things up to God” as I listened to stories of hurt and pain and loss and the constant questioning of “why God could let this happen.”

Then I began to notice that my soul had gotten “quiet.” I was not able to deal with other people’s problems, nor was I interested in doing so. I didn’t want to hear another story or say another prayer with someone. I was compassioned out.

This came as quite a surprise to me since I thought I was so good at self-care.”

She includes a good DISCERNMENT TOOL for us to use in getting in touch with our own mortality.

I also like her list of GENERAL INDICATORS OF IMPENDING DEATH and her list of the THINGS THAT MAY OCCUR AT THE TIME OF DEATH. I ran these by a friend who is an ICU Head Nurse.

The MIRACLES AND CURES chapter is balanced and biblical. It just so happens that over the last couple of weeks, a chaplain and a doctor and a social worker have all shared stories of people insisting on only one form of miraculous cure (and causing much hurtful stress for everyone involved).

I predict that you will be better prepared for your own life and death, and also for ministering to your people — who are also going to live and die — by working through this book. But I do have to stress one thing in closing.

I recommend this book to you because it will help you by raising a host of the right questions, many of which are rarely raised to us before we are in the middle of crisis.

But do note that this book was written in the United States. Yes, the author repeatedly reminds readers that laws and definitions are different there in different States.

But we minister in a different country. Our laws are different in some of the important details from those in the United States.

However, for the most part, things are alike there and here. For example, I checked with our Ethicist here and she agrees that the distinction the author describes between capacity and competence is generally accurate.

But do remember that different Canadian provinces have different laws. In fact, I wouldn’t be surprised to learn that there are subtle differences of interpretation from hospital to hospital and physician to physician.

So if you get this valuable book, make sure that you use it to GET HELP WITH WHAT THE QUESTIONS ARE. The answers may be somewhat different in your jurisdiction.

The Bottom Line: GO TO THIS BOOK FOR HELP WITH QUESTIONS EVEN MORE THAN ANSWERS!! Just knowing what the real questions are will help us all to serve our people in crisis much better.

Where you need precise ANSWERS, talk to a physician you trust or consult the ethics people in your hospital if things are terribly complicated.