Aspects of Spiritual Care at End of Life Situation


What dying people experience?


Spiritual pain: spiritual pain is often ignored and instead, physical components of pain are more focused. Much time is spent in finding the physical source of pain and identifying the disease. Important is to know the impact of disease on patients’ life, hope, and dreams. Ignorance of spiritual pain causes more suffering in dying patient. It cannot be treated with anti-depression or anti-anxiety. There is no medication for loneliness, fear, grief, and despair.

Every physical pain is associated with the spiritual pain. We cannot separate the physical pain from the spiritual pain, however, it can be a matter of the level of pain. It is then a duty of spiritual care provider to explore the sources, dimensions and the intensity of spiritual pain. A patient does not always tell his or her source of spiritual pain until empathetical relation with a patient has been developed and a spiritual care provider has learned the art of communication with the patient.

Death related fear and anxiety: Our society is a death-denying society. Many live in the denial of the reality of death. It may be because we search for the immortality. Some patients have a fear of the process of dying, but it is not the actual fear of death.  There may be a number of reasons for the death anxiety. Dying patients may think that their death could cause grief in relatives and friends. The feeling of permanent detachment from the family members and friends could be very painful for the dying patients. The fear of “not being” or becoming a nothingness is also very common at the end of life situation. It is important to transform fear of nothing to a fear of something. Fear of the punishment of the day of judgment results from the specific way of preaching, is also an important issue which can cause severe anxiety in dying patients.

A dying patient and the life after death: The issue of life after death becomes more important for the dying patients even if they have been denying the day of judgment throughout their life. It has been observed that patients in the palliative care take more interest in knowing more about the life after death. The issues such as mercy, grace, forgiveness and the blessing of God and an eternal peace need to be highlighted before the dying patients. Focusing on the punishment of God can be very poisonous and can cause serious spiritual discomfort in dying patients.

Their connection to the higher power such as God becomes vital. It is also important to facilitate the dying patients to be able to forgive themselves. To achieve this goal, they need to be honest with themselves and acknowledge the truth regarding their actions and attitude.

Dying patients and religious affiliation:  At the end of life situation, only a real faith and belief work for the dying patients. Ritualistic religiosity does not turn into real faith at the end of life situation and hence it does not necessarily provide comfort to a dying patient. It has also been observed that real faith and practical religiosity of some dying patients have placed a huge impact on the nursing staff and the family members and caused them to go through an unbelievable feeling of pride and amusement. True faith can be a great source of strength for them and can bring the highest level of peace and comfort to the dying patients. As a result, it has been seen that a dying patient becomes a source of support for his or her family members.

The importance of the preparation of death and the remembrance of death mentioned in the Islamic scriptures can help us in our advance spiritual care planning and prepare us to cope with the hardships of the end of life situation.

Dying patients and reflecting on the past: The dying patients often remember their past and reflect on their life history. They think about their accomplished or unaccomplished business. They think about their achievements and unsuccessful life experiences. They remember their relationships with others. If they focus more on the tragic, negative or sinful aspects of their life, they can experience feelings of guilt, anxiety, and depression. It is important for them to find meaning and purpose in their life history and focus on the positive aspects of their past life. A spiritual care practitioner can help them to examine their life positively.

Family and community support: Families and friends shoulder many burdens during the terminal illness. Their needs grow as their loved one’s illness progresses. Most of the dying patients cannot endure the hardships of their terminal illness alone. Unfortunately, the importance of support for the grieved person or a dying patient is less realized in the Islamic communities. We are more use to attend the lectures in the mosques and centers but avoid to help others in the real-life situation. Emotional support is a powerful tool to provide comfort to the terminally ill patients. However, support doesn’t mean to visit a patient only, rather it is important to learn how to provide the support effectively.

It is also vital to understand the real importance of support. The principle of support should not be seen in the light of the reward on the day of judgment only. It can entirely change the patients’ distressful condition and transcend him or her to the highest level of comfort. I have seen the patients expressing their sadness in the palliative care who deeply miss their friends and family members, but they don’t show up. I saw the difference between those who are getting their family and friends’ support and who are deprived of their family and friends’ support.

Family and community support can really enhance the quality of life and improve patient’s outcome. It is also important to note that grieved family may the patient make grieved. I have seen in some cases that families are causing more trouble and suffering for their patients because of their own desperate situation and inability to control their grief. Sometimes, dying patients need our presence only and want to share their untold stories. They want someone who could listen to them.

Dying patient often feels loneliness due to lack of family and community support. The loneliness of dying patients is more painful and intolerable. Loneliness can be described as a psychological experience related to social isolation and perceived lack of companionship which may directly or indirectly be a health risk. It is thus an emotional state in which a person experiences a powerful feeling of emptiness and isolation (Rokach & Brock 2007).