Spiritual care at end-of-life

Perhaps I am too close to the issue of physician-assisted dying to write about it. On the other hand, real life experience focuses the mind on what could be helpful in practice. I hope that my personal reflections contribute to a constructive dialogue among us as Canada considers a new law on this matter.

My husband died at home in November after a struggle with cancer. The so-called “cancer journey” is becoming familiar to many families, and terminal cancer is one of the situations frequently cited in the current debate about physician-assisted dying.

Added responsibility

My first observation relates to the nature of the issue we are facing. At several points in our cancer journey we and our doctors faced decisions with life-and-death gravity, such as whether to try an experimental treatment with a small chance of prolonging life with side effects that erode the quality of living. Modern medicine can prolong the physical state of “staying alive” far longer than earlier times and far beyond what is meant by the term “life” in Biblical language.

The decisions we face now are a result of the blessings of modern health care. It is not helpful to frame this issue in terms of moral decay in society or erosion of religious influence, although both may be true in general. With the blessing of advanced health care comes added human responsibility. It makes no sense to say “only God will decide” when we are making choices every day that either prolong “staying alive” or lead to physical death sooner. As with all of life, God’s will and human decisions interact in complex ways; our calling is responsible stewardship of our role in the dance of living with God in God’s world.

Holistic approach of palliative care

Secondly, good palliative care is a gift and area for Christian ministry. In our experience, its values and paradigm for care were more in keeping with a Reformed approach to the meaning of life than some of the legitimately aggressive treatment approaches for cancer. My husband was supported in ways that allowed him to complete a piece of his life’s work, motivated by his deep desire to contribute to the development of God’s creation. The end of breathing was not treated as something to be feared, but part of a transition in the stages of eternal life. Pastoral ministry in our churches could also benefit from the more holistic understanding of the meanings of the words “life” and “death” that undergird palliative care.

We are missing an opportunity for a positive contribution for all persons facing end-of-life decisions.

A thin line

Third, the reality is that the line between good practice in pain alleviation under palliative care and physician assistance to end life is a very thin one. This has also been recognized by some clinicians in recent public debates. While the ethical difference between pain alleviation by any means and assisting death may have moral significance at the level of societal values, it may not have substantive technical or ethical difference in practice in individual cases.

In my view, Christian voices who focus on this thin line as a non-negotiable, great moral divide, similar to how some framed the abortion debate, are making another mistake in our public witness in contemporary culture. To be honest, when I read some of the high-sounding, black-and-white rhetoric from fellow Christians, I want to say “get real.” The majority of church members who express support for some forms on assisted dying in every poll may be ahead of church leaders in discerning our current context and how the Spirit works through history, outside of official church structures when needed.

Spiritual care is essential care

More importantly, we are missing an opportunity for a positive contribution that could make a genuine substantive difference for all persons facing end-of-life decisions. Advocacy for spiritual care as an essential component of end-of-life care would be more constructive for both practice and our public witness. End-of-life transitions are profoundly spiritual moments, for those who practice a particular religion and those who do not. Increasingly they happen at home as well as in hospitals where there may or may not be chaplains on duty. A robust, pluralistic approach to nursing that combines spiritual care and end-of-life care could be developed through cooperation between faith communities and community health care networks. Ensuring that every person has access to spiritual care during end-of-life transitions, based on the patient’s expressed will, is an achievable goal.

In the short-term, mandatory inclusion of spiritual care could significantly influence the development of a more holistic approach to health care for the terminally ill. This is timely in light of Canada’s growing aging population. In the public sphere, rather than being associated with a reactive, illogical stance that can easily be dismissed, Christians could show positive leadership to help shape a new culture that respects and integrates the spiritual and religious dimension of life into public policies for health care.


  • Kathy Vandergrift, a public policy analyst, brings experience in government, social justice work and a Master’s Degree in Public Ethics to her reflections.

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