Sometimes there's just no medical substitute for the soul-soothing power of music. Operating on that premise since 1992, the Chalice of Repose Project, based in Missoula, Mont., has relieved both the mental and physical pain of countless patients facing the end of life.

The project operates as an end-of-life patient care program dedicated to lovingly serving the physical and spiritual needs of the dying through the use of prescriptive music. Housed within the 195-bed acute care facilities of St. Patrick Hospital, the Chalice of Repose Project makes use of a relatively new field of music called music-thanatology.

The field was developed by Therese Schroeder-Sheker and seeks to offer patients and loved ones something meaningful and calming when medical interventions are no longer beneficial.

From its earliest inception, the Chalice of Repose Project vision has been to lovingly serve the physical and spiritual needs of the dying with the delivery of prescriptive music, live at the bedside of the dying person, comments Schroeder-Sheker. “Patients are not wired or connected to more invasive technologies, electrodes or probes. No additional medical apparatus is involved in either delivering or receiving prescriptive music.”

Chalice of Repose practitioners attend deathbed vigils with only their harps and their voices as an offering. The live music is played at the patients' bedside and is designed specifically for the patients' needs. The musical caregiver sets up next to the bed and delivers restful, peaceful harmonies that can facilitate what they describe as “the unbinding process that is central to a peaceful, blessed death.”

It is the beats, the rhythms, and the tone of the music that carry the power to stimulate and soothe processes in the physical body. Practitioners and patients of this therapy notice physiological changes in the patient's nervous, respiratory, circulatory, and metabolic systems. The physical and emotional relief that these changes bring can account for the reduced pain and anxiety that so typically accompany the final hours of debilitating disease.

“Prescriptive music reflects the constantly changing physiological condition of the patient as evidenced by continually monitored vital signs,” says Schroeder-Sheker. “We underscore the differences between live music and prescriptive music. Prescriptive music cannot be prerecorded, for then it could not be responsive to actual fluctuating respiratory patterns, for example, or the sudden spike of an inflammatory condition.”

Throughout the six-and-a-half-year history of the unique program, the professional music-thanatologists have attended over 2000 deathbed vigils. The graduate program is rigorous, encompassing four semesters with over 900 contact hours in five tracts: academic, musical, medical, clinical, and interior. Among these and other commitments, students must complete a year-long clinical internship, a professional paper, and numerous, comprehensive exams.

The scientific basis for music-thanatology stems from Schroeder-Sheker's 25 years of clinical work with the dying. However, the historical and spiritual basis for the work finds roots in monastic medicine, developed at the medieval monastery of Cluny, France.

“We look deeply into the nature of health, illness, disease, life and death,” says Schroeder-Sheker. “Our modern-day inspiration, of course, is palliative medicine.”

It is important to note that music-thanatology is a different field from music therapy. Music-thanatology carries a focus solely based on palliative medicine and care of the dying. Music-thanatologists are caregivers with specific education in medicine and end-of-life care. It is that specific nature of the field, among other differences, which sets it apart. By contrast, music therapy is a field focusing on the assessment of emotional well-being, physical health, social functioning, communication abilities, and cognitive skills through musical responses.

Chalice of Repose practitioners are finding that their work is confidently supported by the physicians and nurses at St. Patrick's Hospital. The practice offers these doctors something they can offer families and patients when “heroic” measures to save a life are no longer feasible. The comfort and beauty that the harpists' therapy brings to a patients' bedside can quite often be the best way for a dying patient to let go of physical fears and spiritual reservations.

Although the job of a music-thanatologist at St. Patrick's Hospital is quite often hectic, the practitioners take comfort in the visible fruits of their labor. It is not uncommon for The Chalice of Repose office to receive letters, calls, pop-in visits and memorial contributions on almost every day of the week. With these daily reminders of success all around, this innovative program has positioned itself to be a vital standard component of supportive care of the dying.

This article was posted on www.lastacts.org on May 6, 1999.

Editor's Note: This article was originally published on www.lastacts.org, the Web site for Last Acts, formerly a national program of the Robert Wood Johnson Foundation. Be advised that the content of this article might be dated or inaccurate. The Foundation is reprinting the article here as a matter of general and historical interest.