Working with the terminally ill, part 2

Taking our topic to a more practical level, let's explore the question, "What are some of the ways that you, as a clergy person, can facilitate the transition of a terminally ill person who is afraid to leave his/her body?"


As mentioned in the previous response, palliative care patients identified their top six spiritual needs as, to have time to think, retain hope, deal with unresolved issues, prepare for death, express true feelings without being judged, and speak of important relationships.

The very best thing anyone can do are the simple but profoundly caring actions of being present and deeply listening. Beyond that, there are a few other options, depending on the comfort and needs of the person. Here are a few:

I can adjust my breathing to theirs, and if theirs is erratic, sometimes that regulates theirs a bit.

I can offer to read to them.  Whatever they would like to hear becomes “scripture” and shared moments of holiness.

If they’re Jewish, I can pray for and/or with them in Hebrew or English, prayers which might be familiar and comforting to them.  If they're not Jewish, I can ask what prayers bring them comfort and recite those with or for them.

I can sing softly, if they find that comforting or encouraging.

If they are very fearful, the best is simply holy listening to their fears. They may have questions I can address, but I would not discourage their fear or minimize it, but let them speak of it and feel it. I would not make this a time to teach or “preach.” If invited or it felt right, I could offer them reassurance that they are loved and safe.

I can offer guided meditation.

Touching a hand or arm can help sometimes, with permission to touch.

If asked, I can speak about prayer, differences between healing of the body and healing of the soul, and have conversations about G!d, if people were open to such dialogue. If they have factual questions, I can provide a truthful answer to the best of my ability, with great compassion.

A friend who has accompanied a few to death’s transition offered this story to me:  “I had a woman who lay silently while her daughter was in the room with us, and then the moment the daughter went to answer their doorbell, this woman sat bolt upright in bed, focused on me, and asked, ‘Will I have much pain before the end?’  She had a brain tumor, already far along.  Oy vey.  I said, ‘I can't say for certain, but I believe you may become unconscious before the end, and I know that if you ask for pain medication they will give you as much as you need.’  She thought about that, nodded, said ‘Thank you’ and lay back quietly as her daughter returned.  I smiled at her with love in my eyes, and she nodded again and slightly smiled as she visibly relaxed.  She died with a week.” I found this a very compassionate and comforting response, and would follow this line of action.

While there are no final answers to the ultimate mystery and enigma of human mortality, about all we can, and must, offer is comfort. Often, especially in the Jewish tradition, this comes through prayers and blessings. As the root berech indicates, prayer itself is a bending or surrender to divine power. Thus, in dealing with sickness and death we surrender our sense of being in control in asking G!d to be an agent of the healing that we cannot do ourselves. Furthermore, brachah, blessing, is connected to the Hebrew word bereichah—a “pool” or a “channel of water  flowing down.” Thus, praying for another person can be seen as dipping into the pool of divine blessing, to bring forth protection or healing to the person for or with whom we are praying.

In our Talmud, a story is told of the death of the sage Yehuda HaNasi, who was frail, suffering, and close to death. As the end of his life drew near, his students continued to pray assiduously for their teacher to live. The Talmud records how Rabbi Yehuda’s handmaid, upon seeing the pain and physical discomfort of her master, ascended to the roof of his house and intentionally threw a jar from the roof that shattered as it hit the ground. Startled by the noise, the students were momentarily distracted from their praying, and at that moment while they were distracted, “the soul of Rabbi Yehuda departed to its eternal rest.” (BT Ket. 104a) This story is often cited to demonstrate how Judaism does not support extraordinary measures in death care; it also reminds us that sometimes prayer needs to turn from healing of body, to healing of the spirit in preparation for death, and to prayers for the graceful transition of the soul as it leaves the body.

The petitionary prayers of the traditional Mi Shebeirach healing ask for a “healing of soul.” But what does it mean to pray for “healing of the soul”? Simply put, it means to pray for peace, wholeness, and completion for an individual, whether they live or die. This notion is consistent with Jewish custom: if someone is sick, it is traditional to wish them “refuah sh’leimah”—“a complete healing.” And praying for the “healing of the soul” is a supplication that, even if unable to have a complete physical recovery, a person may be able to experience a sense of inner wholeness, and a connection with the fullness of their soul.

In addition to physical needs, people who are dying have a wide range of emotional, psycho-social, and spiritual needs. Thus, “healing of the soul” can also be understood as cultivating a sense of wholeness and healing of the emotional, psycho-social, and spiritual dimensions of a person.

In the face of sickness and death, the emotional needs of one who is dying often consists of being able to find peace within, forgive themselves for their shortcomings, see the grand panorama of their life with a sense of equanimity, and ultimately, to transform fear and confusion about dying into a sense of peace and acceptance.

The psycho-social needs for one who is dying is to end life feeling a completion in relationships with the people around them, let go of old resentments and regrets with family, friends and colleagues, forgive those who have disappointed them, and forgive themselves for their shortcomings and interpersonal failings.

All of this refers to what Elisabeth Kübler-Ross called “finishing business”—making peace with the various strands of the emotional and psycho-social reality of our lived life.

Through the dying process, many people, although certainly not all, discover they have deeper spiritual needs, such as meaning-making, acceptance of death, spiritual surrender, wrestling with finding a deeper meaning and significance to life, feeling finished with the work of this life time, surrendering to the unknown of what death may have in store, and opening up in order to move on to the next phase of the journey beyond death, whatever it may be. There is no “one size fits all” in arriving at spiritual resolution in the face of death. Each person must walk their own journey.

At those times when the fear of death gnaws silently in the background, evoking intermittent waves of distress and despair, interspersed with hope and heroism, reaching for Jewish tradition can be, for some at least, spiritually comforting and grounding.

Another function of deathbed prayers is to provide comfort and connection for both patients and care-givers who are companioning the dying. As it sometimes turns out, regardless of the ever-expanding array of doctor’s deliberations and procedures, the extensive protocols around the use of pharmaceutical potions and concoctions, and the trials and tribulations various traditional and experimental medical options, at some point, death is inevitable.

When that time comes, people who are feeling their own death imminent, as well as care-givers, supportive family members, and even the professionals involved in chronic, palliative and hospice care, all experience a profound vulnerability and powerlessness. As Abraham Joshua Heschel says of those moments of darkness, “we grope for solace, for meaning, for prayer.”

In the language of traditional theology, one might say that through prayer, one can experience G!d’s comforting presence. Rabbinic and Kabbalistic tradition affirm this notion in the teaching that Shechinah, the Divine Presence, is present both at the bedside of one who is sick (BT Ned. 40a), and at the time of a person’s death (Zohar III, 88a; Zohar I, 98a). So the very act of praying opens one up to be comforted by G!d’s immanent presence, Shechinah.

One final element of deathbed prayer is what can be called “soul-guiding.” If we start with the assumption that consciousness survives bodily death, as Jewish tradition has always held, then the process of dying is that of the soul leaving the body. And the work of companioning someone who is dying is to offer loving thoughts while reciting or chanting prayers to escort the soul as it exits the body, if that is what the person wants and needs. If they are unconscious at that point, then it is subject to the needs of the family. In the absence of others, it would be left to me as a pastoral presence, hopefully having a sense of what might bring comfort to the dying person.

For Jews, both the Sh’ma and Vidui are important deathbed prayers. There are different versions of the Vidui that can be seen as “soul-guiding” prayers, and there are also different Vidui meditations. The goal of these Vidui prayers and meditations is to help a person feel resolved in their life and to leave the body behind.

The reason to offer soul-guiding prayers is similar to what a midwife does in bringing a child to birth into the world, although in reverse so to speak. Yet in a very real sense, we are midwifing a soul to its new birth into the great mystery that lies beyond our earthly knowing.

Companioning somebody who is dying is a holy act. May we all be worthy of the calling to escort others in the transition between life and death.