Spiritual Care in Death & Dying, Grief & Loss

Greetings! In the

“The dying are usually so lonely, since everyone is avoiding the truth. Don’t worry – you can’t kill a dying person by admitting he might be dying. It’s no shock to him. Be honest about the reality of dying, and then the two of you can get real about your feelings.”

(Smartt 2017, p. 19)

 

Welcome! 

This week we'll get to know each other and I'll talk about course expectations. You'll also learn about the doula approach to caring for people who are dying. 

 

Required Videos

1. Arora Introduction to the Course (Slides)

2. BJ Miller, MD TEDTalk (19:11)

A hospice and palliative care physician shares both personal and professional experiences of loss and grief. Then he challenges all caregivers to help enhance the way we die in the U.S., where the biomedical culture can dehumanize the experience and exacerbate suffering. His comments about simple acts of care and presence reflect the way we want to provide spiritual care in loss, grief, dying and death.

3. Chaplains and end-of-life care (9:21)

Required Readings

1. Arora - Introduction (10 pgs) 

2. Fersko-Weiss -  Chapters 1 & 2 (37 pgs) 

3. I'm confident that we will create and sustain a safe and supportive learning community, keeping in mind that the classroom is not meant to be a therapeutic space. I say more about this in our Learning Covenant.

 

Required Discussion

See the Week 1 Discussion for specific instructions.

Required Survey

Complete this anonymous survey. 

 

Required texts (please acquire you own copies)

Arora, K. (2020). Spirituality and meaning making in chronic illness: How spiritual caregivers can help people navigate long-term health conditions. London, England: Jessica Kingsley.

Fersko-Weiss, H. (2020). Finding peace at the end of life: A death doula's guide for families and caregivers. Newburyport, MA: Red Wheel.

Additional readings and videos will be provided on the Canvas course site with links on the instruction page for the week in which they are assigned.

Assignments and Discussions

Y ou will participate in a number of graded discussion forums, each worth 50 to 100 points.

This Assignment is worth 50 points. Your submission is due by 11:59 p.m. MDT on Sunday May 15.

1. Complete an Advance Directive for yourself. You may use Five Wishes or the Conversation Project

• Five Wishes has a $10 fee for online completion. For $5 you may request a hard copy. This may take several days to receive, so prepare accordingly. https://fivewishes.org/shop/order  If you use the Five Wishes document, on a page where there is room to write in comments, add and respond to this prompt: “What quality of life means to me.”

OR

• The Conversation Project guide: https://theconversationproject.org/wp-content/uploads/2020/12/WhatMattersToMeWorkbook.pdf

 

2. When you have completed your Advance Directive, have a conversation with the person you chose as your healthcare agent/medical power of attorney to share with them your wishes and verify they are willing to serve as your agent.

 

3. Submit a WORD document in which you reflect on the process of completing your Advance Directive. Respond to each of the following prompts:
   1. Complete this attestation: I used _____ (Five Wishes OR the Conversation Project guide) for my Advance Directive.
   2. What was challenging about completing your document?
   3. What was surprising about completing your document?
   4. How was your conversation with your healthcare agent helpful/not helpful in thinking about your Advance Directive? Did you consider/make any changes to your document as a result of this conversation?  

 

4. After completing your own Advance Directive, have a conversation with another person about their medical wishes. Reflect on that experience by explicitly addressing each of the following prompts:
   1. Complete the following attestation: I spoke with _____ (provide first name and last initial). Our relationship is ______. Their approximate age is
   2. What did you learn about yourself from having this conversation?
   3. Name at least one way you judged, disengaged from, defended your values/beliefs, and/or imposed your values/beliefs on the other person during your conversation.
   4. What would help you with future conversations about Advance Directives?

You will also complete independent assignments worth 100-150 points each. In these assignments, you will reflect on personal beliefs and values around loss, grief, dying and death; you will respond to case studies about spiritual struggles and meaning making in illness/dying; and you will reflect on your experience in the course.

Extra credit

Beginning in week 3, you have a weekly opportunity to contribute to an extra credit discussion related to death, dying, grief and loss as portrayed in artwork. Topics we address in this course are often challenging to communicate through words alone, so these discussions invite you to respond to course material in a more intuitive way. Extra credit posts are worth 10 points each, and one post per week is allowed for extra credit. Posts will appear as if they are worth 0 points; this is to avoid penalizing students that do not wish to participate. If you successfully complete an assignment, your grade will show as 10/0, and these extra points will factor into your final course grade.

Other helpful information:

At the end of this course, students will be able to:

1. Identify their personal values, beliefs and meanings around loss, grief, dying and death as a ground from which they demonstrate radical respect for differences, offer a compassionate presence and co-create meanings with other people
2. Reflect theologically on narratives of illness, trauma, dying and death from various perspectives to enhance their ability to offer a compassionate presence and co-create meanings with other people in these experiences
3. Articulate values, beliefs and meanings of people who work in palliative care/hospice settings and funeral homes/crematories in order to effectively collaborate with these professionals
4. Demonstrate spiritual/theological fluency and spiritual/theological reflexivity that integrate perspectives on loss, grief, dying and death from the fields of pastoral theology, spirituality, aging, health care, religious studies and theology
5. Provide spiritual care to people in diverse settings who are experiencing grief, loss, dying and death through engagement with case studies and active participation in a trusting and empathic online learning community  

This course will enhance the student’s attitudes, knowledge and skills in the following areas of competence as a spiritual care provider:

Attitudes:

• Radical respect for differences
• Self-differentiation
• Capacity for empathy and compassion

Knowledge:

• Pastoral/spiritual theology
• Spirituality and health
• Religious and theological studies

Skills:

1. Spiritual/theological fluency and reflexivity
2. Co-creation of meaning
3. Exploration of spiritual practices that connect with goodness
4. Empathic communications skills

Incompletes are not allowed in this course.

Pass/Fail grading is not allowed in this course.

Late Work: Timely submissions are critical for community learning. Notify the instructor if you have an emergency. The instructor will only consider arrangements to submit late work without penalty in rare instances. Otherwise these late penalties account for common circumstances that result in late submissions (e.g., sickness, work demands, travel):

<24 hours late: 10% penalty

24-48 hours late: 20% penalty

48 hours - 1 week late: 40%

> 1 week late: 0 points

Academic Integrity:  All students are expected to abide by Iliff’s statement on Academic Integrity, as published in the Masters Student Handbook, or the Joint PhD Statement on Academic Honesty, as published in the Joint PhD Student Handbook.  

Accommodations:  Iliff engages in a collaborative effort with students who have disabilities to reasonably accommodate student needs.  Students should contact their advisor to request accommodations. Advising center: advising@iliff.edu and 303-765-1146

Writing Lab: Grammar and organization are important for all written assignments.  Help is available from the Iliff Writing Lab (Links to an external site.), which is available for all students who need help beginning an assignment, organizing thoughts, or reviewing a final draft. 

Inclusive Language: Course participants should use inclusive language when speaking and writing. Terms and identifiers should not create barriers to a welcoming and supportive classroom community. 

This is an intercultural spiritual care course where we integrate theory and practice. Given our diverse backgrounds and experiences, this learning covenant will help us create and maintain a safe and formative learning community. In intercultural spiritual care, we demonstrate respect for what is unique and distinct about each other’s values, beliefs, meanings and practices. Our online communications should also reflect this ethos.

 

Academic standards

 All students are expected to abide by Iliff’s statements on Academic Integrity, as published in the Masters Student Handbook and the Joint PhD Student Handbook.

Students should demonstrate academic and professional communication skills that include coherent expression of ideas, use of good grammar, and appropriate citation of sources referenced in responses and assignments. All course participants should use inclusive language and language that respects the diversity of sexuality, gender and sexual orientation.

Discussion posts and responses are also expected to meet these academic standards (vs. more casual standards that apply to other online conversations/emails). Please proofread assignments and discussion posts before you submit. Seek support from the Iliff Writing Lab as needed.  

Timely submissions are critical for effective community learning. Notify the instructor if you have an emergency. The instructor will only consider arrangements to submit late work without penalty in rare instances. Otherwise these late penalties account for common circumstances that result in late submissions (e.g., sickness, work demands, travel):

<24 hours late: 10% penalty

24-48 hours late: 20% penalty

48 hours - 1 week late: 40%

> 1 week late: 0 points

 

Self-disclosure, Self-differentiation and Self-care

Unless specified, the purpose of self-disclosure in this course is not to process our own experiences, but to enhance group learning. Students are strongly encouraged to engage in life-affirming spiritual practices and rely on personal and professional support systems to process experiences that arise from emotionally laden course content. 

Self-differentiation is the ability to separate our own emotions from another person’s emotions and the relational dynamics so that we can respond with compassion without imposing our core values, beliefs, meanings, and practices (i.e., our spiritual orienting system or SOS) on another person. Ultimately, spiritual caregivers should experience emotional/stress reactions as helpful feedback in their ongoing practice of self-awareness.

Given the emotional content of this course, there may be moments when we react strongly to each other and/or to the content or dynamics of the course. When this happens, do an internal check-in, process your reactions and discern how to respond in ways that enhances group learning and are not focused on processing your own feelings. Use “I” statements that identify your feelings, not “you” statements that may imply a global assessment of another person. Internal processing is especially important in an online format because responses have the potential to come across as critical or without the intended compassion that we can more readily communicate through body language and tone of voice.

The course instructor is available for general educational guidance in relation to course content. Faculty are not able to offer ongoing counseling or therapy.  Faculty will offer support, help students evaluate the extent to which counseling may be helpful and make appropriate referrals if needed.

Word limits/ranges for posts, responses and assignments should help you focus on the most salient and meaningful ways to communicate knowledge, offer self-reflection, and provide spiritual care responses. If you are well under word limits, you may be having difficulty processing your own experiences enough to share them in depth. If you are well over word limits, you may be providing too much detail.

 

Confidentiality

 Personal disclosures and conversations occurring in online discussions and with learning partners are not to be shared outside of the course learning community without permission from the persons involved. Students can talk to people in their support systems about their own reactions but not the content of what class members share. Take care to disguise any identifying information about other students while being mindful that Iliff is a small community where other people can be easily identified.

Students must be aware of mandatory reporting laws of the state in which they provide professional care. If students are designated spiritual caregivers within a religious tradition, they also need to be aware of what their religious organization requires.  If students have reason to suspect or have first-hand knowledge of recent, current, or ongoing child abuse or neglect perpetrated on a child currently under the age of 18 years, elder abuse, sexual and domestic violence, or threats of homicide or suicide in any of the spiritual care situations they use for fulfilling the requirements of this course, they need to seek immediate consultation with supervisors, denominational leaders, and the course instructor to abide by proper reporting procedures. We will work together to establish an appropriate spiritual care relationship with all parties facing these crises. 

Faculty also balance confidentiality with mandatory reporting responsibility. It is Iliff’s goal that students feel able to share information related to life experiences in classroom discussions, in written work, and in one-on-one meetings. That said, faculty are required to share with the Iliff Title IX coordinator information regarding instances of sex/gender-based harassment, discrimination and sexual misconduct in the Iliff community. Students may speak to someone confidentially by contacting our Confidential Reporters: Dean of the Chapel and Spiritual Formation, Associate Dean of Admissions and Director of Consultation and Formation.

 

Helpful references

Iliff’s Title IX Policy

State Laws on Mandatory Clergy Reporting  

Colorado Mandatory Reporting 

 

 

Let me know if you have questions! I look forward to exploring these topics with you.

Kelly