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From: Frank Ostaseski, Director, Metta Institute

Contact Information:

Frank Ostaseski 415.331.9600
Metta Institute, PO Box 2710, Sausalito, CA 94966

Embracing the Dying Experience as a Time of Growth:

Metta Institute's End-of-Life Practitioner Program

During his 17 years at the Zen Hospice Project in San Francisco, founder and director Frank Ostaseski created an environment where patients received more than just medical treatment as they neared the end of their lives. The Zen Hospice team also addressed the spiritual dimensions of dying with their patients so that the patients could use this special time as one for growth and enrichment. This was fertile ground that led to the creation of an extraordinary training program to healthcare professionals working in the end-of-life field. According to Ostaseski, the training is design to fill the gap in a medical system that does not embrace the enormity of the dying experience.

The End-of-Life Practitioner Program is designed to provide individual practitioners with the essential clinical competencies, counseling skills and spiritual training to function as "midwives to the dying," similar to the way a midwife guides a pregnant woman through the birthing process by directing the mother-to-be to her own resourcefulness.

"These End-of-Life Care Practitioners can help create support for people to die well in all settings. This is not about managing someone's death, but helping them discover their own, unique way that they will go through this dying process. The midwife travels side by side with them and helps patients discover their way, but does not impose," says Frank.

Ostaseski's new Metta Institute, which runs the End-of-Life Practitioner Program, is currently accepting applications for the 2008 program. Candidates for the End-of-Life Practitioner Program are people who already have experience working with the terminally ill, but they are looking for a deeper approach to their work. Ostaseski is looking for people who entered the medical profession because they wanted to treat people, not diseases, and who have an existing spiritual practice that can be more fully incorporated into their professional work to better serve the needs of the dying.

"Our students see dying as a transformative process, and they value the spiritual dimensions of dying. They are mavericks, inspirational leaders and independent thinkers, looking for more than a new set of tools. Most are often at a change point in their lives. We support and strengthen their skills so that they can go deeper into their work," Ostaseski said.

Mark Gardner is a graduate of the program who found himself yearning for insight into how to take his work to a deeper and more meaningful level. An Episcopalian priest for 11 years, he arrived at Visiting Nurse and Hospice Care of Santa Barbara three years ago, eager to do ministry but not in the traditional church setting. "This organization does good hospice work, but it is hospice work according to the prevailing medical model. There are some limits to depth of the work I can do. I felt I needed additional training and insight into how to take my work to a deeper level."

Patty Wudel also completed the training program. She is the executive director of Joseph's House, a hospice for homeless African-American men in Washington, D.C. When Wudel learned about the program, she knew she had to do it. "I wanted to help deepen our mission. Year after year, we stayed the course and went the distance, but the adrenalin rush was long past. I was getting tired. I needed to grow, and the staff at Joseph House needed to grow," she said.

The End-of-Life Practitioner Program is a year-long training program. Participation in this program requires a tremendous amount of dedication on the part of the students; training is held over seven professional weekends (Thursday evening through Sunday afternoon) and two 10-day periods. All of these are held in San Francisco. While this may seem like a significant commitment to some, the end-of-life professionals who have completed the training found the program to be a life-changing event, both professionally and personally.

"The program is brilliantly conceived," says Gardner. "We all have seeds within us. If we have the right environment, then we will become who we really are. Each person is unique and has potential, and they just need a friendly soil so these things can emerge. This program recognizes our individual gifts and unique talents. The environment is conducive to creative growth."

Gardner found the program challenging, but added that the challenges are designed to keep you focused on what truly matters. "Frank and the other faculty offer just the right mix of mastery, meaning and mystery. Every challenge they put in front of me seemed to recognize the positive, true person inside of me."

The program's faculty is comprised of some of the best experts in spiritual thinking. According to Ostaseski, they are independent thinkers who have had experiences in this area, and they discuss their experiences with the students in a very experiential way. That resonates with program graduates. Three of the core faculty members include Angeles Arrien, Ph.D., an anthropologist, author and founder of Angeles Arrien Foundation for Cross-Cultural Education and Research; Ram Dass, author and internationally recognized lecturer and spiritual teacher; and Rachel Naomi Remen, M.D., clinical professor of family and community medicine at the University of California at San Francisco School of Medicine and founder/director of the Institute for the Study of Health and Illness.

Many of the graduates of the program have gone on to share what they have learned with other providers at their facility and within their community. According to Ostaseski, the benefit to the organizations where the students work can be huge. "They get an individual deep in a new skills set with an extraordinary commitment to this work, who can now become a leader in the organization," he continued.

Patty Winter, RN, CHPN, is the End-of-Life Care Practitioner at the Mercy Medical Center/Mercy Hospice in Roseburg, Ore., and the program's first graduate from the state of Oregon. "The program led me to discover the kind of work I really wanted to do at my hospice. In addition to providing grief and bereavement counseling to patients and their families, I began a program called Compassionate End-of-Life care. We are now educating other health care professionals at nursing homes and assisted living facilities throughout Roseburg. I never thought I'd be doing so much teaching," she said.

Mark Gardner is also doing more teaching at the Visiting Nurse and Hospice Care of Santa Barbara and at other nursing homes in the community. Gardner believes that meeting the spiritual needs of Hospice patients is a responsibility that does not fall solely to the chaplain, but rather to the entire care team. His participation in the End-of-Life Practitioner Program has provided him with the foundation to make that happen.

The End-of-Life Practitioner Program rejuvenated Patty Wudel's commitment to this work. Wudel is now working to create an environment at Joseph's House where there is a lack of embarrassment and unease about exploring these sometimes deep and complex issues. She is beginning to see results. At noon at Joseph's House, the community is called together for a time of silence and prayers. Wudel said that while participation is not mandatory, more and more patients and staff are choosing to come.

"We are cultivating an environment where people can have very honest and open conversations about the end of life. We are creating that space for everyone at Joseph's House," she said.

By providing the End-of-Life Care Practitioner Training to more health care professionals, Ostaseski is hoping to transform care of the dying as more than "making the best of a bad situation."

"Dying is a sacred act, a time, a space, a process of transformation. In this program, we are teaching professionals how to skillfully help others to use their dying to rediscover a sense of wholeness," Ostaseski said.

Applications Being Accepted for 2008 End-of-Life Practitioner Program

The End-of-Life Practitioner Program is currently accepting applications for its 2008 class. Admission to the program is based on a three-step process:

  1. Evaluation of the written application and recommendations of review committee.
  2. Personal or telephone interviews of selected candidates.
  3. Merits of the proposed plan for use of the training (i.e., clarity and specificity, impact on end-of-life care in their area, feasibility and evidence of support for the proposed plan).

Tuition for the one-year training is $5,000. Accommodations (room and board) for the residential segments of the course are an additional $2,900. Transportation costs to all programs and the cost of room and board for the professional weekend sessions are the responsibility of the participants. A limited number of partial scholarships may be available, and requests for those, including an explanation of why the student should qualify for a scholarship, should accompany the application.

Applications are available for download off Metta Institute® Web site ( or by calling 415.331.9600.

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