Research Center for the 21st Century is
an institute for peace, learning, and dialogue
located in Cambridge, Massachusetts.
Founded by Buddhist thinker and leader Daisaku
Ikeda, the BRC bases its work on the concept
of soka — or “value creation.”
For the BRC, this means engaging diverse scholars,
activists, and social innovators in the search
for the ideas and solutions that will assist
in the peaceful evolution of humanity during
the twenty-first century.
Pam Kircher was co-facilitator for “Living
with Mortality: How Our Experiences Change Us,”
the BRC’s 5th Annual Ikeda Forum for Intercultural
Dialogue, held September 20, 2008. Two days
after the event, the BRC’s Mitch Bogen
sat down with Kircher to reflect on the Forum
and to talk about the benefits of a more humanized
approach to healthcare and the process of dying.
Valuing Spaciousness of Time
MB: You have written that for people who
have been transformed by their experience of
being with loved ones who are dying, the change
in their lives is often toward greater balance,
more spaciousness of time, and an emphasis on
peaceful, loving relationships.
PK: What I mean by greater balance in life,
and greater spaciousness – they kind of
go together – is that I see America and
the American culture as being out of balance.
We are very fast and very busy doing little
of true value. Running around doing all sorts
of stuff, we have no spaciousness in our lives.
We’re totally booked. And at the end of
the day, what have we accomplished? Just by
being with a loved one who is dying, of necessity,
you cannot just do, do, do, like you normally
might. There’s no way you could be present
for them. And what we find when being fully
present is that the spaces in the talking are
when the depth arises. Amidst the usual barrage
of words and all the “busy-ness,”
true depth never happens. That’s what
I mean by the value of balance and spaciousness.
Not all relationships are peaceful and loving,
of course, but when peaceful, loving relationships
occur, I think we get an addiction to having
them. That’s what we want. And so we begin
to look more and more for it: How can we make
it happen? Because there isn’t anything
better than the real feeling of a heart connection
with another person. So anytime we have cared
for a loved one and have experienced that feeling
of peaceful, loving connection, we are reminded
of the other relationships in our lives, and
we ask ourselves: How can these also be peaceful?
And what keeps them from being that way?
Creating the Conditions for Meaningful Death
MB: You have also written that before the
start of hospice, in the late ’60s to
early ’70s, most people receiving medical
care at the end of life died alone in ICUs,
with just fifteen-minute visits from loved ones,
once or twice per day. What was the impact of
PK: I think that when you only see a dying
loved one for fifteen minutes once or twice
per day, you’re not likely to catch them
in that spacious moment we talked about. You’re
capturing just a little glimpse of the 24 hours.
And most of the time, the person is not present
in any deep way during that time. And hospital
staff also told family members: Don’t
upset them! So that meant don’t talk about
anything that really matters. Don’t talk
about forgiveness. Don’t talk about feelings.
Don’t talk about what’s going to
happen next – like death! Don’t
mention that word! So you go and talk about
the weather. And frankly, they don’t care
about the weather. They feel you’ve come
in and been completely out of synch with them,
not connected. That does not feel good.
Real connection could happen, but
it would have been almost a miracle, if, in
that little fifteen-minute segment, something
deep and meaningful did occur. Plus, in the
ICU, minimal thought was given to quality of
life; it was about length of life. And it was
about getting the person out of ICU. So any
extreme measure was taken to keep a person alive,
and those measures often resulted in more pain.
And they gave less pain medication than we do
now. I know from being with people in pain that
when the pain is so loud in your life that all
you feel is the pain, it’s very hard to
do anything deep or emotional like forgiveness.
You cannot think. Honestly, the way death was,
people didn’t have a chance to say goodbye.
MB: Even hospitals now are closer to hospice.
PK: The hospital experience has learned
from hospice. The trend in hospitals now is
for it to be a patient’s right to be as
comfortable as they want to be and to receive
proper pain management. Pain management has
really benefited from what doctors have learned
in the hospice setting, namely that more pain
medication can actually be better and that it
is helpful for family members to be there more
often. So even ICUs let people visit a lot more
than they did in the late ’60s.
Good pain management and good symptom management
are important so that the “work”
of dying can actually be done. For example,
a person can do their “life review”
– looking back and seeing what had meaning
in their life and what still needs to be done
for them to have a peaceful death. They can
do that. They can think about things and have
the talks they need to have. And there is also
that spaciousness of time, without the expectation
that someone will be with you for only fifteen
minutes. People can sit together.
MB: And just being together can be so important.
PK: Exactly. So often you don’t have
to say a darn thing. I remember this comment
from one of the other Ikeda Forum panelists,
made during our Friday seminar session: “I
thought I had all of this to say, and I realized
that just being there and breathing with him
was enough. Sitting there we knew we loved each
other. We didn’t need to talk about what
specifically needed to be forgiven.” It
was all water under the bridge, truly washed
Some Lessons Learned
MB: You recommend that we live our lives
from the perspective of a person who expected
to die next week.
PK: And I actually do that. Every morning,
or every evening before I go to bed, I do a
quick check in and ask myself: Is there anything
that happened today, if I never got a chance
to resolve it, I would feel uncomfortable with?
I like to go to bed each night with an absolutely
clear state, so if something isn’t good,
I think about how to clear it up.
MB: You also invite each of us to write
down what we are doing to bring about a simpler,
gentler world for ourselves and others.
PK: I recommend that whenever you really want
to make a change in your life, write it down.
Invest yourself in putting it down on paper.
You can save it and pull it out in a week and
ask: What have I done to achieve this? That’s
more likely to make something happen than just
thinking it. So if I really mean something,
I write it down.
MB: Does it foster hopefulness when people
learn how to take small actions?
PK: To say we’re going to change the
whole world is so overwhelming. We just turn
on the television set! But if you say that when
something comes up that pushes my buttons today,
I’m going to deal with that before I go
to bed: That’s critical. I’m going
to deal with my reaction to it. I’m not
going to fix something “out there”;
I’m going to fix something “in here.”
I’m going to see it another way and become
responsible not only for my actions and words,
but also for my thoughts – because the
actions and words come after the thoughts.
Reflecting on the Ikeda Forum
MB: Which aspects of your work and experience
did you choose to emphasize at the Ikeda Forum?
PK: There were so many things I might have
emphasized, but first of all, I wanted to communicate
a sense of history, so that we could see how
far we’ve come with the hospice movement.
So often we’re not optimistic about things
because we don’t see what has happened
before. So I wanted to give that sense of hope
and the sense that, yes, we’re in the
middle of this revolution. We’re not starting
it; it’s happening.
And in that story is not only the history of
how we treat death and those who are dying;
it’s also the story of how we are taking
back responsibility for our own healthcare and
all the related choices. We’re no longer
laying ourselves on a table in front of a doctor
and saying, “Fix me, I’m a car that’s
out of whack.” We’re saying, “I’m
feeling something in my body that doesn’t
feel balanced, and I want you to give me your
opinion on restoring that innate balance in
I call this the new paradigm in medicine. And
this new paradigm includes a combination of
conventional and complementary medicines. People
are going to conventional doctors for consultations,
but that’s not the only advice they receive.
MB: What do you mean by complementary medicines?
PK: Other kinds of body-mind medicine, like
acupuncture and massage, homeopathy and herbs,
and so on. We are drawing on the whole array
of things that people have done over time to
make themselves well. And now there is a greater
emphasis on wholeness and wellness than on the
disease process and getting rid of symptoms.
We’re moving past just labeling the disease
we have. We’re forcing the medical profession
to no longer refer to “the diabetic in
Room 4.” Now it’s Mr. Smith, who
happens to have diabetes, in Room 4.
MB: During the Ikeda Forum, you framed
your remarks to participants as an invitation
for them to consider and share their own wisdom
around death. This reminded me of a key idea
behind BRC’s entire exploration of this
topic: to “invite death out of the shadows”
– as BRC founder Daisaku Ikeda phrased
it in his 1993 Harvard lecture.
PK: That’s a definite connection. I used
his talk very much as the basis for formulating
what I was going to say and how I wanted the
day to go. I agree with Mr. Ikeda that now is
the time for us to dialogue with one another
about the things that matter most – and
what is more powerful, more connecting, than
death and how we are influenced by it?
MB: Mr. Ikeda also said in that lecture
that we would do well to recognize what he calls
“the deeper continuity of life and death.”
What is your perspective on this?
PK: I’ll preface this by saying that
I never insist that people believe that we live
before birth and live after death. I don’t
think that to live a life of deep meaning, you
absolutely have to believe that. I certainly
do believe it, but I don’t think it’s
required, as we discussed earlier. One can have
a lot of joy in life by simply being present
in the moment and having the intention to be
On the other hand, if you have that perspective,
you get less caught up in what I would call
the illusions of life – those things that
seem so immediate in the moment but that have
no meaning before you come to this world and
will have no meaning when you leave. It helps
you to take everything more lightly. Many people
are able to live an easy, gentle life because
of that wider perspective, but I think it’
possible for others to also live that kind of
life, even if they don’t share my belief.
MB: How would you connect the deeply personal
reflections in the Ikeda Forum’s morning
session with the call for positive social change
in the afternoon? Can our personal experiences
tell us something about our social challenges?
PK: I think that as we experience those changes
that result from being with people who are dying,
we come to see what we really value. And what
we value is relationships and some time for
personal reflection and those things that have
so little to do with status and success and
material acquisitions. And we find that what
we have to do to get these things becomes burdensome
– who would want to spend 80 hours a week
at work? That’s a great way to make a
lot of money and move up the ladder and maybe
even become a CEO of something, but the tradeoff
is you miss the personal reflection, the relationships,
and the time necessary for them, because relationships
are not ready to simply turn on when you show
up. You have to actually be there, to be present.
When we come to value relationships and the
time needed to nurture them – and, I should
add, when we create a society where some of
us don’t have to hold down two jobs just
to make ends meet – we’ll work fewer
hours, we’ll do less running around, and
we’ll hopefully even use less of the world’s
resources. We will be better citizens of the
world when we have more time to reflect on the
fact that we are indeed citizens of the world,
not citizens only of the United States.
And we will have more time to be of service
to one another, without regard to whether it’s
making us any money. The new criterion is not
money but satisfaction at the end of the day
– do I feel like I had a life of service
today? And when I say “service,”
I do so recognizing absolutely that always there
are things to learn from one another and to
give to one another. So it’s not just
one person always giving and one person always
taking. We Americans have things to learn from
every single person in this world.
I want us to be not just givers. I want us
all to be the ones who give and receive,
and in the end you can’t tell which is
happening. That’s the world I want to
see, where we are true citizens and flowing
with everyone else who lives in this world,
not merely using all the resources of our world.
When we do this, we actually have the personal
resources and collective resources to solve
the problems that we have as humanity. And it
is humanity that has the problems now, not just
one person or one country.
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