Some of the hospice patients talk about their impending deaths, or about God. Most just talk about what people always talk about  unfinished business and unanswered questions: regrets over firing an employee 50 years ago; the pet no one has yet promised to adopt; feeling sick to death of being sick yet not ready to die. About Bach. “How did he dream up that music?” one woman asks.

Listening to final inquiries like these has long been the domain of a family priest or rabbi. But for a growing number of Americans who do not know a member of the clergy, that bedside auditor is increasingly likely to belong to an emerging professional class known in the hospice world as a pastoral counselor or chaplain, who may or may not be a clergy member.

The encounter with a chaplain can be profound and spiritual, and sometimes religious in a traditional way. More and more, though, ministering to the terminally ill in hospice care is likely to be nonsectarian, or even secular.

In the quarter-century since Medicare and some private insurers began picking up the bill for hospice care, it has become a common recourse for the terminally ill. With doctors, nurses, social workers and ample supplies of pain medication dispatched to their homes or nursing facilities in the final weeks and months, about 1.3 million Americans died last year in hospice care.