Kasih Hospice Care Society is one of the first registered hospice organizations to apply Buddhist principles in patient care. Our 8 years of experience reaffirm that Buddha’s teaching is the best and most comprehensive manual for hospice care - the holistic care for people with life threatening illnesses. When one is sick with terminal illness, one’s mind is at its weakest, filled with negative emotions such as anxiety, anger, fear, frustration.One is left feeling both helpless and hopeless. At this critical time of death and dying, it is Buddha who becomes our best doctor, psychiatrist, counsellor, nurse and companion….and indeed, it is at this time that many patients we cared for begin their spiritual journey, the search for the meaning of life.
Our spiritual advisor, Lama Zopa Rinpoche has told us, ”To qualify hospice service as Dharma, one must ensure, at a minimum, that one should address the issue of mind and better future lives.”
Spiritual support through universal approach in Malaysia
Malaysia is a multi-ethnic and multicultural society. Kasih Hospice Care Society utilizes skilful means to serve the community made up of different faiths, through universal principles of love, compassion, altruistic joy, equanimity, generosity, patience, tolerance, trust, understanding and peace.We have respect for all life, strive for freedom from selfishness, hatred and delusion, and seek truth and wisdom.All our volunteers are taught Dharma.We apply especially the following teachings, when providing spiritual support to patients.
  1. Precious human rebirth
    Human existence is rare and precious, and is filled vast potential.People of all faiths have an understanding of this potential - the actualisation of one’s inner divinity or ‘bodhi seed’, which is pure and good. It is very beneficial to be reminded of such great potential when one is depressed, as it helps to eliminate one’s sense of hopelessness and helplessness. We also encourage patients to recall virtuous actions that they and others have done, and to rejoice in these good deeds. We have had 2 encounters of helping patients to recall and rejoice in virtuous actions, moments before they took their last breath. It was wonderful to note the change in their facial expression, from fearful and anxious, to peaceful and calm.
  2. The Four Noble Truth
    By applying the teaching of the Four Noble Truths, patients who blame others for their misfortune begin (i) to acknowledge the First Truth of existence of suffering, that no one is free from it; (ii) to accept the Second Truth, that one is responsible for one’s suffering, and must be determined to abandon the cause, (iii) to realise the Third Truth, the truth of cessation of suffering, the state of liberation and enlightenment, and finally (iv) to cultivate the path leading to the cessation of suffering, the Fourth Truth.

    Time and again, we noted that once patients begin to accept the First and Second Truths of suffering, they do not blame others so squarely, and their sorrow and lamentation is lessened. This is particularly obvious among our patients who are dying form HIV/Aids, as they come to understand the causes of their illness, and start to accept responsibility.
  3. The Three Sufferings
    Our encounters with patients reaffirm the existence of the three sufferings. Patients are constantly faced with the:
    • Suffering of physical body.Fortunately however, most of the symptoms can be relieved by proper medication and nursing care given by our hospice team.
    • Suffering of change.Our patients’ mental and physical states change all the time….from feeling well, to feeling discomfort, back to feeling well, and so forth. We use this changeability to encourage our patients, to constantly remind them that suffering is not permanent.
    • Pervasive suffering.It is not easy to share this fact with patients:that as long as we remain in cyclic existence, our contaminated aggregates and all phenomena are, by nature, suffering.So we have to be skilful and convey to patients that this human existence, being part of cyclic existence, is ultimately unsatisfactory.Thus it is not worth attaching oneself to, and we encourage them to let go of their craving for material possessions, relatives, friends, and even their own body.

      From our experience, people with religion are less fearful of death. They believe that there is a brighter future after death, either to be with divine god, or, for Buddhists, a better future rebirth, liberation and full enlightenment. Sadly, for those without religion, we find they have a lot of fear, due to their belief of punishment in hell for everyone without choice.
  4. Death and Impermanence
    Every Kasih Hospice caregiver attends talks on death and impermanence and the 9—round death meditation.They learn that death is certain, the time of death is uncertain, and at the time of death, the only thing that will help us is dharma and our spiritual cultivation. Such awareness and conviction is very useful for our patients and volunteers.
  5. The universallaw of cause and effect / karma
    Volunteers have to be skilful when applying the universal law of causality. Statements like “You got this disease because you have done negative actions in the past!” are highly unwise. All volunteers are taught the four principles of karma:That karma is definite, That karma increases, That you have to do the action to experience the result, and That karma will not disappear - to change it, you have to purify it.We put particular emphasis on the fact that one can still do something to modify the results of karma — that if one does not provide the necessary causes and conditions, and if one applies antidote and practice virtuous, negative results will not ripen.
  6. Purification
    The most wonderful thing that we share with patients is the practice of the four opponent powers. By doing the purification practice, we reduce patients’ fear and uncertainty and give them hope and relief.
    • The power of regret — We advise patients not to have guilt, only a deep sense of regret.This is then followed by the second power.
    • The power of reliance or dependence — We encourage patients to rely on the 3 refuges, or gods of their own religious system
    • Power of remedy — We share with patients antidotes that can be applied to counter afflictions, such as thoughts of loving kindness against hatred. If patients are Buddhists, we recite prayers and mantra together.
    • Power of resistance —We emphasize the importance of the 4th power:Vigilantly keeping the promise to refrain from creating negativities.
    We find out that non- Buddhist faith have the similar practice of purification, of cleansing defilement from negative actions done, through reliance on the divinity such as gods, and through commitment not to repeat the negative action.
  7. Cultivating loving kindness, compassion and altruistic joy
    We often tell our patients that though the body is sick, the mind can be healthy, that one can utter pleasant speech and have good thoughts towards others. One should appreciate the kindness of all others and rejoice on good done by others. We find that many of our patients with physical weaknesses but clear minds are able to apply this very well.
Besides the above dharma knowledge, Kasih Hospice Care volunteers are reminded to set the right motivation to free all beings from suffering and causes of suffering, without personal gain, by inculcating a bodhicitta mind that “I alone create the complete cause to free all beings from suffering and be liberated from samsara”. At the end of each contact with patients, they dedicate their virtuous actions to the relief of all sentient beings’ suffering, and generate the wish for them to achieve the highest state of happiness, i.e. enlightenment.
Volunteers' own spiritual development
Hospice care serves as a platform for volunteers to mobilize dharma into spiritual practice. The by-product is tremendous. Being constantly faced with death & impermanence, volunteers reflect on this teaching and prioritisedharma practice in their own lives. In this way, we hope all our volunteers live happily and die without regrets, and eventually bring their dharma practice to fruition.

Furthermore, serving the sick is one of the greatest virtuous, and virtuous actions will bring about the merit so critically needed to counteract delusions and clear obscuration in our spiritual paths.
Conclusion
Spiritual support is an integral part of hospice care. The universal principle of love, compassion, altruistic joy, equanimity, generosity, patience, tolerance, trust, understanding and peace, belong to no particular religion.Similarly, respect for all life, the wish for freedom from selfishness, hatred and delusion, and the seeking of truth and wisdom are also universal.

One can thus apply these values skilfully to all, without having to utter any religious terminology. Through one’s sincerity and genuine wish to free all beings from suffering, the mere pure motivation and dedication will go a long way. Through this practice, both patients and hospice volunteers are on their path towards higher spiritual attainment.