Applying Christ’s Supremacy: Learning From Hebrews

By Gerald M. Bilkes

Why does the epistle to the Hebrews have the stunning force it clearly has? Of course, God’s Word is always “quick and powerful and sharper than any two-edged sword” (Heb. 4:12). Since it is God-breathed, every part of Scripture is not only true but also powerful. This does not obviate, however, the fact that there are ancillary reasons why one or another part of Scripture has a particular or pronounced force. I believe the following reasons explain why this is true for the epistle to the Hebrews:

First, the abundant and focused use of the Old Testament. The author is very concerned to bring forth out of the Scriptures, and Psalm 110 in particular, the revolutionary and sublime truth that it contains concerning the exaltation of Messiah. The author of Hebrews quotes Psalm 110:1 explicitly four times (1:3, 13; 8:1; 10:12, with Ps. 110:4) and verse 4 seven times (5:6; 6:20; 7:3, 11, 15, 17, 21). Moreover, everything he states in the book is directly or indirectly related to these two verses.

Second, the grand and exclusive focus on Christ. The author moves from the person of Christ (1:5-4:13) to His office (4:14-7:28), and then to the administration of that office (8:1-10:18). The argument of the book is compelling, coherent, and comprehensive. It is the basic outline of what later would be developed in the locus of systematic theology we call Christology, and Christ is the soul of the whole book. The apostle moves from the exalted person of Christ to the exalted work of Christ.

Third, the applicatory orientation of the book. As always in the Scriptures, the exposition of doctrine has an applicatory bent. Here in Hebrews, we see how basic and pervasive this applicatory bent is. The author himself calls it “a word of exhortation” (13:22). There is not only the frequent interspersing of application within the expositional argument, but also the tight relationship to the expository parts of the epistle in application. Moreover, there is the lengthy application at the end of the book (10:19-13:20). In every application, it is clear that the complete Christ sufficiently answers the challenge and need of the moment, whether it is trial, temptation, or false teaching.

Lastly, the radical nature and earnest tone of the apostle’s argument. The apostle sets forth a salvation that is superior, more excellent, eternal, and perfect, while, at the same time, it is an exclusive, unique, and necessary salvation. The line the apostle draws is razor sharp. Salvation is full and free; yet, because of our unbelief and dullness, it is also easily mistaken and missed. This is the logic of the epistle to the Hebrews.

Each one of these points has import for Christian preaching. Preaching ought (1) to adduce and proclaim God’s truth from Scripture; (2) to focus on Christ and salvation through Him alone; (3) to drive the message home to the hearers through application; and (4) to communicate the radical call of the gospel with earnestness. We could expand each of these points showing how the epistle to the Hebrews models this for us. In this article, I wish to examine only how precisely the author of Hebrews applies the supremacy of Christ. In other words, how does he bring the glory of Christ’s supremacy to bear specifically and concretely upon his hearers in masterful avenues of application?

The doctrine of the supremacy of Christ over all things is the glorious theme of the epistle to the Hebrews. It is announced in the opening verses (1:1-3), and functions much like a mountain peak. No matter what verse of Hebrews you read, whenever you look up, there is this awe-inspiring sight of Christ’s supremacy. Yet, the doctrine of Christ’s supremacy is more than an imposing and breathtaking vista. Through exposition and application, this doctrine feeds countless rivers, waterfalls, and streams that each conduct the glory of Christ to the faith and life of the church. For this reason, the theme of this epistle is more properly: The Supremacy of Christ Expounded and Applied. It operates as follows: in exposition, doctrine is released from the watershed of truth; in application this same truth travels the rivers and streams, whereby it reaches the remote stretches of land. This whole process lends the epistle a great force that models how preaching should apply the supremacy of Christ to all the church in all of life.

The author to the Hebrews used three types of speech when applying his doctrines.

1. Inference: drawing a logical conclusion (e.g., “Therefore we ought to give the more earnest heed,” 2:1; “Let us therefore fear,” 4:1; “Let us therefore come boldly,” 4:16)
2. Interrogation: calling into question or raising the possibility of a certain case (e.g., “if we hold fast,” 3:6; “if we hold the beginning of our confidence,” 3:14)
3. Identification: denoting one or other value judgment as true (e.g., “We are persuaded better things of you,” 6:9; “ye are dull of hearing,” 5:11)

These are the formal categories. However, there may be more helpful material categories. If we survey a number of these applications to discover their inner mechanics, we will see how they model for us how applications should operate in preaching. I believe there are essentially four kinds:

1. Better Attention
2. Closer Attachment
3. Greater Assurance
4. Further Ambition

Better Attention

This is the first kind of application in the epistle to the Hebrews, found in his initial exhortation (2:1-4). The author is amplifying on the fact that those whom he is addressing ought to listen and heed. Here the apostle focuses on “giving heed” to the gospel. He has proved from Scripture that Christ is infinitely greater than the angels. Consequently, greater attendance to the gospel of Christ is warranted, and greater punishment is to be anticipated if we neglect this great salvation. There are a number of ways in which this application fits the exposition thus far.

First, note how the apostle carries over into his application the comparative form that he used in his doctrinal exposition. The “so much better” of Christ in comparison with the angels (1:4) ought to induce an equally “greater” heed to the things we have heard. In fact, we may properly deduce that, since the Son is infinitely greater than the angels, being the eternal Son of God, our attendance to Him should be infinitely greater than the angels.

Second, it is noteworthy that his initial application focuses on the audio aspect. The apostle emphasizes what we have “heard” and the more earnest attendance it warrants. This, of course, fits the primary mode of revelation he has been focused on, namely, that of the Word and preaching. In fact, the author began his book with a reference to divine speech: “God spake” (see 1:1-3). He compares the many and various ways and times in which He has spoken in the past. God’s word in these final times has been by His Son, and specifically in the context of the letter, the word of the “session” (1:3). As during the course of Christ’s life the Father’s voice was heard approving of the Son at His baptism, at the Transfiguration, and during His preaching (John 12:28), so now there is another Word from the Father that exceeds all others, saying to the Son face to face in the eternal realms of glory, “Sit.” This redemptive-historical event is a word, a message from the Father to all the church and beyond. Behind this lies a full and great salvation and Savior, to which and to whom the most earnest attendance is warranted.

Third, it is not arbitrary that this exhortation is very much suited to an initial exhortation. It brings the force of the central fact immediately into focus and impresses it directly upon the hearers. At this initial point in his word of exhortation, their attendance to the gospel is both necessary and most highly warranted. It ought not to be confined to a part of this sermon; it ought to govern it. We can infer from this that all preaching ought to take into account all the latest redemptive historical events, including and especially the last. We cannot pretend that we live prior to Christ, as if this victory must yet be attained. This would constitute neglect of “so great a salvation” on the part of those commissioned to teach and preach. Moreover, the session of Christ provides a powerful incentive to command the attention of the church and all people. There is nothing in the world as critical and weighty as the final Word of God to His Son. Angelic beings reckon with it; should the church then let it slip? No, all the world must come face to face with this in this gospel.

This exhortation is, fourth, suited to the particular case of the Hebrews. We later learn that they were “dull of hearing” (5:11). Thus the apostle gives a sort of doctrinal trumpet blast in the first chapter.

Then he pauses and—lest any would fall back into the mode of dullness—sets before them the truth and shows how this truth demands their attendance. There is no more basic act than attendance to the gospel. There is no more critical act than an earnest attendance to the gospel. There is no more woeful prospect than a neglect of the gospel.

This provides a model for preaching. There is no need to apologize for requiring our hearers’ attention. Neither should preaching only present doctrine, but explicitly urge attendance to doctrine. Preaching must reckon with the fact that doctrine does not reach men in a neutral state. Their minds are darkened and, even after grace, can be most dull and dim. They always need to be prepared to hear and heed the gospel, and application in preaching must reckon with that. This is the first kind of application we meet with in the epistle of Hebrews.

Closer Attachment

In Hebrews 3:12-13 we read: “Take heed, brethren, lest there be in any of you an evil heart of unbelief, in departing from the living God. But exhort one another daily, while it is called Today; lest any of you be hardened through the deceitfulness of sin.”

These and the surrounding verses (3:7-4:13) are the second exhortatory section in the epistle, and a lengthy one at that. At the end of 3:6, the apostle, by way of a conditional clause, puts into focus the whole question of participation in the work of Christ: “Whose house are we, if we hold fast the confidence and the rejoicing of the hope firm unto the end.” Having set forth the glorious supremacy of Christ, the apostle shows the need for closer attachment. The glorious supremacy of Christ raises the possibility that there may be an evil heart of unbelief that would exclude a person from belonging to Christ and participating in His benefits. Such an evil heart is marked by unbelief and apostasy, departing from the living God. Thus the apostle holds before his hearers a mirror, asking whether the portrait they see in the mirror betrays a situation that would be most devastating in light of the doctrines set forth. The apostle even calls for “fear.” He writes: “Let us therefore fear” (4:1) of coming short of the promise, of being found without the faith which, by God’s grace, renders the gospel profitable. As glorious as the doctrine of Christ’s supremacy is, so devastating is the neglect or diminishment of it. Here the apostle shows how the doctrine of the supremacy of Christ’s person requires a singular allegiance to the person of Christ. If He were only one of many, no singular devotion could be required. Now that His person is manifest as the singularly unrivalled or unequaled One, our devotion to Him should know no competition.

This attachment, first, then must be an enduring attachment. If Christ is the supreme Mediator, it is impossible that we should be devoted to Him only for a limited amount of time. We are called to “hold the beginning of our confidence steadfast to the end” (3:14). If Christ were only one among many, we should alternate our devotion halfway or at some later time; but that is now wholly unreasonable.

Second, our attachment to Him must be an attachment with an ever-widening scope. Not only should our heart rise up in faith unto this supreme Christ; His supremacy warrants our mutual exhortation, lest any one be hardened. His supremacy calls His kingdom to always be extended. Our devotion to Him should spill over into a desire that others be wholly subject to Him.

Finally, we are told to exhort one another daily. It ought to be an attachment marked by a repetitive exhortation of each other. Christ’s supremacy demands our complete allegiance, our seeking the allegiance of others, and daily engagement in the act of mutual exhortation.

This application shows how the author takes the doctrines and meets his hearers where they are. Their existence is fraught with many dangers and temptations, chief of which is to cherish an evil heart of unbelief. Here the apostle gives us insight into his anthropology. He operates with the view that even professing Christians must examine to what extent they have an evil heart of unbelief. They are in danger of coming up short or hardening their hearts, of grieving the Lord, of lacking the faith that is so necessary.

It could be asked why it is the apostle brings in this negative reality in the midst of a text and a doctrine that is so glorious? Does the text of Psalm 110 and the doctrine of the supremacy of Christ warrant this? We can certainly say that the very fact of bringing this doctrine before his hearers in the act of proclamation demands that the apostle reckon with the states and conditions of his audience. He cannot assume that the glory of the gospel will meet with immediate understanding, embrace, and good-will. He shows himself a “priestly” preacher in taking this glorious truth and applying it according to the predominant situation of the hearers. He desires and endeavors that the glory of Christ would reach the hearts of his hearers and transform them and echo with an undivided attachment or allegiance to this Christ. As a “priest,” he cannot but expose the evil of the human heart, including this tendency in his hearers. The very glory of the doctrine demands this.

Yet, there is something in his text and doctrine that provides an additional warrant. Psalm 110 speaks of “enemies”: “Until thy enemies be made thy footstool” (Ps. 110:1). The glory of Christ reveals itself precisely in contrast with His enemies. The possibility of an evil heart among the author’s audience compels him to call for self-examination. Indeed, there is Christ’s house, and if we hold fast the confidence unto the end, that designation applies to us. There is, however, also an arena not comprising the house of Christ, which Psalm 110 designates as “enemies.”

Why does he take pains to drive this point home? He tells us the reason. The Word of God by its very nature does this. Likewise, God’s Word declaring the session of Christ—“Sit” (Ps. 110:1; Heb. 1:1-3)—does this. It is true, this word is aimed at the Son, but it reverberates through the whole universe. Enemies, angels, kings, princes, all can know it. As that word goes forth, it exposes the inmost recesses of the heart, even in those most privileged in regard to the gospel. The author explicitly states this: “For the word of God is quick [or vibrant], and powerful, and sharper than any twoedged sword, piercing even to the dividing asunder of the soul and spirit, and of the joints and marrow, and is a discerner of the thoughts and intents of the heart. Neither is there any creature that is not manifest in his sight: but all things are naked and opened unto the eyes of him with whom we have to do” (4:12-13). This last phrase translated as “with whom we have to do” literally reads: “with whom is the word/thing.” It can also be translated: “before whom we must give account.” This word of God demands an account. He arrests us, unmasks us, and exposes us. And that is what the apostle aims to do in his application as well.

The Word of God goes forth, opens up closed hearts, and exposes the hidden recesses and motives, laying them bare. This is one of the main principles for the preacher in his application. Though this work of the Word can happen separately from application by the Spirit, the preacher desires to promote this in his preaching. The apostle is convinced that application serves closer attachment to Christ. The Word of God in Christ’s session brings us before “him with whom we have to do,” namely, God and His Christ.

Greater Assurance

In Hebrews 6:9-12, we read: “But, beloved, we are persuaded better things of you, and things that accompany salvation, though we thus speak. For God is not unrighteous to forget your work and labour of love, which ye have shewed toward his name, in that ye have ministered to the saints, and do minister. And we desire that every one of you do shew the same diligence to the full assurance of hope unto the end: that ye be not slothful, but followers of them who through faith and patience inherit the promises.”

This application is in the middle section of the argument of the apostle concerning the supremacy of the office of Christ. The apostle has addressed their dullness and the seriousness of the possibility of apostasy. As he did in 3:12-13, he faces them with their comparative deficiencies, especially in light of Christ’s perfection. Christ as Priest had been subject to all manner of temptation, but always without sin; the Hebrews had been tempted, and were in danger of lapsing. Christ had been made perfect, having learned obedience by the things He suffered (5:8-9). The Hebrews need to be told to “go on unto perfection” (6:1). Again we see how the apostle brings the doctrine of the supremacy of Christ to bear on the Hebrews in the realm of greater assurance. Christ’s perfection brings to light their imperfection; His perfection spurs them on to perfection. This eminently glorious Christ, made perfect through suffering, induces His people as well as enables them to go on to greater assurance.

The apostle uses the image of fruitfulness. “For the earth which drinketh in the rain that cometh oft upon it, and bringeth forth herbs meet for them by whom it is dressed, receiveth blessing from God” (6:7). By contrast, “that which beareth thorns and briers is rejected, and is nigh unto cursing; whose end is to be burned” (6:8).

Notice here how the apostle uses an assuring application. He aims for comfort. Having set forth a terrible scenario, he quickly seeks to speak words of assurance. Lest the tender consciences and minds of his hearers be unduly frightened and they cast aside all confidence, he speaks consolingly. Notice how he phrases his consolation: “we are persuaded better things of you.” Interestingly, he uses a comparative, the grammatical form he favored in his expository section. The character of Christ being “better” (1:4) spills over into His people being “better.” He explains what this “better” is: “things that accompany salvation.” As salvation comes from Christ and is revealed in the gospel, it makes a person who possesses it graciously “better.” Again we see how his application builds on his doctrine.

His assuring application has a strong basis, however. He points to the marks of grace. He mentions their work and labor of love which they showed to God’s name: their ministry to the saints, a ministry which has continued until now. His comforts are not baseless and weak; neither are they generalized and oblique. They have a particular reference. They are attached to the manifestation of the works of faith, the obedience of faith, the ministry of love, etc. Thus he does not comfort them simply with his own estimate of them, but by pointing to the fruits of Christ’s work in them. Christ’s active obedience, so celebrated in Hebrews 5, is the basis and source of their own fruits, and this is the point the apostle makes in this consoling application.

He remarkably speaks of the attribute of God’s justice: “God is not unrighteous to forget your work” (6:10). This is reminiscent of John’s “he is faithful and just to forgive us our sins” (1 John 1:9). The justice of God can be a wonderfully assuring attribute for the believer, and the apostle marshals it here to that end.

Even in a letter as incisive as this letter to the Hebrews, there is much room for assurance. The source of this assurance lies not in the Hebrews, but in the Christ of the session, whose work is now perfect, and by whose perfection His servants are led step by step, and out of whose perfection they receive assurance through the fruit seen in them.

Further Ambition

Hebrews 10:19-25 is a very telling passage in terms of the applications of the epistle. This is the basic turning point from exposition to application. The text divides itself into three indicatives and three imperatives. Together, they combine to circumscribe the life of believers under Christ the High Priest as one with ambition to go further than before. First, the apostle gives the rich privileges at the base of this call:

1. Free access into the holiest. They have the right to enter the sanctuary;
2. A consecrated way by blood through the veil. They have the means to enter the sanctuary, namely, by the blood of Jesus (see 3:6; 4:16), and by a new and living way, which Christ has opened through the veil (His flesh) (see 9:8); and finally,
3. A great Priest: they have the householder (3:1-6) and High Priest (3:1; 8:1).

Second, he expatiates upon the comprehensive aspects of this call:

1. To approach with a true heart in full assurance of faith. The manner the apostle specifies is with true heart; and full assurance: “firm, unwavering trust”; and with the supplementary motives of hearts sprinkled, and bodies washed;
2. To hold fast the confession of our hope without wavering. The supplementary motive the apostle appends is that He is faithful who has promised;
3. To mind how to provoke one another to love and good deeds. The supplementary motive is not to neglect to meet together, but encourage each other in light of the approaching day.

The force of this passage is very clear in terms of the relationship of exposition and application. In the three indicatives (the privileges), the apostle summarizes his exposition, especially in chapters 8-10. He takes it altogether under the three key concepts of access, a consecrated way, and a great Priest. These three concepts show the great accomplishment of Christ’s work as High Priest. They mark the highest privileges possible for anyone anywhere. Here the torrent of the apostle’s argument reaches a bottleneck that makes the water run even faster. It brings us to the pinnacle of a Christian’s inheritance—Christ seated at the right hand in the Holy of Holies in heaven, granting access for the believer to the throne and to the great Priest on the throne.

The apostle is ambitious to go further. He brings these realities to bear on his hearers by calling for an approach in faith, a steadfastness in hope, and a mutual provocation unto love. The three privileges together grant impetus to the three responsibilities.

Christ is at the right hand of His Father. His people are priests. Christian believers have temple privileges as well as temple responsibilities; these are far more exalted than those of any ceremonial rituals. While the Old Testament ceremonies were restrictive, now believers have access. The Old Testament tabernacle had a veil; now believers have a bloody way. The Old Testament church had a priest in the house of God; now believers have a great Priest over the house of God. We have responsibilities of washing and sprinkling associated with faith, as well as custodial (holding fast the confession of our hope) and diaconal duties (provoking one another to love and good deeds). This is our temple religion, which demands a far greater ambition, namely, to go further.

The veil is rent; the access is secure; the High Priest is greater: thus our ambition should take us further. The apostle seeks to induce a disposition and actions that mirror the doctrine set forth. This is the third function of application in the letter to the Hebrews.

Conclusion

The author of the letter to the Hebrews seeks to apply the doctrine of the supremacy of Christ to Christians in their varied and real circumstances. The supremacy of Christ is something that calls for better attention, closer attachment, greater assurance, and further ambition.

Notice the importance of the comparative form: “the more earnest heed” (2:1) and “better things” (6:9). Notice also adverbs and adjectives such as “daily” (3:13); “near” (10:22); and “without wavering” (10:23). Each one of these accentuates the point being made.

Notice, finally, the linkage between the details of Christ’s supremacy expounded and applied.

Exposition: Superiority of …	Application: Superiority of …
1:5-4:13: Christ’s Person	Do not neglect / consider / take heed
4:14-7:28: Christ’s Office	Let us hold fast / go on / show diligence
8:1-10:18: Christ’s Ministration	Draw near / hold fast / provoke each other

The first section uses terminology related to our person; the second section uses terminology related to our calling; the third section uses terminology related to believers as priests unto God. Through his application, the apostle seeks to woo the whole person to the whole Christ, who reigns supreme. Since there can be nothing lacking in the Christ, what is lacking must be ascribed to the Christian, which he must find ever and anew in Christ.

An Everlasting House: An Exegesis Of 2 Samuel 7

By Maarten kuivenhoven

Second Samuel 7 offers a view of the covenant of grace being expanded and amplified. David purposes to build a house for Yahweh, but in turn Yahweh prohibits David from doing this and instead promises to build David’s house. The promise has ramifications for the succession of Solomon to the throne, but it also has profound implications for the Messiah to come from the Davidic line and to reign forever upon the throne of David, bringing salvation and rest to His people of every age. While the word “covenant” is not mentioned explicitly in the context of this chapter, other Scripture references do bear out the fact that this Davidic covenant was a heightening and amplification of the covenant of grace. This article is simply a brief outline and exposition of this chapter and how it unfolds the covenant of grace to David to enrich the understanding of God’s dealings with David, Israel, and subsequent generations of God’s people.

Outline

An Everlasting House

• David’s Purpose (vv. 1-3)
• David’s rest from enemies (1)
• David’s resolve for a house of the Lord (2)
• David’s ratification by Nathan the prophet (3)
• Yahweh’s Promise (vv. 4-17)
• Yahweh’s pattern (4-7)
• Yahweh’s provision (8-17
• David’s Prayer (vv. 18-29)
• David’s abasement before Yahweh (18-21)
• David’s adoration of Yahweh (22-24)
• David’s appeal to Yahweh (25-29) [1]

Exposition

This chapter opens up God’s heart and His ways with His servant David. While the argument could be made, based on the absence of the word “covenant,” that God is not making a covenant with David, the internal evidence of this chapter and the use of other passages of Scripture make it very clear that this is the establishment of the Davidic covenant. [2] Other passages of Scripture such as Psalm 89 and 2 Samuel 23:5 demonstrate clearly that Yahweh made a covenant with David amplifying the Abrahamic covenant, as the seed is revealed to a greater degree; the seed of Abraham and now of David is to be a king, but no ordinary king, because His throne will last forever. [3]

The chapter introduces David sitting in the kingly palace at Jerusalem, having received rest from all his enemies round about him. Frequently throughout the history of Israel the idea of receiving rest from enemies is highlighted. [4] The books of Joshua and Judges, for example, give prominence to this theme. Upon conquest of the land of Canaan, Joshua brought rest to the Israelites from their enemies. The judges in the book of Judges brought the people to enjoy rest from their enemies, albeit these were strictly defined locales within the Promised Land. Now David has received rest from all his enemies. Through military conquest, he has consolidated the nation of Israel and routed his enemies with the help of Yahweh. His kingdom was being prepared for Solomon, whose reign was characterized by peace. [5] Furthermore, this also strengthens the Christ-centeredness of the passage, because Christ would also receive rest from all His enemies through His finished work on the cross.

While sitting upon his throne in his palace in Jerusalem, David ponders the events that have taken place. The ark of God had been brought to Jerusalem by David and his men to rest in the Tabernacle. David lived in a permanent dwelling, but God’s presence still dwelt in a tent of curtains. David ponders this problem of God dwelling in a temporary structure. Nathan the prophet counsels David to go ahead and build a permanent dwelling for the Lord. Nathan gives David the reassurance he needs by saying, “Yahweh is with thee.”

In his sermons on 2 Samuel 7, John Calvin points the reader to the negative aspect of David’s desire to build a house for Yahweh: “We have here an act of David which was highly praiseworthy, and yet it was utterly condemned by God.” [6] Calvin goes on to say that David was too hasty in not waiting upon the Lord for further commands to build a house for the Lord. [7] The desire of David to build a temple or permanent dwelling can be better understood in light of the practices of the Ancient Near East. Robert P. Gordon gives some valuable insights in this regard:

David who is a fairly typical near eastern king in this regard, wants to crown his external achievements with the erection of a temple to Yahweh who has granted him his victories. In the ancient world, moreover, a god who lacked a proper temple was in danger of being regarded as cultically inferior…. In other countries it had long been considered the responsibility of kings both to build and to maintain the dwellings of the gods. [8]

Within this cultural backdrop, David saw the need to build a permanent dwelling place for the Lord. He makes the clear distinction between his permanent dwelling and the dwelling of the Lord literally in the midst of curtains, a reminder of Israel’s previous nomadic existence. In the end, the conclusion is that while David’s intent is upright and moral, there is no word from Yahweh to proceed with such an important endeavor, since Nathan operates based on “his own feelings and not by divine revelation.” [9]

Although Nathan initially tells David to build the house to Yahweh, that very same night the Lord appeared to Nathan and gave him different words to speak to David, words that prohibit David from building a permanent dwelling place for the Lord. The Lord begins with a question to David in verse 5, “Are you to build me a house to dwell in?” It is as if God is saying to David, “Who gave you permission to build Me a house?” God raises His objection. David is going outside the scope of God’s Word and promises. It is primarily through the word of the Lord that David receives the promises, but he has not received a word from the Lord to proceed with building the Temple. God’s word would come, but the content of that word would be to establish an everlasting house for David. God will turn the tables on David. David wanted to build a permanent structure for God to dwell in, but God would build an eternal house or dynasty for David, ending in Christ the Davidic King.

In the following verses, God gives David several reasons for His previous pattern of existence within the Israelite camp and nation. Bill Arnold notes that “Yahweh’s objection to David’s plan has historical reasons.” [10] The first such reason is that the Lord has never dwelt in a permanent residence. The Tabernacle was God’s appointed place of presence from Egypt to the very day that God was speaking with David. Yahweh is free to dwell where He pleases; He Himself commissioned the building of the Tabernacle to Moses and He will remain there. Arnold states that “Yahweh has not requested such a house. Temples were for deities who were tied down. Israel’s God cannot be manipulated or contained in a temple.” [11]

The second historical precedent in verse 7 that Yahweh uses to prevent David from building a temple is that God never commissioned any of the leaders of Israel to build Him a house of cedar. In the long history of Israel up to this point, there was never a word from the Lord to that effect. The tent of meeting that Israel used to this point symbolizes “Yahweh’s sovereign freedom.… Verses 6-7 stress the motif of the unlimited divine freedom, and this is depicted by the very obvious contrast between the movable tent-dwelling or shrine and the sumptuous localized temple.” [12]

Although Yahweh had never commissioned anyone to build Him a permanent dwelling place, He uses this opportunity to reveal His alternate plans for David. Yahweh shows His power in David’s life (vv. 8-9a). The Lord has exalted David from shepherd to king; wherever David went and whatever he did, the Lord was with him. Midway through verse 9, the author switches to the future tense and shows how that the Lord is promising to David things which must yet be fulfilled. [13] First of all, David is promised a great name like the name of the great men of all the earth. It is only through Yahweh’s strength and presence in David’s life that his name will be made great. When God makes the names of men great, He is making His own name great, though men are base and greedy and seek to take the honor to themselves. Here Yahweh reminds David where he has come from and who it is that has brought him thus far. David will be counted among the elite men of the earth, and the Bible certainly fulfills this promise, as David is mentioned nearly sixty times in the New Testament alone.

Israel is also promised a place of rest where Yahweh will plant them and establish them. Gordon draws the parallel here with Hebrews 4:9: “There remaineth therefore a rest to the people of God.” [14] This is particularly important considering that future Israelites would read this in exile while awaiting a new exodus back to Canaan, the Promised Land. This rest can then be taken in the near-future sense as well as the eschatological sense, referring to the rest that awaits the people of God which will be ushered in by the Messiah who would sit upon the throne of David forever. Under the reign of David’s son, Solomon, Israel would enjoy unprecedented rest, and their enemies would no longer humble them. Under the reign of the Messiah, the people of God enjoy undisturbed rest; they will no longer tremble, and the sons of unrighteousness will not humble them. Satan, the enemy, will be forever silenced and they will not be humbled again as in the beginning. In reflecting on the phrase, “as in the beginning,” thoughts were sparked going back to Genesis where Adam and Eve were humbled by Satan, though it likely refers to the Israelites entering the Promised Land in the beginning of the conquest. It is only under the Son of David, the Prince of Peace, that the people of God enjoy true peace.

In verse 11, the Lord promises David rest from his enemies and He promises to build a house for David. David wanted to build a house for the Lord, but “God must first of all build a man’s house, before the man can build God’s house.” [15] A period of rest was required to build the house of God and God needed to first build the house of David. The right to build God’s house was reserved for David’s son, not David, as is shown in verses 12-13.

Verse 12 begins with the temporal marker “when,” indicating that the promise is made to David in the present but will be fulfilled in the future. David will not see the fruition of his plans though he has the promise in hand. He will die before he sees his house built and kingdom established and perpetuated. It is here that the heart of the Davidic covenant is revealed in such key terms as name, land, house, seed, descendants, son-ship, and relationship (vv. 9-14). [16] God is faithful to David in raising up a seed to sit upon his throne. The seed of David is not only Solomon, but all those who would follow on his throne, “but above all he [God] had in mind our Lord Jesus Christ.” [17] Gordon also hooks into Paul’s interpretation of the word “seed” in this verse, saying that it has both the corporate and, more importantly, the individual aspect of the seed, taking it to mean Christ, the Son of David. [18]

The kingdom of this throne will be established forever. This is a kingdom that cannot be shaken (Heb. 12:28) and a kingdom that is forever and ever (Ps. 45:6). The kingdom of David is not merely a physical kingdom but a spiritual one in which Christ, the Anointed One, greater than David, is forever seated. The son who succeeds David will build the Temple, as verse 13 indicates. Yahweh will make David’s name great but his seed will make a house for the Name of Yahweh. Again, this seed, if taken in the singular sense, refers to Christ who is the Temple of God and is building a living temple, not made with hands; but it also refers to Solomon within the context of David’s purpose in verses 1-3.

The relationship between the seed of David and Yahweh will be one of great intimacy. It will be a father-son relationship with the father chastising the son if he goes astray. [19] Yahweh and Solomon share such a close relationship but, even more than that, Christ the Son of David and God the Father enjoy this relationship to a far greater degree. David’s hopes for his throne lay in his son Solomon, but he looks beyond this as 2 Samuel 23:5 demonstrates, “Although my house be not so with God; yet he hath made with me an everlasting covenant, ordered in all things, and sure: for this is all my salvation, and all my desire, although he make it not to grow.” His hope in the promised seed was not only for physical procreation, but for salvation. When Yahweh spoke these promises, David believed and understood them in the spiritual and eschatological sense, though perhaps in a limited manner.

The underlying theme of this whole chapter can be found in the word hesed or covenant loyalty, covenant faithfulness, or “mercy,” as the Authorized Version translates it. Throughout this chapter, Yahweh’s covenant faithfulness is on full display towards David and his house. This mercy will not be turned away as it was turned away from Saul and his house. The author of Samuel sets up the comparison between the house of David and the house of Saul. Christ would come from the house of David, and therefore God’s mercy would not be removed from there as it had been from Saul’s. The Davidic dynasty would be preserved through the Lord’s covenant faithfulness; “the Davidic king may be disciplined, but he will not be set aside.” [20] This covenant faithfulness to David and his seed is most apparent in the case of King Abijah or Abijam, whose heart was not with God even though he did some things right. Despite Abijam’s sin and not being right with God, 1 Kings 15:3-5 speaks of God’s covenant faithfulness to him: “And he [Abijam] walked in all the sins of his father, which he had done before him: and his heart was not perfect with the LORD his God, as the heart of David his father. Nevertheless for David’s sake did the LORD his God give him a lamp in Jerusalem, to set up his son after him, and to establish Jerusalem: because David did that which was right in the eyes of the LORD, and turned not aside from any thing that he commanded him all the days of his life, save only in the matter of Uriah the Hittite.”

Yahweh’s promises are concluded with verse 16, which repeats the theme of the kingdom of David being established forever and his throne being established forever as well. Yahweh wants David to have no doubts about building David’s royal house, a house that would last to eternity. This promise sees its fruition in the long line of kings descending from David, but ultimately sees its fulfillment in Luke 1:32-33, “He shall be great, and shall be called the Son of the Highest: and the Lord God shall give unto him the throne of his father David: and he shall reign over the house of Jacob for ever; and of his kingdom there shall be no end.” And again this promise is fulfilled upon Christ’s session and rule at the right hand of the Father in Hebrews 1:8, “But unto the Son he saith, Thy throne, O God, is forever and ever: a scepter of righteousness is the scepter of thy kingdom.”

Verse 17 operates as a transitional verse within the narrative as it closes out the promises of Yahweh to David. It sums up what the Lord has spoken to Nathan and what he in turn had spoken to David. It also shows the contrast with Nathan’s earlier involvement with David in verse 3. There Nathan simply told David to go do all that was in his heart because Yahweh was with him, but now Nathan acts as the divine mouthpiece to David. Psalm 89:19 likely refers to this occasion, according to Gordon, and it fits the occasion very well as it traces the establishment of the Davidic covenant parallel with 2 Samuel 7: “Then thou spakest in vision to thy holy one, and saidst, I have laid help upon one that is mighty; I have exalted one chosen out of the people.” [21]

Second Samuel 7:18-29 displays David’s heartfelt response to the covenant that Yahweh made with him, holding before the reader an example of worshipful prayer and praise for the faithfulness and uniqueness of Yahweh. Verse 18 sets the background in which David likely enters the Tabernacle before the Lord to abase himself, to worship and adore God for what He has promised and for who He is. [22] David has been steeped in the promises of the Lord for him and his family, promises which are his salvation (cf. 2 Samuel 23:5) and which establish his eternal throne in the Messiah. He appears before the Lord as a man humbled and abased before the awesomeness of Yahweh. He cries out, “Who am I and what is my house?” This question shows the relationship that David has to Yahweh: “it is a polite self-depreciation before a person of higher rank.” [23] It shows David’s sense of unworthiness at having received these promises, the promise of the Messiah no less proceeding from his loins and sitting upon his throne forever. David “sets that dust of the balance, I, a creature, and I, a sinner, with the great God, ‘the high and lofty one that inhabiteth eternity.’” [24] David is in the house of the Lord, and he contrasts this with his own present house, a house fraught with sin and internal strife as later chapters reveal. He is overcome at the holiness of the Lord and his own sinfulness, yet these words were life for David.

Calvin says beautifully of verse 19 that God deals with David in “a human fashion…. David wanted to show here that the goodness of God is all the more worthy of esteem because he comes down in such a way as to make himself familiar to us.” [25] The Lord speaks of David’s house in the future, hence David uses the term “afar off.” David’s response indicates the value and meaning he placed upon the Lord’s promise dealing with his house in the future. It was to be literally “the torah (instruction) of man,” which can be interpreted in several different ways. Both Gordon and Anderson argue that it can be taken as having ramifications for future generations and the effect would be worldwide in terms of the Messiah being promised in the Davidic covenant. [26] Another interpretation that Gordon lists is that this phrase can simply be translated as “Is this your usual way of dealing with men?” [27] This interpretation based on the Hebrew text is untenable because the Hebrew contains no interrogative.

In the context of the covenant that Yahweh makes with David, David sees by faith the future outworking of the covenant in terms of the promised Messiah and he literally is saying, “And this is the instruction/law to man.” David looks back and sees that God has worked this way with Abraham and every succeeding generation, promising a spiritual seed. God deals with man according to His “torah,” or as Walter Kaiser calls it, the “charter for humanity.” [28] In translating it this way, Kaiser sees the implications that the word “torah” has within this amplification of the covenant of grace, from Abraham onwards. He states that this charter “is nothing less than God’s plan for the whole human race. All humanity can profit from what he has just been told about his house/dynasty, kingdom, and throne.” [29] This is not a selfish statement on David’s part, but it is rather a statement that is far-reaching in its vision of God’s grace. Kaiser concludes:

David is realizing that he is getting much more than he ever could have imagined or even thought. The ancient promises that he had grown up on and had counted on as foundation of the hope of his own salvation and for the future are now being repeated to him and placed in his offspring — and there will be no termination point in its provisions. David cannot believe what is happening to him. [30]

Furthermore, Kaiser argues rightly that David is viewing this “torah” or “charter” missiologically within the covenant of grace. This promise that David receives is “to be conveyed to everyone, including all the Gentiles and nations of the earth.” [31] The gospel would indeed proceed to the ends of the earth as a result of the Messiah being born and inhabiting the throne of David—and indeed the gospel is still going forth until the consummation according to God’s covenant promises made to David upon this occasion.

David’s abasement before Yahweh is concluded in verses 20-21 before he moves into extolling Yahweh in the closing verses. David gives a glimpse into the heart of God as He deals with sinners who do not deserve His great mercy, yet receive it. David cannot add anything to the magnificent words he just heard from the Lord and he simply says, “You know your servant.” Thomas Goodwin sheds light on this, saying, “He [God] knew him indeed, and knew not only how he served him afore this covenant, but also how he would serve him.” [32] Despite all this the covenant would be fulfilled, mercy would be shown, and God’s purposes would override all of David’s sins. David concludes in verse 21 by showing how it was by God’s Word and in God’s heart to do all this and to declare it to David. David lives a Word-centered life; he recognizes that nothing operates outside of God’s authoritative Word and this Word is a reflection of what is in God’s heart.

The next three verses, 22-24, show how David extols Yahweh, magnifying His greatness and goodness. He highlights the exclusivity of Yahweh, because no one but God could give such promises and fulfill them, too. The Lord is exalted through what He has told David; He is exalted through His Word. The exclusivity of Yahweh is such that it permeates His chosen people. They, too, are incomparable upon the earth (v. 23), not through anything they have done, but through the redemption of Yahweh. In his commentary, Youngblood highlights three things that Yahweh has done for His people: redeemed them, set His Name among them, and performed great and wondrous things for them. [33] Through these things, Yahweh establishes Israel to be His people. Covenant language is prominent and echoes Exodus 6:7 and various other passages of Scripture which highlight Israel’s unique covenant relationship with an absolutely unique and awesome Yahweh.

The final verses of the chapter, verses 25-29, capture David’s appeal to the Lord for his house. Although these promises are sure because they have been spoken by the Lord Himself, David proceeds to ask for a confirmation of them. David appeals to the Lord to set the words which He has spoken to eternity. David really requests three things here of Yahweh: to set His Word to eternity and, based on that Word, to act, to make His Name great until eternity, and to establish David’s house forever. The reason for these three requests is made apparent in verse 27; Yahweh promised to build David a house. [34] Again, the contrast is highlighted between David’s initial purpose of building a house for Yahweh and now Yahweh’s building a house for him. David requests not that his own name be exalted but that God’s Name and Word and Son would be exalted forever.

The final two verses are exaltation and the final request for blessing on the part of David. He recognizes not only the faithfulness of Yahweh, but also the faithfulness and reliability of God’s own Word. Anderson makes the point that the good thing that David speaks of in this verse is synonymous with the word for covenant and that David acknowledges the covenant that the Lord makes with him here. [35] This is a firm, truthful, and faithful covenant. The final request that David has upon this true and faithful word of the Lord is that the Lord would show willingness and bless the house of David so that it will remain before God forever. This request of David is not merely a request for his throne and royal house to be blessed, but, as Calvin says, “It refers to God’s will to bring salvation to the world from the race of David.” [36]

In conclusion, David’s resolve to build a house for Yahweh is answered by the revelation that it is the Lord’s purpose to build an everlasting house and kingdom for David. Through this everlasting kingdom and throne and from the seed of David would come the Messiah, Jesus Christ. Blind Bartimaeus himself acknowledged the Messiah as such: “Jesus, thou Son of David, have mercy on me” (Mark 10:46ff). While the promises given to David had some immediate impact on his successor to the throne, these promises were ultimately promising to David’s line the King of kings who would sit upon David’s throne, bringing salvation and rest for all His people.

Notes

1. Paul William Tigchelaar Verhoef, “The compositional structure, canonical place, and theological significance of 2 Samuel 7” (Th.M. Thesis, Calvin Theological Seminary, 2004), 37. For a more detailed study of the structure of 2 Samuel 7, see Verhoef. He makes the main structural divisions at vv. 1-3; 4-17; 18-29. Most commentators follow the same structure for the main divisions.
2. Ronald F. Youngblood, 2 Samuel: The Expositor’s Bible Commentary, ed. by Frank Gaebelein (Grand Rapids: Zondervan, 1992), 881.
3. Michael Grisanti, “The Davidic Covenant,” The Master’s Seminary Journal 10.2 (Fall 1999): 234-235.
4. Anderson, 2 Samuel, 116.
5. Ibid.
6. Jean Calvin, Sermons on 2 Samuel: Chapters 1-13 (Edinburgh: Banner of Truth, 1992), 295.
7. Ibid., 296.
8. Robert P. Gordon, 1 & 2 Samuel: A Commentary (Grand Rapids: Zondervan, 1988), 236-237.
9. Carl Friedrich Keil and Franz Delitzsch, Joshua, Judges, Ruth, I & II Samuel (Grand Rapids: Eerdmans, 1982), 341.
10. Bill T. Arnold, 1 and 2 Samuel: The NIV Application Commentary from Biblical Text—to Contemporary Life (Grand Rapids: Zondervan, 2003), 474.
11. Ibid.
12. Anderson, 2 Samuel, 120.
13. Gordon, 1 & 2 Samuel, 238.
14. Ibid.
15. Keil & Delitzsch, 1 and 2 Samuel, 344.
16. Grisanti, “The Davidic Covenant,” 246; Grisanti has a useful chart comparing the promises of the Davidic covenant made in 2 Samuel 7 and the promises of the Abrahamic covenant in Genesis 12 and various other references. The two covenants are remarkably parallel in terms of the basic components that typify the covenant. For a more detailed explanation of the basic components see Willem Van Gemeren, The Progress of Redemption (Grand Rapids: Baker, 1988), 104.
17. Calvin, Sermons on 2 Samuel, 326.
18. Gordon, 1 & 2 Samuel, 239.
19. See Matthew Henry’s comment on the rod of man and the strokes of the sons of man.
20. Gordon, 1 & 2 Samuel, 240.
21. Ibid., 240.
22. Anderson, 2 Samuel, 126.
23. Ibid.
24. Thomas Goodwin, The Works of Thomas Goodwin (Grand Rapids: Reformation Heritage Books, 2006), 9:264.
25. Calvin, Sermons on 2 Samuel, 360.
26. Gordon, 1 & 2 Samuel, 241; Anderson, 2 Samuel, 127.
27. Gordon, 1 & 2 Samuel, 241.
28. Walter Kaiser, The Messiah in the Old Testament (Grand Rapids: Zondervan, 1995), 79.
29. Ibid., 81.
30. Ibid., 79-80.
31. Ibid., 80.
32. Goodwin, The Works, 9:268.
33. Youngblood, 1,2 Samuel, 808.
34. Anderson, 2 Samuel, 128.
35. Ibid.
36. Calvin, Sermons on 2 Samuel, 399.

Pastoral Counseling In The Twenty-First Century For Illness, Disease, And Death

By Christopher Bogosh

In the twenty-first century, many pastors have become unbiblical in their approach to illness, disease, and death. Medical science in the West, with its theory of naturalism and its plan to eradicate these human afflictions at all costs, has influenced even some of the most orthodox pastors. In fact, it is the only goal of many pastors today to enhance the wellness and health of Christians in this present life, rather than to help them understand the providential and afflicting hand of God in their suffering. This paper brings to light some of these issues and presents a model for pastoral counseling to those who are facing illness, disease, and death in the twenty-first century.

The Etiology Of Illness, Disease, And Death

Around the world, ill health, infections, and death are viewed from a variety of perspectives that are influenced by culture, religion, philosophy, and science. In the West, for the most part, these afflictions are seen in a naturalistic context, particularly by the medical sciences That is, illness, disease, and death are caused by impersonal and mechanistic forces in nature. Beyond this point, however, medical science has to join the ranks of false religion, philosophy, and the social sciences and admit that they really have no ultimate answer for the etiology of ailments, pathological conditions, and organic death. Why? No objective evidence exists that explains how these impersonal and mechanistic forces were set into motion. There is a plethora of theories, but there are no concrete answers.

The predominant assumption found in the medical sciences is built on an evolutionary paradigm. Simply stated, this view holds that life started on the earth in molecular form and evolved into cells that contain genetic material called DNA. In the course of cell division, the DNA underwent random aberrations known as mutations. Some of these genetic abnormalities resulted in illness and death for the cells. Other mutations gave rise to cells that became deadly agents like viruses and bacteria. Still other mutations caused the evolution of complex organisms, resulting eventually in a plethora of different species, including Homo sapiens, or human beings. In a nutshell, illness, disease, and death are the result of blind natural forces that are interwoven into the very fabric of our existence.

According to the majority opinion in modern medical science, this is the way life is, and it was never any other way. Ailments, infections, the eventual extinction of our physical bodies, and all the pain and suffering that go along with them are part and parcel of who we are. We cannot escape these conditions! Yet it is the mission and final goal of medical science to hunt down and eradicate these enemies. There is a paradox at this point that medical science with naturalistic assumptions cannot explain. If these enemies are interwoven into the very fabric of our existence, how can they be eradicated?

As with all ideas about the genesis of our existence, certain presuppositions exist that require belief. The doctor with a naturalistic approach to medicine assumes that the world and human beings came into existence through a series of random events, and that illness, disease, and death are in part the result of various mutations that evolved with mankind. On the other hand, the Christian begins with an assumption that God created everything by a deliberate act, and the entire creation was in a state of bliss (Gen. 1:31). The world was free from infectious diseases, pathologic conditions, genetic abnormalities, and death at this time, and all was wellness, health, and life — the state for which humanity longs. [1] The first man and woman had a choice: obey God and choose wellness, health, and life, or rebel against God and choose illness, disease, and death (Gen. 2:17). They chose the latter. Sickness, physical malady, and death were the result, as promised by God, for the man, the woman, and all their posterity; the eternal state of health, wellness, and life was lost. [2] In the Christian paradigm, all suffering and misery stems from the rebellion of mankind against God.

This rebellion incurred the curse of God, and all of mankind was plunged into a state of total depravity. The entire creation was cursed by God as a result, and all of mankind entered into a persistent state of misery that is characterized by illness, disease, pain, suffering, and eventual death. Yet none of it took God by surprise; in fact, it was all according to His incomprehensible plan (Eph. 1:4, 11). This is a riddle, I admit, but it also provides a foundation for hope. God is in control of ailments, physical maladies, and death, but not as a cruel despot. These afflictions are used by Him as a means to accomplish His goals. God is not an impersonal and mechanistic force; He is a personal, interested, and involved God. He was so concerned that He entered into our misery — the misery caused by our own rebellion — and He bore the weight of illness, disease, pain, suffering, and death upon Himself. Jesus Christ willingly took upon Himself the curse that we deserved, thereby absorbing sin’s effects. He provided a way for restoration to all those who believe and obey Him.

The Providence Of God In Illness, Disease, And Death

Perhaps you are wondering: if Jesus restored Christians to wellness, health, and life, then why do they still experience sickness, infectious diseases, and eventual death? Jesus started the restoration, but the full restorative act is yet to come (Rev. 21ff). A day will come when Christ will return, restore the world, and do away with illness, disease, and death altogether. In the present, however, these afflictions and all the suffering that goes along with them are universal and are used by God to accomplish His goals. One of God’s goals is to drive people to seek the hope of restoration found only in Christ. To the non-Christian, illness, disease, and death are but a gentle foretaste of the eternal torments reserved for them without Christ (Matt. 25:41). A second goal is to warn (Deu. 28:58ff.). These afflictions can be used to warn people of ungodly living. A third goal is to sanctify Christians (Rom. 8:28-29). Sickness, illness, infections, and the dying process, with all of their attendant misery, are a means to prepare Christians for everlasting wellness, health, and life in their eternal rest to come (Rev. 21:4).

The ultimate and overarching goal of all illness, disease, and death is to bring glory to God, whether through judgment, affliction, restoration, or endurance (John 9:2 –3).

In a temporal and eschatological sense, illness, disease, and death are always beneficial, but not necessarily pleasant, to the Christian. Christians truly believe “that all things work together for their good” (Rom. 8:28, emphasis mine). This means, as Dr. Robert Smith comments in The Christian Counselor’s Medical Desk Reference, that getting “over the illness should not be the primary goal” for a Christian. [3] He writes further:

What glorifies [God] is what is best for all believers; therefore what glorifies Him will be the best for the sick believer. Getting well is not necessarily the best thing.… The hope for the believer is victory, not relief. Relief is not inherently wrong, but it becomes wrong when it is the primary goal. God promises victory in illnesses and trials, not deliverance from them.

This distinction is very important, especially in light of the philosophic underpinnings of modern medicine. The biblical view of illness, disease, and death is the polar opposite; yet, how many Christians seek relief from these afflictions at all costs?

The Christian is sanctified by God’s providential hand in the experience of sickness, infectious disease, congenital defects, and dying. First, a Christian who suffers these afflictions will enter into the experience of Christ and become more like Him in suffering (Rom. 8:29). Second, illness, disease, and death are reminders of the fleetingness of this life and the hope of eternal rest to come (James 4:14; Rom. 8:18). Third, endurance under misery and suffering testifies to a Christian’s character and to God’s sustaining grace (Job 2:3-6; 1 Cor. 10:13). Fourth, affliction, sickness, disease, and impending death are used to increase a believer’s ministry. [4] The Christian who sees the providential hand of God behind his afflictions as a means of sanctification will find great comfort in knowing that God is in control. “God never lays a rod upon his children’s back,” writes William Bridge, “but he first puts a staff into their hand to bear it.” [5]

If the providence of God is behind illness, disease, and death and these afflictions benefit the Christian, then why seek medical treatment? The reason is that Christians must be good stewards of their bodies. There is an important categorical difference at this point. Christians do not seek medical treatment simply in order to get well; rather, Christians seek wellness and health in order to take care of their bodies (1 Cor. 6:19-20). If the possibility exists for a Christian to improve his physical health, then he should do so, “that [he] may continue serving the Lord as long and as productively as possible.” [6] By the same token, a Christian can be a poor steward of his body when he seeks medical treatment that will only prolong his suffering or destroy his body. I am reminded of a Christian lady who received radiation treatment for cancer. She suffered more from the medical treatment and the complications to her body than from the disease itself. Her latter days were miserable and painful. A weighty and difficult task for the pastor is to discern the providence of God in illness, disease, and death; the need for wellness, health, and life in this present existence; and how to utilize medical science biblically.

The Pastor: Illness, Disease, And Death

There is perhaps no area of pastoral care more prone to misstep than ministry to those who are ill, afflicted with disease, or near death. Some of the most frequent pitfalls for a pastor are personal insecurity in dealing with illness, disease, and death; making personal experiences normative; sentimentality; working from personal rather than biblical presuppositions; rigid application of certain protocols from counseling books; not understanding the relationship between what is considered subjective and objective data in medicine; playing doctor; providing people with reasons to avoid personal responsibility; not looking at people holistically; not understanding side effects of medications; being intimidated by the medical community; and providing people with false hopes of healing when they have received a terminal diagnosis. These are but a few of the errors that the pastor must be on guard against.

How should a pastor counsel a person facing illness, disease, or death? First and foremost, a pastor must discern to the best of his ability whether or not that person is a believer. If a person is not a Christian, then the goal of counseling must be evangelism. Illness, disease, and impending death are excellent evangelistic tools, so don’t pass them up! One of my goals in counseling afflicted non-Christians is to uncover their hopelessness without Christ. A simple question like “What is going to help you through this?” will usually open up the conversation. Conversation will usually come to a point where I can communicate a few biblical truths. It is important to pray for these people and follow-up with them. We need to remember that every bit of gospel truth, in both word and deed, is used by the Holy Spirit to reveal Christ. [7]

When working with Christians facing illness and disease, the pastor will be able to counsel biblically. Initially he must gather accurate data. First, he must find out how the condition was diagnosed. [8] Second, he needs to inquire about the history of the condition. Third, he has to discover the effects of the condition on the person’s lifestyle. Fourth, he has to determine how the condition impacts the person’s thinking and attitudes. Fifth, he will need to find out how relatives and friends respond to the person’s condition. Sixth, he should learn about any medications that may have been prescribed. [9] The purpose of gathering data is not to verify or disprove a diagnosis, but it is to help the pastor counsel appropriately.

The pastor should cover the following topics when counseling, but not necessarily in this order. First, the afflicted person will need to understand how non-Christian health practitioners view illness, disease, and death so that he will not be confused by the presuppositions of naturalistic medicine. Second, the person must be taught a biblical understanding of illness, disease, and death. He needs to hear that the ultimate cause of afflictions is sin, not blind, random processes. He also needs to know that his affliction is according to God’s incomprehensible plan, and that God is still in control no matter how he feels. Third, the person must be reminded that Jesus bore all of his afflictions, no matter how ill or diseased he may become. The person needs to understand that at present, God is using this affliction to sanctify him and to direct his eyes to Christ in deeper faith. Fourth, the person must come to terms with the fact that this affliction is beneficial in some way. God is using it for His purposes, so it is up to Him, and not medical science, to remove it, although He may use medical techniques to do so. Fifth, the person must seek to promote good health as a steward, even if it means turning away from medical procedures that may cure the disease but destroy the body.

The pastor should seek to discern, to the best of his ability, when medical intervention is advantageous and when it is futile, and he should know how to counsel biblically in either case. If medical intervention is advantageous, the pastor’s counseling will be directed toward recovery. But if medical intervention is futile, his counseling will be directed towards comfort and accepting death. [10] It is important for the pastor to know that medical science has, in some cases, created extensive suffering, pain, psychological distress, fruitless hope, disfigurement, and immobility for many people in sincere but biased attempts to eradicate illness, disease, and syndromes at all costs. The goal of bodily stewardship, and not the healing of the body, must always be in the forefront of a pastor’s thinking. Death is sometimes a welcome option for the Christian, especially if the future will be filled with extreme pain, sickness, bodily disfigurement, family distress, hopeless grasping after cures, suffering, misery, and increased expense due to protracted medical intervention.

The pastor will play an important role when counseling individuals who are terminally ill, diseased, and dying. First and foremost, the pastor must be aware of his own insecurities concerning death. He can do a lot of damage by saying, “Don’t worry, everything will be okay,” or “We will pray for your healing.” Statements like this do not benefit the dying person or his family but serve to alleviate the pastor’s discomfort. For a Christian, the role of the pastor is to provide comfort and assurance of heaven, not false hopes of healing. In addition to the counseling about medical treatments mentioned above, the pastor must prepare the dying person and family for death. Today, hospice services are available to provide comfort and care in the dying process, and the pastor needs to be knowledgeable about these services. [11] He should understand the dying process, be knowledgeable about the medications used for palliation, assist the family in funeral arrangements, and be the level-headed point of contact for the family. The pastor will also need to provide bereavement counseling for the family after the person dies.

Traditional Hospice And Christianity

Within the last forty years, hospice and palliative care services have gained a reputable position in the medical community. This was due mostly to the pioneering work of Dr. Elisabeth Kübler-Ross, who in 1969 published On Death and Dying, a scathing indictment of the medical community’s ignorance, insensitivity, fear, and approach towards death and dying. In the words of Time magazine, Kübler-Ross “has brought death out of the darkness.” Not long after Kübler-Ross’s book came out, federal legislation facilitated a hospice benefit for Medicare, and private insurers followed suit. This benefit is now available to people with a prognosis of three months or less to live. [12] As a result, hospice agencies sprouted throughout the nation.

When a person decides that medical intervention is futile and death is imminent, he should be referred to hospice services. [13] At this juncture, another significant challenge confronts the pastor. Certain assumptions about palliation of symptoms, death, and the afterlife are made by hospice agencies that guide the care they give. [14] One assumption is described by Kübler-Ross in her book Death: the Final Stage of Growth and holds that death gives birth to a new stage of life, an afterlife that is in harmony with one’s private beliefs. This assumption is an attempt to unite naturalism with polytheism. Another assumption is that the body is the prison house of the soul. To quote from Gone from My Sight: the Dying Experience, a popular booklet by Barbara Karnes that is handed out to thousands of patients and families who enroll in hospice services, “The separation becomes complete when breathing stops. What appears to be the last breath is often followed by one or two long spaced breaths and then the physical body is empty. The owner is no longer in need of a heavy, non-functioning vehicle.” This assumption stems from a Platonic understanding of soul and body, which asserts that the necessary immaterial soul is imprisoned in an unnecessary physical body. A third assumption is that man is the center of the universe: “The good death and all its ingredients, once the options have been offered, is the choice of the final decision maker…the patient,” writes one author. [15] This idea stems from secular humanism and denies the transcendence and sovereignty of God. Fourth, fear, anxiety, guilt, and all other uncomfortable feelings are viewed as unnecessary evils that must be eradicated. Hospice agencies have an arsenal of medications to numb the patient, and clinicians usually affirm the idea that everything will be okay in the end no matter what is felt or believed. This assumption is based on a hedonistic view of life that denies the immanence of God. [16] These are four basic assumptions that underline, direct, and drive traditional hospice care in the United States.

Because these four presuppositions militate against Christian beliefs, it is crucial for the pastor to have not only a clear understanding of these underpinnings, but also of biblical theology, anthropology, and eschatology. Christianity has always affirmed that God is the final decision maker and not man or “the patient.” God is transcendent and sovereign; He rules over all, controls all, and determines all (Isa. 40:10-15). He created man, gives life to man, and determines when He will take life away from man (Gen. 2:7; Eccl. 3:2). A proper theology underscores God’s transcendent and sovereign activity and is the foundation on which any worthwhile counsel is given.

It is equally important to understand that the “wages of sin is death” (Rom. 6:23). We die because of sin; death is not some “final stage of growth” in a naturalistic process. Death and the dying process are always the culmination of misery, pain, and suffering due to our sin. So, a “good death” in this sense of the term is a misnomer, for there are no “good deaths.” Death is the result of man’s rebellion against his Creator! It must be remembered, however, that death itself is no longer a curse for the Christian but a point of transition; it is where “mortality puts on immortality” (1 Cor. 15:55 –57). So in this sense death is beneficial, and Christians can die well, but death itself is never “good.” Death and the dying process are real and miserable, and this must never be minimized, trivialized, or misrepresented as something that is “good.”

At the time of death, the soul leaves the body and enters into the intermediate state. [17] At this point the believer’s soul is made perfect in holiness and passes into the glorious reality of heaven to experience eternal bliss. [18] When an unbeliever dies, his soul enters into a state of eternal torment, and he is separated from the grace of God forever (Luke 16:23-24). Both the bodies of believers and unbelievers return to the dust and await the resurrection. This body is not the “heavy, non-functioning vehicle” of Platonism; it is what God has created and will take back on the Day of Judgment. In this state of bodily decay, the believer is still united to Christ; the unbeliever’s body is alienated from Christ and the hope of eternal life forever.

The Pastor And Hospice

When a Christian decides that medical intervention is futile, death is imminent, and hospice is a viable option, it is important for the pastor to be involved immediately. [19] If the individual agrees, the pastor should be present at the initial hospice admission visit and be identified as the person managing the spiritual care. [20] This important step will accomplish three things. First, it will allow the pastor to direct the philosophy of care given. This is of utmost importance. Second, it will place the pastor in a position to communicate on behalf of the dying member and the family to the hospice agency. This step will eliminate a lot of stress for the individual and family. Third, it will allow the pastor to counsel the person and family without the unbiblical influences mentioned earlier.

The pluralism that hospice programs advocate is a blessing in disguise for the pastor. The patient directs the spiritual care he receives, and to go against the patient’s convictions is discriminatory and therefore illegal. However, it will be necessary for the dying individual, or family if the person is unconscious, to identify the pastor as the person managing the spiritual aspects of the patient’s care. The next important step is for the pastor to explain his role clearly. First, he will assist the family in their social needs (funeral arrangements, visitation, etc). Second, he will provide all the necessary counseling for the dying individual and family, as well as the bereavement follow-up. Third, he will work with the other hospice professionals in order to provide comfort and management of pain and symptoms for the individual and family

As mentioned earlier, the goal of hospice care is to alleviate suffering, not only spiritually, but mentally, and physically. [21] This is an admirable goal and should be viewed as such. Jesus alleviated mental and physical anguish everywhere he went. In order to accomplish this task, hospice agencies have several medications to assist them. [22] There are two groups of medications that the pastor must be aware of: psychotropic drugs and narcotics. These medications concern the pastor because they can have adverse and unwanted side-effects, can be abused, can cause an overdose, and can hasten death. The pastor needs to be observant when these medications are in use.

It will be important for the pastor to establish with the dying individual, if conscious, the level of pain and discomfort he is willing to endure, and to communicate this desire along with the dying individual to the hospice nurse. [23] Because of sin and the curse on the creation, it is impossible to eliminate pain and discomfort entirely. The goal, therefore, is to keep the individual as physically and mentally comfortable as possible, while maintaining consciousness, clarity, and the ability to communicate, but not to obtund him. [24] The pastor should encourage the individual to make his last days on earth a blessing to others through his undying testimony of God’s grace to him in Jesus Christ.

The Pastor And End Of Life Counseling

Hospice agencies will typically follow a framework by Kübler-Ross called “stages of death.” In this framework, five transitional stages lead up to death: 1) denial and isolation, 2) anger, 3) bargaining, 4) depression, and 5) acceptance. I have found that the conditions of these stages are accurate, but the idea that a progression exists is not correct, at least in my experience. I believe it is more accurate to see these elements in constant flux and not as “stages” but as “states.” Typically, when a person hears that he is going to die, denial does indeed set in, but it is usually in the form of an unrealistic acceptance of death. It is not until reality sinks in that true denial, periods of isolation, bargaining, depression, and periods of acceptance begin to occur. All of these stages are in constant flux as a person nears death. A person may be more accepting one day and depressed the next, and so on. There is no clear-cut progression as described by Kübler-Ross, but her work is accurate and valuable insofar as it pertains to the existence of the various states. The pastor should seek to identify these states when counseling.

As mentioned earlier, the main focus of counseling is to alleviate spiritual, mental, and physical suffering, to help the Christian individual and family understand properly this providential affliction, and to assist them in accepting death. Narcotics may be used to control physical pain and suffering, and psychotropic drugs may be used for mental and bodily suffering. When the person receives a terminal diagnosis and as he nears death, significant changes will occur not only physically but mentally. The individual may experience depression, anxiety, mania, hallucinations, and a host of other psychological afflictions due to the crisis, spiritual malady, physical sickness, underlying psychosis, or the disease process. Psychotropic drugs and narcotics can be used effectively to maintain mental stability and to provide important physical comfort to the individual that will permit the pastor to counsel biblically. So it is incumbent on the pastor to identify these physical and mental afflictions and report them to the hospice nurse so that she can give the proper medications and adjust the dosages as needed. [25]

Where counseling should begin depends on how well the Christian individual and family are coping with the impending death. No matter where the pastor begins, there are four hopeful teachings that he should consciously and continuously intertwine as he counsels. First and foremost, he must bring to remembrance the victory that Christ has over death (1 Cor. 15:55). Although death may be a fearful foe and dying may be miserable, Christ has gained the victory and has eliminated its sting. Death for the Christian is the doorway to Immanuel’s Land, and the place where mortality puts on immortality. It is the place where illness, disease, pain, suffering, and death will be completely done away with. Second, the pastor should bring the hope of assurance to the individual. It is important to communicate clearly that God accepts everyone who sincerely believes in Jesus and His righteousness as his only hope for salvation and that He will never leave him nor forsake him (John 10:27-29; Rom. 8:31– 39). Third, the pastor should address the individual’s many questions: What is the providence of God in all of this (Rom. 8:28)? Why is God doing this? What will happen to my family after I am gone? How will God be glorified? Fourth, the pastor should remind the individual of the beautiful promises of eternal life to come. There are several passages a pastor can turn to in this area. Three of my favorites are John 14:1– 6 and Revelation 21:1–4 and 22:1–5. At all times, the pastor must remember to pray and to sing psalms, hymns, and spiritual songs with the dying individual and his family.

The pastor will also have some very important social work to do, so it will be important to mobilize the diaconal team in the congregation. The family and dying individual will require extensive and organized support, both during and after the death. Diaconal care includes organizing visitation, providing opportunities for the family to get away, providing meals, watching children, taking care of pets, and assistance around the house. The pastor will need to make funeral arrangements. This is a difficult but important and necessary step. After the individual dies, the hospice nurse will pronounce the patient dead, and the funeral home will remove the body from the house. Making many of the funeral arrangements beforehand eliminates a great amount of unnecessary stress on the family, and planning the funeral with the dying individual and the family can be a healthy experience. The pastor must recognize that he is only one part — but an important part — of the hospice team and church team, and that he cannot do it all.

Finally, the pastor has the important responsibility of providing bereavement counseling for the family. Immediately following the death, the pastor should plan to visit the closest family members daily for a few days, until the funeral, then weekly for four weeks, and monthly for the next two months. [26] The pastor must keep in mind that the impact of death does not usually hit the family until a month or two later. Counseling should initially focus on helping the person(s) grieve. It is not normal for family members to be insensitive to the death of a loved one; they should feel sadness and grief. If this is not obvious to the pastor, he should ask whether or not the person(s) has cried over the death. Helping to process the death, understanding the death biblically, and moving on in fervent service for Christ will be the primary goal of the pastor in bereavement counseling. [27]

Pastors in the twenty-first century need to re-examine their approach to counseling the ill, diseased, and dying. The pastor has a responsibility to communicate the true etiology of our afflictions and to trace the providential hand of God that is behind them all. This is a difficult but necessary task in today’s medical milieu. It is essential for people to come to terms with these truths and to establish a biblical understanding of illness, disease, and death. This is their only hope! Medical science has become a negative, in many ways, simply because so many pastors have been bound by its subtle influence. However, the pastor must not be swayed; he must maintain a biblical and balanced understanding of illness, disease, and death in order to counsel appropriately in the twenty-first century and beyond.

Appendix A

Commonly Used Psychotropic Drugs and Narcotics

Psychotropic Drugs

Medications: lorazepam; diazepam

Uses: Anxiety, restlessness, difficulty sleeping

Side Effects: drowsiness, forgetfulness, dizziness, weakness, confusion

Adverse Reactions (particular in the elderly): risk of falling, severe agitation or confusion, hallucinations, agitation, confusion

Medications: haloperidol; olanzepine; chlorpromazine

Uses: Hallucinations, agitation, confusion, mania

Side Effects: drowsiness, dry mouth, slow breathing

Adverse Reactions: risk of falling, severe agitation or confusion

Medications: prochlorperazine; metoclopramide; chlorpromazine

Uses: Nausea and vomiting

Side Effects: dizziness, sleepiness, restlessness, tremor, dry mouth, constipation or diarrhea

Adverse Reaction: increased nausea

Medications: Phenobarbital; diazepam

Uses: Seizures

Side Effects: drowsiness, hallucinations, flushing, nausea, “hangover headache”

Adverse Reactions: risk of falling, severe agitation

Medications: diphenhydramine; lorazepam; temazepam

Uses: Insomnia

Side Effects: drowsiness, dizziness

Adverse Reactions: risk of falling, severe irritability or anxiety

It is also important to note that antidepressant medications are sometimes used to control neurological pain (sharp, tingling or burning pain). If the hospice clinician desires to use an antidepressant it is not necessarily for depression, although it may be. It will be important to find out if the antidepressant is used for depression. Some of the most common antidepressants used in hospice are: neurontin, nortriptyline, trazadone, venlafaxine, amitriptyline, paroxetine, fluoxetine, mirtazapine, bupropion, and sertraline.

Narcotics

Medications: morphine; oxycodone; hydromorphone; fentanyl

Uses: Pain management

Side Effects: drowsiness, dizziness, confusion, constipation, hallucinations, nausea, difficulty urinating, rash, itch; risk of withdrawal symptoms if stopped abruptly (nausea, cramps)

Adverse Reactions: risk of falling, constipation; very slow breathing

Appendix B

Signs and Symptoms that May Occur as a Person Nears Death:

One to Three Months

1. Withdrawal from the world and people
2. Decreased food intake
3. Increased sleep
4. Introversion and less communication

One to Two Weeks

1. Disorientation
2. Confusion
3. Agitation
4. Talking to unseen people (Hallucinations & Delusions)
5. Picking at clothes
6. Physical signs and symptoms:

A. Decrease in blood pressure

B. Increase or decrease in pulse

C. Color changes to the skin (pale, grayish, bluish)

D. Increased perspiration

E. Respiration irregularities

F. Congestion and raspy breathing

G. Sleeping but responding to tactile stimuli

H. Complaints of body feeling tired and heavy

I. Not eating, taking in little fluids (do not force a person to eat)

J. Body temperature can be either hot or cold

Days to Hours

1. Intensification of “one to two week signs”
2. Sudden surge of energy
3. Physical signs and symptoms:

A. Continued decrease in blood pressure

B. Glassy eyes, tearing and half open eyes

C. Irregular breathing with long pauses between breaths

D. Increased restlessness or even no activity at all

E. Purplish knees, feet, hands, and “blotchy”

F. Pulse weak and hard to find

G. Decreased urine output, may wet or stool the bed

Minutes

1. “Fish out of water” breathing
2. Cannot be aroused or awakened
3. Cold, clammy, pale, gray, ashen, or bluish body

Works Cited

• Bridge, W., The Works of William Bridge. Beaver Falls, PA: Soli Deo Gloria Publications, 1989.
• Smith, R., The Christian Counselor’s Medical Desk Reference. Stanley, NC: Timeless Texts, 2000.
• Rev. Christopher W. Bogosh, BTh, RN
• Hazleton Area Reformed Presbyterian Church, 680 Roosevelt Street, Hazleton, PA 18201. 570-450-0148. www.hazletonrpc.com

Notes

1. It is important to distinguish between what I call microbiological death and biological death. In the garden, Adam, Eve, and the animals ate plants, so this required the death of the plant for digestive purposes on the microbiological level. So death in one sense always existed prior to the fall. The Bible teaches that biological death — that is, the death of a living species with blood in it — did not occur until after the fall (Gen. 2:17; Lev. 17:11; Rom. 6:23).
2. See Genesis 3ff.; Revelation 20:14; and Romans 5:12; 6:23.
3. Robert Smith, The Christian Counselor’s Medical Desk Reference (Stanley: Timeless Texts, 2000), 31.
4. In my experience, I have come across many Christians who think that they have an excuse to stop ministering when they become ill, contract a disease, or even face death. This kind of thinking is radically unbiblical (cf. Job 2:10; the supreme example to the contrary is Christ on the cross: Luke 23:24, 39-43; John 19:25-27; Mat. 26:53-54). Although it may be a struggle to cope under these afflictions and still minister, the excuses not to minister are based on sentimentality and a low view of God’s providence. As long as a Christian is in a state of consciousness, he should seek to minister to others, even if that means a death bed ministry of prayer. For a powerful testimony to God’s sustaining grace in one man’s death-bed experience that still ministers to us today, see the Memoirs of Thomas Halyburton, ed. Joel R. Beeke (Grand Rapids: Reformation Heritage Books, 1996), 226-94.
5. William Bridge, The Works of William Bridge (Beaver Falls: Soli Deo Gloria Publications, 1989), 2:191.
6. Smith, 41.
7. The two-fold effect of the Gospel is in view here (2 Cor. 2:15 –16).
8. It is very important for the pastor to discern between what are called symptoms (subjective findings) and signs (objective findings) Technically, in order for a disease to be diagnosed, factual evidence (blood pressure, lab tests, MRI, etc.) must exist. The medical community has a tendency to label subjective complaints (symptoms) as a disease without any objective findings (signs), and this is wrong. Alcoholism, and a plethora of psychological conditions, are examples of so-called diseases that are diagnosed from subjective data.
9. Smith, 49-51. It is not necessary to know the dosages, but it is important to understand why the medication was prescribed and any side effects.
10. It is extremely important that the pastor recognize his boundaries at this point. He should never make the decision to pursue or not to pursue medical intervention. The pastor should act as a guide who provides factual information in light of medical findings and provides counsel that is biblical. Ultimately, the person or his family must make the final decision to pursue or to forgo medical treatment. This does not mean, however, that a pastor does not give his opinion in light of medical findings, but only that he should not make the decisions for the parties involved.
11. It is important for the pastor to realize that hospice agencies have their own presuppositions about life and death that stem from the ideas of Dr. Kübler-Ross and New Age spirituality. It is also worth noting that many hospice agencies advocate euthanasia and support the “Right to Die” movement. For the sake of the person dying and the family, the pastor needs to become a part of the hospice team and advocate for the family during this difficult time. More will be said on this later.
12. The three-month window is not very rigid and has been broadened recently. A terminal prognosis is still necessary, but a terminal prognosis can be given if a person decides that he no longer wants to take medications that are necessary to sustain life. If a treating physician is of the opinion that death would occur if certain medications were stopped, then hospice services may be referred. When a person signs on to hospice care, he is reviewed at three-month intervals for the first two certification periods and six months thereafter. If the person improves (and many do), he is discharged from service.
13. Unfortunately, there are many physicians who refuse to refer their patients to hospice because of a drive to cure the disease at all costs. In these instances, the patient and family must request hospice services and/or to have a second opinion from another doctor.
14. I will focus on the assumptions about life and death made by hospice agencies that are considered worthy of Medicare reimbursement. Most private insurers follow these guidelines as well.
15. Quoted from a standard admission packet that is handed out to patients prior to enrollment in hospice services.
16. The term “immanence” is a concept from philosophy that describes God’s presence and activity in the world. It is the action behind God’s transcendent providence. This view is in contradistinction to Pantheism, which believes that God’s essence is identical with the creation.
17. The “intermediate state” is the time between the death of the body and departure of the soul in this present life, and the resurrection of the body and reunion of the soul at the second coming of Christ.
18. Heb. 12:23; 2 Cor. 5:1, 6, 8.
19. There are some important things for the pastor to know about hospice care. First, the goal of hospice care is not to cure the disease, but to reduce the symptoms of the disease by providing physical, emotional, and spiritual support to the patient and family. This means that treatment is palliative in nature and does not include such measures as cardiopulmonary resuscitation (CPR) or other advanced life support systems. The person signing onto hospice agrees to forgo any further medical treatment for his disease. This is an important fact that the pastor must keep in the forefront at all times. He must make sure the dying individual and the family understand clearly the decision that is being made. Second, the admitting nurse should explain what is called a “do not resuscitate” (DNR) order and what this means to the family. Basically, CPR and other life saving measures will not be performed at the time of death; therefore, the hospice agency, and not an ambulance, should be called. Third, the nurse should explain repeatedly that all the care given is palliative, and medical treatment such as intravenous infusions and tube feedings are usually contraindicated. Fourth, the nurse should make sure a health care proxy is identified and the proper forms are filled out. She should explain the health care proxy’s role and make sure he understands that he may have to make important decisions on behalf of the dying individual. Fifth and ongoing, the nurse will provide teaching about medications and the progression toward death and will seek to provide support to the patient and family.
20. Hospice agencies are required by law to provide chaplaincy (spiritual) services for the dying and their families.
21. I do not advocate a trichotomist view of man, but for practical purposes I will distinguish between the mind, body, and soul. Edward T. Welch, in his book Blame it on the Brain: Distinguishing Chemical Imbalances, Brain Disorders, and Disobedience (Phillipsburg: P&R Publishing, 1998), does an excellent job explaining the relationship between body and soul, their integrated components, and how they affect one another.
22. See appendix A for a list of commonly used medications and their side effects.
23. It is important to mention that when a person is in an unconscious state, he will still experience pain and discomfort. This is usually evident through wincing, irritability, picking, rapid breathing, raspy breathing, and moaning. See appendix B for a list of physical and mental signs and symptoms that appear when a person is nearing death. Also, the nurse is skilled at assessing pain and discomfort. She should establish this baseline with the patient right away, and should also explain that as the disease progresses and death nears, more medication may be required to alleviate pain and discomfort. The main thing the pastor needs to do is to make sure a biblical balance is maintained, and the member is not overly influenced by the nurse, who will be inevitably biased in her approach.
24. The pastor should never assume that he knows the level of suffering or pain a person is experiencing. Pain, discomfort, and suffering are subjective and are always what the person says they are.
25. The individual may report having guilt, remorse, visions, bizarre dreams, and visitations from people he was acquainted with who have already died. These may be important areas where repentance and forgiveness are needed, especially if guilt and remorse is the cause. On the other hand, these experiences may be pleasant, such as experiences of the heavenly reality to come or a reunion with long-dead saints. It is important for the pastor to explore these things with the parishioner and to recommend the use of medication wisely. Do not write off dreams, visions, or other experiences too quickly, because these experiences are doorways into the subconscious world of the dying individual (I do not mean to sound Freudian or Jungian!) and they will help the pastor to counsel effectively.
26. This is not a rigid schedule, because each situation is unique. Visits should be based on the family’s needs.
27. Moving on with life does not mean doing away with memories. In fact, tapping into memories can be a good way to get people to grieve and move on with their lives.