Monday, October 13, 2008

Here to help! Some searching questions...

The following questions came to us from someone embarking on a research exercise into hospice development, and I attach my responses (for what they are worth). The questions were sincerely put, and I hope that my unvarnished responses have not dampened the enthusiasm of the researcher to enquire further.

What do you see as the most challenging aspect of your work with the dying?

Difficult question to answer.

Working with people in crisis is always something of a challenge to all involved. Dying is a crisis in the same way most of the rest of life throws up situations of challenging change, crises. Dying isn't qualitatively different, and Buddhism teaches us not to see death as something essentially different. The way people deal with dying is the way they deal with all crisis. We are creatures of habit. As we live, so we shall die. But perhaps Buddhists learn through their practice that they don't have to be challenged by change; indeed, Buddhism has acceptance at its heart. In acceptance nothing challenges, and there is no-one to be challenged.

Practice isn't easy, so perhaps that's the everyday challenge, to do what we can to practice, whatever we understand that to mean. And that's a challenge too, understanding what it means to practice. It isn't bowing, making obeisance to the Buddha, or sitting on the cushion.

What is - in your religion/spirituality - the most important aspect of the dying process?

It's important not to get hung up on 'the dying process', whatever that means. Dying is a normal physiological process and there's no part to which it is worth attaching symbolic importance, or thinking it is more important than another. The question arises out of the tendency on the part of many Buddhists to take teachings about the bardos too literally. One might quite as earnestly ask "What is the most important part of the process of evacuating the bowels?" Or, "what is the most important part of the process of digesting one's dinner?"

As a nurse I have attended the deathbeds of very many people, and death - you can rest assured - is always 100% successful. Every death is unique, and the process may be very drawn-out, or it may (of course) be instantaneous, as in a plane crash or 9/11. It doesn't matter how we die, what matters is how we live. I don't think the Buddha had a lot to say about deathbeds.

What are the most recurrent problems you are facing with dying people?

There are generally no problems to be faced with dying people except the usual ones such as "If I am visiting shall I find a place to park?" or, in my case, "Will my wife get irritated that I am not at home to help her with the household chores and domestic worries she has to face alone because I am attending to my "good works" with others?" You may have heard the Bible saying ascribed to Yeshwa (Jesus), "Leave the dead to bury their dead". It makes a lot of sense.

As the Chairman of a Buddhist charity, it is sometimes a problem fending off Buddhist volunteers who want to be "in on the act" at other people's deaths. If you ask them to address envelopes, wash up or serve tea they feel snubbed and hurt, that they have some special gift to impart, and you are standing in their way! Not all volunteers are like this, of course, but it is disheartening to find how many are.

Which are the situations in which you find yourself helpless?

Helplessness is a most desirable default mode to cultivate when being with the dying.

There is nothing to do, so the mind of helplessness is entirely congruent with that. "Doing less, being more" is the motto. If we can cultivate a heart of helplessness compassion will flow into it and, in that heart of compassion, 'helper' and 'helped' will encounter each other without distinction and in perfect reciprocity.

How supportive/unsupportive do you consider your society with death, religious approach to death, and religions in general?

Our own (British) society has been greatly shaped by Christendom including the tenets of Christian belief and doctrine, in their many vernacular forms, and there is no doubt in my mind that established religion in UK does provide a framework for many in helping them to find meaning and consolation in suffering and loss. Some individuals find it difficult to talk about death, to talk naturally to a person who has been bereaved and so on, and this reticence is part of the way people feel about death; it is not our part to judge them, or to characterise them as unsupportive. People have a right to their feelings, and there is nothing wrong with the way they behave.

I have deep admiration for Christian clergy and for many church-goers. I don't find that Buddhists are better at dying and death and supporting others than members of other faiths. Some are very good, some less so. I think that humans (regardless of their religious affiliations or lack of them) are on the whole infinitely capable of acceptance, equanimity, "courage", and of healing into their true nature.

Although I'm a Buddhist and it has worked for me, it's my point of departure in what I do, and I have no interest in or ambition to convert others to Buddhism. I lived and worked in Africa for many years, where Buddhism is just unknown. But the people there live richly-engaged dharma lives, and have no need of the teachings of Gotama to guide them away from what they know and do.

What do you think could be common ground for our different religions to expand our support in hospice work?

Our common humanity supplies enough ground, I think, for interfaith cooperation and mutual support in the face of suffering. Suffering feels and looks the same in all creeds. We don't need to wrestle with conceptual issues, indeed, they get in the way of collaboration.

There are certain principles of the hospice movement, and of the palliative and "end-of-life-care" movements, that are worth fostering because they have made a major difference to terminal care. Hospices as institutions where people go to die, however, are giving way (for various reasons including cost) to death at home, or in some other 'preferred place', as the spectrum of care-provision changes in line with popular choice, and improved technology.

How do you deal with mental and spiritual suffering in your work with dying people? What are the words and attitudes that seem to relieve anxiety, fears and agitation?

How do you, the questioner, distinguish mental and spiritual suffering? My question is intended to challenge you, the questioner, out of a state of mind that reduces life to a number of discrete compartments or categories that call out to be 'dealt with'. I don't intend to insult or attack you, and I know you are in a reflective situation, and just putting your toe in the water. But I think you are also robust enough to follow my drift.

Suffering does not call for formulaic responses, words, attitudes or theories. I can only be alongside the one who suffers, and dwell with her/him. In helplessness the words and actions may arise that are fitting, appropriate or 'helpful'; but they will be uncontrived, not 'mine', not to be held on to. Buddhism has nothing 'off the shelf' to offer, does it? The following true anecdote illustrates the folly of taking a 'cook-book' approach to death, however eminent the 'cook', and however well-intentioned the recipe.

I once met a very devout and kindly Buddhist woman who, when her old Glaswegian mother was dying, plucked up her courage to begin reading her Mam a few words from the Tibetan Book of Living and Dying. Her mother opened her eyes, gazed steadily at her daughter and said in a clear voice, "Aye, and ye can fuck off dearie, and tak' yer fucking book wi' ye!" That old dying woman was Buddha, and her daughter never forgot the lesson she was taught that day. Talk about enlightenment!

What has changed for you from your experience of dying people?

Well, I have never sentimentalised death, and I don't put dying on some sort of pedestal. I have come to understand that death takes care of itself and needs no facilitation. Death is good, death is kind, or so it seems to me. Dying may be difficult, and in some cases it presents difficulties for which there may be remedies, e.g. pain and symptom relief. People often need good nursing care. People largely prefer to die at home (if they can be adequately cared for at home), and this has affected the way hospices are funded and operated.

People who are dying appreciate the friendship and support of others who come with no helping agenda, no spiritual mouthings, no religious templates of belief or doctrine to pass on, no formulas, interpretations or solutions. Such people are rather rare, including amongst Buddhists.

And, to quote Christina Feldman, "We are always beginners in the art of compassion".

Is there any aspect of Buddhism that you feel may be particularly useful with dying

No, no agenda, no special tool in my tool box. Possibly I might remind myself often that Gotama said "No person can save another. Work out your own salvation, with diligence".

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