The pastoral challenge of people dying at home

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Revd Ian Ainsworth-Smith The pastoral challenge of people dying at home, presented at the Holy Living, Holy Dying conference held in Exeter on 2 November 2009

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The pastoral challenge of people dying at home

  1. 3. <ul><li>A celibate, like the fly in the heart of an apple, dwells in a perpetual sweetness, but sits alone, and is confined and dies in singularity. </li></ul><ul><li>God hath given to man a short time here upon earth, and yet upon this short time eternity depends. </li></ul>
  2. 4. <ul><li>Know that you are your greatest enemy, but also your greatest friend. </li></ul><ul><li>Love is friendship set on fire </li></ul><ul><li>The best theology is rather a divine life than a divine knowledge </li></ul>
  3. 5. <ul><li>“ Going Home” </li></ul><ul><li>Literal, Figurative </li></ul><ul><li>Or Both? </li></ul>
  4. 7. . Our findings show that the sustainability of keeping terminally ill patients at home depends on how close the families are and how able they are to care for their loved ones at home. The sharing of responsibilities between family members, besides taking the burden of care from one person's shoulders, also offers a source of mutual support for carers Gomez & Higginson BMJ 2006
  5. 8. <ul><li>The Patient to desire/opt for a death at home </li></ul><ul><li>The Caregiver(s) to desire/opt for a death at home </li></ul><ul><li>Good Clinician Support (especially GP/Nursing) </li></ul><ul><li>Good Social Support preferably 2 or more informal caregivers </li></ul><ul><li>Adequate Financial Resources </li></ul>
  6. 9. <ul><li>Clear Agreement between Patient and Caregiver(s) on the desirability of a Home Death </li></ul><ul><li>Presence of at least 2 caregivers </li></ul><ul><li>Knowledge of 24 hour on call Clinical Support </li></ul>
  7. 10. <ul><li>Pastoral Care tries not to pose </li></ul><ul><li>Moralistic Questions (“What have you done?”) </li></ul><ul><li>OR </li></ul><ul><li>Diagnostic Questions (“ What is wrong with you?”) </li></ul>
  8. 11. <ul><li>But poses the question </li></ul><ul><li>“ Where are You?” </li></ul>
  9. 12. <ul><li>Plan and Discuss! </li></ul><ul><li>But.......... </li></ul><ul><li>Circumstances can Change </li></ul>
  10. 13. <ul><li>“ Reservations Can Always Be Cancelled!” </li></ul>
  11. 14. <ul><li>Spiritual and related issues may emerge when:  </li></ul><ul><li>new symptoms appear </li></ul><ul><li>side-effects of treatment become distressing </li></ul><ul><li>patients and those close to them must adapt to changes in their lives which have emotional and social consequences </li></ul><ul><li>changes occur in relationships with key people . </li></ul><ul><li>  </li></ul><ul><li>  </li></ul><ul><li>  </li></ul>
  12. 15. <ul><li>Beliefs may be:- </li></ul><ul><li>  </li></ul><ul><li>religious </li></ul><ul><li>  </li></ul><ul><li>philosophical </li></ul><ul><li>  </li></ul><ul><li>broadly spiritual. </li></ul><ul><li>  </li></ul><ul><li>“ Holding past, present and future in some sort of scheme and continuity.” </li></ul><ul><li>  </li></ul>
  13. 16. <ul><li>Practicalities </li></ul><ul><li>Readjustments </li></ul>
  14. 17. <ul><li>Respect need to talk, (or not !) </li></ul><ul><li>Assume Nothing! </li></ul>

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