This March in Portland, a woman in her 80s became the first person in the United States to legally take her own life with a physician's assistance. Oregon is the only state in the country with a formal assisted-suicide law.

The issues surrounding death are manifold and complex. Christians have a needed perspective to bring to the debate, but to be effective they must be informed, compassionate and available. The Voice hopes to aid in this process.

One of the many alternatives to doctor-assisted suicide is hospice care. Hospice is an intensive, home-based, caring environment that emphasizes the control of pain and other symptoms associated with terminal illness. The care is given by medical professionals, family, friends, volunteers and clergy.

This philosophy of care is directed at improving the quality of life for the terminally ill patient and promoting dignity and loving concern for the patient and his family.

The Voice recently interviewed two people who provide hospice care. Chaplain David Hardisty has been a hospice chaplain for more than 10 years and is providing spiritual care in seven nursing homes for more than 750 patients and their families. Karen Arnold is the volunteer coordinator at the Adventist Home Health Care Center in Portland.


The Voice: Why do you do this?

Hardisty: I pursued chaplaincy and found this is exactly what God wants me to do, so I consider it a call. And it has been confirmed many times. That was back in 1988. I have been doing it ever since.

Arnold: Many individuals feel "called" to this work. They would say, "I just know this is what I'm supposed to be doing." There is great appeal to the work in that it is so personal. You get to witness and work with a great variety of home settings and family dynamics. You have the opportunity to work at the level of life where the issues are not superficial. The appreciation from those we serve is incredible and very humbling. It makes us glad to do what we do. The work has meaning; it makes a positive difference in the lives of others.

The Voice: What is the question people most often ask, or the thing most on their minds, as they are nearing death?

Hardisty: The question they ask more often than anything else is, "What church do you come from?" I try to dispel that by saying, "I am not a denominational person. I am here strictly as one of God's people to help serve you." The question they don't ask is the one that they really mean, and that is, "What's happening to me? Where am I headed? How can I know where I am headed?" Those are the kinds of questions that you have to draw out of them.

Arnold: They want to know, "How long do I have?" People are concerned about the control of their symptoms. If they are not comfortable physically, all other concerns usually take a back seat. They are concerned about whether or not they will be alone. They usually want to die at home. They are concerned about how those who survive them will manage. They aren't so much afraid of death itself; they fear the process to get there.

The Voice: How is the process of dying similar for each person? How is it different?

Hardisty: I don't know that there are any hard and fast rules. If a person has Jesus Christ in his heart, you have a great opportunity to work from that base to try to help. If they don't have the Lord in their lives, then that has to be a first. We are talking about something that will take them into their eternity.

Many of them think it can't be anything worse than what they are going through right then, but I try to bring to their awareness that the hell that they do not know about is going to be a lot worse. By dying you don't get out of it; you walk deeper into it. I don't try, however, to twist their arm. I think it is the Spirit of God that does the twisting if there is going to be any. My job is to deliver the message.

Arnold: The process is similar in physical ways and, actually, in emotional ways, too. For the most part, the physical signs and symptoms of approaching death are generally similar no matter what other differences brought them to this point. And for the most part, deaths are peaceful. It's different because it's happening to that particular person; it holds individual impact unlike anyone else's death.

The Voice: How important is religious faith to the patients and their families? Has the Christian faith in particular helped individuals face death with greater peace and confidence than those of other faiths or no faith at all?

Hardisty: If you know that God has died and paid the penalty for your sins and has said, "You are one of my family members. You have the promise of eternal life," then that is the foundation for knowing that the soul and spirit are going to find their way into God's loving presence.

For people who are in a lot of pain, people who are dealing with the deterioration of the body they have become so used to, the promise that the body is going to be a new body, one that is indestructible and incorruptible, is very comforting. Having that belief is the thing that will help them get across whatever threshold they are going to have to face.

It is amazing. The Spirit of God is there and can bring those that know the truth through this transition with the peace that they will come through it. In fact, they minister more to me than I do to them sometimes.

But the people who don't have faith are people who don't have any idea where they are headed. Some of them think the lights go out and it is all over, but that is not what Scripture says.

Arnold: I have seen the Christian faith give people the resources and strength they need to cope hour by hour. I have also seen similar awe-inspiring courage and strength from those of other faiths and no faith at all. Most of the people we serve say they have no religious preference, yet they cope just as well (and sometimes much better) than those who claim strong faith.

In my opinion, those who are religious tend to have a more difficult time than those who are spiritual. The grace and love of God transcends our religious systems and reaches those who do not acknowledge him to no less a degree than those who do. The difference, of course, would be in whether or not his hand is perceived.

The Voice: How involved emotionally do you get with the patients and their families, and does their situation influence your view of death?

Hardisty: Some very fine chaplains get involved emotionally with the patients. They really suffer. You begin to pick up the load of one grief after another, and it begins to inundate you. Some have had to leave the ministry because they were not able to keep some control.

I have had three deaths in my immediate family. I have lost a son, a wife, a father, and my mother is now 93, going on 94. I know she is probably going to be gone pretty soon. God has been very good and given me some kind of mechanism in buffering myself from the loss of an individual. I go through the feelings, and I know what it means to lose somebody, but I am not inundated by it. The strength of the Spirit of God protects me.

Arnold: Professional practice demands good and healthy boundaries. Although there are always some situations that touch your heart and emotions in special ways like no other, there is not a problem with emotional involvement or a person could not do this work. The influence on personal views of mortality is a healthy one. We learn to appreciate life and not fear death.

The Voice: For many friends and family members, death is an awkward time. They never know what to say or do. What advice to you have for them?

Hardisty: Most people are not wanting you to visit for the purpose of solving their problem because the solution is not going to come that easy. What they want you to do is come and be there. You don't have to say anything. All you have to do is sit in the same room, or simply put an arm on their shoulder and just say, "I'd like to pray for you. Let's weep together."

It might be that you just bring food to them. You sense their needs, and you meet them. You don't ask them if they want help; you just do it. Spouting off Scripture verses to someone who has just lost a loved one is inappropriate. This is the time to grieve. There will come a time when they will want to deal with those issues but not right then. Just be there.

Arnold: Saying and doing are not the most important things. Remembering and being there are far more important. We're still dealing with people here. They appreciate all the same things you do. Don't say, "Call me if I can go to the store for you." Say, "I'm going to the store this afternoon, and I will get you some fresh fruit; what is your preference?" or "I'll bring dinner every Tuesday night."

One of the easiest things you can say is, "I've been thinking of you, and I just wanted you to know that I love you and I'm praying for you." If you say you will pray, then do it. It's best if you pray right then and there with them; then they know you mean it. Keep your visits short, and stay in touch by phone or note. Don't take it personally if they seem to close you out. That's normal for someone saying goodbye and grieving.

The Voice: How do you care for the emotional needs of the patient's family?

Hardisty: If the person is a believer, the family are usually believers too. And they always are grateful for my being there because I am there not only to help minister to the person who is in bed but also to them. Very few people are really prepared for this kind of thing and not too many people want to try to prepare themselves in advance. They put off anything having to do with death and dying until the last moment. And when they do have to face it, often times they are not prepared for it. So I try to help. And if God is part of their lives, they need a kind of consolation, the kind of conversation and encouragement that a chaplain can bring.

Arnold: With their families, you apply your understanding that emotions are a part of the journey; they have value to the person who owns them. You give a rare gift when you are willing to witness their journey and not do the driving. You listen better than you ever listened before. You remember that everyone has one life and one death, and when it's your turn, you can do it your way.

The Voice: How can those preparing for Christian ministry prepare themselves to help people in this time?

Hardisty: I think that the seminaries and the Bible schools do a fine job of helping people to prepare for pulpit and public ministry. But I don't see that they do much in terms of helping people to prepare for one-on-one ministry. There is a greater need for one-on-one ministry, where you sit down with people and interact with them. You find out where they are, what their beliefs are, what their feelings are, and what obstacles might keep them from having a right relationship with the Lord.

If a pastor truly is to prepare his congregation for the realities of death and dying, he must have dealt with the issue himself before he can help his congregation deal with it.

Arnold: Learn to be real. Deal with your own fears first. Try your best to put aside your own agendas. Trust God and train your heart to be led by His Spirit. Don't be afraid of silence-- treasure it. Lots of work gets done in silence. Don't assume that you are important. Don't assume that you have to provide answers. Don't assume that you have to understand.

The Voice: What is your opinion of doctor-assisted suicide?

Hardisty: I believe in the sanctity of life. God alone has that power. God has title to our lives. If God allows us to go through pain, if he wants us to enter in to his suffering, then I'm not one to say why or how long it should be.

But we as caregivers should do everything possible to provide for the physical, emotional, psychological and spiritual needs of the person. We should not only help them stay alive but also help them want to stay alive and leave the rest up to God.

Arnold: I regret that people even think they need it. As a hospice worker, I feel that if physicians and patients were aware of the resources of pain and symptom management and emotional support available through care such as hospice provides, the option of hastening death would lose its appeal.