This article was printed in RAFT, Journal of the Buddhist Hospice Trust as a result of the editor’s request for comments on the notion of ‘a good death’ from Buddhist points of view.

In short, a ‘good death’ might be understood as a death that directly addresses the needs of the dying person. We have released most of our earlier ideas about how people should die. They only seemed to create more separation and in some cases, even a sense of failure. At the same time, we hold that people often make the journey from tragedy to transformation if they are properly supported. As caregivers we can hold open possibilities - we can even ‘open the door’ - but the choice to enter (or not) must always reside with the person who is dying. This appears to involve three key elements:

1. Presence
2. Compassionate Companionship
3. Supportive Inquiry

At Zen Hospice we say there is no real service unless both people [those who are cared for and the caregiver] are being served. When I’m truly working with someone who’s dying, I’m also working on myself. I’m watching my own mind and noticing how my own heart opens and closes. I’m aware of my own grief and fear of dying. In this way I begin to understand that this other person’s suffering is also my suffering.

My good friend Rachel Remen, author of Kitchen Table Wisdom, wrote about this sort of helping and I think it’s one of the most beautiful descriptions of service that I know. To paraphrase her, she pointed out that: “Service is not the same as helping. Helping is based on inequality. It’s not a relationship between equals. When you help, you use your strength to help someone of lesser strength. It’s a one-up/one-down relationship and people feel this inequality. When we help, we may inadvertently take away more than we give diminishing people’s sense of self-worth and self-esteem.”

When I help, I’m very aware of my own strength but we don’t serve just from our strength. We serve from our whole selves – we draw from our total experience. Our wounds and limitations serve us – even our darkness can serve us. The wholeness within us also serves the wholeness within others and of life itself. But helping also incurs a debt: when you help someone, they owe you one. But, of course, service is mutual. When I help I have a feeling of satisfaction, but when I serve I have a feeling of gratitude.

In dying, spiritual support is every bit as important as good medical care and yet we rarely extend this kind of support in any meaningful way. Consequently, as a result, too many people die in distress and fear rather than at peace. We can do something about this. But what is spiritual support ? Well first and foremost it is simply bearing witness. This means not turning away when the going gets rough and staying present in the territory of mystery and unanswerable questions. It’s assisting a person to discover their own truth – even if it’s one that you don’t agree with.

Sometimes it’s calling a priest to administer the last rites or meditating together, or writing a final letter that aims at reconciliation. In my experience, spiritual support is not generally a matter of existential discussions or esoteric practices: it’s not about escaping this life – it’s about facing it directly. It’s about being aware of the opportunities here and now to extend love and compassion. To be of real support we have to be willing to step out from behind our well-defended personalities or belief systems and relinquish our need to control. In this act of surrendering, a door opens and we discover, with the dying person, a spaciousness that is larger than our individual life but which is able to include it. This evokes a heightened sense of appreciation for the sacredness in ordinary things and activities. Our heaven, our enlightenment, is here and now and we can help people taste these experiences before they die.

It’s important in offering spiritual support to remember that even when there’s no chance of curing the disease, healing is always possible. The distinction is important to understand. Healing comes from the same root as ‘wholeness’ which basically means not broken or damaged. In healing, we re-discover our intrinsic wholeness.

To be useful, spiritual support needs to address the very worldly issues of fear, meaning and purpose – as well as allowing for the mystery that defines our dying. There are countless ways of offering spiritual support to people in the last weeks of their lives. For example: practices of compassion (such as Tibetan tonglen), death awareness practices, loving-kindness meditations, contemplative prayer, concentration practices that stabilize the mind and rituals that bring our attention to our impending death. All of these in the hands of a skilful practitioner may be of invaluable service to someone who’s dying.

However, as a caregiver, the most essential practice is your commitment to maintain awareness of your own body, heart and mind. In so doing, you help to sustain a calm and receptive environment for the dying person. In a sense, you lend them the stability of your mind, just as you lend them the strength of your body in other care-giving activities. Also, your calmness can serve as a model for others.

As we come into contact with the precarious nature of this life, we also come to appreciate its preciousness. It shows us what is most important, so we don’t want to waste a moment of our lives and fully enter into it. It can be a time of great aliveness for everyone.

Now, I don’t mean to suggest that caring for people who are sick isn’t difficult or hard work. Caring for those who are dying will challenge your most basic beliefs, it will ask you to push past fatigue and cause you to face unimaginable doubt. Restlessness will rule at times. You will question your ability and motivation time and time again. Your own deep clingings, aversions and habitual patterns will present themselves for review. Helplessness and insecurity will become your companions but, above all, you will face loss and confront the fragility of your own life. It can also break your heart wide open but perhaps it’s here, in the open heart, that we discover what actually helps.

This is a journey of continuous discovery. We are always be entering new territory. We have no idea how it will turn out and it takes courage and flexibility: one moment we will say or do the right thing but could be totally wrong in the next. But we find a balance. When the heart is open and the mind is still, when our attention is fully in this present moment, the world becomes undivided for us and we know what to do.

Frank Ostaseski founded Zen Hospice Project, the first Buddhist hospice in America, in 1987. He currently directs the Institute on Dying, which is the Project’s new educational arm. Through lectures, retreats and workshops – both national and international – he has introduced thousands to the practices of mindful, compassionate care of the dying.

Further information about Frank’s work and the Zen Hospice Project can be found on their website: zenhospice.org

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