QUESTIONS CONCERNING PASTORAL VISITATION

OF THE DYING

JAY E. ADAMS

HEN he stands by his bedside to minister to one of his

W parishioners who appears to have but a few hours to live,
a pastorfinallyknows whether he has what it takes or not. What
does one say and do? I did not ask, what does he feel? Even
those who are most bold and most faithful find that their feel-
ings betray them from time to time. The question is: how
faithfully does he minister to such a person? And, behind that
one, what constitutes faithfulness?
First, the faithful pastor seeks to speak to the sick member
alone. Direct interference, tears, outbursts of weeping from
others, and the like, can be very distracting. It may be wise,
when necessary, to request the opportunity to visit alone.
Secondly, he never says that he knows that another is dying;
he does not know that. There are plenty of cases on record
where the former "dying" patient attended the pastor's funeral !
Yet, he deals with the sick member as if death were a distinct
possibility. It is. This means that he speaks directly about
death and eternal life. If he does so frequently anyway from
the pulpit and in ordinary pastoral conversations, it will not be
so difficult to do so here. He rehearses the gospel message in
simplicity and with clarity. He reminds the patient of the need
for a Savior that was brought about by sin. He rehearses the
wonderful message of the good news that God, out of pure grace,
sent his own Son to die in the place of guilty sinners, taking
the punishment that they deserved for their sins. He speaks
of the resurrection as God's stamp of approval upon the work of
his son on the cross, and the certain assurance that our frail
bodies shall be raised and together with our souls shall live
forever. He clearly outlines the means by which the elect enter
into the promises of eternal life: through simple faith in Christ.
Then, he may ask, "George, you are trusting in Jesus Christ
209
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as your Savior, aren't you?" or "Are you ready to meet

Christ if God should call you to do so?" When a true believer
triumphantly reaffirms his faith, the pastor comforts and re-
assures him of the great hope that is his by reference to any of
God's many marvelous promises to his children. Prominent at
such times are such passages as John 3:16, 3:36, 5:24, 14:1-8,
and Psalms 23 and 90.
If problems (doubts about salvation ; the need for confession
of some sin, etc.) arise, or if the sick person makes no profession
of salvation, the pastor must straightforwardly deal with the
issue (or issues) involved. He should warn of his danger,
present the gospel clearly, and call upon the unsaved patient to
believe in the Lord Jesus Christ.
In ministering to the dying believer, the pastor should keep
in mind the possible mixes of pain, fear, sorrow, worry, weak-
ness, helplessness, anger, and guilt that may be present. In
looking for the dominant strains of each of these (seen, for
instance, in bitter complaints, "Why did this have to happen
just when we moved into our new home?" or in anxious con-
cern: "What will happen to Mary and the little one?"), the
pastor will discover the concerns and needs that must be met.
A faithful shepherd, like the good Shepherd, will meet all of
the needs of the sheep: "The Lord is my Shepherd [therefore] ;
I shall not lack" (Psalm 23:1). It is his task to do so as fully
as he is able in the remaining time that God allots.
At times the faithful pastor must call to repentance and
forgiveness; on occasions he may promise to look into and
attempt to settle any matters that the dying believer is now
unable to handle for himself. He may need to point to the
relevant words of God in the Scriptures pertaining to his
problems or attitudes. But most of all — and uppermost in the
pastor's thinking — always must be the need for rehearsing
the simple, but wonderful story of the gospel of Jesus Christ.
The plan of salvation as executed by the Lord Jesus should be the
theme of any and all conversation with the dying, no matter
what other subjects also may be of importance.
Now, let us consider a current problem that many pastors
encounter only too late to do anything about it: the problem of
the use and misuse of modern medications. Frequently, by the
time that the pastor and/or family arrive at the hospital upon
 PASTORAL VISITATION OF THE DYING 211

learning of the impending death of a loved one, he has been so

doped up with medication that a sensible conversation of the
sort just described is nearly impossible. The true shepherd,
anxious to minister, is stymied. This problem often becomes a
source of great regret to all and should become a matter of real
concern to a pastor who cares. What should he think about this
and what may he do?
First, it is important for every person who has contracted
what is now coldly referred to as a "terminal illness" to know
that fact. The pastor can urge the physician and members of the
family to be honest and tell George from the beginning that he
has cancer. Lying about this can never be condoned. But never
can it be more destructive than under such circumstances.
Families that could spend last weeks (or months, or years)
making the most of their last earthly hours, drawn more
closely together, resolving tensions and differences, and planning
for the future, instead grow apart, become cold toward and
fearful of one another because of the great secret that is covered
by a thousand lies. Seeking to know and seeking to tell, the sick
and the well reach out to one another only to find that the other
has moved apart. Instead of drawing close, they are driven
asunder ; instead of understanding and discussion, the Great Lie
closes all significant communication. Instead of grieving to-
gether, the surviving partner must bear the grief alone —and
in a context of drifting apart amidst untold unresolved issues.1
This situation should not exist among the saints of God. The lie
is wrong; and it hurts. So, if his last hours are likely to be
spent in unintelligibility and insensitivity to those around him,
it is imperative to tell the "terminal" patient of his condition
in plenty of time for him to take care of all such matters. Fear
of injurious psychological impact must not deter. Yet that is
precisely where true ministry makes all of the difference. The
pastor who knows and believes I Corinthians 10:13, who
ministers in the spirit of I Corinthians 15:54-58, will do so
with the assurance that the resources of God are sufficient for
the believer in that hour. People who stress the hard effects of
iCf. "Grief as a Counseling Opportunity," The Big Umbrella (1972),
pp. 82-84 for further implications of this question. Pastors should consider
how impossible it is to function as members of a body (the church or
home) apart from truthful communication (cf. Ephesians 4:25).
212 WESTMINSTER THEOLOGICAL JOURNAL

learning the truth usually fail to recognize the bad effects of not
divulging it.2
Secondly, every man is entitled to know that he is likely to die
soon. Why should everyone else but the dying one know? Who
is the principal person involved in the illness? Christ took time
on the Mount of Transfiguration and in the Garden of Geth-
semane to prepare for his death. In these two places he dis-
cussed the coming death with others and with God. True, his
death had implications greater than all of the deaths of all of
the men of all time lumped together. Though in no way
approximating his, a weak, fearful sinner's own death is the most
formidable encounter of his life. If Jesus needed to prepare for
his death and to discuss it with God and with others, so too do
we.
Now also super-impose upon this discussion the patriarchial
scene of Genesis 49. The dying Jacob gathers his children
round about him and speaks to each about his future. Contrast
that with the most common modern mode of dying, in which the
father and husband disappears from the scene as a deceived,
doped, deluded, and despairing person — dying alone in a stupor
without a parting word on his lips for anyone. Everyone is
separated and alone; no one can reach through to touch or hold.
There is little to carry away but regrets, unresolved problems,
and a gnawing sense of guilt over the grand deception. Which
is more Christian?
Christian pastors must begin to instruct members of their
congregations to insist upon changes. Medical personnel often
have claimed rights and prerogatives at this point that do not
belong to them. Christian families must begin to stand up and
be counted concerning such matters as the insatiable prolonging
of life under vegetative and totally artificial conditions when
its maintenance is merely mechanical. They also must begin to
require physicians and hospitals to tell the truth to the patient.
They should insist upon the use of medication that will permit
the patient to function with mental clarity so long as he desires
in order to speak with God, his wife, family, minister, and
friends.3 Physicians must be told that pain is not the only evil,
2
Cf. Samuel Standard and Helmuth Nathan, Should the Patient Know
the Truth? (Springer Pub. Co.: N.Y., 1955), pp. 40, 42, 65, 72, 77f.
8
It is true that there may come a time when the words of Proverbs
31:6, 7 become pertinent. But Christ's rejection of such an anesthetic
 PASTORAL VISITATION OF THE DYING 213

and that it must not always become the principal target for
attack, taking precedence over all else. Moreover, medication
exists today that, in most cases, will relieve a patient of pain
without surrendering consciousness.
The pastor also must consider what to do when faced with
choices between family, medical, and scriptural viewpoints.
Picture a (not unusual) situation in which a husband has
cancer which has been declared "terminal," the likelihood being
that he will not live another six months. The physicians have
told the family, but together they have decided to deceive the
sick man. "Your problem is curable," they have informed him,
"but conditions may become worse before they get any better."
Joe, the patient, is a believing member of your congregation.
The family tells you about his condition and what they have
done about it. They assume that you will go along. What will
you do?4 As a faithful minister of the gospel, you must do
something like the following:
1. Tell them that this lie is a sin against God, against Joe,
against his wife and family, and against the church (which is
hampered thereby in exercising its proper ministry toward him).
An attempt should be made to persuade them to tell the truth
(many of the reasons mentioned above might be cited — the
benefits of the last weeks' planning and growing together, the
ability to grieve with one another rather than in the bitterness
of isolation, his right to know and his need to prepare himself,
his affairs, and his family — but none of these should take
precedence over the fact that to lie to Joe is a sin, perhaps the
greatest deceit that ever could be committed against another
human being). The pastor may even offer to be the one to
break the news to Joe (Joe may already know or strongly
suspect — as in so many cases). To do so takes boldness to be
lovingly frank. The pastor who does so must ask God for
tender courage. But to do so is also to have the privilege of

potion (Mark 15:23) in order to retain full consciousness and sensibility

during his unique and incomparable task shows clearly the secondary
rather than primal concern over pain.
4
Of course, it is better to prevent this problem whenever possible by
speaking about the matter beforehand from the pulpit, in Sunday School,
in couples' club meetings, etc. Members of a conservative church should
(themselves) demand of physicians and the family that they be told the
truth should they become incurably ill.
214 WESTMINSTER THEOLOGICAL JOURNAL

helping Joe to handle the problem as a Christian. It means to

help him to sort out his relationship and responsibilities to God,
5
to his family, to his church, etc. A pastor must not think of
pulling the stopper on the truth, only to walk away unconcerned
about the results. There may be a period of heartache and
sorrow atfirst.There may be bitterness and resentment to work
through, but the faithful shepherd remains at hand guiding,
bringing to reconciliation, helping to plan, and (in general)
assisting him in every way that he can.
2. But what must be done when the family refuses? Espe­
cially, how does one face the argument, "But the physician
said that we should not tell him, and (after all) Joe is under
his care." First, the pastor should note that the decision, though
it may have medical implications, is not fundamentally a medical
one. The physician has no special expertise, knowledge, or
authority in the matter. His viewpoint, therefore, always will
be personal, not professional.
When all persuasion fails, the pastor must make clear to the
members of the family that the impasse must be broken. The
matter cannot be avoided. He may need to turn to Hebrews
13:17: "Obey your leaders, and submit to them; for they keep
watch over your souls, as those who must give an account/'
In direct application of the passage, the pastor may state, "Long
before the physician took Joe under his care, Joe asked us in
Christ's name to take him under our care, which is a perpetual
and more basic one. It is a care in which we have obligated
ourselves to 'watch over his life' and for which we must 'give
an account' to God."6

δ
Every minister should be ready and able to give help and direction
to dying members (or others) who seek advice on willing a portion of
their estate to the church, theological seminaries, or other Christian
organizations. Such information often can be obtained readily from
officers of the organization itself. Mr. Robert den Dulk, of Westminster
Theological Seminary, who is an expert in such matters, has expressed
his willingness to give help to pastors who would like to learn how best
to handle the many problems connected with this matter. He may be con­
tacted at the seminary: Westminster Theological Seminary, Chestnut
Hill, Philadelphia, Pennsylvania, 19118.
6
The general question should have been discussed and settled with
the other elders in the church long before this particular instance arose.
Their commitment to back up the pastor in such situations at times could
 PASTORAL VISITATION OF THE DYING 215

If the members of the family are Christians, who themselves

are under the same care, the first part of the verse also may
be stressed ("Obey them that have the rule over you"). If
ever there were a good example of the kind of situation in
which a clash of views were to be resolved by the authority of
the church of Christ mentioned in this verse, then this is it.
In either case, their refusal to divulge the truth must be coun-
tered by (1) a similar refusal to join in the lie, (2) a willingness
to wait prayerfully and patiently for a time while the family
is urged to discuss and pray about the matter, but (3) in the
event that there is an ultimate refusal by the family to do so,
a warning that the pastor himself will be under obligation to
tell Joe.
In short, the pastor in caring for the dying must never
merely float with the current, being told what to do and what
to say. Instead, he must introduce the biblical message of
redemption where it is lacking, stress the importance of solving
any unresolved problems, and straightforwardly insist upon a
ministry that confronts rather than by-passes the hard issues
to the honor of Christ and for the welfare of the flock.

be vital. Their failure to do so could be devastating. Such issues will be

handled best when a pastor has taken the time to instruct, cultivate, and
work with his board of elders.
 ^ s
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