What do you want me to do for you? ​ Pastoral Care of the Sick and Dying

Jesus’ question, What do you want me to do for you? (Mark 10:51) highlights the invitational nature of the role of those who provide pastoral care for the sick and dying in hospitals and aged care facilities.

Some time ago many Catholics would not leave home without having some message on their person advising, ‘I am a Catholic: in the event of an accident, please call a priest’. The person’s faith and the invitation for the Church to administer the sacraments and to pray with them were explicit.

These days such an identification with the Church is rare. Even the number of calls to a priest from families and patients has greatly diminished. It is most often up to the pastoral carer on duty to be the one to approach the sick person. During their pastoral assessment and through forming a relationship with the patient, they discover an invitation (or not) to engage in prayer and sacrament. Very often an openness to engage with the Church’s representative, the pastoral carer, is clear. However, barriers to the graces offered by the Church need to be uncovered and burdens lifted to free the sick person from possible hurt, fear or sometimes a sense of guilt and shame. This is often the task of pastoral care.

Casey’s journey

As pastoral carer on the oncology ward, I visited Casey. She was listed as a Catholic on the patient list I was given. It is out of respect for the patient that the pastoral carer makes known who they are, from what denomination they come, and their purpose in turning up at the bedside uninvited. In fulfilling these requirements, I sensed that I may be welcome to ask Casey if I could sit down. We talked about a few things, and it wasn’t long before Casey told me of her incurable cancer and the news that she had a very short time left. She was weak and there were silences. In quietly waiting for what Casey may have wished to talk about, she finally found some words that were most important for her to express. She shared many things she had done in her life which, she acknowledged, were far from the values of her faith and for which she held deep regret. She shared she had not been near the church since she left school. By offering her the uninterrupted gift of silent attentiveness, she felt safe to continue her story. As her tears began to flow, I asked her what it was she wanted most of all at this point in her life. Her answer was ‘forgiveness and peace’. I asked her what she believed could bring her this state of forgiveness and peace and she answered, ‘I want to say I am sorry’. Casey had made her confession. I asked her if she would like the blessing of the Church upon her now and for her journey ahead. Too emotional to speak she nodded in the affirmative.

The priest on call visited her that afternoon.

Casey died the following day.

It seems often that, when people can be unburdened of their life’s regrets and sense of sin, they can surrender into the arms of God. Casey had found forgiveness and peace.

Sharing ministry to the sick and the dying

Priests will readily acknowledge that the lay pastoral carer is essential in reaching those who are seeking God’s mercy during times of sickness or when approaching death. The shared ministry enables the sick person to engage with and clearly answer Jesus’ question: What do you want me to do for you?

The Rites of the Church

Whenever pastoral care of the sick and the dying is being offered in hospitals, hospices, in aged care or nursing homes, or in a person’s home, it is important to know and understand the rites and prayers for the sick and dying. There is a wealth of ecclesial wisdom, ministerial guidance and pastoral suggestions in Pastoral Care of the Sick: Rites of Anointing and Viaticum (Sydney: E.J. Dwyer, 1982).

It is important to trust the rites in the ministry of pastoral care. This means knowing the rites thoroughly through experience in the clinical setting. Ministers will see the range of options available – visits to sick people, communion of the sick, anointing of the sick, celebration of viaticum, commendation of the dying, and prayers for the dead – and will understand the basic human and pastoral difference between a ministry to the sick and the care of the dying.

The rites and prayers should not be delivered in a mechanical way at the bedside. The ritual book certainly doesn’t assume the Church’s representative in that moment - whether it be an ordained minister or a lay pastoral carer or chaplain – exercises a purely functional ministry, offering merely ‘by rote’ responses. Care, concern, compassion, and the Shepherd’s attentiveness to the one who is sick or dying is what the Church asks of all her ministers. Pope Francis speaks of serving people in their humanity first. Taking the time to find out from those gathered what they want you to do for them, in a gentle invitational way, can open their hearts to the beauty of the rites.

Ministry to Lucy

I was called to visit ICU where Lucy was lying in her bed with a very short time to live, surrounded by her family. The family was able to tell me that the priest had been called to their mother during the previous night.

Even in our increasingly secular society, all hospitals (private and public) still uphold the wishes of the sick and dying in relation to the spiritual care they elect to receive. Priest rosters are in place and often staff themselves will make the call on behalf of a patient whom they know has a faith background.

So Lucy had very recently received ministry from the priest appropriate to her circumstances, and this would have been at the discretion of the priest. The family were not requesting that the priest return at this final stage. I took the chance firstly to ask the family if they knew any of their mother’s favourite prayers. Amidst tears one of the adult children remembered they would say the Hail Holy Queen before bed sometimes and they remembered it from school. Together we prayed this prayer as they rested their hands on their mother.

Within this sacred tableau of children honouring the faith of their mother, I began reciting the Prayers for the Dying. To conclude I invited each of them, as they were ready, to mark the sign of the cross on their mother’s forehead. I then left them to say their final farewells to their mother.

The changing landscape of hospitals and aged care facilities across Australia

Hospitals and aged care facilities will have different agreements with priests. Many larger hospitals may have full-time priests and lay ministers in the pastoral care/chaplaincy department. Smaller hospitals may rely on the local parish priest who is assigned to a hospital within the parish boundaries.

Aged care facilities may have a resident older priest who agrees (in association with the local bishop and parish priest) to be available for ministry to the residents. This can be a special source of joy for the community. At the same time, many such facilities across the nation rely on the appointed chaplains. In larger parishes such as on the coastline of Australia there could be more than twenty aged care communities within the one parish.

The ministry of the priest

When a priest is called to see someone in any clinical setting, he would be wise to ask for a briefing from the staff member who called him. Essential questions in this briefing include the person’s preferred name, their age, their condition, whether they are ‘nil-by-mouth’ and who may be with them in the room or by the bedside. In general, it is worth asking if there is anything that the priest needs to know before meeting the person and ministering to them.

A pastoral approach to hospital and clinical staff builds professional rapport between the priest and members of staff. It demonstrates a collaborative response to the needs of the person who is sick. At times it may be that the nurse who briefs the priest is a committed Catholic or even a parishioner known to the priest and this is a bonus when it comes to ministering to the person. The same approach applies to the lay pastoral carer or chaplain who may be caring for the person whom the priest has been asked to see.

When the priest is with the person who is sick and/or their family, he needs to make an almost immediate assessment of what is required both for the sick person and other people in the same room or by the bedside. He needs to be attentive to the non-verbals in the room, to have a ‘sixth sense’, and to be listening to what is being said and to what is not being said. If he knows the ritual book for the sick and dying, he can then discern what liturgical prayers, rites, gestures and symbols may deepen the experience of Christ the Healer for the person and their loved ones in this moment. After a sacramental encounter with a sick person, it is a good practice to find the ward clerk or ward team leader and ask them to record in the patient’s file that the priest has visited and what sacraments may have been celebrated. Where there are multiple priests who are on-call for the same hospital such recording is essential to avoid duplication and doubling up of ministry.

Today’s collective pastoral experience suggests that it is more common now than in previous decades that the visit of the priest may be the first time the sick person has encountered a priest. Again, in the first few minutes of conversing with the person, the priest can try to formulate a few pastoral assumptions about the person’s relationship with the Church, though this would rarely be voiced to the person. A pastor will need to be sensitive to all requests which may include conversation, prayer, giving communion, celebrating penance, anointing. He will have to make a pastoral judgement whether or not to anoint if he has been told the person is dying. The practice of anointing may become complicated depending on the expectations and understandings of the sick person and the family. It must be emphasised once again that there is no one rule for every occasion. As we suggested earlier, the Church does not envisage a mechanistic or rote response to the needs of the person.

The role of lay pastoral carers

Pastoral carers and/or chaplains who are lay are the face of the Church for many in our hospitals and aged care facilities. They may be there every day or at least once or twice a week. Sometimes there is a team of carers; sometimes it is a single person. We know of one person in a rural aged care facility who has been the sole pastoral carer for over thirty years. She ministers to all residents regardless of their faith or in the absence of faith. This a most significant reality in many clinical settings across the nation and it is now often the norm.

The priest who has pastoral responsibilities to the same hospital or aged care facility by virtue of his appointment to the local parish is called to co-minister with lay pastoral carers. This can be a rich experience of pastoral ministry for the priest who may feel more supported in the mutual pastoral care exercised in these settings. He will learn to trust the experience, instincts and insights of the pastoral carer as together they navigate Christ’s concern for people who are sick and dying.

Know the person, read the pastoral moment and trust the rites

Recently we offered a series of all-day workshops in the Archdiocese of Brisbane for pastoral carers and chaplains. We titled the session: Trusting the Rites: Pastoral Accompaniment of the Sick and Dying. We were touched by the commitment of the chaplains and carers to this ministry. We were astounded by their honesty as they described the contemporary realities they are facing in the here-and-now of pastoral ministry.

After listening to their reflections and honouring their ministerial experiences, we believe that further reflection is necessary for the Church as together we face the reality of a patient who has chosen voluntary assisted dying (VAD). Such situations are not for the faint-hearted. We know that this reality was not faced by previous generations of lay and ordained ministers in clinical settings.

In conclusion, we turn again to Pope Francis’ invitation to serve humanity first. We are encouraged by the Church to trust the liturgical gestures within the rites in the Pastoral Care of the Sick: words that welcome, phrases from sacred scripture, the laying on of hands, anointing human skin with reverence, and tracing the cross with solemnity and meaning as death approaches. There is a time… we hear proclaimed in the word of God; we ministers are the ones entrusted with meeting the pastoral needs of the person who is sick or dying in this moment.