Medicine and Religion at the end of life.

There are no guidebooks about getting old. Each of us experiences aging differently and we each deal with these changes in our own way. When we are younger, we have a very general sense—perhaps a distant idea—about aging.  But generally, our ideas don’t get more refined until we actually experience changes associated with aging.  These changes slowly make us aware about our eventual death.

Most of us have come across statistics about death, but these facts get blurred.  It is uncomfortable to think about death.  But while growing old may be a privilege, death is a certainty.

The British geriatrician Arthur Norman Exton-Smith—in a classic study—found that nearly half of his dying elderly patients were delirious at the time of death.  Despite the availability of hospice care both at home and hospital which often provides palliative care that deals with the pain rather than the disease—most people either do not utilize this service or use it too late. As a result, widespread distress about death remains common.

A study in 1997 by Joanne Lynn and her colleagues at George Washington University interviewed family members of older adults who died in hospitals. The authors reported that four in ten patients had severe pain most of the time. Overall, one in ten patients had a final resuscitation attempt. One fourth of patients were put under a ventilator, and a feeding tube was used in four tenths of patients. Under these circumstances death becomes a medical and technological failure.

With this overwhelming failure, some look to religion for answers. It is not by chance that all religions deal with death.  Most have fairly elaborate rituals that formalize how the dying person—and their loved ones—deal with life’s end-game.

Despite its historical role in filling this vacuum, some religions today seem to be diluting these important rituals. How prepared are faith leaders to deal with their constituents’ end-of-life issues? A number of Master theses within the Department of Gerontology and Religious Studies at SDSU have attempted to answer this question, resulting in some surprising answers.

The studies found that despite growing numbers of older constituents, most faith leaders are ill-equipped to deal with such issues. Religious leaders often receive little formal training in dealing with end-of-life issues; devote very little time to dying congregational members; and most surprisingly, are not comfortable talking about death.

Both religion and medicine are coming together to address the needs of people at the end-of-life. The evolving methods to deal with death is a central mission of hospice care—started in the 1950s by Dame Cicely Saunders, an Oxford graduate. Modern day hospice has evolved to include the spiritual as well as the palliative. In addition to providing spiritual and palliative care to the patient, one of the evolving roles is to provide spiritual counseling, respite and education for grieving loved ones. Sometimes continuing this support to the family even after the patient has died. Dealing with death requires help, support and some guidance to understanding its finality.