Table Of ContentA b i d i n g i n L i m i n a l Space(s):
I n s c r i b i n g M i n d f u l L i v i n g / D y i n g W i t h ( I n ) E n d - o f - L i f e C a r
by
W . Anne Bruce
R . N . , Victoria General Hospital (Halifax), 1977
B . S . N . , University of Victoria, 1992
A thesis submitted in partial fulfillment of
the requirements for the degree of
D O C T O R OF P H I L O S O P H Y
in
T H E F A C U L T Y OF G R A D U A T E STUDIES
S C H O O L OF N U R S P N G
We agcepPthis thesis as conforming to the required standard
T H E U N I V E R S I T Y OF B R I T I S H C O L U M B I A
October 2002
© Winifred Anne Bruce, 2002
In presenting this thesis in partial fulfilment of the requirements for an advanced
degree at the University of British Columbia, I agree that the Library shall make it
freely available for reference and study. I further agree that permission for extensive
copying of this thesis for scholarly purposes may be granted by the head of my
department or by his or her representatives. It is understood that copying or
publication of this thesis for financial gain shall not be allowed without my written
permission.
Department-of 3 C . K Q Q \ Q-P K)U/S>'
The University of British Columbia
Vancouver, Canada
Date Oct- n ,^ooa
DE-6 (2/88)
ABSTRACT
Abiding in Liminal Spaces:
Inscribing Mindful Living/Dying With(In) End-of-Life Care
Mind-body approaches such as mindfulness meditation are increasingly
incorporated into health care. Despite a growing interest in mindfulness, its Buddhist
philosophical underpinnings remain unexplored in nursing. Without an awareness o f the
nondualistic assumptions embedded in mindfulness and Buddhism, interpretations of this
Eastern practice are limited. This inquiry engages Buddhist philosophical thought and the
experiences of meditation practitioners.
The purpose of this study was to explore mindfulness by those who regularly
practiced mindfulness meditation and were caregivers in a Zen hospice or living with a
life threatening illness. Approximately ten weeks of residency in a Zen monastery, and
participation in day-to-day volunteer caregiving in the Zen hospice were undertaken. In-
depth unstructured conversations were conducted; mindful, open-ended reflexivity
(Varela, Thompson, & Rosch, 1991) and koan construction were used in ongoing
analyses and interpretation.
Theoretical explorations in this inquiry constitute and reflect knowledge(s) about
that which is unknowable, indistinct, and ambiguous. The inquiry addresses how we may
point to 'that' which is beyond words with attention given to language and what happens
with/in language as we write and are written through texts. Unconventional forms and
writing are used to question conventional privileging of representational binaries that
value words over silence, life over death, clarity over paradox, and knowing over
unknowing.
Death, re-interpreted in the Buddhist sense of the participants, is constructed as
momentary experience occurring each mind-moment. Life is not necessarily privileged
over death, but rather is seen as a doubling of living/dying intertwining within
momentary awareness. A re-configuring of living/dying is suggested that differs from
Western perspectives where ' l iv ing ' holds hegemony over 'dying' . Death is situated in
:
the midst o/ —liminal space(s) of being/not being and ubiquitous change while
mindfulness meditation is seen as a parallel process providing an embodied realization of
this transience.
These perspectives may help nurses and health care professionals go beyond
dualistic views and provide guidance for abiding in the midst of suffering that may be
beyond words. Further inquiry into non-conceptual awareness and its relationship with
health and wellness is needed.
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TABLE OF CONTENTS
ABSTRACT
TABLE OF CONTENTS
LIST OF TABLES
ACKNOWLEDGEMENTS
DEDICATION
STRAND O N E - G/round of Inquiry
G/round
Introduction
Purpose
Background
Buddhism in North America
Establishing Intention
Locating the Inquiry and Inquirer
Edges o f Modernist Views
Edges of Non-Modernist Views
Attending to Language
Locating Theoretical Context (s) o f Buddhism
Buddhism in Nursing Theorizing
Eastern and Western Philosophical Views
Twofold Truth
Buddhism
G/round of Buddhist Thought
Four Noble Truths
Nonduality
Self/No-self
Meditation Practice
Introduction to Meditation
Meditation and Relaxation
Types o f Meditation
Concentration
Mindfulness
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STRAND TWO ~ Diverse Voices in End-Of-Life 48
Changing Conceptualizations o f Death 49
Contemporary Hospice/Paliative Care Movement 51
Shifting ground- Hospice and Paliation 52
Shifting ground ~ Humanist and Transpersonal Orientations 54
Meditation and Dying: Death of the Body, Death of the Self 58
Integrating East and West ~ Zen Hospice Project 61
Mindfulnes Meditation and Health 64
Curent Inquiry 65
Mising Voices 69
STRAND T H R E E - Path of Inquiry 71
Introduction 72
Mindful Reflexivity 76
Reflexive Aproaches 76
Reflection and Reflexivity 76
Mindful, Open-ended Reflexivity 78
Inquiry Design , 80
Locating Sites and Negotiating Access . 80
Inviting Participation 85
Generating Data 89
Reflexive Participation 89
Audiotaped Conversations 93
Engaging with Texts - Practical Considerations 95
Audiotaped Conversations 95
Ensuring Ethical Inquiry 9
Aproaches to Interpretation 10
Preliminary Aproaches in Analysis and Interpretation 10
Strategies of Mindful Reflexivity 102
Steps along the path 103
Koans 107
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S T R A N D F O U R - Frui t ion of Inquiry
F R U I T I O N
K O A N
C O M M E N T A R Y
Dying as Interesting
Re/cognizing M i n d
Situating M i n d
Constituting M i n d as Doubling
Existential Questioning
Situating Birth-and-Death
Non-Existential Questioning
Doubling of Life-and-Death
Examining the Play of M i n d
Meditation and Dying as Parallel Processes
Turing Inwardly Outward
Silences
Inter/play of Silence
Letting Go
Letting Go of Fixed M i n d
Letting Go of Time
Linear time
Cyclical time
Present time
Dissolution
Martin's Dissolution Story
Dissolution of Elements
Inner and Outer Manifestations of Elements
Sophia's Dissolution Story
Hospice Care as Meditation-in-Action
Intentionality of Service
Caregiving With a Unique V i e w
Engaging and Being Engaged
Cultivating Un/Knowing
Discovering More Possibilities
Doubling: Seeing Differently
Realizing Impermanence
Resting In Groundlessness
V E R S E
STRAND FIVE ~ Discussion and Implications
Introduction
Situating within Nursing Philosophy
Resonance and Disjunctures
Presence/ Absence
Knowing / Un/knowing
Re-configuring Death
Living / Dying
Further Implications
Relevance for Nursing Practice
Relevance for Nursing Education
Relevance for Future Inquiry
STAND SIX ~ Lingering Meditation
REFERENCES
APPENDICES
Appendix A : Copy of Consent Form
Appendix B : Copy of Conversation Questions
v i
LIST OF TABLES
TABLE 1 : Demographic profile o f inquiry participants
TABLE 2 : Inner and outer manifestations of elements
i.
v i i
A C K N O W L E D G E M E N T S
Although writing a dissertation often feels like a solitary endeavour, the solitude
is teaming with people who have been accompanying me along the way. To these
teachers, friends, and family, I am deeply indebted.
To my committee members, who gave me the freedom to follow my inclinations
and 'suffer the questions,' I extend my heartfelt thanks. Dr. Betty Davies has provided
unwavering gentleness and opened opportunities to engage in additional research projects
and publishing experiences that have inadvertently benefited this project. Dr. Joy Johnson
has been an insightful role model with enthusiasm and openness to learn from each other,
and was invaluable in her support for obtaining funding for this inquiry. Although busy
and in great demand, Joy and Betty always appeared unhurried, available, and sincerely
interested in this inquiry. Dr. Ted A o k i was a mentor and sensei (master teacher) in
cracking open wor(l)ds and assumptions. Ted's teaching through his richly textured
handwritten messages or conversations over coffee, infused vitality and possibility
throughout this inquiry process. A n d finally, Dr. Heesoon Bai has been a kindred spirit.
Heesoon's thoughtful questioning, strong philosophical training, and interest in
Buddhadharma have provided a touchstone for this writing.
This project could not have happened without the support of Zen Hospice Project.
Thank-you to Zuza Engler, Si lvia Fiscallini, Brad Byrum, and Frank Ostaseski for their
generous invitation into Zen Hospice. I am grateful to the study volunteers for sharing
their experiences and wisdom, and the Hartford Street Zen Center H I V - A I D S sitting
group for welcoming me into their fold. In addition, thank-you to Michael Wenger, Paul
Hallar, Jen Hagar, and Alison Jordan who made my stay at the San Fransisco Zen Center
an embodied experience of loving-kindness.
The hidden skills and tenacity of friends who stayed the course over these years
cannot go unnoticed. Nine bows (Zen form of appreciation) to Barb Moffat, Katherine
Doranne McGeean, Stephen Swick, and Jacques LaCroix for their editorial sensibilities
and warm friendships. In addition, thanks to Camil la Morrow, Sonia MacPherson, and
Wi l l i e Chen for persistent telephone contact and endless discussions about all matters
esoteric. For earthly concerns, I thank Bev McCarthy for her soups, Barb's insistence on
maintaining our seasonal opera tickets, and my sister Susan for her unbounded
kindnesses.
I would like to acknowledge the generous financial support from the Social
Sciences and Humanities Research Council of Canada, the Michael Smith Foundation for
Health Research, U B C School of Nursing, and U B C Green College. Finally, I am most
grateful to my parents, Sophia and Thomas Bruce, for so many reasons including their
good humour, unfailing compassion, and grounded optimism.
vi i i
D E D I C A T I O N
This thesis is dedicated to
my parents
Sophia (Starks) Bruce and Thomas Anthony Bruce
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