Preparing For Death And Helping The Dying

This booklet is based on a handout used during a seminar that I have taught a number of times in Singapore and elsewhere, entitled 揚reparing for Death and Helping the Dying.� This seminar answers a genuine need in today抯 world, as expressed by one participant: 揑 am interested to know more about death and how to help dying people, but it抯 very difficult to find anyone willing to talk about these things.�

The material for the seminar (which I usually teach over 3-4 sessions) is taken mainly from two sources: traditional Buddhist teachings, and contemporary writings in the field of caring for the dying. This booklet is meant as a brief introduction to the subject rather than a detailed explanation. My hope is that it will spark interest in the ideas presented. For those of you who wish to learn more, a list of recommended books is provided at the end. There is also a list of hospice care services in Singapore for those in need of such services for family members or friends, or for those who would like to serve as a volunteer. We also plan to continue working on this booklet to improve and expand it, and publish it for free distribution in the near future. Any ideas, feedback or suggestions will be gratefully accepted.

INTRODUCTION

Death is a subject that most people do not like to hear about, talk about, or even think about. Why is this? After all, whether we like it or not, each and every one of us will have to die one day. And even before we have to face our own death, we will most probably have to face the deaths of other people -- our family members, friends, colleagues, and so forth. Death is a reality, a fact of life, so wouldn抰 it be better to approach it with openness and acceptance, rather than fear and denial?

Perhaps the discomfort we have towards death is because we think it will be a terrible, painful and depressing experience. However, it doesn抰 have to be so. Dying can be a time of learning and growth; a time of deepening our love, our awareness of what is important in life, and our faith and commitment to spiritual beliefs and practices. Death can even be an opportunity to gain insight into the true nature of ourselves and all things, an insight which will enable us to become free from all suffering.

Let抯 take the example of Inta McKimm, the director of a Buddhist centre in Brisbane, Australia. Inta died of lung cancer in August, 1997. Two months before her death she wrote in a letter to her Spiritual Teacher, Lama Zopa Rinpoche: 揂lthough I am dying, this is the happiest time of my life!�. For a long time life seemed so hard, so difficult. But when really recognizing death it turned into the greatest happiness. I wouldn抰 want anyone to miss out on their own death, the great happiness that comes with having recognized impermanence and death. This is quite surprising and unexpected, and extremely joyful. It is the greatest happiness of my whole life, the greatest adventure and the greatest party!�

Inta spent the last few months of her life dedicating herself to spiritual practice. At the time of her death her mind was peaceful, and she was surrounded by family and friends praying for her. There are many similar stories of Lamas, monks, nuns and spiritual practitioners who are able to face death with serenity and dignity, and in some cases are even able to remain in a state of meditation during and after their death. With the proper training and preparation, a peaceful and positive death is possible for each and every one of us.

First of all, let抯 look at how death is viewed in the Buddhist tradition.

BUDDHIST PERSPECTIVES ON DEATH

Death Is A Natural, Inevitable Part Of Life

People sometimes think of death as a punishment for bad things they have done, or as a failure or mistake, but it is none of these. It is a natural part of life. The sun rises and sets; the seasons come and go; beautiful flowers become withered and brown; people and other beings are born, live for some time, then die.

牋牋牋 The Buddha imparted the teaching on the inevitability of death in a very skilful way to one of his disciples, Kisa Gotami. Kisa Gotami was married and had a child who was very dear to her heart. When the child was about one year old, he became ill and died. Overcome with grief and unable to accept the death of her child, Kisa Gotami took him in her arms and went in search of someone who could bring him back to life. Finally she met the Buddha, and begged Him to help her. The Buddha agreed, and asked her to bring Him four or five mustard seeds, but they had to be obtained from a house where no one had ever died

牋牋牋 Kisa Gotami went from house to house in the village, and although everyone was willing to give her some mustard seeds, she was unable to find a house where death had not occurred. Gradually she realized that death happened to everyone, and returned to the Buddha, buried her child and become one of His followers. Under His guidance, she was able to attain Nirvana, complete freedom from the cycle of birth and death.

牋牋牋 People may fear that accepting and thinking about death will make them morbid, or spoil their enjoyment of life抯 pleasures. But surprisingly, the opposite is true. Denying death makes us tense; accepting it brings peace. And it helps us become aware of what is really important in life � for example, being kind and loving to others, being honest and unselfish � so that we will put our energy into those things and avoid doing what would cause us to feel fear and regret in the face of death.

It Is Very Important To Accept And Be Aware Of Death

In the Great Nirvana Sutra, the Buddha said:
牋牋牋

Of all ploughing, ploughing in the autumn is supreme.

牋牋牋 Of all footprints, the elephant抯 is supreme.

牋牋牋 Of all perceptions, remembering death and impermanence is supreme.

Awareness and remembrance of death are extremely important in Buddhism for two main reasons:

1) By realising that our life is transitory, we will be more likely to spend our time wisely, doing positive, beneficial, virtuous actions, and refraining from negative, non-virtuous actions. The result of this is that we will be able to die without regret, and will be born in fortunate circumstances in our next life.

2) Remembering death will induce a sense of the great need to prepare ourselves for death. There are various methods (e.g. prayer, meditation, working on our mind) that will enable us to overcome fear, attachment and other emotions that could arise at the time of death and cause our mind to be disturbed, unpeaceful, and even negative. Preparing for death will enable us to die peacefully, with a clear, positive state of mind.

Death Is Not The End Of Everything, But A Gateway Into Another Life

�

Each of us is made up of a body and a mind. The body consists of our physical parts � skin, bones, organs, etc. � and the mind consists of our thoughts, perceptions, emotions, etc. The mind is a continuous, ever-changing stream of experiences. It has no beginning and no end. When we die, our mind separates from our body and goes on to take a new life.� The type of life we will be born into and the experiences we will have are determined by the way we live our life. Positive, beneficial, ethical actions will lead to a good rebirth and happy experiences, whereas negative, harmful actions will lead to an unfortunate rebirth and miserable experiences.

牋牋牋 Another factor that is crucial in determining our next rebirth is the state of our mind at the time of death. We should aim to die with a positive, peaceful state of mind, to ensure a good rebirth. Dying with anger, attachment or other negative attitudes will cause us to be born in unfortunate circumstances in our next life. This is another reason why it is so important to prepare ourselves for death, because in order to have a positive state of mind at that time, we need to start now to learn how to keep our minds free from negative attitudes, and to familiarize ourselves with positive attitudes, as much as possible.

It Is Possible To Become Free From Death And Rebirth

Dying and taking rebirth are two of the symptoms of ordinary, cyclic existence (samsara), the state of continuously-recurring problems, dissatisfaction, and non-freedom which all of us are caught in. The reason we are in this situation is because of the presence in our mind of delusions � chiefly attachment, anger and ignorance � and the imprints of our actions (karma) performed under the influence of delusions.

The Buddha was once like us, caught in samsara, but He found a way to become free, and achieved the state of perfect, complete Enlightenment. He did this not just for His own sake, but for the sake of all other beings, because he realized that all beings have the potential to become enlightened � this is called our 揃uddha nature�, and it is the true, pure nature of our minds.

Buddha has the most perfect, pure compassion and love for all of us, all living beings, and taught us how we too could become free from suffering and attain enlightenment. That抯 what his teachings, the Dharma, are all about. The Dharma shows us how we can free our minds from delusions and karma � the causes of death, rebirth and all the other problems of samsara � and thus to become free from samsara and attain the ultimate state of enlightenment. Remembering death is one of the most powerful sources of the energy we need to practise the Buddha抯 teachings and thus attain their blissful results.

Now let抯 take a look at some of the ways in which we can begin preparing ourselves for death.

HOW TO PREPARE FOR DEATH

The Four Tasks Of Living And Dying

Christine Longaker, an American woman with over 20 years� experience working with the dying, has formulated four tasks which will help us to prepare for death, as well as to live our lives fully and meaningfully. The four are:

1) Understanding and transforming suffering. Basically this means coming to an acceptance of the various problems, difficulties and painful experiences which are an inevitable part of life, and learning to cope with them. If we can learn to cope with the smaller sufferings that we encounter as we go through life, we will be better able to cope with the bigger sufferings that we will face when we die.

2) Making a connection, healing relationships and letting go. This task refers to our relationships with others, particularly family and friends. The main points here are to learn to communicate honestly, compassionately and unselfishly, and to resolve any unresolved problems we may have with others.

3) Preparing spiritually for death. Christine writes: 揈very religious tradition emphasizes that to prepare spiritually for death it is vital that we establish right now a daily spiritual practice, a practice so deeply ingrained that it becomes part of our flesh and bones, our reflexive response to every situation in life, including our experiences of suffering.�[i] A list of recommended spiritual practices from the Buddhist tradition can be found below.

4) Finding meaning in life. Many of us go through life without a clear idea as to what is the purpose and meaning of our existence. This lack of clarity can become a problem as we become older and closer to death because we become less capable and more dependent upon others. So it is important to explore such questions as 揥hat is the purpose of my life? Why am I here? What is important and not important?�

These four tasks are fully explained in Facing Death and Finding Hope by Christine Longaker (London: Century, 1997)� p. 37-157.

Live Ethically

Painful or frightening experiences that occur at the time of death and afterwards � in the intermediate state and the next rebirth � are the result of negative actions, or karma. To prevent such experiences, we need to refrain from negative actions and do as many positive actions as we can. For example, we can do our best to avoid the ten non-virtuous actions (killing, stealing, sexual misconduct, harsh speech, lying, slander, gossip, covetousness, ill-will and wrong views) and� to practise the ten virtues (consciously refraining from killing, etc). It抯 also good to take vows or precepts, and do purification practices on a daily basis.

牋牋牋 Another aspect of Buddhist ethics is working on our minds to reduce the very causes of negative actions: delusions, or disturbing emotions, such as anger, greed, pride, and so forth.� And awareness of death itself is one of the most effective antidotes for delusions. For example, realizing that we and everyone else will die one day helps us to realize the futility of hating our enemies and clinging to loved ones. Thus we should try to resolve our conflicts with others as early as possible so that we do not die with those burdens on our mind. Also, as we approach death, it抯 good to start giving away our possessions, or at least make a will -- that will help reduce attachment and worry at the time of death.

Study Spiritual Teachings

牋牋牋 Learning spiritual teachings such as those given by the Buddha will help us to overcome delusions and negative behaviour, and will help us to become more wise and compassionate. Also, the more we understand reality or truth -- the nature of our life, the universe, karma, our capacity for spiritual development and how to bring it about -- the less we will be afraid of death.

Cultivate A Spiritual Practice

As we are dying, we may find ourselves experiencing physical discomfort and pain. In addition to this, we will most probably also experience disturbing thoughts and emotions, such as regrets about the past, fears about the future, sadness about having to separate from our loved ones and possessions, and anger about the misfortunes that are happening to us. As mentioned above, it is very important to keep our mind free from such negative thoughts, and instead to have positive thoughts at the time of death. Examples of positive thoughts could include:

keeping in mind an object of our faith such as Buddha or God,
calm acceptance of our death and the problems associated with it,
non-attachment to our loved ones and possessions,
feeling positive about the way we have lived our life; remembering good things we have done;
feeling loving-kindness and compassion for others.

In order to be able to invoke such thoughts or attitudes at the time of death, we need to be familiar with them. Familiarity with positive states of mind depends upon putting time effort into spiritual practice while we are alive. And the best time to start is now, since we have no way of knowing when death will happen.

Some recommended practices from the Buddhist tradition include:

1) Taking refuge

In Buddhism, taking refuge is an attitude of feeling faith in and relying upon the Three Jewels: Buddha, Dharma and Sangha, accompanied by a sincere effort to learn and practice the Buddhist teachings in our life. It is said in the Buddhist teachings that taking refuge at the time of death will ensure that we will obtain a fortunate rebirth and avoid an unfortunate one in our next lifetime.[ii] Faith in one抯 personal spiritual teachers, or in a specific Buddha or bodhisattva such as Amitabha or Kuan Yin, will also have the same result and will bring great comfort to the mind at the time of death.

2) Pure Land practice

A popular practice, particularly in the Mahayana tradition, is to pray for rebirth in a Pure Land, such as the Pure Land of Bliss (Sukhavati) of Amitabha Buddha.� Pure Lands are manifested by the Buddhas to aid those who wish to continue their spiritual practice in the next life, free of the distractions, hassles and interferences of the ordinary world.

Bokar Rinpoche mentions four essential conditions that need to be cultivated in order to take birth in Amitabha抯 Pure Land: 1) making ourselves familiar with the image of the Pure Land and meditating upon it; 2) having a sincere wish to be born there, and making regular prayers for such a rebirth; 3) purifying our negative actions and accumulating positive actions, and dedicating these to be born in the Pure Land; 4) having the motivation of bodhicitta梩he aspiration to attain enlightenment (Buddhahood) to be able to help all beings � as the reason for wishing to be born in the Pure Land.[iii]

3) Mindfulness

Mindfulness is a meditative practice that involves become aware of whatever is

happening in our body and mind accompanied by equanimity, free of attachment to what is pleasant and aversion to what is unpleasant. Strong familiarity with this practice would enable one to cope with pain, discomfort and disturbing emotions, keep the mind free from disturbing emotions, and� remain peaceful while dying.

4)� Loving-kindness

This practice involves cultivating feelings of care, concern and kindness towards all other

beings. When we face difficulties or pain, our strong attachment to 慖� augments our suffering; being less concerned with ourselves and more concerned for others diminishes our suffering. At the time of death, thinking of other beings and wishing them to be happy and free from suffering would bring great peace to our mind. It is also a practice that purifies our negativities and accumulates positive potential, or merit, which would ensure a good rebirth in the next life.

Become Familiar With The Stages Of The Death Process

One reason why people tend to be afraid of death is because they do not know what will happen to them. However, in the Tibetan tradition of Buddhism, there is a clear and detailed explanation of the process of dying, which involves eight stages. The eight stages correspond to the gradual dissolution of various factors, such as the four elements: earth, water, fire and air. As one passes through the eight stages, there are various internal and external signs.

The four elements dissolve over the first four stages. In the first stage, where the earth element dissolves, the external signs are that one抯 body becomes thinner and weaker, and internally one sees mirages. The second stage involves the dissolution of the water element; the external sign is that one抯 bodily fluids dry up, and internally one has a vision of smoke. The fire element dissolves in the third stage; the external sign is that the heat and digestive power of the body decline, and internally one has a vision of sparks. In the fourth stage, where the wind or air element dissolves, the external sign is that breathing ceases, and internally one has a vision of a flame about to go out.

This is the point at which one would normally be declared clinically death. The gross physical elements have all dissolved, the breath has stopped, and there is no longer any movement in the brain or circulatory system. However, according to Buddhism death has not yet taken place because the mind or consciousness is still present in the body.

There are various levels of the mind: gross, subtle and very subtle. The gross mind or consciousness includes our six sense consciousnesses and eighty instinctive conceptions. The former dissolve over the first four stages, and the latter dissolves in the fifth stage, following which one experiences a white vision. In the sixth stage, the white vision dissolves and a red vision appears. In the seventh stage, the red vision dissolves and a vision of darkness appears. The white, red and dark visions constitute the subtle level of consciousness.

�Finally, in the eighth stage, the dark vision dissolves and the very subtle mind of clear light becomes manifest. This is the most subtle and pure level of our mind, or consciousness, and experienced meditators are able to use this clear light mind to meditate and gain a realization of absolute truth, and even attain enlightenment. That is why such meditators are not afraid of death, and even look forward to death as if they were going on a holiday!

牋牋牋 This is just a brief explanation of the eight stages. More detailed explanations can be found in a number of books (see the recommended reading list), such as The Tibetan Book of the Dead, translated by Robert Thurman, p.23-50. Since we are naturally more frightened of what is not known to us, becoming familiar with the stages of the death process would help ease some of our fear of death. And if we are able to practise the meditations on simulating the death process and awakening the clear light mind which are found in the Tibetan Vajrayana tradition, we might even be able to attain realizations as we die.

These are just a few recommended spiritual practices that we can learn and train ourselves in during the course of our life which will help us be more prepared for death. However, there are many other methods, which are suited to people of different temperaments. When it comes to choosing the method that is right for us, we can use our own intuition and wisdom, or consult reliable spiritual teachers with whom we have an affinity.

Now let抯 look at what we can do to help other people who are dying.

HELPING OTHERS WHO ARE DYING

It is said in the Buddhist teachings that helping another person to die with a peaceful, positive state of mind is one of the greatest acts of kindness we can offer. The reason for this is that the moment of death is so crucial for determining the rebirth to come, which in turn will affect subsequent rebirths.

However, helping a dying person is no easy task. When people die, they experience numerous difficulties and changes, and this would naturally give rise to confusion as well as painful emotions. They have physical needs � relief from pain and discomfort, assistance in performing the most basic tasks such as drinking, eating, bathing and so forth. They have emotional needs � to be treated with love, kindness and respect; to talk and be listened to; or, at certain times, to be left alone and in silence. They have spiritual needs � to make sense of their life, their suffering, their death; to have hope for what lies beyond death; to feel that they will be cared for and guided by someone or something wiser and more powerful than themselves.

Thus one of the most important skills in helping a dying person is to try to understand what their needs are, and do what we can to take care of these. We can best do this by putting aside our own needs and wishes whenever we visit them, and make up our mind to simply be there for them, ready to do whatever has to be done, whatever will help them to be more comfortable, happy and at peace.

There are many excellent books available on how to care for a dying person in terms of their physical and emotional needs (see the recommended reading list). Here we will focus on the spiritual needs and how to provide for these.

1.牋 Working on our own emotions

As mentioned above, when people approach death they will at times experience disturbing emotions such as fear, regret, sadness, clinging to the people and things of this life, and even anger. They may have difficulty coping with these emotions, and may find themselves overwhelmed, as if drowning in them. What is helpful to them during these difficult times is to sit with them, listen compassionately and offer comforting words to calm their minds.

But to be able to do this effectively, we need to know how to cope with our own emotions. Being in the presence of death will most probably bring up the same disturbing emotions in our mind as in the dying person抯 mind � fear, sadness, attachment, a sense of helplessness, and so forth. Some of these emotions we may never have experienced before, and we may feel surprised and even confused to find them in our mind. Thus we need to know how to deal with them in ourselves before we can really help someone else to deal with them.

One of the best methods for dealing with emotions is mindfulness meditation (explained above). Another is reminding ourselves of impermanence: the fact that we ourselves, other people, our bodies and minds, and just about everything in the world around us, is constantly changing, never the same from one moment to the next. Awareness and acceptance of impermanence is one of the most powerful antidotes to clinging and attachment, as well as to fear, which is often a sense of resistance to change. Also, cultivating firm faith in the Three Jewels of Refuge is extremely useful in providing the strength and courage we need to face and deal with turbulent emotions.

牋牋牋 If the dying person is a family member or friend, we will have the additional challenge of having to deal with the attachments and expectations we have towards that person. Although it is difficult, the best thing we can do is learn to let them go. Clinging to them is unrealistic, and will only cause more suffering for both of us. Again, remembering impermanence is the most effective remedy to attachment.

2.� How to help someone who is a Buddhist

牋牋牋 If the dying person is a Buddhist, ask questions to find out how much they know and understand, and that should give you a better idea about what to do to help them spiritually. For example, if the person has strong faith in Kuan Yin, then you should encourage them to keep that faith in their mind and pray to Kuan Yin as much as possible. Or if the person were a practitioner of mindfulness meditation, encourage them to do that practice as often as they can. In short, whatever teachings and practices they are familiar and comfortable with, remind them of these and do whatever you can to provide them with confidence and inspiration to do these practices. If they have difficulty practising on their own, due to pain or tiredness or a confused state of mind, do the practice with them.

牋牋牋 If possible, place images of Buddha, Kuan Yin, Amitabha, and so forth within sight of the person. Speak to them, or read passages from books, about impermanence and other Buddhist teachings � but do this only if they are receptive, do not force it on them. Also, do not try to teach them something that would cause their mind to be confused or upset (for example, if the subject is too difficult for them to understand, or if it is new and unfamiliar). The most important thing is to help the person have a peaceful and positive state of mind before and during their death.

It may be that the dying person does not know how to meditate or pray. In that case you can meditate or do other prayers or practices in their presence, dedicating the merit of these that they have a peaceful mind at the time of death and a good rebirth. You can also teach them how to pray, by reciting standard Buddhist prayers, or by praying in their own words, in their own hearts. For example, they can pray to Buddha, Kuan Yin or whoever they can most easily feel faith in, to be with them during this difficult time, to help them find the strength and courage to deal with their suffering and to keep their minds peaceful, and to guide them to a good rebirth in the next life. Also, to help their minds be free of worry and anxiety, encourage them to not worry about their loved ones and their possessions, and to not be afraid of what lies ahead but to have faith in the Three Jewels. Do what you can to help them cultivate positive thoughts, such as faith, loving-kindness and compassion, and to avoid negative thoughts such as anger and attachment.

3.� How to help someone who is not a Buddhist

牋牋牋 If the dying person belongs to another religion, make an effort to understand what they know, understand and believe, and speak to them accordingly. For example, if they believe in God and heaven, encourage them to have faith in and pray to God, and to feel hopeful about being with God in heaven after they leave this life. And have a respectful attitude towards the person and their beliefs and practices. Remember, the most important thing is to help the person to have positive thoughts in their mind, in accordance with their religious beliefs and practices. Do NOT attempt to impose your own beliefs or try to convert them. That could cause them to become confused and disturbed.�

牋牋牋 If the person has no religion, use non-religious terminology to speak to them in ways that will help them to be free of negative thoughts such as anger and attachment, and� develop positive thoughts and a peaceful state of mind. If they show interest in knowing what you believe in, you can tell them, but be careful not to preach. It might be more effective to have a discussion in which you openly share ideas with each other, For example, if the person asks you what happens after we die, instead of immediately launching into an explanation of rebirth, you might say something like 揑抦 not really sure. What do you think?� And take it from there.

If they genuinely wish to know about Buddhist beliefs and practices, it抯 perfectly OK to explain these to them. You can talk about the Buddha抯 life and teachings, the Four Noble Truths, impermanence, loving-kindness and compassion, and so forth. Just be sensitive to their response � be careful not to be pushy, otherwise the person could become negative. Remember, the bottom line is to help them remain free from negative thoughts as much as possible, and to have a positive, peaceful state of mind.

牋牋牋 If the person is not a Buddhist and would not be comfortable hearing or seeing you do any Buddhist prayers or practices, you can still do these practices silently, without them knowing it. For example, you could sit beside them and meditate on loving-kindness and send the energy of loving kindness from your heart to fill them with peace. Or you could visualize Buddha or Kuan Yin above the person抯 head and silently recite prayers or mantras while visualizing a shower of light flowing from the Buddha into the person, purifying them and helping their mind to become more pure and peaceful. It is quite possible that the person will feel the effects of these practices even though they have no idea that they are being done on their behalf!

4.� Helping by accumulating merit

牋牋牋 After the person has passed away, we can continue to benefit them by doing positive, virtuous actions � such as saying prayers (or asking monks and nuns to say prayers), making offerings, releasing animals who are destined to be slaughtered, doing meditation, etc. � and dedicate the merits for the person to have a good rebirth, and to quickly become free from cyclic existence and attain enlightenment. It is perfectly all right to do these practices whether the person was a Buddhist or not.

It is good to use some of the person抯 own money to create merit, for example, making donations to charity. Also, merit accumulated by family members (direct relatives of the deceased person) is especially powerful and helpful. Doing virtuous actions and dedicating the merits to the deceased can help the person in the bardo (the intermediate state between death and the next life). However, once they have taken rebirth, the merit we dedicate may not help them in that life, but could help them in their subsequent rebirth, for example, by shortening the length of an unfortunate rebirth.

CONCLUSION

I hope that the ideas presented in this booklet will help you to be more accepting and less fearful of death, your own and others�. There is a great wealth of material � from ancient religious and spiritual traditions as well as from modern fields such as psychology, sociology and palliative care � that can guide us in living our lives in such a way as to be peaceful, calm and courageous in the face of death. And when someone we love is going through that experience, we can be a source of comfort, serenity and hope for them. May this small work inspire you to learn more on this subject. And may all beings become free from the sufferings of death, and attain the highest peace and happiness beyond the cycle of birth and death.