Wednesday, March 23, 2011

Holding the Space for the Dying



A lot of people ask me what can be done to support those who are in the process of dying. This is a big topic, but I wanted to offer a few words.

If you are visiting a dying person, I feel, the best thing is to hold the space. Others feel that mantras and prayers are helpful, which I believe can be true, but that has to be done in the context of holding the space. One should only recite out loud if it's in keeping with the dying person's belief system. One should not recite anything if the dying person has expressed any form of aversion to religious anything. The idea is to gently promote as positive a frame of mind as possible in oneself and in the dying person. Someone who goes in to see a dying person to change his or her belief system is making a mistake through disrespecting the rights and wishes of the dying person. Unconditional, as in non-judgmental, loving witnessing and holding the space are a good and safe way to proceed.

What do I mean by "holding the space?" I mean that one should oneself enter a centered and internally quiet frame of mind, as unsentimental as possible, as open, warm, and loving as possible, as "witnessing" as possible, and solidly grounded. Without this, it's very difficult to hold the space. Holding the space invokes a sort of presence in the room that can bring tremendous healing and calm. 

One should not speak much unless the dying person requests to. Usually a person just about to die is not very interested in conversation. Likewise, usually a person gravely ill is also not interested in speaking or hearing much; it tends to be very exhausting for a person in that position to  have to speak or listen. 

We often feel that we have to fill silence with a lot of words. This I can tell you, is not what the dying person needs. A few words of course can be comforting; softly, gently, and compassionately uttered. Noise, loud talking, drama, or commotion in the dying person's space should be avoided. If it is unavoidable, as in the context of war, I guess nothing can be done other than other individuals mentally holding the space as much as possible. Untimely death is another matter altogether, since in that context the person has no time at all to prepare the mind. 

Dr. Ira Byock, a hospice physician at the Dartmouth Medical Center in New Hampshire, USA, has written a number of fine books on assisting the dying. If the person is not imminently at the point of death, but has, for example, been diagnosed with a terminal illness, he suggests that the person be guided by a friend, health care worker, therapist, or loved one, to be able to address unresolved relationships and issues with the help of the following four phrases:

1) Forgive me
2) I forgive you
3) Thank you
4) I love you

Since we are all technically dying from before the minute we are born, it's good to familiarize ourselves with the above four universal points.  Making a practice of these alone is very beneficial. These four phrases, Dr. Byock has found through many years of work with the dying, when expressed by and to a dying person can serve as powerful preparation for transition. There are many who go out with great resistance, fear, and attachment, for whom the transition can be very traumatic. 

It tends to be the case that those who have some form of spiritual practice, whether they be religious or not, who have tried to live well, are at peace in their relationships and with their lives,  who accept the inevitability of death, and who have been able to let go of attachments to material things and people, such as by giving things away before they die, go out more happily, peacefully, and  confidently.

Kyabje Dagpo Rinpoche of France has given extensive teachings on how to assist the dying that have been attended by hundreds of people, including hundreds of health care workers in France and elsewhere. These are available as MP3 recordings in English translation through his center in France, Ganden Ling.

From a Buddhist perspective, once the person has stopped breathing he or she is still not actually dead, in the sense that his or her consciousnesses have not completely ceased their functioning. For this reason, Buddhists will take a lot more time, sometimes about three days or more, before they touch or move the body. It is best not to touch the lower part of the body, the feet, legs, etc. at all while the person is dying and once they have passed away. Likewise, it is best not to disturb the body immediately after the cessation of the breath. Many cultures the world over, not knowing the energetic subtleties of what happens at death as well as qualified spiritual masters do, are quick to dispose of the body immediately after the cessation of the breath. This is a shame since it can really traumatize the transition. 

Being with the dying is a privilege and an art.  You can ask anyone who has done hospice work or nursed the dying and you will get a lot of tips that way as well. I am hoping that more and more people will explore the knowledge of the process of dying that qualified spiritual masters and practitioners have investigated for centuries. I really feel that this understanding could benefit countless beings and make their transitions much smoother.