7 Ways to Shepherd the Terminally Ill

I’m writing about caring for terminally ill church members while going through treatment for an incurable non-Hodgkin’s lymphoma. I’ve been coming to terms with the reality that, apart from divine intervention, my life expectancy may be much shorter than I had anticipated for decades.

No doubt, I see terminal illness from a new angle. That, as a gift from the Lord, has helped shape my thoughts on serving the terminally ill.

Honestly, visiting a home or hospital with a terminal patient can be uncomfortable. We may say the wrong thing. We may fret about how we’ll react when we see a friend’s grim physical decline. Or we may grow anxious that we won’t have the answer to questions a family member asks. Those are reasonable fears, but not reasonable enough to keep us from serving those who need gospel ministry more than ever.

There’s something about vulnerable, compassionate service in the name of Christ, dependent on the help of the Spirit, that allays such fears. The Lord has called elders to shepherd the flock, even those sheep facing the immediacy of death. How should we shepherd terminally ill church members?

Let’s consider seven aspects of shepherding the terminally ill.

1. Shepherd them the way you would want to be shepherded.

As my wife and I walked the long corridors at MD Anderson Cancer Center in Houston where I was receiving treatment, I commented, “There are so many terminal patients here.” She reminded me, “We’re all terminal.” Living to be 80 or 90 may seem like a long time, but it’s a speck of dust compared to eternity. As we seek to serve those that may be much closer to death than we are now, let’s keep in mind our own mortality. How would we want to be shepherded in such times?

You want someone who’s compassionate, who seeks to enter into the anguish you’re facing rather than just wanting to check another duty off a to-do list. The terminally ill need someone who’s realistic about what lies ahead, not a well-wisher who keeps repeating, “I just think everything is going to be okay.” Yes, everything will be all right when we see Jesus, but right now it’s not. Face reality with this suffering saint.

2. Shepherd them with compassion, eye contact, gentleness, and touch.

Terminal illness can bring an almost non-human sense to the suffering person. The way that person had lived for so long has suddenly changed. Now they live with IVs, beeping machines, bedside monitors, lack of mobility, too-frequent visits from the phlebotomist, medical personnel coming and going, the weakening of body and mind, shortness of breath, and struggles to do what should be normal. The appetite has waned or disappeared. Kidneys start to fail. Skin color changes.

What do they need in such a time?

They need your focus, touch, and sensitivity. Unsightly things and unpleasant odors may be around, but you’re there to serve with love and compassion.

Years ago, I got a call that one of our members was nearing death. I drove to the home where she lay on a hospital bed, receiving hospice care. The sights and odors were enough to turn my stomach, but God gave grace to stay and serve this dear lady and her husband until the last breath. I had to get over my squeamishness, realizing how self-centered it would be to do a pop-in visit when her husband needed me to help spiritually and physically at such a time.

So what do you do in such cases? You give eye-to-eye focus. You hold a hand as you talk and pray. You speak with tenderness. You look for ways to serve. You treat them as a suffering saint who will soon see Jesus.

3. Shepherd them with gospel truth.

It’s always appropriate to talk about Christ. Reading Gospel portions breathes peace into a weary soul (e.g. John 5; 6; 10; 11). We derive great comfort from the faithfulness and sufficiency of Jesus revealed in the gospel (2 Tim. 1:8–12; Titus 2:11–14).

If there is no comfort in the gospel, there is no real comfort anywhere.

So speak about what Christ has done (John 19). Rehearse the effectiveness of his work (Heb. 10), the power of his death over sin (Rom. 3), and the triumph of his resurrection over death (1 Cor. 15).

Talk about how nothing more can be added to what Jesus has finished (Gal. 2). Reflect on his faithfulness to bear us up until the end (Rom. 8). If there is no comfort in the gospel, there is no real comfort anywhere. Rely on the sufficiency of Christ to help that suffering saint walk the last steps into the arms of the Savior.

4. Shepherd them with a view to eternity with hope fixed on Christ.

Here’s where we need to lay groundwork in our weekly exposition of God’s Word. So much of Scripture focuses on eternity. We’re a generation far more accustomed to thinking about living than about life’s brevity and the glory of eternity.

If we’ve worked through passage after passage that helps us to think about death and eternity, then our bedside conversations with a dying saint will be spent returning to those passages. We read these texts, offer brief comments, maybe even share an excerpt from a past sermon that this brother or sister has heard, share in the joy of what lies ahead, and help them ponder the staggering reality of seeing the glory of Christ. If you’re not excited about seeing Christ and spending eternity with him, it will be quite evident when you icily discuss eternity.

5. Shepherd them toward assurance of salvation.

When someone’s body and mind is weakened in the face of death, when a long life narrows to a few brief days, expect the adversary to attack. Satan never seems to back off, finding fiendish pleasure in denying believers joy in Christ. So talk about assurance of salvation with the dying saint. Read Romans 8 and John 10 with joy. (Greg Gilbert’s new book, Assured: Discover Grace, Let Go of Guilt, and Rest in Your Salvation, is helpful medicine.)

Gently ask questions and make comments about relying on Christ alone. Help to them see that Jesus is faithful to keep his own for eternity, that nothing can separate us from his love.

6. Shepherd them toward joy in God’s sovereignty.

I’ve been helped over and over by Revelation 5, where John gives us a picture of the sovereign rule of Jesus over the details of our lives—including our suffering and dying. When John explained that the Lamb “came and took the book out of the right hand of him who sat on the throne” (Rev. 5:7), he gave assurance to suffering saints that affliction is never in vain. Everything is on schedule to display the goodness and grace of God.

Everything is on schedule to display the goodness and grace of God.

Romans 8:28–39 details the way “God is for us” despite dark circumstances. Knowing his love for his people breathes comfort into that brother or sister who needs to be reminded that the loving Lord is on the throne.

7. Shepherd them with Scripture-soaked prayers, good hymnody, and stories of saints finishing well.

Prayer must always be part of your service to the terminally ill. Let your prayers reflect the application of Scripture you’ve read and discussed. You want to help this struggling saint visualize God’s faithfulness to his promises. Include them in your pastoral prayers so the entire congregation joins in interceding for them during this critical time. Let them know that though they are weak and may find prayer difficult, the body is praying with them and the Spirit is helping them in their weakness (Rom. 8:26–27).

Singing or reading a hymn at the bedside may also offer special comfort. Sing “He Will Hold Me Fast,” “Be Still My Soul,” “A Mighty Fortress,” “And Can It Be,” “The Power of the Cross,” “In Christ Alone,” or other great hymns. Bring along a couple more members to join you in singing with that brother or sister.

Borrow lines from John Bunyan’s The Pilgrim’s Progress that help to tell the story of crossing over into eternal glory. Read portions from the Puritans, who seem to be in a category of their own in visualizing the glories of eternity. Tell about Henry Martyn or Eric Liddell or David Brainerd or Robert Murray M’Cheyne or Charles Spurgeon—or any number of believers as they faced death.

Help Them Cross Over

My wife and I visited with one of our oldest members the night before she faced serious heart surgery. We didn’t know that the next morning during the surgery she would see her beloved Savior face-to-face. But we talked about the Lord Jesus, his faithfulness, eternity ahead, the joy of hope fixed on Christ, the beauty of heaven, and the deepest satisfactions found in knowing Jesus.

She was terminal, and we didn’t know it.

Yet the conversation, the Scripture discussed, the reflections on recent sermons, and the prayers all filled her with joy. Hours later she saw with clearer eyes, felt with deeper emotions, and heard with more delight the sights and sounds we’d attempted to talk and pray about together.

Our ministry to the terminally ill extends what we’ve been doing from the pulpit each week by bringing it home in fullest application. Let’s never be afraid to linger with the dying in order to help them cross to the other side ahead of us.