Christian communities face significant challenges in providing pastoral support to individuals nearing the end of life and to their families. Too often the church has accepted a role secondary to that of medical personnel, who tend to dominate while pursuing restorative and palliative goals. Equally, the church has too often misunderstood that the clergy are the primary providers of spiritual ministry in these circumstances because of the authority and representative features of the pastoral office. Both these responses to the opportunities for ministry occasioned by terminal illness reflect an understanding of caregiving as a professional service. Clearly there is a unique role for clergy as one nears life's end, but the ministry of the church ought not be reduced to the presence and ministry of clergy.

The term pastoral care denotes care that the whole church community provides to its members. It is a ministry of the congregation both through its ordained and its lay members. A call to ministry is inherent in baptism, which is, in effect, a general ordination of all Christians from which specific ministries evolve. Accordingly, laypeople have no option but to discover their particular gifts for ministry and to express those gifts along with clergy. Some laypeople will discover gifts for pastoral caregiving that will direct them to care for people at the end of life.

Laypeople across the nation are effectively meeting this call through Care Team ministry. Dr. Ron Sunderland and I created the Care Team concept in 1985 as we sought to engage the faith communities in Houston, Texas, in a compassionate, hands-on ministry with people with AIDS whose needs for daily care and support were too great for a single caregiver to meet.

A Care Team consists of twelve or more members of a congregation who are trained to provide social, emotional, physical, and spiritual care to individuals and families caring at home for a disabled or terminally ill patient. By sharing and coordinating the care provided, a Care Team can have a meaningful and more comprehensive ministry with people whose multifaceted and intense needs cannot be met by a single caregiver.

The success of AIDS Care Teams in Houston led us to adapt the model to respond to the comparable needs of others, such as dementia patients (Alzheimer's Care Teams), frail or terminally ill adults (Second Family Care Teams), and impaired children (Kids' Pals Care Teams). Presently 1,500 members of eighty congregations participate in our Care Team program. Faith-based groups have replicated our Care Team model throughout the U.S.

Understanding pastoral care as a ministry of the congregation is one strength of the Care Team concept. The New Testament presents life in Christ as a compassionate life lived together as community (Phil. 2:1–4). It is this compassion that draws members to offer care and support to others who are vulnerable and broken. By their presence and care on behalf of the community, they are expressions of God's presence.

Pastoral caregiving is fundamentally a ministry of sustaining presence. Both "sustaining" and "presence" denote key elements of the relationship. Caring relationships, from a theological perspective, are grounded in God's sustaining love and seek the growth and well being of the care partners. Thus, the focus should be God, who is present and who brings people together in the midst of need.

As God seeks to embrace people and empower them to realize the divine purpose in and through relationship, pastoral caregivers in end-of-life situations should seek the same end.

Although through their compassion caregivers provide practical comfort and assistance, this is not the ultimate intent of their compassionate acts. Rather, acts of compassion should seek to realize the underlying divine purpose. The relationship of and care by the community of faith has a sustaining quality that invites and nurtures openness to God's grace and redemptive purpose. It is by and through presence, an expression of relationship, that the divine purpose is sought and realized.

From a Christian perspective, caregiving is incarnational. Through human presence, God becomes present and active in the world. Presence is more than the essential method of pastoral caregiving. It is a symbol of goodness, kindness, hope, and, most important, grace. It is a sign that a person's suffering does not separate that person from God or God's community of care and concern. The presence of God's people manifests a redemptive power sufficient to prevent evil, pain, or loss from gaining an ultimate victory (Rom. 8:38–39). God's promise "I am with you" (Gen. 26:24) is echoed throughout scripture. It is presence, in and through God's people, that gives the promise substance. The promise does not portend a divine fix to one's problems. Rather, it is a word of grace that has power to overcome isolation, weakness, failure, pain, and loss.

The relationships between Care Team members and the families they serve are inherently spiritual. Care Team members are encouraged to reflect on each experience of caregiving to learn the deeper truths of God's grace and to be conscious of how their faith is shaped by their ministries of sustaining presence. The individuals and families who receive care are similarly encouraged to recognize the spiritual heart of the pastoral caregiving relationships that have formed around a threat of death. They are supported in their spiritual journey. No effort is made to determine the content or outcome of the pilgrimage or to define God's purpose.

Pastoral caregiving among Care Teams is a form of servanthood characterized by mutuality among the participants and an openness to God's grace and redemptive purpose. It is thoroughly spiritual. It is an expression of God's promise that "I am with you." For one at the end of life, there may be nothing more to be said or sought.

Earl E. Shelp is President of Interfaith CarePartners, Houston, Texas. This article is adapted from Sustaining Presence: A Model of Caring by People of Faith, (Abingdon Press 2000).