The challenge of caring vs. curing
Convo keynoters explore sensitive faith/health issues

Paul Engstrom

Physicians have a hard time seeing a distinction between their role as healers and a "palliative" role, providing care and comfort to ill patients approaching the end of their lives. "Doctors have a natural tendency to focus on the curative role because that is how they have been trained," oncologist Paul Engstrom told a seminary spring convocation audience of alums April 9. "They value cure over care."

Engstrom called upon clergy to do what they could do contribute to a growing need "to improve end of life decision-making," a process avoided by patients, families and doctors alike. "Detailed discussions and decision-making on issues such as whether to resuscitate" a dying patient are uncommon, said Engstrom, who is a senior vice president at the Fox Chase Cancer Center in Philadelphia and a member of Christ Lutheran Church, Oreland, PA. In addition, Engstrom cited a survey in which 73 percent of clergy said they had received no training in a health-related program. (The seminary assigns clinical pastoral education field work to Lutheran candidates for the ordained ministry in its program.) He specifically urged clergy to seek cancer-care training, contending it would help them relate to ailing parishioners and their physicians.

Story-telling colleague John Shea of Chicago, a consultant on faith-based health care, told the audience to "hold their world of expectations lightly" when they enter a role as caregiver to a dying loved one. He described the caregiver journey. "Your weakest resource will get tested." For example, if a caregiver dislikes conflict, the loved one will inquire, sometimes not so gently, "Why are you doing this for me?" Answering may prove to be a test. Caregivers may get caught in the role of sick vs. well person, and the caregiver may find that along the journey that he or she learns to "meet the person" being cared for, rather than the disease. "Isn't it remarkable," he said at one point, "how people won't take our good advice?" What happens for many caregivers is a journey of purification. "The ego gets stripped away during the journey and both of you walk each other home."

During a workshop earlier in the day, Engstrom walked his audience through the various complementary treatment routes that cancer patients try out in addition to more conventional cancer therapy. He defined the role churches can play in supporting cancer patients.

"They can help people negotiate the health care system," Engstrom said. "That goes beyond transporting people from place to place. Churches can help people determine where to go for treatment and support, what practitioners to see, and they can provide education about preventing diseases."

Another key role is to provide badly needed support to health care practitioners, nurses and doctors by ministering to their spiritual needs. "Be open to discussing issues such as how to approach the matter of death," he said. Engstrom noted that Fox Chase has a strong mutual support network between health care colleagues, but many doctors and nurses elsewhere don't have a similarly strong professional support network. "It helps to talk with us about issues surrounding whether to resuscitate a dying person. It's good to deal with questions such as, what do our religious beliefs say about how aggressive we should be in keeping someone alive?" Engstrom said there are sometimes religious reasons for rejecting recommendations made by a physician.

He noted that both spiritual leaders and doctors are often placed in the position by dying persons and families "of trying to answer unanswerable questions." And it is going beyond a doctor's role to impose one's religious beliefs on a patient. A doctor can fall into the trap of providing a patient premature reassurance about care or a cure, or resort to giving patients and families "simple answers" to unanswerable questions. Thus it may be helpful for physicians and pastors to team together when exploring how best to empathize with patients who are also parishioners. Patients sometimes need help to understand the value of such a team approach. Part of the value of such a wholistic approach may be to arrive at thoughtful end of life decisions. "And don't overlook how much a physician will often value being the recipient of spiritual care too in the process," Engstrom concluded.

At another workshop, keynoter Shea focused on the topic "spiritual journeys of sickness." He noted that during a serious illness people may be "catapulted into a spiritual journey" in which the mind becomes the "gateway to the spirit." Some people make that journey alone and some may need someone out ahead of them to present an option they haven't seen. Faith seeks the integration of the mind, body and soul to achieve deeper levels of perception and awareness, he said. The journey can cause individuals who are seriously ill to notice parts of their selves they have ignored before. Such a spiritual journey can lead them to a kind of "inner purification," he said.