Photo by Markus Spiske on Unsplash

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​Interfaith Hospice Care
In the Compassionate Community 
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In appreciation of  Dame Cicely Mary Saunders 
​founder of the hospice movement.
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​Interfaith hospice care serves people who are religiously affiliated and people who are “spiritual but not religious.”  Some who are served believe in God, some do not, and many are somewhere in between.  All can live well at the end of life.  All have a spark of wellness in their souls.  Interfaith hospice workers try to kindle this spark by applying practical skills, by listening, and by sharing their talents in life-enhancing ways.  In our time these workers need to know something about the world’s religions. They need to be religiously literate.  But they also need to know about the spiritual side of life, to be spiritually literate. Accordingly it helps to know about the many spiritual moods and attitudes that reveal the spark and are building blocks of wellness: attention, compassion, devotion, faith, forgiveness, gratitude, hope, hospitality, imagination, joy, kindness, listening, love, meaning-making, nurturing, peace, play, questing, reverence, silence, and transformation.  They need to recognize and honor these moods, helping people at the end of life claim them as their own.  In doing this the interfaith hospice worker does the great work.  He or she helps people make the transition to the next phase, whatever it is, and, along the way, find joy in the process.  The work adds as much to the hospice worker as to the person being served.  The work itself is a holy communion.

-- Jay McDaniel

Cicely Saunders:
Founder of the Hospice Movement
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Dame Cicely Mary Saunders, Founder of the Hospice Movement

​“Sanders developed a program for care of the dying based on three key principles: pain control, family and community involvement, and engagement with the dying person’s spiritual needs…While the first two of Saunders’ principles have been well-studied, the third, engagement with the dying person’s most deeply rooted spirituality, has been largely ignored in recent years.”   

-- Spirituality in Palliative Hospice Care, State University of New York Press, 2013

Biography of Cicely Saunders

The Need to Move Beyond
Christian-Based Hospice Care
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First Chapter of book PDF

​Explores the end-of-life spiritual needs of people who do not identify with traditional religions.

"This groundbreaking book addresses the spiritual aspect of hospice care for those who do not fit easily within traditional religious beliefs and categories. A companion volume to Religious Understandings of a Good Death in Hospice Palliative Care, this work also advocates for renewed attention to the spiritual, the often overlooked element of hospice care. Drawing on data from clinical case studies, new sociological research, and the perspectives of agnostics, atheists, those who emphasize the spiritual rather than institutional dimensions of a traditional religion, and the rapidly growing cohort of those who describe themselves as spiritual-but-not-religious, the contributors to this volume interpret the shift from predominantly Christian-based pastoral services to a new approach to “the spiritual” shaped by the increasing diversity of Western societies and new understandings of the nature of secular society. How do we use it in a way that enables caregivers to assist patients? Clinicians and policy makers will appreciate the book’s practical recommendations regarding staff roles, training, and resource allocation. General readers will be moved by the persuasive call for greater religious and spiritual literacy at every level of health care in order to respond to the full spectrum of human needs in life and in death."

-- From SUNY Press, August 2013

​Books for the Interfaith Hospice Worker

Process Theology for the
Interfaith Hospice Worker

five ideas worth considering
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by Jay McDaniel

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“Sanders developed a program for care of the dying based on three key principles: pain control, family and community involvement, and engagement with the dying person’s spiritual needs…While the first two of Saunders’ principles have been well-studied, the third, engagement with the dying person’s most deeply rooted spirituality, has been largely ignored in recent years.”   So write the authors Spirituality in Palliative Hospice Care (Bramadat, Coward, & Stajduhar, 2013). 

They recognize that, for increasing numbers of people, spiritual needs of those who are dying are not identical with their religious affiliation or lack thereof.   Some people in the end of life are atheists, some are agnostic, some are religiously affiliated but only in a nominal way, and many are spiritually interested but not religiously affiliated, or spiritual but not religious.  Doctors, nurses, administrators, social workers, psychologists, chaplains, and volunteers need to know how to deal with the “spiritual but not religious” even as they deal with the religiously affiliated.  On this open and relational (process) theology can help with five key ideas:

Spirituality is the act of being awake, aware, and well (even at the end of life)

First, it offers a way of distinguishing the spiritual side of a person’s life from questions of theology and religious affiliation.  The spiritual side of life is that aspect of a person’s mind and heart which seeks to be awake, aware, and alive in any and every stage of life, whatever the conditions, including the process of dying.  David Steindl-Rast: “Sometimes people get the mistaken notion that spirituality is a separate department of life, the penthouse of our existence.  But rightly understood, it is a vital awareness that pervades all realms of our being.  Someone will say, “I come alive when I listen to music,” or “I come to lie when I garden, or “I come alive when I play golf.”   Wherever we come alive, that is the area in which we are spiritual.  And then we can say: “I know at least how one is spiritual in that area.” To be vital, awake, aware, in all areas of our lives is the task that is never accomplished, but it remains the goal."  However and importantly, spiritual aliveness need not be conscious or self-conscious in order to be significant in a person's life. Much if not most of our "spirituality" is pre-reflective and pre-verbal.  We human beings are much more than our conscious experience, important as that is. A person who is dying has a spiritual side even as she may be consciously unaware of it.  It is as important to be sensitive to what is implicit but unsaid: the desire to be satisfied in the moment at hand.

Total pain is an obstacle to spirituality.
Palliative care can be an important part of hospice care.

Second, palliative care and hospice care can work together.  Dame Cicely Saunders defined total pain as the suffering that encompasses all of a person's physical, psychological, social, spiritual and practical struggles.  Palliative care, including the use of medicine, can reduce pain and help a dying person claim the spiritual side of her life.  The reduction of suffering and pain is a doorway into whatever forms of spiritual aliveness are available to a person. 

Interfaith hospice workers need to understand the many moods of spirituality.
They should know the spiritual alphabet.

Third, open and relational theology recognizes that each person’s life is itself a process of becoming, that this process unfolds over time, and that healthy living – indeed healthy spirituality – will look different at different moment’s in a person’s life.  At a certain age “spirituality” or full aliveness may take the form of enthusiasm for life, whereas while dying it may take the form of “gratitude” for having been alive and the enjoyment of “connectedness” with friends and family.  Frederic and Mary Ann Brussat have created a “spiritual alphabet” which includes one mood, emotion, or ability per letter in the alphabet, and in some instances two: attention, beauty, being present, compassion, connection, devotion, enthusiasm, faith, forgiveness, grace, gratitude, hope, hospitality, imagination, joy, justice, kindness, listening, love, meaning, nurturing, openness, peace, play, questing, reverence, shadow, silence, teachers, transformation, unity, vision, wonder, the X-factor (otherwise called mystery, yearning, you, and zeal. The hospice worker can and should be sensitive to these various moods.

All persons have a spark of inner wellness, a side of their lives that seeks to be well.
There is a spirit of creative transformation at work in the world at work in this inner spark.

Fourth, open and relational (process) theology proposes that there is indeed a spirit of healing, wholeness, and creative transformation at work in a person’s life as he or she is dying, whether recognized or not by that person.  This living spirit is God’s breathing.  It is not all-powerful, it does not cause the dying; but it is real and ever-present.  Moreover, it is omni-adaptive, in that it adjusts to each new circumstance in a person’s life through the provision of what process thinkers call “initial aims” or fresh possibilities for responding to existing circumstances in satisfying ways.  These initial aims are possibilities for being alive in the circumstances at hand.  The calling of the hospice worker is to be a vessel for this possibility, to help us discern the best for the situation at hand.  She does so through palliative care

Hospice care is itself a spiritual practice: the practice of compassion and connectedness.
It begins and sustains itself through listening: feeling the feelings of others.

Fifth, open and relational (process) theology proposes that we humans can feel the feelings of others in direct ways and empathically imagine ourselves inside the lives of others.  We are already connected to one another in unconscious ways; active listening can help us become aware of these connections.   In moments when we are truly present to those at the end of life, we are embodying a form of spirituality essential to the well-being of life.  Hospice care is a spiritual practice. These are but four of many ways in which open and relational (process) theology can assist hospice are.  The points made above are four ideas that can empower interfaith hospice care, when complemented by spiritual literacy of the sort developed by Frederic and Mary Ann Brussat and a wide range of practices developed by hospice care workers over the past six decades.