Death exists as an unnatural act for all human beings to endure. Perhaps the foreign nature of death in the created order causes many of us to either ignore its existence or become infatuated with its mystique. Death was not originally a part of God’s created fabric, but rather God created a world where death could come into existence depending upon humanity’s obedience (Genesis 2:15–17). After Adam and Eve ate the forbidden fruit (Genesis 3:19), death was ushered into the world and remains a consequence we are still dealing with today. Yet, Jesus shows us the redemptive component associated with death in that his death and subsequent resurrection ushered in God’s gracious plan of salvation for all who repent and believe in him (Romans 6:10; Mark 1:15).
As pastors, we are keenly aware of the awkwardness associated with being with those in their final stages of death and the relief that comes when those same people have made a profession of faith. Nevertheless, being present when suffering and death are observable weighs us down with burdensome emotions. One place these feelings are most evident is when we are visiting people in intensive care units (ICU). How should pastors’ approach such a moment in their pastoral care ministry?
5 Tips for Pastoral Care in an ICU Unit
As a pastor and one who studies end-of-life ethics in the academy, here are five tips to guide you in this area of pastoral ministry:
Pray. A great habit to formulate for those conducting pastoral care is to pray before, during, and as you leave the intensive care unit. Typically, you could be walking into a situation that will be difficult to process. If the family is present, you may be asked questions that you probably feel inadequate to handle. Pray that the Lord would allow the Holy Spirit to illuminate Scripture in such a way as to give you the words to say. Perhaps the family or person in the room needs to hear words of encouragement, or the gospel, or the faithfulness of the Lord, or words of wisdom. We should be continuously praying for discernment as we approach these end-of-life scenarios. Prayer should be an essential component of any pastoral care situation, and sometimes when you don’t have the words to say, you just ask them if you can pray to the one with all the answers—the Lord Jesus Christ.
Abide by hospital protocol. Pastors should create solid relationships with medical personnel in their local community to ensure they are conforming to the policies and procedures of their local hospital’s intensive care unit. If you’re unsure about the hospital’s protocols, ask someone who works there or the medical professional that grants people entry into the intensive care unit. We should all remember that while we have important work to do for the Lord, we need to do this work under the authority of the hospital’s policies. Many hospital workers have caring hearts for people. Sometimes speaking to one of the caregivers before entering a room can help you get a better grasp of the situation before you approach the bedside or the family. Many medical professionals want to help their patients and will assist you if needed. Additionally, some intensive care units will have time limits, specific visiting hours, or a maximum capacity of people who can occupy the space. We need to be aware of these rules that are designed to protect the patients, and consider these rules as means to love our neighbors during their times of need (Matthew 22:37–40).
Silence is acceptable. We are pastors so we do an abundance of speaking. This means that sometimes we feel uncomfortable in silence. However, silence may be what is required in certain intensive care unit situations. At times, we could experience walking into a room and the words we thought to say may completely escape our minds when we experience the unnatural sight of physical death occurring. Family members could be weeping or processing, and you will see people in a vulnerable state. Beloved, don’t take for granted the power of your presence with all those in the room, even when you don’t know what to say. An older pastor once told me to just “minister the presence.” Your presence as a minister of the gospel is a reminder to those enduring this situation of Christ’s reconciling power through his life, death, and victorious resurrection over death (cf. 2 Corinthians 5:20). Do not feel compelled to speak but accept silence because you bring comfort just by being in the room.
Pastoral care requires us to display genuine empathy when caring for others in intensive care units.
Show appropriate affection. Some people in the room are your brothers and sisters in Christ. In other words, they are your family. Pastors should not be afraid to give a brother or sister in Christ a hug or put an arm on their shoulder or just lend a shoulder for someone to cry on during their time of grief. Even if they are not believers, don’t underestimate showing appropriate affection to them because they are processing this pain without a Christian worldview—i.e., without hope in Jesus Christ who gives life abundantly (John 10:10). Moreover, don’t forget about the human being lying in the bed. We should make it a practice to talk to that individual even if they are unconscious or hold their hand as we speak with them and as we pray for them. Showing appropriate affection could comfort those who are experiencing the effects of the Fall in an intensive care unit.
Display genuine empathy. Sometimes the awkwardness of the situation may cause us to speak words that are meant to sound compassionate but could be misconstrued as indifferent. Many of us will walk into situations that we have never had to deal with before in our own personal journeys of life. This means that we are unable to know how the family members or the person in the bed are truly feeling or coping with the dying process. In other words, we should be careful not to insinuate that we do know what they are experiencing. As one of my mentors reminded me, we should be honest with the inability to imagine what they are experiencing in these end-of-life moments. Therefore, when engaging with people in intensive care units, ask empathetic “how” questions like: How can we pray, serve, and help you or your family during this difficult time? Because we cannot fathom the various emotions you are experiencing right now. Pastoral care requires us to display genuine empathy when caring for others in intensive care units.
An Opportunity to Display Grace
Pastoral care in intensive care facilities can be one of the most difficult aspects of pastoral ministry. Death is an unnatural reality, but it is a reality that we need to be ready to deal with in ministry. These moments are burdensome, but they are an opportunity to display the grace, compassion, and mercy of Jesus Christ who died for our sins. These moments are opportunities where we get to share the only hope this fallen and broken world needs. That hope is that we have a Lord and Savior who saved us from our sin and gave us new life, but also a hope that one day King Jesus will return and make all things new (Revelation 21:1–4).
Come Lord Jesus, but until then, help all of us to minister the gospel faithfully when we enter an intensive care unit.
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