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Caregivers' Dispiriting Dilemma

Patients Near Death Turn Conversations to Spiritual, but Rules Prevent Religious Talk

February 03, 2001|WILLIAM LOBDELL

What would you do?

You're a caregiver. A month ago, you were assigned to take care of an elderly woman who's dying. It's a job most people wouldn't take because along with death comes indignity.. You must feed her and clothe her. And you have to change her diapers.

But you work this minimum-wage job because you believe it's a noble profession. For 40 hours a week, you give the old woman care, companionship and, with any luck, a sense of dignity.

She has no one else, so she talks with you. As her health slips from bad to worse, she's scared. And she wants to know about God. She wants you to tell her about him.

This shouldn't be too hard. You're a church-going Christian. You can speak easily about your faith. But you don't answer her. You have a dilemma.

The company that employs you has a rule: No discussing religion with your patients.

Though no industrywide standards exist, the no-religion clause has been instituted by many home health-care agencies. They fear the overzealous and unmonitored worker who proselytizes to dying clients--taking advantage of their vulnerable state.

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And if the caregiver's religion is different from the patient's, the problem grows because now they'll often have angry families to contend with.

Breaking the rule can lead to a suspension or termination.

So what would you do?

You're not alone with the problem. Religious-rights attorneys say they are seeing more and more of this in recent years. The thorny question:

What kind of spiritual care should caregivers--and nurses--give to their dying patients?

"The key thing is spirituality is different than religious conversion," said Mary Rapp, president of the National Conference of the Gerontological Nurse Practitioners. "It's not uncommon for patients to have spiritual concerns and real spiritual pain at the end of life. Offering comfort may be as essential as relieving their pain."

Rapp cautioned, however, that if religious questions went into much depth, a chaplain, not a caregiver, would be best equipped to answer them.

Many times, caregivers become the best friends of patients who are slipping toward death, making the ban on religious discussions difficult to enforce.

"I would suggest not to go into a discussion on faith. We discourage it," said one Orange County home-care provider who, like most agencies contacted, asked not to be named. "But [on the other hand] you're not there holding their hand, you're not there wiping away the tears.

"That can be a real pickle."

And then there are the 1st Amendment concerns.

"It's becoming more and more of an issue," said Matthew Staver, founder of Liberty Counsel, which specializes in defending religious civil liberties.

"There's a difference between using your position as a bully pulpit to proselytize and sharing information through normal conversation about your faith. And that line is easily determined."

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No one says that providing spiritual aid to a dying patient is wrong. Nurses and caregivers agree that faith is good medicine to the receptive patient.

And with death imminent, God is often a new-found passion for patients. But how do you, the caregiver, give gentle aid but pull up short of making a deathbed conversion? And how will your boss know that you didn't cross that line?

So, with the dying woman looking into your eyes, the question remains:

What would you do?

William Lobdell is the religion reporter-editor for The Times' Orange County edition. His column runs Saturday. His e-mail address is bill.lobdell@latimes.com.

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