Palliative care I Fear

Pastoral care

Among all forms of fear, the fear of death and dying is exemplary: it is the experience of facing something unknown, something foreign, and feeling overwhelmed by it. Death is outside our experience and no one can know for certain where we go when we lose all the support that we can still find in being connected with our body, even in pain.

Whoever stands at the side of someone in such a situation and would like to give assistance, is already a help by the mere fact of his presence. To be left alone is one of the main fears.

Further help can be given by acknowledging the fact of approaching death. Everything that becomes a fact holds security, even if its coming is unwelcome. Those who affirm their own condition usually find the ground under their feet again. It is the opposite of doubt and far more effective than withholding the truth from someone or giving them false hope. By speaking such a truth, the pastor easily touches a deeper layer in the dying person, which the person already suspects or knows exists and now perhaps finds a whole new security in.

It also becomes clear that a large part of those feelings about the future, based on imaginings, often dissolve in the moment that was feared so much. One can draw attention to the fact that no one can predict whether there will be any cause for fear in dying. Often the opposite is the case, due to the loving accompaniment of such events.

Also helpful would be if it is possible to strengthen courage and trust in surrendering to the dying process. This expands the soul into its surroundings, while fear cramps everything and constricts the soul. The biblical word for this is “Amen”—let what is right happen. Of course, every kind of faith helps to achieve this; in Christianity this comes through frequent reference to living on after death.

If the conditions of consciousness allow it, it would be important in preparatory conversations with the patient to search together for a meaning which his dying will have, even if this seems hidden at first. This creates peace. Any kind of meaning can become an instrument of peace, an effective remedy against fear.

I like to give a dying person who is still conscious three questions to think about, to answer to himself:

Who was most important to me?
What was the most important event in my life?
What did I not manage to do?

Sometimes it is even possible to find solutions to the last question and help rectify it. This is a very strong fear dissipater, especially in the area of forgiveness.