This article is about providing pastoral care to the dying. This care focuses on the present, past and future realities of the dying person and other people involved.

Source: Faith in Focus, 1998. 4 pages.

Rays of Light in the Shadow of Death (The Pastoral Care of the Dying)

Our denomi­nation in New Zealand is fairly young, as denomina­tions go. Of course, some of the congre­gations – hav­ing been en­gaged in the 'parenting' of 'daughter' churches – are older than others, with an older generation to cater for, and so are equipped with more experience in providing pastoral care for those afflicted with terminal illnesses. My own experi­ence in this regard, as a pastor, is some­what limited. However, I do treasure the memories of being called upon to spiritually care for the 'Oma' in my first con­gregation: confined to the city hospital in the latter stages of malignant cancer, she was always a joy to visit ... ministering more to me (I do believe) than I ended up ministering to her!

Thus, someone required to shed some light on this aspect of pastoring God's people as they enter "the valley of the shadow of death" – and not hav­ing fellow-travelled too often that way before – needs to draw on the counsel of others. If I am advantaged in any way at all, it is because I have lived a bit longer than some of my colleagues, and have had a bit more life-experience to draw upon ... including an operation (last year) for cancer of the colon! However, thank­fully, there are those who have made a special study of this aspect of ministry, and from their insights we may gain a fairly rounded picture of the unique pas­toral situation under discussion, and how the necessary care may be provided.

Before exploring the 'just how' of all this, it is appropriate to make two im­portant points. First, this pastoral care is not just the province of the pastor (or elders) to attend to, but is the privilege and responsibility of all those near-and­-dear. Second, such pastoral care not only embraces the dear departing one, but also the dear remaining ones ... those being left behind. This latter aspect can be largely overlooked in the very legiti­mate focus of attention upon the one with the greatest need. Further, the whole situation has such great potential for drawing families – and the members of the congregation – together in bonds of love. But, more about that later on...

In our seeking to give true, spiritual comfort to those whose days upon this earth are clearly numbered, it seems that there are three distinct realities which must be faced up to – not only by the departing one, but (in some respects) also by those who have to witness that departure. We may term them ... in logi­cal order ... the present, past and future realities, and proceed to deal with them in that sequence:

The Present Reality🔗

In God's Providence, there is given to some an 'advance notice' of their being called home to be with the Lord. We speak, of course, of those incorporated into His family ... here-and-now ... by faith. The intimation is usually not by way of some premonition (although that may cer­tainly be present), but – in this age of medical advances, especially in the area of diagnostic aids – it is through the de­tection of an incurable disease, a com­plaint classified as 'terminal'. The physi­cian is not 'playing God' when he comes up with such a prognosis, but is simply stating a medical 'fact': in the light of what is then known about the disease, its treat­ment, and the effect of such treatment, the patient has just 'so long' to live. Remain­ing earthly days are not pre­cisely numbered, but all of a sudden the tallying of them assumes a new dimension.

Now, we all know that the days of our life are num­bered by our Creator, and that we ... in turn ... are to "number our days" in light of this (Psalm 90:10, 12). How­ever, it has not been uncom­mon ... particularly in past times ... for a physician to withhold the truth of his di­agnosis – and consequently, his prognosis – from some­one who has contracted a terminal illness. Sometimes the relatives are involved in this cover-up. Such a prac­tice is possible because, in the initial stages, the patient may be feeling physi­cally very well. It is all done under the banner of 'kindness'. But there can be no real display of kindness at the ex­pense of truth...

The Scriptures exhort us to speak the truth in love (cf. Ephesians 4:15, 25). The 'con­duit' of love determines what we convey by way of truth, and how we convey it. Surely it is the loving thing to share the truth – as far as it can be ascertained – in regard to a loved one's terminal illness. Here is a spiritual crisis which needs to be worked through ... together. Here is a unique opportunity, granted by the Lord, for all to face up to the inescapable real­ity of death. This is no time for pretence, for hushing things up: it is not long be­fore the dying one has an inkling of the truth of the matter, anyway. Here is a precious time for all to prepare them­selves to say their farewells in terms of 'au revoir': as C.S. Lewis has affirmed, "Christians NEVER say good-bye!"

And, for all concerned – not least of all for the dying one – there are massive ad­justments to be made. They involve past, present and future: obligations that have been entered into, the existing responsi­bilities and the prospect of unfulfilled fu­ture hopes ... all these need to be tack­led in an open, clear-eyed manner. It is truly a time of faith-testing. There is the need to leave everything (as much as pos­sible) in 'good order'. By the way, have you made your will ... is it right up-to-date? As for other very practical considerations, the one upon whom the Lord has laid His hand needs to consider (together with the loved ones) the possibilities of a de­creased physical mobility, diminished mental faculties, and the presence of pain – and, with all this, a growing dependence. This is not something that is always read­ily accepted, to say the least.

Yes, there is much by way of a present reality which can move into acute focus when we come face-to-face with the pros­pect of impending decease. It has been observed that the news that one is to be hanged in a fortnight "focuses the mind wonderfully". It is not only those who are dying, but those who seek to pastor them, who must come (biblically) to grips with the reality of death itself. In all this there is the need to call upon the Lord for His peace, "which surpasses all comprehension", to guard both hearts and minds.

The Past Reality🔗

Those who have had a narrow escape from death are said to have had their whole life flashed before their eyes. Most of us are ill-prepared to depart this life, and face the Lord. In terms of the immediate present, there can be a fear of the unknown ... and a pervading sorrow at the thought of losing those near-and‑dear. This was also the lot of Jesus' disciples, and he did not hold it against them: there were times when He bade them to "fear not" and "take courage"; on the eve of His own 'departure' from them He comforted them with the promise that he was not leaving them ... or forsaking them. Who is dearer to us than our precious Redeemer?! Those nearest-and-dearest to us are closest because they are near-and‑dear to Him, and He will not let them go! At the prospect of our departing from this life, we may be comforted ... and comfort one another ... with these abiding truths.

However, while the present may immediately impact upon us, it is the past which catches up with us ... and, in a rush. So many things we have hitherto managed to put to one side, we can no longer avoid. There are the sins of omission. Who amongst us has not been handicapped in life with besetting failures, unsuccessfully dealt with? There are the fractured relationships which we have omitted to mend (a failure with so many) ... the responsibilities we have refused to shoulder ... our lovelessness, etc. And, as for the sins of commission, well, the trickle of the recollection of some of them ...  in occasional quiet moments ... 'now' becomes a veritable flood: as the 'Oma' (I mentioned before) was wont to say, "mountains of sin ... mountains of sin!" Yes, in terms of a past reality, the coming encounter with death embraces so many shortcomings in our dealings – both with the Lord and with others. Sa­tan, as the ever-ready 'accuser', is so quick to capitalize on the guilt that sur­faces, whether it be real or imagined.

So, this 'past reality' is a very real prob­lem, a very pressing one. But, as the con­science becomes more tender, more in tune with God's Law, what a wonderful opportunity is presented for the applica­tion of Gospel-truth! We are speaking here, again, of those possessed of a lively faith. My own experience in seeking to counsel patients who were terminally ill (as a student, assigned to a hospital ward) bears out the observation of oth­ers: those who have long resisted the means of grace, usually continue in this vein – providing no fertile ground for Word-reception, even in the midst of dying.

However, with the Lord's own, there are times or 'seasons' when the pasto­ral ground is particularly receptive to the ministry of God's Word – especially when the soil is disturbed and softened by the providential ploughing of the Lord, in His 'sending' of a terminal illness. The Word of God's forgiveness, in Christ, is drunk in as thirstily as a dry land receives the seasonal rain...

Thus may our loved one, on the eve of accountability, be reassured that Christ has fully dealt with past "moun­tains of sin", and that He continues to deal (by His grace and mercy) with daily additions to such! The forgiveness of all our sins is the blessing of the covenant: we may have omitted to keep 'short ac­counts' with God, but He has fully reck­oned with all of our sins ... discharging our debt through the Son of His love.

Now, how may we minister this life-sustaining, liberating Gospel-Word? Here we can encounter two (perhaps) associ­ated factors. The first is a spiritual one. Too many of the Lord's people enter the declining years of their lives – when they are all the more likely to contract a termi­nal complaint – in poor spiritual shape. For long they have not made diligent use of the means of grace, have been largely content to 'grab a bite' of spiritual food here and there. It is not likely, with such, that the familiar, acceptable diet of "milk" will be readily replaced by servings of "meat". Thus, the portions of God's Word will have to be well-known passages, not too long, and clearly and carefully ex­plained and applied – unless, of course, a deeper discussion is requested.

The other factor can be a physical one. In the latter stages of terminal ill­ness, there can be the (added) complica­tion of the decline of bodily strength and function, pain and/or drowsiness, with resultant loss of mental acuteness. If such be the case, then brevity is the or­der-of-the-day: just a verse or two of well-loved, well-remembered Scripture will suffice, carefully and caringly 'prayed in'. There is still very much (nay, even more so) the need for spiritual food, but those consigned to a 'drip' for their physical sustenance are not usually up to tackling a 'steak' in spiritual terms. Often, as the shadows of death begin to deepen, the only recourse to Word-nour­ishment can be in the singing of familiar psalms and hymns (cf. Ephesians 5:19-20 & Colossians 3:16): the words are known by heart, the truths are long-taught and treasured, and the singing of them together can be – as many have gratefully attested – a rich source of mutual comfort and joy.

Lastly, here, what about the ones who are doing the ministering? Well, they need to be those who are in the closest of rela­tionships with the dear-departing one. Just as those of our congregations need to enter into the latter years of their lives in good spiritual 'nick' (READ Psalm 92:12-13) ... well-fortified in the event of the 'shut­ting-down' of their systems (cf. Ecclesiastes 12!) by the Word which they have hidden in their hearts ... so also do those pastoring to them need to be spiritually vibrant and warmly self-giving. Here, there has to be the preparation of our self, as well as what we hope to supply. Often, towards the end, it is what we really 'are' (and how we relate ... just being there, just in touch) rather than anything we may say, that counts most of all.

The Future Reality🔗

In the final analysis, all our pastoring is designed to draw everyone closer to the Lord, and therefore closer to each other. As Bunyan reminds us (in his "Pil­grim's Progress"), the Christian has that last, deep river to cross, and a spiritual battle is in progress. We must not be surprised if our dear one appears to fal­ter at times, and the faith we had as­sumed to be so strong is found to have its flaws. The dying one is, humanly speaking, very much on his own as he enters "death's dark vale": he may with­draw within himself, and those about him may unconsciously withdraw themselves from him. We need to watch out for this, and take steps to remedy the situation: we are in the better position to do so.

But, what of the 'other side' of death's deep, dark 'river'? When any of us are planning to visit some far-away place, we seek to be as well-prepared as we pos­sibly can be: what is the best way to get to that place? ... what will it be like? ... and, what can we do there? Accordingly, we make sure that we do all our 'homework' in regard to these questions, not lack­ing in application and anticipation! But now ... what about that inevitable, ulti­mate trip that we all must take? Is it not true that we mostly avoid any real think­ing about it, and often show no more than a casual interest in the nature of the (our!) final destination. Oh, yes, we sing the hymn "Jerusalem the golden...", but are we really entranced by "what joys await us there"? Sure, we may sing "Heaven is a wonderful place, full of glory and grace", but do we long to see our Saviour's face more than all other faces ... those so familiar to us?!

The truth is, heaven is just glorious! And, if we are to speak of this as a future reality to those who are shortly (God willing, by His grace and mercy) to arrive there, we do need to rehearse this truth from Scripture – both for our own benefit, as well as theirs.

Paul, on one occasion, had a glimpse of Paradise when he was "caught up to the third heaven"; but, he was not per­mitted to pass on the "inexpressible words" he heard there (2 Corinthians 12:2-4). John, in that extraordinary vision set forth in the book of Revelation, has given us some wonderful word-pictures of heaven's glory ... centering upon God's throne, and elaborating upon the eternal city (READ Revelation 4, 5, 7, 15, 21 & 22). There is only One who has actually been to heaven – has come from there, and returned there – and that is our Lord Jesus! Heaven is where He is, and it is 'heavenly' for us because of Him! Above all, we have His reassuring words that He has prepared a place for His loved ones there, and when they depart this life they go to be with Him (John 14:1-3).

When all is said and done – said by Him, done by Him! – There can be no greater joy and comfort than knowing this, and conveying this to those falling asleep in Christ.

In many respects, the pastoral care of those who are approaching the end of life's journey is suitable for those who are proceeding through its interim stages. We are all faced with present, past and future realities ... and although we are called upon to "bear one anoth­er's burdens", in the final analysis "each one shall have to bear his own load" (Galatians 6:2, 5). The fact is, the Lord is al­ways "at hand", and we are to prepare ourselves to meet Him. When we come to think of it, as those alive in Christ we all want to "die well", don't we? And, how may we do that?: why, by living well ... of course!

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