An Offering of Comfort – A Contemplative Response to Futile Treatment
by Ann Grossman, graduate 2008.
In September, 2007, I had the great fortune to be accepted into the first class of the NYZCCC Chaplaincy Program.
My reasons for applying to the program were multifaceted; but the primary reason was to explore seamless integration of my Buddhist practice into my practice of medicine.
I am a physician assistant, and coordinator of an inpatient Palliative Care Team at Capital Health, in Trenton, New Jersey. Although not all my patients are actively dying, all have some form of chronic, debilitating disease and symptoms that disrupt their life. I witness my patient’s suffering daily.
The most profound suffering I witness is that of a patient or family of a patient who has decided to withdraw futile treatment. Futile treatment is any medication, device, or therapy that cannot cure or reverse underlying disease in an actively dying patient. It is, in essence, artificially prolonging the dying process, rather than enabling a patient to continue life. The removal of futile treatment is an act of liberation for the patient, as they are freed to proceed with the work of dying a natural death. Family members and friends left behind start a journey of their own filled with a myriad of emotions that may include relief, guilt, sadness and loss.
In many hospitals, futile medical treatment is stopped in a business-like and clinical manner. Families gather at the bedside and begin the “death-watch”. As a chaplaincy student, I could not find a bedside ceremony to console people at this critical time in their life. Not quite dead; unhappily tethered to a mindless machine or dependent upon chemicals that bind the physical body to this world, the patient and their family are caught in an undefined space.
When the Chaplaincy Program assigned a Final Project, it was described in the syllabus as: “a way of developing your skills in a particular area of contemplative caregiving, and a way to show your uniqueness as a caregiver in a focused way.” I decided to develop a ceremony to address patients actively dying after withdrawal of futile treatment, and the people who bear witness to their death.
I set a firm intention and “An Offering of Comfort” began to arise. It combined my love of medical practice with my devotion to Buddhist practice, creating a ceremony rooted in contemplative care of the medically fragile, dying patient. The “Offering” also cares for the chaplain called to the bedside, who may be witnessing death for the first time.
“An Offering of Comfort” is contained in a small, spiral-bound booklet. The introduction and first section is my own original writing. The remainder is composed of readings I gathered from a variety of inspired sources.
It begins by addressing the chaplain regarding changes in the physical appearance of the dying, preparing the patient’s room prior to the ceremony, and a brief review of the four sections of the ceremony. The first section addresses viewing the dying patient within the four Brahma-vihara and through the practice of Tonglen; the second honors family and friends for supporting the dying patient; the third speaks to the patient’s journey of active dying; the fourth serves as a post-mortem voice from the dead to the living.
I have used the “Offering” numerous times. The entire ceremony was designed to take only 10 minutes, but families appear to derive such joy from Tonglen that it has become my habit to allow more time for it. Additionally, families usually request more readings from various sections of the ceremony. I continue to receive positive comments from patient’s family members (they seek me out when visiting other patients) long after their loved ones have died.
I presented “An Offering of Comfort” as a poster session at the Cleveland Clinic’s 13th Annual International Symposium in Palliative Medicine and Supportive Oncology 2009. The Symposium specifically asked for submission abstracts related to spiritual care of the patient. “An Offering of Comfort” was selected for it’s ability to address the spiritual needs of a small population of patients whose deaths often become a medical event rather than a natural part of life. I feel my unique view as physician assistant and chaplaincy volunteer in my hospital enabled me to present “An Offering of Comfort” in a manner that enabled both physicians non-physicians at the conference to recognize this neglected aspect of patient care.
