Book Review: Spiritual Care at the End of Life (Steve Nolan)

Spiritual Care at the End of LifeISBN 9781849051996
Available from Amazon

Reviewed by the Rev. Kerry Walters. Deacon Walters teaches philosophy and peace and justice studies at Gettysburg College. His latest book is The Art of Dying and Living (Orbis, 2011).

A friend of mine with whom I did CPE and who's now a Lutheran pastor recently told me about his visit with a hospice patient who was close to death. Despite her weakness, she was a tough customer who wanted to make one thing clear right off the bat. Although she admitted she was scared of dying, she didn’t put much stock in religion. So she didn’t want my friend throwing any "bible verses or other such rigmarole" at her.

This probably sounds familiar to anyone who's served as a hospice or hospital chaplain and ministered to unchurched patients skeptical about or perhaps hostile to religion. Even lifelong Christians can fall into a despairing dread as death approaches which assails their faith and can’t be assuaged by religious reassurances. As C.S. Lewis once noted, we don’t really know how strong our faith is until we’re up against it.

How, then, ought we to go about ministering to them?

Steve Nolan, a British palliative care chaplain, argues in Spiritual Care at the End of Life that what clergy must do when attending to the dying is resist the temptation to "fix" the situation with religious platitudes. Bible readings and prayer may indeed be helpful to the patient. But when they aren't, all that clergy really have to offer is their sheer presence, their willingness to "be-with" the dying patient as she enters ever deeper into the end of life process.

The kind of presence recommended by Nolan is one that ultimately leads to hope on the dying person's part. This requires the clergyperson first to be "evocatively" present by patiently accepting negative projections from the patient. This first kind of presence allows an air-clearing release of frustration, fear, and wishful thinking on the part of the patient. When she comes to the realization that she isn’t going to be judged or offered cheap consolation, a bond of trust is established that allows the clergyperson to become an "accompanying" presence. Accompaniment of the patient means that the clergyperson follows her lead and refuses to impose on her expectations of a prescribed outcome (conversion, for example, or confession). This acknowledgment of her freedom and respect for her dignity invites the patient to discover hope—not in the false sense that she may not die after all, but in the "absolute" sense that affirms the goodness of existence and the real possibility that there exists a wider reality not defeated by death. In inviting this realization, the clergyperson becomes a "hopeful" presence whose "being-with" accompaniment strengthens the patient.

Nolan explores the three ways clergy can be present to the dying through a judicious combination of rigorous analyses from social scientists and theologians and insightful observations gleaned from his own experiences in the wards. Just as importantly, he also takes some time to reflect on the psychological and spiritual toil that being present to the dying can take on clergy.

And what of my friend and his hospice patient? Excellent pastor that he is, he took the situation in stride. After being told by her to leave Jesus and his Bible in his pocket, he simply replied, "How about I just sit here with you for a while? We can talk about anything you like." He accepted her negative projection, which allowed her to open up in trust to him. Before long, he was accompanying her as she spoke tenderly of her grandchildren and her deep love of the ocean. By the end of their time together, she was peaceful, strengthened by a sense of gratitude for the life she had lived and, perhaps, a sustaining inkling of the depth of existence.

Steve Nolan would say that my friend got it just about right.