Healing Bodies and Souls at the EndOfLife

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Healing Bodies and Souls at the End-Of-Life

• James Hallenbeck, MD
• Director, Palliative Care Services
• VA Palo Alto HCS

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Key Points

• Clergy bear much in common with physicians in how
  we minister to dying patients
• In training emphasis on knowledge, ritual skills
  and death
• Little specific training on dying
• Inadequate attention to communication
• Changes in how we die pose new challenges
• Remedial training is required

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Questions Doctors Must Face

• Why did God do this to me?
• Do you believe in God?
• What do you think will happen when we die?
• Are you Saved?
• Dont you believe in miracles?

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Questions Clergy May Face

• Cant they do something for the pain?
• He wont eat and the doctors wont do anything.
  We cant just let him starve to death, can we?
• They are talking about discontinuing
  life-support. If they take her off the machine,
  isnt that like killing?
• Since she died, I cant sleep or function. Ive
  lost 20 lbs. I wish I could join her. Why did
  she have to die first?

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Changes in How We Die

• Most deaths now in institutions
• Families less able to care for dying patients
• Most deaths due to chronic illness
• Dying usually takes a long time
• Dying is expensive
• Many options available
• Treatments, care systems, where to die

Many now view dying itself as a choice
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Top 5 Causes of Death 1900
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Top 5 Causes of Death 1994
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Where Do We Die
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Dying Takes a Long Time

• From brief transition period to LIFE STAGE
• Social Implications new systems needed
• Cultural Implications meaning of stage and
  relation to other life stages
• Personal Implications- what is to be accomplished
  in dying?

When does dying begin?
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Implications
From
To

• Focus on death/afterlife
• Care for dying as simple kindness
• Dying understood as inevitable, beyond mortal
  control

• Focus on dying
• Complicated systems of care
• Difficult and confusing choices
• Dying understood as optional, a matter of
  personal choice

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Overlapping domains
Spiritual
Psychological
Social
Physical
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Alternate View
Spiritual
Psychological
Social
Physical
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Communication Challenges

• Ambiguity
• Can I go?
• Hidden meanings
• Can I have a sleeping pill?

In most cultures explicit discussion about death
and dying taboo
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Communication layers

• Thinking
• Knowledge, facts
• Meaning
• Emotional
• Spiritual

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Example Why did I get this awful disease?
Choices in communication

• Explore ambiguity What did you mean when you
  said
• Address thinking Why do you think you got it?
• Address feeling It is sad that this happened
• Spiritual How would you address the spiritual
  implications in this question?

Most why questions, if not technical, are
spiritual in nature
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Communication more than words

• Words
• Work with words that are comfortable for the
  person
• Ritual
• Physicians listening to heart and lungs, feeling
  pulse
• Religious rituals
• Context
• Who is present
• Body language
• Time and circumstance

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Presence

• The Dying and their families very sensitive to
  the presence of others, looking to us for cues as
  to how to respond
• Does our presence communicate
• Peace or Distress?
• A desire to be there or elsewhere?
• At home or not at home?

We must become the change we want to see Gandhi
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Teamwork

• Clergy, like physicians may be used to going it
  alone
• Shared notions of confidentiality
• Clergy, like physicians, may be used to being
  the boss
• Care for the dying requires teamwork
• Shared responsibility communicating with
  other team members
• Ability to elicit and receive feedback on ones
  work from people in other disciplines

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Healing into Death

• Healing happens of itself our role to promote
  healing
• Healing transcends bodily integrity
• Healing differs from cure in that it is an
  ongoing process cure is a outcome

While cure may not always be possible, healing is
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SUMMARY

• New ways of dying require the acquisition of new
  skills on the part of clergy, as well as
  physicians
• While we can find great wisdom in our traditions,
  specific behaviors must adapt to our new
  circumstances
• If we are to be of better service to those for
  whom we care, we must take responsibility for
  improving skills in end-of-life care