Clergy talking about death

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Some years ago, I was asked to address a group of community clergy regarding death, dying and end of life care.  In the course of my lecture, I indicated that this topic is mostly taboo from a pulpit because the clergy themselves struggle with a sense of self death-awareness.  Most in the audience agreed.  As I continued, focusing one how our public prayers contain many references to death and life after death.  We can say the words in prayer, but to have intention and meaning in those words tends not to be emphasized.

A short piece, Religion, patients, providers, was published describing the value of religious leaders having end-of-life discussions.  While it is unfortunate that the article doesn’t discuss the importance of how chaplain/spiritual care providers can be a resource for this discussion, it is encouraging to see the increase in confronting the realities of life in religious communities.

Religion, patients, providers

Published 8:13 pm, Friday, December 2, 2016

Talking about death is a daunting topic, and we applaud the growing number of congregations that are giving their members tools and resources to have conversations with their families and loved ones around end-of-life preferences.

But as important as these discussions are, it is also crucial that health care providers are prepared to have end-of-life conversations with patients, especially when religion plays a role in the patient’s decision-making.

In the United States, where 78 percent say religion is important to their lives, it will inevitably emerge in health care. A study found 41 percent of patients thought of a time when religion influenced one of their health care decisions. Its impact might be patients needing a kosher, halal or vegetarian hospital meal or requests to coordinate medical procedures around prayer times.

The most profound intersection may be in end-of-life care. Religion can influence the procedures patients want to receive, or reject, such as starting artificial respiration or removing this support once it is in place. Religious beliefs may affect patients’ beliefs about the afterlife and help frame their illness in a context that medical professionals need to understand.

Yet health care providers are often ill-equipped to discuss religion when it does come up, with one study finding that one in five medical residents reported being unprepared to care for patients whose religious beliefs affected their treatment. This discomfort means that important conversations about how religion affects patients’ end-of-life decisions simply never happen.

Medical students, residents, nurses and nurses’ aides need training that goes beyond a one-off course in cultural competence. They need expertise in taking a spiritual history as a routine part of taking a patient’s history.

Even when patients don’t know right away what their care might entail or how religion may be relevant for them, asking these initial questions can open the door to further conversations and make the patient more comfortable voicing their beliefs if and when they become relevant. The result can lead to better care every day, and certainly as life draws to a close.

Clinicians need to learn to recognize signs of spiritual distress so they can refer patients to pastoral care for spiritual support and guidance. These should be skill sets that we expect from our providers and that they are trained to execute.

Today, more and more organizations and communities, including religious communities are promoting open, honest and proactive conversations around end-of-life preferences.

As that trend continues, it is important to ensure that health care providers need know to ask about a dimension of many people’s lives that influences their choices, and then incorporate their patients’ religious beliefs and practices into a plan for care.

Eliza Blanchard works at the Tanenbaum Center for Interreligious Understanding.

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