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How to Die Well

How to Die Well

The late great Tibetan Buddhist teacher Kirti Tsenshab Rinpoche (1926 – 2006), answers questions about death and dying put by Ven. Pende Hawter, founder of Karuna Hospice Services in Brisbane, Australia, in Dharamsala, India, in May 1990. This piece was excerpted from an article from Mandala Magazine’s Sep-Oct 1997 issue. You can read the entire interview and additional advice from other Buddhist teachers in Mandala’s eBook Meeting Death with Wisdom. 

Photo: Wolfgang Saumweber; Kalachakranet.org.

What is the best way that we can help people who are dying or who have just died?

When a person is dying and in great trouble there is great benefit in trying to get them to feel a bit better, a bit happier, to turn their mind to good thoughts.

If a person has faith in Buddhism, we can enunciate to them the things they have learned to trust and take refuge in. We can remind them about bodhicitta, about equanimity, about stabilizing the mind in meditative concentration, etc.

For a person who does not have religious faith, we can advise them to think, “May everybody be happy, may all living beings please be happy, may every living being please somehow be freed from their misery.”

Also, for a Buddhist who is about to pass away it can be very beneficial to gently remind them of the qualities of the Buddha, to encourage them to bring to mind the form of the Buddha, to put a picture of the Buddha in their room. These things can have great benefit and can cause the person to take rebirth in a fine place. You can also say prayers in their presence.

Is it better for Dharma practitioners to take as little medication as possible at the time of death?

There is no blanket answer here. You have to look at the individual person. If a person is in excruciating pain, then to relieve them of pain is obviously a good thing. However, if the person has a tremendous spirit or a tremendous capability, who can bear the pain and keep a clarity of what is happening to them, then to give that person a soporific that takes away that clarity is maybe not the thing to do. So it completely depends on the person.

For a Buddhist with meditational practices it can be very helpful to employ practices such as: bringing to mind that the pain has arisen because of certain causes and conditions, karma; remember various mind training ideas that can really strengthen and build up the mind, like convincing themselves that they are capable of bearing all sorts of difficulties.

A person who has never had the opportunity of doing such practices can be told things such as, no matter what a person believes, they are going to get these pains so there is no point in being tied up in them and worried by them; it is better to try to distance themselves from them and to see that just like everybody else it is happening to them too. Most people can probably get their mind around the idea (at times at least) that being upset won’t make the pain go away, it is not giving any relief.

It can also be tremendously beneficial to repeat thoughts such as, “May this excruciating pain never happen to anybody else,” or “If this pain ever happens to anybody else may they quickly be relieved of it.” Even if a person has never been religious in their life before, these sorts of prayers can help greatly.

In the West the usual signs of death are when the breathing and heart have stopped. But, in Buddhist terms, how long is it before the consciousness leaves the body after these things have occurred?

There are probably two types of people that can be identified here. The first type is somebody like a young child or someone who has been wasting away for a long period of time, a person who has had a long gradual process leading to death. In this sort of case the subtle mind or consciousness probably won’t remain in the body very long, perhaps only for a day or so.

The second type is somebody who has quite a strong body, who has been in quite good health, and dies rather more quickly. For this type of person the subtle mind or consciousness can stay for as long as three days.

Another sort of death is that of a sudden, violent death. An example would be the case of two people fighting and one of them is killed and dies suddenly. In terms of the length of time the consciousness remains in the body of such a person we could put this type of case in the first category, that is, a person who has undergone a long slide into death, with the subtle consciousness leaving fairly quickly.

How can you tell when the consciousness has left the body? What are the signs of the consciousness leaving the body?

For the person whose mind may remain in the body for as long as three days, it is said that just before the subtle consciousness leaves the body it becomes enclosed in a smaller and smaller dimension, and that dimension is said to be defined by a red and white sphere. When this sphere comes apart, the subtle consciousness is let free and this is indicated by a small amount of blood coming from the nose and a white fluid from the sexual organ.

Even though you sometimes find people in whom there is no sign of any blood or fluid from the lower part of the body, it usually does occur. Remember, I am not talking about the person who dies suddenly.

What effect does it have on the consciousness if the body is touched or moved before the consciousness leaves the body? For example, often in a hospital, after the person’s breathing and heart have stopped, various procedures are done on the body. Does this interfere with the consciousness?

Firstly, if the person was an adept with some sort of meditational abilities, they are trying to remain with a gentle sort of concentration at this point. If we shake the person violently at this stage it will disturb that concentration.

That is why there is a tradition in Tibet for the helpers of a dying person, even if that person is not a great yogi or yogini, to avoid disturbing the body for as long as three days. And if the body has to be moved, they would do so very gently and carefully, not violently or suddenly. This tradition has come about in Tibet to avoid disturbing the mind of the dead person.

In addition, if we have to remove the sheets and mattress, etc., from the bed of the person who has just died, we should do so slowly and gently so as not to disturb the person’s mind.

Similarly, if a person dies with their eyes open, there is a tradition to close the eyes, and if there is an unpleasant expression on the face it is common to smooth out the skin to make the face look more pleasant. These things should also be done with gentle and slow movements to avoid disturbing the mind of the person who has just died.

Everybody has their own burial habits, and in Tibet we had ours. The tradition in Tibet was for the body to be taken away for disposal after three days. To facilitate this, the arms and legs would be bent into the flexed position. Because the weather could be cold, if the person’s arms and legs were outstretched when they died it could be rather difficult to get them into that flexed position. So slowly, slowly over the three days you would make sure you could work them up into that position so that you would be okay when it was time for the body to be taken away. I doubt if there is much need for that where you all come from!

What is the Buddhist view of suicide?

It is a great fault for a Buddhist to kill themselves. Why is this so? Because all living beings are important and to hurt or destroy any living being, oneself included, is wrong. Suicide is usually the result of anger. Just as anger directed towards others can lead to their being killed, which is a great fault, so to hurt or to kill oneself is also wrong. For a non-Buddhist, it is the same. As I mentioned, all living beings are important and to harm somebody or some thing that is important is considered wrong.

So we have to think about how we can help these people who are experiencing this tremendous suffering and hardship. If over a period of time we can introduce them to ideas about how their mind is working, then we can really be of tremendous benefit to them and help them out of the difficulties they find themselves in.

What is the best way to prepare for one’s own death?

For the person who is already familiar with meditational practices, when they see that their death is approaching, this is the time to turn the mind to practice.

For those who have not thought much about religious things at all in their life, they should try and get hold of that which is the heart of religion. And what is the heart of religion? It is to be kind, to think well of others, to hope that good comes to others in their lives. If a person who has never before thought about those things can somehow do so, then this is the best thing they can do to prepare for death.

The person with some knowledge of religion from before will enjoy listening to stories about the Buddha’s excellent qualities, what they did for others and so forth, and this will bring joy to their mind. For the other sort of person, it can make them feel good and bring joy to their mind to tell them how certain people have helped others, how somebody did something nice for somebody else, etc.

What I am saying, in other words, is that dying is a situation where a person needs to have prepared beforehand because you can’t get it together while you are in the middle of it.

 

Further Reading

“Affirmation,” by Donald Hall

“Affirmation,” by Donald Hall

To grow old is to lose everything.
Aging, everybody knows it.
Even when we are young,
we glimpse it sometimes, and nod our heads
when a grandfather dies.
Then we row for years on the midsummer
pond, ignorant and content. But a marriage,
that began without harm, scatters
into debris on the shore,
and a friend from school drops
cold on a rocky strand.
If a new love carries us
past middle age, our wife will die
at her strongest and most beautiful.
New women come and go. All go.
The pretty lover who announces
that she is temporary
is temporary. The bold woman,
middle-aged against our old age,
sinks under an anxiety she cannot withstand.
Another friend of decades estranges himself
in words that pollute thirty years.
Let us stifle under mud at the pond’s edge
and affirm that it is fitting
and delicious to lose everything.

 


Coral Tree In-home Care provides caregivers, old-fashioned kindness, and neighborly support to older adults who want to live at own home safely, comfortably, and as independently as possible. Since 2010 we’ve helped more than 350 families in Newport Beach, Laguna Beach, Newport Coast, and neighboring Southern California communities live safer, happier lives.
These Evening Bodies That We Wear

These Evening Bodies That We Wear

These Evening Bodies That We Wear

Yesterday evening, instead of spring cleaning, I was doing some fall trashing of old magazines that had gathered under tables in dead stacks, a heap of paper. Paging through a few of them, I stopped at the following poem I might have missed before. It read exactly as I felt last night, stiff from sitting, dizzy with a drift of glossy paper. The poet caught my aging body in its October nightdress.

Evening Poem by Alice Oswald

Old scrap-iron foxgloves
rusty rods of the broken woods

what a faded knocked-out stiffness
as if you’d sprung from the horsehair
of a whole Victorian sofa buried in the mud down there

or at any rate something dropped from a great height
straight through flesh and out the other side
has left your casing pale and loose and finally

just a heap of shoes

they say the gods being so uplifted
can’t really walk on feet but take tottering steps
and lean like this closer and closer to the ground

which gods?

it is the hours on bird-thin legs
the same old choirs of hours
returning their summer clothes to the earth

with the night now
as if dropped from a great height

falling

 


 
Coral Tree In-home Care provides caregivers, old-fashioned kindness, and neighborly support to older adults who want to live at own home safely, comfortably, and as independently as possible. Since 2010 we’ve helped more than 350 families in Newport Beach, Laguna Beach, Newport Coast, and neighboring Southern California communities live safer, happier lives.
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How to Die Well

The late great Tibetan Buddhist teacher Kirti Tsenshab Rinpoche (1926 – 2006), answers questions about death and dying put by Ven. Pende Hawter, founder of Karuna Hospice Services in Brisbane, Australia, in Dharamsala, India, in May 1990. This piece was excerpted from...

Impermanence Is the Source of All Continuity

Impermanence Is the Source of All Continuity

Mighty or Not, We All Fall Down

Published on LionsRoar.com, March 8, 2012

The first I saw of the oak were its raw roots crusted with mud and tilted up into the air so that the whole root ball projected six or eight feet above my head. It was a massive valley oak, its great trunk sprawled out on the ground to a length the equivalence of two railroad cars. It had been raining for weeks and a night wind had brought this ancient elder crashing to the valley floor. How many centuries had this old oak stood, spreading its arching limbs above the grassy undergrowth? It would already have been an old tree when the Maidu harvested its acorns long before European settlers first stood in the cooling shade of its summer leaves. And I, such a latecomer with such an abbreviated life, can only look and wonder at the demise of something so long-lived. Nothing lasts forever, does it?

But I’m lately struck by the realization that impermanence is the source of all continuity. Nothing survives to live another day but that impermanence propels it onward. It is impermanence that underwrites the everlasting.

Carcasses of these old trees lie all about me here in the woods, strewn on the forest floor by storms of past years, just as my life is strewn with the carcasses of things and people I’ve loved -fallen friends, a mother, father, brother; a whole county of farms and small towns buried under malls and subdivisions. I’ve somehow outstayed so many and so much that my very survival is sometimes felt by me as an affront to the fallen. This toppled oak is just another instance of the natural law of impermanence. But I’m lately struck by the realization that impermanence is the source of all continuity. Nothing survives to live another day but that impermanence propels it onward. It is impermanence that underwrites the everlasting.

If you walk in the woods, you can’t help but observe how a fallen tree eventually rots away, leaving a legacy of enriched forest soil where something new springs up in its stead. The same thing’s been happening on the street where I live. Several aged widows have passed away, their old houses subsequently occupied by young couples who have fixed up the old structures and proceeded to house new families in them. In a neighborhood where we were all growing old, infant strollers are going up and down the sidewalks once again. Impermanence is midwife to the newborn, new life springing from the womb of the old. Things rise and fall, rise and fall. In all that goes down, there lives a going up. This is reassuring when you’re witnessing the end of something.

Many years ago now, I awoke in a room I’d rented at the rear of a stranger’s house. It was my first morning in these unfamiliar quarters after having moved out of my home of twenty-four years at the request of my wife who no longer wanted to be married. She’d apparently fallen out of love. The closet in this rented room of mine was mostly occupied by someone else’s clothing, with just enough space left for what little I had of my own. I’d thought to bring hangers and so set about to hang up my things in the portion of the closet allotted me, but it felt intrusive of these stranger’s clothes that my clothes must hang next to his. Besides, up until a few hours before, my clothes had hung in a closest of my own in the second story bedroom of a house I’d built with my own hands. That was where my clothes belonged. That house was home, where my son and daughter had grown into adulthood.

Things rise and fall, rise and fall. In all that goes down, there lives a going up. This is reassuring when you’re witnessing the end of something.

A fallen tree never rights itself nor will I ever go home again and see my clothes hanging neatly in a closet of my own design and familiarity. So where’s the quality of continuity in a circumstance like this? The continuity exists in that you don’t get the next moment until this moment passes. The future, any future, depends on the demise of the past. When a relationship fails, an uncharted space opens up in its absence. The rejected husband’s future lies in his coming to terms with a stranger’s closet and a life of unforeseen options as yet unknown to him. The tree falls and rots fully away, but seedlings of future promise come to occupy the vacuum left behind.

For all its distress, a failed relationship, a lost job, a missed bus or mortgage payment beckons an unavoidable beginning. When my wife asked me to move out, I felt pretty miserable at first. A colleague of mine at the college where I taught had been divorced five years earlier and he assured me that I could expect to suffer for “at least three years” as he apparently had. He did me a big favor with that forecast, because I thought it over and decided that I had no intention of relegating the next three years of my life to continuing misery. Instead I got curious about what I might make of my new circumstance. Of course, I didn’t know at the time know what I would make of it, and that fact itself was energizing. One thing I can thank my wife for is that her decision to go it alone resulted in the same for me, and made of me a traveler in new territories and relationships.

Well I’m much older now and remarried. I have my routines, but life has never lapsed back into the merely predictable or familiar. I don’t know what tomorrow will bring, and I like having it that way. Ageing is itself an agent of impermanence. The flesh gradually atrophies and the bones ache a little, signaling the end that is to come. I’m discovering aging to be an interesting uncharted territory to journey in. It’s not that there’s no distress at all in growing old. Most of us can reconcile ourselves to running a slower 10K as I have had to do, but struggling to walk up a set of stairs or involuntarily peeing in your pants might be quite another thing. But I’m curious to see what will come with old age, and I’m not planning to make myself miserable by resisting its advance.

I dreamt the other night that I was in an underground shelter, a large concrete space with stairs leading up to the street. There seemed to be some sort of threat present like that in a World War II air raid shelter where neighbors huddled in anticipation of falling bombs; only in the dream the threat was somehow more generalized and vague in kind and origin. It wasn’t clear what the threat was or where it came from.

Except for one old wrinkled woman, thin with pinched lips and brittle gray hair, I was the only one there. I was old myself. The old woman stood facing me, and for all the ravages age had wrought upon her, her eyes, looking into mine, were remarkably clear and present. We were the only two people left in the world so far as either of us knew. “Are you afraid?” she asked. “A little,” I said. “I think I’ll just rest awhile,” I added. I lay down then and stretched myself out on a blanket seemingly spread there for just this purpose. The old woman stood over me for a bit, and then said, “I think I’ll rest too.” She lay down on the blanket alongside me where we stretched out together in some sort of uncertain anticipation of what was to come. I had the sense we would never rise again. Then this stranger of which I had no prior knowledge curled up to me and lay her head on my shoulder. I held her close, and together we gave birth to a moment as dear to me as any I’ve ever known.

 


Coral Tree In-home Care provides caregivers, old-fashioned kindness, and neighborly support to older adults who want to live at own home safely, comfortably, and as independently as possible. Since 2010 we’ve helped more than 350 families in Newport Beach, Laguna Beach, Newport Coast, and neighboring Southern California communities live safer, happier lives.
The Dalai Lama’s Perspective on Aging

The Dalai Lama’s Perspective on Aging

Featured image: The Dalai Lama visits a patient at Westmead Hospital in Sydney in 2013. Photo Rusty Stewart/Dalai Lama in Australia (DLIA).

In April 2013 the Dalai Lama met scientists at the Université de Lausanne in Switzerland to participate in a conference on aging: “Living and Dying in Peace – Crossed Perspectives on Aging.” Below is a summary and some highlights from the talk, excerpted from the article about the conference, Conference on ‘Living and Dying in Peace’ at University of Lausanne.

“From the individual’s point of view, if we train from a young age on a mental level, developing our analytical ability, the mind will remain alert. I’ve noticed that people who do this may face physical decline, but their minds remain clear and alert. From the family point of view, affection and support are important.”

The first question put to His Holiness imagined a young boy asking his grandfather “Is it a good thing to grow old?”

His Holiness replied:

“I think it depends on what kind of life you have led, whether your life was meaningful and of benefit to other people. The grandfather might say time keeps moving on, eventually we all become old. One day, although you are young now, you will be old too. This is a natural process. He might say I’m fortunate to have lived this long, but I’ve not wasted my time and I’ve gained some experience of how to live.

“On the other hand, if he’s filled his time with sensory pursuits and dedicated himself, for example, to sport, he might say I can’t hear properly any more, can’t see properly – it’s all become hard work.”

His Holiness with his mother, Diki Tsering.

The first presenter spoke about increasing life expectancy and different categories of older people, the ‘young old’ who are still active and the ‘old old’ who are increasingly frail. He asked: “How can we age well when our physical abilities are declining?” His Holiness answered that an important factor is your state of mind. Whether your mind is calm and peaceful depends not on your being knowledgeable, but on whether you are warm-hearted. Inner peace automatically gives rise to trust and friendship. On the other hand suspicion, mistrust and lies mean you end up alone and unhappy.

“From the individual’s point of view, if we train from a young age on a mental level, developing our analytical ability, the mind will remain alert. I’ve noticed that people who do this may face physical decline, but their minds remain clear and alert. From the family point of view, affection and support are important.”

Asked how to deal with dementia in the old, His Holiness replied:

“I don’t know, because I have no experience, but I believe showing affection is very important. You can show affection without having to rely on words.”

He speculated about how memory declines, noting that while you tend not to forget faces, remembering names is difficult and because of the concepts they represent there is terminology that you never forget. He wondered whether we forget names because they have no meaning, whereas terms with meaning are much easier to remember.

Asked how to deal with dementia in the old, His Holiness replied:

“I don’t know, because I have no experience, but I believe showing affection is very important. You can show affection without having to rely on words.”

A question about spirituality prompted him to try to define the term, wondering if it means looking for meaning in life and the world; a collection of visions and values that are beneficial to ourselves and others. Because there could be spirituality linked to religious faith and independent of it, he suggested that people who have no faith might derive benefit from secular ethics. Otherwise, they are prone to come under the sway of destructive emotions. He stressed that just as it is wise to take care of our physical health, we also need to take care of our emotional well-being and proposed a programme of emotional hygiene.

University of Lausanne Rector Dominique Arlettaz welcoming His Holiness the Dalai Lama during his opening address at the conference on “Living and Dying in Peace” at the University of Lausanne in Lausanne, Switzerland, on April 15, 2013. Photo/Jeremy Russell/OHHDL

The discussion came round to the role of the aging in society. His Holiness recollected a programme in Stockholm in which old people were brought in to work in kindergartens. They took part in the care of young children, played with them and told them stories. He said that there is great potential for mutual benefit in such activities. The children liked the presence of the old people, who in turn were re-energised in the presence of children. His Holiness joked:

“When I talk to young people it makes me feel young, but when I’m talking to old people I wonder ‘Who’ll be going first, you or me?’”

His Holiness said that his discussions with scientists, educationists, social workers and other concerned people lead to the conclusion that we need a system of values that contributes to the basic happiness of all members of society. Such a system could include techniques for training the mind. Education is the avenue for change. Education is the way we can change the course of humanity. And he suggested that ancient Indian knowledge about the mind and emotions as preserved in literature belonging to the Nalanda tradition could make a valuable contribution to this.

When pressed to recommend ways that the elderly who have not trained themselves earlier in life could begin to change, His Holiness said he doubted that there was an effective method, pointing out that such methods need to be adopted when we are young.

After a leisurely lunch filled with conversation and discussion the conference resumed. Asked to respond to the statistic that a majority of people die in hospital His Holiness surprised the panel by saying that if you die in hospital it means that all efforts to save your life have been exhausted, so there will be no room for regret. On the other hand he agreed that doctors and nurses need to treat their patients as beings with feelings of pleasure and pain, rather than as inanimate machines brought in for repair.

When pressed to recommend ways that the elderly who have not trained themselves earlier in life could begin to change, His Holiness said he doubted that there was an effective method, pointing out that such methods need to be adopted when we are young.

Commenting on whether warm-heartedness is a natural function, he said:

“Yes, our lives begin in our mother’s womb and her physical touch and expression of affection are essential to our healthy growth. This is the basis for our later development of a warm heart.”

To questions about helping the old or sick to die, he said we have to investigate why they wish to die. We have to use both compassion and wisdom to assess what is the best course of action. He said that in Buddhist practice helping to end someone’s life is permitted if it will benefit them in the long run, but again compassion and wisdom are needed to make the judgement.

He was asked whether it is important to train ourselves to meet death, and if so, how to do it.

“Death will come because it is a part of life,” he said. “People who avoid the very words old age and death will be caught unawares when it comes. In some of our meditation practice we visualize the process of death and the associated dissolution of the elements every day, so that we may be prepared for the actual event. For those who believe in a succession of lives, death is just like changing your body. If you have led a meaningful life, when death takes place there’ll be no need for regret.

“Training depends on the individual’s ability. One approach is to develop awareness of your dreams. If you can train yourself to recognise that you are in the dream state and take control of it, you can have a deeper experience of the dissolution of the elements that take place during the process of death.”

When it came to questions about rituals associated with death, His Holiness was firm in asserting his scepticism about the efficacy of rituals in the process. He conceded that if they were conducted by someone with experience and understanding they may have some benefit, but otherwise he doubted they would be of much help.

“Death will come because it is a part of life,” he said. “People who avoid the very words old age and death will be caught unawares when it comes. In some of our meditation practice we visualize the process of death and the associated dissolution of the elements every day, so that we may be prepared for the actual event. For those who believe in a succession of lives, death is just like changing your body. If you have led a meaningful life, when death takes place there’ll be no need for regret.”

Coming back to the meditative practices that in effect rehearse the process of dying, he mentioned that he goes through them himself four of five times a day. In this connection he talked about meditators who remain in posthumous meditative equipoise after death. These are cases in which brain activity and the heart have ceased and yet the body remains fresh for several days. Over the last 50 years he is aware of 30-40 cases like this, including that of his Senior Tutor who stayed in such meditation for 13 days after he died. Science has as yet no explanation of this phenomenon, while the Buddhist explanation is that it involves the existence of subtler levels of consciousness. Although the heart, circulation and the brain have stopped, it is only when the subtle consciousness departs that the dying moment is reached and the decay of the corpse begins. (DalaiLama.com)

 


Coral Tree In-home Care provides caregivers, old-fashioned kindness, and neighborly support to older adults who want to live at own home safely, comfortably, and as independently as possible. Since 2010 we’ve helped more than 250 families in Newport Beach, Laguna Beach, Newport Coast, and neighboring Southern California communities live safer, happier lives.
Being Mortal

Being Mortal

FRONTLINE follows renowned New Yorker writer and Boston surgeon Atul Gawande as he explores the relationships doctors have with patients who are nearing the end of life. In conjunction with Gawande’s book, Being Mortal, the film investigates the practice of caring for the dying, and shows how doctors — himself included — are often remarkably untrained, ill-suited and uncomfortable talking about chronic illness and death with their patients.

“We’ve been wrong about what our job is in medicine. We think our job is to ensure health and survival. But really it is larger than that. It is to enable well-being.”
― Atul Gawande, Being Mortal: Illness, Medicine and What Matters in the End

 


Coral Tree In-home Care provides caregivers, old-fashioned kindness, and neighborly support to older adults who want to live at own home safely, comfortably, and as independently as possible. Since 2010 we’ve helped more than 350 families in Newport Beach, Laguna Beach, Newport Coast, and neighboring Southern California communities live safer, happier lives.