This document was prepared by the Drepung Loseling Monastery (DLM) Member Eldercare Group of Atlanta, Georgia, in consultation with DLM teachers, Geshe Ngawang Phende and Geshe Dadul Namgyal. It was developed for an August 20, 2017 DLM Member Eldercare Special Discussion on Buddhist End-of-Life Practices and Care. It includes important principles that Buddhist practitioners can use to guide their end-of-life spiritual preparation and practice—as well as guidance for the caregivers and loved ones of the dying practitioner.
1. It is very important for all Buddhist practitioners to study and practice the dharma while they are able to do so—the sooner the better, because the time and manner of one’s death is uncertain.
2. Practitioners should become familiar with the physical and mental stages of dying and how to best transition through them to a good rebirth.
3. Diminish physical obstacles for a peaceful death by having advance healthcare directives and communicating them to your caregivers and loved ones.
4. Diminish spiritual obstacles for a peaceful death by writing down your preferences for spiritual practices (a dharma will) and communicating them to your caregivers and loved ones.
5. During the early stages of dying following the diagnosis of a terminal condition, it is important for practitioners to fully accept the reality of their impending death.
6. To prepare for growing confusion or loss or mental clarity, the practitioner can keep a visible picture of a significant deity or spiritual master in the room.
7. During the final stages of dying, the practitioner should:
a) do your dharma practice to remain positive and altruistic
b) if needed, use medication for pain and symptom management to maintain mental stability
c) accept whatever happens at the time of death; take everything in stride
d) try to keep your last minute/moments virtuous
Caregivers and Loved Ones of Buddhist Practitioners
1. To support the transition of a practitioner, caregivers and loved ones can help by providing a peaceful and supportive environment as the practitioner approaches the end of life.
2. Caregivers and loved ones should remind the practitioners to do their core practices.
3. To help alleviate a practitioner’s fear and anxiety, caregivers and loved ones can provide:
a. reminders of their guru and other respected teachers—including their photos
b. practice aids that are viewed as helpful to them—such as thangkas or mandalas
c. printed matter, recorded teachings, mantras, or prayers related to the practitioner’s practice
d. recitation of a bardo or other end-of-life sutra can be beneficial, if the practitioner is familiar with it
e. a calm setting with no conflict and minimal distractions
f. quiet companionship and, if beneficial, soft music, touch, or massage
4. Caregivers and loved ones should become familiar with the physical and mental stages of dying and how to best help the practitioner through them to achieve a good rebirth.
5. Loved ones can support the practitioner’s end-of-life wishes and communicate these wishes to the practitioner’s caregivers and spiritual community.
Additional End-of-life Principles for Traditional Practitioners of Tibetan Buddhism
1. Traditional practitioners of Tibetan Buddhism believe that death occurs when one’s mind or consciousness leaves the body through the central channel, hours or days after the cessation of breathing and blood circulation.
2. The body of a dying traditional practitioner is generally not disturbed after breathing has stopped, until it is believed that the practitioner’s consciousness has left the body.
3. A clear sign of a traditional practitioner’s death is when bodily fluids come from the nostrils or other body openings.
4. Most Western hospitals and long-term care facilities do not offer an environment that is conducive to traditional Tibetan Buddhist end-of-life practice.
5. Most Western hospitals, long-term care facilities, and in-patient hospices are required to move the body within hours of the cessation of breathing and blood circulation.
6. The optional practice of organ donation often requires removal of the organ within hours of the cessation of breathing and blood circulation; thus, it can conflict with practices associated with a traditional Buddhist death.
7. If the body must be moved or touched soon after clinical death but before Tibetan Buddhist death, it is customary to first touch the crown of the head to help open up the practitioner’s central channel.
8. Dying in a home or hospice facility that can accommodate and support traditional Buddhist practice is desirable, but often not possible in the West.
9. A sangha member or Buddhist hospice worker could do a phowa practice at the time of death to help propel the practitioner’s consciousness into a pure land.
10. Most traditional practitioners of Tibetan Buddhism have their bodies cremated following death.
11. At the time of burial or cremation, special prayers are typically said to bless the remains.
12. One’s ashes can be buried or scattered on a mountain, in a forest, a river, a lake, the ocean, or a sacred place. Some of the ashes can also be blessed with special rituals and mixed with clay or other casting material to make a statue in the form of a buddha.
13. During the 49-day bardo period following death, special rituals are typically performed every day to console the dead and alleviate their sufferings during the transition period.
14. Special pujas can be held during the bardo period, every seventh day until the 7th week, i.e., the 49th day, to help remove obstacles for a good rebirth and to benefit the family and friends of the practitioner.