A Practice to Alleviate Moral Injury When Patients Are Dying

This script was written by two buddhists, so it is not necessarily secular. It’s up to you to edit it as you like; if you do not resonate with words like karma, or the idea that consciousness is much vaster than the body, no big deal- Take what’s useful and leave the rest. May this be of benefit.

The Boundless Abodes for Caregiving, Dying, Grieving

by: Joan Halifax Roshi

There are four Boundless Abodes: 1) lovingkindness, 2) compassion, 3) sympathetic joy, and 4) equanimity. The phrases in this meditation are used in generating the energy of lovingkindness, compassion, sympathetic joy, and equanimity.

You can radiate them to yourself, a benefactor, a friend, an enemy, one toward whom you feel neutral, and groups. Feel free to modify any of these phrases to fit your own situation. They connect us to the stream of basic goodness, and they connect us to one another. They are the qualitative basis for our work in being with dying. In some deep sense, strengthening the qualities of the four Boundless Abodes is the ultimate form of self-care.

Boundless Practices for the Caregiver

Balancing Equanimity and Compassion

These practices that bring together the strength of equanimity and the tenderness of compassion, the courage of presence and openness of surrender were crafted by the Buddhist teacher Sharon Salzberg and me, as well as those participating in Upaya’s training program for health care professionals. Most particularly I want to thank Sharon for opening for me the great gift of the Brahmaviharas, or the Boundless Abodes.

They can live in the background of the mind and heart and nourish healthy caregiving practice as we offer our lives to the well being of others. When we lose balance, we can remember one or another phrase as a way to help us right ourselves and be present for others and face suffering, our own and the suffering of others. And we can offer these phrases to those in our lives who are besieged by suffering.

In the experience of giving care, there is a delicate balance between opening our heart endlessly (which is compassion) and accepting the limits of what we can do and how we and others feel with equanimity. In dying, we need to both let go and be present for what is happening. In grieving, we need to touch our suffering and be present as sorrow washes through us.

Here are practices for cultivating the balance between compassion and equanimity. Compassion is the tenderness of the heart in response to suffering. Equanimity is a spacious stillness that accepts things as they are. The balance of compassion and equanimity allows us to care without becoming overwhelmed and unable to cope because of that caring.

The phrases we use reflect this balance. Choose the phrases that are personally meaningful to you and use those in your practice. You can alter them in any way you wish or create your own.

To begin the practice, take as comfortable a position as possible, sitting or lying down. Take a few deep, soft breaths to let your body settle. Bring your attention to your breath and begin to silently say your chosen phrase in rhythm with the breath. You can also experiment with just having your attention settle in the phrase, without using the anchor of the breath. Feel the meaning of what you are saying, without trying or forcing anything. Let the practice carry you along.

Meditation: Boundless Practices for Caregivers

•May my love for others flow boundlessly. •May the power of lovingkindness sustain me. •May you be happy and free of pain. •May all those who suffer be free of pain. •May this experience in some way be a blessing for you. •May I offer my care and presence unconditionally, knowing it may be met by gratitude, indifference, anger or anguish. •May I offer love, knowing that I cannot control the course of live, suffering, or death. •May I find the inner resources to truly be able to give. •May I remain in peace and let go of expectations. •I care about your pain and suffering; may I be present for it. •I care about your pain and suffering, and your release from suffering depends on your choices and your karma. •I will care for you and I cannot take away your suffering. •I care about your suffering, and I cannot end your suffering for you. •May I accept things as they are. •I wish you happiness and peace, and I cannot make your choices for you. •May this experience open me to the true nature of life. •May I see my limits compassionately, just as I view the suffering of others. •May I and all beings live and die in ease.

*These phrases may be used by dying people.

Meditation: Boundless Abodes for the Dying Person

Letting Go

All our lives our innate wisdom tells us to let go, to relax, and to relinquish fearful efforts to control. Our culturalconditioning and personal history, however, usually tell us to hold on to people, experiences, and accomplishments in order to be happy. Many times our lives are spent in a battle between our innate wisdom and the culture’s message about clinging and control. Being with dying is above all the time to turn to, trust, and rest in the voice of truth within.

In the following practices for the dying person, choose the phrases that are personally meaningful to you and use those in your practice. You can alter them in any way you wish or create your own.

To begin the practice, take as comfortable a position as possible, sitting or lying down. Take a few deep, soft breaths to let your body settle. Bring your attention to your breath and begin to silently say your chosen phrase in rhythm with the breath. You can also experiment with just having your attention settle in the phrase, without using the anchor of the breath. Feel the meaning of what you are saying, without trying or forcing anything. Let the practice carry you along.

The Practice

•May I accept my anger, fear and sadness, knowing that my vast heart is not limited by them. •May I be peaceful and let go of expectations. •May I accept my pain and suffering, knowing that my experience of illness does not make me bad or wrong. •May I accept my pain, knowing that I am not my pain, not my body, not my illness. •May I be filled with compassion and lovingkindness for myself and others. •May I be peaceful in body and mind. •May I be free from anger, fear and worry. •May I be open with myself and others about my experience. •May I receive other’s love and compassion. •May I be filled with compassion and lovingkindness for myself and others. •I ask forgiveness from those whom I have harmed. •I freely forgive all those who have harmed me. •I forgive myself for mistakes made and things left undone. •May all those I leave behind be safe and peaceful. •May I remember my consciousness is much vaster than this body,as I let go of this body. •May I accept things as they are. •May I realize the truth of impermanence. •May I be open to the true nature of life. •May I open to the unknown as I leave behind the known. •May I live and die in ease. •May I, and all beings, live and die peacefully.

These phrases can be used by caregivers or dying people.

Meditation: Boundless Practices for Grieving

•May the power of loving-kindness sustain me. •May I be peaceful in body and mind.•May I receive other’s love and compassion. •May I open with gentleness to the pain of grief. •May I see my limits compassionately, just as I view the suffering of others. •May I come to recognize the gift of my loved one’s death by opening my heart of compassion. •May I be free from suffering. •May those around me be free from suffering. •May I accept my suffering, knowing that I am not my suffering. •May I accept my anger, fear and sadness, knowing that they do not limit my vast heart.•May I let go of guilt and resentment.•May I know forgiveness. •May I offer forgiveness. •May I forgive myself for mistakes made and things left undone. •May I forgive myself for not meeting my loved one’s needs. •May I accept my human limitations with compassion. •May I accept things as they are. •May I be open to the true nature of living and dying. •May I find peace and strength that I may use my resources to help others. •May I fully face life and death. •May I offer love, knowing I cannot control the course of life, suffering, or death. •May love heal my body and mind. •May I be peaceful and let go of expectations. •May I find the inner resources to be present for suffering. •May all beings live and die in peace.

*Note that many of these phrases can be used by caregivers and dying people.

Transforming Grief

The practices that follow focus on two dimensions of grieving. The first aspect draws on the resources of the Four Boundless Abodes—lovingkindness, compassion, sympathetic joy, and equanimity to strengthen ourselves as we surrender to grief. The second dimensions focuses on the importance of being in the stream of sorrow—to be touched by it, come to know it, and to be purified through the experience of being fully washed by loss. In the practice of the Abodes, we use lovingkindness as a way to turn toward suffering with strength, resolve, and depth. In this way we can more fully realize the wisdom that is inherent in the experience of suffering. This is the very basis of compassion and the means of transforming suffering into wisdom.

The Practice
Being present for suffering:

•May I find the inner resources to be present for suffering. •May I fully face life and death, loss and sorrow. •May I accept things as they are. •May I be open to the pain of grief. •May I accept my pain, knowing that it does not make me bad or wrong. •May I accept my suffering, knowing that I am not my suffering. •May I accept my anger, fear, and sadness, knowing that they do not limit the openness of my heart. •May I be open with myself and others about my experience of suffering.

Transforming suffering:

•May sorrow show me the way to compassion.•May I come to recognize the gift of my loved one’s death by opening my heart of compassion. •May I realize grace in the midst of suffering. •May this experience in some way be a blessing for me. •May lovingkindness sustain me. •May love fill and heal my body and mind.•May I be peaceful and let go of expectations. •May I find peace and strength that I may use my resources to help others. •May I receive the love and compassion of others. •May all those who are grieving be released from their suffering. •May I offer love, knowing that I cannot control the course of life, suffering, or death.

Forgiveness:

•May I let go of guilt and resentment.•May I forgive myself for mistakes made and things left undone.•May I forgive and be forgiven.•May I forgive myself for not meeting my loved one’s needs. •May I accept my human limitations with compassion.

Coming home:

•May I be open to the true nature of life.•May I open to the unknown as I let go of the known. •May I offer gratitude to those around me.•May I be grateful for this life.•May I and all beings live and die peacefully.

At the end of this practice period, again let yourself rest in openness, inviting the feeling of gratitude to be present. How rare it is to open to the nourishment of basic goodness! Then dedicate the merit of the practice to all beings everywhere.

About the Authors:

Roshi Joan Halifax is a Buddhist teacher, Zen priest, anthropologist, and pioneer in the field of end-of-life care. She is Founder, Abbot, and Head Teacher of Upaya Institute and Zen Center in Santa Fe, New Mexico. She received her Ph.D. in medical anthropology in 1973 and has lectured on the subject of death and dying at many academic institutions and medical centers around the world. She received a National Science Foundation Fellowship in Visual Anthropology, was an Honorary Research Fellow in Medical Ethnobotany at Harvard University, and was a Distinguished Visiting Scholar at the Library of Congress.

From 1972-1975, she worked with psychiatrist Stanislav Grof at the Maryland Psychiatric Research Center with dying cancer patients. She has continued to work with dying people and their families, and to teach health care professionals and family caregivers the psycho-social, ethical and spiritual aspects of care of the dying. She is Director of the Project on Being with Dying, and Founder of the Upaya Prison Project that develops programs on meditation for prisoners. She is also founder of the Nomads Clinic in Nepal.

She studied for a decade with Zen Teacher Seung Sahn and was a teacher in the Kwan Um Zen School. She received the Lamp Transmission from Thich Nhat Hanh, and was given Inka by Roshi Bernie Glassman.

A Founding Teacher of the Zen Peacemaker Order and founder of Prajna Mountain Buddhist Order, her work and practice for more than four decades has focused on engaged Buddhism. Her books include: The Human Encounter with Death (with Stanislav Grof); The Fruitful Darkness, A Journey Through Buddhist Practice; Simplicity in the Complex: A Buddhist Life in America; Being with Dying: Cultivating Compassion and Wisdom in the Presence of Death; and Standing at the Edge: Finding Freedom Where Fear and Courage Meet which was released on May 1, 2018.

Please visit the Upaya Zen Center website for more information and resources.

Born in New York City in 1952, Sharon Salzberg experienced a childhood involving considerable loss and turmoil. An early realization of the power of meditation to overcome personal suffering determined her life direction. Her teaching and writing now communicates that power to a worldwide audience of practitioners. She offers non-sectarian retreat and study opportunities for participants from widely diverse backgrounds. Sharon first encountered Buddhism in 1969, in an Asian philosophy course at the State University of New York, Buffalo. The course sparked an interest that, in 1970, took her to India, for an independent study program. Sharon traveled motivated by “an intuition that the methods of meditation would bring me some clarity and peace.” In 1971, in Bodh Gaya, India, Sharon attended her first intensive meditation course. She spent the next years engaged in intensive study with highly respected meditation teachers. She returned to America in 1974 and began teaching vipassana (insight) meditation. In 1976, she established, together with Joseph Goldstein and Jack Kornfield, the Insight Meditation Society (IMS) in Barre, Massachusetts, which now ranks as one of the most prominent and active meditation centers in the Western world. Sharon and Joseph Goldstein expanded their vision in 1989 by co-founding the Barre Center for Buddhist Studies (BCBS). In 1998, they initiated the Forest Refuge, a long-term retreat center secluded in a wooded area on IMS property. Today she leads teaches a variety of offerings around the globe. Sharon resides in Barre, Massachusetts, and New York City. Sharon has also emerged as a featured speaker and teacher at a wide variety of events. She served as a panelist with the Dalai Lama and leading scientists at the 2005 Mind and Life Investigating the Mind Conference in Washington, DC. She also coordinated the meditation faculty for the 2005 Mind and Life Summer Institute, an intensive five-day meeting to advance research on the intersection of meditation and the cognitive and behavioral sciences. At the 2005 Sacred Circles Conference at the Washington National Cathedral, Sharon served as a keynote speaker. She has addressed audiences at the State of the World Forum, the Peacemakers Conference (sharing a plenary panel with Nobel Laureates His Holiness the Dalai Lama and Jose Ramos Horta) and has delivered keynotes at Tricycle’s Buddhism in America Conference, as well as Yoga Journal, Kripalu and Omega conferences. She was selected to attend the Gethsemani encounter, a dialogue on spiritual life between Buddhist and Christian leaders that included His Holiness the Dalai Lama. The written word is central to Sharon Salzberg’s teaching and studies. She is the author of eleven books including Lovingkindness, the NY Times best seller Real Happiness, and her 2017 work, Real Love: The Art of Mindful Connectionand her newest book, Real Change: Mindfulness To Heal Ourselves and the World, coming in September of 2020 from Flatiron Books. In her early Buddhist studies at the University of Buffalo, she discovered Chogyam Trungpa Rinpoche’s book, Meditation in Action. She later heard him speak at a nearby school:  he was the first practicing Buddhist she encountered. While studying in India, Shunryu Suzuki’s book Zen Mind, Beginner’s Mind profoundly influenced the direction of her meditation practice. Sharon’s writing can be found on Medium, On Being, the Maria Shriver blog, and Huffington Post and she was a contributing editor of Oprah’s O Magazine for several years. She has appeared in Time Magazine, Yoga Journal, msnbc.com, Tricycle, Real Simple, Body & Soul, Mirabella, Good Housekeeping, Self, Buddhadharma, More and Shambhala Sun, as well as on a variety of radio programs. Various anthologies on spirituality have featured Sharon Salzberg and her work, including Meetings with Remarkable Women, Gifts of the Spirit, A Complete Guide to Buddhist America, Handbook of the Heart, The Best Guide to Meditation, From the Ashes—A Spiritual Response to the Attack on America, and How to Stop the Next War Now: Effective Responses to Violence and Terrorism. Sharon is the host of her own podcast, The Metta Hour, featuring 100+ interviews with the top leaders and voices in the meditation and mindfulness movement. Please visit her website.