Icons of presence: Reimagining the landscape of the living in end of life chaplaincy and spiritual care

Is the hospital chaplain in end-of-life spiritual care an ‘icon’ of God’s reconciling, merciful presence? At the heart of spiritual care in hospital chaplaincy and work with the dying is the unique quality of the relationship that ministers develop, often over very brief periods, with patients facing the end of life. This form of care involves reflection on and a praxis of ‘companionship’ as a radical ethic of love in action. Concrete, pastoral interventions communicating the message that ‘you are not alone’ or ‘you are cared for’ or ‘you are loved’, moreover, entail a countercultural ethic of defending human dignity and preserving life. In this ministry, notions of providing comfort, being an ‘accompanying presence’, and naming what is of ‘hope in the present’ are essential ground on which chaplains build relationship with those under their care. As others have pointed out, this is more than ‘maintenance of life’ (S. Nolan, 2011) and providing a ‘good death’ (R. Pettigrew, 2024). In this article, we look at case studies in end-of-life care to flesh out the concept of an ‘iconography' of presence in prayer and dialogue mediating God, eternity, spiritual reconciliation, and hope for the afterlife.