Forum on Religion, Spirituality and Aging
FORSA - An ASA Constituent Group

’Til Death Do Us Part: Support at the End of Life for the Spiritual Needs of Older Couples

by Susan C. Mitchell

When an elder receives a terminal diagnosis, he or she may have been fighting a disease for many years and may feel defeated or exhausted. A spouse or partner may feel guilty about having been unable to save the dying person. Together, the couple may feel anger, sorrow, fear, resignation and relief.

Religious professionals can offer the couple assistance in managing the dying person’s symptoms, a compassionate listening presence, acceptance of the couple’s situation and beliefs, space and encouragement to grow, and assistance in arranging whatever rituals are important to them now and after death.

The dying process can bring anger at God and at religious institutions and the individuals representing them. Being angry with God is a sign that the patient and the spouse believed God would act differently in their lives; the terminal diagnosis may challenge their entire value system.

A Nonjudgemental Listener

Both members of the couple may need to tell their individual stories and their joint story to a nonjudgmental person who listens with an ear to the emotions behind the stories and who responds to those emotions. The couple needs to express their feelings to the Divine in whatever way they are able. If the couple are members of a worshipping community, religious professionals must remain aware of their own feelings of grief and loss and of their expectations about how a good believer should act.

Regardless of religious affiliation, individuals have a relationship to something greater than themselves. Even members of a couple who have expressed indifference or aversion to religion need the opportunity to explore their spirituality -- whether that is feeling a sense of awe toward nature, wondering over the origins of life, or working for justice and wanting to leave a legacy of social change. What gives life meaning is what will give death meaning.

Some people’s spirituality expands as they are dying, and they want to share this with others. Sometimes spouses have different beliefs and ways of expressing them, and need individual support. Both members of a couple need space and room to grow, even if they are going in different directions.

Traditional Rituals

At their most profound, rituals are concrete, physical actions that connect the human and the Divine.

The traditional rituals of a person’s stated faith can be important even if they have not been observed for years. Many people coping with a terminal illness go back to the church of their origin for rituals such as communion or anointing of the sick. They may look for meaning in the Scriptures or other spiritual writings. As a hospice chaplain, I sing familiar hymns with patients and their families and pray traditional prayers that even someone in the terminal stage of dementia can often recognize.

Some couples may need help in finding the support of a particular faith tradition that is in the minority in their present community. Specific cultural requests need to be both elicited and honored. Some couples like to plan the memorial service or funeral together. They may need help selecting readings and prayers for reflection. The memorial service itself can be a gift from the dying person to those left behind, giving great joy to all involved.

Caregivers for a dying person also need the support and acceptance of others in that role. They need to be able to express their feelings. This can be especially the case in nontraditional or newly established relationships that the dying person’s family doesn’t accept. The caregiver may need a respite from the physical, emotional and spiritual burdens of the dying process. Religious professionals may help the caregiver obtain help from friends and family members who can provide down time or services such as transportation, food or the completion of specific tasks.

A Troubled Relationship

The dying process can be even more difficult when the spouses have a troubled relationship and the caregiver is trying to make up for perceived past deficiencies. Such people may feel that they need to atone for past failings by doing all the caregiving themselves. They may feel guilt that they have not loved the dying person enough or anger at their spouses for dying and leaving them alone. Couples need the opportunity to forgive and to ask forgiveness, to say goodbye and express their love for each other.

In providing spiritual support to couples, we can be companions to a couple on their journey until death parts them. We can reassure them of God’s love for them. We can elicit their beliefs on what is to come and help them understand and express these beliefs. If they wish, we can be with them as they die and stay with the one left behind. We can reassure them that love is never wasted and never lost.

Susan C. Mitchell is an NACC board-certified chaplain at Casey House, an inpatient facility of Montgomery Hospice in Rockville, Md. Contact her at smitchell@montgomeryhospice.org. Visit the Montgomery Hospice website at www.montgomeryhospice.org.