Assisted dying became legally available on 7 November 2021. Our lecturer in Pastoral Care and Counselling, Dr Phil Halstead, begins this series of articles to resource and support our churches at this time.
My heart sunk as I read Mike Crudge’s email in which he invited me to write a brief pastoral piece on the End of Life Choice Act 2019 that came into effect on November 7, 2021.1 I thought, “This is a controversial topic that I know little about. I could get into all kinds of hot water here.” “There are so many others who are better equipped than me to pen such an offering.” “How can I politely wriggle out of this conundrum?” And then, I struck gold: I wrote back to Mike and said, “I’d like to be able to help, but there could be a problem: I’ve never encountered this situation in my pastoral ministry.” I saw this as my get-out-of-jail-for-free-card. However, perhaps foolishly, I added, “I could, however, provide an outline of a pastoral process I would follow if I were to encounter an end-of-life scenario and were given time to think about it. Thus, rather than attempting to offer answers to the questions that arise, I could illustrate a method that anyone can work through to come up with their own responses.” Mike responded by saying he liked my idea and pointed out that since it’s a brand-new Act very few pastoral workers would approach this topic from a vantage point of experience. Touché.
So, how might I or any pastoral caregiver respond if two adult siblings were to make an appointment to talk through their terminally ill 89-year-old mother’s request for an assisted death? And what would I do if a 60-year-old man told me that after many years of fighting a losing battle with a chronic illness his life was no longer bearable and he wanted out?
I imagine after catching my breath, saying “I’m so sorry that you’re in this very difficult situation,” and quietly crying out to God for help and wisdom, I’d go to my default position: I’d listen to these people’s full stories. Rachel Remen says, “I suspect that the most basic and powerful way to connect to another person is to listen. Just listen. Perhaps the most important thing we can ever give each other is our attention. And especially if it’s given from the heart.”2 To listen is to care. We can’t always cure, but we can always care. No one expects us to have all the answers, but we can sit with the hurting and appease their loneliness a tad.
Somewhere in this process, I’d invite those directly involved with the end-of-life scenarios to work through Emmanuel Lartey’s five-phase pastoral cycle with me.3 There are many advantages of persons working collectively and thinking theologically, biblically, pastorally, and prayerfully about real issues.
Assuming people agree to explore the topic, we’d first need to try to park our preconceived ideas regarding assisted dying on a metaphorical bookshelf. For me this includes the question, “What would happen over time to the psychological health of the physicians who oversee or administer the final dose?” I’d also need to strive to ensure that my struggles with Parkinson’s don’t blur the lenses I’d be looking through on this journey. I wonder what you ought to park.
Lartey’s model begins with concrete experience. Optimally, we’d hear from those directly involved with the triggering situation, as well as from folks with first-hand experiences beyond the immediate circle. This wider group might include persons who have assisted someone to die, or individuals who have changed their minds about ending their lives, for example. The primary goal here is to listen to and live with people’s stories, so that our study is grounded in lived experience. The goal is not to advise, disagree, or convert. I’m guessing this exercise would begin to show us that there are many different facets to people’s end-of-life situations. We’d also be reminded that an experiential view of assisted dying is different from a conceptual view. Both perspectives are important, but they are not the same.
The second phase of Lartey’s model is a situational analysis. Here, we’d listen to the voices of others to gain a clearer understanding of people’s experiences with end-of-life questions. This “social perspective taking”4 might entail viewing movies like Million Dollar Baby5 and The Sea Inside.6 It would involve reading the End-of-Life Choice Act, and the Ministry of Health’s Assisted Dying Service.7 We might also read books like Jesse Bering’s A Very Human Ending8 and seek the counsel of lawyers and palliative care authorities. Ideally, we’d also survey the social, political, psychological, and economic factors that affect end-of-life decisions. Clearly this kind of “collective seeing” can’t happen overnight.9 If you’re time-poor, you may have to be very selective with who and what you listen to. If you’re time-rich, you can do much of this work before you encounter people grappling with end-of-life issues.
Undertaking a theological analysis comprises the third component of Lartey’s model. This is where faith perspectives respectfully engage with, and question, people’s experiences and the insights identified via the situational analysis. You may choose to divvy up amongst yourselves who will research what here, for plainly the pool of potential material to explore is endless. Examples include ethical issues such as the dignity of the individual, human freedom, and the sanctity of life,10 as well as theological and biblical takes on topics like compassion, the purpose of suffering, and life after death.
You might also wish to engage with some classic pastoral care definitions. Liston Mills contends that every genuine definition of pastoral care has at its core “a way of understanding our relatedness to God and the ingredients or acts which may serve to enhance or detract from that relatedness.”11 Consequently, you might ponder how you could help your care-seekers to connect with Jesus. Howard Clinebell defines pastoral care as “the broad, inclusive ministry of healing and growth within a congregation and its community, through the life cycle.”12 One of many questions that emerges here is whether the age of the individuals investigating assisted dying with you change anything? And William Clebsch and Charles Jaekle reason that “pastoral care consists of helping acts done by representative Christian persons, directed toward the healing, sustaining, guiding, and reconciling of troubled persons …”13 How might you connect these principles to the cluster of care-seekers you’re journeying with? Clearly, when you chat about your discoveries you could be in for a long night. I suggest you organise some strong coffee to be on hand.
In Lartey’s fourth stage, which he has entitled situational analysis of theology, one’s theology is subjected to the critique of all kinds of questions including those from the people and resources we’ve consulted in our research. Where possible, it would also be beneficial to open this part of the study up to a wider audience, so that their questions and perspectives could further refine our thinking. Who knows where this could lead?
Lartey’s fifth stage is the response phase. Here, “the group explores the response options that are available to [people] in the light of all the stages that have gone before.”14 I realise that the gravity of our context hits here. Where Lartey’s model at this juncture enables provisional decisions to be made, trialled, assessed, and revised, people in our context usually don’t have such space. Nonetheless, I trust that this offering motivates you to carve out some time to research thoroughly end-of-life (and other) matters of import. Of the multiple benefits that may stem from this kind of labour, one may well be to mitigate your fear of receiving indiscriminate e-mails from Mike.
Contributor: Dr Phil Halstead, Lecturer in Pastoral Care and Counselling, Carey Baptist College.
- Ministry of Health, “The End of Life Choice Act 2019,” Ministry of Health, www.health.govt.nz/our-work/life-stages/assisted-dying-service/end-life-choice-act-2019
- Rachel Naomi Remen, Kitchen Table Wisdom: Stories that Heal (Sydney: Pan Macmillian, 1996), 143.
- Emmanuel Y. Lartey, In Living Color: An Intercultural Approach to Pastoral Care and Counseling. 2nd ed. (London: Jessica Kingsley, 2003), 132.
- Lartey, In Living Color, 132.
- Clint Eastwood, Million Dollar Baby. DVD. Burbank, CA: Lakeshore Entertainment Malpaso Productions, 2004.
- Alejandro Amenábar, The Sea Inside. DVD. Warner Sogefilms (Spain), 2004.
- Ministry of Health, “Assisted dying Service,” Ministry of Health, www.health.govt.nz/our-work/life-stages/assisted-dying-service
- Jesse Bering, A Very Human Ending: How Suicide Haunts our Species (London: Doubleday, 2018).
- Lartey, In Living Color, 133.
- Jonathan Sachs identifies seven features of Jewish ethics. These are the first three. The remaining four are Guilt, not shame; loyalty and love; the ethics of covenant; and the dual covenant. Jonathan Sachs, Essays on Ethics: A Weekly Reading of the Jewish Bible (New Milford, CT: Maggid Books, 2016), xx-xxxi.
- Liston O. Mills, “Pastoral Care: History, Traditions, and Definitions”, in Dictionary of Pastoral Care and Counseling (ed. Rodney J. Hunter et al; Nashville: Abingdon Press, 2005), 837.
- Howard Clinebell, Basic Types of Pastoral Care and Counseling: Resources for the Ministry of Healing and Growth. Rev. and enl. ed. (Nashville: Abingdon Press, 1984), 26.
- William Clebsch, and Charles Jaekle, Pastoral Care in Historical Perspective (New York: Prentice Hall, 1964), 4.
- Lartey, In Living Color, 133.