When visiting the sick, the 1662 Church of England Book of Common Prayer Order for the Visitation of the Sick, directs the minister to say, “whatsoever your sickness is, know you certainly that it is God’s visitation.” The instruction continues with two possible causes of the person’s sickness, one being to try the patience of the sick for an example to others and the other that the sickness may have been, “sent unto you to correct and amend in you whatsoever doth offend the eyes of your heavenly Father”.
In 1798 Charles Simeon of Cambridge wrote a sermon outline, subsequently published in his 21 volume Horea Homiletica (outline 421). In summary, Simeon’s outline calls upon the people to repent and make a covenant with God because the calamities that have come upon them are indicative of God’s wrath against them. Without repentance, they cannot hope to escape. With repentance, there is nothing to fear.
These examples from the seventeenth and eighteenth centuries show a belief that sickness and other ‘calamities’ may be a warning from God. They serve as a warning that the sick person should examine their lives to see if there is some sin from which they should repent. A biblical justification for this theological understanding of sickness may come from Luke 13:4-5 where Jesus suggests that natural disasters act as warnings to others that they should repent. Neither Jesus’ words, nor the words of the seventeenth and eighteenth century authors, suggest the calamity or sickness has come as a punishment for sin. They serve as a warning and encouragement to a person to examine their own life to see if there is any sin they must repent of.
This approach to pastoral care has a clear understanding that a person will face God as their judge. Sickness and disaster are opportunities, sent by God, to examine one’s life, recognising that in the human condition we are finally answerable to God.
In his book, Pastoral Care Emergencies, David Switzwer suggests there are nine needs of the dying. They are: Expressing feelings, overcoming loneliness, finding meaning in the present, believing that life has been meaningful, having consistency between one’s own perception of self and other people’s perception of our self, having control, continuing to feel useful, expressing spiritual needs and, finally, finding the ability to let go.
Building on the work of Howard Clinebell, Highfield and Cason declare that there are four spiritual needs shared amongst all humanity. They are the need for: meaning and purpose, to give love, to receive love and the need for hope and creativity.
These twentieth century authors approach pastoral care entirely from the perspective of the patient. They focus on what perceived needs the patient may have and attempt to direct the patient to some point of acceptance or integration of these needs. This approach is entirely person centred. There is no orientation towards God.
From a Christian perspective of pastoral care, these twentieth century approaches are inadequate. If the human condition is that we are sinners in need of God’s forgiveness, before we face Him as our judge, Christian pastoral care must encourage those who are sick to take the opportunity of their sickness to examine their lives and to repent of any sin they might become aware of. The sickness is seen as a gracious visitation of God to prepare us for the final judgement we will all face.
In speaking of spiritual needs, Christian pastoral care must consider the biblical understanding of the human condition. As human beings, we are people created in the image of God but that image has been adversely affected by sin. As such we are answerable to God. We will face judgement. Christian pastoral care therefore encourages the sick to take stock of their lives and to take the opportunity presented by God to repent of sin.
 David K Switzer: Pastoral Care Emergencies. Paulist Press. 1989
 Howard Clinebell: Basic Types of Pastoral Counselling. Abingdom Press. 1966. Clinebell suggests there are four basic spiritual needs: 1. to find meaning in life. 2. to have a sense of the transcendent. 3. to have healthy relationships with God, others and with nature. 4. to experience inner awareness, creativity and freedom.
 M F Highfield and C Cason. “Spiritual Needs of Patients: Are they Recognised?” Cancer Nurs. 1983 Jun;6(3):187-92.