Pastoral Care at Life’s End

I currently work as the Manager of Spiritual Care and the Centre Director for the Clinical Pastoral Education Centre at Austin Health in Melbourne.

Sue Westhorpe

I’ve worked as a hospital chaplain for over 11 years now and, in that time, I’ve spent significant time ministering to patients and families at the end of life. I am always immensely grateful to be invited into this very intimate time in patients’ lives.

End of life care, or “palliative” care, is specialised care and support that recognises the unique needs of a person who has a terminal condition, and their family and carers. Palliative care can commence as early as diagnosis of a terminal condition or as late as the day someone dies. The main goal is to help the patient to live as well as possible, including treatment of pain and other symptoms. We also help family and carers to manage during the patient’s illness, and in bereavement. So palliative care addresses every area of need: physical, emotional, social, cultural, and spiritual.

Spiritual/pastoral care is perhaps the only domain of care where the patient’s expertise and authority are recognised. It is their spiritual journey and only they know what is important to them. It is part of my role to help them articulate this and address the question, “How do I make sense of what I am experiencing in hospital?” This question often leads to further questions of meaning, such as:

  • Who am I?
  • Who is closest and most important to me?
  • What communities am I part of?
  • What else nurtures me?
  • Who or what do I believe in?

You may be surprised to know that I minister to all patients, religious or not, and that each of these patients has his or her own unique spirituality. My practice is underpinned by the philosophy that every human being, religious or not, possesses spirituality. Spirituality here is understood to encompass meaning, purpose and connection.

My tasks often involve:

  • assisting patients to live with the uncertainty of a life-shortening illness;
  • assisting patients and families to prepare for death;
  • reviewing life, focusing on their identity, their professional life, and what matters to them as individuals;
  • providing ritual to help prepare for death, to live fully in the moment, transcend the present situation, or celebrate life;
  • debriefing other staff and providing support for them.

As patients have the chance to reflect on their lives, they often discover areas of “unfinished business”. As a chaplain, I journey with these patients to complete whatever “work” they need to in the time they have remaining.

One of the questions I’m asked a lot is, “How do you bring Jesus to people who are dying?” Chaplaincy is not about conversion – it is about conversation and presence. In the midst of suffering, I bring Christ’s presence to these patients and Christ’s companionship on their journey towards death – the crucified Christ – the Christ who knows pain, who knows rejection, who knows suffering, and who never leaves us.

Let me give you an example:

Andrew (31) had attempted suicide and was taken to Intensive Care. After three days it was determined that he had irreversible severe brain damage, and life support was withdrawn. As is sometimes the case with younger people, his heart continued to beat, and he continued to breathe on his own. I was paged to meet with his family after nursing staff became concerned about the tensions that existed between family members. During my conversation with his mother, she revealed that her eldest daughter had committed suicide 10 years previously, and that her marriage had broken down as a result. She and Andrew’s father had not seen each other for eight years and had been unable to stop fighting since they had seen each other again two days ago. I entered Andrew’s room and noticed that Andrew, though unconscious, was moaning and looked distressed. His levels of distress seemed to increase whenever voices were raised, or when the tension between family members became more palpable. Over the next few days, I spent time listening to Andrew’s father, mother, and remaining sister as they spoke of their sadness at Andrew’s condition. Gradually they realised that this sadness was also about the fractured state of their relationships, and all of them acknowledged that they would like this to change. After much talking and crying, we gathered around Andrew’s bed, and all of the family members told Andrew how much they loved him. They then turned to each other and spoke words of forgiveness, words that had the effect of calming Andrew within minutes. We all noticed the change of atmosphere in the room – a sense of peace had descended on us, and particularly on Andrew. Later that evening Andrew died peacefully, surrounded by his family.

Ministry situations such as this, while challenging, bless me as I bear witness to God’s gifts of reconciliation, peace, and love at the end of life.

About the Author

Sue Westhorp

Sue is Manager of Spiritual Care and the Centre Director for the Clinical Pastoral Education Centre at Austin Health in Melbourne

Leave a Reply

Your email address will not be published. Required fields are marked *