As Christians, we live between the certainty of death and the promise of resurrection. Jesus proclaims this paradox in John’s Gospel: “I am the resurrection and the life. Whoever believes in me will live, even though they die. Everyone who lives and believes in me will never die” (John 11:25-26). In the face of loss, we pray that God may help us “to live as those who are prepared to die, and when our days here are accomplished, enable us to die as those who go forth to live, so that living or dying, our life may be in you, and that nothing in life or in death will be able to separate us from your great love in Christ Jesus our Lord” (United Methodist Hymnal, A Service of Death and Resurrection, p. 871). All Christians therefore have a ministry of faithful care for persons suffering and dying. As we minister to others we minister to Christ (Matthew 25:34-40). We exercise that ministry when we care for those who are closest to us as well as to those who are strangers. We exercise that ministry in a number of important ways.
Preparation for Our Own Death and Resurrection
Our ministry to persons who are suffering and dying necessarily includes ourselves. Recognizing that death faces each of us, we are called to prepare for our own death and resurrection. That includes affirming and exercising our relationship with God in Christ. It includes reconciliation with others. It includes making wills—the legal preparation for others to take on the stewardship of the material goods which God has entrusted to us. It includes obtaining social and health insurance when it is available to us so that we minimize the burden we place on others. And it includes preparation for times of illness when we are not able to speak for ourselves. Living wills and instructions provide not only clarity and guidance to care providers and loved ones, but immeasurable relief from the burden of their decision making on our behalf in times of great stress.
Assisting Others Who Face Suffering and Dying
Care for others is the calling of the whole community of faith, not only pastors and chaplains. Because Christian faith is relevant to every aspect of life, no one should be expected to cope with life’s pain, suffering, and ultimate death without the help of God through other people. In care, God’s help and presence are revealed. When we as the church offer care, we empathize with suffering patients and share in the wounds of their lives. When we listen as patients express their feelings of guilt, fear, doubt, loneliness, hurt, and anger we offer them a connection with others and God. When we listen as patients tell their stories of both the extraordinary and the everyday, we help them to make connections between their experiences and God’s joy. We provide resources for reconciliation and wholeness and assist persons in reactivating broken or idle relationships with God and with others. We provide comfort by pointing to sources of strength, hope, and wholeness, especially Scriptures and prayer. Family and friends as well as those who are suffering and dying need care. Those who are grieving need the assurance that their feelings are normal human responses and need not cause embarrassment or guilt. Health-care workers—doctors and others who have intimate contact with dying persons—also need care.
Pastoral Care by Pastors and Chaplains
We exercise our ministry for persons suffering and dying as we support those in specialized ministries. Pastors and chaplains sustain the spiritual growth of patients, families, and health-care personnel. They bear witness to God’s grace with words of comfort and salvation. They provide nurture by reading the Scriptures with patients and loved ones, by Holy Communion, by the laying on of hands, and by prayers of praise, petition, repentance, reconciliation, and intercession. They provide comfort and grace with prayer or anointing after a death. They conduct rituals in connection with a terminal illness, of welcome into the care of hospice or a nursing center, or of return to a local congregation by persons who have been absent.
Pastoral caregivers not only offer comfort and counsel, but help patients understand their illness. They can assist families in understanding and coming to grips with information provided by medical personnel. Pastoral caregivers are especially needed when illness is terminal and patients and family members have difficulty discussing this reality freely.
As human interventions, medical technologies are only justified by the help that they can give. Their use requires responsible judgment about when life-sustaining treatments truly support the goals of life, and when they have reached their limits. There is no moral or religious obligation to use them when the burdens they impose outweigh the benefits they offer, or when the use of medical technology only extends the process of dying. Therefore, families should have the liberty to discontinue treatments when they cease to be of benefit to the dying person.
The World Health Organization has described palliative care as care that improves the quality of life of patients and their families through the prevention and relief of suffering. It provides relief from pain; it intends to neither hasten nor postpone death; it integrates the psychological and spiritual aspects of patient care. It provides support both to patient and family. It is applicable early in the course of illness, may accompany treatment, and while its intent is simply relief from distressing symptoms, it may positively influence the course of illness. Ministering to the needs of the suffering and dying includes affirming the need for palliative care, as well as the need for comfort, encouragement, and companionship. Those who are very ill and the dying especially express their needs as they confront fear and grief and loneliness.
When there is no reasonable hope that health will improve, and the rationale for treatment may diminish or cease, palliative care becomes the dominant ministry. Hospital care may be of no benefit and the family can be encouraged to take the loved one home so that the loved one can die surrounded by family and in familiar circumstances.
We exercise the ministry of faithful care as we support the rights of patients. As Christians, we have a duty to provide counsel, and patients have a right to receive it. Decisions can be complex and not easily made. We affirm that:
a. Patients deserve to be told the truth.
b. Patients are entitled to a share of decision-making both before and during their illness.
c. Patients have a right to refuse nourishment and medical care.
d. Decisions are best made within a family of faith.
The complexity of treatment options and requests by physicians for patient and family involvement in life-prolonging decisions require good communication. Pastoral caregivers can bring insights rooted in Christian convictions and Christian hope into the decision-making process. When advance directives for treatment, often called “living wills” or “durable powers of attorney,” are being interpreted, the pastoral caregivers can offer support and guidance to those involved in decision-making. They can facilitate discussion of treatment and palliative options, including home and hospice care. Decisions concerning faithful care for the suffering and the dying are always made in a social context that includes laws, policies, and practices of legislative bodies, public agencies and institutions, and the social consensus that supports them. The social and theological context of dying affects individual decisions concerning treatment and care and even the acceptance of death. Therefore, pastoral caregivers must be attentive to the social situations and policies that affect the care of the suffering and dying and must interpret these to patients and family members in the context of Christian affirmations of faithful care.
We exercise that ministry as we affirm both life and death. In providing counsel, we affirm the Christian tradition that has drawn a distinction between the cessation of treatment and the use of active measures by the patient or caregiver which aim to bring about death. Patients and those who act on their behalf have a right to cease nourishment and treatment when it is clear that God is calling the patient home. By contrast, however, we understand as a direct and intentional taking of life the use of active measures by the patient or caregiver that aim to bring about death. This United Methodist tradition opposes the taking of life as an offense against God’s sole dominion over life, and an abandonment of hope and humility before God. The absence of affordable, available comfort care can increase the pressure on families to consider unacceptable means to end the suffering of the dying.
The withholding or withdrawing of life-sustaining interventions should not be confused with abandoning the dying or ceasing to provide care. Even when staving off death seems futile or unreasonably burdensome to continue, we must continue to offer comfort care: effective pain relief, companionship, and support for the patient in the hard and sacred work of preparing for death.
Health Delivery Reform
We exercise our ministry as we advocate for the reform of structures and institutions. As Christians, we have a duty to advocate.
We advocate for patient rights, which are easily neglected, especially when patients cannot speak for themselves, and when families are overwhelmed by the stress and confusion of difficult news. This is a reason that preparation is so important.
The duty to care for the sick calls us to reform the structures and institutions by which health and spiritual care are delivered when they fail to provide the comprehensive physical, social, emotional, and spiritual care needed by those facing grave illness and death.
We advocate for health coverage for all globally. In the world today, many nations do not have universal health care and many millions of people have either no health insurance or grossly inadequate coverage, leaving them without reliable access to medical treatment. Even when basic access is provided, good quality comfort care—including effective pain relief, social and emotional support, and spiritual counsel—is often not available.
Absence of comfort care can leave people with a distorted choice between enduring unrelieved suffering and isolation, and choosing death. This choice undermines rather than enhances our humanity. We as a society must assure that patients’ desire not to be a financial burden does not tempt them to choose death rather than receiving the care and support that could enable them to live out their remaining time in comfort and peace.
We charge the General Board of Church and Society to advocate, identify, and address instances where proper care for the suffering and dying is unavailable due to scarcity of resources, unhealthy ideologies, and oppressive conditions.
Proclaiming the Good News
We exercise our ministry as we teach the Christian good news in the context of suffering and dying. We call upon the General Boards of Discipleship and Higher Education and Ministry to develop and promote resources and training for clergy and laity globally that:
Acknowledge dying as part of human existence, without romanticizing it. In dying, as in living, mercy and justice must shape our corporate response to human need and vulnerability.
Accept relief of suffering as a goal for care of dying persons rather than focusing primarily on prolonging life. Pain control and comfort-giving measures are essentials in our care of those who are suffering.
Train pastors and pastoral caregivers in the issues of bioethics as well as in the techniques of compassionate companionship with those who are suffering and dying.
Educate and equip Christians through preaching resources and adult education programs to consider treatments for the suffering and the dying in the context of Christian affirmations of God’s providence and hope.
Acknowledge, in our Christian witness and pastoral care, the diverse social, economic, political, cultural, religious and ethnic contexts around the world where United Methodists care for the dying.
We also call upon the General Board of Global Ministries to promote our understanding of Ministry to Persons Suffering and Dying in United Methodist health-care institutions around the globe.
AMENDED AND READOPTED 2016
RESOLUTION #3205, 2008, 2012 BOOK OF RESOLUTIONS
RESOLUTION #115, 2004 BOOK OF RESOLUTIONS
See Social Principles, ¶¶ 161M and 162V.
From The Book of Resolutions of The United Methodist Church, 2016. Copyright © 2016 by The United Methodist Publishing House. Used by permission.