Do Clergy Increase End-of-life Costs of Care?

When a loved one is challenged with a significant health crisis we request prayers for healing—just listen to the prayer requests on Sunday mornings. We want those who are struggling with health issues and who live with pain to get better. Whether it is living for second chances or for some long-awaited day or age, our initial desire is to live even when there are significant medical issues. We are after all, a people of faith that believes in miracles so we make decisions with the hope and yearning that things will get better.

When my father was diagnosed with cancer 17 years ago at the age of 63, we hadn’t had family conversations about end of life. We assumed that he would live into his 80s as did his parents. Once the cycles of chemo and radiation began, he didn’t want to talk about the “what ifs” and the inevitability of death because such talk would have felt like we were giving up on him. When the doctors told us that treatment options had been exhausted, even though we were unable to have the direct conversation with him, at least the rest of the family was aware that his death was imminent. We rallied to support him and worked with his doctors to keep him comfortable, understanding that there were to be no more tests or extensive life-saving measures.

As a pastor, I have had the privilege and responsibility to help other families engage in these challenging conversations. I always approached end of life conversations as being some of the most significant and spiritually profound that I had to offer. But not all clergy are willing or able to have those conversations.

Two recent national studies suggest that clergy find these conversations about the end of life decisions to be challenging. The researchers conclude that those individuals who are guided through these periods of health crisis by miracle-hoping, life-affirming, faithful clergy are more likely to increase the cost of their medical care. This is compared to the lower cost of those whose spiritual beliefs are honored by and supported primarily by medical staff. You may read more about this research here.

These studies lift up three areas of concern:

  • More than 30% of clergy said they would strongly agree with their church member who believes that God will cure their cancer.
  • Clergy apparently lack knowledge about palliative care and rely too much on nominal benefits that are offered with aggressive treatments at end-of-life.
  • Many clergy are most comfortable with supporting whatever their members decide even when those decisions can lead to prolonged and increased suffering for the individuals and their families, and even though the clergy personally believe it was against God’s will for people to suffer.

Death is never an easy subject. However, as clergy, don’t we have both the perspective and the grounding, morally and spiritually, to initiate these conversations with our congregants? If we are people of the resurrection, we need to be able to talk about death.  As one minister in the report stated, sometimes “death itself is a cure to what ails you. It’s the healing.”

Here are some suggestions to move the conversations forward:

  • Not comfortable talking about such things? Engage in continuing education to increase your knowledge about death and end-of-life care.
  • On-going personal work regarding one’s own mortality is also important.
  • Read “Being Mortal” by Atul Gwande or watch the FRONTLINE video by the same title as the basis for congregational and family discussions.
  • If you have a UCC health care or senior care organization near you, invite their staff to come and provide a program for your congregation about preparing for end of life decisions.
  • Invite hospice or palliative care chaplains or medical staff to come and talk with your congregation about end-of-life decisions.
  • Take opportunities to close the gap between personal beliefs and actions regarding end-of-life decisions.

In the words of the researchers: “What clergy say – and what they do not say—can make a major difference in whether believers experience a “good death”. So, let us say what needs to be said in order that our members experience the “good death” and their families can experience healing through their grief process. Such conversations have significant spiritual, medical and financial implications.

Beth Long-HigginsRev. Beth Long-Higgins serves as Executive Director, Ruth Parker Center for Abundant Aging at United Church Homes in Marion, Ohio, a member organization of the United Church of Christ Council for Health and Human Services Ministries.

4 thoughts on “Do Clergy Increase End-of-life Costs of Care?

  1. When accompanying parishioners and their family at meetings with medical staff to discuss end of life options, I always ask if they want me to pray at the beginning and have never been turned down. I give thanks for the loved one and medical staff, etc., pray for our understanding of the situation and God’s guidance for a decision that honors God and the loved one facing death. I have found it helpful to use active listening techniques on the family’s behalf: “What I hear you (the doctor) say is…; is that correct?” Rephrasing medical terminology in language the family can better understand and/or rephrasing in ways that bring out issues of concern to the family can help them discern the way forward. I will also ask questions that I have heard family members ask outside the doctor’s presence, if the family member does not ask, to ensure those concerns are addressed. On the few occasions when the family has asked me, “What do you think, Pastor?” I have responded by identifying the concerns they have stated to me and pointing to the option(s) that address those concerns. Asking clarifying questions can gently lead the family to make decisions that honor their loved ones and their faith values while avoiding excessive medical interventions and costs. Fortunately, I have yet to encounter a deeply divided family that cannot agree on an end of life decision, nor have I been involved in a situation that might lead to the loved one being in a legally ambiguous state, such as a persistent vegetative state.


  2. You really have to phrase it the right way to avoid coming off as trying to coerce or brainwash people. Avoid a tone of “if you just knew better / could be more open / were thinking of her instead of yourself…” Make sure ALL options have been explained, pain is being managed, and the doctors agree there is no hope.


  3. Pingback: Do Clergy Increase End-of-life Costs of Care? - Ruth Frost Parker Center for Abundant Aging

  4. Pingback: Do Clergy Increase End-of-life Costs of Care? | Vital Signs and Statistics - Ruth Frost Parker Center for Abundant Aging

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