Caring for elderly family members, by Mollie

April 25th, 2009 Post by

I’m working on a story about how families should plan the end-of-life care of elderly family members and treat it as a sanctity of life issue.

I’m wondering if anyone has any thoughts about what this might mean from a Lutheran perspective. What should we keep in mind, vocationally and otherwise, as we work on this?

Of my four grandparents, one died of cancer before my parents married, two died suddenly and one died after being diagnosed with pancreatic cancer. For her, my grandmother, we were able to plan for in-home hospice care with a focus on pain management. Pancreatic cancer is a particularly lethal form of the disease and we did not catch it early enough to attempt surgery. So we knew we had a limited frame of time. Still, the process taught me a lot about how important it is to communicate with surviving family members and keep a balance on caring for the dying family member spiritually, physically and otherwise.

Anyway, I’m wondering if any pastors or deaconesses or anyone else has any thoughts about what they wish families in their parish would keep in mind when confronting end-of-life care.


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  1. Rev. Alan J. Wollenburg
    April 26th, 2009 at 12:40 | #1

    Well, I do not want to get this going in the wrong direction, but I have become a pastor who regularly tells members that the Funeral Worship Service which is in LSB is really good and it is what I expect to be used. Jokes and story-telling can be done in another venue, but certainly not as part of the Divine Service where Christ is present with His Word. I also strongly suggest to families that funeral worship services belong at the church — it was in church where they received Christ in His Word and Sacraments and it is where they should want their families and friends to gather after they die. Worship music is the hymnody of the church, not cutesy songs or pop ballads which trivialize and, in some cases, even deny God.

    I try to suggest to persons and their families that they want to leave the clearest possible testimony to the crucified and risen Christ, His forgiveness of sins, to the parousia (Second Coming), and to the resurrection. To that end, they will consult with their pastor who has (surely!) been in the closest of contact with the person who has been living through their end-of-life concerns.

    I have also sought to teach simple prayers to those who were going to die difficult deaths: one man who was dying of lung cancer, at my urging, prayed over and over “Lord, have mercy; Christ have mercy; Lord, have mercy.” Another person learned the 23rd Psalm so very well that it was a part of her vocabulary and she could go to it even when it was difficult to concentrate on other things. That kind of stuff.

    We want folks to live and die in the glorious hope which Christ has purchased for us.

    I hope that I’m sharing things which are truly salutary . . .

  2. helen
    April 26th, 2009 at 13:07 | #2

    Mollie,
    I have been working on this for myself.
    I have a Medical Power of Attorney with an ordained friend whom I trust to be objective. (He’s also near by; others aren’t.) We have discussed what’s reasonable and what’s not.
    If this is the sort of thing you want to know, Norm can give you my address.

  3. Jeremy Loesch
    April 26th, 2009 at 19:34 | #3

    Hi Mollie,

    One thing that I stress with the members of the church I serve is that when they are in the position of caring for parents/spouse/child, it is very important to keep in mind the value of the individual. Our worth begins in the womb, and doesn’t end until we are ‘cradled’ to our Father’s bosom. When so many people determine worth based on what you can do or contribute, it becomes easy to disregard the elderly as ‘useless’. But it is our Father who determines who is worthy.

    More later, screaming child.

    Jeremy

  4. Jeremy Loesch
    April 26th, 2009 at 19:45 | #4

    Hi Mollie, this is Jeremy again. (15 month old son going through some growing pains. Hot, cranky, doesn’t want to sleep.)

    Back to your good topic- People lose sight of their identity throughout their life. I started as an infant, moved on to toddler, then to schoolchild, then to teenager, high school student, band geek, college boy, vicar, boyfriend, pastor, husband, father, you get the picture. All of those identities changed as the settings changed. What identity that I did possess that didn’t change is my baptismal identity. By God’s grace I have been brought into God’s family. Someday our sons will grow up and leave the house. Someday my wife and I will retire. Someday one of us may contract a deadly illness. (I already have type-1 diabetes.) My identity may be changed for me. But I will always be a lamb safe in God’s keeping.

    Our baptismal identity is so vital and it is an identity that cannot be altered. Jesus reveals a lot about himself in the Gospels, and we should not be afraid to hear what is revealed about us. When Jesus says, ‘I AM the Bread of Life’ I think to myself, ‘I am fed by Him’. When Jesus talks about himself as the Good Shepherd, I think to myself, ‘Boy am I glad to be a sheep watched by him!’

    Anyway, this is getting too long. Hope this was something helpful.

    To sum up: It’s all about our identity in relation to the triune God.

    Jeremy

  5. Jeff Samelson
    April 26th, 2009 at 19:53 | #5

    You might find some helpful references at the Christian Life Resources site: http://www.christianliferesources.com/?library/list.php&categoryid=4

  6. REE
    April 27th, 2009 at 06:19 | #6

    Mollie,

    First, allow me to take you to task for a moment. Why is your question about “end-of life-care” and not about how do we confront and provide care for one facing death. Do we as Christians believe that death is the end of “life”? Does using the phrase “end of life” convey beliefs that we as believers then must contort and explain our way through? How do we use the phrase “end of life” in the same sentence as “Lord of Life”, “Eternal Life” or “New Life in Christ”? When we avoid using the word “death” are we capitulating to the “sting of death?”

    What I am saying is we must be careful in our use of language. Let’s call things what they are. We have used language, or avoided using language, in an attempt to blend with a world view that wants to avoid and deny death. Our world has no answers beyond this physical so let us avoid the questions. Let us move death out of our view. Place it behind the walls of hospitals and nursing homes. Let us remove death from our our presence and leave it to professional doctors, nurses and funeral directors, hidden behind their walls. Death, since the fall, is a part of life’s journey. The world wants to deny the tomb. We with fear and trembling, go to the tomb and see that it is empty.

    Your request touched upon some important points. Somewhere in my past, I read a statistic that the average family has the death of a family member every seven years. With the exception of a few Biblical characters, most of us will only experience physical death once in our lifetime. Your situation is not unique in having limited experience. Please encourage your readers to speak with their pastor early on. The individual and their family are not alone. As we “walk through the valley of the shadow of death” Christ has promised His presence, to comfort our fear. Pastors walk with many through that valley. Both Christ and I especially want to walk with the individual and the family at this time.

    Please allow me to address one other issue that you raised in your request. We often think in terms of the “medical sciences.” Academically, this is a valid term. In the practical world it is the “medical arts.” Personally, I feel that the term “science” allows my mind to remove God from the equation. If we do this and that and the other thing here will be the results. Individuals are left years latter with the grief of “if we had caught it early”, “if we had done surgery,” if, if if…. The reality is that Christ is the Lord. We use the tools of reason, the medical arts, of time to make that best decisions possible and yet pray “thy will be done.” The death of your grandmother was in the Lord’s timing.

    I hope that somethings in this help.

  7. PPPadre
    April 27th, 2009 at 07:50 | #7

    Vocation, Vocation, Vocation. Together with Pr. Loesch’s observations about baptismal identity, the thing I have learned that I wish everyone understood better is that our 4th commandment vocation doesn’t expire after we have reached the age of majority.

    I owe a great deal of gratitude in this lesson to my own father. When I was in college, my father and stepmother were basically running a nursing home out of their house – his father, her mother, and her aunt were all living in the house as well. My father had to have surgery, and, as the eldest son, the responsibility of helping my grandfather bathe fell to me. Being a typical, self-absorbed college student, I wasn’t thrilled about the prospect, but it was my responsibility and my response to the love that had been showered upon me for almost two decades.

    Law is what first motivated me, but I was quickly mindful of Christ’s own humility and service toward me. As I stooped to help take off my grandfather’s shoes, I thought of Jesus’ washing of the disciples feet (and what happened the next day). This was nothing compared to what Jesus had done for me – this was nothing compared to what my parents and grandparents had done for me. This was my vocation as son/grandson. It was there I began to learn the meaning of 1 Timothy 5:4 “…these should learn first of all to put their religion into practice by caring for their own family and so repaying their parents and grandparents, for this is pleasing to God.”

    There was one woman in my parish who always prided herself on appropriate conduct and dress – not conceited pridefulness, but something worth taking the time to do right. The last week or so of her life, she was in the hospital and not looking/feeling particularly beautiful. Every time I entered the room, I greeted her with “Hello, beautiful!” Her beauty, her value, was not a result of outward appearance but the righteousness of Christ, and that is how we started every visit once we new that the end of her life in this world was imminent. Her hair was scraggly and unkempt, her countenance sunken and void of the makeup that covered her “flaws,” but she was still a beautiful child of God, forgiven in Christ and covered in His righteousness. This message became the theme of the sermon at her funeral, carrying over a consistent message for her family from bedside to funeral and beyond.

    When I was at the Seminary, I took a class on devotional literature. My final paper was on the “Ars Moriendi” – the Art of Dying. The original devotion booklet focused a lot on what Pr. Loesch talked about before, baptismal identity and looking to Christ and His saving work alone. Later versions began to show a more pietistic focus on what the dying person had done. I have long wanted (but have lacked the expertise) to write a book entitled “Ars Nova – A New Look at the Craft of Dying” which would combine the best of the devotional tradition with some material describing the medical, legal, financial considerations.

    Keep up the good work, Mollie, and God bless you on your article.

    The Padre

  8. Jeremy Loesch
    April 27th, 2009 at 08:40 | #8

    Hello REE,

    I hear your comments about why we use the phrase ‘end-of-life’. As one who uses that phrase, I suppose I do it because it is understood by the folks I am talking to, regardless of their level of connection to the church or a church. The Christian family, I believe, sees the pending death as (choose your own image) a door, the entrance, the springboard- my favorite- to life with God in heaven. Not to go down too much of a divergent track, but when I die, my body will be in the ground while my soul is with my Lord. My body will still be waiting for the resurrection of all flesh. Does that change the way we talk during these times, about life and death? I honestly don’t know. I think during the process of death, we talk about death a lot and do not shy away from it. I think that using the phrase ‘end-of-life’ is a little more…happy? And if we speak of beginning-of-life issues, I think using end-of-life helps tie the issues together in one package. The elderly gentleman in the nursing home who is bedridden has just as much a right to life as does the child in the womb.

    The family is seeking how best to cope with the new responsibilities that are placed upon them. And Padre’s comments about understanding the 4th Commandment were really good. I tell my confirmation kids- “These commandments never expire!”

    Anyway, good comments from everyone on an important topic. We cannot stress our identity in Christ enough.

    Jeremy

  9. Mollie
    April 27th, 2009 at 09:52 | #9

    Thank you everyone for these wonderfully insightful comments. Keep them coming!

  10. REE
    April 27th, 2009 at 20:47 | #10

    Shalom: Jeremy, Mollie, et al,

    I agree with Jeremy that the phrase “end of life” is a convenient way of speaking about these issues. Especially it is convenient when speaking with those of any / no religious strip. I will readily admit that I also have used the phrase. At the same time, I want words that say what they mean. Calling it “the little table at the front of the church” conveys a far different message than calling it an altar. Calling it “end-of-life” conveys a different message than calling it “death.” We as believers use many other terms that are not common to “every day” usage.

    I have been married to an individual for over thirty years who has a chronic fatal illness. When that day comes, I already know what the cause of death will be on her death certificate (unless she is hit by a bus) I also know the joys and frustrations of living the vocation of care giver as her abilities and life skills fail. When we were dating, my wife and I talked about our wishes when death is near. Sanctity of life issues are a part of our daily ethics. We do not sugar coat our words.

    I believe that it is best that Christians express their desires long before emotions and worldly expectations get in the way. Several years ago, I had two members of my congregation, first cousins, born and raised in the same community, same church, opposite ends of the street die within 2 hours of each other. The first family acknowledged, talked about, and prepared, down to a numbered phone list, their wishes. The other family refused hearing that anything was wrong despite several hospitalizations and frank talks with physicians. They tried to deny death. The first family grieved but as those with a lively hope in Christ. At the second service, the hope in Christ was proclaimed, but I’m not sure that it was heard.

    The “Ars Moriendi” is practiced in our daily drowning and dying and emerging and living now and forever. For are we not all individuals suffering with a chronic fatal illness called sin?

  11. Mollie
    April 27th, 2009 at 20:49 | #11

    It’s amazing — and disconcerting — how frequently I adopt euphemisms without realizing it. Particularly given my profession.

    I think that fear of the use of words ‘death’ and ‘dying’ says a lot about our culture and how our culture has seeped into the church.

  12. Jeremy Loesch
    April 28th, 2009 at 06:37 | #12

    What words or phrases should we be using? I ask because I don’t believe we are afraid of the words ‘death’ or ‘dying’ but that those two words have lost their meaning and significance. Have you played a first-person shooter video game recently? Just hit the reset button and everything will be okay. I think it was Scott Klusendorf on IE who talked about the pro-life folks ‘going visual’ with things. What hits home for a lot of high school students are the smashed up cars of their friends who are killed in drunk-driving accidents.

    We are desensitized to death, because we have accepted it as normal and have removed sin-as-cause from the picture. So how should we talk? What words or phrases should be used in place of ‘end-of-life’?

    Here’s one suggestion that I would offer. (And please forgive any sense of presumptuousness on my part or that I speak with any sort of authority.)

    -process of death. I use this phrase frequently to help us (the family and friends and the dying one) to realize that death is more than the moment when the heart stops beating and brain function stops. Death is a process and many things will happen, some noticeable and some not. Allow the dying individual to live a witness to their faith. Allow the dying individual to say what is on their minds and allow the family members to say what they need to say. (It’s terribly hard to deal with the “I didn’t get a chance to say X to my father.” when they had multiple opportunities.)

    When I talk about death as a process that provides me the opportunity to speak about what happens after death as well. The dying process doesn’t stop either when the heart stops, but is one more ‘marker’ along the path to where God has promised his people. Death is not normal, but it is not something that terrorizes or traumatizes us either. Especially not during this Easter!

    It is true that we have been desensitized to death but perhaps the desensitization (is that a word?) allows us to speak the truth about death and the life that is to come!

    And then from death awaken me
    That these mine eyes with joy may see
    O Son of God, Thy glorious face
    My Savior and my Fount of Grace!

    For the Christian, death is only sleep. After all, that is how the NT speaks about it.

    Well, this got a little long and I’d be curious to hear what other ways could be used to talk about this key topic.

    Jeremy

  13. John
    April 30th, 2009 at 23:14 | #13

    Mollie,

    This is an important topic because a majority of the deaths that occur in our nation occur only after someone–the person dying, their family, or medical professionals–is required to make a decision that will shorten life, allow death, or prolong the dying process. My statistics are more than a decade old, but given the way medical knowledge has progressed I’m sure more decisions rather than fewer are presented today.

    To get a handle on this I would encourage you and anyone else who is interested in this issue to check out “. . . And a Time to Die, How American Hospitals Shape the End of Life” by Sharon R. Kaufman, (Scribner, 2005). It’s not a theological book, but it describes in great detail how Americans die. It shows what concerns hospitals have, what pressures they face, and how families are guided to move the process along. Kaufman reports on the role of doctors, nurses, social workers and ethics committees, and how their own thinking and emotions affect outcomes. Besides describing the ordinary sorts of choices that need to be made there are a couple of instances in the book that are quite chilling, one which I can only conclude was murder by morphine. Kaufman does a good job of describing the cultural context within which decisions are demanded.

    In teaching I try to draw a bright line distinction between causing death–which God has not given us to do–and prolonging the dying process by any and every means possible, which God does not require. This is most definitely a sanctity of life issue. It requires careful moral consideration in advance when emotions are not yet aroused, a clear understanding of the loved one’s condition as it deteriorates, and the purpose and effects of the various options for medical treatment. Whatever bright line you can recognize in theory, it all becomes very complicated in real life when what seems should be black and white takes on a confusing cast of grey. And this is complicated by the changes that continue to occur. What is a godly decision one day may become a bad decision the next. For instance, most of the time withholding nutrition or hydration can cause death, but when the body stops metabolizing withholding food is proper. When liver and kidneys cease to function, continuing hydration can actually cause death.

    Obviously I’ve only scratched the surface, but I’ve sketched what I believe to be some of the central issues that need to be considered.

  14. Jeremy Loesch
    May 1st, 2009 at 05:30 | #14

    John,

    You make some wonderful comments. The role of the hospital and what part it plays in the dying process is indeed quite significant. And it very much is a sanctity of life issue. ‘Hospitals’- admins, doctors, nurses, chaplains- may do things at the end of life that are not necessarily encouraging to life. In the same way, hospitals do things that are harmful at the beginning of life. Labor and Delivery has taken on an assembly-line affair. If the mother is here too long (cost and time wasted), drugs will be administered to speed things up and if the mother still won’t deliver, let’s create an emergency to justify a C-section. The labor-inducing drugs inhibit milk production so that when the baby is born, there is nothing to feed them except formula. And formula can never replace mother’s milk. That’s a life issue too.

    I thought your comments were great!

    I’ll check out that book when I have the chance. Thanks.

    Jeremy

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