Joan Halifax Dharma Talk: A Practice of Compassionate Care of the Dying

A Practice of Compassionate Care of the Dying

by Joan Jiko Halifax

The practice of Giving and Receiving is done to develop our compassion and our ability to be present for our own suffering and the suffering of others. It is also a practice of loving kindness, a practice that opens up our whole being to the overwhelming presence of suffering and our strength and willingness to transform suffering and confusion into peace and well-being through the energy of loving kindness.

Sending and receiving is one of the richest and bravest practices that we can do with people who are dying. In teaching this practice to caregivers for more than twenty years, I have been told again and again that this one practice has helped them immeasurably in attending to their own fears around pain, suffering and dying. This is one of the great meditation jewels that offers a way for us to cultivate natural mercy.

We begin the practice with a heart that is truly committed to helping ourselves and others to be with suffering and be with dying. When we look deeply into how this can actually happen, we see that to help others, we must relate with kindness toward our own suffering, our rage, helplessness, and frustration, our doubt, bitterness, and fear.

We see that by touching the roots of our own suffering, we are more able to accept and understand the suffering of others. Our realization of compassion is based in our particular and unique experience of life and suffering. It cannot be arrived at through theories. Rather compassion arises because we have been able to look deeply and with kindness into our fears and feelings of impoverishment. Our acceptance of and kindness toward our own suffering gives us both understanding of the roots of our suffering as well as the suffering of others. Another way to say this is that our suffering is the very stuff that makes compassion possible, if we touch our suffering with awareness and love. Sending and Receiving, then, is a practice of transformation.

This is the very basis for giving compassionate care to people who are suffering and dying. When we understand our own fear of pain and death, we can understand the fear of pain and death that others have. When we have transformed our fears through awareness and kindness, we can more readily offer genuine awareness and kindness to others who are touching these same areas of human experience. When we do this with someone who is suffering, she can more readily learn to do it for herself.

Mindfulness practice has been a way for us to watch the ebb and flow of the activity of the mind. We have seen with gentle precision and honesty foul weather and clear skies come and go. We have seen not only the changing of mental weather, we have had insights into the nature and cause of our suffering and also the possibility that at the very ground of our being, we and others are free from all forms of conditioning.

The basis of this practice is in the realization that suffering exists and that beings can be free of suffering. These are the two great points of faith or realization that guide us in this practice. We have to know this through our own experience. To deny suffering is to close off the heart to what others, and perhaps we, experience. To deny the possibility that we and others can be free from suffering might mean that we have not seen our own vast, good and tender heart.

When I sit with a dying person, I must see both of these dimensions. If I fixate on this one’s suffering, I have seen only as far as my own suffering. I must look from a place in myself that includes suffering but is bigger than suffering. I must look from a heart that is so big that it holds everything, including freedom from suffering. Can I see her suffering and her great heart as well? Can I see his true nature, who he really is, deeper than the story?

The practice of Giving and Receiving asks us to invite in all of our suffering and the suffering of others and let it break open our untrusting and protected heart. When our heart breaks open by being deeply touched by suffering, its tender spaciousness becomes the ground for the awakening of selfless mercy. We cannot help but send all of our love and kindness to this one who is suffering, be it us or others. This natural mercy is the gift of Sending and Receiving.


To begin the practice, you want to feel relaxed and open. You can sit in meditation posture, relax in a chair, or lie down. Gently close your eyes and let your body and mind settle. You want your mind to be clear, calm and spacious. If you are feeling contracted, agitated, angry or afraid, breath in whatever you are feeling, accepting it. On your exhalation, breath out peacefulness and well-being. Let yourself clear the atmosphere of your mind by bringing your awareness to what is agitating you and accepting it with kindness. Then give yourself some spaciousness. Do this breath practice until you are calm and alert.

The Texture of the Breath Practice

When you are calm and clear, you can begin the second stage of the practice. For some people who have never done this before, it will seem counterintuitive because it involves working with the breath in an unusual way.

You begin by breathing in hot, dark, heavy, polluted smoke. On your exhalation, you breathe out a breath that is light, cool, and fresh. Your next inhalation is of hot, smoky pollution. Your next out breath is cool and light. You stay in this rhythmic pattern of inhaling dark smoke and exhaling cool and light breath.

You breathe not only through your nose, but your whole body is breathing. On your in breath, dark smoke enters every pore of your body. On your out breath, coolness flows from every pore of your body. The feeling is very kinesthetic, as though every pore in your body is breathing in polluted smoke from all around you, and on your out breath, cool, healing breath is flowing out of every pore in your body. Let yourself become familiar with the pattern of the smoky in breath and the fresh out breath.

The Metal Sheath Around the Heart

Next, you visualize a metal sheath around your heart. That metal sheath is your self-importance, your selfishness, your self-cherishing, your self-pity, all of the fearful contractions that are difficult for you to accept. It is the fear that hardens your heart.

The practice invites you to break apart or dissolve the metal sheath around your heart, to open your heart to its natural non judgmental state of warmth, kindness, and spaciousness. This can be accomplished by visualizing the metal sheath breaking apart or dissolving when the in breath of suffering touches it. When the heart opens, the smoke dissolves immediately, vanishing into the great space of your true and vast heart, and what arises is natural mercy. It is this quality of heart which allows you to be with suffering and at the same time to see beneath the suffering.

The Outline of the Practice

You have now touched the initial elements of the practice: first, calming and opening the mind; second, accomplishing the rhythm and texture of the breath practice; third, visualizing the metal sheath of ego around the heart, its immediate dissolution when the in breath of suffering touches it, the spontaneous appearance of the vast heart of mercy, and the instantaneous disappearance of the smoke into space; and fourth, the out breath of healing.

Awakening the Heart

Now you remember why you are doing this practice. You remember that you are suffering, others are suffering, and you wish with all of your heart that all beings can be free from suffering. You remember that all beings will inevitably die and all beings want a good and peaceful death.

You want to care, to genuinely care. This wish cannot be general. It needs to be very specific, personal, and authentic. The Tibetan teacher Trungpa Rinpoche, when he practiced Sending and Receiving, remembered a puppy he had seen when he was eight years old who was being stoned to death. The people who were brutalizing the puppy were laughing as they killed the little creature. He would have done anything to relieve the dog of its suffering. Whenever he thought about the puppy, his heart broke open. The memory of this helpless little creature was a key that helped him do the practice with commitment, resolve and love.

Your heart tender, let your body settle. If you would like, close your eyes. Bring to your mind some being to whom you feel a deep connection, whether this being is dead or alive, someone who is suffering, not a being whose life is all grace, but someone who really has suffered and whom you wish to help by virtue of this practice, whom you really want to see free from suffering. May this be someone whom you love, admire and toward whom you feel gratitude, a parent, a child, a pet, your grandmother, your dearest friend, your beloved teacher. You would do anything to help this one. And you never forget that sooner or later this one will die. Be with her or him and let yourself feel what this one is experiencing. Let your whole being turn toward this one’s suffering and wish that he or she may be healed. You see how really vulnerable he or she is. You know that one day, this one will be dead. You wish the very best for your friend. You want to help now. Like a mother who will do anything to help her child, you will do anything to help your friend.

Now breathe in this one’s suffering as hot, heavy, grimy smoke. Let it break your heart open. It is this one who kindles your compassion, your kindness and your resolve. On your out breath, send this one peace and relief from suffering.

Now breathe through your whole body the suffering of your beloved, as heavy, polluted, hot smoke. The instant that the in breath of suffering touches the metal sheath of self-centeredness around your heart, the sheath breaks apart or dissolves and your heart opens to the suffering. The hot smoke of suffering instantly vanishes into the great space of your heart and from this space arises spontaneously an out breath of mercy and healing. Send a deep, cool and healing breath to this friend. Let this out breath flow through every pore in your body.

Then again, inhale the hot smoke of suffering. The metal sheath around your heart dissolves, your vast heart opens. The smoke disappears into space. From that vastness, send mercy and love to the one who suffers. Remember that this practice can be done on every breath that you take, every breath that you give. Cultivate the detail and the craft of this practice. Draw in the dark, heavy, hot smoke of suffering, breaking the heart open. Your self-importance disappears and reveals the vast heart of who you truly are. Send a light, cool breath of clarity and love to the sufferer.

Now let this one’s suffering remind you of all those who suffer in the same way. There must be so many others who find themselves in this situation. This friend is your connection to them. Breathe in their suffering. Let your heart break open. Send them healing with your out breath. Continue with this practice.

Remember this feeling, this broken-heartedness and resolve to help all beings. This is your awakened heart.

Continuing the Practice with Universal Suffering

Please dissolve the image of your friend, your beloved. Practice letting go of the image of this one. Let him go, let her go.

Even as you do, keep breathing in the dark heavy hot smoke of universal suffering. Let your vast heart open as the smoke of suffering touches the hardness around your heart and the grimy smoke vanishes into space. On your out breath, send healing to all beings.

So much suffering in our lives, so much suffering in the world: universal suffering, breathe it in as hot, heavy, dark smoke. The metal sheath of self-importance around your heart breaks open, and your true heart appears as vast and empty space. Let a cool, light, refreshing breath of healing flow from you entire body.

Practicing with a Parent

Again, let the visualization become particular. I want you to bring into your presence the parent with whom you have had the greatest difficulty, whether dead or alive, or foster parent. See in your mind the person who raised you, with whom you had the greatest difficulty, mother or father. See this one sitting before you. Maintaining the rhythm of the hot smoky in breath and cool light out breath, consider how this one and you have suffered. For a minute, internally raise your eyes to this one and look at his or her hair. Let yourself slowly and mindfully examine the cheekbones, nose, the mouth, the jaw of your parent.

Now gently raise your eyes, internally, and gaze into the eyes of this parent with whom you have had a problem. Very simply gaze into his or her eyes. Perhaps you have never looked so directly into the eyes of your parent. Notice if this is difficult for you. Perhaps looking at him or her in a mental photograph might help. See the wear on his face. Maybe her life has been full of disappointment and frustration. Maybe she was afraid. Maybe he was numb. Perhaps you experience anger, maybe disappointment or heartbreak. Let yourself feel whatever comes up.

Imagine your parent as a three or four-year old child. See his or her face free from wear. Imagine this one without suffering. See his or her face fresh and open, full of anticipation. Perhaps you remember a photograph of this face. If it is difficult for you to see your parent in this way, please notice the resistance that might be there. This is all right. Breathe in the resistance; breathe out acceptance and spaciousness, warmth and relief. If your parent is still alive, remember that he or she will die one day.

See if you can allow yourself to be in touch with the difficulties that this one has had and realize that if he or she had not been born into a particular culture, a particular family or situation, he or she might have been able to give you love in a form that could have nourished you. Whatever display of his suffering, her anger, his cruelty, or her inability to be present for you, if he or she had been in a different situation, maybe even having been given the life that you have had, she or he might have known greater ease.

If this is difficult for you, and you feel alienated and contracted, skeptical or afraid, turn towards your own situation. This is also suffering.

Breathe deep into your belly. You now resolve to transform your alienation in order to help others and to help yourself be free from suffering. I ask you to breathe through your whole body your own suffering, your own alienation as heavy, polluted, hot smoke. The instant that the in breath of suffering touches the metal sheath of self centeredness around your heart, the sheath breaks apart or dissolves and your heart can open to your own suffering. The hot smoke of suffering instantly vanishes into your heart and from this space, an out breath of mercy and healing arises spontaneously. Send a deep, cool and healing breath to yourself. Let this out breath flow through every pore in your body.

Then again, inhale the hot smoke of your own suffering. The metal sheath around your heart dissolves, your vast heart opens. The smoke disappears into space. From that vastness, send mercy and love to yourself. Now, at this moment, please remember the being with whom you connected at the beginning of this practice, this one helps your heart to feel tender and ready. Remember the sincere wish that he or she be free from suffering. You may touch his or her suffering, visualizing the metal of resistance and self-importance around your hear. Now breathe in blameless suffering as dark, heavy, hot smoke. Let it break open the sheath around your heart. Let your out breath that carries all that is good in your life flow from every pore of your body.

Now consider your parent whom you have visualized. See him or her as vividly as possible. You have seen this one as a child. Now you see him or her as you last remember this one. Breathing in the hot, heavy, dark smoke of his suffering, let it dissolve the hardness around your heart so that your great heart can absorb the smoke of suffering. On your out breath, send all of your strength, understanding, caring, and love to your parent. Give it away that this one may be healed in this or the after life, that your ancestors may be healed, that your mother or father may come home, may truly come home. Breathing in suffering, hot, heavy, dark smoke, heart breaking open, smoke disappearing, breathing out cool, light healing. Notice when resistance comes up and remember the strength of who you really are. Bring yourself back to the practice. Let your great heart open. Break open. Dissolve open.

Now allow yourself to let go of the visualization of your parent and keep the rhythm of the breathing steady, breathing in dark, hot, heavy smoke, smoke that dissolves completely into the vastness of your heart. Breathe out through every pore of your body coolness and healing. Send it to the whole world.

Practicing with Your Own Situation

We now want to bring the practice to your own life. Remember a particular time when you were in a difficult situation. You may still hold energy around this difficulty. You may have been hurt, angry, depressed, outraged, or afraid. Remembering this feeling as vividly as possible, breathe in the feeling as hot, heavy, polluted smoke. Breathe in just the feeling. Let go of any sense of blame. Let go of the object of your blame and directly breathe in the raw feeling as the hot smoke of suffering. Take it in completely through every pore of your body. Own it completely, this rawness.

This takes a lot of courage. You might resist doing it. If this is the case, then you can breathe in your resistance as hot, heavy, dark smoke. Let the ego sheath around your heart dissolve or break open to reveal instantaneously your vast heart. Breathe out from this heart spaciousness, openness, kindness and surrender, letting go of the your tightness, your anger, your shame. The small, tight box of the ego opens by ventilating and giving sympathetic space to your suffering.

Again, turning your heart and mind toward your own situation, your resistance, your alienation, your piety, your boredom, your arrogance, your confusion, your grief, your clinging, on your next inhalation, breathe in your own suffering as dark, heavy, hot smoke. Let it break open the metal sheath of self-pity and self-importance around your own heart. Let your own vast heart open to really who you are.

On your out breath, send to your whole being clarity and space with a cool, light breath. Notice if there is any resistance and let that resistance be the metal around the heart, the sheath around the heart. Breathe in hot, heavy, dark smoke that dissolves the sheath around the heart, dissolving it into the vast and true nature of who you really are. The smoke instantly vanishes into space. Send to yourself a cool breath of goodness. Heal yourself. You have the power in you to come home.

On your in breath, breathe in the smoke of your suffering. Let it break open your heart. See the suffering dissipate into space. Send to yourself, on the out breath, and through every pore of your body a cool light breath of forgiveness, of freedom. If the practice is difficult for you, you might do the practice as if your very life depended on it. Your very death depended on it. As if others depended on it.

When the mind drifts, bring it back. Please stay with the practice, for you and for all beings. Come home. You coming home brings all beings home. If you are a Christian or Jew, you might say: “I want to come home to God.” What separates you from God is the hardness around your heart, the fear in your heart. Breathe in the hot smoke of suffering of separation from God. Breathe in fear. Let the heavy polluted smoke dissolve the hardness around your heart. What is left is love. Let all suffering disappear into its vastness. On your out breath, send a cool breath of radiant healing to yourself and come home to God. In your exhalation is the breath of spirit, the goodness of God bringing you home.

Breathing in this dark, heavy, hot smoke, let it dissolve the sheath of alienation around your true heart, the vast heart of emptiness, the heart of, your free and unconditioned heart. The smoke of suffering dissipates completely in the vast space of your heart. Give, with your out breath, every good thing in your life to yourself that you may be free from suffering. Continue with this practice of forgiveness and healing. Don’t analyze what you are doing. Don’t try to figure it out. Don’t justify it. Simply do the practice. Breathe in the heavy hot smoke of your suffering and breathe out sympathetic space. As you breathe in your hot heavy tarlike suffering, own it completely. Then breathe out clarity and surrender, relief and kindness.

Connecting with Those Who are Suffering Like You

Now consider that many others are experiencing this same kind of misery at this very moment. The specific causes of this type of distress are not important. Simply connect with the truth that others are suffering just like you. Feel it: your distress, their distress, and breathe it in for others, as well as for yourself.

This will not make your suffering greater. Rather the practice helps you realize that you are not alone in this suffering. It opens your heart to the truth that others are suffering as you are. This is not your burden alone. Let yourself connect with others who are feeling like you. Let this connectedness open your sympathy toward yourself and them. And as you breathe out clarity and kindness, let the breath go to all those who are suffering as you have.

Sending and Receiving is a practice that develops genuine caring and kindness for others and yourself. It allows you not only to connect with the suffering of others but also to understand and hold with a good heart the suffering of people and creatures from the truth of your own experience. It is not possible to do this selfishly. Your selfishness must crack open to reveal who you really are.

Now, dissolve the visualization and continue with the breath practice, breathing in universal suffering, yours and the suffering of all beings as dark, heavy, hot smoke. The hardness around your heart dissolves and your great heart appears so the smoke of suffering disappears into its vast space. Through every pore of your body, breathe out goodness and healing as a cool, light breath. Please continue with this practice.

Practicing Directly with Another

Now turn on your cushion or your chair to the one sitting next to you. Turn silently toward each other and gently close your eyes. Stay with the practice, letting yourself continue to breathe in universal suffering. The sheath around the heart breaks open, and the smoke of suffering dissolves into the spaciousness of your heart. Through every pore in your body, exhale all of your goodness and healing for the world.

Now please open your eyes and gaze into the chest area of this one sitting across from you. If you wish, you may gently synchronize your breathing with each other. Practicing non-dual presence and continuing the practice with your inhalation, breathe in hot, heavy smoke, letting that smoke dissolve the sheath around your heart, and breathing out cool light goodness. Be a breathing presence for all beings, as you sit across from this one.

If fear or resistance comes up, notice it. Remember the depth of your commitment. Rekindle your determination and your awakened heart if fear makes if difficult for you for you to be in the practice. Breathe in the fear and breathe out ease.

When you are ready, let your eyes rise and gaze into the throat area of this person across from you. Continue sending and receiving. Let the specific identity of this one sitting across from you become a little more revealed to you. Stay in the truth of your practice. When you are ready, let your eyes rise to meet the eyes of the friend sitting across from you. Not grasping but being present, gaze into the eyes of your friend. Let your good heart connect with this one sitting across from you. This one, like you, has suffered. This one’s life, like all lives, has had its pain and sorrow. This one, like you, will die one day. See the lines of weariness, concern, disappointment or sadness in this one’s face. It is not necessary to give what you see a story. Just be with the life that this one has lived. Keep it very simple. If you feel as though you are beginning to fixate, close your eyes and return to your breath practice and open your eyes when you are steady.

Now imagine this one as a three-year old child. See him or her as this one might have been when he was very young and free of any pain. Imagine that this young, fresh and hopeful being is still alive in your friend. Now, bring your friend into the present.

In Buddhism, we say that all beings, whether male or female, have been our mother in some other lifetime, have given birth to us, carried us into life, have cared for us, have nurtured us, have protected us. Allow this one to be your mother, and see not only her difficulties but also her compassion. Your gratitude to her is very deep. With all your heart, you want to repay her kindness.

This one has also been your child. See not only the mother in her or him, but also the child, your child. Imagine the love that you might feel for your child. You would do anything to help this one be peaceful and free of distress.

On your next in breath, breathe in the suffering of this one. Breathe in dark, heavy, hot smoke that breaks apart the metal sheath of self-importance around your heart. The smoke of this friend’s suffering dissipates into the vastness of your true heart. On your out breath, breathe out a cool light breath of kindness.

Remember that this one whom you are practicing with will die. We do not know when or how. See how his or her life is hanging by a breath. You hope that this one will be able to come home. Your heart of compassion is wide open. Put any negative aspects of your personality into the metal sheath around your heart. On your next in breath, the dark, heavy, hot smoke of this friend’s suffering transforms your negativity into mercy.

Now imagine that this one sitting across from you will not be alive tomorrow. There is always that possibility. The thought of impermanence can help deepen the commitment to the practice. Breathe in suffering. Breathe out kindness.

When you feel ready, allow your eyes to close. Let go of this friend sitting across from you. Open the focus of your practice to the universe. Breathe in universal suffering, dissolving your own self-importance. Give away all of your goodness to all beings who suffer.

Practicing with Someone Who is Dying

Now imagine that you are sitting with someone who is dying. See him or her as clearly as you can. You are sitting next to her, following her breath. You see that he is in pain. You can almost feel his pain. Visualize the sheath of ego around your heart. And now breathe in her pain as hot, heavy, dark, grimy smoke. Breathe in through every pore in your body. Let your heart break open to his pain. Now release the pain completely as you breathe out a breath of kindness, sending all of the good that you have known in your life to her. Continue with this practice.

When you are done, dissolve the visualization.

Completing the Practice

Please send whatever good that you might have derived from the practice to suffering beings everywhere. Release it for the benefit of others. When you are ready, open your eyes and make contact with this friend sitting across from you. In a way that is appropriate for you, thank this one. If you wish, speak with each other about what came up for you, what you saw, what you learned.

(A final variation of the practice can be done. A simple reminder of the practice is given if people know how to do Sending and Receiving. Then people are asked to give the names of friends and family for whom they want this practice done. As each name is given and written down, the participant also tells us from what his or her friend is suffering. For example, someone might say, “Ellen, breast cancer.” or “John, depression.” In this way, a list is created.

After the list is complete, it is read back to the group. The group is then asked to begin the practice by remembering truly why they are practicing. Then the meditation is simply guided on breathing in suffering as hot dark smoke, letting the metal sheath around the heart dissolve, and breathing out healing.)

The practice of Sending and Receiving helps us to get in touch with the obstacles that prevent us from understanding and caring. Through our own experience with suffering and the development of an atmosphere of openness toward it, we can begin to accept and be with the suffering of others in a more open, kind and understanding way.

Our difficult personal experiences become the bridge that leads us to compassion. In this way, we do not reject difficulties or difficult people or creatures. Rather we meet them exactly where they are. This is the basis for our work with dying people. We cannot prevent death from happening. We try to learn to meet it, accept it, and find mercy in it. The hardness around the heart may lessen or disappear, and we can learn to love without conditions since we see that no matter what we will lose everything that we love when we die.