Supporting at End-of-Life: What It Means to Sit With Suffering You Can’t Take Away

Explore how to shift from trying to fix end-of-life suffering to skillfully and compassionately being with it—enhancing your capacity to support patients in ways that reduce isolation and deepen care, even when nothing can be resolved.

There are some types of suffering at the end-of-life that cannot be taken away. They often arise through confrontation with mortality, uncertainty, and separation—experiences that are intrinsic to dying.

“Some suffering at the end-of-life is intrinsic to the experience of being human—and simply cannot be resolved,” notes Celina Carter, PhD, MN, RN.

A key clinical distinction follows: the difference between relieving suffering and relating to it. When this is blurred, clinicians and caregivers may default to over-intervening or withdrawing—moving away from the patient’s lived experience.

Contemplative approaches invite a shift from fixing to presence. By turning toward suffering with curiosity and compassion, caregivers can support a different kind of care, one that does not remove suffering, but changes how it is held.

This article draws from Celina Carter’s teachings in her upcoming workshop Sitting with Suffering: Mindfulness at End-of-Life, exploring why some suffering is unresolvable, the limits of treatment, and how “sitting with suffering” can be developed as a clinical skill—and a form of courage.

Contents:

1. Unresolvable Suffering at End-of-Life
2. The Limits of Treatment
3. The Power of Presence
4. Sitting With Suffering as a Clinical Skill
5. Courage in the Face of the Unfixable
6. Learn More: Sitting with Suffering: Mindfulness at End-of-Life

Unresolvable Suffering at End-of-Life

End-of-life suffering is not only physical. It is layered and often rooted in the fundamental realities of being human.

• There is loss—of independence, identity, roles, and future.
• There is uncertainty—about what lies ahead, about death itself.
• There is separation—from loved ones, from life as it has been.

Some of this suffering is intrinsic. It is not a complication of dying; it is part of it.

As Carter notes, aspects of end-of-life suffering “simply cannot be resolved”. The grief of leaving children behind. The fear of the unknown. The heartbreak of unfinished life.
These are not problems with solutions.

Clinically, suffering can be understood as a perceived threat to the integrity of the person—the sense that something essential about who they are is being lost or undone. This helps explain why suffering at the end-of-life can feel so profound, even when physical symptoms are managed.

Importantly, suffering rarely exists in a single domain. In palliative care, it is often described as “total pain”—a convergence of physical, emotional, relational, and spiritual distress. Treating one dimension alone may leave the deeper experience untouched.

Yet clinicians are often trained to treat suffering as something that can be alleviated. When it cannot be, a quiet dissonance emerges: If suffering remains, has something failed?

When Treatment Reaches Its Limits

Biomedicine offers powerful tools—especially for physical pain and symptoms at the end-of-life. But it has limits. When suffering becomes existential, relational, or spiritual, many clinicians feel uncertain about how to proceed. These dimensions cannot be resolved in the same way—and often require a different kind of attention.
In these moments, clinicians can be pulled in two directions.

One response is to do more—to order more tests, try more interventions, push harder for solutions. This “hyper-engagement” is often driven by the discomfort of not being able to fix what is in front of them.
The other is to withdraw—to distance, focus on tasks, or avoid difficult conversations.

Both are human. But both can move clincians away from the patient’s lived experience.

Underneath these responses is often the clinician’s own suffering—thoughts like “There’s nothing I can do” or “We’ve reached the end of the road,” accompanied by feelings of helplessness, urgency, or grief.

And when we turn away, intentionally or not, patients may experience an additional layer of suffering: isolation, abandonment, or increased anxiety. What Carter describes reflects a kind of “second arrow”—not the suffering of dying itself, but the suffering of being left alone in it.

When intrinsic suffering is experienced, what patients often need most is more presence.

The question shifts—from What more can I do? to How can I be here differently?

At the end-of-life, there will always be suffering that cannot be taken away. But this does not mean care has reached its limit. When we shift from fixing to sitting with, something changes. The focus moves from eliminating suffering to transforming how it is held.

Patients are no longer alone in their experience. Their suffering is witnessed and met with compassion. And in that space, even unresolvable suffering can soften—not because it disappears, but because it is carried with care.

The Power of Presence

Presence is often misunderstood as passive. In reality, it is one of the most active forms of care.

To be present is to remain with someone’s suffering—without turning away, without rushing to fix, and without needing it to be different.

It means:

• Listening with compassion
• Acknowledging what is true, even when it’s hard
• Holding space for grief, fear, and uncertainty
• Staying in relationship when there is nothing to “do”

In a clinical culture that prioritizes action, this can feel unfamiliar—even uncomfortable. But presence is not the absence of care. It is a different expression.
When patients feel seen, heard, and accompanied, their experience of suffering can shift, even if the circumstances do not.

And that matters.

Sitting With Suffering as a Clinical Skill

“Sitting with suffering” is not something clinicians are automatically equipped to do. It is a skill, one that requires intention, awareness, and practice.

It begins with a shift in orientation:

• From fixing to understanding
• From problem solving to witnessing
• From doing to being

Instead of asking, How do I solve this?, the clinician can ask, What is this like for you?

Rather than moving quickly to reassure or intervene, they become curious about the roots of suffering, how it lives in the body, emotions, and the person’s story.

Carter highlights the importance of describing suffering rather than analyzing it, helping patients articulate their experience through language, metaphor, or imagery. This alone can deepen understanding and shift the relationship to suffering.

This shift also involves moving from empathy to compassion. While empathy allows clinicians to feel with a patient, it can lead to overwhelm. Compassion, by contrast, recognizes suffering and responds with care—without becoming consumed by it.

Crucially, this skill also involves turning toward one’s own internal experience.

Learning to recognize our own reactions—helplessness, urgency, discomfort—and respond with compassion rather than avoidance, shame, or judgement. Without this, it becomes difficult to remain present with others.

Micro-practices can support this shift in real time:

• Pausing to notice your internal state
• Naming what is present (emotion, sensation, thought)
• Softening and reconnecting with compassion
• Asking: What might bring even a small shift right now?

In this sense, the ability to sit with suffering in others depends on the ability to sit with it in oneself.

Courage in the Face of the Unfixable

There is a quiet courage required to stay present when nothing can be fixed.

Not retreating into busyness or detachment. Not offering false reassurance. Not turning away. Instead, remaining.

Carter describes “sitting with suffering” as a clinical stance, a skill, and a form of courage. It asks clinicians to let go of the need to resolve everything—and to trust that their presence has value.

This is not easy work.

It challenges deeply held assumptions about what it means to help. It asks clinicians to face their own discomfort with uncertainty, loss, and mortality.

It also opens the door to a more humane and relational form of care.

One where the goal is not always to cure—but to accompany.

Learn More: Sitting with Suffering: Mindfulness at End-of-Life

Interested in learning more? You can deepen your understanding of mindful, compassionate ways of working with suffering at end-of-life in our workshop: Sitting with Suffering: Mindfulness at End-of-Life with Celina Carter, PhD, MN, RN.

Through this experiential, practice-based resource, you’ll explore how suffering at the end-of-life is shaped by multidimensional factors—including psychological, relational, and spiritual dimensions—and how mindfulness can support a different relationship to what cannot be resolved. You’ll be guided through inquiry and reflective practices for working skillfully with suffering, along with micro-awareness practices that build insight into bodily sensations, emotional responses, and meaning-making processes. The workshop includes high-definition video lessons with professional transcripts, and practical guidance for integrating these tools into clinical work in clear, flexible, and evidence-informed ways.

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Celina Carter, PhD, MN, RN is a nurse scholar, psychotherapist, and educator. For the past eight years she taught in the certificate program, 'Mindfulness-Informed End of Life' at the University of Toronto. Her latest research examines how mindfulness can mitigate burnout and support occupational wellbeing in hospice care for people experiencing homelessness. Clinically, she offers mindfulness-based and somatic-informed psychotherapy at New Pathways Therapy Centre.

Sarah Kraftchuk, MSc, RP (qualifying), is Head of Learning at the Mindful Institute. She is a licensed clinician, certified mindfulness facilitator, art therapist, and children’s book author. 

Michael Apollo, MHSc, RP, is a licensed clinician, mindfulness educator, and Founder of the Mindful Institute. With over 15 years of experience, he specializes in practical, evidence-based mindfulness training for helping professionals. Formerly Director of Mindfulness Programs at the University of Toronto, Michael has collaborated with organizations like the World Health Organization, the UK NHS, and the Canadian Parliament to support mental well-being and resilience in diverse settings.

References:

Back, A. L., Rushton, C. H., Kaszniak, A. W., & Halifax, J. S. (2015). “Why are we doing this?”: clinician helplessness in the face of suffering. Journal of Palliative Medicine, 18(1), 26-30.

Chaban, M., Librach, S.L. (2014). Working With Dying Patients and Their Families: A Task-Oriented Approach, The Working With Families Institute, Department of Family & Community Medicine, University of Toronto.

Cassell, E. J. (1998). The nature of suffering and the goals of medicine. Loss, Grief & Care, 8(1-2), 129-142.

Rattner, M., & Berzoff, J. (2016). Rethinking suffering: allowing for suffering that is intrinsic at end of life. Journal of Social Work in End-of-Life & Palliative Care, 12(3), 240-258.

Disclaimer

The content in our blog articles is not intended to substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your health provider with any questions you may have regarding your mental health.