Rev. DeVries is pastor of the Protestant Reformed Church of Edgerton, Minnesota.
Yea, though I walk through the valley of the shadow of death, I will fear no evil: for thou art with me; thy rod and thy staff they comfort me.
In a talk given in our Protestant Reformed Seminary several years ago on the subject of “Sick-Visiting” Rev. C. Hanko, a veteran pastor, remarked regarding terminal cases, “You walk with them down the valley. You must stay behind. Sometimes you’ll envy them. The grace of God will amaze you.” To a student, the truth of those remarks did not really “sink in.” But now, having served as minister of the Word and as pastor to the dying for several years, I can say that the truth of those remarks has struck me again and again.
Though our entire earthly life is a walk through that valley, the consciousness of that is most emphatically realized when one is confronted with the reality of terminal illness. It is then that the valley is the darkest, the most lonely, the most dangerous. Especially then the sheep need Christ their Shepherd. Especially then they need to be able to confess with the Psalmist, “I will fear no evil: for thou art with me!” That means, very simply, that the undershepherds of the Good Shepherd must be there. The officebearers of the church, minister, elders, and deacons must be busy visiting the dying. They come as representatives of Christ in the service of the Good Shepherd.
We will not belabor what ought to be obvious – that the undershepherd and ambassador of Christ must only and always come with the Word of Christ. The sheep, especially the dying sheep, need to hear the voice of the Good Shepherd! We must be there to bring the Word! Our ministering to the terminally ill is not a series of social visits, not a series of medical consultations, not a series of psychiatric sessions. Briefly, pointedly, simply, bring the Word! Usually five to ten verses are enough. In some instances just a verse or two may be sufficient. But bring the Word, a specific passage, and briefly explain and apply it. We ought not lecture or sermonize, but rather authoritatively, yet with compassion and sensitivity, open and expound the Word for them. Bring the good news of Christ, and Him crucified and risen again!
The other essential in ministering to the terminally ill is prayer. Come to the dying with the prayer of faith which saves the sick (‘James 5:13). Always pray! The needs of the dying must be brought to the throne of grace. The dying usually want us to pray, and often need us to pray. It can be difficult for them to pray for themselves. In prayer lead the dying in the confession of their sins; lead them to the cross of Christ and forgiveness; lead them to the riches of the salvation we have in Christ; lead them to the grace and mercy of our sympathetic Savior who is there to help in time of need; lead them to the victory we have in Christ even over death and the grave.
Bring the Word! Pray! Indeed, these are basic, indispensable in ministering to the terminally ill. Never despair of the Word and prayer – even if the dying saint has lapsed into a coma or has sustained brain damage. God never leaves His saints without the consciousness of His Word. Jesus promises: “My sheep hear my voice.”
But it is my conviction that much more is necessary to make that Word and prayer more effective by the grace of God, in the working of His Spirit. Consider the following:
Officebearers ought to realize that the dying saint probably knows he is going to die, whether he has been told or not. We ought to be sensitive to their struggle in that connection. The dying person always has a struggle! After all, death is the last enemy. But rest assured that the Lord never fails to give dying-grace to the dying.
We must strive to be sensitive to the fears and feelings of the terminally ill. There are fears of being useless. There is the realization, almost surely disappointing that his work, his contribution is ending. He has achieved as much as he will ever achieve, whether in vocation, or raising children, or forming relationships. There can also be a growing understanding and fear of the separation death will bring. There is the fear, too, of becoming a burden. Serious illness is seen as imposing inconvenience on family and friends. Prolonged illness may be feared as being financially disastrous to survivors. There may be the fear of pain, which is inseparably linked to dying in most people’s minds. There may be fears of personal indignity, of being subjected to medical procedures, to paraphernalia in the body, etc.
Be sensitive to what the dying says both verbally and non-verbally. Tears, turning to the wall, not wanting to talk- each of these says something.
To minister effectively to the terminally ill saint, one should try to understand the emotional stages they may pass through. It is striking that the terminal patient’s grief before death is very similar to the grief experienced by the survivors after death. Dr. Elisabeth Kubler-Ross has given the classic description of the coping patterns of patients who know their diagnosis is terminal, in her book On Death and Dying (New Y o r k : Macmillan, 1969).
The first stage is denial. “No, not me.” “There must be a mistake of some kind.”
Next comes anger or resentment. “Why me?” “Why now?”
The third stage is bargaining. “Yes me, but-‘” “If You just give me five years, I’ll . …” “I’ll be a better father if you just give me another chance.”
The fourth stage is depression. Now he says, “Yes, me.” “I’ll never feel good again.” “I’ll never see my grandchildren grow up.”
Finally comes acceptance, a time of facing death calmly, of quiet submission to the Lord’s way. “I am at peace. ” “I’m ready.”
During visits we must strive to be sensitive to where the patient is, with respect to these stages, after a few minutes of conversation. But bear in mind that these stages are not like climbing a ladder. One does not necessarily go up one rung at a time. And the lines between them are not clearly drawn. Further, the dying saint may fluctuate from day to day – anger on Monday, accepting on Wednesday, and back to anger on Friday.
Be sensitive too to the fact that the family, loved ones, are going through their own stages of anticipatory grief and may not always be in synchronization with the terminal patient. In this connection, the loved ones also need the pastor’s care and must not be ignored. As much as or more than the ill, they need to be prepared for the reality of death.
Finally, be sensitive to sin; that is, recognize that the need of the sick, also the terminally ill, is fundamentally spiritual. Sickness and dying are inseparably connected to sin. There may be instances where a concrete sin may and must be pointed out – for example, drunkenness. But beyond this we cannot go. Generally it must be left between the individual and God. But be sensitive to a need there might be to talk about a sin. And lead the dying into the comfort of the gospel of our salvation.
This sensitivity with regard to the dying saint and his needs means that preparation for the visit is essential for the officebearer of Christ. Prayerfully prepare. Decide what to read and what to say. Take time to collect your thoughts, whether it be in the study or in the car. Focus on your purpose for visiting. Determine how the Word you are bringing will meet the need of the dying saint. Especially for lengthy illnesses, keep careful record of the visits, passages read, etc. Above all, pray! Be conscious of your dependence upon Christ in this difficult labor.
Then, having prepared, be flexible. Being sensitive to the needs of the dying saint, determine the situation that day (is it an “up” day or a “down” day), and minister to him with the Word and prayer. You may decide to bring an entirely different Word from that for which you prepared.
Though this is an aspect of being sensitive to the needs of the dying saint, it deserves separate emphasis. G. Clarke Chapman, Jr. writes in the foreword of Albert J.D. Walsh’s book Reflections on Death and Grief, “When we are called to minister to the dying and/or bereaved, many of us who count ourselves as servants of God too easily prejudge the matter and rush in with words and a trite formula. Words have become our trade, jargon our bane, and verbiage our downfall.” Perhaps it seems a harsh judgment, but in some instances it is undoubtedly deserved. This is one occasion in which we ought to “be swift to hear, slow to speak.” After greeting them, listen! Let them tell you how they feel and what is going on with them. Do not assume anything. You may ask leading questions, you may guide the conversation to keep it on a spiritual level, but be sure to listen. Listening does not come easy. Walsh puts it this way in his book, Reflections on Death and Grief (Grand Rapids: Baker Book House, 1986): “When we truly listen to the dying and the bereaved, we will bear their pain in our heart, as though it were our own. Listening implies an honest, heartfelt, and courageous response to genuine suffering and the deep sense of loss death brings in its wake.”
Though the pastor or elder must always remember his office and maintain a ministerial dignity as the representative of Christ, he ought not overlook the power and significance of touch, especially with the terminally ill. A firm handshake, a gentle touch, a hand on the arm can say much more than many words. Feeling increasingly isolated from the world and people, the dying saint often desires and appreciates touch. Walsh writes, “I stress the importance of these expressions of affection and concern because my experience has been that the dying often feel untouchable, as though death were a contagious disease. We who would minister to the dying experience a curious sense of discomfort, making it difficult for us to reach out and touch and embrace. And this is the place for candor: death has a certain sight, smell, and sound that can be distasteful.” In “Help, I Have Cancer-My personal thoughts on what people can do for me,” Pete Meulenberg writes, “Touch me as you leave. The isolation of having cancer makes the power of your touch sweet with love.”
The dying need their pastor! No matter how busy you are, take the time to visit. And let the dying saint and his family know that you are available at any hour, day or night, and that you want to be with them in times of crisis. Visits may need to be frequent. But the undershepherds of Christ must be with the sheep especially in their dying. The dying must be assured that you will be with them as they walk down the valley.
It used to be much simpler, this whole business of dying. For the most part people used to die at home, often surrounded by their children and grandchildren. Now it may well be in the intensive care unit of the hospital, surrounded by tubes and needles, respirator, heart stimulator, etc. It was not long ago that the lack of heartbeat was considered final evidence of death. Because of modem medical technology the attention has shifted from heart to brain for a reliable criterion of when death has occurred. It is my conviction that there are no easy, pat answers as far as life support is concerned. Each case must be considered on its own merits.
As God’s children we struggle along with the apostle Paul who was “in a strait betwixt two, having a desire to depart, and to be with Christ; which is far better: nevertheless to abide in the flesh is more needful for you” (Phil. 1:23, 24). Our testimony then must also be, “For to me to live is Christ, and to die is gain” (Phil. 1:21). The pastor must emphasize, in that light, that the main question for the child of God is not his recovery, not something physical, but spiritual. Is the dying content and even happy in the way of the Lord? Is he able to testify of that? Or are we assured of that?
Many factors must be considered with regard to life support, both its use and its removal. Obviously the medical condition is at the forefront. Many aspects must be weighed: prognosis, risk, treatments, success rate, pain, benefits. I believe it is wise to get a second medical opinion in most cases. Certainly legal aspects must be considered. State regulations, as well as hospital policy, are involved. Even financial factors ought not be ignored.
It is my conviction that the pastor and elders ought to refrain from “playing God” in any sense. They ought not seek to impose their will or opinion upon the dying or his family. As much as possible the under-shepherds of Christ must be sympathetic and supportive of both patient and family. At the same time, the patient (if possible) and the family must be led to see and to be submissive to the will of God. They must be led in the Scriptures and through prayer to commit their way unto the Lord. And I believe that the Lord will make His will plain in due time. His grace will be sufficient both for the patient and for the family.
In conclusion, undoubtedly ministering to the terminally ill is some of the most difficult, yet at the same time some of the most spiritually edifying and rewarding, of an officebearer’s labors. It is indeed blessed to walk with the saints down the valley. The grace of God is, indeed, amazing! To Him be the glory!