Experts give advice to the terminally ill, their care givers and bereaved at workshop organised by the Singapore Pastoral Institute and Catholic Nurses Guild.
"IT IS ALWAYS better to tell the patient the truth (that he is dying)," said Dr Rilly Ray, "as it allows the patient to have a more peaceful death, contrary to what well-meaning family members may think."
Dr Ray, a pioneer with the Home Nursing Foundation, was one of four speakers at the Pastoral Care for the Terminally Ill and Bereaved workshop. She was speaking at the session on preparing the family and terminally ill person for inevitable death. The two-day workshop was held at the Catholic Archdiocesan Education Centre on Nov 12 and 13.
She stressed the importance of facing up to the reality of the approaching death, rather than avoiding the issue.
Family members often think that if a person knows that he is dying, he may give up on life. However, knowing the truth relieves the emotional and psychological pain which doctors cannot treat. It is a pain in which only the truth helps, she said.
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On palliative care
Total care of the human person concerns not only the relief of physical pain, but also that of emotional and psychological, social, and spiritual pain, Dr Ray said.
Total care of a person and his family is called palliative care, which requires a multi-care team at a time when the patient's disease is no longer responding to curative treatment and life expectancy is relatively short.
The goal of such palliative care is to provide support and care to patients in the last phases of the disease so that they can live as fully and comfortably as possible.
Such palliative care is provided by hospices in Singapore, such as the Assisi Home and Hospice, Dover Park Hospice and St. Joseph's Home.
"A hospice is not a place that you go to die," clarified Dr Ray, explaining that a hospice assists patients in completing life's unfinished business.
Some important matters that should be settled before death are:
- The will
- Repair relationships that went sour
- Meet with loved ones and say all that we want to say
- Settle any personal matters e.g. loans
- Visit places e.g. Lourdes, or other pilgrimage sites
- Funeral service preferences
- Treatment of ashes after cremation
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On steps to take after death
When a patient dies at home, a doctor should be asked to make a house call to confirm the death as soon as possible. It should be a doctor who has been treating the patient prior to his death.
On receiving the death certificate, a family member should check that the data on it matches the data on the deceased's NRIC. He should make at least 10 copies and not give the original to anyone.
The undertaker should be contacted. He will arrange to embalm the body, book the crematorium and help with the funeral.
Other decisions to be made include:
- The choice of having the wake at a funeral parlour or at home;
- The choice of prayers to be said;
- Arrangements for food and drinks for visitors to the wake.
Most undertakers will help to coordinate such arrangements.
No amount of preparation will remove the initial shock of the death of the family member. There should be at least one family member or family friend who can help take charge and to make decisions on behalf of the family.
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On spiritual care
Left, Sister Una Boland explains that although the mind and the body are often well taken care of, the spiritual side of a grieving person is usually neglected.
For those nearing the end of life, there is commonly an increased and renewed need for answers to questions such as:
- Why am I suffering? (the meaning of life)
- What's the use of possessions, money, position in society? (value system)
- Where is God now? (quest for God)
- Why didn't I do that? (guilt feelings)
- What happens to me after death? (fears)
As such, spiritual care becomes of paramount importance.
Sister Una Boland, from the order of the Little Company of Mary, conducts a course with Sister Chad McCollum at Mount Alvernia Hospital. During the workshop, she gave a talk on understanding bereavement.
"The â€˜why?' question is always a spiritual question," she said gently, explaining that although the mind and the body are often well taken care of, the spiritual side of a grieving person is usually neglected.
"Whatever problems you have about death, sort it out today," she said, "because that is how you will deal with death throughout your life."
She stressed the importance of preparing the bereaved before the death of a loved one, for "the more we do before the death, the less we have to do after the death during the grieving process."
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Left, Wendy Louis, Director of the Singapore Pastoral Institute attempted to provide the participants of the workshop with several possible reasons why it is now diocesan policy not to have Mass celebrated during wakes.
On liturgical practices at wakes and funerals
Following a recent ruling by Archbishop Nicholas Chia, it is now diocesan policy not to have Mass celebrated during wakes.
Although no official explanation was given, Wendy Louis, Director of the Singapore Pastoral Institute, attempted to provide the participants of the workshop with several possible reasons.
- People of different faiths gather at wakes, so the exclusively Catholic Mass is not the best liturgical practice at wakes.
- Comparisons are made when certain priests celebrate Mass at wakes and others do not. To maintain consistency, it is necessary to lay down a policy for all priests in the diocese to follow.
- The funeral Mass is already a Mass for the deceased.
In place of a Eucharistic celebration during wakes, the church provides funeral liturgies or paraliturgies.
A paraliturgy is a format of praying that does not require a priest. It is a form of prayer for the deceased that does not require its participants to be Catholics in order to be a part of the ritual, unlike the celebration of the Eucharist.
The format of a paraliturgy for the deceased normally takes the following form:
- Opening prayer
- First reading
- Gospel reading
- Shared reflections on the deceased
- Prayers of the faithful
- Concluding prayer
An alternative would be to use the Evening Prayer for the Dead (or the Office of the Dead), which is found in any missal at any parish.
Preparation of a funeral booklet is another area that the family of the deceased needs to look into. The family has to be aware of the liturgical options such as the choice of readings and hymns, especially if the deceased had made known certain preferences before his death.
Catholics are reminded to remember the many people of different faiths present at funeral Masses. Simple hymns that can be sung by all are recommended. The order of the funeral service and a very brief biography of the deceased should also be put into the booklet.
Finally, the family needs to be aware of the multilingual people who attend the funeral Mass, and to include translations, if possible, in the booklet, so that all may follow the celebration.
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Right, Susanne Richmond, Principal Therapist of Family Life Society saya accepting the loss and feeling the pain are both very necessary for the grieving process.
Grieving is a process of adjusting to the loss of something or someone valued, and is universally recognised across all cultures, said Susanne Richmond, Principal Therapist of Family Life Society.
Accepting the loss and feeling the pain are both very necessary for the grieving process, Mrs Richmond advised. She encouraged the bereaved to talk about the pain to "get in touch with their feelings", rather than to keep busy which distracts them from the grieving.
"The grieving process takes as long as it takes," she explained, urging the bereaved to take one day at a time.
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On helping the bereaved
The first encounter is usually the hardest.
Say "I'm sorry" or "I don't know what to say", or remain silent.
Avoid clichÃ©s such as "I understand how you feel", "It was God's will", "It was meant to be" or "God will never give you more than you can handle", as these minimises the feelings that the bereaved have.
Friends of the bereaved are encouraged to hold their hand, or if they are close enough, to give them a hug.
The real support that the bereaved requires often takes place after the funeral is over. If you are close to the bereaved, offer to help in basic housekeeping such as doing the laundry, or looking after the children.
Be sure to ask for permission from the family before removing anything that belonged to the deceased.
Be someone that the bereaved can talk to about their feelings. Most of the time, they need someone to confirm that it is alright to feel the way that they are feeling. Then they can grieve better. The more a person can speak about, and even laugh about, their loss, the more they can heal.