Frank Ostaseski on how to offer compassionate companionship to the dying

Danny Fisher interviews Frank Ostaseski about his work with the Zen Hospice Project and the upcoming Metta Institute program.

Danny Fisher
11 November 2010

Danny Fisher interviews Frank Ostaseski about his work with the Zen Hospice Project and the upcoming Metta Institute End-of-Life Care Practitioner Program.

Buddhist chaplains like myself owe much to a small, core group of dedicated practitioners whose considerable efforts a couple of decades ago did much to stimulate a lot of thought and activity around Buddhism and the caring professions in the United States.  Chief among these individuals is Frank Ostaseski, who helped form the Zen Hospice Project and founded the Metta Institute.  I recently caught up via email with Frank, who is preparing to begin another Metta Institute End-of-Life Care Practitioner Program (applications are being accepted until November 20, by the way).

Frank, the Metta Institute has a program coming up.  Can you tell us a little bit about it? What is it? Why might our readers consider it?

The Metta Institute End-of-Life Care Practitioner Program is certainly one of the most comprehensive trainings in contemplative care. The nine-month program builds essential clinical skills, enhances individuals’ capacity for compassionate service, and develops the participants’ spiritual practice. It is primarily aimed at healthcare professionals and offers a unique opportunity for both personal and professional development. Students commute to the San Francisco Bay Area for six residential sessions over the term of the course. They continue working in their local organizations or communities while being individually mentored by members of our extraordinary faculty. The faculty, by the way, includes Ram Dass; Rachel Naomi Remen, MD (author of Kitchen Table Wisdom); Norman Fischer (former abbot of the San Francisco Zen Center); Charlie Garfield, PhD (founder of the Shanti Project); and others.

Our graduates are pioneers, change agents, intermediaries helping to return the soul to care giving. The great thing about the training is, when it’s over…it’s just beginning. The graduates join a national network of like-minded peers. They share resources, participate in collaborative projects, annual retreats, teleconferences, and monthly phone support groups. It is an amazing community.

Our next course begins in January 2011. We just extended the applications deadline to November 30. All the info is online at

The work of the Zen Hospice Project, the Metta Institute, and this program seem to me to have been enormously influential in terms of bringing Buddhist wisdom to the caring professions. I’m curious: as this relationship between Buddhism and care giving in the Western world has developed in the last quarter-century, what have you been most struck or inspired by? Conversely, what work remains — where can we make room for improvement?

Almost twenty-five years ago, I founded the first Buddhist hospice in America. I saw it as a fusion of spiritual insight and practical social action. It seemed to me that there was a natural match between those cultivating the listening mind and those who really needed to be heard: folks who were dying.

I believe Buddhism has a unique and helpful perspective on impermanence, suffering, and emptiness that can be of enormous support in the time of dying. I’m not interested in pushing any dogma. I’m interested in people discovering freedom. That happens more easily in the presence of compassion.

The environment in which people are dying — by this I mean who is present, and how they are present — has a big impact on how people die. One calm person in the room can make all the difference. When we move a patient from the bed to the commode we lend them the strength of our back and legs. We can also lend patients the concentration of our minds, the fearlessness of our hearts. We can be a reminder of stability and confidence. We can expand our heart in such a way that it can inspire the individual who is struggling to do likewise. Then we can be a true compassionate refuge.

Of course this way of thinking is not the sole domain of Buddhism. Yet, we must recognize that we have had an important impact. Thanks to the work of Jon Kabat-Zinn, myself, Joan Halifax, and others, healthcare and hospices are embracing the fundamental principals of mindfulness. This is leading to more inquiry about how to care for whole human beings.

While we have a long way to go, I am hopeful. There are enormous time and financial pressures in healthcare. I tell nurses and doctors that mindfulness doesn’t take more time. In fact, an absence of mindfulness leads to all sorts of mistakes that take more time and money to rectify.

Frank, you’ve spoken about three important elements in the care of the dying: presence, compassionate companionship, and supportive inquiry. Would you say a little bit about these for the benefit of our readers who might not be able to participate in the program but want to become better caregivers?

Yes, there are three characteristics that I find are essential in being a compassionate companion.

First: an ability to be compassionately present for suffering. This means to offer our nonjudgmental attention and be willing to attune our self precisely to the suffering of the other.

The ability to be present for suffering begins with making room for our own pain. It’s our exploration of our own grief, helplessness, confusion that enables us to be of real assistance. That’s what allows us to touch another human being’s pain with compassion instead of with fear and pity.

We can’t travel with others in territory that we haven’t explored ourselves. For example, if we haven’t investigated our response to fear or to impermanence, come to know these states intimately, then when we say “I understand,” the person who is dying will know that we are just guessing, and he will sniff out our sentimentality and our insincerity.

Second: a willingness to release ourselves and others from the limitations of roles. This means we need to come out from behind our cherished beliefs, the defenses of our expertise, and our well-constructed self-image. When I am dying I don’t want a role next to me, I want a human being. We don’t heal just because our problems are being solved. We heal through relationships. This is intimate work; we can’t do it from a distance. Professional warmth doesn’t heal.

Third: a deep trust in the sacred process of dying and an abiding confidence that we are more than the separate self we have taken ourselves to be.

Spiritual support is every bit as important as good pain management. Yet it’s rarely offered in any meaningful way. As a result, too many people die in distress and fear. We can do something about that.

Dying is not predominantly a medical event, and we need to stop treating it as if it was — it’s not just about “making the best of a bad situation” — a view strongly held in our healthcare system and even by some hospice workers. Dying is at its heart a sacred act, it is itself a time, a space, and process of surrender and transformation.


For more with Frank, be sure to check out Shambhala Sun web editor Rod Meade Sperry’s two-part audio interview with him.  Listen here and here.

Danny Fisher

Danny Fisher

Rev. Danny Fisher, M.Div., D.B.S. (Cand.), is a professor and Coordinator of the Buddhist Chaplaincy Program at University of the West in Rosemead, CA. He was ordained as a lay Buddhist minister by the Buddhist Sangha Council of Southern California in 2008. In addition, he is certified as a mindfulness meditation instructor by Naropa University in association with Shambhala International. A member of the National Association of College and University Chaplains, he serves on the advisory council for the Upaya Buddhist Chaplaincy Training Program.