How to Help the Very Sick and Dying

Buddhist perspective on providing emotional and spiritual care for those who are very sick or dying.

A. Introduction

Ven Sangye Khadro, in her book Preparing for Death and Helping the Dying, Kong Meng San Phor Kark See Monastery, Singapore, 2005, explains why it is important to help the dying and why most of us need training to do it properly: “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, relieving themselves, bathing and so forth. They have emotional needs – to be treated with respect, kindness and love; 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.”

In the following articles, we explore the emotional, spiritual, medical and legal aspects of helping friends and loved ones at the time of death. You may then have the courage and the knowledge to help skillfully and compassionately at this crucial time. The articles are written from the perspective of the Tibetan Buddhist tradition called Gelugpa, which follows the Mahayana path. However, in general, practitioners from all Buddhist traditions, and those from non-Buddhist religions, and even those who are non-believers, should find help and benefit in the following pages.

If you would like to discuss these topics with others in an informal atmosphere, consult the Latest News webpage of Wheel of Life for the dates and times of upcoming Wheel of Life Palliative Care Support Group workshops at the Hayagriva Buddhist Centre.

B. Ten Points of Care For a Loved One or Friend Who is Dying

The following list of ten points was compiled to be of use to people of all beliefs, or none. Each point is based on the Buddhist understanding of the death process. (Compiled by Venerable Losang Chodron and Len Warren, 25 Nov 2008, Wheel of Life Hospice Service, Hayagriva Buddhist Centre, Kensington.)

Death is a special time according to the Buddha’s teachings. If your mind is peaceful and virtuous at the end, it helps achieve a good transition to the next life.

Approaching the Time of Death

Maintain a peaceful, relaxed atmosphere in the person’s room. Do not argue, gossip or talk about medical procedures or such across the person’s bed, even if they appear unconscious. Leave the room if you are emotionally upset or crying.

Assume that the dying person can hear, even though they may be unconscious

Try to adjust the level of pain relief so that the person is relatively peaceful, yet remains as mentally alert as possible. Unless instructed otherwise, arrange to have the person’s closest family and/or friends present. Unless instructed otherwise, allow religious teachers and friends, relevant to the person’s spiritual beliefs, to phone and visit, even though they may not be family.

Some people may not want medical interventions that artificially prolong life; this needs to be checked with each individual. If they cannot communicate, the instructions in their “Living Will” should be carried out.

Family or friends may be invited to help set up a small, simple altar in full view of the person, and according to their wishes.

Respect the spiritual beliefs of the dying person; silent or spoken prayers may be helpful.

After breathing has ceased, maintain a peaceful, quiet atmosphere

Buddhists believe that the death process continues even after the heart stops beating. Preferably, the body should be disturbed as little as possible, if at all, during this time, which may last 24 hours or even longer. (Some Buddhists approve of transplanting organs. If so, then the body will need to be touched, moved and operated on before the heart has stopped beating.)

From the Foreword by Jeffrey Hopkins: “I gained many insights from the Dalai Lama’s teaching and learned much that later turned out to be very useful.” (Note: The dot points below were composed by the Wheel of Life Training Team and are designed to help the reader understand the significance of the stories told by Jeffrey Hopkins.)

Death of Jeffrey’s father

My father had a stroke when he was 81. We were all very relieved when he rose from his comatose state and even returned home. However, by the time I arrived a few weeks later my father was back in hospital, comatose again. One day he was lying on his back and he opened his eyes. He turned and we began gently talking. At one point with a playful gleam in his eyes he said, “You wouldn’t believe what’s going on in this hospital.” Wondering what he meant, I happened to look up at the TV at the foot of his bed.

A steamy hospital soap opera was on, and I noticed that the hospital had put a small speaker by his pillow. While in his coma he had heard all those shows! I later turned off the speaker, remembering that at the time of death it is most valuable to have someone remind you of virtuous thoughts. A few days later when he again regained consciousness, I turned off the TV that was blasting out a quiz show, and we went on to have a nice conversation. He died during the night. How relieved I was that before he died, he had come to his senses with his spirits restored. And that the TV was silent. I sat beside his body, and kept silent because I did not know his particular vocabulary of religious belief. Just by being there I felt I could support him on his journey.

Did you know that near death, people can hear and know what’s going on, even though they may appear unconscious? Well before death, it is important to practise being peaceful from moment to moment; then there is a better chance of being peaceful at death. At death, it is important to try to recall virtuous actions. It would help to be clear about what is virtuous and to have created some virtue during your life. Did you know that a person who has just died can sense your thoughts and will be supported by silent prayer? You need first to believe in the power of prayer and it helps to know how to pray and what to pray for.

Death of Jeffrey’s mother

A year later my mother suffered what was probably a stroke. Mother rang my brother and said she felt terrible. Then her voice faded away. Subsequently the hospital brought her back from death’s door three times, leaving her struggling to communicate. Seeing her incoherent struggle, I remembered that the Dalai Lama had spoken of the need for friendly advice that could evoke a virtuous attitude, and approached her bedside. I knew that her special word was “spirit” so I said, “Mother, this is Jeff. Now is the time for the spirit.” She immediately settled down and stopped struggling. I gently repeated, “Now is the time for the spirit.” A few days later, she died peacefully.

Have you ever noticed whether any of your close relatives or friends have special words, phrases, or sayings that are specially meaningful to them from an emotional or spiritual point of view? To be of any use after a stroke and before death, meaningful words, phrases, or mantras would preferably need to have been used and thought about for many years beforehand.

Death of Jeffrey’s cousin Bobby

When my cousin Bobby was diagnosed with brain cancer, he said that what he would like while he was still active was for all the cousins to gather and tell stories about grandpa. Most of us had hilarious stories to tell, which I videotaped. On Bobby’s next-to-last day, the family watched the videotape of the cousins’ gathering and put it away. The next day with everything kept simple and quiet, he died.

It helps the dying person to let go if objects of attachment (sometimes this might also include family and friends), a day or so before death. Death of Jeffrey’s friend Raymond

When my friend Raymond knew he was dying of AIDS, he and his partner asked me what they should do. Remembering my parents’ deaths and my own paralysis and near death from Lyme disease, I knew that long after we become unable to interact with others, we can have a strong, lucid, interior life. During my extreme illness, I internally repeated a mantra that I had recited over the course of almost thirty years.

Bearing in mind my own experience, I suggested to Raymond that he choose a saying that he could repeat over and over again. Raymond had time to practise his mantra. His partner put it in a plastic frame by his bedside, so when Raymond turned his head, he saw it and was reminded to repeat it. After he lost the capacity to speak or to move at all, I sat on the floor beside his bed and gently repeated the words of his mantra, “May I be filled with loving-kindness.” Then his face lit up and his eyes moved underneath his closed eyelids. It had worked!

Conclusions

To make the most of your own death, you need to become familiar with what will happen and how you should try to respond to the stages of dying. To help others who are dying, you need to have confronted your own death, studied the teachings, and tried to practise them over the years. To have the courage to suggest things for others to do at the time of death, you need to have thought deeply about dying beforehand yourself. The Buddhist teachings contain all the steps you need to prepare for death, as well as detailed descriptions of the death process, the intermediate state and rebirth.

Wheel of Life Palliative Care Support Group: Hayagriva Buddhist Centre 2011

D. Working with Disturbing Emotions

As we approach death, or when facing the death of a loved one, we might find ourselves experiencing painful, disturbing emotions or attitudes. These can include denial, anger, fear or anxiety, sadness, and guilt. What can we do about these?

General Ways of Working with Disturbing Emotions

1) Accept and acknowledge them non-judgmentally. Avoid thinking “I shouldn’t feel this way” or “I’m bad because I feel this way.” Being judgmental only makes things worse. Remember that it’s only natural to have such emotions, given your present situation.

2) On the other hand, try to not be overwhelmed by them, or get stuck in them. Remember impermanence: emotions are just aspects of your mind, transitory, like clouds passing through the sky. They arise due to causes and conditions, and they will pass.

3) Understand that you have a choice: you can get caught up in the emotion, and even act it out; or you can deal with it in a more skilful way, such as turning your mind to more positive thoughts. Consider the different consequences of these two choices: how they will affect you, and the people around you….

4) Learn to de-identify with the emotion. It’s not you, it’s just something passing through your mind. Sometimes it’s there, sometimes not. Don’t identify with it as “I.” Say to yourself “anger/fear is in my mind” rather than “I am angry/frightened.”

5) Remember the nature of your mind: clear, pure, with infinite potential to feel love, compassion, joy and other positive emotions.

6) Remember that you are not the only one who experiences such emotions. There are many other people who also experience them, and some have even greater suffering than you do (for example, someone who loses several loved ones at the same time). Generate compassion for all other people and beings, wishing them to be free from all suffering and its causes.

7) Disturbing emotions are usually based on self-centeredness or self-cherishing: the attitude that thinks “I am more important than others.” Meditating on love and compassion, or doing the practice of tonglen (taking and giving) will help us to decrease self-cherishing and increase altruism: caring for others. The more altruism we have, the less our mind will be invaded by disturbing emotions. Also, these meditations are very beneficial tools for transforming difficult situations into spiritual growth.

8) Do a reality check: step back and look at what is going on in your mind. Are you seeing things realistically? Or is your mind exaggerating or fantasizing, seeing things unrealistically? If you recognize mistakes in your way of thinking, change them so that you look at things more realistically.

Working with Specific Emotions/Attitudes

1. Denial a. Gently remind yourself of the inevitability of death: it happens to everyone. b. Your denial may be due to fear, so try the methods for working with fear (below). Also, understand that if you become more familiar with and accepting of death, it will seem less frightening.

2. Anger a. Contemplate the faults of anger:

1) It harms you, physically and mentally;

2) It can become harmful to others, including your loved ones;

3) It becomes a habit: each time you get angry, you create the cause to get angry again;

4) Getting angry creates the karma to suffer in the future;

5) It’s a major obstacle to attaining more pure, blissful states such as enlightenment. Then resolve to refrain from getting angry and acting it out, and instead learn to transform your mind and behavior in more positive ways. b.

If you are angry at someone, generate loving-kindness. One way to do this is to understand that the person you are angry at is just like you in that they wish to be happy and to not suffer; generate the wish for them to be happy and not suffer. Another way is to bring to mind good things the person has done, or good qualities they have. c. If you are angry about your sickness or impending death—“Why me?”—remember that you are not the only one having to go through such experiences. All other people have to go through them. And remember karma. Whatever unwanted things happen to us are the result of unskilful actions we did in the past. Resolve to refrain from negative, harmful actions and to do positive, beneficial actions as much as you can. Also, you can do purification to free yourself from whatever negative actions you remember doing in this life.

3. Fear a. Examine your fear: what are you afraid of? Then check: is there something I can do about it? If so, do it. If not, accept it. b. Pray, take refuge. c. Fear is usually based on self-centredness, so it’s helpful to generate loving-kindness and compassion, and the wish to benefit others.

4. Sadness a. Sadness is usually due to attachment, not wanting to separate from people and things. Contemplate the faults of attachment, e.g. clinging disturbs the mind, causes unhappiness, creates problems at the time of death. b. The best remedy to attachment is to contemplate impermanence and death. We will have to let go of everything and everyone one day, so it’s better to start letting go now. c. Remember that the love and positive experiences you had with your loved ones will live on, after death, in your heart. d. The mind never dies—it just separates from the body, then continues in another life.

5. Guilt a. If you feel guilty about negative, harmful things you have done, generate regret, rather than guilt, and do a purification practice with the four opponent powers. b. Remember impermanence—the I who made the mistake is not something permanent, unchanging, fixed for all of time. There is no permanent “bad” person. Remember that you have also have good qualities, and do good things. c. Do a reality check: is your guilt justified? We sometimes feel guilty because we are healthy and happy while someone else is sick and suffering. Is that correct? Is it helpful? Instead of feeling guilty, resolve to use your health and happiness to be of benefit to others, to help relieve their suffering.

The Difference Between Pain and Suffering

There is a difference between physical pain, which is a physiological process, and suffering, which is our mental and emotional response to the pain. In addition to physical pain, there is mental pain, from a mind agitated and disturbed by negative thoughts.

If you can, test the ideas below, and try to find one or more that appeal to you, that seem to help you cope with the pain. Then, for best results, practise that method every day. (For a quick look at traditional drug treatment of pain for palliative patients, click here.)

Twenty Non-Medical Ways to Help You Cope With Pain and Suffering

Come to the realization that you are not alone: everyone, without exception, faces pain, loss and suffering sooner or later. Feel the burden you thought you were bearing alone lift a little.

Realize that there may be others who are experiencing similar or even greater pain than you. Generate the wish that they may be freed from their pain. Realize that pain and suffering are a natural part of life – in fact suffering is in the very nature of our existence. It is being truly happy that is unusual. Familiarize yourself with the inevitable sufferings – old age, illness and death.

Realize that reacting to your pain with anger, frustration or despair will not help ease the pain

Given that your pain is not over yet, decide that you will tolerate and accept it. Then you will no longer be its victim. Recognize the impermanence of all things – no matter how painful or pleasurable your experience may be, it will not last. “This too shall pass“. Visualize, for instance, a soothing, luminous nectar that soaks into the centre of pain and gradually dissolves it into a feeling of well-being. The nectar then permeates your entire body and the pain fades away. Alternatively, visualize a scene that is a source of peace for you.

Directly confront your suffering, don’t find ways to avoid it

When we feel severe physical or emotional pain, we may simply look at the experience. Even when it is crippling, we must ponder whether it has any colour, shape, or any other immutable characteristic. We find that the more we try to bring it into focus, the more the pain’s definition becomes blurred. Objectively analyze the situation, take an holistic view. Are there any positives in your life at present? Nothing is 100% bad or 100% good. Has your suffering led to anything useful or positive in your life? Sometimes out of the deepest crisis comes understanding and spiritual progress.

Don’t take things too personally

Don’t think that your suffering is unfair – it is in fact the result of your previous actions (karma). The Buddha observed that there is a natural Law of Cause and Effect: virtuous actions lead to happiness, non-virtuous actions lead to suffering.

Your pain is not a punishment by God or Buddha for previous wrongdoings; it’s just what happens according to the Law of Cause and Effect. You have the power to choose not to create the actions that may lead to further pain and suffering, and to purify accumulated negativities. Don’t allow regret to degenerate into guilt (self-blame, self-hatred).

Don’t let regret weigh you down but move ahead and help others to the best of your ability. If it is possible, try to help others who are in greater trouble. At least send them your love through prayer.

Extracts from the Summary

Sarah died at 8:15am on 12 June 2000, in Sydney, aged 39 years, survived by a husband and two children, aged 6 and 4 years. She had lived with breast cancer for four years, through operations, radiation and chemotherapy. Three weeks before her death, Sarah was admitted to a palliative care unit. Her goal was to die a peaceful death. At the time of her admission, extensive discussions were carried out between her, her family and the multidisciplinary team. Sarah prepared for her own death and expressed wishes that she hoped could be carried out in the last few days of her life.

Sarah practised Buddhism on a daily basis. She asked that she be allowed to be in charge of her death as much as possible.This was very important to her, in relation to her religious beliefs. She was not afraid to die, and as death became more imminent she welcomed it and longed for it.

List of Events in Last Few Days

In the last week or so before her death, Sarah was distressed as a result of fatigue. She could not meditate more than 10 minutes. She often needed help to complete her practices.

10 June:

Sarah became too weak to eat or drink. She knew this was a normal stage of dying. Her husband gave a few drops of water with a syringe every half hour.

Sarah had asked that morphine for pain control not be increased during the last 48 hours of life i.e. she had refused “terminal sedation”. At times, she moaned or cried out when being repositioned, but then settled. She relied on meditation and calm support from family and her Buddhist teacher to deal with pain.

Sarah started to become short of breath, and breathing became noisy and rapid (“terminal dyspnoea”). Sarah preferred a cool, gentle stream of air from a fan rather than oxygen via a nasal cannula. A low dose of morphine was given when she was distressed with not being able to breathe.

11 June:

Sarah became dehydrated, with dry skin and membranes and thickened secretions. But she had refused “terminal rehydration”, as she knew that dehydration was a natural stage of dying.

In the evening, Sarah’s respirations became very moist with prominent “terminal death rattle”; she was semi-conscious and unable to swallow. She was lucid for about an hour.

12 June:

Soon after midnight, Sarah became very restless (she had been calm up to this point). She started having hallucinations, and would toss and turn while moaning, reach out to something. Her family believed that she was experiencing blissful visions. This stage is called “terminal restlessness” and most dying people experience it; often they appear frightened, distressed and anxious.

At 8:15 am, Sarah died quietly, surrounded by her family and her buddhist teacher.

G. What to do when someone is dying

Ven. Dondrub: And staff these days in hospitals are very sympathetic in most cases. When I was in Adelaide a few years ago I had the experience of being with a woman who died, I was there when she died and she knew she was dying for some time and so she prepared everything really, really well. She had a person she appointed to look after all the kind of worldly aspects, her possessions and arranging the funeral and bits and pieces like that and then she had another person who looked after all the Dharma side of things.

So that person would contact people and that’s how I ended up knowing her because they knew I was in town and so they asked me to come and be with her. I didn’t know the woman at all but she was connected to Buddha House, our centre in Adelaide, and she had also spoken to her mother long before and explained, her mother was Christian, but she completely accepted her daughter’s views and she explained to her mother please don’t touch the body and all these things and it worked out really well.

I’ve told this story before but it was very interesting. Her mother was sitting right next to me at the bed and she had two friends with her and none of these people were Buddhist and as soon as the woman’s breath stopped they all looked at each other and they all sort of took in this breath and were all about to burst into tears because this is what you do when people die, this is like we’re programmed to show how we love someone, we have to burst into tears.

Sorry if I’m sounding cynical because I don’t mean that, but it was really obvious being there because she wasn’t a friend, I didn’t know her, she seemed to be a nice person, but I had no involvement with her and the people at all and so I could just observe and you could see they really did love her, you could almost see the programming that now I have to cry. They weren’t crying as she was dying but as soon as she stopped breathing they were about to start.

I was with this other friend who was a Buddhist and a bit of a character. I felt a bit shy of saying anything to them, I wanted to say please don’t cry, this is the worst time to do it right now. But this other friend who is a bit of a character, got a very good heart, he said exactly those things in a kind of humorous way which is kind of amazing with this dead body there, he’s a real kind of party guy but very good hearted, and he said it in a very kind of joking way but in a

way that they really took it to heart and he was explaining don’t cry this doesn’t help, just be really calm and peaceful and send good thoughts to her and you could see how relieved they were to know what to do. That he was someone who seemed to have some authority and to know what they were talking about and they were completely relaxed about it. So that’s my long-winded way of saying that it’s really important to let people know what your beliefs are, what you want and if they love you, then hopefully people will listen despite what strong emotion there may be if they can remember those things. It’s really important and so I think we need to, while we have the time, to try to let people know these things.

H. What To Do When You Visit the Very Sick or Dying

(Compiled by the Wheel of Life Training Team for the Workshop held on 16 Oct 2010. The advice is given from the point of view of a visitor who has taken refuge as a Buddhist, but can be easily adapted to suit your beliefs. Certain practices such as tonglen are explained later in this document.)

Preparation for a Visit

• Call the person or their carer on the phone to arrange the first and subsequent visits, provide comfort, catch up on developments etc.

• Try to be on time. Check that you have the appropriate materials & documents for that visit. Be prepared to be flexible. You may be dismissed shortly after arriving or you may be deeply involved for several hours.

• Prepare yourself before the visit, e.g. if you are a Buddhist, take refuge, generate compassion and the bodhicitta thought.

• Prepare yourself again immediately before entering the room.

Building Trust

• Bring a peaceful mental atmosphere with you, and if appropriate try to create a peaceful physical atmosphere in the room.

• Listen to what the person has to say (use ‘active listening’, empathy, sincere interest, ‘effective communication’ etc).

• Help the person to tell their story. Emphasize the positive aspects of their life.

• Encourage them to remember the beneficial things they did in their life.

• Try to clarify why the person or their carer has asked you to come. Have they got a particular request? What’s on their mind?

• Develop the relationship by slowly building trust.

• When their needs become clearer, decide on the extent of your “offer” of help, e.g., in terms of when, how, why, what.

• Don’t overstay your welcome; very sick people tire easily. Try to get independent feedback on your visit (this may or may not be possible; don’t worry).

Secular Actions

• Be aware of, and try to be open with, other family or friends who may be present, and who may or may not agree with your presence. Try to gain their confidence but respect their wishes.

• If asked and if appropriate, guide the person in calming meditations e.g. body awareness, focussing on the breath, nine-round breathing.

• Don’t be afraid to touch because at this time the simple holding of a hand or gentle stroking of hand can be very reassuring; but be mindful and only proceed if you see that the person is accepting.

• Where appropriate offer timely and relevant information e.g. links to other Wheel of Life & Hayagriva Buddhist Centre services, other palliative care services.

• If asked and if appropriate, link the person to appropriate experts in drafting a Will, Power of Attorney, Living Will or Funeral.

Spiritual Actions

• If asked, say the person’s favourite prayers with them or read them aloud to them, whether Buddhist or not.

• If asked, read to the person their favourite spiritual teachings, psalms etc., whether Buddhist or not.

• Whether asked or not, say silent prayers for the person, including doing the practice of tonglen for the person. If the person is conscious and agrees, suggest they hold a stupa while they do tonglen themselves.

• If asked and if appropriate, set up an altar for the person with their favourite images etc, whether Buddhist or not.

• If asked and if appropriate, suggest practices that the person might do to cope with pain, fear, regret, unease etc.

• If appropriate, help the person to deal with “unfinished business”. Encourage them to forgive whomever they need to forgive and to apologize to whomever they need to apologize to.

• If invited, discuss with the person the process of dying and death and the next life.

• If asked, explain the basic principles of Buddhist philosophy and practice in a way that is relevant to the person.

• If asked and if appropriate, leave prayers, mantras, CD’s, books, etc.

Secular Actions

• Maintain a peaceful, relaxed atmosphere in the person’s room. Do not argue, gossip or talk about medical procedures or such across the person’s bed, even if they appear unconscious. Leave the room if you are emotionally upset or crying.

• Assume that the dying person can hear, even though they may be unconscious.

• Try to adjust the level of pain relief so that the person is relatively peaceful, yet remains as mentally alert as possible.

• Unless instructed otherwise, arrange to have the person’s closest family and/or friends present.

• Frequently the person who is about to die will wait to die until family members have left the room and they are either alone or with someone who is not family. Don’t feel that you “did something wrong” or abandoned them if they die while you are not there.

• Remember: you can’t prevent anyone from dying.

• Trust them in their process and be supportive.

Spiritual Actions

• Respect the spiritual beliefs of the dying person; silent or spoken prayers may be helpful.

• Family or friends may be invited to help set up a small, simple altar in full view of the person, and according to their wishes.

• Encourage the person to hold a stupa as often as possible. If unconscious, place a sheet of paper with the Ten Great Mantras written on it, on their heart, with dedications. Or do whatever is appropriate from their spiritual tradition.

• If the dying person asks for their Buddhist teachers, or Buddhist friends to phone and visit, even though they may not be family, try to arrange this through their family. The same applies whether the dying person is Christian, Muslim, Jewish, Hindu, etc.

• Some Buddhists may not want medical interventions that artificially prolong life; this needs to be checked with each individual. If they are unable to communicate, refer to their “Living Will” or their “Last Letter”.

• Give the dying person permission to die, especially if you are very close to them.

• Reassure the dying person that all will be well after they die; they will be guided and cared for by a power greater than them.

Wheel of Life Palliative Care Support Group: Hayagriva Buddhist Centre 2011

I. Writing a Last Letter to Your Loved Ones

Why would you want to write a “last letter” now, or to encourage the person you are caring for to write their own? Because:

o Death is definite.

o Death can come at any time.

o If you are a practitioner, you should want to die with a virtuous and calm mind…

o And you should want to leave others in as calm a state of mind as possible. You can help to do this by writing down, for them, your last wishes and instructions. The worst outcome would be for your loved ones to squabble over your possessions, or become angry about one person’s share versus another’s, or become annoyed at having to do a lot of work to tidy up an estate etc.

In the “living will” you can leave instructions for your medical treatment in the situation where you can no longer communicate with people. For example, the Buddha suggested that we focus on the stages of dissolution during the death process, but to do that we need an alert mind, so, therefore, some pain is preferable to complete sedation in order to allow the mind to function, and quietness is needed so please cry outside the room. Always, heartfelt prayers will help the dying person.

Also, advanced practitioners can continue to meditate after they have stopped breathing, because their consciousness has not yet left their body. Your practice may not be very advanced, but you still might want to leave instructions that your body not be disturbed until the consciousness has exited. Alternatively, you may have decided that it is OK to cut out your organs while you are still breathing (but “brain dead”) so you may want to specify what you want done.

In the “last letter” you can leave personal thanks, goodbyes, apologies, and wishes that you may find too difficult to express now. For example you can ask your carers to create a peaceful environment for you even if you can’t communicate with them at the end. You might request them to set up a simple altar in your room. If you want to continue your daily practice but you are too ill, then you could indicate in the letter that you would dearly love others to read the practices for you. In your last letter, you might also want to leave wishes for how your funeral is to be conducted.

In the weeks or months before you die, write a letter to your loved ones.

• Specify on the envelope when you want it opened – for example, when you can no longer communicate with them, or after you have died. Tell them where you have put the letter.

• Express your positive feelings for your loved ones. Tell them you love them (It is better to speak with them directly now rather than to wait until they open your letter after you can no longer communicate with them or have died.)

• Thank them for sharing their love and kindness with you. Say you remember all of the love and kindness that they have given you and others during their lifetime.

• If necessary express regrets, ask them to accept this regret with kindness.

• Clear up your relationship with them. If you need to forgive them or apologize to them, do that. If they have apologized to you accept their apology with a kind heart.

In your “last letter” advise others that, at the time of your death, they should:

• Make the room as quiet and peaceful as possible.

• Be peaceful and calm. Avoid crying in the room, someone to assist with this to allow others to cry and grieve outside the room.

• Mentally give them a heartfelt hug and let them know of your love for them, but do not cling or encourage them to cling.

• If it seems necessary, remind your children and other family members they will be all right after you pass away.

• If you are of a particularly strong faith, talk to them in the language of that faith — use words, symbols, and concepts that are familiar to them. Encourage them to have faith and to generate a kind heart towards others. If they are not religious, talk about compassion or loving-kindness. That will help their mind to be calm and peaceful.

• Ask them to recite mantra or say prayers, quietly or out loud, depending on what is appropriate, as you are dying.

J. Lama Zopa Rinpoche: Caring for the Dying

Extracts from How to Benefit the Dying and the Dead, pages 32-40, in: Advice and Practices for Death & Dying, FPMT 2003. Lama Zopa Rinpoche is the spiritual leader of the organization called the Foundation for the Preservation of the Mahayana Tradition (FPMT), that has 150 centres, projects and study groups worldwide. Hayagriva Buddhist Centre is part of FPMT. Lama Zopa’s advice in this article is directed towards practising Buddhists.

During an illness the main thing is to take care of the dying person’s mind. Many others can take care of the body, but we can take care of the mind.

The most worthwhile thing to do is to inspire the person to think of others with loving kindness and compassion, to wish others to be happy and free from suffering. If a person dies with the thought of benefiting others, their mind is naturally happy and this makes their death meaningful.

You can teach the person taking-and-giving (tonglen) meditation or loving kindness meditation, according to the capacity of his or her mind. If the person has a more compassionate nature, a “brave mind,” they will be able to do tonglen, taking others’ suffering and giving out happiness. If the person can do tonglen, that is the best way to die, as it means dying with bodhichitta. His Holiness the Dalai Lama calls this a self-supporting death. For those who don’t think others are more important than themselves, wishing others happiness and to be free of suffering is more difficult.

It is very important to know a person’s mind. You can teach according to their capacity: check at the time, use your own wisdom, and judge how profound a method to present to them. It would be best if you could give the dying person some idea of the death process according to tantra: the evolution of the dissolution of the elements, the senses, the consciousness, all the way to the subtle consciousness.

For a person who has lost their capacity to understand because of coma, dementia, and so forth, there is not much possibility for them to understand. We should aim to help them get at least a precious human rebirth. This should be our aim, not that the person must necessarily believe in karma, for example, but that they die with a positive, happy mind, with loving kindness and compassion; this is our precious gift. Our main aim in taking care of the physical body is so that we can take care of the mind, to transform their mind to the positive so that at least the person can die without anger, desire, and so forth.

You should learn various methods to benefit and calm down the mind, and to benefit now and in the future. You should get an idea of what level of method to offer.

If, for example, one visualizes Buddha or watches the conventional nature of mind – its clarity – other thoughts such as anger and attachment do not arise. If one is able to do this at the time of death, according to the person’s mind, you can talk about the “fully enlightened being” rather than the Sanskrit “Buddha.” You can talk about God if that is more skillful: a compassionate God or a loving God, or Omniscient One. Explain to the person that the nature of their mind, their heart, is completely pure; that the fully enlightened one, God, is compassionate to everyone, including them. Help them to think that their loving heart is oneness with God, that the kingdom of God is within. This frees people from guilt and anger, from their negative thoughts.

Mantra, for example, helps a person to eventually attain a higher rebirth after their positive karma is used up. Even if a person doesn’t want to hear mantra, still it leaves a positive imprint on the mind. Then sooner or later that person will meet the path and have the ability to practice the teachings, to clear obscurations and attain enlightenment. Even if someone gets angry hearing mantras and dies with an angry mind, it is still better than not hearing any mantras at all and staying peaceful. In this way, step-by-step, a person’s karma will bring them to the Mahayana path and to enlightenment. Someone on the Mahayana path will attain enlightenment, while an arhat gets stuck, even if the arhat starts off with the higher rebirth.

One way of thinking about this issue is to not recite mantras to a dying person if it causes the person’s mind to be unhappy, to generate anger, and to be disturbed at the time of death, so that he or she will not be reborn in the lower realms. However, by leaving imprints on the person’s mind, Buddha’s mantras offer the benefit that the person will not be reborn in the lower realms.

Even if a person becomes angry from hearing mantras, still, in the long run, they receive benefit, because the mantras leave imprints on the mind and bring them to enlightenment. This comes just through the power of hearing the Buddha’s mantras. Otherwise, although the person who is dying may have a happy mind, if you don’t recite mantras, you have done nothing to cause the person to achieve enlightenment, or to save him or her from the lower realms. Even though the dying person’s mind may be positive, if there is desire in the mind — for example, fear of separation from family and friends — then the person won’t have a peaceful mind when dying.

A person needs a positive mind in order to have a good rebirth. A positive mind means having non-anger, non-attachment, and so forth. Only then will the result be a good rebirth. Even if a person dies with anger, Buddha’s powerful words — mantras, sutras, and especially the tantric method of jangwa — can change their rebirth, because of their power.

You may think that to have a good rebirth, the person has to have a positive mind when dying. But the goal, what you are wishing for, is for the person to achieve enlightenment. This comes from leaving imprints on the person’s mind from the power of Buddha’s mantras, and so on. Even if they are temporarily reborn in the lower realms because they were annoyed by the mantras, nevertheless, because of the imprints left on the mind, they will later achieve enlightenment and liberation from samsara.

There is a story about Wusun, who was about to give teachings to 500 monks. They all would have achieved arhatship upon hearing them, but Manjushri arrived before Wusun, and gave them Mahayana teachings first. The 500 monks developed heretical thoughts toward the Dharma, and were reborn in the lower realms. Wusun went to the Buddha, and said that because Manjushri gave them Mahayana teachings, the 500 monks were reborn in the lower realms. The Buddha answered that this was very good, and that this was an example of Manjushri’s skillful means. If the 500 monks had just heard teachings on the lesser path from Wusan and achieved arhatship, they would still be there now in the state of arhatship, but because of Manjushri’s skillful means, they generated heretical thoughts and took rebirth in the lower realms for a shorter time, and then they achieved enlightenment.

Creating a Conducive Environment for Dying

Make the place as beautiful as possible; a calm, peaceful, serene, holy environment is so important. There should be beautiful views, beautiful art, flowers, images of deities and holy beings. Flowers give a very special spiritual feeling. The point is to make a positive imprint on the person’s mind. Because of being there, the person’s mind is elevated, and they are not afraid of dying.

The advice you give the person depends on what you have been doing yourself – the lam-rim, thought transformation – what you have been practicing in daily life, beyond mere sitting meditation. In general, the Mahayana has much to offer to the dying, or to anyone with problems. Highest yoga tantra is the only system that offers a real explanation of death. The precise instructions only exist in highest yoga tantra, not in other traditions. Other traditions give only general instructions; they do not provide explanations in terms of the subtle consciousness, winds, chakras, etc.

If one becomes accomplished at phowa and receives the signs of accomplishment, then this can be the best public service – liberating others and helping them at the time of death.

It is okay to ask lamas to do phowa; one can ask any Tibetan lama who is a good practitioner. The lama can do phowa wherever they are, from a distance. You will need to inform the lama which direction the head is facing.

When the Person is Dying

If you have studied the death process, you will be able to recognize the stages through which a person’s consciousness is passing, what elements are absorbing, and so forth, when the person is actually dying. It is better if the family members don’t cry within hearing distance, as this creates clinging in the mind of the dying person. There are sounds to help the consciousness at the time of death, sounds that benefit, such as mantras and so on. Other than this, it is best to keep quiet and don’t make any sounds. You should teach the family how to create this atmosphere.

It is okay to medicate pain in order to help the person to be able to think, but medicating for mental anguish is not advisable. Sedation of this sort before death prevents the person from exhausting negative karma. Anguish becomes fruitful if the person can experience it and finish the bad karma. It is hard to tell the difference. Often families want the patient medicated, but it is more for their own comfort than the patient’s.

At death, invite the Sangha to chant mantras nicely, in an uplifting way. When they chant like this, the person feels that nothing is more important than Amitabha Buddha. They feel protected, supported, and guided. Chanting the names of the Thirty-five Confession Buddhas is extremely powerful; people can come to the room and chant together. Also, it is good to chant the very powerful mantras of the five deities normally used in jangwa puja that liberate both those dying and those already dead. These mantras also purify living beings and liberate those in the lower realms. The text Giving Breath to the Wretched has powerful mantras and is also good to recite.

Place a stupa on the person’s chest or let them hold it. Each time the stupa touches them, it purifies negative karma. Even if the consciousness has already left the body, there is still benefit in touching the body with the stupa. This is also good to do with babies or with people who don’t understand. If the person is a non-Buddhist, say that the stupa is for peace or healing or purification. The person can visualize light rays coming from the stupa. It is also good to have a few stupas on hand for healing or to dispel spirit harm. Also, a sheet of paper with the ten great mantras written can be put on the dying person’s body (at the heart) while reciting a dedication prayer.

When the Breath has Stopped

The very first thing to do after the breath has stopped is Medicine Buddha practice. As a group or individually (and for animals as well), chant the names of the Medicine Buddhas and the mantra. Medicine Buddha made a promise that if anyone chants his name and mantra, all their prayers and wishes will succeed. The power of prayer has been accomplished by Medicine Buddha, so this practice is very powerful to make your prayers succeed. From among the ten powers, one is the power of prayer; pray as if you are the Medicine Buddha’s agent, on behalf of the being who has died. Then you can do Amitabha phowa, transference of consciousness to a pure land, followed by other practices.

Recite Sang Chö, The Prayer of Good Deeds, commonly known as The King of Prayers. At funerals, it is also good for everyone attending to read this prayer together. You can recite the Namgyälma mantra twenty-one times, then blow on water, sesame seeds, perfume, or talcum powder, and then sprinkle that over the dead body. The Namgyälma mantra is very powerful for purifying. It is best to recite the long mantra if possible, but the short mantra can also be recited. Also, if this mantra is written on cloth or paper and placed on a mountaintop or roof where the wind can blow it, whoever is touched by the wind receives blessings and their karma is purified. Circumambulating a stupa that contains the mantra purifies all the karma to be reborn in the hot hells.

In Tibet, after the breath stops, you would not touch the body until a lama in the village did phowa; this is important. Look for signs that the consciousness has left the body: the white drop, like pus or water from the nostril, or for a woman, blood and water from the lower part. Then, before moving the body, pull the hair in the center of the crown towards the back, so that the consciousness comes out through there.

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, relieving themselves, bathing and so forth. They have emotional needs – to be treated with respect, kindness and love; 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.

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’s 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. 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 (Buddha, Dharma and Sangha) is extremely useful in providing the strength and courage we need to face and deal with turbulent emotions.

If the dying person is a family member or friend, we will have the additional challenge of having to deal with our attachments and expectations in relation to him or her. Although it is difficult, the best thing we can do is learn to let go of the person. 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.

Giving Hope and Finding Forgiveness

Sogyal Rinpoche, in The Tibetan Book of Living and Dying (pages 212-213), says that two things that are very important in helping a dying person are giving hope and finding forgiveness. When dying, many people experience guilt, regret, depression or a sense of hopelessness. You can help them by allowing them to express their feelings, and by listening compassionately and non-judgementally. But encourage them to remember the good things they have done in their life, and to feel positive about the way they have lived. Focus on their successes and virtues, not on their failings and wrongdoings. If they are open to the idea, remind them that their nature is basically pure and good (in Buddhism we call this “Buddha nature”) and that their faults and mistakes are transitory and removable, like dirt on a window.

Some people may be concerned that their wrongdoings are so numerous and great that they could never be forgiven. If they believe in God or Buddha, assure them that the nature of God and Buddha is pure, unconditional love and compassion, so they always forgive whatever mistakes we make. If the person has no such belief, then what they need is to forgive themselves. You can help them to do this by encouraging them to express their heartfelt regret for their mistakes and ask for forgiveness. That is all they need to do. Remind them that whatever actions were done in the past are over and cannot be changed, so it’s best to let go of them. However, we can change from this moment on. If the person truly regrets her mistakes and wishes to transform herself, there is no reason she cannot find forgiveness. If there are specific people the person has harmed and who are still alive, encourage the person to express his regret and request forgiveness.

Sogyal Rinpoche says (p. 213):All religions stress the power of forgiveness, and this power is never more necessary, nor more deeply felt, than when someone is dying. Through forgiving and being forgiven, we purify ourselves of the darkness of what we have done, and prepare ourselves more completely for the journey through death.

How to Help Someone Who Is a Buddhist

If the dying person is a Buddhist, ask questions to find out how much they know and understand, and their answers 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 (Tib: Chenrezig, Skt: Avalokitesvara), 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 practicing on their own, due to pain or tiredness or a confused state of mind, do the practice with them.

If possible, place images of Buddha, Kuan Yin, Amitabha, and so forth within sight of the person. If he or she has any Spiritual Teachers, you can put their pictures as well. It’s also very beneficial to recite the names of Buddhas to the person, because the Buddhas have promised to help living beings avoid being reborn in states of suffering.

Speak to the person, 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, be cautious about teaching 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). Remember that 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, using standard Buddhist prayers, or by praying in their own words, in their own hearts. For example, they can pray to Buddha, Kuan Yin or whichever Buddha-figure they are familiar with, to be with them during this difficult time, to help them find the strength and courage to deal with their suffering, to keep their mind peaceful, and to guide them to a good rebirth in the next life.

Here is a simple meditation you could teach the dying person to do: ask them to visualize in front of them whatever Buddha-figure they have faith in, seeing it as the embodiment of all positive, pure qualities such as compassion, loving-kindness, forgiveness and wisdom. Light flows from this figure, filling their body and mind, purifying them of all the negative things they have ever done or thought, and blessing them to have only pure, positive thoughts in their mind. The person’s mind becomes oneness with the Buddha’s mind, completely pure and good. If the dying person is not able to do this meditation (e.g. if they are too ill, or unconscious) then you can do it for them, imagining the Buddha-figure above the person’s head.

Also, to help their minds be free of worry and anxiety, encourage them to not worry about their loved ones and their possessions—assure them that everything will be taken care of– 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.

How to Help Someone Who Is Not a Buddhist

If the dying person belongs to another religion, make an effort to understand what they know 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 confident that they will be 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. To do that would be disrespectful and unethical, and could cause them to become confused and disturbed.

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 “I’m not really sure. What do you think?” And take it from there.

If they genuinely wish to know about Buddhist beliefs and practices, it’s perfectly OK to explain these to them. You can talk about the Buddha’s 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.

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’s 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!

My brother had been ill with hepatitis C for some years…they had discovered several malignant tumours on his liver and lungs…Lama Zopa Rinpoche gave me specific instructions for helping Malcolm prepare for his death…upon arrival in Australia, I met up with my sisters and went immediately to the hospital…he lay still and lifeless…he woke, and his eyes widened in disbelief that I was there…I carefully dropped the tiny speck of precious relic into his mouth.

Here are some observations written by my sister Louise, a proclaimed skeptic: “In the weeks leading up to this point, Malcolm had been extremely difficult and impatient with everyone, particularly mum and dad…it was shocking and distressing…Pam placed the special relic in his mouth telling him about its extraordinary qualities…next day…it was obvious to all that Malcolm was in a totally different state of mind…he was much calmer, and while still in great pain, very loving, especially towards our parents…his anger and self-pity were gone.”

So we went back to our parents’ home and slowly settled into regular sessions of recitations, visualizations and teachings…Malcolm was a spiritual, sensitive musician and poet who, like many of the sixties generation, sought bliss and relief from samsara in drugs and intoxicants…they not only stole his happiness, they stole his life as well…but even though he hadn’t had many teachings, he had a strong conviction in the Dharma.

On Sunday we thought that Malcolm was very near to death…I called…Land of Medicine Buddha (California)…and kept Malcolm informed of all the prayers and pujas that are being done for him around the world…throughout the day and night we took turns reading “The King of Prayers”, special mantras for the time of death, “Heart Spoon” by Pabongka Rinpoche, Vajrasattva and Shakyamuni Buddha purification visualizations and mantras and reading from “Wisdom Energy 2”…Christopher, Dale and I also did a Medicine Buddha Puja with Malcolm…afterward…he looked like he was in a deep, blissful meditation.

Last week, Malcolm vomited a large amount of blood…the doctor thought he would die from bleeding…as instructed by Rinpoche, I put the prescribed prayers on his crown, mantras on his chest, and a blessing pill in his mouth…the nurses believe it was nothing short of a miracle and they are convinced the pill stopped the bleeding.

Rinpoche told me to go over and over the death process with Malcolm…tell Malcolm that when he sees the clear light of death, he should know that THIS is the Buddha’s mind, the clear light, and that he should STAY in the clear light…Karuna sent this inspiring email to Malcolm: “Thank you for your kind generosity…it is really a great gift to give people hope…you are showing them that death is nothing more than a transition…His Holiness said last year; “Death is just another state of consciousness.”

In the final weeks, he renounced methodone and proclaimed heroin to be the greatest regret of his life…his primary palliative care nurse wrote: “Caring for Malcolm…has been a highlight in my twenty-seven year nursing career…I hope that I can put into practice all that you and Malcolm taught me about dying”…our parents, although they are not Buddhist, were very open-minded and patient with all of the changes taking place in their home…two of their daughters, a son-in-law, and two of their grandsons were doing Buddhist prayers and pujas throughout the day and night…our mother even remarked a few times: “I want you to do this for me when it is my time to die”.

At the end, we placed mantras on Malcolm’s chest, Kalachakra sand and a phowa pill on his crown and a blessing pill in his mouth…we were able to place him on his right side…he totally relaxed, took three short puffs in and three long breaths out.

Malcolm took his entire family on an extraordinary journey of discovery and transformation, guided by our impeccable and infallible guide, Lama Zopa Rinpoche.

M. Silent Prayers for the Sick, the Dying or the Dead

These prayers can be said at any time in any place, because they are done silently, with your own mind. They can be useful when you are with your loved one in their room, or by their bed, even when others are present.

Prayers

“May you be well and happy; if not, may you have a peaceful death and a good rebirth.”

“I am visiting this sick/dying person in order to help him/her to have less suffering, and also to create the causes to become enlightened so that I may help all beings be freed from suffering”

“Just as I am now helping this person, may I one day be able to help all beings to be free of all suffering and to attain enlightenment.”

“May this person be freed from all their pain and suffering and completely recover and find new meaning and fulfilment in their life. Or, if that is not possible, then may they be freed of pain and suffering sufficiently to have a peaceful and virtuous death, and be reborn in a Pure Land where they can get enlightened. Or at least may they have a precious human rebirth, meet a spiritual teacher and quickly become enlightened.”

Visualization

“Visualize Medicine Buddha or another Buddha (Shakyamuni, Avalokitesvara, etc) above the crown of the sick/dying person’s head. Imagine white light nectar flowing down from the Buddha into the person’s crown and completely filling their body, purifying their body of all disease, spirit harm, negative karma and defilements, which manifest as thick, black smoke that passes out of the lower part of their body and completely disappears. Now imagine yellow light nectar filling the person’s body with compassion, loving kindness, forgiveness and wisdom, and blessing them to have only pure, positive thoughts in their mind. Imagine further that the person’s mind becomes one with the Buddha’s mind, completely pure and good.”

Tonglen

“Summon and invoke the presence of all the buddhas, bodhisattvas and enlightened beings, so that, through their inspiration and blessing, compassion may be born in your heart. Now imagine that every aspect of the person’s pain, distress, and suffering manifest together and gather into a great mass of hot, black, grimy smoke. With your in-breath imagine that this black smoke streams out of the person and gathers around you as a cloud. With each in-breath drain that person’s suffering away until it has entirely disappeared.

Now imagine that all your selfishness, self-grasping and self-cherishing manifests as a hard black rock at your heart. With your out-breath, imagine that the cloud is transformed into a huge bolt of lightning that strikes at the rock of self-grasping at your heart and shatters it into a million pieces that scatter and dissolve completely. Continue with each out-breath until your self-grasping is totally destroyed and the black cloud around you has disappeared, and with it all the dying person’s pain and suffering.

Imagine now that the heart of your enlightened mind, your bodhicitta, has been revealed. As you breathe out, then, imagine that you are sending out its brilliant, cooling light of peace, joy, happiness, and ultimate well-being to your friend in pain, and that its rays are purifying all their negative karma. At the moment the light of your bodhicitta streams out to touch your friend in pain, feel a firm conviction that all of his or her negative karma has been purified, and to feel a deep, lasting joy that he or she has been totally freed of suffering and pain.“

Loving Kindness Meditation

One of the hardest things about suffering is the feeling that we are trapped in our painful circumstances – lost, hopeless and alone. We fear our suffering will go on forever, and that there is no way out of it. And when we don’t know how to transform or heal our own suffering, we may find it difficult to be with and support others in distress. Before we can extend compassion toward others, we must first feel love. If we find our own heart is wounded or walled up, the Loving Kindness Meditation can help reconnect us to the source of love within. Once this love opens our heart and heals our pain, then we will be able to offer our genuine love and fearless compassion to others.

Sit quietly, and let all the scattered aspects of your mind and energies settle down. Acknowledge and embrace gently any suffering or struggle that you become aware of.

Now, remember a person from your life who once loved you very much. Imagine this person sitting in front of you at this very moment, extending his or her love to you once again. It’s alright if you can recall only one happy memory with the person – make that memory of love your entire experience and bathe in its healing warmth.

Feel the other person’s love coming towards you like rays warm rays of sunlight, permeating your entire being, and especially filling and warming your heart. If there is an old barrier around your heart, see it not as a massive or impenetrable wall, but as a fragile or thin layer of ice. Let the love flowing toward you melt the ice of your old hurt or fear, warming and nourishing your heart.

As this healing love comes into you, you feel your heart overflowing with love and gratitude. You feel peaceful, whole and replenished with love. Naturally, your love and gratitude now goes out to the person who evoked it, wholly and unconditionally.

Once this giving and receiving of love is flowing strongly, expand the direction of your love another degree. Imagine that your friend who is in pain or who is suffering and dying is in front of you. Extend the same love to them, fully and joyfully. See your love as white light/nectar and send it straight to their heart, filling them with peace and happiness. Feel that their whole body becomes peaceful, pure white light, and that they can rest in joy and peace, at least for a few moments.

If time is short, you can finish the meditation here and dedicate the positive merit you have generated to all sentient beings, wishing that they may quickly reach their full and complete potential.

Otherwise, continue and consider now that on either side of this central person are other people in your life whom you love and cherish, and extend the same love to them, fully and unconditionally. Then extend your love to encompass even those you don’t know very well: co-workers, shopkeepers, neighbours, even strangers you pass on the street. Expanding your love further, visualize that in front of you are those who irritate you, those you’ve been angry with, or those who seem to be your enemies. Extend the same love to them, fully and completely, loving and accepting them exactly as they are.

Finally, expand your love to embrace all beings. Consider now that the whole space in front of you is filled with beings throughout the universe, all forms of conscious life, including the tiniest insect, and even those who have died. Now your love is boundless and unbiased, and it shines powerfully onto each and every one, extending happiness to all existence.

As you conclude his practice, don’t shake off the inspiration, awareness, or limitless love it has aroused. Instead, as much as you can, continue practising the essence of this meditation throughout the day, extending unconditional love firstly to yourself but at the same time toward everyone you meet.

The Compassion Practices of Tonglen

The Loving Kindness Meditation helps to reawaken our inherent capacity to give and receive love, and the compassion practices take us one step further. They are designed to completely eliminate the source of our suffering: our belief in and identification with our selfish ego.

By reflecting on the immense suffering that all beings, everywhere, experience, our compassion becomes deeper and more limitless. We wish to free all beings from their suffering and even its causes; we desire, more than anything, to bring them happiness and peace.

Compassion is a far greater and nobler thing than pity. Pity has its roots in fear, and a sense of arrogance and condescension, sometimes even a smug feeling of, “I’m glad it’s not me.” Compassion is the deep and genuine wish that others be freed from their suffering and its causes. When you meditate deeply enough on compassion, there will arise in you a strong determination to alleviate the suffering of all beings, and an acute sense of responsibility toward that noble aim.

One way of mentally directing this compassion and making it active is to pray to all the buddhas and enlightened beings, from the depths of your heart, that everything you do, all your thoughts, words, and deeds, should only benefit other beings and bring them happiness. In the words of one great prayer: “Bless me into usefulness.” Pray that you benefit all who come into contact with you, and help them transform their suffering and their lives.

Another powerful way of extending our compassion to others is the practice of tonglen. Tonglen means “giving and receiving”. In the tonglen visualization, we receive, with a strong compassionate motivation, the suffering and pain of others; and we give them, with a tender and confident heart, all of our love, joy, well-being and peace. Normally, we don’t want to give away our happiness, or take on another person’s suffering, but this not-wanting is the voice of our selfish ego. The voice of your ego may warn you that tonglen could “harm” you but this is not true. The compassion practices are designed to unravel the selfish patterning of the ego, and gradually reinforce your confidence in the radiant wisdom and compassion of your true nature, which is indestructible.

Before beginning any of the tonglen practices, spend some time in meditation, settling your mind and energies, and arousing your compassionate motivation for doing the practice.

The Main Tonglen Practice

The process of taking and giving that finds its complete expression in the main practice of tonglen. We take on, through compassion, all the various mental and physical sufferings of all beings: their fear, frustration, pain, anger, guilt, bitterness, doubt, and rage, and we give them, through love, all our happiness, and well-being, peace of mind, healing and fulfilment. In particular, the practice can be directed toward one person whom you wish to help, and then expanded to all sentient beings.

1. Before you begin with this practice, sit quietly and bring the mind home. Then, making use of any of the exercises or methods above, whichever one you find really inspires you and works for you, for example, the Loving Kindness meditation, meditate deeply on compassion. Summon and invoke the presence of all the buddhas, bodhisattvas and enlightened beings, so that, through their inspiration and blessing, compassion may be born in your heart.

2. Imagine in front of you, as vividly and poignantly as possible, someone you care for who is suffering. Try and imagine every aspect of the person’s pain and distress. Then, as you feel your heart opening in compassion towards the person, imagine that all of his or her sufferings manifest together and gather into a great mass of hot, black, grimy smoke.

3. Now, as you breathe in, visualize that this mass of black smoke dissolves, with your in-breath, into the very core of the self-grasping at your heart. There it destroys completely all traces of self-cherishing, thereby purifying all your negative karma. You may wish to imagine that your selfish ego, your obsessive self-cherishing, manifest at your heart in the form of a hard stone, and that the hot black smoke of the other’s suffering smashes the stone into a billion pieces that dissolve and completely disappear.

Also, instead of doing the visualization on one in-breath, you may wish to take it gradually, and as you remove the suffering from your friend with each of several in-breaths, let it build up as a black cloud around you, and then on an out-breath, let if stream toward the stone of selfishness at your heart and destroy it. Choose whichever method works for you.

4. Imagine now that your self-cherishing has been destroyed, so that the heart of your enlightened mind, your bodhicitta, has been revealed. As you breathe out, then, imagine that you are sending out its brilliant, cooling light of peace, joy, happiness, and ultimate well-being to your friend in pain, and that its rays are purifying all their negative karma.

5. At the moment the light of your bodhicitta streams out to touch your friend in pain, it is essential to feel a firm conviction that all of his or her negative karma has been purified, and to feel a deep, lasting joy that he or she has been totally freed of suffering and pain. Then, as you go on breathing normally, in and out, continue steadily with this practice.

What more wonderful and consoling gift could you give to the dying than the knowledge that they are being prayed for, and that you are taking on their suffering and purifying their negative karma through your practice for them? Even if they don’t know you are practising for them, you are helping them and in turn they are helping you. They are actively helping you develop your compassion, and so purify and heal yourself.

The tonglen practice is also effective if the person you care for has already died. If they have died recently, and are still in the intermediate state or bardo, if you can help to purify and pacify their minds, it will make a precious human rebirth more likely for them. If they have been reborn, in whatever realm of existence, you can benefit them by taking on any current suffering and difficulties they may have, leaving them pure and clean and whole, and ready to meet the Mahayana Path and quickly become enlightened.

The Holy Secret

You may be asking yourself this question: “If I take in the suffering and pain of others, won’t I risk harming myself?” If you feel at all hesitant, just imagine yourself doing it, saying in your mind, “As I breathe in I am taking on the suffering of my friend, and as I breathe out, I am giving him happiness and peace.” Again, if you feel unable to do the whole practice, you can also do tonglen in the form of a simple prayer, deeply aspiring to help others. You might pray, for example: “My I be able to take on the suffering of others; may I be able to give my well-being and happiness to them.”

The one thing you should know for certain is that the only thing that tonglen could harm is the one thing that has been harming you the most: your own ego, your self-grasping, self-cherishing mind, which is the root of suffering. As Shantideva says:Whoever wishes to quickly afford protectionTo both himself and othersShould practice the holy secret:The exchanging of self for others.

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