A developmental Approach to Spiritual Experience at Life’s End



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A Developmental Approach to Spiritual Experience at Life’s End

By Ira Byock

Death and the knowledge of its approach confront us with questions that define the spiritual domains of human life. Death forces us to turn our faces toward that which we want most to avoid—toward profound questions, such as "What is the meaning of my own, individual life?" or "Is there continued existence beyond this life?"

These questions are relevant for us all, but they are critically important to the research and practice of those of us who have chosen to care for and support people who are dying, and those who are caregivers, and those who grieve. How do we respect and care for the spiritual well-being of dying persons and their families?

Medicine approaches dying as if it were solely a problematic medical event. Patients and families receive evaluation and intervention only when there are "problems" that reach clinical proportions. Conversely, when pain is controlled and there are no identifiable problems, medicine is presumed to have no further role to play and no legitimate services to offer.

But dying is more than a set of medical problems. Despite the many medical needs of people as they become progressively more ill, the fundamental nature of dying is personal—and experiential. It involves suffering, transition, and transcendence, a new sense of meaning and felt connection to something that endures. Spiritual questions and dimensions commonly assume greater importance since one nears the end of life as one’s perspective becomes less obstructed by the demands and priorities of a full and busy life.

People can continue to change in important, substantive ways—to grow—even as they are dying. A developmental taxonomy encompasses the experience of reconciling fractured relationships, healing interpersonal wounds, as well as "inner wounds" related to past disappointments, unfulfilled dreams, grief, anger, and remorse. It clarifies the value of things through life review and storytelling—activities that help people make meaning of their own life.

Therapeutics within a developmental model is neither mystical nor overly technical. Indeed, it will be recognized by most clinicians in hospice or palliative care as the sort of work we already do. For instance, I often suggest patients ask themselves, "What would be left undone, if I were to die suddenly, today?" This is a question that puts things in perspective, challenging us to examine the relationships that could be mended, the promises as yet unfulfilled, the things we would like to say to others who are important in our lives, the projects that we must complete or turn over. This question can open the door to the questions of meaning and connection within a mysterious universe that lie at the heart of spiritual experience. As clinicians, our caring interventions can be directed at helping the person to achieve a sense of completion within each sphere of his or her life. Roles and relationships are not ripped from the person as much as completed and then released as the person progressively "lets go."

I am not proposing new clinical interventions. I am suggesting that there is value in thinking of familiar counseling strategies and therapeutic techniques within a developmental approach to spiritual development at the end of life. Even spiritual activities such as prayer, meditation, and religious rituals can be understood within a developmental model in a manner that fosters specificity within our pastoral counseling interventions.

How do we facilitate spiritual growth within this clinical model? One patient—and one family—at a time. It may well not be what we do, but rather how we are that matters most, such as demonstrating tender, loving care—touching suffering patients, gently massaging a patient’s hands or feet, or singing softly can soothe dying patients in distress. These can be part of spiritual care. Finally, involving a patient’s family and community in the dying process is essential. Spirituality is inherent in both family and community; a person’s connectedness to family and community instills meaning in his or her life and can endure beyond death into the distant future. Ethicist Laurie Zoloth has written: "That each of us will die is inevitable; what must come to be understood as miraculous is our ability to love and bear the weight of the dying in fellowship."

Palliative care can be practiced in a manner that acknowledges the full range of human experience and human potential within the people we serve. By reflecting these values and perspectives in the manner in which we relate to and care for people who are confronting life’s end, and by modeling tender loving care, we can nurture peoples’ capacity to grow—inwardly, outwardly, and together—through the very end of life.



Ira Byock, M.D., is co-founder and principal investigator of the Missoula Demonstration Project—a collaborative, community-wide effort to study and transform end-of-life experience and care—in Missoula, Mont. He is also director of the Palliative Care Service.

(Reprinted from Spirituality and Medicine Connection, Volume 4, Issue 4, National Institute for Healthcare Research in Rockville, Md.)



Volume 11/12 July/August 2001

The Mystery of Altruism

Jeffrey Schloss on the relationship between evolution and Christian love

By Thomas E. Hosinski

Jeffrey Schloss, professor of biology at Westmont College, Santa Barbara, Calif., delivered a public lecture on April 3, 2001 at the University of Portland titled, "Is Christian Love Evolutionarily Impossible?: Darwinian and Theological Perspectives on the Mystery of Altruism."

Schloss is a nationally-known expert on evolutionary theories of altruistic morality. The lecture was co-sponsored by the American Scientific Affiliation, the Templeton Foundation, and the College of Arts and Sciences of the University of Portland. It was the final lecture in a series of three lectures on science and religion delivered at the University of Portland in the past three semesters, supported mainly by ASA/Templeton Science-Religion Lecture Grants.

The audience, numbering approximately 200 persons, was a mixture of undergraduate students, faculty in biology, theology, and other disciplines, a few clergy, and interested persons from the Portland area.

Schloss began by contextualizing the problem of altruistic love in the history of evolutionary theory. Before Darwin, developments in the geological and biological sciences had begun to reveal the scale and scope of animal suffering and death. Alfred Lord Tennyson’s "In Memoriam" had already expressed the implications of early evolutionary theories that nature, while beautiful, could not be seen as governed by goodness or love. Darwin’s theory of evolution by natural selection seemed to require competition, struggle for existence, and death as the engine driving the evolution of living organisms. In such a struggle, self-interest seemed to be a major constraint on the very possibility of altruistic behavior. Darwin himself held that natural selection could not account for any characteristic in an organism that benefits only some other organism. Yet observations of apparently altruistic behavior in animals, such as sterile insect castes and warning calls of birds in mixed flocks, seemed to contradict the predictions of Darwin’s theory.

Schloss then summarized the various developments in the discussion of altruism in 20th-century biology, beginning with sociobiology. Kin selection or inclusive fitness theory (that organisms will self-sacrifice for other organisms that share a significant percentage of the same genes) and the theory of reciprocal altruism ("you scratch my back, I’ll scratch yours") seemed to resolve the problems posed by sterile insect castes and warning calls in mixed flocks of birds. But further observational research and the explicit application of these theories to human nature and conduct posed new problems. Genetic lag theory and manipulation theory seem to recognize that altruistic behavior actually exists, that there is room for characteristics and behavior that are not biologically beneficial. Altruism, defined as any behavior that benefits others at a cost to self, seems to sneak past natural selection and be present in animal behavior, especially in human beings.

In response to these developments, a class of theories known as "indirect benefits" theories try to explain apparently altruistic behavior as causing reputational benefits or disbenefits for the organism. Self-deception theory holds that altruism is actually a costly and hard-to-fake signal that one is a reciprocator, not a cheater, but that this is really motivated by self-interest. The best way to cheat and not be detected would be to self-deceive, to consciously think of oneself as altruistic yet be unconsciously motivated by self-interest. This theory arose to explain moral teachings such as Jesus’ command to love one’s enemy as oneself. Schloss pointed out that this theory does not contradict the religious understanding of human nature. The Judeo-Christian tradition emphasizes the reality of self-deception and hypocrisy, as in Jeremiah’s lament on God’s behalf that the people honor God with their lips, while at the same time their hearts are far from God.

But although religion can accept the reality of self-deception and hypocrisy, recent research shows the actual existence of true altruism in human society. The most recent developments in the field, hierarchical approaches (levels of selection theory), suggest that, at least for humans, behavior is influenced not just by "selfish" genes, but also by ideas. Schloss pointed out that this is recognizing a non-material basis for human behavior and admitting that reductionist approaches to understanding altruism are not sufficient to account for observations. While this is currently a topic of hot debate among those who theorize about altruism, it seems that the most recent developments open the possibility of a constructive conversation between science and religion on this topic of altruism.



Rev. Thomas E. Hosinski, C.S.C., Ph.D., professor of theology at the University of Portland, is a 1998 Templeton Science-Religion Course Award winner. He specializes in philosophical and systematic theology and the science-religion dialogue. He has taught an annual course on science and religion for more than 20 years.

Volume 1.10 June 2001

Voluntarism: The Secret to Happiness, Health, and Longevity



By Douglas M. Lawson

Recently in the New York Times, Dr. William Sunderman, a 102-year-old physician who remains active in the workforce, made these revealing observations about friends who have retired to Florida: "The first year, they play golf three or four days a week and have a highball before dinner. The next year they play twice a week and start having liquor at lunch. Then they forget about golf, become alcoholics, and pass away."

However, Sunderman, who is in his second century, remains committed to helping others. His accomplishments are, as he says, "too long to tell." They include faculty positions at nine medical schools. He also served as chief of clinical pathology at the Communicable Disease Center at the United States Public Health Service.

Another active centenarian, Milton W. Garland died last year at the young age of 104. Up until two months before his death, Garland, who had earned 41 patents in the field of refrigeration and was known affectionately as "Mr. Refrigeration," he worked 20 hours a week evaluating refrigeration patents. Garland is quoted in the New York Times as saying, "Live like you’re going to live forever, not like you’re going to die tomorrow."

At 79, Walter Burnette operates a power shovel for eight hours a day in Virginia. At 92, Charlotte Haugland, a CPA in Tacoma, Washington, remains active daily, doing accounting and taxes for both individuals and businesses from her home. And at 93, Clarence Wilcox of Sierra Vista, Arizona, works 40 hours a week as a civil engineer.

What do all these people have in common? They work daily, and in so doing they have found a purpose in their lives as they grow younger each year they live over 65.

But is work the only way to find purpose in our lives as we age? Absolutely not. Another equally meaningful way to find a purpose is through volunteering.

As Dr. Harold Koenig pointed out in his 1998 literature review for the Templeton Foundation, purpose in life leads to greater joy, mental health, productivity, and better physical health. One of the greatest ways for older people to find that purpose in their lives is through volunteering.

Referring to Viktor Frankl’s Man’s Search for Meaning, Koenig points out that the sense of "boredom" directly points to a lack of purpose in life. Quoting from a national random sample of 1,644 persons aged 60 or over by McIntosh and Danigelis, Koenig notes the authors’ conclusion: "It is clear that the most important productive activity for predicting [well-being] among seniors is informal volunteering, and the least important is paid work."

At 65, Maida Apodaca of El Paso, Tex., is a volunteer extraordinaire. She has a purpose in life, and she stands out as an example of how one dedicated person can make a difference. Over the years, she has been spearheading the building of homes for needy families in Mexico. Through a non-denominational Christian organization, Casas por Cristo, she has raised money to build 242 square-foot, two-room houses which are a vast improvement over the dirt-floor cardboard shacks where the families were previously living.

A devout Catholic, Apodaca sees her volunteer efforts as "the Lord’s work." She notes that once you get started in work like this, you can’t stop. She is thankful she has a chance to be a volunteer, for as she puts it, "You always get more than you give."

In Dallas, a retired multi-millionaire, Mort Meyerson, learned about volunteering when he teamed up with H. Ross Perot to run Perot Systems after he had successfully been the CEO of EDS, Perot’s Dallas company. One Christmas, he surprised everyone at the company by canceling the Christmas party, and used the $360,000 they were going to spend on the party to buy food, clothes, and toys. He then asked fellow employees to deliver the goods to inner city people in need. Meyerson describes the reaction in vivid terms: "The result was, first, outrage that we canceled the party, then depression, then recognition that we were doing something different, and then elation for those who actually took those things."

What this volunteer task did for employees was extraordinary. "It made them more human," said Meyerson. "It made them more effective as employees. It made them better family members. It did a whole bunch of things. I mean, I had an old-line operations person from the computer center come to me after he delivered some of the goods in inner city Dallas, and he had tears in his eyes. I’d never seen him show an emotion, much less tears. And he said, ‘When you first canceled the Christmas parties, I could have strangled you. But I just returned from giving some toys, and I’ve seen the life that these people live. I’ve been to the inner city. I’ve never experienced this. This has changed my life.’ "

Community involvement through voluntarism offers people an opportunity to participate in efforts toward self-fulfillment, self-esteem, and greater joy in life. The United States is the wealthiest country in the world, although it contains only five percent of the world’s population. Our culture hungers for more meaning and purpose in life, and volunteering is a way to shift our focus from money to purpose and satisfaction. Volunteering time, talent, and treasury is one of the best ways to find the meaning we all seek.

If volunteering is this important, particularly for older persons as they search for meaning in their lives, how can we motivate more people to volunteer? The answer is three-fold. First, volunteers are happier than non-volunteers. Since Tom Jefferson proclaimed "happiness" to be one of our inalienable rights in the Declaration of Independence, all Americans have sought the secret to happiness. It is a very elusive butterfly until one finds out how happiness is really achieved–not by seeking it, but by first giving happiness to someone else. In making another person happy through our volunteering efforts on their behalf, we become happier ourselves. That happiness is seen in the tears of the Perot Systems on-line operations person when he returned from delivering the toys to the underprivileged children of Dallas. A Christmas party did not bring this kind of happiness to this man; his voluntary effort on behalf of others did.

Cornell University tracked a group of people over a 30-year period and reported that those who volunteered were happier and healthier than those who did not. It was clearly determined those who volunteered had a greater sense of self-satisfaction, a purpose in life, and were happier overall than those who did not volunteer.

Volunteering also significantly allows a reduction of toxic stress in our lives. This gives us feelings of self-acceptance which then allows us to feel compassion and empathy for others.

But you don’t have to change the world to benefit from the happiness derived from volunteering. A person can find small ways to serve his or her community which correspond with the person’s interests and available time. Happiness through volunteering is truly ours for the taking. This is the first motivating factor that we can use in influencing others to volunteer.

A second motivational influence that can elicit a positive response from a person debating whether or not to volunteer is the fact that volunteers are healthier than non-volunteers. Physiological responses from volunteering can be measured and charted by medical technicians in lowered stress levels, heightened immune systems, and better sleeping patterns. Volunteering releases natural chemicals in our brain called endorphins that produce a feeling of joy and greater clarity, much like the feeling athletes experience during a good workout.

Volunteers have been studied, and researchers have found that after just a few hours of volunteering, a person’s general physiological demeanor and psychological well being are so heightened that this has been nicknamed "the Helper’s High." Proof of this has been found in the heightened endorphin levels found in women after just one day of volunteering at a hospital.

The third influence on the thinking of a person contemplating volunteering is the documented fact that people who volunteer live longer than people who do not. As already noted, volunteering provides a person with a significant reduction in toxic stress chemicals in the body, actually reducing stress levels. Volunteering decreases a person’s metabolic rate and increases the possibilities of a good night’s sleep. Volunteering also enhances proper functioning of the immune system, and all of these positive effects of volunteering seem to add to the result that volunteering can lengthen a person’s life. Medical schools have studied men who volunteer after age 65 and those who do not. On average, senior men who volunteer outlive the non-volunteers. This is a medical fact that too many retired men do not know.

But the greatest benefits for a person living a healthy and long life as a result of voluntarism are spiritual. As a person becomes a volunteer, he or she steps out into the community with a greater sense of connection to his or her fellow citizens. The volunteer has a better appreciation and acceptance of others with a greater clarity about the meaning and purpose of life.

One of the questions asked by a non-volunteer when contemplating the possibility of volunteering is, "Will my volunteering make any real difference?" The answer is a positive "Yes!" Like a pebble thrown into a pond whose ripples flutter to the shore, every act of kindness displayed by the volunteer creates a chain of positive good into the lives of thousands of people the volunteer will never meet and continues into future generations.

Our cultural tendency for immediate gratification often blinds us to our own effectiveness. A person can volunteer in ways that will make small changes over time, affecting the long-term greater good of the community and the world. Taking a longer look at voluntarism can help the person contemplating becoming a volunteer understand him or her small role in the great scheme of making this a better world for everyone.

Did Mother Theresa’s life as a volunteer among the oppressed make a difference? Did Princess Diana’s life as a volunteer really touch the lives of other people around the world? Did Victor Frankl’s search for meaning in the concentration camps really prove useful to mankind? We know that these well-known people of different faiths, all of whom were taken from us in the same week, did make a difference. Volunteers can make a difference in their own lives of service to others. This is a very important motivational tool as we attempt to influence others to volunteer. Will what I do really make a difference? The answer is, "Yes," regardless of who we are and what our circumstances are in life.

As a person grows older, the question of how to handle death is always near. Can a life of volunteering help a person face death? Volunteering helps a person face life daily, and it also helps a person face the issue of his or her own mortality. Being fully engaged in life as a volunteer helps a person live a life rich with truth instead of a life filled with fantasy and escape. A person can derive so many extraordinary benefits from volunteering that he or she can experience a life that is almost completely free from self-obsession and worry about mortality.

All of us want to leave something behind, a token of our attempt to make the world a little better. Anindividual may be able to leave a legacy by donating enough money to have a building named after his or her. Other individuals may leave their marks on this earth because they gave their time to deliver meals to shut-ins, offered their services in their place of worship, or worked in the civic affairs of their community.

When Mort Meyerson was CEO of 45,000 people at EDS and 13,000 at Perot Systems, and canceled Christmas parties, he said he only gave 10 percent of his time to community and philanthropic projects. Now that he is retired, he gives 50 percent of his time to these activities as a volunteer. In his words, "I think I make a bigger difference in life today than when I was a (CEO). . . . I mean, I was paid a lot of money, and it was a good thing. But the facts are, I was simply in front of a herd of people pushing me forward. Now (as a volunteer) I’m right where the rubber meets the road."

Proverbs 29:18 points out this everlasting truth: "Where there is no vision, the people perish." One of the best motivating factors in compelling a person to become a volunteer at any age is "vision" and getting a person to see it, feel it, and internalize it. The greatest barrier to improving society and the environment is indifference. So many people absorbed with their own needs and immediate problems do not see that all of us ultimately are affected when any one of us suffers. If we are sufficiently troubled about the future, the resulting fear eventually breeds insensitivity. We lose perspective, to the point that all our energy and thoughts are for ourselves, not for others.

This is the beginning of a living death that only gets worse as we grow older. How can we get out of this prison? One way is through giving ourselves to others by volunteering our time and talent. Do people want to exist in this lonely living death of indifference to others? The answer is, "No." But if volunteering is our way out of this lonely living death, how do we get this message to the non-volunteer who is experiencing this living death everyday?

We start by communicating to the non-volunteer the three motivational tools–a longer, healthier, and happier life that are the rewards for volunteering. The giving of oneself to others offers a person the opportunity to glimpse life beyond his or her own unique perspective and find a greater understanding of the world around themselves by discovering a true sense of compassion for others. We learn how to live by learning to face the world around us and offering ourselves for service where we can help make a difference. This is our way out of the living death.

If all the world stayed home indulging only in personal, individual pursuits, we would be reduced to wild animals who defend their territories with cruel vengeance. However, in contrast, when we open our hearts and leave our homes and go into our communities, we find beauty, mystery, and the true connection to the world in which we live. In fact, community involvement actually reduces our level of fear of the unknown because we see the world with open eyes instead of through imaginary fearful thoughts. Facing life by addressing needs in our immediate neighborhood or city shakes up our own belief system, regardless of our religious persuasion, and reveals to us how the world really works. When we learn about the real world by participating in it as volunteers, we are capable of listening to the truth told by other people, and then life becomes a harmony.

The busy "marketplace" of life has produced a culture of people directed toward individualistic pursuits. In contrast, it has also produced a culture of volunteers who are willing to step outside their personal needs long enough to find a deeper, richer significance in their lives that money, fame, beauty, or education cannot buy. The "pearl of great price" is voluntary service to others. The only way to find life is to lose it first in service to others. And that’s what we really want, a life that is found which becomes a life full of meaning. That’s what volunteering is all about. That is the motivational message we have for everyone of any age, but it is particularly the message we have for older persons: "You can find meaning in your life, but you can only find it truly in service to others."

And where can older persons find places to volunteer their services to others? The easiest place is in the faith-based charities in our communities where we live. Most easily found are charities such as Habitat for Humanity International, where volunteers young and old build affordable housing for the poor, or perhaps in one of the more than 50 faith-based organizations that Fannie Mae has worked with to expand affordable housing and community development, especially to minority families and underserved groups.

Several years ago I wrote a book titled Give to Live: How Giving Can Change Your Life. In San Diego, where I gave a lecture based on this concept, I met a 90-year-old man who had been practicing with his wife all the principles I expounded in the book about giving and volunteering. His name was Cecil Green, one of the founders of Texas Instruments. By the time I met him, he and his wife, Ida, had already given away over 150 million dollars. I gave Dr. Green a copy of my book, Give to Live, and after reading it, he wrote me back these words: "I believe what you say in your book is true. But the way Ida and I would have put it is ‘We Lived to Give.’"

Cecil Green is now 100 and still living to give. What an example to all of us, rich or poor. We get our lives through giving to others. "And if any man would lose his life for my sake, the same shall find it."

Cecil and Ida Green lived to give. May the same be said of you, me, and all of us who strive to find meaning in this life we live as we live to Cecil’s young age of 100. Following an example like his and the thousands of volunteers who have gone before us, may the end be the greatest motivational factor in getting all of us, young and old, to become volunteers.

Douglas M. Lawson, Ph.D., is the founding chairman of Douglas M. Lawson Associates, Inc., a fund-raising and management consulting firm that has represented such clients as Habitat for Humanity International and Special Olympics International. Lawson is the author of Give to Live and More Give to Live: How Giving Can Change Your Life.

Volume 11/12 July/August 2001

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