PlainViews

Rev. Sue Wintz on the impact a chaplain can have on organ donation

Enhancing the Precious Gift of Life

April is National Donate Life Month. Donating organs, marrow, and tissue is a kind and compassionate act that can protect and enhance the precious gift of life. During National Donate Life Month, the generosity of donors is recognized and awareness is raised of the importance of donating.

Organ, tissue, and research donation is a part of end-of-life decisions and is an area in which the contributions of professional chaplaincy can be identified, measured, and replicated. In January 2007, St. Joseph’s Hospital and Medical Center in Phoenix, Arizona and the Donor Network of Arizona (DNA/SJH) launched a pilot project focusing on value-centered conversations. Value-centered conversation is based on the belief that there are core principles held by individuals and families that give meaning to and/or help to interpret events and motivate a person or group to make decisions or act concretely in a way that is consistent with those values. These core beliefs and values can often be obscured by immediate physical or emotional states, including those experienced by families facing a traumatic event.

The DNA/SJH pilot project places an emphasis on the total context and processes experienced by families during the patient’s hospital course. As one of the medical center’s professional chaplain, I serve as the lead in donation support, along with the hospital’s in-house Organ Procurement Organization (OPO) coordinator, and the OPO Family Advocates. Together we designed and are overseeing the project. Education was initiated throughout the medical center to encourage the recognition and respect of mutual critical roles from the families’first contact with security and the unit secretary through all aspects of care and conversation, based on identifying and affirming awareness of family needs and values.

An integral goal of the project is to determine whether early assessment and involvement by professional board certified chaplains contribute as model interventions for increasing organ donation consents. A procedure was developed to ensure a spiritual care consult be initiated when a patient meets potential donor criteria. An outcome-based spiritual assessment tool was developed that includes eleven potential components to be addressed, four of which are specifically tied to collaborative efforts with the in-house OPO coordinator and its Family Advocates. Measures were also identified to evaluate family satisfaction with the experience of the donation approach and lowered anxiety and improved grief coping during the donation process.

Initial data has demonstrated the impact and effectiveness of chaplain involvement.
Since the inception of the pilot project, 100% of the potential donor families received a spiritual care consult and assessment. Our intervention in assisting families to identify values held by the patient and themselves was a key factor in over 50% of the cases; working with family history and dynamics to facilitate multidisciplinary conferences occurred in nearly 60% of cases, and assisting with family facilitation of grief in order to accept a diagnosis of brain death occurred 67% of the time. While only 11% of the families indicated that they were members of a local religious community and only 6% had their local religious leaders present to provide support during the donation process, a chaplain was requested to provide prayer, ritual, or other resource to almost 80% of the families.

The ongoing evaluation of the project is specifically aimed at chaplaincy assessment and interventions. The goal is to identify chaplaincy standards of practice that reflect the particular needs of families facing decisions regarding donation as well as contributions in the area of communication and collaboration within the multidisciplinary team and between the medical center and OPO.

The goal of the National Organ Donation Breakthrough Collaborative is 75 percent. St. Joseph’s organ donation rate rose in the first three months of 2007 from 54% to 94%, and the trend is continuing! At the recent state education mini-collaborative, the in-house coordinator, and one of the OPO family advocates and I, presented the project as a best practice. One outcome of this collaborative was a request made by another Arizona hospital to replicate the project. Plans for the beta study are now in process. The project will also be presented at an upcoming national breakthrough collaborative education event. At the state collaborative, SJH received the Overall Hospital Leadership Award and I was honored with an award for Outstanding Family Support; both indicate the importance of chaplaincy contributions.

This is one project that shows the importance of including a professional chaplain in the ongoing quality improvement process of a hospital. It is an especially important one because of the need for organ donation and the sensitivity that needs to prevail when dealing with a family that needs to make a decision about providing a gift of life in the midst of death.

As the Korean community grows in America, many Korean chaplains believe that it is important to form a chaplaincy organization to connect Korean chaplains with each other, to further educate Korean chaplains on their roles in their respective communities, and to educate Koreans in the care of non-Koreans and, conversely, non-Koreans in the care of Koreans.

On December 21, 2006, eight Korean chaplains, four women and four men, gathered together at The HealthCare Chaplaincy (HCC) to create the Association of Korean Chaplains (AKC). There were sparks among us and our energy lit up the room with excitement. This was an historic moment in the professional lives of Korean chaplains.

The idea and encouragement to organize Korean chaplains came from Rabbi Bonita E. Taylor, Associate Director of CPE at The HealthCare Chaplaincy. Rev. Meigs Ross, who is the program’s Director, enthusiastically supported the idea. We thank The Chaplaincy for encouraging and hosting our first meeting.

To begin, the attendees* shared their experiences as multifaith chaplains in the Greater New York area, including at: St. Luke’s-Roosevelt Hospital Center, Lenox Hill Hospital, NYU Hospitals Center, North Shore University Hospital, Winthrop-University Hospital, Bellevue Hospital, New York Hospital Queens, New York Presbyterian Hospital-Weill Cornell Medical Center, and New York Presbyterian Hospital-Columbia campus.

Rev. Young-ki Eun was elected AKC’s first president. He defined its central purpose to connect Korean chaplains worldwide to bring better pastoral care to Koreans and non-Koreans in distress. He further dedicated the AKC to highlighting the importance of Korean culture in the United States. Among the methods used will be contributing essays to PlainViews, The Journal of Pastoral Care and Counseling, and other professional journals.

We plan to educate Korean leaders both in the United States and in Korea of the importance of systematic study in pastoral care. We acknowledged the value of CPE and how it has further developed our pastoral care skills. Equally important, we have had opportunities to learn about colleagues from other cultures and religions –and they about us. We noted that CPE in Korea is not very active. Most seminaries in Korea do not emphasize pastoral care courses or CPE. The AKC plans to dialogue with Korean seminaries, churches and hospitals about the benefits of CPE. The AKC also plans to be a bridge between chaplains and CPE students in Korea and those in the United States.

To qualify as a member of AKC, a Korean individual must complete at least one unit of CPE. A student who does not meet this pre-requisite can join as an associate-member. There are membership fees to cover organizational expenses. We are also planning to open a bank account and to file with New York State as a non-profit organization. Meetings will be held quarterly in 2007.

A secular sage said, “To start something is the same as having it already half-way done.”Did not a Bible verse also encourage us, “Your beginnings will seem humble, so prosperous will your future be! (Job 8:7)”

If you are a Korean or a non-Korean Chaplain who serves a Korean population, please contact us through youngki.eun@utoronto.ca.

* Attendees were: Jongmi Bae, Jaeyoun Chang, Young-Ki Eun, Paul Y. Hong, Eun Joo Kim, Sungmin Lee, Min-Jung Park, and Seung-Jin Yun.

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Chaplain Larry Hirst wrote, "A person seeks medical attention …because he or she is afraid." (PlainViews, Vol. 4, No. 3) My experience is different. People with broken bodies are not necessarily afraid; they are in pain. Fear, indeed, may enter into someone's decision to seek medical attention. But even when it does, it’s an emotion, not "a soul response to stimuli."

My biggest initial block to discovering someone's spiritual needs is their distinctly compromised physical condition. Pain, grief from lost abilities, reduced ability (or opportunity) to make decisions, in addition to a lack of information (or an inability or unwillingness to process the information) are often the presenting symptoms of someone's barrier to peace of mind and soul.

Spirituality is out of range for most patients. I think Maslow had trouble, too. His list of needs goes from the most primitive to the highest levels, the top being self-actualization. Self-transcendence, or spirituality, while mentioned, is missing from the triangle. Even when included, it comes after all else is taken care of.

Lack of information is a problem for the patient. Early in my chaplaincy, nurses would say the patient and family had been fully informed. Patient and family would declare ignorance. Who's right? I found both often were correct! In a crisis our minds allow in only that which is 1) able to be processed without significant psychological damage; and 2) essential to immediate survival. The competent medical staff can pronounce all the facts in a case and ask for questions; the patient and family hear only that "the tests are inconclusive, so we need to take more tests to find out what it is." That may be complete information but not complete communication.

Those who seek drastic medical intervention seem to be the kind of people who tend to resist trusting their fate to a higher power. This tendency is social, not “soulcial”(if I may coin a new word). For the majority, the loss of hopes, dreams, and expectations is a big deal when mortality looms.

A couple of years ago I spent three days as a hospital patient. I had signs of a stroke. Initially, there was a brief feeling of fear when I sat in the emergency room and realized I could die! Then I asked myself if I believed all the stuff I proclaimed. A peace settled over me at that moment. During the stay my family visited; my boss visited; my superintendent visited; even my bishop visited! Much to their dismay, I talked freely about death. I told them that my life was full of fulfilled hopes and dreams thanks to many of them. And I shared that some had blessed me with things I hadn't even dreamed of. I got a new perspective on life. Hospital rooms can do that, if you let them.

When I hear a complaint, I know stress is present. Finding out if it is spiritual in nature takes some empathetic listening and love. This is doubly true when the patient is "waiting.”

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In her recently published memoir of faith, Barbara Brown Taylor claims “that the call to serve God is first and last the call to be fully human.”[1] As I reflect on this insight, sitting with a pager on each hip, seven months of residency behind me –and six more ahead –I am struck by the truth in this claim.

When I signed on for a year of residency, I knew I had signed on for a year of emotional intensity, personal growth, theological reflection, and challenge all around. I knew that listening to the stories of others would possess precious truth and profound pain. I knew that seeking grace and peace in the face of crisis and trauma would result in exhilaration and exhaustion. And I knew that learning to offer myself as vulnerable learner alongside colleagues would result in insight at times and frustration at others. In some vague way, I felt a sense of what would be the hardest parts of a year residency and what might be the most delightful. With all of this in mind, I entered the world of the hospital with equally matched tentativeness and expectation. At this halfway point of the residency year, I can easily admit that, so far, my adventures as a pediatric chaplain have surpassed anything I thought I knew, or didn’t know for that matter.

The most desperate and devastating moments of this residency so far have not been tidal waves: they have not come crashing down in a moment, leaving me discombobulated or stunned. Instead they have struck me at odd moments, often several days later, moving me to a place of confusion, unsteadiness, and uncertainty. When upon me, these moments sting and linger for a while but, so far and thanks be to God, they eventually have been replaced with a gentler wave of peace and balance. The most life-giving moments of this residency so far have not been grand moments of revelation, announcing themselves with bright light shining down or trumpets blasting. Rather, they have tiptoed up next to me during times when I have struggled to see the beauty, the serenity, and the hope around me. They have come and reminded me that this year –this life –is not only about serving God but also about realizing that no matter how faithful, how connected with the Divine, how spirit-filled, I am still human. Fully human.

To recognize the burden and ultimately the blessing then of serving God is to recognize that I am my most faithful when I am my most human. I am the most authentic chaplain not when I am reaching higher and higher for a theologically significant insight but when I am humbly grounded in the realities of truth in those around me and the God among us. This opens up space to take more risks, make more mistakes, ask more questions, and confess more doubts. It also carves out a place where, in the midst of it all, grace can slip in and fill up. I have learned that, as I dare myself to celebrate all the many parts of me that are far from perfect, I –for perhaps the first time ever in my life, and not without surprise –become more attuned to the uniqueness of my human self and can more deeply connect with the humanness of those around me. In turn, our shared humanity is more beautifully illuminated by God’s divine presence among us. And this, I have learned, is what it means to serve.

During this last CPE unit, I will pack and carry along with me the gifts of what I have learned up until now. Gratefully, I shall seek new ways to serve and try to live as fully human as possible. So here goes…

[1] Barbara Brown Taylor, Leaving Church: A Memoir of Faith, HarperSanFrancisco: May 2006, preface.

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EthicsWalk addresses spiritual care as an ethical enterprise. It explores why relationships between spiritual care providers and those they serve need protection, and examines what that protection entails. PlainViews invites our readers to share their responses to each EthicsWalk column, which will be published in the following issue.

If you’d like to respond to EthicsWalk, please send a comment of no more than 100 words. You can use the e-form below (click on "hearing from you," link) or submit your commentary to the editors in the body of an e-mail (or as a Microsoft Word attachment) sent to Info@PlainViews.org. Please put the phrase “EthicsWalk” in your subject line.

We look forward to hearing from you.

Financial health for many patients is as fragile as physical, psychological, emotional and spiritual well being. All are linked. The latter four are addressed daily by spiritual and other health care providers. The first is among the American Discussion Taboos. This column confronts an epidemic ravaging the financial health of many Americans: sub prime mortgages. Disproportionately damaging to populations whose vulnerability is heightened by illness, age, disability, and racial or ethnic minority status, regulation of subprimes is a justice issue for people of faith.

Home ownership remains the strongest opportunity for American families to build wealth, establish economic security and enter or remain in the economic middle class.[1] As home values rose in 2000, subprime lenders began providing mortgage loans for people with impaired or limited credit histories. Predatory lending practices soon emerged, blemishing the industry. Today, more people are losing homes than acquiring them through their involvement in the subprime market. [2]

The majority of subprime loans are taken out to refinance property. Refinancing represents the greatest danger to home ownership. Its usual impetus is securing funds for health care, compensation for job loss, or paying for education. Equally pernicious is the desire to “cash out”a portion of rising home equity to consolidate debt, buy a car, or just take a vacation.

Subprimes are usually marketed by mortgage brokers who make their money “placing”mortgages with a “lender.”Unlike similar professionals, brokers acknowledge no fiduciary duty to the consumer-client and are unregulated in many states. They push subprimes with seductive, temporary two or three year “teaser”rates, frequently fail to escrow taxes and insurance, and often don’t disclose loan origination and prepayment fees until the closing, at which time emotional involvement and practical considerations block most buyers from backing out. “Informed consent”is absent in abusive subprime sales.

Borrowers may be approved, with minimal screening, based on the value of the property, not their ability to pay. During the “teaser”period, almost anyone feels capable of meeting the loan terms. Thereafter, the rate rises every six months based on a complex formula. In short order, payments outstrip what the borrower can afford and exceed the rates of conventional mortgages.

Subprime borrowers become self-defining. Once perceived (by self and lenders) as less worthy of conventional financing, and caught in the cycle of excessive fees and charges, families find it difficult to escape. The result is an accelerating succession of ‘flipped’subprime loans, culminating in foreclosure and Chapter 7 bankruptcy.[3]

Predatory lenders claim that their product permits low income and credit challenged borrowers to enter the American wealth stream. The assertion is false. The majority of subprimes are used to refinance existing mortgages, not to acquire new property.[4] And, most people obtaining subprime loans could qualify for conventional or government insured mortgages were not unscrupulous mortgage brokers soliciting and steering vulnerable populations to the sub-prime market.[5]

Owning a home is the American Dream and home equity is the strongest predictor of economic security. Subprimes promise the dream but are the financial equivalent of prescribing opiates to patients. Occasionally after non-narcotic drugs have been tried, the opiate is necessary. But its use is closely monitored and patients are weaned to conventional treatments as soon as possible. Vulnerable people deserve the same carefully controlled processes for their financial healing. Justice here demands knowledgeable advocacy.[6]

[1] Center for Responsible Lending (www.responsiblelending.org). Data and analysis on subprime mortgages obtained from materials provided at this site and in testimony by the center’s president, Michael D. Calhoun before the U.S. House Committee on Financial Services, Subcommittee on Financial Institutions and Consumer Credit, March 27, 2007.

[2] From 1998 -2006, subprime loans have led or will lead to a net loss of homeownership for almost one million families. Net homeownership loss occurred in subprime loans made in every one of the past nine years.

[3] Lehman Brothers projects that “cumulative defaults may run as high as 30%”on sub-primes made in 2006.

[4] Estimates are that since 1998, only 9% of subprime loans have gone to first-time homebuyers and hence led to increased homeownership. CRL Issue Paper, No. 14, March 27, 2007.

[5] Subprimes are disproportionately made in communities of color. They constitute 52% of mortgages in African American communities and 40% in Latino. For white communities, they are 19%. Appendix B, Michael D. Calhoun testimony.

[6] On March 8, 2007, federal financial regulators issued the Proposed Statement on Sub-prime Mortgage Lending, a strong national anti-predatory lending recommendation currently before Congress. It advocates requiring an evaluation of the borrower’s ability to repay the debt by its final maturity at the fully indexed rate, assuming a fully amortized repayment schedule, rather than basing the loan on the value of the borrower’s property at the time the sub-prime is made as well as full disclosure of fees and costs. Similar measures are before a number of state legislatures. More information at www.responsiblelending.org.

We post an ethical or situational concern that has arisen in a facility where one of our readers works. It has no identifiers included. It gives you only the facts of the case. Then, you can respond to that concern. This is an ongoing dialogue, with comments added as they come in. In the following issue, assuming it has been resolved, we give you the outcome from the facility where the incident took place.

We are always looking for cases. Please send any cases that you would like considered for inclusion to: info@plainviews.org We will ensure that it is stripped of any identifiers. For further guidance about how to write up a CaseConference, please refer to the CaseConference Archives, Vol. 4, No. 3 "How to Submit a Case for CaseConference." (Click HERE)

We hope that this will help to inform not only those who are dealing with the issue, but will enable all of our readers to learn from the experiences and perhaps mistakes of others.

PLEASE NOTE: Due to unanticipated continuing responses to both the case and the resolution of the case, added responses can be viewed in the archives. Click HERE.

Editor's note: this case was submitted by a chaplain seeking feedback on his/her own work. This is part of why CaseConference was created. We applaud this chaplain for stepping forward to seek consultation in this very public way and we hope others will do likewise. This is an example of how we might all improve our practice and advance best practice in our profession.

A code pink was called in the urgent care clinic. The chaplain responded to the call and was informed that an infant boy had died. The specialist explained to the team that the child’s death was expected, although he died much sooner than anticipated. The condition could not be treated. Another doctor asked the specialist if she was okay. She said she was fine, stating again that his death was expected.

The chaplain was directed to the grandmother and stayed with her until the nurse manager arrived to escort them to view the dead child. The grandmother had brought the child to the clinic for the first appointment with a specialist. The family had moved to the area recently. Prior to their move, their son had been diagnosed with a terminal condition.

When the parents and the grandfather arrived, the chaplain continued to be present with them. They welcomed the time to be with their child.

The specialist came into the room very briefly when the parents arrived. She offered a quick summary of what had happened and then left. The parents grieved appropriately. (Yes, they expected their child to die but not that day.) The reason for the referral to this specialist was their hope that treatment would ease their child’s pain and allow them to hold him without discomfort to him.

After the family left, the chaplain visited with some members of the staff, and later attempted to determine if a debriefing session would be called. The nurse manager, who decides if there will be a debriefing session, decided that a session was not needed (the staff had not requested one). Even with the support of the director of pastoral care, the nurse manager did not see the need for the session.

What is the chaplain’s role when he/she feels that a decision made is incorrect?

How can the chaplain ensure that staff involved are given the support needed so that they can continue to do their jobs?

Is there a systemic issue that the chaplain needs to consider and try to improve?

My first observation is that if the chaplain sees the need for a debriefing, but the staff, the nurse manager, and the physician do not, then perhaps it is the chaplain who experienced the child's death as traumatic and not the medical staff. Certainly the death of a child is one of those events that is usually high on a critical incident list, but not every member of a team experiences the same event in the same way and what is traumatic for one staff member may not be traumatic for another staff member, what is not traumatic today may be devastating tomorrow or a month from now. The impact of this child's death may hit certain staff members later, or it may be triggered by another child's death, or it simply may not be a critical incident for this staff in this time and this place.

My second observation is that within the tools available for critical incident stress management, perhaps the chaplain chose the wrong intervention or limited him/herself to a single intervention rather than considering the many tools available in a situation like this and offering the nurse manager and the staff some options other than debriefing. A debriefing is a major intervention in terms of time, money, and emotional investment and to pursue debriefing when a staff does not want or need one is wasteful. It can also be hurtful to force debriefing on staff who do not want or need it. It isn't a matter of debriefing or nothing. Perhaps if the chaplain had offered pastoral care or a different critical incident tool -- defusing or demobilization, for instance -- the nurse manager and the rest of the staff would have been more receptive or would have seen their need in a different light. Following some other preliminary critical incident intervention or just good pastoral care, they may have welcomed a debriefing later. Certainly, they will view the chaplain in a different light if the chaplain offers what the staff needs rather than what the chaplain wants to give.

My third observation is that the chaplain still has available to him/her the gifts and interventions of pastoral care to offer that staff on an ongoing basis. The staff are denying the need for a debriefing. They may or may not need a debriefing, but they state that they do not. They may, on the other hand, welcome the pastoral support and care of a gifted chaplain.

My fourth observation is that this case refers to the medical staff -- nurses, nurse managers, specialists -- but makes no mention of the other staff who witnessed the child's death or the events surrounding the child's death -- housekeeping, clerical, administrative staff, security. A child death in any setting is shocking; a child death in an outpatient clinic is especially shocking. The other staff who were present need to be included in any critical incident response and in the chaplain's follow-up care. It is possible that their managers and directors would welcome intervention that the nurse manager does not.

My fifth observation is that the chaplain him/herself may be in need of post-critical incident intervention which his/her director can provide or arrange in order for the chaplain to return to work.

What is the chaplain's role with the nurse manager? If the nurse manager were refusing pastoral care and critical incident intervention when the staff is saying they need it, then the chaplain's role is clear. However, in this instance the staff, too, are saying they do not need an intervention at this time and are ready and able to return to work. The chaplain's role is to be sensitive to their needs, to be available when they do need intervention -- which may be the next shift, the next month, or the next child death -- and to have more than one intervention to offer. The chaplain's role is not to play pastor-knows-best.

Is there a systemic issue that the chaplain needs to consider and try to improve? That's difficult to answer on the basis of the information provided. If the critical incident policies and procedures for this setting are not clear or are not reasonable or are only honored in the breech, then there may be a need for review, for a champion in the system, or for other action. The chaplain can be an effective and appropriate advocate for those things. Perhaps the systemic issue is that the chaplain does not have the trust of the staff or the nurse manager and so any care offered will be declined; again, the chaplain's role or the director's role is clear if this is the situation. Perhaps the systemic issue is systemic w/in the chaplain, though, who desperately needs to provide pastoral care to a staff who do not want, and may or may not need, the specific care the chaplain is offering them in the moment.

Linda Brown
Staff Chaplain / Coordinator of Spiritual Health Services
Truman Medical Center - Hospital Hill
Kansas City, MO

Please check the archives below for comments made about previous CaseConferences.

Chaplains will be drawn to this engaging film on the interrelationship between Judaism and Christianity. The award-winning documentary is based on the book Our Father Abraham: The Jewish Roots of the Christian Faith by Marvin R. Wilson, PhD, and includes lively interviews with close to forty Jewish and Christian scholars along with spontaneous commentary by lay people.

The filmmakers gained access to numerous interfaith programs in action and the camera captures Rabbis answering probing questions from Catholic high-schoolers and Priests answering Jewish students’questions. Teachers wrestle in roundtable discussions over the best way to tackle difficult interfaith issues in the classroom and congregations of Jews and Christians meet to argue their differences and honor their commonalities.

Much of the film focuses on the common roots of these two major religions. As Dr. Harvey Cox, Professor of Divinity at Harvard notes at one point: “Jesus would seek out a synagogue if he came back to pray.”

The camera intercuts between Ash Wednesday services and Yom Kippur services with commentary from theologians and Rabbis regarding ash as it was symbolized in the first century and now. Scholars then consider water as a symbol of cleansing and immersion, and as the camera films baptisms in the river Jordan, viewers are reminded that John the Baptist was a Jew and that the Jewish tradition of thrice immersion in the first century gave rise to the Christian baptismal ritual of thrice immersion in the name of the Father, Son and Holy Spirit.

The camera travels back and forth between a Seder and Good Friday service, underlining the textual similarities and differences in a visual way. Common threads of wilderness and temptation are delineated.

The sacred texts are addressed from many angles. A tour guide in Jerusalem comments: “There is not a word in the Lord’s Prayer that would not be said by an Orthodox Jew…The words are kosher to the hilt.”Another scholar dwells on the psalms and their roots in the synagogue system.

As Gustav Niebuhr commented in The New York Times in a film review, difficult as it can be to accomplish, “…Jews & Christians: A Journey of Faith successfully turn[s] a scholarly work into film.”

Completed: 2002
Running Time: 116 Minutes
Directors/Producers: Gerald Krell and Meyer Odze

If you are interested in purchasing this film, you can do so on Amazon.com. The cost of the film series is $35.00 for a DVD.

Sarah Masters is the Managing Director of the Hartley Film Foundation, a non-profit foundation dedicated to cultivation, support, production and distribution of the best documentaries and audio meditations on world religions, spirituality, ethics and well-being.

“There is no purple prose in these sermons, preached in the most painful of circumstances, the death of a young person. Language has been cut to the bone. They are intensely moving. And authentically Christian.”(p. ix) These words from the forward by Nicholas Wolterstorff, himself a grieving father and author, couldn’t be more true. Editor Michael D. Bush has compiled a soul-affirming collection of sermons preached on the tragic occasion of the deaths of young persons. Ranging in age from just a few days to mid-life and caused by illness, accident and suicide, this anthology provides great comfort in the midst of the greatest anguish that may be endured, the untimely death of a child.

As a grieving father whose only son, Mark, 18, died over four years ago, I identify with these messages. This Incomplete One affirms the great love that parents have for their children. The sermons affirm with Isaiah that in the Messianic age “No more shall there be an infant that lives but a few days, or an old person who does not live out a lifetime.”[Isaiah 65:20]

Sadly, because we still live under the curse of Adam’s sin, our world is diseased, dangerous and fraught with disaster. Parents must bury their children. This collection offers a measure of solace during the deepest losses. Healthcare chaplaincy has taught me that every life has value; every loss is significant; no loss can be compared with another and grief journeys are unique. But the death of a child is particularly devastating to parents, siblings, grandparents, friends and classmates. My wife’s grandmother lived over 92 years. Two of her seven children, first her youngest son and then her oldest son, preceded her in death. Though her husband died almost thirty years earlier, by her own testimony, the deaths of her children were more difficult than her spouse.

Each sermon includes a brief description of the circumstances that occasioned it and the person whose life it acknowledges. Some are written by the pastor who ministered capably to a grieving family; some are written by the grieving parent. “There are…two recurrent themes. Amidst the grief over the brevity of this child’s life, there is gratitude for his or her presence in our midst. The child was a gift. The grief does not smother the gratitude. And death, they all affirm, is not the end. We grieve, but not as those who have no hope. Yet none says that since death is not the end, we should not grieve. Though grief does not smother hope, neither does hope smother grief.”(Forward, p. x)

Of historical interest is a sermon from the heart of Karl Barth, whose son Matthias died in a climbing accident in the Swiss Alps, published for the first time in English. And of interest is a sermon by Jonathan Edwards at the death of young missionary David Brainerd. Edwards’own daughter, Jerusha, nursed Brainerd through his illness and death from tuberculosis. She died two weeks later and was buried beside him. There are outstanding messages from William Sloane Coffin, Jr., whose son Alex was killed when his car plunged into Boston harbor from a rain-soaked highway, and from John Claypool whose daughter Laura Lue died of leukemia. Written nearly twenty years later, Claypool’s message, “What Can We Expect of God? from Isaiah 40:27-31, is a masterpiece! I heartily commend This Incomplete One to pastors, chaplains, grief counselors and grieving families whose children have died at any age from any cause. These sermons are destined to become classics!

Bush, Michael D, editor. This Incomplete One: Words Occasioned by the Death of a Young Person. Wm. B. Eerdmans Publishing Co., 2006, pp 169.

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