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Declined Chaplain Visits

It never gets easier to say.

Every two weeks, I spend about four hours with other members of the Bristol Hospice team. Following a discussion of new admissions, we turn our attention to those who continue to receive end-of-life comfort care. The clinical supervisor calls out a name, and around the circle we go, giving our reports: nurse, social worker, volunteer coordinator and chaplain.

For approximately ten to fifteen percent of my patients – about five to eight people – my verbal report is exactly the same every time. Three short words: Declined Chaplain Visits.

My written report on the patient’s chart is less succinct: Patient/Family have declined regular Chaplain visits. No visits given in this period. Chaplain will be available to patient and family if requested.

It never gets easier – to say it or to write it. A small, gray cloud of sadness momentarily hangs over my soul.

Hospice is all about comfort care in the last chapter of life, as a team of workers seek to relieve pain of all types – physical, social, psychological, emotional, and spiritual.

If you want to be on hospice, you must consent to having a nurse visit regularly to assess and treat your physical needs. But you are given a choice as to whether you want the rest of the team to visit and attend to the other types of pain. In other words, the patient, family, or loved ones have the right and privilege to decline visits by the home-health aide, the social worker, and me, the chaplain.

Upon admission to hospice, then, Medicare requires that I attempt to call and introduce myself and explain my role. The core assignment for chaplains is to bring emotional care to patient and family because there are matters of the heart that the nurse can’t listen to with a stethoscope.

Additionally, if they desire or request it, we personally provide or coordinate spiritual care in line with their beliefs and convictions.

The vast majority of families and patients welcome me into their lives and their homes. But some say no, which can make for an awkward first conversation. It’s not easy to tell someone – I don’t want to see you.

Sometimes their decision reflects an abiding and trusted relationship with a pastor, priest, or rabbi. That’s understandable.

Others are very cautious about only receiving spiritual care in line with their belief system. Jehovah Witnesses and Islam are two examples. I get that.

But in the absence of these specific reasons, I generally hear statements like these: My dad is not religious. We don’t believe in organized religion. Mom is doing fine, and she has a lot of friends who come by. Everyone is doing okay.

In other words: No thanks. Not interested.

I don’t take the decision personally. I know they’re not rejecting me. Instead, they are likely anxious and guarded about inviting (or re-inviting) into their lives an unwanted presence, a memory, or a voice from the past into this difficult chapter of life.

Specifically, they are concerned about what the Chaplain might do, say, or imply …

  • Standing above and apart from wounded souls and weary pilgrims.

  • Covering them with a sheet of shame for their past actions.

  • Offering a transactional sale pitch – if you say this, you’ll get that.

  • Reciting pious spiritual jargon divorced from daily realities.

… all of which potentially bring discomfort and misery, the polar opposite of hospice care.

And to all those fears – be they founded or unfounded – they understandably declare: Chaplain services declined.

Although I explain in that initial conversation what I will do and what I won’t do, they generally hold their ground. And my heart aches for them.

Not in frustration with them, but in sadness over what has happened to them or what they fear will happen, culminating in a decision to decline the offer of spiritual care. Over the centuries, and to this day, the message of the church has not sounded like good news.

Nobody stiff-armed Jesus. No one declined the visits of Christ. They were drawn to him, not repulsed by him. How did we get so far off the path of the one we pledged to follow? The Apostle Paul said we are to be a life-giving fragrance that remind people of Jesus*, not a repulsive scent marked by not-so-subtle hints of despair and guilt.

The pertinent questions, therefore, follow immediately: Am I any different? Do I remind people of Jesus? In some small ways, possibly, but I’m not sure about the overall impression I give.

What I am sure about are the characteristics of God. He is light and he is love. He entered our world and continues to do so. He is gracious and compassionate, full of mercy and kindness. He is an overflowing fountain of joy and beauty.

Knowing that, and seeking to communicate the same in word and deed, I have a few personal convictions and practices. I’ll share a few of them with you.

I always pull up a chair at eye-level, as I never want to stand above my patients. I do this with family when appropriate. Finding a chair at a facility can be a frustration, so I frequently bring my portable three-legged backpack chair.

I pray in common language, addressing whatever we have talked about, and using short everyday words like thanks and help. I also encourage them to do the same when they pray.

I regularly employ a couple of helpful images. In the first one, I ask my patients to imagine being on a peaceful, gentle and calm river on a sturdy craft that won’t capsize. Why this image? Many traditions have compared the human journey to a voyage on the river of life.

I share with my patients that they can be assured of where the river leads, right into the presence of God.** I encourage them to let the gentle current of love carry them, putting down the oars of busyness and our need to control our circumstances.

None of us know how many times the river will bend before we get there. But we do know what we will see when we finally and fully enter into his presence: light and love, beauty beyond our imagination, and abounding joy and peace.

What shall be our response to this vision? To help them, I give them another image – a flower that opens to the light each morning.

Quoting the opening words of one of my favorite hymns – hearts unfold like flowers before You, opening to the sun above *** – I encourage them with these words: Open yourself up fully to the light of the one who has known you and loved you since birth, and will continue to love you until you take your last breath.

I will often follow these images by praying for them, asking God to help them to enjoy the ride, to let the current of his faithful love carry them into the light of his presence, and to open up heart and soul to his abiding and cleansing love.

That’s what God does: in the quiet hours he has wondrous ways of drawing both faithful and wandering souls unto himself, and so I entrust my patients to his care and to his unbounding love.

But whether I share those images or not with my patients, my goal is the same: to reflect the light, love, and joy of our Father – every day, with every person.

And so I pray for you who read this, and offer you this benediction:

May you see this post as more than information about chaplains and hospice care, but instead a personal reminder of the purpose God has given each of his followers, to you and to me – to let his loving light shine through us. Every day.

May you ask yourself some hard questions. For example, has the way you have spoken or acted as a believer resulted in you getting silent or subtle messages, effectively declining visits from former friends? From family? From your adult children? From your parents?

May you see yourself anew as one God’s vessels, pouring out light and love and joy, and simply being present with everyone you meet, but especially with those you know and love.

* See 2 Corinthians 2:14-17 and Ephesians 5:1-2.

** Revelation 22:1-5

*** Joyful Joyful, We Adore Thee. Words by Henry VanDyke, 1907. Here is all of verse 1:

Joyful, joyful, we adore You, God of glory, Lord of love; Hearts unfold like flow'rs before You, Op'ning to the sun above. Melt the clouds of sin and sadness; Drive the dark of doubt away; Giver of immortal gladness, Fill us with the light of day!


No Thanks: ShutterStock

River: Paul Siewert on Unsplash

Girls and flowers: ShutterStock

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All Scripture quotations, unless otherwise indicated, are taken from the Holy Bible, New International Version, NIV. Copyright 1973, 1978, 1984, 2011 by

Biblica, Inc. TM


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