Closure and Legacy Near End of Life Donald Benjamin
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BRINGING PRESENCE: CLOSURE AND LEGACY NEAR END OF LIFE DONALD BENJAMIN RALPH DOHERTY B.A., Acadia University, 1983 D.P.M., Acadia Divinity College, 1986 M.Div., Acadia Divinity College, 1986 Th.D., Fountain of Life School of Ministry, 2006 Thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Ministry Acadia Divinity College Acadia University Spring Graduation 2018 © by DONALD BENJAMIN RALPH DOHERTY This thesis by Donald Benjamin Ralph Doherty was defended successfully in an oral examination on 30 August 2017. The examining committee for the thesis was: Dr. Stephen McMullin, Chair Dr. John Sumarah, External Examiner Dr. Glenn Wooden, Internal Examiner Dr. Carol Anne Janzen, Supervisor Dr. John McNally, DMin Program Director This thesis is accepted in its present form by Acadia Divinity College, the Faculty of Theology of Acadia University, as satisfying the thesis requirements for the degree of Doctor of Ministry. ii I, Donald Benjamin Ralph Doherty, hereby grant permission to the University Librarian at Acadia University to provide copies of my thesis, upon request, on a non-profit basis. Donald Benjamin Ralph Doherty Author Dr. Carol Anne Janzen Supervisor 30 August 2017 Date iii TABLE OF CONTENTS TITLE PAGE AND SIGNATURES i TABLE OF CONTENTS iv ABSTRACT xi CHAPTER 1: Biblical Foundations 1 Introduction Thesis purpose and Scriptural basis 2 Scriptural substantiation 3 First Scripture (with a promise): Exodus 20:12, the 5th Commandment 4 The Promise 6 Scripture examined: Ephesians 6:1–3 Further Scriptural foundation: 1st Timothy 5:1- 4 and v.8 10 Conclusion for previous Scripture passages 13 Wisdom: Wealth of Experience 15 The Love of God and τὴν ἀγάπην, the ‘first love’ as mentioned in Revelation 2:4 16 Exodus 33:14-15: ‘Presence’ of God 19 Bringing ‘Presence’ in the New Testament 23 Transcendence and Immanence of Presence 24 Ministry of Presence: a theology of ‘the image of God’ and of love in action 26 Contemporary ethnographers and theologians: a sampling review 29 William James: ethnography and religious experience 30 iv Table of Contents: Chapter 1 (continued) Leland J. White: ethnography and the Bible, the social scientific approach 32 Mary McClintok Fulkerson: context driven ethnography 35 Summary: ethnography and theology within this thesis 37 Historically Negative vs Positive Resolve 38 Concluding Thoughts 40 CHAPTER 2: Theoretical Foundations 41 Prejudice 43 Ageism 45 Ethic of love: ‘other-person centeredness’ 46 Significance of the work of God 48 The work of God: simply believing Christ 50 Enlightenment regarding work 51 Theory behind the practical need: the work of God in a community of faith 52 Preserving Dignity The substance of ‘faith’ in community 53 Overcoming the fear of Death 57 Final crisis: ego integrity versus despair 60 Needs of the dying from a psychosocial contextual approach … 63 Attending and redirection: prime factors and necessity 64 Legacy: The Ethical Will in enhancing dignity 67 Four pillars of Dying with Dignity 70 v Table of Contents: Chapter 2 (continued) The Interview 72 Logistics to be considered 73 Inuksuk Book Foundation Inc. Two-week Clinical Pastoral Education training course 74 Christian Body: helping to meet the need 75 Theory of the Question 76 The need for review 77 CHAPTER 3: Research Methodology and Process 81 Ethnography Introduction to the life review process 82 Catharsis, the purging of pain 83 Regarding the second thesis purpose: the Question Late stage/near end of life interview process 85 Interview delivery and specifics 86 Review and Debriefing 89 Potential harms 90 Potential benefits Confidentiality 91 Compensation Deception: avoiding bias Deception: innocuous 92 Other agencies doing similar work 93 vi Table of Contents: Chapter 3 (continued) Purchasing the equipment for the training aspect 94 Difficulty obtaining church support The Salvation Army and the Dignity Manifesto 96 THE DIGNITY MANIFESTO The alternate route: Inuksuk Book Foundation Inc. 97 INUNNGUAG - LIKE A PERSON 99 Traditions that shape and protect us 100 Interview process in practice: preparing for the interviews 101 Mont St. Joseph, the resident facility RESIDENT/ELDER BILL OF RIGHTS The Interviews 103 The first set of three Drafts and family review 104 The recording software and the transcribing 105 Supplied ‘life history’ suggested questions list For future data basing 107 Second group of interviews The final participant and a welcome printing option 109 Last stage 111 Final production process specifics Front cover and back with logo 112 Binding vii Table of Contents: Chapter 3 (continued) Final distribution 113 Conclusion of Chapter 3: Methodology and the end result CHAPTER 4: Analysis of the Life Story Interviews 115 Post Interview Individual Responses 1) Participant Number 1: Ms. S Participant follow-up response Comfort, closure, legacy, posterity and interview feedback As to the thesis Question under consideration and as stated on page 3, chapter 1 116 2) Participant Number 2: Ms. I 117 Participant follow-up response for Ms. I 118 Regarding comfort, closure, legacy, posterity and interview feedback As to the thesis question under consideration and as stated on page 3, chapter 1 121 3) Participant Number 3: Ms. G 123 Participant follow-up response Regarding comfort, closure, legacy, posterity and interview feedback As to the thesis Question under consideration and as stated on page 3, chapter 1 126 4) Participant number 4: Mr. R 127 Participant follow-up response Regarding comfort, closure, legacy, posterity and interview feedback 128 As to the thesis Question under consideration and as stated on page 3, chapter 1 131 viii Table of Contents: Chapter 4 (continued) 5) Participant number 5: Mr. T 132 Participant follow-up response Regarding comfort, closure, legacy, posterity and interview feedback 133 As to the thesis Question under consideration and as stated on page 3, chapter 1 136 6) Participant Number 6: Ms. M Participant follow-up response 137 Regarding comfort, closure, legacy, posterity and interview feedback As to the thesis Question under consideration and as stated on page 3, chapter 1 144 Final Response: Post Interview Facility Response Sheet On the response by Pastoral Care Coordinator, Deacon Eldon Danielson 146 CHAPTER 5: Conclusion 147 Brief recap of the purpose of the thesis Summary: Chapter 1 148 Summary: Chapter 2 Summary: Chapter 3 149 Summary: Chapter 4 150 Critical reflections: thesis Question; strengths and weaknesses of research; suggestions for further research and practice FOLLOWERS OF THE WAY: 153 Synthesis of findings 156 Closing critical reflections 157 Project summary and conclusion 159 ix Table of Contents (continued) BIBLIOGRAPHY 165 Texts Referenced Online Topic or Name and Website Referenced 169 On-line News or Television Productions Referenced by Name or Topic 172 APPENDICES Note: In general, appendix content retains original size font and formatting. Appendix A: Life Interview Questions, Life Events 173 Appendix B: Life Interview Research Consent Form - Interviewee 177 Appendix C: Life Interview Research Consent Form - Facilitating interviewer/transcriber 179 Appendix D: Life Interview Research Consent Form – Care Facility 181 Appendix E: Training Module to be used for teaching the ‘My Life Story’ process 185 Appendix F: Life Story Interviews 197 1) Life Story #1: Ms. S, aged 96 199 2) Life Story #2: Ms. I, aged 95 233 3) Life Story #3: Ms. G, age 39, classified as Palliative 267 4) Life Story #4: Mr. R, aged 86 279 5) Life Story #5: Mr. T, age 82, classifed as Palliative 307 6) Life Story #6: Ms. M, age 83 359 Appendix G: Foundational Documents of Inuksuk Book Foundation Inc. 419 x Bringing Presence: closure and legacy near end of life ABSTRACT In answer to a perceived need to mine like gold the wisdom of the elderly and those in palliative care for the good of society before it is too late to do so, this project was undertaken to develop a simple methodology for life story interviewing. A not-for-profit incorporated entity was created with intent to foster the ‘near end-of-life’ interview process as an option for everyone in society, regardless of background or culture. Four principal goals undergird the theoretical consideration, i.e. for provision of comfort, help with closure, provision of a legacy document for the family and, last but not least, for the sake of posterity. It is a moot point that, without the wisdom of the ages (or the ‘aged’ per se), generations to follow would be doomed to what some refer to as ‘insanity,’ i.e. ‘to do the same thing over and over again expecting a different result.’ Within this project, biblical validation was primary. The first step was stringent application of hermeneutic principle to exegete significant Scriptures that validate the project effort, e.g. the notion of honouring ‘mother’ and ‘father’ and the ramifications of this God driven requirement when interpreted within context. Following the validation and theoretical consideration, a simple training process for the individual life story interview was developed for application post thesis, principally as a course in clinical pastoral education but readily adaptable for training volunteers. Six interviews were completed, stories that tell of life. From immigrants who came to early twentieth century Canada in pursuit of a better life, to the tragedy of having to surrender control of life and family due to illness and palliative care, their stories tell of a moral courage, of faith and a willingness to engage and overcome against the odds. xi CHAPTER 1: Biblical Foundations Introduction This thesis project is on the practical and specific topic of elder and palliative care. It is an effort to create a working standard for what may be at times a neglected part of our social support network and fabric, i.e., service to the elderly and the dying for the sake of both recipient and those who remain, the living, who may need to be reminded that they soon may follow as recipients of this service.