Compassionate and Mindful End-of-life Care: A Relational-Contemplative Approach for Clinicians

Roshi Joan Halifax is no longer afraid of getting what the dying have because she has recognized she’s already got it. We are all mortal. Both as a Zen priest and medical anthropologist she has paid 40 years of close attention to the marginalized position of the dying. At Upaya Zen Center in Santa Fe she long-ago established a training program, “Being with Dying,” that approaches the problems of suffering at the end of life by proposing an end to the duality that divides us from the dying. Compassion means “feeling with,” and today she gave us a very fast overview of the sources of our suffering not only as patients but as caregivers and clinicians, asking us “how can we create the conditions that will allow dying people to express themselves most fully?” We have wonderful therapies for physical pain but the “total pain” of losing the world is more difficult.

This can’t be made easy, but we can accompany our patients and loved ones more compassionately by recognizing our own struggles with burnout, compassion fatigue, moral distress, colleagial hostility, and the structural violence of our “system of no system.” Roshi Halifax proposed mindfulness practices as providing another way of relating more compassionately. Contemplative practices can teach us to focus our stable attention in a way that allows our open presence to patients in need.

Mindfulness practices have been established in RCTs as an effective stress reduction strategy. Roshi Joan’s critical insight seems to me to be the need to take better care of our patients by taking better care of ourselves as clinicians and caregivers.

I was left longing for the hour long dharma talks and half-day seminars that have been my previous contacts with her ideas. For more detail regarding the integration of contemplative practice and clinical work, please review the article Dr. Halifax coauthored with Tony Back and others in JPM volume 12 number 12 2009 pp 1113-1117, “Compassionate Silence in the Patient-Clinician Encounter: a Contemplative Approach.” Or better yet, enroll in “Being with Dying.” The 2010 spring session is full. I just signed up for 2011.

Patrick Clary, MD

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