A recent survey by the George H. Gallup International Institute demonstrated that American medicine often fails to provide what dying patients want most—death at home among close friends and family, assurance that the family will not be overburdened, and support for the spiritual concerns that accompany dying. While hospital, hospice, and congregational clergy are uniquely situated to support these wishes, only 36 percent of respondents in the Gallup survey saw the clergy providing adequate support.

In order to improve clergy members' effectiveness in meeting dying patients' spiritual needs, the Park Ridge Center will conduct a qualitative research study to better understand this critical issue. With funding from the Nathan R. Cummings Foundation, the project will provide a more substantial understanding of people's spiritual beliefs about death and dying, and offer concrete strategies to help dying people.

While the Gallup findings offer much useful information for hospital, hospice, and congregational clergy, they do not probe deeply enough into spiritual care at the end of life.

A number of questions need answering, such as, what do clergy understand spirituality to mean? What spiritual needs do clergy have as they seek to recognize and support the spiritual concerns of dying people? What barriers do clergy perceive to this type of care?

For the past twenty-five years, efforts to improve the experience of dying have been characterized by the assumption that professional bias, insensitivity, and dominance have prevented Americans from dying as they would like. Accordingly, solutions have included attempts to improve communication between patient and health care professional, promote advance directives, and defend the right to refuse treatment. However, as the Gallup results show, people are very dissatisfied with the care they receive at the end of life. If attempts to significantly improve the lot of the dying based on this paradigm have failed, perhaps we have focused too much attention on hospitals and other health care institutions, on the relationships of patients with doctors and nurses, and on legislative reform. We need to take a fresh look at the spiritual resources the dying draw upon when facing physical, emotional, and social suffering.

Over 90 percent of Americans now die in hospital or hospice, with attention to spiritual care provided by pastoral care professionals during the last few days of life. Congregational clergy have relinquished care for dying people and families to health care chaplains, concentrating instead on the tasks of nurturing the healthy religious and spiritual lives of their communities. As a result, congregational clergy now know less about the needs of dying people and spend less time with them and their families. These clergy are not much better prepared than any other American to support people through their chronic or acute illness to their death and dying.

Because of their unique involvement with parishioners over the life cycle, clergy offer a potential resource for improved spiritual end-of-life care. However, the issues clergy face are not well understood. Hospital chaplains have more training specifically related to the spiritual care of people who are very ill or who are dying. At the same time, they often experience systemic and personal constraints. For hospice chaplains, too, there is a need to better understand the problems of spiritual care at the end of life. There is a concern that hospice care is becoming bureaucratized, thus compromising the movement's founding ideals. As the original cadre of dedicated idealists leave, hospices are increasingly focused on shifting to the values of efficiency and effectiveness that mainstream health care demands.

By placing observers in the day-to-day environment of a hospital, hospice, and congregation, the Park Ridge Center researchers hope to gain insight into concrete issues facing clergy caregivers and the people whom they serve. Such insight will provide information unavailable through the 1997 Gallup survey. Given a more in-depth investigation of what end-of-life spiritual care means to people, about what spiritual support they want, and what prevents the clergy from offering that support, we can learn appropriate, practical responses by clergy might.