"A Welcoming Community of Faith Rooted in
the Catholic Tradition"
Pastoral and
Sacramental Care
for the
Sick and Dying
†
“When you pass through
the waters, I will be with you”
(Isaiah 43:2)
Suffering and illness have always been among the greatest problems that trouble the human spirit. Every person of faith feels and experiences pain as do all other people; yet their faith helps them to grasp more deeply the mystery of suffering and to bear their pain with greater courage. From Christ’s words they know that sickness has meaning and value for their own salvation and for the salvation of the world. They also know that Christ, who during his life often visited and healed the sick, loves them in their illness.
Pastoral care ministry is modeled on the Gospels and Jesus’ example of love and concern for the sick and those separated from their family, friends and community. Pastoral care ministers give personal witness to the presence of God in the church through the expression of their faith, hope and love in their outreach and visitation to the sick, the elderly, homebound and their caregivers. This ministry maintains the vital relationship between those being served and their parish community.
FOUNDATIONS OF PASTORAL CARE FOR THE SICK AND THE DYING
The theology of the Evangelical Catholic Church with regard to the pastoral care and anointing of the sick and dying may be taken from the Pastoral Care of the Sick: Rites of Anointing and Viaticum (1983).
In its rite for anointing and care of the sick, the Church notes the following:
When the Church cares for the sick, it serves Christ himself in the suffering members of his Mystical Body. When it follows the example of the Lord Jesus, who ‘went about doing good and healing all’ (Acts 10:38), the Church obeys his command to care for the sick (see Mark 16:18).
The Church shows this solicitude not only by visiting those who are in poor health but also by raising them up through the sacrament of anointing and nourishing them with the Eucharist during their illness and when they are in danger of death. Finally, the Church offers prayers for the sick to commend them to God, especially in the last crisis of life.
In this, several theological and pastoral themes are evident. We see ecclesiological and Christological elements: that is, the Church serves the members of Christ’s Mystical Body. The missionary aspect is evident as the Church follows the Lord’s example and cares for the sick when and where they need us most. The sacramental aspect is evident as anointing of the sick is intended for “raising them up” and the Eucharist for nourishing them “during their illness and when they are in danger of death. We also see a pastoral reality, that anointing is situated within the wider context of visiting and caring for the sick.
While the Anointing of the Sick is a central part of the Church’s care of the sick, it does not stand on its own. It is complemented with pastoral visits and with the celebration of Holy Communion. In fact, the Introduction to Part I of the ritual states, “Because the sick are prevented from celebrating the Eucharist with the rest of the community, the most important visits are those during which they receive Holy Communion” [PCS 51]. In receiving Holy Communion those who are ill are united to Christ and to the Eucharistic community.
In the pastoral care of the dying, rites are elaborated for the celebration of Viaticum, for the commendation of the dying, and for exceptional circumstances (including a continuous rite of Penance, Anointing and Viaticum and also a rite used for emergencies). Prayers for the Dead are also included. These rites are different from the above mentioned rites for the care of the sick. As the Introduction to Part I of the Pastoral Care mentions, the rites for the sick “are distinct from those in the second part of this book, which are provided to comfort and strengthen a Christian in the passage from this life” [PCS 42]. In the ritual, Pastoral Care of the Sick, we thus see the entire panorama of the Church’s ritual response to the sick and dying.
The Pastoral Obligations for Response
There are various levels through which the Church responds to the needs of the sick and dying. The first level might be considered the closest circle of persons who surround the sick or dying person, usually family, neighbors, and friends. Their care, concern, and prayers strengthen the sick person’s spirit as he or she struggles with the physical difficulties. The element of emotional and physical separation from the wider community is lessened by the presence and care of those closest to the sick person.
The second level might be considered the parish community. When the sick person is able to participate in communal prayers for the sick, it serves to strengthen and encourage them. Visits to the sick in their homes by members of the parish community are important for reminding the sick person of his or her connection to the parish community. The reception of Holy Communion is especially important when a sick person cannot participate in the community’s Eucharistic celebration: it allows them a sacramental expression of their communion with the faith community of the Church.
The third level of care of the Church may be considered pastoral or hospital care. When a sick person is in the hospital, chaplains are often able to visit them, bring them Holy Communion and anoint them when necessary.
Pastoral and Sacramental Objectives
Healing is not seen as a single goal, or even a main thrust of the Church’s rites. Suffering is a mystery. This does not mean a sleuth-like approach will always net a neat solution. The cause and purpose of suffering often lies beyond rational understanding. The believer searches for deeper meaning when encountering a mystery. We begin with what we know: first, the link between illness and salvation, and second, that Christ’s gospel witness is verified in his healings as well as his compassion.Although closely linked with the human condition, sickness cannot as a general rule be regarded as a punishment inflicted on each individual for personal sins (see John 9:3). Christ himself, who is without sin, in fulfilling the words of Isaiah took on all the wounds of his passion and shared in all human pain (see Isaiah 53:4-5). Christ is still pained and tormented in his members, made like him. Still, our afflictions seem but momentary and slight when compared to the greatness of the eternal glory for which they prepare us (see 2 Corinthians 4:17).
Pastoral Assessments of Patient Needs
In order to achieve the best pastoral potential when meeting patients, hospitals, hospices and nursing home may wish to consider including the following assessment tool and providing the results to their Chaplains.
FAITH
What is your faith or belief?
Do you consider yourself spiritual or religious?
What things do you believe in that give meaning to your life?
IMPORTANCE or INFLUENCE
Is your faith important in your life?
How do your beliefs affect or influence your behavior or health?
COMMUNITY
Are you part of a religious or spiritual community?
How is it important?
Who do you love or who is important to you?
ADDRESS
How would you like me to address these issues in your care?Caring for the Terminally Ill
In terminal illness several stages have been identified. Initially there is a stage of denial, although usually a temporary response that is replaced by some degree of acceptance. The denial can be followed by a stage of anger expressed in “Why me?” and often the anger can be directed against anyone or anything. Next is the stage of attempted bargaining, usually with God, to delay the end. This is followed by a stage of depression due to the patient realizing what they are going to lose because of their illness, be it a bodily part, a physical activity or an important function in the daily activity of life. The final stage is of acceptance, which is not necessarily a happy or peaceful stage, but the time when the patient stops fighting their illness and regard death as a relief. These different stage are coping mechanisms one uses to deal with a difficult situation and often throughout there is a usually some hope for a miracle cure. Similar stages also occur with family members, for they can also engage in denial, expressions of anger, attempts to bargain, depression and reluctant accepting the situation.
The Chaplain throughout the States of Terminal Illness
In order to be an effective presence, the Chaplain has to assess which stage the patient is in. If the patient is in the stage of denial, the Chaplain should not judge them for what they are saying. The Chaplain should realize and accept that anger could often be a desire for attention, opening the door for interaction. When caring for patients who are in the bargaining stage, it is important not to given them any false assurances. Often the best response is to listen.
Many of the problems experienced by terminally-ill patients can be classified as fear. There is the fear of unknown consequences, perhaps formed by the knowledge they have of others who experienced terminal illness. It is a natural response for people to fear suffering and pain; in terminal illness there can be both physical and emotional suffering. Often there is the fear of physical disfigurement resulting from the progression of their disease. Also, many people fear the process of dying rather than death itself.
Patient Needs
A patient usually has at least four types of need: physical, emotional, spiritual and social. The physical needs can be fulfilled by control of distressing symptoms through nursing care. Emotional needs can be fulfilled by proper care of the psychological issues with the possible use of anti-depressant and anti-anxiety medications. Social needs are usually fulfilled by those prepared to spend quality time with the patient and assuring them of their personal value despite their illness.
Each of the aforementioned supports are concerned with helping the patient have as comfortable as possible journey through their terminal illness. Yet the pastoral role is uniquely different, for the Chaplain’s main concern is with the spiritual needs of the patient and those of the family. In contrast the Chaplain not only has to cope with the reality of a pending death, they many have to explain the meaning of death to both patient and their family. And sometimes they must also do this for the team of health care providers.
The Chaplain’s goals
First, the Chaplain must aim to avoid mere professionalism in such a situation. In most cases, the Chaplain will have dealt previously with terminal illness, either in their family or through their ministry; also they will have studied appropriate literature and attended relevant courses; these factors can help prepare for involvement with terminally-ill people, but they also allow for the danger of rote professionalism. The Chaplain needs to remind themselves of the uniqueness of each terminally-ill person, and should respond to them as if they were the only person they are caring for.
The Chaplain and the Family
There are a variety of issues that can arise in this relationship. The Chaplain must aim at enabling the family to face the looming separation in the context of faith.. This does not mean they have to experience a negative anticipation for several weeks. The period of terminal illness can be a time of family bonding, when family members can express their love and appreciation of one another and also make any appropriate confessions of wrong attitudes. It can be appropriate for the Chaplain to ask the patient, if possible, to initiate and continue to contribute to this as it will help the family realize they are not adding to their burdens. The dying person should be encouraged to be a help to their relatives in the grieving process. They may have a sense of guilt, either for past failures or even for their inability to help their loved one at this time of crisis. It is also an effective means of removing possible causes of guilt after the death of the patient. Such bonding is not merely based on family relationships but has the added dimension of experiencing the mercy and grace of God and of looking forward together to heaven.
Belief and Culture
Spiritual, religious, and cultural beliefs and practices play a significant role in the lives of patients who are seriously ill and dying. In addition to providing an ethical foundation for clinical decision making, spiritual and religious traditions provide a conceptual framework for understanding the human experience of death and dying, and the meaning of illness and suffering.
The importance of spiritual and religious beliefs in coping with illness, suffering, and dying is supported by clinical studies. Most patients derive comfort from their religious/spiritual beliefs as they face the end of life, and some find reassurance through a belief in continued existence after physical death. However, religious concerns can also be a source of pain and spiritual distress, for example, if a patient feels punished or abandoned by God. Furthermore, beyond the role of religious faith in coping and adjusting to illness, religion also influences patient's medical decisions, both about active treatment and end of life care.
A common goal for the dying patient, family members, and the health care professional is for a meaningful dying experience, in which loss is framed in the context of a life legacy. Such an experience includes support for the patient's suffering, the avoidance of undesired artificial prolongation of life, involvement of family and/or close friends, resolution of remaining life conflicts, and attention to spiritual issues that surround the meaning of illness and death.
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Chaplains must be encouraged to set realistic goals for themselves. Their primary goal should be the person whom God has called to this vocation. Their goals should never be given priority over God’s leading presence. This makes their goals be just what God wishes to be at that particular moment (1 Thessalonians 4:3).
Preparation Prayers
It is important to be spiritually prepared when making a pastoral visit. Central in that preparation is praying beforehand. The Chaplain should strive to clear themselves of any barriers between themselves and God. They should also pray for the presence of the Holy Spirit during the visit.
The Healer's Prayer
I am here only to be truly helpful.
I am here to represent You who sent me.
I do not have to worry about what to say or what to do,
because You who sent me will direct me.
I am content to be wherever You wish, knowing You go there with me.
I will be healed as I let You teach me to heal.
I am here only to be truly helpful.
†
Respectfully Yours in Christ,
James Alan Wilkowski
Evangelical Catholic Bishop for the Diocese of the Northwest
The Feast of Our Lady of Lourdes
Patroness of the Sick
February 11, 2012
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