In discussing the spiritual needs of the dying from the Buddhist perspective, we firstly need to look at several key points, namely :
Reflections On Death
In order to gain an understanding of the shortness and preciousness of life and how to make it meaningful we need to reflect on the fact that death is certain and that the time of death is uncertain. These points may seem obvious but we rarely stop to consider the truth of them.
For example, when we consider that death is certain we can reflect on several points:
1) there is no possible way to escape death (nobody ever has),
2) life has a definite, inflexible limit and each moment brings us closer to the end of this life, and
3) death comes in a moment and it’s time is unexpected (and even while alive we devote very little of our life to spiritual practice).
When reflecting on the fact that the time of death in uncertain we can analyse this further by recognising that:
1) the duration of our lifespan is uncertain – young people can die before old people, the healthy before the sick, etc.
2) there are many causes and circumstances that lead to death but few that favour the sustenance of life – in fact even the things that sustain life and make it comfortable can kill us e.g. food, our house, our car.
3) the weakness and fragility of our body contributes to life’s uncertainty –
our body can be easily destroyed by disease or accident.
Reflecting on these points can help us to realise that life is short and precious and that there is no time to lose. It is good to remind ourselves of these points each day. It can be very helpful when first getting up each day to say to ourselves “today may be the last day of my life, let me live it therefore by making it as meaningful as possible, being of benefit to others, etc.”.
It can also be very helpful to consider how we would react if we were told, for example, that we only had 3 or 6 months to live, to ask ourselves questions like:
The other critical point is to consider what will help us at the time of death. Reflection here reveals that:
1) worldly possessions such as wealth, position or money can’t help us
2) relatives and friends can neither prevent death nor go with us
3) even our own precious body is of no help to us and we have to leave it behind.
So ultimately the only thing that can help us is the state of our mind, the state of our mental or spiritual development.
Karma and the mind
How is this so? The Buddhist belief is that every action of body, speech and mind that we create lays down a subtle imprint in our mind which has the potential to ripen as future happiness or suffering, depending on whether the action was positive or negative. These imprints remain in the mind until they ripen or until they are purified or cleansed by spiritual practices. This process in known as the law of karma.
The mind itself is formless, shapeless, colourless, genderless, and has the ability to know or cognize all phenomena. It’s basic nature is luminous and knowing. The mind also has different levels – gross, subtle, and very subtle. The very subtle mind is very clear and is usually only experienced at the time of death or during advanced meditation practices. The imprints of our actions (karmic imprints) are stored in the very subtle mind.
Death, intermediate state and rebirth
At the time of death, the body and mind go through a process of dissolution, where the 25 psycho-physical constituents that we are comprised of gradually absorb and lose their ability to function.  This process of dissolution is associated with external and internal signs. This process continues even after the breathing ceases, for up to 3 days.
During this process the mind becomes more and more subtle and clear until it eventually reaches the point of the ‘clear light of death’, where it is said to be approximately 9 times more clear than in the normal waking state. At this point the mind separates from the body, taking with it all of the subtle imprints from that life and previous ones.
This very subtle mind or consciousness and the very subtle wind upon which it rides then arises into an intermediate state (bardo) being which has a subtle (non-physical) body that can move through solid objects, travel anywhere just by thinking of that place, and so on. The intermediate state being stays in that state for up to 7 weeks, by which time a suitable place of rebirth is usually found. This place of rebirth is determined by the force of karma, whereby the intermediate state being dies and the consciousness is propelled without control towards the place of rebirth. The consciousness enters the fertilized egg at or near the moment of conception and the new life begins.
Crucial in this whole process is the state of mind at the time of death, because it is this that determines the situation a person will be reborn into. If the mind is calm and peaceful and imbued with positive thoughts at the time of death, this will augur well for a happy rebirth. However, if the mind is in a state of anger or has strong desire or is fearful etc, this will predispose to an unhappy or lower type of rebirth.
The mind that arises at the time of death is usually the one that the person is most habituated to. People tend to die in character, although this is not always so. So in the Buddhist tradition it is emphasised strongly that the time to prepare for death is now, because if we develop and gain control over our mind now and create many positive causes we will have a calm and controlled mind at the time of death and be free of fear. In effect, our whole life is a preparation for death and it is said that the mark of a spiritual practitioner is to have no regrets at the time of death. As a friend of mine said recently on hearing about these concepts, “Perhaps it’s time I started swotting for the finals!”
The Spiritual Needs of the Dying
When considering the spiritual needs of the dying, the basic principle is to do whatever you can do to help the person die with a calm and peaceful mind, with spiritual/positive thoughts uppermost. This is because it is believed that the state of mind at the time of death is vitally important and plays an important role in determining what will happen to the person after death.
So whether we are a doctor or nurse relieving pain and other distressing symptoms and reassuring the family, a counsellor helping to resolve emotional issues, a minister of religion offering spiritual counsel, or a volunteer who offers companionship and support for the dying person and their loved ones, we are all contributing significantly towards obtaining this calm and peaceful state of mind.
Within this basic principle, there are several ways we can categorise people which will help to determine the type of spiritual support that they need, namely:
Is the person conscious or unconscious?
Does the person have specific religious beliefs or not?
For a person with a spiritual faith it is beneficial to have spiritual objects around them e.g. an altar, a rosary, photos of their spiritual teacher, or to play spiritual music, or to burn incense, and so on – whatever reminds them of their spiritual practice. It is good also to talk to them about their spiritual practices, recite prayers with them and so forth. For an unconscious person it is said to be good to recite prayers, mantras etc into their ear.
If a person does not have a spiritual faith, it is helpful to remind them of positive things they have done in their life, or of positive qualities such as love and compassion and kindness.
It is important to avoid religious activities that are inappropriate or unwanted by the dying person. Someone standing at the end of the bed reciting prayers may be an annoyance, and I have seen a case of an attempted deathbed salvation which greatly angered the dying person.
The basic aim is to avoid any objects or people that generate strong attachment or anger in the mind of the dying person. From the spiritual viewpoint it is desirable to avoid loud shows of emotion in the presence of the dying person. We have to remind ourselves that the dying process is of great spiritual importance and we don’t want to disturb the mind of the dying person, which is in an increasingly clear and subtle state. We have to do whatever we can to allow the person to die in a calm/happy/peaceful state of mind.
Meditations for sick and dying people
For those who have advanced illness but are still conscious there are a number of simple meditation techniques or visualisations that can be very helpful.
For those who are anxious or fearful of dying, teaching them relaxation or guiding them through a simple relaxation technique can be very beneficial. I will usually leave them a relaxation tape that they can use any time of day or night, whenever the need arises. When appropriate, touch, massage, reflexology and similar techniques can also be very soothing and stress-relieving, especially as the person may be somewhat starved of touch due to the fears and awkwardness of people who visit them.
A simple meditation technique that is very effective is awareness of the breath. The person becomes aware of the movement of the breath inwards and outwards at the level of the nostrils, breathing naturally and easily, not forcing or exaggerating the breath. At the same time, any thoughts that arise are let go of, constantly bringing the mind back to the breath. This technique, although simple, can generate very calm states of mind and relieve anxiety.
When the awareness of breath is then combined with the recitation of certain words or mantras or prayer it becomes very powerful. Just to say “Let…go…let…go…” in time with the in and out breaths can be soothing and relaxing. A person with a spiritual belief can use a prayer or mantra with the breath. For example, one lady whom I was visiting who was an ex-Catholic nun chose the prayer “not mine, Lord, but thy will be done”. She shortened this by reciting “Not my will” on the in-breath and “but yours” on the out-breath, repeating this over and over again.
The beauty of this technique is that 1) it can be done for short periods of time and requires little concentration, which is often reduced by the effects of disease and medication, 2) it helps to calm the mind and reduce anxiety, 3) it utilizes and strengthens the person’s spiritual refuge, 4) it does not require anything other than the breath.
For both a religious and a non-religious person a white light ‘healing’ meditation can bring a lot of comfort and benefit. The person visualizes a brilliant ball of white light above their head, with the light streaming down through their bodies, removing sickness, pain, fear, anxiety and filling the body with blissful healing light energy. Depending on the person’s belief system, they can see the light as being in the nature of Jesus, or Buddha or some other spiritual figure, or they can just visualise it as a source of universal healing energy. This meditation combines very well with the breath awareness technique and is also good to have on tape to leave with the person, to be used whenever needed day or night. When a person is close to death they can also be encouraged to let go into the light, into the heart of Jesus or Buddha seated above their head, whatever is appropriate for that person.
The use of guided imagery or gentle music can also be soothing and relaxing and help the person to have a calm and peaceful mind as they approach death.
A person in pain can also be guided through a pain meditation, a technique whereby the pain is explored in detail, often leading to a reduction or eradication of the pain.  A very profound meditative technique is to actually use the illness or pain as a way of developing compassion. For those who can use this technique the results can be very great. The person is encouraged to think that “by me experiencing this cancer/AIDS/pain etc, may all other beings in the world be free of this, and may they have good health, happiness and long life”. The person uses their sickness or pain as a way of opening their heart to others who are in a similar situation. People who have used this technique have often gone from being totally caught up in their own misery to a state of open-heartedness and peace.
An even more advanced technique is the meditation on “taking and giving on the breath” as described in the Tibetan Buddhist scriptures. In this meditation, one visualises taking on the suffering of all other living beings (or this could be restricted to those with cancer or AIDS etc) in the form of black smoke, which is taken in on the in-breath. Then on the out-breath all of our health and happiness and all positive qualities are sent out to other living beings in the form of white light, and we visualise them receiving everything that they want. At our heart we visualise a black rock of selfishness, and as the black smoke is inhaled we visualise it hitting the black rock and smashing it completely, thus eradicating all trace of selfishness from our minds.
This meditation is a profound method for developing compassion quickly but there will only be a minority of patients who will be able to use this method. The usual way to progress in these meditations is to start with small problems such as a headache or tiredness etc, then gradually train our minds to transform bigger and bigger problems.
The aim of all these methods is to help the dying person die with a calm, happy and positive mind. Anything that we can do to achieve this will benefit the person, whether that be good nursing care and pain relief, massage, the presence of a loving family, or whatever. It is said that the best thing we can bring to a dying person is our own quiet and peaceful mind.
In this way we will help the dying person make the transition from this life to the next as smooth and as meaningful as possible, recognising the vital spiritual importance of this transition.
My wish is that this short paper may in some way be of benefit to those who read it and reflect on it, and hence to the sick or suffering people that you serve.
Last revised August 1995
Fremantle, Francesca and Chogyam Trungpa, The Tibetan Book of the Dead: The Great Liberation Through Hearing in the Bardo, Shambala, Boulder and London 1975.
(or the new translation by Robert A.F. Thurman, Aquarian Press, London, 1994)
Kapleau, Philip, The Wheel of Life and Death, Doubleday, New York, 1989.
Lati Rinbochay and Jeffrey Hopkins, Death, Intermediate State and Rebirth in Tibetan Buddhism, Rider & Co, London,1979.
Levine, Stephen, Healing Into Life and Death, Anchor Press/Doubleday, New York, 1987.
Levine, Stephen, Who Dies, Anchor Press/Doubleday, New York, 1982.
Mackenzie, Vicki, Reincarnation: The Boy Lama, Bloomsbury, London, 1988
Mackenzie, Vicki, Reborn in the West: The Reincarnation Masters, Bloomsbury, London, 1995
Mullin, Glenn H., Death and Dying: The Tibetan Tradition, Arkana, London, 1986.
Sogyal Rinpoche, The Tibetan Book of Living and Dying, Rider, London, 1992.
 see “Death, Intermediate State and Rebirth” by Lati Rinbochay and Jeffrey Hopkins or my paper on “Death and Dying in the Tibetan Buddhist Tradition” for full details of this process.
 for full details of this technique, refer to “You Can Conquer Cancer” by Ian Gawler, pp 177-180 or to my paper “Relaxation Therapy and Meditation in Pain Control”.