Part III: Introduction
III. INTRODUCTION
Hospice Foundation of America is pleased to present this report to the Florida Department of Elder Affairs in fulfillment of the appropriation of the 2002 legislative session to conduct a statewide program of clergy education in bereavement and end-of-life care.
The Statewide Hospice Clergy End-of-Life Education Enhancement Project is the first statewide project of its kind in Florida, and one of the first in the nation, directed toward addressing the learning needs of clergy and faith community leadership so that they are empowered to minister effectively to families facing end-of-life issues. Its goal was to mitigate the deleterious physical and mental effects of futile aggressive care at the end of life by educating faith communities on end-of-life options, so that they may more effectively minister to families facing impending loss. As a method of expanding access to quality end-of-life information and care, this project, with its focus on specialized education, seeks to extend the traditional end-of-life education provided primarily by nurses and social workers to include clergy and faith community leaders as a resource for information in the health care decision-making process.
The project was a collaborative effort. Under the leadership of the Hospice Foundation of America it combined the statistical and planning expertise of the Health Council of South Florida, the community building skills of the Council of Community Coalitions of the Florida Partnership for End-Of-Life Care, the outreach and program planning abilities of regional health planning councils, the educational expertise of local hospices, and the clinical expertise of the Lamers Medical Group. An Advisory Committee, made up of an eclectic group of clergy, bereavement professionals, educational design specialists and hospice personnel, provided clinical and educational expertise and outreach advice.
Prior to entering into this project, the management team met with a number of organizations and individuals who had been involved in clergy education efforts. Every conversation produced the same admonition - the daily pressures upon clergy will seriously inhibit our ability to recruit clergy to attend the educational forums. We took that advice seriously, and placed our energies into program design at the management level, and labor intensive individual contact with clergy at the field level. Our participants numbered just over 600 clergy in 13 counties over a four month period. That amazing turnout is due to the concentrated energies of all the collaborators in the project.
If each of the 613 clergy or other faith community leaders who attended the educational sessions tend to a congregation of 300 people (not a particularly high estimate) we can potentially affect about 75,000 people over a period of time. However, clergy are in ministries for a lifetime, and we are unable to say how many hundreds of thousands of people can benefit from the information over a longer period of time.
In 1998 there were over 157,000 deaths in Florida. Studies have indicated that in many cases physicians do not know their own patients' wishes at the end of life, and many people die in pain. Individuals look to clergy for guidance during spiritual and medical crises. Because of the role that clergy play, both in the lives of individuals and their communities, they can be influential in improving the way people die in Florida. Many clergy members of all faiths and denominations, however, do not always feel comfortable participating in these situations. Investigations throughout the country indicate that end-of-life subjects are not included in the clergy educational curricula regardless of faith or denomination.
The failure of seminaries to train their students, coupled with the inherent difficulty in conversing with the terminally ill and their families, the lack of knowledge of the legal issues, the daily demands placed upon clergy that hinder the pursuit of continuing education, and the marginalization of clergy by the medical community, all serve as barriers to the clergy's unique mission of service and charity.
Clergy members, whether in a small congregation or a large one, are usually understaffed and frequently under funded. A pastor, priest or rabbi must be many things to many people. The demands placed upon them are many. This was recognized by the Florida Legislature in the study completed by Florida's Panel for the Study of End-of-Life Care, which noted that "greater efforts are needed to help Florida's residents receive more compassionate, dignified care as they near the end of their lives.."
Hospice Foundation of America is committed to assisting those who cope, either personally or professionally, with terminal illness, death and the process of grief. The Foundation works as an advocate for the hospice concept of care by conducting programs of professional development and working for the inclusion of hospice principles into the broader health care system. The Foundation has extensive experience in presenting mass education projects based upon adult learning theories and practice. With these qualifications, the Foundation undertook the Clergy End-Of-Life Education Project, with the express intent of furthering the acceptance and viability of hospice as a cost-effective care option at the end of life.
Caring for the dying and their bereaved loved ones is particularly challenging because there is often little tangible evidence of the good that is being accomplished. Sometimes there is little that is even said. It is precisely this intangibility that makes clergy so helpful in ministering to the terminally ill, because they (perhaps more than anyone else) are best able to combine the mystery of spirituality with the search for answers. The interior explorations of the dying regarding life's meaning and purpose, their personal and spiritual transformations, and the evaluating of meaningful relationships can be aided by a clergy member who understands the person's spiritual beliefs and who is familiar with grief and bereavement issues.
The clergy participants in this project do so out of a natural propensity to care for the bereaved. The bereaved may be the dying, their families, members of a faith community, friends and even strangers. Underlying all the facts, observations and recommendations presented by this project is the simple truth that it is a personal presence that is the most important element in caring for the dying. When combined with a basic knowledge, the clergy become a powerful force for improving the way Floridians die in the future.
