At Death's Door: Threshholds of Change

January 1st, 2011

A mother decides when to remove life support from a 25-year-old son who withdrew from the family to live a life of chaos and addiction.

A 45-year-old daughter sees in the uncle who is dying the man who abused her as a child.

A family gathers around the bed of a mother of three teenage children and wonders how they will care for children who will soon be without a mother or a father.

A son, convinced that his father did not love him because of choices the son made in life, now hears the dying father proclaim the words of love that have been so long in coming.

In our ministry with the living and the dying, we encounter families for whom the grief process opens up new possibilities of transformation. The potential arises for healing old wounds, for the reconciliation of broken or fractured relationships, or for the honest confrontation that leads to grace as family members face the reality of death. Pastors who are unaware or oblivious to the dynamics being played out in front of them miss the opportunity to be the embodied representatives of the God of healing, of hope, and of grace. Transformation requires dying to old ways of relating and living into new patterns and behaviors. Families can be changed radically by the intervention of a minister who invites them into such change during the grieving process. While there are several aspects to this ministry, the following are essential: 1) to recognize the dynamics of a family; 2) to discern ways to offer care in the moment; and, 3) to plan for ongoing pastoral presence for the family in the future.

In order to recognize the dynamics in a family, pastors need to grow in their knowledge of family systems theory. Participation in continuing education events, consultations, and supervisions with trained pastoral counselors or therapists, and reading books and articles are fundamental for those who engage in ministry.

Recognizing that not all feelings and dynamics are visible to the human eye, pastoral care requires that we listen to families with all of our being. Care involves such things as: listening for what we hear and what is silent; listening to the stories that are easily evoked and inviting narratives that are under the surface and painful; and listening to our own emotions and feelings as we sit with families. Sometimes the dynamics that are present in a family are very visible through the emotional responses family members have with one another; at other times the feelings may be so much beneath the surface that it is difficult to discern that they are even present. Likewise, determining the history or reason for intense feelings might be more difficult and will most likely take interventions that extend beyond the immediate death of someone in the family.

Sometimes people and families are at their best during the dying process. The resources of faith or of friends and family may create opportunities for family members to be more present and tender with one another than they have been in years. At other times, it is easy to note that persons are at their worst during the process of letting go of their own lives or the lives of those they love. Hence, a caring pastor will take seriously the feelings and expressions that are present in the moment while, at the same time, remembering that this is only one part of a larger journey. Pastoral responses in the present are appropriate when they encourage persons to be careful with one another's feelings.

The following questions are helpful to keep in mind as we care for families:

  • Who seems most anxious, or most comfortable, when the family gathers at the bedside of someone who is dying? Who carries the emotional responses on behalf of the family and what might this mean?

  • Are all members of the family equally free to express their feelings about one another and about the person who is dying? Are feelings of hurt and pain as easily named as feelings of love and warmth? What words are left unspoken? How has this family dealt with disappointment in one another in the past? What desires and feelings are alluded to without resolution?

  • What kinds of stories are dominant in conversations? What narratives are missing from the family stories?

To discern how best to respond to a family in the midst of someone's dying, ministers must attend carefully to the emotional needs of those involved. Pastors are most helpful when they allow individuals within the families to take initiative about the depth of emotional processing they need in the moment. Ministers can honestly and carefully name the dynamics they see, while reminding persons that they can continue to work on these issues in the future. The deeper emotional work most often occurs in aftercare as persons find themselves more able to devote energy to the process.

This does not mean that pastors should avoid getting into deep pain and struggles if persons want to talk about these in the moment. Core beliefs about ourselves, about our relationships, about the health and strength of our families, about our faith and about God often are challenged in the process of watching and sitting with someone who is dying. Allowing the space and room for persons to voice their deepest held convictions and their deepest questions could transform a family as it offers people the opportunity to name their greatest fears and their strongest beliefs.

Yet, it is more often in the long term care after death that walking with individuals and families will elicit deeper and more transformative responses. At these times an appropriate referral to a pastoral counselor or therapist can assist families at getting at some of the deeper meanings and possibilities. Ministers are called to be participants in a greater network of care, remembering that we are not the only ones called and trained to offer care.

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