Spiritual Palliative Care

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Spiritual Palliative Care

• A Christian approach to ministry in the valley of
  the shadow of death

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Jesus Christ says The Spirit of the Lord JHWH is
on Me, because JHWH has anointed Me to preach the
gospel to the meek, He has sent Me to bind up the
broken-hearted to proclaim liberty to captives,
and complete deliverance to the bound ones to
declare the acceptable year of JHWH, and the day
of vengeance of our God to comfort all who
mourn to appoint to those who mourn in Zion to
give them beauty instead of ashes, the oil of joy
instead of mourning, the mantle of praise instead
of the spirit of infirmity so that one calls them
trees of righteousness, the planting of JHWH, in
order to glorify Himself, Isaiah 611-3
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• WHO1990 Palliative care is the active total
  care of patients whose disease is not responsive
  to curative treatment. Control of pain, of other
  physical, and of psychological, social and
  spiritual problems, is paramount. The goal of
  palliative care is achievement of the best
  possible quality of life for patients and their
  families. Many aspects of palliative care are
  also applicable earlier in the course of the
  illness, in conjunction with anti-cancer
  treatment.
• Palliative care
• Affirms life and regards dying as a normal
  process
• Neither hastens nor postpones death
• Provides relief from pain and other distressing
  symptoms
• Integrates the psychological and spiritual
  aspects of patients care
• Offers a support system to help patients live as
  actively as possible until death
• Offers a support system to help the family cope
  during the patients illness and in their own
  bereavement.
• Radiotherapy, chemotherapy, and surgery have a
  place in palliative care, provided that the
  symptomatic benefits outweigh the disadvantages.
  Investigative procedures are kept to a minimum.

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Elements of palliative care (Steiner 2003)

1. Optimal identification of symptoms
2. Optimal relief of symptoms
3. Optimal interdisciplinary teamwork in the care
4. Optimal continuance of care
5. Optimal involvement of patient/family as real
   partners of the palliative care team
6. Optimal psycho-social support of the patient and
   family
7. Optimal spiritual support

Pneumo-psycho-social care spiritual care
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World view (basic beliefs) palliative care
Palliative care in practice
Vision of palliative care
Health/Disease/Death
Truth/Science/Research
Ethics/Values/Norms
Human being
God
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The course in a nutshell

• Prepared and cared-for care-givers
• seek to reach six goals
• via seven points of attention
• in their care of the dying person

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The dying person a Christian perspective

1. Underlying view of man
2. An integral whole created in image of God, Gen 1,
   2
3. Inner person is primary aspect (leaves at death,
   James 2 26)
4. Outer person is secondary aspect (will be
   replaced, 2 Cor 5)
5. At death the inner person is temporarily
   separated from outer person (rejoined with
   resurrection body, 1 Cor 15)
6. Care of inner outer person important, Matt 25
   33-46
7. Spiritual care care of the inner person
8. Care of inner person focus of this seminar

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The dying person 7 basic spiritual needs

1. Good relationship with God
2. Clear conscience
3. Hope
4. Meaning
5. Purpose
6. Life concluded with no loose ends
7. Prepared for the transition

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The dying person over timea Christian perspective
Conception
Birth
Death
Second coming
Paradise
New heaven and new earth
Hades
Gehenna / Hell
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Prepared care-giver Face own death

1. Present behavior negatively influenced by past
   experiences?
2. Which feelings surface when you think about your
   death?
3. Know for sure where you are going when you die?
   Yes / No
4. Satisfied with ultimate destination? Yes / No
5. If you could choose, how would you like to die?
6. Which way of dying is the most unacceptable to
   you?
7. Which person most difficult to leave behind when
   you die?
8. Which things most difficult to leave behind?
9. Adequate preparations regarding your own death
   and burial?
10. Body / Possessions
11. Job / business
12. Ministry in the church, etc

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Cared-for care-giver

1. Care for the care-givers multi-facetted
2. Self-care more input than output re-creation
3. Team member mutual care
4. Team leader cares for team member well-being
5. Care by appointing body, including finances
6. Referred care if necessary
7. Professional group care e.g. nursing society
8. Local church care
9. Care types
10. Informal colleagues, friends, family
11. Formal counselling, coaching, mentoring
12. Non-formal seminars, in-service training

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Six Aspects and Six Goals

• Aspects
• Losses
• Isolation
• Fear
• Guilt
• Emotional struggles
• Pain

• Goals
• Work through the losses
• Break through the isolation
• Deliver from fear
• Deal with guilt
• Enhance emotional stability
• Face the pain

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A1 Understand their losses and grief

1. Wellbeing / ability to move around / physical
   self-control
2. External dignity / psychological dignity / mental
   dignity
3. Bodily strength
4. Identity / control and making of decisions
5. Relationships
6. Work and financial security / social status /
   possessions
7. Immediate future perspective
8. For not-yet-regenerate the final opportunity to
   save their soul from second death
9. Ultimately, loss of own body

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Goal 1 Comfort the grieving

1. Point to Jesus He comforts the weeping, Lk 4
   18
2. Help them to express their grief
3. Tell you / the Lord about their losses and how
   that affects them
4. Expressing grief is OK self-pity leads to
   bondage
5. Encourage them to let go and say good-bye
6. social / psychological / physical / faith

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A2 Understand their isolation/loneliness

1. Dying is an individual process
2. Social factors can contribute
3. Nature of the disease can contribute
4. Can experience isolation even when not so

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Goal 2 Break through their isolation

1. Point to Jesus He restores relationships, 1
   John 1 7
2. Ask help me to understand questions
3. Explain own motives
4. Only make promises you will certainly keep
5. Be honest about own limitations / struggles
6. Use psychological judo
7. Tell me about the pain behind your anger
8. What do you think is the answer?
9. Ask questions about key words
10. Build relationship bridge

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A3 Understand their fear

1. The nature and seriousness of the disease
2. The future / re family / re finances
3. Increasing dependence on others / Helplessness
4. Being a burden
5. Being alone, of being abandoned
6. Suffering and pain
7. Humiliation
8. Not being able to cope emotionally
9. Separation from loved ones / from God
10. The unknown
11. Punishment / judgment
12. Losing their mental capacities

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Goal 3 Delivery from fear

• Point to Jesus He delivers from fear, Heb
  214-15
• Show understanding and identify the fears
• Draw a brick wall, each brick is a fear, name
  them
• Cast the fears on to Jesus
• Repent of unbelief where necessary
• Request Jesus to be Shalom
• Call on His Name whenever fears assail
• Involve others to stand with you
• Build faith Ps 23 1 John 418.

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A4 Understand issues of guilt

1. Who is guilty You / someone else?
2. who is really responsible?
3. Real / false
4. condemnation if only did you enough?
5. Guilt is the consequence of breaking a law it is
   a judicial state, not a feeling
6. Four types of guilt
7. Personal
8. Social
9. Legal
10. Theological

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Goal 4 Dealing with guilt

• Point to Jesus He forgives, Mark 2 5-10
• Show way of repentance, 1 John 1 9
• Work towards true forgiveness
• Transgression name it describe impact
• Seek justice legal, social, personal,
  theological
• Give anger / bitterness / hate to God
• Let transgressor go leave vengeance to God
• Come to God for healing
• Hold the forgiveness available
• Practice forgiveness each time it is remembered
• Then work for reconciliation as possible

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A5 Understand their emotional struggles

• Denial ??
• Rebellion ??
• Negotiation ??
• Restlessness ??
• Anger ??
• Distrust ??
• Despair ??
• Disappointment ??
• Doubt ??
• Criticism ??
• Depression ??
• Bitterness ??

1. Insight
2. Surrender
3. Acceptance
4. Peace, clear conscience
5. Meekness
6. Trust in relationships
7. Courage, hope
8. Satisfaction
9. Certainty, security
10. Appreciation, gratitude
11. Comforted, joy
12. Reconciliation, forgiveness

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Goal 5 Enhance emotional stability

• Point to Jesus He is the Shepherd, Ps 23
• Identify the struggle
• Agree on the positive element as the goal
• Agree on the route to get there
• Patiently walk the road together
• Let the suffering person indicate the pace
• Involve others where necessary

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6. Understand whole person pain
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Goal 6 Face the pain together

• Point to Jesus He knows suffering, Isaiah 53
• Involve care team which includes the relatives
• Diagnose
• Which of the ten aspects are relevant?
• Describe the pain
• Determine cause where does that come from?
• Treat
• Give appropriate treatment to both symptoms and
  causes

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The Seven Points of Attention

1. Communicating eyes
2. Listening ears
3. Wise words
4. Loving hearts
5. Comforting hands
6. Praying knees
7. Serving feet

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Point 1 Communicating eyes

• Mark 10 21a
• Heart to heart communication through the windows
  of the soul
• Careful observation

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Point 2 Listening ears

• John 4 7-26 James 1 19 Job 21 1-3a
• Be fully there
• Ask specific questions

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Point 3 Wise words

• Luke 4 22a Proverbs 13 14 15 14 Mark 10
  51 Proverbs 12 18b James 3 17
• Be open, 1 John 1 7
• Give true hope, Hebrews 6 18
• Speak truth in love, Ephesians 4

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Point 4 Loving hearts

• Matt 9 36 15 32 Mk 6 31-34 2 Cor. 5 14
• Agape love
• Desire, choose and act for highest good
• Show compassion Luke 7 13
• Build a relationship of trust

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Point 5 Comforting hands

• Mark 1 41a
• Gather relevant information
• Impart comfort
• Appropriateness
• Approach
• Duration
• Location
• Intensity

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Point 6 Prayerful knees

• Luke 5 15,16
• Pray for the person
• Pray with the person

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Point 7 Serving feet

• Luke 22 27b Mark 6 30-34 10 45.
• Attitude of service
• Practical service

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Revision The course in a nutshell

• The prepared and cared-for care-giver
• seeks to reach six goals
• via seven points of attention
• in his relationship with the dying person

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Conclusion

• Prepared to face your own death?
• What will change in your involvement?
• How will it change?
• Commitment for change