Cultivating divine wholeness amid human brokenness:

Ministry to the sick, dying, and grieving

Amanda E. Sanders, MDiv, BCC, is a healthcare chaplain for the Providence Healthcare System, Seattle, Washington, United States.

Olivia was a patient who died unexpectedly from a perfect storm of unpredictable complications before I saw her and her family. She was six years old.

Ministering in such situations as Olivia’s case is an intimidating aspect of pastoral work, yet we cannot neglect them because suffering hearts are searching for spiritual healing. When individuals face life-altering illnesses, are actively dying, or are deeply grieving, spiritual care by both church pastors and clinical chaplains helps them navigate the gulf between the reality of human brokenness and the divine wholeness that God intended for us. As spiritual caregivers, we seek to help them find their way to the true Source of hope and healing.

But that challenges the pastoral status quo. Because suffering creates deep spiritual wounds, we must adapt practical ministry skills to meet their needs. Pastoral care becomes bearing witness, counseling becomes existential exploration, preaching and teaching become reflection and the making of new meaning, and leadership becomes ethical guidance. Within this context, as spiritual caregivers, we must be aware of the unique challenges that arise so that spiritual healing can take place.

Bearing witness

To “bear witness” is to sit with someone who is suffering, creating an opportunity for honest conversation about that pain. It gives legitimacy to suffering that is both very real and intangible. Take Olivia’s family: sitting with them; encouraging them; listening to their stories and remaining present as they feel every raw emotion; telling them that their pain, the love they felt for their daughter, and the future that they could not now imagine for themselves all mattered. The medical team, with their focus on physical solutions, will often overlook such pain, and well-meaning family members and friends might unintentionally dismiss the emotions experienced.

Spiritual caregivers must provide space for people to safely share their deepest pains. It involves an act of will and courage on our part because deep suffering radiates pain. Listening without judgment challenges our natural instinct of self-preservation. Being fully attentive means hearing the pain behind the words and recognizing when our personal emotional reactions threaten to take away focus from the one who is struggling.

As pastors and chaplains, we can slip into a number of common mistakes:

1. Being uncomfortable with strong emotions. Tears and angry outbursts are normal and natural and provide healing, although it is difficult for others to endure. The discomfort of being around such reactions can create a strong desire to escape or shut down that emotion. Such phrases as “just have faith” devalue the enormity of such pain, making the suffering individual feel even worse.

Solution: Go to therapy. Getting comfortable with personal feelings and processing trauma and pain enables us to have greater empathy. It also creates an ability to recognize personal emotional reactions that can get in the way of being fully present in someone else’s pain.

2. Being uncomfortable with death. Theoretical and spiritual knowledge of death is not the same as sitting in a room with it. Death is scary, painful, and confusing, and facing it brings up feelings that can overwhelm anyone. Efforts to make personal pain stop cause greater disconnection and more grief.

Solution: Take a clinical pastoral education class. Volunteer with a hospice or nursing home. Take time to really listen to those facing death and learn from them. The more comfortable we are with our own mortality, the more we will be with those dying.

3. Being too busy. Stories of suffering are often time-consuming and emotionally draining, making it challenging to set aside tasks that we might feel to be otherwise more productive. A distracted mind takes away from the sacred space needed to process pain and suffering.

Solution: Prioritize. Acknowledge the trust and courage it takes for someone to share their pain, and respect that by leaving behind distracting thoughts and daily tasks. Stepping into another’s pain is walking onto holy ground, and we must keep that space and time sacred.

Existential exploration

Suffering brings up existential questions that can seem too big or scary to talk through. They can even feel like a denial of faith, causing great emotional distress. For example, anger toward God is a common reaction to suffering. If left unacknowledged, it can grow into questions about God’s existence and the meaning of life. Existential exploration requires conversation about such topics as ultimate meaning, feelings of condemnation, and other, even deeper, questions. Initiating such uncomfortable conversations gives “permission” to speak what otherwise feels unutterable and thus begins the process of dealing with deep pain.

Suffering itself is a taboo subject that can trigger difficult questions. Our pastoral role is helping individuals learn how to be honest with God about things that they might consider unspeakable. Spiritual caregivers must be competent in meeting specific spiritual pain, such as deep grief, with appropriate spiritual practices. We encounter the true depths of human brokenness in conversations about “forbidden” Christian topics and existential questions.

Common mistakes in existential exploration:

1. Avoidance. When we, as spiritual caregivers, actively evade hard topics or make it clear that we are uncomfortable with them, we reinforce the isolation that those who are suffering already feel. It promotes unhealthy healing practices, and we miss opportunities to point hurting people to Jesus.

Solution: Listen to the Holy Spirit. Trust that God has called you to this place and given you the right instincts, especially when it feels uncomfortable. Get familiar with taboo suffering. One of the most common forms of this kind of suffering is miscarriage. Parents struggle to feel permission to grieve if they did not have a baby in their arms, yet a life has ended, which means that grief will be present.

2. Preaching/teaching. When we feel uncomfortable, it is easy to slip into this trap. We must balance nonjudgmental guidance with enough distance to allow individuals to find their own path of healing. In such situations, preaching and teaching are more of a crutch for the uncomfortable caregiver than a solution for suffering.

Solution: Rely on your “bearing witness” skills and have deeply formed relationships. Often, people have their own solutions and just need someone willing to listen attentively to help them work through them. Part of it involves having developed enough trust for them to have a safe place to talk through difficult topics.

3. Expecting solutions. We cannot solve suffering from this side of heaven—we can only struggle through it, especially when facing existential questions. It is in this process of wrestling with our existence that we find God. The only way to truly help someone who is suffering is to simply be with them.

Solution: Be intentional about not setting an agenda. Recognize that, as painful as it is, working through suffering is valuable in and of itself. There does not have to be a time frame or specific outcome.

Reflection and meaning making

Illness, death, and grief are transitional moments when people begin to question things that once brought value and meaning to life. Spiritual care offers safety in such searching as people reconnect with familiar practices such as Scripture, prayer, and anointing. Rituals give us a deeper sense of God’s presence. They also provide vital stability, especially in tragic, unexpected, or violent circumstances.

Spiritual care through reflection and meaning making (making sense of life events) helps people process suffering and reestablish normalcy. As spiritual caregivers, we must come to know our care recipients well because the practices we employ must have some kind of personal meaning for them as they seek to establish a new spiritual foundation. To help determine what will be ef­fective for each situation, we must have conversations about things like hope, relationships, meaning, and peace as we seek to find ways to connect ind­ividuals back to the familiar comfort they once found.

Some common mistakes in this area:

1. Apathy. It is easy to jump straight into beloved Bible texts rather than assessing the most effective practices for a particular situation because, often, we need a break from the pain.

Solution: Because this is deeply painful work, we must pay attention to ourselves and our personal reactions so that we can offer the right kind of spiritual care at the appropriate time.

2. Assumption. Choosing rituals, practices, or services “generally” considered comforting can devalue the individual circumstance. Take the example of feeling abandoned by God. While we usually consider Psalm 23 comforting, if someone feels as if God has left them, hearing about Him as an ever-present shepherd can make them feel more distanced.

Solution: Listen well and be bold in asking about needs. We must see those suffering in the light of their pain, which requires conscious effort. Asking what someone wants to pray for, for example, can open doors for assessment and conversation.

3. Preaching or teaching. To be preached to or lectured at when suffering can feel dismissive. It requires a judicious call because the line between it and spiritual reflection is blurry. Generally, the person talking most is the one who is healing most. Preaching or teaching can easily slip into alleviating our personal discomfort or stroking ego instead of helping.

Solution: Intentionally choose your responses. Use a good spiritual assessment model to determine the pressing needs and then select interventions that will be helpful. Use discernment and read body language so that you can adjust the intervention as needed.

Ethical guidance

In medical care, life-altering, ethically gray decisions come up on a regular basis, often because of limited information or time. It leaves people feeling lost, confused, and scared. Spiritual caregivers must be ready to have difficult conversations about topics such as euthanasia, termination of pregnancy, and ending life-sustaining treatments in relation to big questions about God, spirituality, and salvation. We also must always consider the complicated emotional responses that emerge in such issues.

Spiritual care in ethically sticky situations involves helping individuals find God amid their uncertainty. We must be willing and able to take in the available information and guide conversations to make the best decisions. That starts with understanding the value systems of the people involved and staying connected with them as circumstances change. The most important thing is to facilitate open, honest conversations.

Common mistakes made in ethical guidance:

1. Pride. Being on the outside of a situation can make certain decisions feel obvious, and with unchecked pride, our counsel can become pushy, cruel, and even abusive. No one is morally superior in ethically gray areas. Keep in mind that we are not God. There are questions that we cannot answer, no matter how much education or experience we might have.

Solution: Humility. Remind people you cannot make decisions for them. Liberal prayer will remind everyone involved that God is the only One who possesses all wisdom and that He is bigger than any situation we might encounter.

2. Personal opinions. Our personal opinions must not dictate the final decision. No matter how much individuals ask, we do not get to make their choices for them. Even if we do share our views, we should do so judiciously.

Solution: Be honest, clear, and firm. Use compassion and empathy to point individuals back to God. Our responsibility is to help people explore their own relationship with Him and then receive discernment from Him alone.

3. Fear. It will be crushing for those suffering if we avoid them or dismiss the pain they experience. Anyone facing life-altering decisions already feels alone and overwhelmed. Our role is to walk with them through it, no matter what we might feel.

Solution: We must wrestle with such issues ourselves. The more confident we are in what we believe, the less intimidated we will feel when such topics come up. It will prepare us to be humble, empathetic, and honest in our conversations. Because such circumstances take a spiritual and emotional toll, we must have our own spiritual counselors.

Final thoughts

Spiritual care for those facing life-altering illnesses, actively dying, and deeply grieving can feel impossible. Ministry to Olivia’s family felt impossible. What could I, a fallible, limited human being, do? The truth is, it is the space we are all in when offering spiritual care during moments of deep pain—a space of both deep fragility and immense resiliency that we must recognize and hold with tenderness. It is the space where our pastoral calling lies: in serving the deepest needs of suffering humanity by helping others to navigate through the brokenness of life toward the wholeness that only Jesus offers.


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Amanda E. Sanders, MDiv, BCC, is a healthcare chaplain for the Providence Healthcare System, Seattle, Washington, United States.

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