Existential and spiritual questions often overlap. Who have I been in my life? What has my life been? What have I been like when dealing with other people, and what have I received and experienced in return? What have I done to deserve this illness? If an omnipotent God exists, why aren’t my prayers heard? These are the questions or reflections that come up when dealing with an incurable illness or when processing the finite nature of life.
Existential and spiritual support in palliative care
Existential issues deal with questions related to personal values, the meaning of life, and existence. Spirituality is a part of these existential issues.
Having an illness robs us of our feeling of safety. We’ve lost our health, which we may have taken for granted up until this point. Losing one’s health poses a threat to human life and increases our feelings of unsafety. The unsafety and uncertainty of life make us think about our situation and the future. This gives rise to various questions.
Why, why me? Can my illness be cured? Will there be pain? Will I be healthy again? Am I going to die? What’s going to happen to the life I’ve lived before the illness? How will my loved ones cope with my illness? How are they going to manage? What about my finances, my work, and everything that’s still unfinished?
These kinds of questions are filled with uncertainty and force us to pause. We are afraid. If a person is taken to the middle of a dark, unfamiliar forest and left there alone, fear is a normal reaction, because the unfamiliar and the unknown are scary to us. People are supposed to flinch at things that threaten them – this is how a healthy mind works.
Especially in the early stages of illness, there are no answers available to our questions right away. The same questions resurface during critical transitions in the illness. Such transitions include changes in the illness itself and in treatments or treatment intent.
The question “why?” is not always really a question, but rather an expression of confusion and disbelief about the new life situation. The new situation doesn’t feel like our own life. It’s like watching someone else’s life, only from within. However, to move forward in life, even just a few steps, we have to face our own life. It may feel like a stranger that we’d rather not get to know, but if we fail to get acquainted with our own life, everything is going to stand still.
When getting to know our own life, it’s important to take our new life situation and break it down into smaller pieces. Getting things into focus is important. In the middle of chaos, many people find this difficult, or even impossible. The knot is too tight to untangle. However, even the tightest knot can often be untangled with the help of existential or spiritual support. This requires support from another person.
Existential support is essentially about one person – the helper – placing themselves by the side of another – a person living with, or close to someone, with an illness. Being by someone’s side requires the helper to be able to handle the life situation, reflections, questions, and pain of the person they are helping. The recipient needs to be able to count on the helper being there for them. The person dealing with an illness needs to be able to feel like the helper is taking their thoughts, emotions, and questions seriously. Since there are no words, medicines, or therapies available to change facts, there’s no room for empty words of consolation or for denial of facts. It’s important to be able to talk about the things that the person with an illness particularly wants to talk about.
Sometimes it’s hard to talk about things that we consider difficult with those close to us. It feels like a thing is harmless as long as we don’t mention it; it might as well not even exist. As a result, it may be difficult to discuss topics such as death or our thoughts related to it with our loved ones. At the same time, the presence of illness – especially a serious illness – almost always leads our thoughts to death. However, not everyone with an illness is able or willing to talk about their life situation or other personal matters. If a person is used to solving difficult problems by means other than talking, having a serious illness might not make them change their approach. It’s important to understand that this is their choice to make.
To provide a person with an illness with a safe conversation partner who can serve as a mirror for their thoughts, there are many kinds of professional help and peer support available. Some care institutions offer the services of a psychologist or a psychiatrist. Some also provide support in the form of psychotherapy or family counselling. In addition, hospitals feature hospital chaplains who provide professional support on both spiritual and existential matters. Different patient organisations offer various forms of both professional and volunteer-based support.
Having an illness, especially a serious one, often brings spiritual questions to mind. If spirituality was already a part of the person’s life before the illness, it’s natural to find it important after becoming ill as well. Based on experience, it appears that spiritual questions, or ones resembling them, often also become relevant to those who didn’t consider spiritual activities or questions particularly important in their life before. In both cases, the questions on the person’s mind are usually existential in nature.
Spiritual support means pausing to consider these questions. It also means giving these questions permission to exist. Spiritual support is centred on utilising the spiritual resources that the person already possesses, and searching for those that add to these resources.
The main religion in Finland, Evangelical Lutheran Christianity, has religious practices that enhance spiritual support. These include prayer, intercessory prayer (praying on behalf of someone else), the Lord’s Blessing, and Holy Communion. These are all a part of spiritual support, alongside reading the Bible and singing hymns.
However, in the case of an illness, pastoral counselling discussions are perhaps the most essential form of spiritual support. These discussions concern both existential and spiritual questions, either separately or together. In Finland, faith-based Christian spiritual support is provided by parishes. There are hospital chaplains, with specialist training in clinical work, working in hospitals and care institutions. Hospital chaplains respect everyone’s convictions. Pastoral care can be described as existential support that adheres to the person’s convictions.
For those belonging to other religious communities, support from their own community is available in bigger cities; elsewhere in the country, the situation varies by region. For contact information, ask care institutions or a hospital chaplain, or see the webpage of the community in question.
Updated 30.4.2025