Deliver us from evil

I often describe my work as a palliative care physician as pastoral medicine, underscoring the way that caring for seriously ill patients necessitates blurring the distinctions we've come to expect in healthcare.Of course, the interdisciplinary aspect of care is well acknowledged in the field.Yet, while palliative physicians have become part-social worker, part-psychologist, and part-pharmacist, how comfortable are we as part-chaplain?I do not advocate for physicians to provide spiritual counsel to patients routinely, but the doctor-as-chaplain is not discussed often enough.As a new attending physician out of training, a patient asked me to be his chaplain; in fact, he specifically requested we not call a chaplain, preferring that I attend to his spiritual needs.This is obviously not something I was taught in medical school!Let's call the patient Robert.I was consulted on Robert's care to help clarify his goals of care with a likely new diagnosis of metastatic prostate cancer.One of our social workers and I sat with him as he shared his octogenarian life review in some detail.It became apparent that Robert's soul was guilt-stricken as he returned to this theme repeatedly throughout our conversation.He identified himself as a Christian from a mainline Protestant denomination.Over and over again, he asked me: "Will God accept me?" Ordinarily, Christian moral theology views guilt as a symptom of sin or wrongdoing; it is a healthy conscience doing what it ought to do to provoke a person to seek forgiveness and reform their life.His confessed shortcomings, though, appeared quite ordinary and even banal, or perhaps scrupulous.In this case, Robert was tempted to despair.Despair is the sin opposed to the theological virtue of hope, the virtue by which Christians confidently look forward to the kingdom of heaven, trusting in the promises of Jesus, hoping for the fulfillment of what we cannot yet see.Hope is "a sure and steadfast anchor of the soul" (Hebrews 6:19) stabilizing it to live faithfully in times of trial.For Robert his guilt prevented him from prayer, reading the Bible, or allowing a chaplain in the room.Instead of a means to forgiveness and mercy, it was an obstacle, and a serious one at that.Despair obstructs the primary task of a Christian in preparing to meet God upon death, and can shut off the soul from the possibility of forgiveness and thus salvation by falsely believing oneself to be unlovable or "too far gone." It is a sin against the truth.In the Biblical new testament, despair is often identified with the "sin against the Holy Spirit" (Matthew 12:31) and Judas's suicide after betraying Christ to his crucifixion (Matthew 27:5).As a pastoral matter, how can one respond to Robert's question authentically without falling into superficial spiritual reassurance?A recent volume, The Art of Dying: A New Annotated Translation, from physician and Dominican friar Columba Thomas provides a nice starting point, though some background is in needed first (2021).The "art of dying" (Ars Moriendi in Latin) was a popular 15th century Roman Catholic text intended to help Christians spiritually prepare for death, a final chance for repentance on the deathbed before the soul is judged after departing the body.As Thomas discusses, medieval piety featured robust belief both in realities after death and the spiritual power of the Church's sacraments (Cf.Aries 1981).In fact, the text was intended not only for the sick and their caregivers but also for the healthy.The art of dying was a mirror to the art of living, not unlike our observation today that people tend to die in a manner resonant with how they lived.There was also a very practical pastoral problem facing 15th century Europe: countless priests died from the plague through their pastoral work leading to a serious clergy shortage to minister to the sick and dying faithful.So, the medieval text was a kind of spiritual "self-help" book for Christians without access to a priest.Recent authors have drawn inspiration from the medieval text to engage a broader Christian or secular audience (Dugdale 2020; Verhey 2011).The art of dying text from Thomas reproduces much of the "abridged" medieval text with laudable annotation.The core of the text presents five temptations from wicked demonic spirits and five inspirations from holy angelic spirits to counter them centering upon the theological virtues and seven deadly sins.First, the temptation against faith and inspiration to faith; second, the temptation to despair and inspiration against despair (hope); third, the temptation to impatience and inspiration against impatience (charity, love); fourth, the temptation to vainglory (pride) and inspiration against vainglory (humility); fifth, the temptation to avarice (greed) and