Julie: What is your position on removing life support systems for a terminally ill patient?
Roshi Joan: I don’t have a position per say. But I do have a position, and my position is to do what is most compassionate and what will really serve the individual. Sometimes life support systems are removed for reasons that are not entirely ethical but can be economically based or even reflect the challenges in hospitals for sustaining life.
These kinds of questions I don’t think we’re in a position to adjudicate. Our relationships to these questions has to be informed by a deep sense of ethics and a deep sense of moral concern for what will really serve the individual who is facing death.
Julie: It can be argued that people are left on life support systems simply because our technology has gotten so good. This could cause more suffering. Your thoughts?
Roshi Joan: There’s an account of a man from Arkansas who was in a persistent vegetative state for nineteen years and then woke up, somewhat. His presence appears to be a great enrichment at some level to his family. He has elements of personality, for example.
“a Boddhisattva will never choose an easy situation.”
Whether or not to bring life support into the picture is first of all a decision that hopefully most individuals will make before they need life support. So advanced directives are very important. If the family is in the position of having to make that decision on the behalf of the individual then it’s important for someone with equanimity to sit with the family and helps assess what will really be served by sustaining life.
Julie: Now if we decide to commit suicide, what is happening here?
Roshi Joan: At some level suicide means killing the self. If we just simply translate the word ‘suicide,’ in the best spiritual practices we are allowing the self to die. Our life choices also are often suicidal in nature.
Julie: Can you comment in terms of consciousness or karmic implications?
Joan: There are different belief systems with regards to: continuity of consciousness, or the mind after death; what happens in terms of the karmic consequences, that is causality and the feature of cause and effect in one’s future life.
I’m not convinced, but I hold a very open attitude toward the continuity of the subtle mind and toward the consequentiality factor operating in future lives. But, maybe not.
Julie: The present is all we can be certain about, is what I hear you saying.
Joan: This could be it. Or, the importance of the deep present could produce a kind of selfishness in individuals because the idea of future incarnations and karma is a great psycho-social incentive for living a life that benefits others. That is un-selfish.
When one has a moment of deepening, one realizes living unselfishly is the only way to live whether it’s just in this moment or for many life-times.
Julie: You practice Engaged Buddhism. Would you briefly explain what it is, please?
“You have to put yourself in the elements, so to speak, that can forge a character of strength and depth and tenderness.”
Roshi Joan: Engaged Buddhism is, at a very deep level, having to do with how to live as a Bodhisattva, to really serve the welfare of all beings – not just two-legged but all beings. Engaged Buddhism is about bringing that sensibility forward in practical action, for example the work that we do in the prison system, the work that we do with dying people, or educationally serving people which is training health care professionals or it could be directed towards the transformation of social institutions that promulgate structural violence.
Julie: Why are you doing the prison work?
Roshi Joan: It’s just natural. It’s a place to serve. The thing about working in the prison system and with dying people is that it’s fundamentally a hopeless situation. For many of the people that we work with in the prison system, there’s very little prospect for such individuals. But, miracles do happen.
Julie: In terms of changing their behaviors, their thought patterns…?
Roshi Joan: Working with people who are marginalized, whether in the prison population or dying people, provides a special opportunity because the marginalization is not only in relation to psychological, social and cultural reasons, but also because the prospects for these two populations aren’t necessarily very hopeful.
Julie: It’s really about the practice then…with these people…I’m hearing you say they’re the tools for the practice.
Roshi Joan: No, I wouldn’t call them tools. I would say you just do the best that you can in all situations to relieve suffering. At the same time, in terms of character development, a Boddhisattva will never choose an easy situation. If you’re going to have depth of character and develop true pro-social capacities, it means that you have to put yourself in the elements, so to speak, that can forge a character of strength and depth and tenderness.
Julie: Mother Theresa comes to mind and…
Roshi Joan: …Desmond Tutu and Nelson Mandela, Gandhi. There are hundreds of upon hundreds of examples of individuals who have chosen the most difficult path for the reason that their life circumstances drove them to that.
Julie: Can we experience growth, for example, through grieving?
Roshi Joan: Grieving is one of those incredible mixed blessings of an individual’s life because ultimately we lose everything; so all of the small losses of our life and then the bigger ones prepare us for dying, when we do lose everything. If we’ve done our practice deeply, in losing everything we open up the opportunity, the most precious opportunity – for liberation, complete liberation from all the suffering, the body unbinds and is liberated. Death presents us with the most profound opportunity for complete enlightenment.
Julie: When you are teaching caregivers and healthcare professionals how to assist dying persons, do you teach them specific practices?
Roshi Joan: I was raised a Christian and I was a cross-cultural anthropologist. After looking for ways to stabilize my own mind, I began to work with dying people, and with people working in the field of End of Life Care. I looked in many different arenas for insights and practices that would serve people facing death and serve those who served people facing death.
I looked at Christianity, Buddhism, Hinduism, Judaism, the Muslim faith, modern psychology. The unparalleled treasure house for approaches or skillful means for working with dying people is within the tradition of all three schools of Buddhism.
Julie: Were you a Buddhist at that time?
Roshi Joan: Well I became a Buddhist formally in the mid 1970s, but I began practicing in 1965. Definitely I was a ‘kind of a Buddhist person’ for a long time. Buddhism didn’t exist ‘til after the Buddha died. Anyway, I’m not so interested in institutionalized religion.
In fact, our work with professional caregivers, physicians and nurses is completely nonsectarian. The perspective in Buddhism provides us a phenomenal range of perspectives and meditational approaches that are extremely easy to translate into non-sectarian terms and are profoundly useful for caregivers of all denominations.
Julie: Who attends your training program?
Roshi Joan: We have physicians and nurses, chaplains and therapists who receive fifty units for continuing medical education, which is a phenomenal amount. This acknowledges the rigor of the training and its spirit which is very inclusive.
Julie: What are some of the tools you teach?
Joan: Well, there are many. For example, we deal with the development of attention. Attentional balance is essential in working with dying people; but you know it’s also essential in learning, in education, in politics, in law and of course in the practice of medicine it’s paramount. We also work in the area of intentionality, motivation, aspiration.
Julie: You believe in asking “why do you care about this job.”
Joan: That’s right. “Why are you a doctor, really?” “Why have you entered into the field of care giving?” So the intentional, the motivation aspect is very important to understand because the more grounded and compassionate the motivation, and the clearer one is about one’s motivation, the less burn-out there is.
We also address issues related to emotional balance. How do you develop perspective on emotional reactivity in the personalization of very difficult situations?
And then, how do you develop pro-social behaviors? That is compassion, kindness, joy, equanimity, a wide range of pro-social qualities which are essential in the care giving field.
Julie: These are things one would hope to take for granted with care givers.
Roshi Joan: But we can’t because care givers are just like the rest of us.
Julie: They’re trained to do a procedure, not the ‘soft’ forms of care?
Roshi Joan: They’re trained to do a medical procedure and hopefully they are present, not absent when they do it. And hopefully they’re able to do it with compassion so that they can sense what’s happening in the experience of the other person, and they can do the procedure in a way that is non harmful.
Julie: An older woman lies in the hospital for a cancer treatment. She’s been given a lot of morphine. She’s not dying, or they say she’s not, but she dies during the treatment. What would a care giver be doing with this person in that situation, knowing that she could die now or she may come through; she’s not fully conscious. A care giver who’s gone through your training program, what might they do?
“It’s important for someone with equanimity to sit with the family and helps assess what will really be served by sustaining life.”
Roshi Joan: There’s a great sanctity for human life, as well as sanctity for the body after death that needs to be preserved and developed and deepened. This aspect of being a care giver has to do with coming to a sense of the sacredness of life and that the person might not be conscious or might be very close to death but their life is still precious and rare. That sort of elemental respect and care has to be engendered in all situations.
Julie: After having gone through your training is there anything that brings the care giver to show concern about one’s consciousness moving on after death?
Roshi Joan: You see we can’t prove that…
Julie: We don’t have to go there if you don’t want to.
Roshi Joan: I don’t really go there with anybody. I think what’s important is that care givers come in with belief systems and that we essentially acknowledge the importance of these belief systems, their values and how these elements influence how they give care. But it’s not to tell an incredibly skilled and loving Christian physician that there’s heaven or there’s no heaven, or [to tell] a Hindu nurse or doctor who’s come from India and trained in this country that there’s not reincarnation or to say to everyone else that there is reincarnation.
Julie: So it’s more about helping people live while they’re alive, enhancing what ever quality of life is available.
On another subject, I noticed that you offer yoga here to some people.
Roshi Joan: Actually to a lot of people. We teach yoga at many of our retreats including at the eight-day training for health care professionals. Ashtanga yogi Richard Freeman and I teach a retreat every year which brings Buddhism and yoga together in a very profound way.
Julie: What do you hope to accomplish in the next ten years?
Roshi Joan: My main work has been in bringing the Buddhist perspective, the philosophy and the practices of Buddhism, together with social action.
This is a beautiful place with wonderful facilities and we just opened up a new facility now, too, in northern New Mexico that’s in deep wilderness and that’s extraordinary.
My vision is to bring the values, philosophy, psychology, the practice of Buddhism forward in many different arenas. Not only in the work with dying people but also in social, political and environmental transformation.
Julie: Would you give a brief assessment of your view of the state of our country?
Joan: I’m very disturbed and heartbroken about the state of the world, politically and environmentally. There are very few social and political role models that our young people can look up to.
The corruption in our government is visible to everyone on this planet including in remote Tibet from which I just returned from spending time with our nomad’s clinic, which is an incredible endeavor to deliver health care to people living in remote areas there. Those people even know what’s going on in terms of the great problems and challenges that we in our country face.
Julie: Leadership and moral values?
Joan: Leadership and moral values, putting it mildly. Just a sense of deepening alienation in terms of values in general, the sanctity of all of life on our planet, environmental concerns and cultural integrity.
Julie: What would you like to say in closing?
Roshi Joan: I’m just doing the best that I can with this one life that I have. I feel very blessed to have been given the resources to be able to create a mandala that has helped some beings.
