David J. Zucker, Ph.D., reviews

A Clergy Guide to End-of-Life Issues

The name of the Rev. Dr. Martha R. Jacobs is well-known to and certainly well-appreciated by the readers of this electronic journal. She is the Founding Managing Editor of this interfaith international chaplaincy resource, and continues to serve in that capacity. For over seven years, she has guided PlainViews, continually raising the level of its professional voice. Now, through the publication of this book, Rev. Jacobs’ name will become if not a household word, at least a valued resource for clergy as they deal with End-of-Life issues with their congregations. As shall be explained below, this well-crafted and attractively presented book is framed toward Christian, and more specifically Protestant clergy, but it has wide applications, and with a bit of effort, it will be useful for clergy across the board.

Early on in the volume, Jacobs refers to Ernest Becker’s 1973 Pulitzer Prize winning book, The Denial of Death. “Becker believed that the denial of death pervades human culture. The notion of immortality pushes us to work to ensure that our lives have meaning, whereas death suggests that life adds up to nothing” (p. 7). Yet, despite the fact that most of us tend to deny death, “Death is a powerful part of our living. It is something that we all do. And whether or not we want to admit it, it is on our minds and in our hearts” (p. 13). This book therefore offers its readers a wide range of materials that will help them – and will help them to help others – to be more prepared for our common destiny.

The nub and purpose of the book is captured in a few lines in the first chapter:

Clergy trained in dealing with end-of-life issues can . . . begin conversations with their congregants about their health care wishes. Congregants would then be better prepared with advanced directives, or at least know to discuss their wishes with family members and, perhaps with . . . their clergyperson. (p. 3)

Death is not the enemy, and yet we treat it as it is. . . When clergy address, teach, and model . . . [the] realities of our living and our dying, death can once again become a natural and much less frightening part of life. (p. 4).

This eminently practical and well-researched handbook divides into three major sections. Part One sets out End-of-Life Issues, more specifically Legal, and then Medical issues. Part Two, Theological Issues divides into Miracles and Cures, and Our Own Demons. Finally, Part Three presents Pastoral Issues, this final set of chapters focusing on clergy working with congregants: Preparing for the End of Life; Working with Congregations; Knowing the Options; and Focusing on Transformation.

Finally come over twenty-five pages of Appendices that are filled with valuable information, including links to various relevant websites that address many of the issues found in the book:

• State-Specific Websites for Information about Advance Directives
• Denominational Links to End-of-Life Issues and Other Denominational Resources
• Advance Directives and End-of-Life Web Resources
• Prayerful Discernment Process for Congregational Use
• Materials and Resources for Use with Congregations
• Book Suggestions on Grieving and Rituals
• Sample Sermon: “A Chaplain’s Prayer”

Notes and a helpful Bibliography complete the book, as well as a website that offers additional resources (www.deathisnottheenemy.com).

Jacobs demystifies many technical terms that are part of the jargon of End-of-Life decision making, such as Advanced Directives, Living Wills, Do-Not-Resuscitate (DNR) Orders, Do-Not-Intubate (DNI) Orders, Capacity vs. Competence, and Physicians Orders for Life-Sustaining Treatment (POLST).

Alongside this she explains what one might see when someone is Actively Dying, and then considers such issues as Pain Control, Artificial Nutrition and Hydration, Brain Death, and Terminal Sedation.

When discussing the matter of Artificial Nutrition and Hydration (ANH) Jacobs makes it clear that “Artificial nutrition is not ‘food.’ It is a chemically balanced mix of nutrients and fluids. It is ‘being forced into the body to keep a body functioning (not necessarily alive).’ . . . [Jacobs then explains that some] studies show that continuing ANH creates a ‘bad death.’” She is well aware of, and comments on the fact that “Eating is the central focus of many cultures” (p. 43) and that this presents its own set of conflicting problems for the family who want to do what is best for the loved one.

She likewise has informative sections on “Racial, Cultural, Social, and Economic Issues” (pp. 55-60) as well as “Sexual Orientation” (pp. 60-61) and how clergy should be sensitive to these considerations as they impact upon end-of-life decision making.

In chapter 6, Jacobs offers a list of commonly held beliefs on what constitutes a “Good death” (p. 74).

Jacobs understands that most clergy successfully have avoided asking themselves the hard questions about how they feel about dying and death. Therefore, she has added a section for clergy titled “The Prayerful Discernment Process” where she invites readers to consider not only their mortality, but decisions about their own end-of-life care.

This work addresses Christian clergy, and more specifically Protestant clergy. The Denominational Links to End-of-Life Issues and Other Denominational Resources range from the American Baptist Church through the Unitarian Universalist, but makes no reference to the Roman Catholic Church. Jacobs does quote from the Christian Scriptures, and including the Gospels and Romans. Though this work has relevance for any clergy, Christian or not, periodically she frames language in a denominational way. The section on Transformation is decidedly Christian in nature (pp. 112-123).

Though much of the religious language is Christian, this book has much to teach readers irrespective of one’s religious affiliation. This is a fine introduction to the whole area of End-of-Life issues. Certainly, with a bit of effort, the Pastoral Issues can be translated from a Protestant model to other religious systems.

It also can be an excellent resource for professional chaplains to suggest to their local clergy. Jacobs points out several times that the best way for a local clergyperson to navigate the hospital system is by getting to know and utilizing the hospital’s chaplain.

As noted earlier, Death is a powerful part of our living. It is something we all do. This work brings to the fore relevant and needed dialogue concerning End-of-Life Issues.

Martha R. Jacobs, A Clergy Guide to End-of-Life Issues, Cleveland: Pilgrim Press, 2010, 164 pp.

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