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by Clare Seligmann
In the 20th century, medicine and improved public health measures in Australia were very successful in increasing life expectancy. However, this has changed the pattern of ageing and the pattern of dying.
Increased longevity has created a new population of people burdened with complex and chronic disease and ‘advanced frailty’. For this population, the traditional models of care, focusing on curative and life-prolonging treatments, without having concurrent goals of enhancing the quality of life for patients and their families, can contribute to unnecessary and prolonged suffering at the end of life, according to the Australian & New Zealand Society of Palliative Medicine.
Many people find it hard to face the dependency, helplessness and discomfort that often accompanies ageing, chronic disease and impending death. They need increased support from family, carers, health practitioners and chaplains – and they need to be respected, cared for and loved as people created and loved by God.
The LCANZ, through aged care and other pastoral care ministries, has opportunities to serve people at the end of life in physical and psychological caring; and providing spiritual care to assist with a ‘good death’ for those in our care. That’s the ethos that underpins the service of many of our church’s care agencies, such as the Queensland District’s Lutheran Services.
Just as having a legal will plays a significant role in ‘getting our affairs in order’ before we die in terms of the material and financial, advanced-care planning has a very important function for other end-of-life considerations.
It is a journey with people and their families which includes starting the conversation about death; establishing the person’s priorities for their life and any goals that are outstanding; discussing values and beliefs and what will help quality of life; discussing specific details about treatments and symptom management; and documenting the conversation.
There are also legal documentation processes prepared in advance, that assist with decision-making if a dying person loses their decision-making capacity. In addition to a will, these include appointing an enduring power of attorney/s for health and finance matters and completing an advance health/care directive, depending on the jurisdiction across Australia and New Zealand.
A term we often refer to within end-of-life contexts is palliative care, which even applies to non-specialist care. It is defined by the World Health Organisation (WHO) as: ‘ … an approach to care that improves the quality of life of patients (adults and children) and their families who are facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and correct assessment and treatment of pain and other problems, whether physical, psychosocial or spiritual. Palliative care also respects the choice of patients and helps their families to deal with practical issues, including coping with loss and grief throughout the illness and in case of bereavement.’
Appropriate palliative care is not confined to end-of-life care and can be provided in parallel with curative treatment, having different goals and focus. Palliative care is usually multidisciplinary and it is part of whole-person care that is not disease-specific and therefore can be complementary to curative treatment.
Again according to the WHO, when considered early in the course of the illness, palliative care not only improves the quality of life for patients, but also reduces unnecessary hospitalisations and the use of health services. Palliative care is never about withdrawing treatment or ‘doing nothing’. It requires as much work and expertise as curative treatment, but the goals are different. Access to palliative care is considered a human right by the WHO.
Specialist palliative care is only one component of palliative care service delivery. A sustainable, quality and accessible palliative care system needs to be integrated into primary health care, community and home-based care, as well as supporting care providers such as family and community volunteers.
Providing palliative care is legal, so long as the health professional intends to reduce or relieve a patient’s pain and suffering, not hasten their death. The majority of interventions given in end-of-life care by skilled health care teams neither hasten nor obstruct the person’s natural dying.
Care of the person and their family extends beyond death. Respectful treatment of a person’s remains and observance of cultural or religious practices need to be considered. Families also need to be cared for with appropriate time and space to grieve and follow up with bereavement counselling if this is wanted.
If end-of-life care is well managed, symptoms should be minimised and the transition from life on earth, through death to life in eternity, made as smooth as possible. In most cases, suffering at the end of life can be prevented or significantly reduced. It is often suffering and loss of control that people fear more than death.
The most controversial topic in the end-of-life area is euthanasia – the deliberate act of one person to end the life of another person to relieve that person’s suffering. Physician-assisted suicide occurs when a person requests a doctor to assist them in committing suicide. Both euthanasia and assisted suicide are currently illegal in most Australian states and territories and may result in a person being charged with murder, manslaughter or assisting suicide. However, voluntary assisted dying has been legal in Victoria since 2019 and will become legal in Western Australia in the middle of this year. New Zealanders last year voted in a referendum to legalise euthanasia, with the new law expected to come into effect late this year.
The LCANZ’s Commission on Social and Bioethical Questions CSBQ has a statement on this subject ‘Euthanasia or Mercy Killing’, which rejects the practice in all its forms, ‘because such killing is contrary to the word and law of God’. Adopted by the General Convention of Synod in 1981, you can read this on the LCA website (www.lca.org.au/social-bioethical-questions – Papers adopted by General Synod). Lutherans for Life, which is accountable to the church through CSBQ and promotes the sanctity of life, also offers resources and information on end-of-life issues.
Rather than euthanasia, the church calls for greater efforts to improve and extend palliative care and other measures to reduce suffering in our society. Such measures have demonstrated productive outcomes in the management of pain and the care of those at the end of their earthly life.
Dr Clare Seligmann is a General Practitioner with a particular interest and expertise in aged care and palliative care and a member of the LCANZ’s Committee for Ministry with the Ageing. She is the GP representative on the Queensland Health Department’s Frail Older Persons Collaborative. She served as chairperson of the LCANZ Queensland District’s Lutheran Services council from 2009 to 2019. She is a member of the Royal Australian College of General Practitioners, the AMA and the Australian & New Zealand Society of Palliative Medicine. She worships at St Peters Indooroopilly in suburban Brisbane.
Christian meditation is an ancient practice dating back thousands of years, to the first days of the church. And it was part of the tradition of those of the Jewish faith long before that. There are many biblical references to meditation, from Genesis through the New Testament, with many specific mentions in the Psalms.
In fact in Psalm 1, God’s people are urged to meditate on his word – on his law – ‘day and night’.
Martin Luther, too, practised, taught and wrote on meditation. He reformed and simplified the medieval monastic model as he did so, according to LCA Pastor Tim Jarick, in his paper ‘Mysticism, Monks and Marty: Meditation in the Lutheran tradition’.
Pastor Tim, Chaplain at Pacific Lutheran College at Caloundra in Queensland, explains that Luther put praying to God for guidance first before reading the Scriptures in his model and made the cross of Christ central to the Lutheran tradition of meditation.
And yet, as Lutherans in Australia and New Zealand, many of us have grown without much knowledge of what Christian meditation is and how and why it is an important, even central, element of our faith journeys.
Indeed, until recent times, many modern Christians have shied away from the practice, says Lutheran Pastor Stephen Abraham. Pastor Stephen, who was already teaching Christian meditation when a spinal injury left him with permanent debilitating and chronic pain and forced his retirement from full-time ministry in his early 30s, uses meditation whenever his pain is severe.
He has developed his own style of Christian meditation over three decades, which draws on a range of influences including the Desert Fathers (early Christian hermits, ascetics and monks, who lived in the Egyptian desert from the 3rd century); Roman Catholic priest, Benedictine monk and spiritual writer John Main; the French ecumenical monastic fraternity Taizé, Martin Luther and, of course, the meditations present in the Bible.
Pastor Stephen says that in other religions meditation is about ‘controlling your mind’ or ‘mindlessly losing yourself’, whereas, in Christianity, it is about ‘giving your thoughts to God’ and ‘giving him control of your thinking’. ‘It is letting your mind-space be governed by God’s word so that the Holy Spirit can direct your daily life’, he says.
‘Meditation is something all humans share: a relaxed focus, a tool to calm mind and body, a place of solace in a busy world.
‘Muslims pray, but we as Christians aren’t afraid to pray or use Christian prayer in our daily life just because Muslims pray. Hindus sing, but we don’t write off all singing us “un-Christian” or an evil practice. Likewise, Buddhists meditate, but for 3000 or more years meditation has been part of the Judeo/Christian experience, even if modern Christians have shied away from it.
‘Just as Christian prayers and music are uniquely Christian, Christian meditation flows from our encounter with the Trinity as revealed in the Bible. In practice, it is a place where the Holy Spirit can guide our reflection as we focus on God’s word.’
Pastor Anthony Price, who serves the worshipping communities of Gawler Lutheran Church north of Adelaide and is accredited as a Spiritual Director and Retreat Leader, teaches Christian meditation and offers spiritual direction. He believes there are several reasons why meditation may have become a ‘lost’ practice in the Lutheran church.
‘Firstly, maybe that’s to do with the New Age movement and that people have a perception that it’s a bit weird’, he says. ‘That’s the unhealthy forms of meditation that take us off of the word, and Jesus and the Triune God.
‘I also think there’s a fear of the unknown – people just don’t know about it.
‘And I have to think about my role as a church leader. If I wasn’t really experiencing it myself, I wouldn’t have been teaching it. So while we as pastors may have learnt about it, if we haven’t experienced it in a life-transforming way, we may not have taken on board the centrality of meditation. And Luther is a fine example, who tells us and teaches us how important it is for us.’
Kathy Worthing, a member of the World Community for Christian Meditation state executive for South Australia and leader of a Christian meditation group, believes this contemplative ministry form is having a revival among everyday Christians – including in the LCA/NZ.
‘Recent spiritual writers such as John Main, Laurence Freeman, Joan Chittister and Richard Rohr have been at the forefront of the resurgence in the practice of Christian meditation, taking it beyond the monastery walls and into the lives of everyday Christians’, she says. ‘As Laurence Freeman said in A Pearl of Great Price, “Our world sorely needs the silent infrastructure of contemplation woven into the institutions and frenetic schedules. It needs the healing and transforming power that only the spirit can set free in us and among us”.’
Pastor Anthony, who had a life-changing experience through attending a retreat based on the Spiritual Exercises of St Ignatius in 2009 says he came to realise that it’s an important element of our faith-life to have a heart – or experiential – connection with Scripture, as well as a head – or intellectual – one.
He took a year out of parish ministry in 2012 to complete a Master’s degree in Spiritual Direction with the University of Divinity. He has led retreats using his Lutheran adaptation of The Ignatian Exercises, a retreat program written by Ignatius of Loyola, a Spanish Christian layman at the time who would later become the founder of the Jesuits. The program features Christian meditations centred on the Scriptures, the gospels and various prayers.
He believes the main benefit of Christian meditation ‘is to experience Christ himself’. ‘He says, “I am with you always”, so it enables us to experience him and his love and helps us to grow in faith, to grow in hope, to grow in love – real love in action as we join Jesus in his mission’, Pastor Anthony says.
‘The word meditation literally means “to chew on”, so it belongs to all of us as human beings. Jesus says, “Do not worry”, and worry is a form of meditation; it’s something that we ruminate again and again. So we all naturally meditate, but in terms of Christian meditation, the all-important aspect is, “Where’s the emphasis? What’s the content that we’re meditating on?”
‘For us as Christians, it’s the God that we believe in, the Triune God, Father, Son and Spirit, and where we experience him most centrally is in Scripture, through God’s word.’
Pastor Stephen has written a Christian meditation program with the hope of making the practice easy for time-poor people. For a copy, you can email him at stephen.abraham@lca.org.au
He also has produced YouTube meditation videos, which can be watched and heard at www.youtube.com/c/StephenAbrahamMusic/videos and songs on online social audio platform SoundCloud, which are available for free at https://soundcloud.com/stephenabraham/sets/breathing-scripture/s-pv895
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