Medical Science, Consciousness and Death: Self-Realization and Spiritual Care for the Terminally Ill

by M. Govindan Satchidananda

The practice of medicine in the modern world has emerged into a healthcare industry which has become very adept at integrating advancements from scientific research into improved treatments for sickness and cures for disease. And it can be argued quite successfully that the human experience of life resulting from these developments has become on average, increasingly longer in duration and of a higher quality when measured against preceding generations. But where does this leave humanity if the human body can be kept alive interminably by technological means? Is this what is really intended in the search for the betterment of humanity’s well being?

Of course, beyond the countless masses living healthy lives, there are very significant numbers of individuals whose health and wellbeing cannot be restored by physicians and medical miracles because they are terminally ill. Yet, while these persons possess the certain knowledge of their demise, they still continue to receive a special type of medical attention which replaces the aggressive curative care with more compassionate treatments. The care is directed towards reducing suffering and the variously distressful symptoms experienced by those who are dying from terminal illnesses.

This approach to end-of-life care has come to be known over recent decades as hospice-palliative care. Its origins can be traced back into the distant past where the devoutly religious would travel great distances proceeding to destinations such as Rome, Jerusalem, Mecca, or to numerous houses of worship and shrines of holy significance in search of spiritual meaning. Along the way, the pilgrims would need to find locations to rest, sleep, and eat as well as to be cared for, in case of peril, injury and death. The establishments which arose to provide this care were known as hospices, a word that has its etymological roots in the Latin word ‘hospes’ meaning both host and guest.

One of the aims of this article then, is to demonstrate that the great progress in medical science which has produced so many beneficial results for the physical health of mankind can be shown to have been founded originally in man’s eternal quest for spiritual knowledge. More importantly, the article will also attempt to show that this original search for meaning remains very much alive among the caregivers who are at the heart of modern hospices, who are serving the dying and their families that experience existential distress as they face the threshold of the great unknown. It is here that spirituality, a personal spiritual practice and spiritual end-of-life care play important roles that can be empirically proven to be real, essential and effective.

Why this subject should be of interest to anyone at all, might be a question that could be posed quite reasonably. And what relevance does this have for those who have been initiated into Babaji’s Kriya Yoga? As practitioners of Kriya Yoga, we are all well aware that there are many useful kriyas available to us that can help in our own self-realization.

For many people who do not have a personal spiritual practice, it is only when they are on the verge of death that their consciousness turns to some of the eternal questions of life: who am I?...where am I going?... what was the meaning of my life? And it is at this time in the lives of the dying that there is an utmost need for compassionate care that is founded in a truly spiritual perspective.

As can be recalled from each level of initiation in Babaji’s Kriya Yoga, as well as from ashram lectures, sacred written sources, personal encounters with other kriyabans, and daily life, self-realization must continually face the duality of the two prime perspectives in life: the subjective and the objective. And it is within the history of the progress of science that a seriously conflicting tension between these two fundamental perspectives can also be witnessed; between factions firmly rooted in the assertions that true knowledge can come only from objectivity or from subjectivity. The dilemma facing each yoga practitioner then is also, quite appropriately, at the source of the most important current scientific enquiries about caring for the dying and their consciousness before and at death.

In particular, there is one fundamental problem which rests at the centre of the conflict between the most well recognized proponents of the subjective and objective aspects of science, and it is posed as follows. Either consciousness is solely a mechanical activity of the brain, which is the materialist perspective; or, as the non-positivist, non-materialist, spiritual perspective has advocated, it is an activity of the mind.

We live in a world in which two distinct self-images, vying for our allegiance, disagree about human nature and about the ground of meaning. One image says humans are possessed of a spiritual part – an incorporeal mind or soul – and that one’s life and eternal fate turn on the state of this soul. The other image says that there is no such thing as the soul and thus that nothing – nothing at all – depends on its state. We are finite social animals. When we die, we – or better: the particles that once composed us – return to nature’s bosom, not to God’s right hand. (Flanagan, 2002)

The reason why the issue of consciousness is raised at this point in the discussion of spirituality and spiritual care in end-of-life care is because of the exceptional importance that consciousness must occupy in any discussion about life and death. Consciousness has virtually everything to do with the event of death. Generally speaking from a medical perspective, it can be said that death is the process by which a person permanently loses their consciousness and the body stops functioning.

Yet, despite centuries of philosophical and scientific research into the nature of the mind, at present there is no technology that can detect the presence or absence of any kind of consciousness, for scientists do not even know what exactly is to be measured. Strictly speaking, at present there is no scientific evidence even for the existence of consciousness. All the direct evidence we have consists of nonscientific, first-person accounts of being conscious.

However, neuroscientific research has now been able to produce empirical results which show that certain patients, previously believed to have been in varying states of unconsciousness, or in comas, are actually conscious and able to communicate with the researchers. Their subjective experiences have been objectively confirmed through the use of brain imaging techniques which record unique neural activity that a patient intentionally generates in response to questions asked by the researchers (Owen, Coleman, Boly, Davis, Laureys, & Pickard, 2006).

The significance of this work in relation to spirituality and spiritual care is highly important because a significant body of researchers is attempting to move beyond the critics who hold that proof of consciousness is impossible, let alone proof of the existence of spiritual consciousness. Recent research efforts have been conducted by neuroscientists to demonstrate the unique characteristics of spiritual consciousness. This has led the researchers to scan the human brains of Buddhist monks, Franciscan and Carmelite nuns while they subjectively report they are having a spiritual experience. D’Aquili and Newberg (2000) defined that spiritual state as one of “absolute unitary being”. Discrete entities which are relating, no longer exist. The boundaries and entities of the world disappear, and the self-other dichotomy is totally obliterated. There is no expansion of space, nor duration of time; it is interpreted as the experience of God or Unio Mystica. Practitioners of Kriya Yoga will know that the state of ‘oneness’ being described is that of ‘samadhi’ and written accounts by mystics of numerous traditions refer to the state as one where the breath is taken away. Strict empiricists however, refute the results of these experiments as simply showing images of brain activity, not the objective proof of spiritual awareness.

So where does this lead us in our examination of spiritual care for the terminally ill if the very existence of consciousness is still questioned by many establishments of modern science? Well, objective research has been able to prove that spiritual care, which attends to the existential distress and suffering of the terminally ill, does improve their quality of life in objectively measurable ways. And it is not unlike the similarly subjective nature of physical pain and its relief. The history of nursing care is replete with accounts of women (Hildegaard von Bingen, Louise de Maurillac, Florence Nightingale, St. Clare of Assisi, Mother Theresa) who became members of religious orders because of their spiritual motivations and who worked caring for the wounded and dying.

The modern hospice movement was founded in the United Kingdom after WWII, by Cecily Saunders who had very similar aspirations. She had experienced a spiritual awakening that motivated her to advance the use of pain relief among the casualties of war and cancer sufferers so they could properly attend to their social, emotional and existential needs before dying. What has occurred, as a direct result of the past advancements in care for the relief of physical suffering, is that a great amount of attention is now being paid to existential suffering among the dying.

The need for spiritual care often increases as terminal patients struggle to accept the dying process. When patients’ spiritual needs are not fulfilled a deepening sense of existential pain can result. Hospice patients report measurable relief from spiritual distress when spiritual care is delivered. The researcher Puchalski, defined the basic elements of spiritual care as follows: compassion and love for another; healing partnerships; reverence of mystery; and self-care of the caregiver – having a spiritual practice. Spiritual care usually involves a patient's religious leader, hospice chaplain, or social worker who has the ability to provide spiritually sensitive generalist practices. The spiritual care providers deliver spiritual care by acting with a supportive presence, developing an effective method of communicating, and by establishing authentic emotional connections.

The role of caregiver is to identify places in a patient’s life or self regard that are broken; where the person’s sense of purpose or meaning has been frustrated. The spiritual caregiver listens actively and sensitively to the patient’s life story to discover the location of broken relationships and to determine whether there is a technique which can be used to help heal or restore the person’s connection to any spiritual aspirations. Religion is one of the tools that connect the dying with spirituality, but it is not the only one. The healing effects that prayer, sacred writings, religious rituals, and symbols have on the faithful are well known. Other techniques that can be useful in spiritual care include art, exercise, journaling, meditation, music, play, and therapeutic touch, to name a few.

“[D]ouble blind, randomized, controlled trials on many aspects of spiritual medicine are now being conducted. The role of spirituality in medicine has become a legitimate and frequent subject of empirical research” (Fenwick, 2004,).

Very current research that directly and decidedly supports the contention that spiritual care is beneficial to the dying was completed by Balboni et al. (2010). The purpose of their study was to find out whether spiritual care from the medical team caring for patients with advanced cancer, impacts the quality of life at the end of life. Their findings showed that greater hospice use and less aggressive medical care prolongs life among patients identified as coping well religiously and spiritually. Spiritual care is associated with better patient quality of life.

And so this brings us towards to the end of the discussion about spiritual care, consciousness and dying. As a Kriya Yoga sadhak, for some ten years now, the author as reflected at great length about the meaning of death and its place in life. The impetus for my spiritual aspirations was greatly influenced by the death of my mother from cancer. In her final days she was admitted to hospice-palliative care and it was a very beneficial event for her and for our family. Her death and the events surrounding it, prompted me to take up a daily yoga practice, and to become a hospice volunteer in support of those dying from terminal illnesses. It has also led me to recently complete a master’s of science degree in hospice and palliative care at Madonna University.

The basis for this article was my thesis research into spiritual care in hospice. Calling upon hospice participants in Canada, the United States and the United Kingdom, I was able to obtain empirical proof, by means of statistical analysis of my research findings that spiritual care for the dying is effective and meaningful. Demographic variables such as age, sex, and education to name just a few, had no significance on the effectiveness of the promotion or actual delivery of spiritual care. However, a very strong correlation was identified between hospice’s intention to provide spiritual care and the level of spiritual care actually delivered. The more a hospice intends to deliver spiritual care, the better it actually delivers meaningful results as judged by those who provide the care and by the families who have witnessed loved ones receiving spiritual care.

During my work in hospice care for the dying, I was introduced to a patient named “Robert”, a gentleman in his 60’s who was dying from a cancerous brain tumor. When I met Robert, he had been in hospice for several weeks. During that time he had received many friends and family who had celebrated his life through reminiscences, gifts and repeated visits. One day when I asked Robert how he was feeling he replied that he was bored. And I asked why he felt that way. His response was very specific, “…..because I can’t find my way out of here”. Robert had been an accomplished engineer and had become successful at solving problems in is role in a large industrial company. He had become adept at finding solutions at work but now he couldn’t solve his present dilemma. He was tired of his illness and wanted to know how to move on. While witnessing a discussion between Robert and a family friend who was strongly religious, Robert replied that he didn’t believe that one person, whether it was Christ, Buddha or any other religious leader could be divine. Listening to this conversation indicated to me that I could potentially identify a tool that Robert could use to help him in his conflict. When I next visited Robert I suggested that he practice deep diaphragmatic breathing, to focus his closed eyes on the point between his eyebrows and to be patient as he would eventually perceive some measure of light. When I next returned to the hospice several days later and stopped to ask the nurses about Robert, I was told that he had passed away peacefully the day before.

More recently I have been privileged to receive knowledge about Shiva Das, a fellow sadhak of Babaji’s Kriya Yoga, with whom I traveled to Badrinath in 2006 as a spiritual pilgrim. He passed away this spring in Birmingham U.K. He too, was admitted to hospice in his final days after being afflicted with cancer. By all accounts, his passing appeared to be one that can be represented as “mahasamadhi”.

It is our yoga practice that leads us to experience the unity of life. Just as we struggle each day to determine whether the subjective or objective perspective is the ‘correct’ one, scientific research is also facing the inexorable conclusion that a synthesis of objectivity and subjectivity is the ultimate truth. It is our dharma to experience this oneness in life by an infinite variety of paths. Whether we do it now, tomorrow or on our death beds, it is inevitable that the unity of life will present itself to us in innumerable ways….some of which we will need to be especially sensitive to perceive.

Caring for those who are terminally ill is but one way that a spiritual life can be lived. However, in all reality it is each one of us who is dying a little bit each day. To forget this is sadness…to remember it is compassion. Be kind to yourself - practice your yoga each day with a sincere intention and when you least likely to expect it, self awareness will occur. Caring compassionately for others and your self are in essence the same thing. Start anywhere, keep practicing and be patient ….or in the words of medical science, be ‘a patient’….and in another turn of the phrase: embody patience.

From the Kriya Yoga Journal, no. 70, Summer 2011

Copyright © by Douglas Lawson June 2011