A Good Death –  an exploration into Buddhist practices
for people at end of life

Wai Yee (普儿 )  


Introduction
I am currently working in an environment that cares for dying patients with an expected lifespan of usually not more than 3 months. In the course of my work, I have come into contact with many Buddhists – colleagues, volunteers, patients, family members and their associated religious communities. I hope to share my observations of some current Buddhist practices with the dying, explore their implications and offer some suggestions.

What is a good death?
What is a good death? If I were to ask fellow Buddhists, I wonder how they would describe one. This question is worthy of asking only because the way we construct death would influence our approaches in facing the deaths (and lives) of ourselves and others. Otherwise, never mind what we think of it – death happens for all of us (death does happen to us, it is part of being human). For the purpose of this article, the notion of a good death implies a judgement, it is embedded with expectations and ignites a will to pursue a course of actions to achieve one for self or others. In this discussion, I have arbitrarily delineated my observations into a dichotomy – harmful or beneficial practices. This is a relative position as these practices actually fall onto a continuum of skilful and not so skilful means.

‘Harmful’ practices versus beneficial practices Bedside conversion – are we different from non-Buddhists?
Buddhists are generally concerned with and raised objections to the conversion of a dying person through evangelical means. We oppose our loved ones, when nearing death, to be initiated into another religion, whether they professed a religion to begin with. Yet, some of us do not think twice about introducing Buddhist practices to a dying person who has never been a Buddhist. Popular practices with the dying patients include convenient gifts of chanting beads or a recorder with the chanting of a Buddha’s name. Other patients were advised to take the Three Refuges in order to die as a Buddhist or denied their usual diet in order to become a vegetarian to secure a better afterlife. We need to be careful not to fool ourselves into believing that we have it all fixed for our loved ones just to help us feel better. Such mentality is no different from non-Buddhists! A worthy approach which I have seen was that of a Buddhist nun who on the request of a dying patient, came to see her to find out her reasons for wanting to take refuge. The nun took the time to understand the needs of the patient, explained the significance of the act, and confirmed again her intention before reciting the verses for refuge taking. The teachings offered by the nun had allowed the patient to find peace and enough spiritual courage to reconcile a difficult relationship she had with a family member and to let go of ill will. Here, I differentiate between Buddhist teachings and practices. Through the teachings of Buddhism, faith can arise from the varying levels of understanding. However, without right understanding, faith is blind. Buddhist practices are sometimes ‘prescribed’ to dying persons without a foundation in right understanding and faith. Such imposition, albeit well intended, is a desperate attempt that might go futile. It could just be a mental bandage that covers but not heal.


Treating the alive as dead – if it was not part of a person’s life, it will not be at her deathbed An incident of one of my patients had caused much anguish among my colleagues. Her daughter has engaged a Buddhist group to chant for her in the days counting down to her death. My patient was experiencing confusion and agitation. Familiarity and routine were essential to her sense of well-being as she was demented. The sight of strangers surrounding her bedside and loudly chanting away without engaging with her had left her totally bewildered. Although her daughter was in the room, she was instructed not to touch her mother during the chanting session while she was covered by a yellow blanket filled with mantras. The whole experience had left the patient trembling in wide –eyed fear. We had to re-educate her daughter on her mother’s condition and challenge her to reconsider if such a practice was helpful and appropriate for her mother. In this instance, the patient was treated as if she were already dead and rendered invisible. Having a Buddhistlike death was more important than being human. I wonder how anyone could consider this a good death if Buddhist teachings never had a place in the life of this patient.

On the other hand, there was this Buddhist wife who demonstrated much skill in supporting her dying husband and left an indelible impression in me. Both of them were long-time vegetarians and actively participated in a Buddhist group. When the husband was near death, his wife consulted him on whom to invite among his Buddhist friends to offer overnight chanting. With his agreement, his friends organized themselves and took turns to be with him right till he took his last breathe. Although death came with all the difficulties one could expect whether one is a Buddhist or otherwise, a supportive community of spiritual friends cultivated over the years would do much to comfort the dying. No instant chanting group can take its place. We need to create our own conditions for a good death. Insistence on conscious dying – letting go of what is not to be Some Buddhist patients were guided by the belief to stay conscious till the last breath in order to secure a better afterlife. They hope to achieve one pointedness and full concentration. However, this is not the usual trajectory of dying for most of us, whether with cancer or without. Most people would become unconscious, confused, drifting in and out of awareness in their last moments which could last from hours to days. Only the highly cultivated are capable of achieving one-pointedness and full concentration at death – after many years or probably many lives of right effort and practice. The insistence on conscious dying has left some suffering excruciating physical pain and other complicated symptoms to avoid the use of painkillers that might alter their level and duration of consciousness. Some may be filled with remorse and guilt for lost opportunities to cultivate. Dying in pain and remorse could cause much disturbance to our consciousness and there is hardly any way to stay one-pointedness and concentrated. Not to mention the distress we might cause to those around us. A kinder way to die is probably to give ourselves permission to let go of this expectation when it is not achievable and focus on the needs of the here and now. Buddhists should not have feelings – but humans have immense potential to feel A medical colleague once remarked that Buddhism is a religion void of emotions. It is a religion of the ‘head’ – a philosophy. He recounted his experience with a group of Buddhists who reprimanded the bereaved family members for crying at the demise of their loved one. It seems that any expression of intense emotions would hinder the departure of the dying. The expression of sadness and hence the feelings of sadness was not permitted. Unfortunately, feelings, like thoughts, are fleeting encounters all of us have by virtue that we are humans. Whether we judge them, allow their expression, they still are. Instead of supporting the bereaved to look deeply and contemplate on the emotions that have arisen due to a death encounter in order to understand the nature of these emotions, they were denied. They do not go away simply because we sweep them under our mind’s carpet. The time around separation by death is a time of magnified emotions. The spiritual work for Buddhists may be to creatively construct a way to channel and transform the emotions before they become disruptive and not to suppress them.

The work on our feelings should preferably start earlier, not near to death. However, we could still engage our emotions positively around someone who is dying. The Four Immeasurables in the Buddhist teaching is a suggested framework – loving kindness, compassion, joy
and equanimity. These practices have the capacity to address anger, hatred, prejudice and suffering. Hence, I would encourage the expression of gratitude, appreciation, unconditional love and forgiveness between the dying and those around. The practice of equanimity would encourage us to look at all phenomena impartially and work on our attachment, including attachment to life. Family members and the dying persons should be encouraged to say their goodbyes instead of hiding from the impending separation and pretending that ‘everything is going to be ok’. Putting things in order before death occurs may ease some of the pain. We could support the dying to let go of their worries by making sure that their financial concerns are addressed, the well-being of family members are looked into and reminding them of all the virtues they have cultivated
in this life.

Conclusion

The process of dying is one of the eight dimensions of suffering. It interacts with other dimensions of suffering – the disintegration of our physical and mental faculties, the impending separation from our loved ones and sufferings arising from an unenlightened mind – through ignorance,  resulting in experiences of fear and anxiety. It is a time where much suffering culminates. As Buddhists, we could offer our presence to our loved ones who are dying – to listen to them deeply, to be with them in their suffering and to give what is asked for, not what we think they need. Letting go of dogmatic practices and rituals, no matter how good our intentions, would be key.

Death is neither good nor bad, it is part of cyclic existence. Yet, the ensuing suffering can be reduced if we have the right understanding of the Buddha’s exhortation on interdependency – conditioned existence. I propose that Buddhist practices for the support of dying persons have to be grounded in the right understanding of the teachings. We can support the deaths of others through our practice of the Eightfold Paths, the Six Paramitas and the Four Immeasurables. A lay bodhisattva, in his own vulnerability to death and dying, has the opportunity to practice wholeheartedly when faced with the sufferings of others who are near the end of their life manifestation. It is a time of engagement, not judgement. Harmful practices are the outcomes of a lack of right understanding and skilful means. They could potentially cause more suffering.
Let us encourage one another to hear the Dharma, reflect on the teachings and put them to our daily practice and in our care for the dying – these are probably the conditions that would support us in achieving a good death for ourselves. While I am deeply indebted to the ordained and lay community at The Mahaprajna Buddhist Society for my initiation to the teachings of the Buddha, this is a thought article and reflects only the limited perspectives of myself. It is an invitation to the readers to contemplate further on the Buddha’s teachings in relation to death and dying, and may you derive immense benefits for yourselves and your loved ones from doing so.

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