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Questions of Death and Dying

Emotional and Spiritual Concerns at the End of Life

One of the most important people on the palliative care team isn't a doctor or a nurse. In fact, he or she doesn't have a medical degree at all. It's the chaplain.

The term "chaplain" might make you think of the Army, M*A*S*H* and Father Mulcahy, but chaplains aren't just for the military. They are typically ordained members of a particular faith -- Roman Catholic, Protestant, Jewish, Muslim, or another faith -- but on the palliative care team, they serve the spiritual needs of all patients and their families, no matter what religious beliefs they have (or don't have).

Because as someone nears the end of life, they and their loved ones usually have important emotional and spiritual questions and concerns -- and they need someone to hear them.

Helen Franssell serves as the chaplain for Capital Caring, which cares for more than 1,000 people living with advanced illness in the Washington, D.C. area. She says that there are a few shared emotional and spiritual concerns that many people have at the end of life.

Why is this happening to me, or to my loved one?

This is by far the most common question dying people and their families ask. And it's not really a question.

"This isn't an intellectual why, it's an emotional crying out," Franssell says. "It's shock, it's anger. It's not a question to answer in a theological or a medical sense. People don't want to talk about that, they want to express their grief, their shock, their sorrow. It's the role of the chaplain to allow the patient or the family member to give expression to that emotion."

What comes next?

At the end of life, people aren't usually looking for new answers to the age-old question of what happens after we die, Franssell says.

"Instead, people hearken back to what they have lived and what they have known in the past," she says. "It's my role as their chaplain to support that spiritual history. If I can't do that myself, then it's my job to go out into the community and find what they need."

I want to tell my story.

People who are dying, or those who are losing a loved one, often want to go over the story of their life -- and their illness.

"You need someone who will let you tell your story from the start," Franssell says. "Some people just need to go over the diagnosis, where they were when they heard it, what happened next, a certain number of times."

I have regrets.

If your loved one is dying, have you said everything that you need to say to him or her?

"Preparing for death is a time to write letters, sit down with people, and make peace and say what you've been wanting to say," Franssell says. "Even if your loved one is very near death and not conscious, they are often aware of what you're saying, even if you don't get words of response. So it's not too late to say, 'I'm sorry' and 'I love you.'"

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