Already during his civilian service at the Hospic Anežky České in Červený Kostelec, priest Mgr. Václav Tomiczek, a parish priest in the Beskydy village of Čeladná, came to serve the sick. He completed his civilian service after his studies as a deacon and for about 10 months as a priest, yet in the position of a bedside caregiver, which he considers a very valuable practical experience. Currently, for more than two years, he has been visiting the medical facility Gaudium in Frýdek-Místek and also collaborates with Hospic sv. Lukáše in Ostrava, where he also dedicates himself to the spiritual guidance of staff in the form of catechesis and spiritual retreats. At the same time, he is pursuing doctoral studies in pastoral theology at the Cyrilometodějská teologická fakulta of Univerzita Palackého in Olomouc, where he specializes in pastoral care for the sick and related topics. On what values is spiritual assistance to the dying founded? Right at the outset, I want to state that I speak from a Christian perspective, specifically from the perspective of the Catholic Church; however, as will surely become clear later, the Christian values upon which European civilization grew provide a much broader framework than might first appear. When we seek a basis for justifying service and help to another person, especially in their illness and suffering, we must start from respect for life, which is a value in itself, regardless of age, gender, or any limitations, including health-related ones. God created man in his own image, and therefore man is willed by God, as is the whole world. On the basis of this gift of life, the human person receives his uniqueness and dignity, from conception until natural death. The Catechism of the Catholic Church draws consequences from this for spiritual assistance, which must stem precisely from unconditional respect for the human person and his uniqueness. In the tenth chapter of the Gospel of Luke, we find a very inspiring parable of Jesus about the Good Samaritan, who is willing to expend much effort and money to save a person with whom he would not normally speak at all.
What does spiritual service to the dying include? Can we say what still is and what is no longer spiritual accompaniment? I would distinguish between service and accompaniment. By the former is meant the so-called sacramental service, that is, celebrating Holy Mass, Holy Communion, or the Anointing of the Sick. Spiritual accompaniment, however, I perceive as a broader concept, and not only in connection with illness. In the history of the Church, we encounter spiritual figures, often monks or hermits, whom people visited with requests for advice, help, and prayer. Such a spiritual leader then accompanied a person on his journey through life, helped him discover new values, and together they drew closer to God. I speak of this both to make us realize that it was a broader help than just administering sacraments, and also because accompaniment on the spiritual path must never become manipulation under any circumstances.
What principles do you follow when communicating with the dying? I can say that in communication with the sick, a basic principle should apply, namely to talk in the manner of the recipient, to try to tune into his "wavelength". This not only gains trust but also prevents me from foisting anything on the patient. But I would like to emphasize one important fact. Especially seniors often recall their youth, that they went to church and to religious education, but then all of that somehow faded into the background. But they want to talk, they are also interested in receiving the sacraments, perhaps even after a long time. There can be no question of manipulation on my part, not in the slightest. Rather, it is about rediscovering what is already within the person, only it has somehow been pushed into the background. It seems similar to when we teach a person to speak again after a stroke. He also used speech normally before, and now the speech therapist's task is to help him "remember" how to speak again.
What do patients ask of you, what are their needs or requests? I assume they ask themselves and you many existential questions… The fundamental question that every sick person asks themselves and others is expressed by the adverb "why?". Why do I suffer, what are the causes, what are the consequences, what effect does this have on my life here and now. "Why?" thus turns towards the past, present, and future. Questions about meaning are very often hidden; patients rarely express them openly and "without wrapping". The one who listens must do so really attentively and try to read "between the lines". The patient thus involuntarily tests the listener, and at this point great sensitivity is needed, as well as sensing the opportunity to get to the root of the problem, because such an opportunity may not present itself a second time. So perhaps the most common existential question is asking about the meaning of illness, suffering, and life, and from this arise further questions about realities that transcend us, and questions about God or, more generally, about a higher existence.
In contacts with the dying, do questions arise about what comes after death, whether there is an afterlife, whether they will get to heaven, what about hell, the devil? As I already said, these questions are far from being so open, although they are naturally oriented toward the ultimate things of human life. One thing is peculiar. Most patients ask about hope, they seek hope, which is actually the answer to the question about the meaning of suffering, so they try to find some kind of positive resolution to their situation. The one who seeks to provide spiritual accompaniment to the sick should not so much argue at this moment as rather bear witness to his hope in God, who gives meaning to life and thus also to suffering and pain, even if it is difficult to accept in human understanding.
I believe there are many prejudices, false notions about spiritual service. How then do you work with prejudices when providing spiritual comfort, strength to the dying? Of course, prejudices exist and there are quite a lot of them. They are rooted precisely in a misunderstanding of the fundamentals of spiritual service. Very often, priests encounter negative bias towards their person and the church institution. In such a case, a little more empathy and interest is often enough to break down ingrained stereotypes. Unfortunately, the sacrament of the Anointing of the Sick is still poorly understood, with many still calling it "extreme unction". But the Anointing of the Sick is in fact a very important sacrament precisely for strength in the struggle with illness and old age, and it is far from concerning only the dying. When I consider my parish, we celebrate the communal administration of the Anointing of the Sick every year, which I recommend to everyone over 65, but where younger people with long-term diagnoses also come, about whom I myself have no idea. Simply put, those people receive the sacrament as strength and help in their illness.
Do you yourself start talking about God, faith, or do you wait until the patient begins to ask about spiritual questions, topics related to dying? I try not to start myself. It is of course necessary that during the first contact with the patient I introduce myself — present myself and clearly say what I do and why I have come to see him. Already based on the first reactions, it becomes clear to what extent he wants to talk with me. Reactions vary, but it rarely happens that someone outright refuses. Especially in the first meetings, one must be cautious with questions.
Does spiritual service differ depending on whether the patient is a believer or non-believer? In other words: are there specifics of contact with believing vs. non-believing dying persons? Strictly distinguishing between a believer and a non-believer is actually not really possible. But what does manifest itself is the difference between an active (practicing) Christian and a rather searching person. Of course, it pleases me when I hear that someone was already looking forward to the priest's visit, wants to pray together, go to confession, receive Holy Communion, or talk about matters of faith. It is easier for me not only in the initial introduction but also in subsequent work. On the other hand, it is no less encouraging when someone experiences a personal conversion; even if they did not want to communicate initially, over time they begin to engage with matters of faith and deepen their spiritual life.
Do you encounter the theme of guilt and the associated need for forgiveness and reconciliation? The need for forgiveness and reconciliation occurs primarily at the level of relationships with one's surroundings. People experience their relationships in various ways and do not always have them harmonious. During life, they do not even realize how this hurts them and how they hurt others. However, in the final stage, at the moment when they themselves are approaching the end of earthly life, they have the interest and sincere effort to put their relationships in order. This is another important moment when the one who provides spiritual accompaniment can effectively help. He can become the one who listens, connects with the patient's suffering in empathetic silence, but is also able to arrange a visit from relatives, perhaps even help a little in initiating a mutual conversation. While resolving conflicts primarily concerns social bonds, these almost always have an overlap into the spiritual realm as well. A person does not forgive and ask for forgiveness only from their loved ones, but also from God; they ask for healing of wounds caused by others, but also of those they themselves often inflicted on their loved ones. An irreplaceable and still underestimated role here is played by the sacrament of reconciliation — confession — and the Catholic priest, who can thus mediate God's forgiveness.
Do you also provide spiritual service to bereaved mourners? I have heard an opinion from a hospice that hospital chaplains focus only on helping the dying. If so, why is that? Personally, I try not to perceive spiritual care in healthcare narrowly, in the sense that we are only here for the sick. Relatives also need help, they need someone to share their pain from the illness of a person close to them. Sometimes, and this is an experience especially from hospice, a patient is brought from the hospital in such a serious condition that communication with him is no longer really possible, which does not mean that we do not pray for such a person. His family, on the other hand, is in a very bad psychological state and needs strengthening and help through conversation, advice, and prayer. In a way, they experience the loss even before the death of the seriously ill person, and this helps them prepare for the moment of their loved one's actual departure. If they have someone nearby who listens to them and strengthens them, they bear their grief better and it can move them forward in some way. But when it comes to establishing a relationship with a relative, it must be said that we rather wait for their initiative; here it applies doubly that it is not good to force them into a conversation in any way, and rather to wait whether they show interest.
Author: Pavel Bajer
The report was published in the journal Sociální práce/Sociálna práca, issue 2/2010 Social Work and the Fight against Poverty, http://www.socialniprace.cz Order the journal Sociální práce/Sociálna práca via the online order form at http://www.socialniprace.cz/objednavka.php and get 160 pages of professional inspiration on how to work professionally and effectively with your clients. Order communication is handled by Olga Cídlová (e-mail: olga.cidlova@socialniprace.cz, tel.: +420 549 495 224).