Iadmit that I don’t have a strong religious belief system. But, I admire those who possess strong faith, especially when it comes to the frightening prospect of illness and death. My friend Lisa dreamed that Jesus was calling to her when she was sick with lung cancer, which allowed her to face her early death with uncommon courage. I have also heard Christian and Muslim patients talk about ‘the better place that awaits them’ and am grateful that, despite their grave illness, they can look forward to something better. Deep faith makes miracles seem possible that my medical brain rejects.

On the other hand, I have also seen cases when the belief that God will deliver a miracle is used to promote aggressive medical care, even with the odds are long. Aggressive medical care, such as surgery, chemotherapy and ICU care,  increases the chance that someone will die in the hospital, in pain. That is not how one would imagine a spiritual person wanting to die, is it?

I suspect that the social pressures outweigh the philosophic quandaries when religion and severe illness intersect. More than worries about prolonging life at all costs i.e honoring the “sanctity of life,”  the idea that the faithful will be not be viewed as “blessed” by their faith community prevents patients and families from dying in peace.  I remember a client of mine telling me that the the idea of admitting to her fellow parishioners that she was dying was as painful as the idea of death itself!

In fact, my perceptions have been reinforced by a study out of Harvard published in JAMA Internal Medicine in 2013.1 As the researchers noted, patients who identified as having a strong outside religious community and support system where more likely to receive aggressive care, such as ICU care and less likely to receive hospice care at the end of their lives.

This is rationalized by Ray Barfield, MD in the Christian journal Mockingbird.2 Dr. Barfield is unique in that he is a theologian, an oncologist and is also trained in Palliative Care. He says:

…there’s a particular biblical, theological or religious calculus that occurs. I’ll give you one version: Jesus said that if you have faith the size of a mustard seed, then you can say to this mountain, “Get up and throw yourself into the sea,” and it’ll throw itself into the sea. That’s an if-then statement. You want the mountain to throw itself into the sea, but there’s a condition: you have to show faith. That’s the condition for the miracle. And what I’ve seen a lot of times in the ICU—and I’ve seen pastors push this position before—is that the mountain you want to hurl into the sea is the disease.

The challenge then, is to allow people to access their faith even when the miracle isn’t delivered in the form of a cure. For this reason, and many others, I believe Pastoral Care is one of the most important, powerful and underutilized services in hospitals. Chaplains, who are inter-denominational spiritual counselors, provide comfort, reassurance and grief counseling for patients and families of all faiths.  I have seen them work miracles, often by praying for a patient with their distressed family. A friend of mine from high school, Elizabeth Dickey Blaine, works as a hospital chaplain now. She described her work to me:

We don’t have the power to cure the patient’s disease, and in many cases, even medical science can’t provide a cure.  Chaplains, pastors and other health care providers can promote healing, though, by recognizing that healing can take different forms for different patients.  For some people, healing may mean coming to terms with their mortality.  For others, it may be reconciling with family members with whom they have been estranged, or making sense of tough chapters in their lives.

In fact, Pastoral Care as part of a person’s medical care has the opposite effect that strong outside religious community support systems exert. When the Harvard researchers looked at what happened to patients when the medical team included Pastoral Care within the hospital, something very different happened. Patients and families of faith were able to make decisions about end of life that didn’t involve the frantic desire to avoid death. In other words, they were more likely die without ICU care, and more likely to access hospice services.

A hospital Chaplain is often well-versed in the teachings of each faith regarding the sanctity-of-life and the impossible medical choices that sometimes come at the end. In many instances, the support of a Chaplain allows the faithful to be assured that they are not dishonoring God’s gift of life by removing, or not choosing, aggressive “life-prolonging” measures.

That’s not to say this can’t happen outside the hospital though. I’ll never forget when a faithful congregant and missionary came to see me about getting a second opinion for his advanced cancer. He seemed anxious and unsettled, in the midst of a spiritual crisis. “How can this be happening to me?” he practically screamed. The next time he came in, he was calmer, almost happy. He had disclosed his diagnosis to his minister. He told me:

I told her that I had something shocking to tell her. I then told her I was dying of cancer. She replied “I’m so sorry you are ill, but why would I be shocked about the dying?”

For him, that was permission to be sick and to die, even though he was a good Christian. She was saying ‘We are all going to die. Even the most faithful among us.’ He felt blessed by her. Though she was not a hospital-based chaplain, she knew just what to say.

The social pressures within some religious groups can be intense.  For instance, tele-evangelist Joel Osteen’s Prosperity Gospel, which identifies health and wealth as outward signs of God’s blessing has infiltrated Christianity in a deep way. Kate Barlow, a professor and writer about Prosperity Gospel as well as a cancer patient, summed it up well in a New York Times Op-Ed:3

As a Christian, I can say that the Kingdom of God is not yet fully here, and so we get sick and die. And as a scholar, I can say that our society is steeped in a culture of facile reasoning.

I recently came across an article on a Christian site called belief.net about worry. It struck me that this is an example of the kind of prayer that hospital based Chaplains lead daily. It goes:

God, I welcome your love. I invite your peace. Fill my heart and soul with your wisdom. Show me my next steps. Give me courage and hope. Sustain me with your message.

Blessed are they who can access these traditions at life’s most terrifying junctures. Patients, families, and Pastoral Care providers can access so much more than simply a “prayer for the cure” and raise the possibility of a quieter, gentler death too.

-Jennifer Brokaw, November 2017

Notes:


  1. The JAMA study, “Provision of Spiritual Support to Patients With Advanced Cancer by Religious Communities and Associations With Medical Care at the End of Life,” was published by Tracy A. Balboni, Michael Balboni, Andrea C. Enzinger, and others in 2013. You can read it here
  2. For rhe full interview with Ray Barlow in Mockingbird, click here
  3. Kate Barlow’s full New York Times Op Ed, “Death, the Prosperity Gospel, and Me” is here

Posted by Jennifer Brokaw

Dr. Jennifer Brokaw worked for fourteen years as a board-certified emergency physician before becoming a private consultant, patient advocate, writer, and speaker on the topics of end-of-life planning, medical decision-making and medical advocacy.

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