End-of-Life Care Ministry in the African American Church

Abstract 

“God of our weary years, God of our silent tears,
Thou who has brought us this far on our way,
Thou who has by thy might led us into the light,
Keep us forever in the path we pray.”

Lift Every Voice and Sing - Negro National Anthem
James Weldon Johnson

The character and identity of the African American church has been forged out of a particular historical, cultural and theological context. As a result of the long, difficult and often violent history of slavery, racism and continuing oppression that African Americans have suffered in this country, the church has traditionally been and continues to serve as the center of African American community life. In addition, the church has been viewed as the institution that African Americans have turned to most often for comfort and support during the periods of crisis that have occurred at various points of transition in life. From birth to death, the church has been the place where African Americans have come to share their joys and their sorrows when the larger society refused to grant them dignity or respect. Because of the danger and the threat of physical violence that has always been a part of African American life in this country, one of the most important of those transition points was at the time of death or when a member of the community was dying.

Historical and Cultural Context

The history of African Americans in America is a history filled with violence and death. This history is referred to by Dr. Karla Holloway in her book, “Passed On: African American Mourning Stories” as “black death and dying.” Dr. Holloway defines “black death and dying” as a century-long experience that is characterized by a particular vulnerability to untimely death.

Holloway sees black death and dying as death that results from white rage and violence and what she cogently refers to as “color-coded death, which is death that occurs for no other reason than the victim’s skin color. She defines this color-coded death as death resulting from the residue of riots, executions and suicides, all the result of African Americans being viewed as having less value than whites.

In addition to the kinds of violent death that are included in Dr. Holloway’s description of black death and dying, African Americans have also suffered untimely death and dying as a result of hazardous and unhealthy work conditions through the exposure to asbestos and other carcinogens in the coal mines and shipyards of the south and manufacturing plants of the north.

Apart from the violent and untimely deaths described above, African Americans have suffered unnecessary death at the hands of the medical establishment resulting from unethical experiments such as the well-documented syphilis experiments at Tuskegee University and similar studies at John Hopkins, Chicago Medical College and the Medical College of Virginia.

The most well-know example of this practice was documented in the Tuskegee Syphilis Study. This study, also known as the Public Health Service Syphilis Study, was a clinical trial that ran from 1932 through 1972. The trial, conducted around Tuskegee, Alabama, included 400 poor, mostly illiterate African American sharecroppers who became part of a study on the treatment and natural history of syphilis. Individuals enrolled in the study did not give informed consent, were not told of their diagnosis and were denied treatment that could have resulted in a cure, so that researcher could observe the natural progression of a disease that resulted in death.

In addition, a historical progression of poor health care and a lack of access to quality health care services have created a deep-seated distrust in the health care system. For African Americans, the system, designed to provide care and an opportunity for healing, has often resulted in untimely and unnecessary death. Because of this distrust, African Americans are generally less compliant in following medical regimes during illnesses. This has resulted in increased mortality among African Americans for cancer and other serious illnesses that could have been treated more successfully with earlier detection.

The result of this difficult and painful history has been the development of a collective cultural psyche toward death and dying. The implications of such a collective cultural psyche developed as a result of violence and oppression are important and far-reaching because this approach can be very useful in understanding how African Americans view death and dying.

Because of the violence and oppression they have endured and the ways that oppression has affected and influenced their experiences with death and dying in America, African Americans have generally not denied death. Rather than fear death, African Americans have often viewed dying as an opportunity to be liberated from a racist reality and as a way to freedom from the troubles of a mean old world.

According to Dr. Holloway, death and dying have historically been viewed as an ever-present part of the African American reality. Far from being unusual occurrences, to African Americans, death and dying have been seen as persistent events in the cycles of daily life. To her, they constitute an untimely accompaniment to the life of black folk.

From the hush harbors of the “Invisible Institution” of the Antebellum South, to the organized independent “Black Churches,” the African American church has been the institution that has ministered to the needs of black people in this country. E. Franklin Frazier wrote in his book, The Negro Church in America, that it was the black church that provided the social cohesion for black people in America. Even prior to the organization of the black church as a formal institution, slaves who had been introduced to “Christianity” by their masters exercised the social function of the church when they gathered in secret to practice the spiritual rituals and sing the newly learned songs that sustained them in their difficult everyday life.

These gatherings provided the slaves with an important orientation to their new world. From that initial orientation, the slaves went on to develop a unique religious expression that was forged from the African religions of the motherland mixed with the Christian religion of their new-world experience. The merger of the two created an African American religious experience that spoke to their existential plight as Africans in America.

In his works, Deep River and The Negro Spiritual Speaks of Life and Death, Howard Thurman provides some insights on how the slaves sought to address the challenges of theologizing about their experiences with death and dying in America. According to Thurman, death was not the worst of all possible things that could happen to an individual, as there were some things in life that were worse than death. To Thurman, the necessity of living in a climate that stripped the human spirit of its essential dignity was worse than dying.

Death was theologized by the slaves as release and was regarded as complete surcease from anxiety and care. For them, it was not a renunciation of life because its terms had been refused, but an exulting sigh of sheer release from a very wearying burden:

I know moon-rise, I know star-rise,
I lay this body down.
I walk in the moon-light; I walk in the star-light
To lay this body down.
I walk in the graveyard, I walk through the graveyard
To lay this body down.
I lie in the grave and stretch out my arms,
To lay this body down.

According to Thurman, another attitude of the slaves toward death and dying was one of resignation mixed with elements of fear and a manifestation of muted dread despite the fact that there seemed to have been a careful note of familiarity with the experience of death. In contrasting contemporary attitudes toward death and dying with that of the slaves, Thurman says:

“We know that death is a commonplace in the experience of life and yet we keep it behind a curtain or locked in a closet, as it were. To us, death is gruesome and aesthetically distasteful as a primary contact for ourselves and our children.

 

For most of us, when members of our immediate families die, the death itself takes place in a hospital. From the hospital, the deceased is carried to the mortuary. When we see the beloved one again, the body has been washed, embalmed, and dressed for burial. Our exposure to the facts involved, the silent intimacies in preparation for burial are almost entirely secondary, to say the least. The hospital and the mortuary have entered profoundly into [modern life] at this point. The result is that death [and dying] has been largely alienated from the normal compass of daily experience....”

This was not the situation with the creators of the Spirituals. Their contact with dead [and dying] was immediate, inescapable, and dramatic. The family or friends washed the body of the dead; the grave clothes were carefully and personally selected or especially made. The coffin itself was built by a familiar hand....During all these processes, the body remained in the home...In the case of death from illness all of the final aspects of their experience were shared by those who had taken their turn “keeping watch.”

Every detail was etched in the mind and emotions against the background of the approaching end. The “death rattle” in the throat, the spasm of tense vibration in the body as the struggle for air increased in intensity, the sheer physical panic sometimes manifest—all these were a familiar part of the commonplace pattern of daily experience. Out of a full knowledge of fact such a song as this was born:

I want to die easy when I die,
I want to die easy when I die,
Shout salvation as I fly,
I want to die easy when I die.

According to Thurman, the good death [as theologized] by the slaves was a quiet death without the seizure of panic, the closing of the door to earthly life...to die easy when they died. Death and dying was a personal and attached experience for the slaves. Family and friends were with loved ones when they died.

The “slave songs” sung in the hush harbors and cotton fields of the Antebellum South were more than mere songs, they were ritualistic responses of the slaves to their experiences with black death and dying and serve as a foundation for end-of-life care ministry in the African American church.

The African American church was first organized as an official institution in Philadelphia in 1787. Unlike most religious groups that are born out of a theological or doctrinal issue or concern, the African American church began in protest. Following the leadership of Richard Allen, a former slave who is considered the founder of the African Methodist Episcopal Church, a group of black parishioners walked out in the middle of a Sunday worship service because they were not allowed to kneel for prayer in the section of the church where they wished to sit. Allen, an influential member of the Philadelphia community and an expert in extemporaneous sermons, was invited to preach at St. Georges, the first Methodist Church in America.

Allen’s preaching was so successful that many new members, most of whom were black, joined St. George’s on a weekly basis. Recognizing that black parishioners had special spiritual needs and that the white members were becoming uneasy with the large number of new black members, Alan approached the elder at St. George’s and asked permission to establish a black church. The elder denied the request, and a year later when Allen made another request, that one was denied as well.

On April 12, 1787, Allen and Absalom Jones formed the Free African Society. Though not a religious organization, the Society served the black community much like a church.

The Society was funded by dues-paying members whose goal was to extend aid to widows, the sick and the jobless. Allen believed that members, while lifting themselves, could lift all black people. The Society also regulated marriages, taught the importance of thrift, condemned the practice of adultery and worked to improve moral values in the community.

The mounting racial tensions at St. George’s finally came to a head on the first Sunday after completion of a newly constructed upper gallery. Unknown to the black parishioners, they were to be relegated entirely to this area. When Allen and Absalom Jones took seats outside of the gallery, they were accosted by a trustee as they knelt in prayer. Allen and the other black parishioners were incensed by this insult and left the church in a body, never to return again. Allen and his followers later organized Bethel Church and, in 1816, established the African Methodist Episcopal Church as a separate denomination with Richard Allen as its first bishop.

The Role of the Church

With this history as a backdrop, it is important to consider how today’s church has been— and continues to be—shaped and influenced by that history. Building on Richard Allen’s original vision of the church as a center of social, moral and economic support in the midst of racial, social and religious oppression, the African American church has continued to evolve. In the midst of the racism and violence that has characterized the African American experience since the end of slavery, the church has been the most visible and vocal institution working to ensure the rights and the value of African American life. When African Americans were shut out of mainstream opportunities by segregation, the church led the way to the development of a viable community.

Some of the many important contributions of the African American church to the betterment of African American life fall within the areas of education, health, socialization and economic development.

In the volatile Civil Rights era of the 1960s, the church and its leaders led the way in the struggle for equality and equal rights. In the two hundred years since its official beginning, the African American church has become the repository of African American life, African American values, African American history and the African American’s hope. It was this hope that allowed them to live in an oppressive society that in many ways embodied an absence of hope and to find ways to transcend that absence.

One of the most important roles that the African American church has traditionally filled is the care and service that it offers to its membership and to the larger community at the time of death.

The church has been the institution that African Americans have turned to for comfort and support during the periods of crisis that have occurred at various points of transition in life. Because of the danger and the threat of physical violence that has always been a part of African American life in this country, one of the most important of those transition points was when a member of the community died. In the African American community, the funeral service is an important ritual that calls the community together in recognition and celebration of the life of the deceased and in support of the family and friends. As the place where the funeral was held and as the organization that stepped to the front to provide most of the services related to the event, the church was at the center of this occasion for both its members and for persons who were not a part of the church body.

Developing End-of-Life Ministries

While the African American church has always had a commitment to pastoral care for its members, developing a ministry especially dedicated to serving dying persons and their families could be one of the most significant services that a church can provide. Visitation of the sick is one of the primary tasks of African American ministers, but few churches have developed focused end-of-life care programs. A small number of larger, more progressive churches have developed such programs, but they represent a small percentage of the whole. To undertake this focus requires a great deal of commitment and a major educational effort to obtain information about the current trends and issues surrounding the increasing public dialogue about palliative medicine and end-of-life care.

A recent survey of all faith leaders in the Kansas City metropolitan area conducted by the Center for Practical Bioethics revealed the following:

  • Thirty-seven percent of faith leaders surveyed thought they minister “very effectively” to those who are seriously ill or dying.
  • Less than 44 percent of faith leaders surveyed thought they were “very prepared” to minister to those who were seriously ill or dying..
  • Only 8 percent 21 of the faith leaders surveyed thought that their congregations were “very prepared” to minister to the seriously ill and dying.
  • More than half (57 percent) of the congregations surveyed had not participated in any program to enhance their ability to minister to the seriously ill and dying.
  • Sixty-six percent of the congregations surveyed did not have any programs or other means of teaching members of their congregation how to minister to the seriously ill and dying.
  • About 50 percent of the faith leaders surveyed rated their familiarity with the resources that are available to help them minister to the seriously ill and dying as “poor” or “very poor.”

Recent studies have shown that people in America die in hospitals isolated from meaningful human contact with their family and friends. In the past, dying was considered a natural part of life, and most people died at home. Medical advances in the late 20 th century created a new milieu so that now most people die in the hospital where death is seen as a technological and medical failure. Dying persons can suffer needlessly because the medical team has not been trained to offer compassionate care, and communications can be poor between the patient and family and the medical team.

The focus of dying has shifted from the spiritual realm of reconciliation and the healing power of God to the secular realm of medical technology. Secular views of dying, which often promote a cure at all costs, can conflict with Christian views, which see death as a natural part of the life cycle and which encompass a different form of healing—God’s action to bring peace to the dying person. As a result, the process of dying in America has become detached and impersonal. As more and more palliative medicine and end-of -life care programs have developed, much has been written about how the church can play a larger role in propagating palliative care and encouraging African Americans to embrace these principles. Many believe that the church is the only institution in the African American community that can address these issues.

What has not been given proper consideration is the fact that as the repository of African American history, culture and values, any approach that the church might take must be one that honors that history, culture and values.

It is indeed true that the church needs to be involved in the ongoing dialogue and in the changes that are occurring in the medical system as a result of the principles of palliative care. But, it is also true that for the African American church and its members, those principles need to be redefined in a way that takes into consideration the uniqueness of their history and the psychological, emotional, spiritual and practical consequences of the oppression that makes up that history. Because the larger white society placed so little value on the lives of African Americans, African Americans have not been eager to accept the concepts of palliative care that have become so prevalent in white society and have no faith in the medical establishment to decide who should live or die.

The basic principles of end-of-life care are supposedly based on the ancient Christian tradition of caring, but for African Americans in this country, there is very little relationship between those principles and the way that their lives were impacted. Because of the understandable distrust that African Americans have for the medical establishment, any effort to engage the church must be informed within a context of providing the church and its people with knowledge so that they can make their own choices.

What End-of-Life Care Ministry Should Include

What we know about ministry in the African American church from a historical, cultural and theological perspective as well as what we know about the ongoing dialogue in contemporary society can help to shape a more effective approach to end-of-life ministry in the African American church.

A number of factors should be considered:

  • Use of Sermons - In order to set the tone for the church, the minister must be willing to use sermons to help the congregation understand that death is a natural part of life and that intentional care of the dying is an important part of the church’s ministry.
  • Educational Programs - Any church-based end-of-life program should offer intentional opportunities to increase the congregation’s awareness of “culturally sensitive” resources that are available to assist the seriously ill and dying as well as opportunities to improve the congregation’s ability to address issues related to death and dying.
  • Skill Development - In addition to educational programs, congregations can establish programs to help members develop the skills within the congregation that will enable the church to effectively address the needs of the seriously ill and dying.
  • Advocacy - Ministers and other church leaders can become knowledgeable enough to join the dialogue in order to take their place as advocates for the persons that they serve.
  • Establishment of Support Programs - The church is a natural and ideal place for the establishment of support groups for patients, family members and other persons who are impacted by a life-threatening illness.
  • Development of Rituals - End-of-life care ministry should work toward developing culturally sensitive rituals that value in death what the seriously ill and dying valued in life. As the slaves created the spirituals or “slave songs” that ritualized death and dying, so must the African American church create similar rituals to serve a similar purpose.
  • Explore the Use of Community Resources - Because the church represents a large number of members, a congregation can collect information on the resources that are available in the community and establish partnership relationships with them on behalf of its members.

Conclusion

As a result of the long, difficult and often violent history of slavery, racism and continuing oppression that African Americans have suffered in this country, the church has traditionally been and continues to serve as the center of African American community life. The church has been viewed as the institution that African Americans have turned to most often for comfort and support during periods of crisis. Because of the danger and the threat of physical violence that has always been a part of African American life in this country, one of the most important of those transition points was at the time of death or when a member of the community was dying.

The focus of dying has shifted from the spiritual realm of reconciliation and the healing power of God to the secular realm of medical technology. Secular views of dying, which often promote a cure at all costs, can conflict with Christian views, which see death as a natural part of the life cycle and which encompass a different form of healing—God’s action to bring peace to the dying person. As a result, the process of dying in America has become detached and impersonal.

As more and more palliative medicine and end-of-life care programs have developed, much has been written about how the church can play a larger role in propagating palliative care and encouraging African Americans to embrace these principles. Many believe that the church is the only institution in the African American community that can address these issues.

It is indeed true that the church needs to be involved in the ongoing dialogue and in the changes that are occurring in the medical system as a result of the principles of palliative care.

But it is also true that for the African American church and its members, those principles need to be redefined in a way that takes into consideration the uniqueness of their history and the psychological, emotional, spiritual and practical consequences of the oppression that makes up that history.

Bibliography

Frazier, E. Franklin. The Negro Church in America. New York : Schocken Books, 1966.

Gray, Fred D. The Tuskegee Syphilis Study: The Real Story and Beyond. Montgomery : New South Books, 1998.

Holloway, Karla FC. Passed On: African American Mourning Stories. Durham : Duke University Press, 2002.

Lincoln, C. Eric. The Black Church Since Frazier, New York : Schocken, 1974.

Lincoln, C. Eric. Race, Religion and the Continuing American Dilemma, New York : Hill and Wang, 1984.

Lincoln, C. Eric and Mayima, LH. The African American Church in the African American Experience. Durham : Duke University Press, 1991.

Meyer, Charles. Surviving Death: A Practical Guide to Caring for the Dying and Bereaved. Mystic: Twenty-Third Publications, 1991.

Thurman, Howard. Deep River and the Negro Spiritual Speaks of Life and Death. Richmond : Friends United Press, 1975.