Notes on a Theravada Approach to Spiritual Care to the Dying and the Dead By Gil Fronsdal
Notes on a Theravada Approach to Spiritual Care to the Dying and the Dead
(Originally written for people offering Buddhist Spiritual Care)
By Gil Fronsdal
Death and dying have central roles in Theravada Buddhism, as they do in most Buddhist traditions. They are important catalysts for engaging in Buddhist practice and are frequently used as themes of reflection to deepen one’s practice. In offering spiritual care to Theravada Buddhists one should be prepared to respond to people’s needs and concerns related to death. For example, Buddhist monastics, teachers and chaplains may be called on to discuss existential issues related to our mortality, offer instructions in Buddhist practices related to death, counsel and guide the dying, and offer support to family and friends of the dying or the dead. In addition, an important role for spiritual care givers may be to officiate funerals and memorial services.
While different Buddhist traditions have varied customs around dying and death, an enduring understanding in all these traditions is that death is not a final end. For people who are not fully enlightened rebirth follows death. For those individuals who are fully awakened it is considered impossible to make any assertion what happens after death, including the idea that they are or are not reborn. However, even though Buddhist traditions share in the idea of rebirth, there are differences among some of the traditions in how they understand the various destinations and forms of rebirth a person might take. There are also differences within traditions (and between Buddhist teachers) in how much emphasis or importance is placed on the notion of rebirth. For some, the emphasis is on practicing fully in this life without any thought for what will follow. For others, planning for and arranging for favorable rebirths is the central thrust of their religious practice. The notion of rebirth often brings much solace to those who are distressed by the alternative. However, there are many people for whom the idea of rebirth is itself distressing as they imagine some of the unfortunate circumstances they may be headed for. In classic Indian Buddhism being stuck in an endless cycle of birth, death and rebirth is considered undesirable and the ultimate direction of Buddhist practice is to be released from this cycle. It is understood that the fuel for further rebirth is clinging and once this fuel has been fully dissolved, death will not lead to further rebirth.
Whether one believes in the literal idea of rebirth or not, all Buddhists understand that clinging also fuels the constant cycle of suffering that is born and dies in our minds each unliberated moment. The work of waking up and becoming free of these momentary cycles is the same work as becoming free from the cycles of rebirth. For many Buddhist practitioners, believing in rebirth over lifetimes is a great motivator for their practice. For some people this belief can lead to complacency if they put off practicing until a future lifetime.
Whether one believes in rebirth or not, dying is a time when we are confronted with life’s deepest truths. To be able to learn and be transformed by these truths is one of the ultimate tasks of Buddhist practice.
Preparing for Death
In all circumstances connected to death and dying, the most important offering of the Buddhist chaplain is his or her own equanimity and lack of conflict regarding death. Engaging in reflections and practices that prepare one for death is perhaps the most important preparation the chaplain needs to be ready to respond wisely and compassionately to people facing issues of death and dying. An important role of Buddhist chaplains is to encourage people to consider the reality of death. To do this with authenticity and credibility, the chaplain needs to have done this for herself or himself.
Theravada Buddhism encourages people to prepare for death. This preparation is considered part of living a mindful, conscientious life. Preparing helps make the circumstance of dying easier for everyone concerned. There are both practical and spiritual aspects to such readiness. To have our affairs in order simplifies our own life when our death approaches and so it is easier to focus on what is most important at this time. It is also an expression of goodwill for our family and friends since it simplifies their work in caring for us and our possessions both before and after our death. To be spiritually and emotionally prepared for our death optimizes the chances that we can use the period of dying for its unparalleled opportunity for Buddhist practice. When appropriate, chaplains should encourage people to be prepared for their death. In a sense, all Buddhist practice prepares a person to die. For example, people who meditate regularly will generally have less fear of death than people who don’t.
They will have developed some of the inner qualities that help bring balance and equanimity in the face of death. With the development of concentration, the mind tends to remain more balanced and less reactive than a mind without this stabilizing force. With the development of mindfulness meditators have a deep appreciation of moment to moment impermanence, i.e., the birth and death that happens every instant. This can also provide the trust or confidence to go along with the letting go process that dying is. Because it helps us to be present for what is happening without being caught by aversion, desire or doubt, the best single preparation for death is mindfulness meditation. Also, the insights of mindfulness practice are the springboards to liberation. The ability to practice mindfulness on one’s deathbed is considered one of the most opportune times for liberation.
In addition, Buddhism encourages people to take the time to actually contemplate the topic of death. Instead of avoiding the topic, one is encouraged to confront it as directly as possible and to recognize that death is inherent in life. Some teachers instruct practitioners to maintain death as a constant companion. One way to do this is to wear a mala or Buddhist “prayer beads” made of bone, each bead sculpted in the shape of a skull.
There are other benefits from maranasati (contemplation of death) beyond its value in preparing for death. For example, it can help keep one’s priorities straight and it can be a catalyst for getting serious about one’s spiritual practice. In fact, Milarepa, the great Tibetan yogi said, “Without mindfulness of death, whatever Dharma practice you take up will be merely superficial.” Confronting death directly also allows us to work through our fear, aversion and confusion around death. Done well, the contemplation of death can help bring a deep sense of peace and well being.
In the discourses of the Buddha, the contemplation of death is integrated with the overall development of mindfulness. The sutta on the Four Foundations of Mindfulness lists nine different contemplations on a corpse at different stages of decay. It is not clear in this discourse whether one is to look at an actual corpse or one is to imagine a corpse. In either case, one is to remind oneself that as this corpse has the nature to decay, so one’s own body has the nature to decay as well. Since nowadays bodies are not allowed to decay in charnel grounds, some people have adapted this practice to one of visiting hospitals or morgues where one might have permission to sit with a corpse. Sometimes people will use a photo of a dead person as a focus of this contemplation.
Classically, in Theravada Buddhism, meditators are encouraged to practice reflecting on the “four protections” which are said to support the deepening of meditation practice. These four are the contemplation of the qualities of the Buddha to protect us from doubt and discouragement, the practice of loving-kindness for anger, contemplating the unappetizing aspects of the body to calm desire, especially sexual desire, and the contemplation of death as a protection from heedlessness and laziness.
- A. Awareness of the Inevitability of death
- B. Awareness of the time of Death
- C. Awareness that only Insight into Dharma can help us at the time of death
- 7. Reflecting that our possessions and enjoyments cannot help.
- 8. Reflecting that our loved ones cannot help.
- 9. Reflecting that our own body cannot help.
Larry Rosenberg recommends practicing these reflections for about 20 minutes a day after first calming the mind through breath meditation, for example. Each day one focuses on one of the reflections. Sometimes the practice can simply entail repeating one of the contemplations and then exploring the feeling, thoughts and body sensations that arise. For example, one could say to oneself, “Everyone must die.” In addition one can actively think or contemplate each phrase and its meanings, implications and value. The various mindfulness practices around death are not meant to be morbid or distressing contemplations. In fact, if that is the result one should probably not bother with the practices or should talk to a teacher about one’s experience. While these practices have been Buddhist meditations since ancient times, they are perhaps particularly important in our modern times where death and dying usually happen privately, beyond the view of regular daily life. Buddhism encourages us to see death as a natural occurrence.
Being prepared to die also entails healing any relationships with conflict or unfinished business. Hopefully, such relationships are dealt with as soon as possible, well before an impeding death. Since death can arrive unexpectedly, it is important not to delay resolving our difficulties with others. Buddhist resources for this work include loving-kindness and forgiveness practices, confession and apologies where needed, and the practices of honesty, ethics and generosity. Even if the other party in a conflict does not want reconciliation, it is still possible to do the inner work of releasing one’s own resentment, anger or fear. It is hard to die peacefully if we die with resentments or regrets.
It can be extremely difficult to “turn the corner” to really understand and accept the fact that one is dying. One might remain in denial about how serious the situation is. Or one may hold onto hope at all costs. Or someone might be seriously sick but there remains real medical hope for recovery even right up to the time of death. The advantage of fully accepting one’s approaching death is that it gives the person the opportunity to live accordingly. When appropriate, it can be the role of the Buddhist chaplain or teacher to help dying people to wisely “turn the corner.”
When a Buddhist practitioner knows he or she is going to die, their practice becomes extremely important. In fact, when death is inevitable, one would hopefully put aside as much time as possible for practice. Some people find it important to have lots of support for practice. They might invite friends or sangha members to their home or hospital room to meditate with them. They might arrange for regular interviews with a Buddhist teacher to discuss their practice and concerns. Some people prefer having lots of solitude and silence as they die. Others prefer the company of loved ones or fellow sangha members. If, for whatever reason, one does not have the ability to maintain one’s own practice, an option is to ask friends or teachers to lead you in guided meditation or to read passages of spiritual wisdom or spiritual instruction.
The nature of one’s spiritual practice will change depending on where one is in the dying process. At times practice may be quite active and directed, for example in healing interpersonal issues, cultivating loving-kindness and forgiveness, and developing one’s concentration and calm. At other times the practice may mostly entail deeper and deeper forms of letting go and surrender. When one experiences fear, anger, or other painful emotions, these too should be seen as important parts of the overall dying process to be included in one’s mindfulness practice.
The goal in dying is to try to die with as much awareness as possible and in a wholesome state of mind. Mindfulness itself is a wholesome activity of mind and so some people simply focus on continuing with the mindfulness practice as long as they can. One of the reasons for healing interpersonal relationships is to mitigate against being plagued by unwholesome feelings while one is dying. A number of practices are recommended for improving the quality of one’s mind. For example, one can recall one’s good deeds, virtues or memories. One can think about the Buddha or other inspiring spiritual teachers. One can practice loving-kindness to gladden the mind. One can perform acts of generosity. One can arrange for one’s environment to be as peaceful and spiritually supportive as possible. Some people set up an altar or have pictures of loved ones or important spiritual teachers placed around the room.
How to care for the dying
It is easy for caregivers to focus exclusively on the needs of the person dying. However, in order to offer the best spiritual care, it is important that the caregivers be self-aware enough to be able to monitor the state of their own mind. If we want to help a person die with as much peace, acceptance and love as possible, the caregiver needs to be aiming toward having these qualities established in him or herself. This does not mean that these qualities need to be present, it means that we take responsibility for how we are feeling. Caregivers themselves may need support and it is important to search it out. Caring for the dying can be a spiritual prac tice in its own right that can support the spiritual practice of the dying. The chaplain also needs to be sensitive to the family, friends, and caregivers around the dying. When family and friends can’t let go of their clinging to the dying person, it can be harder for the person to die. Sometimes it can be wise for the chaplain to help family and friends to resolve their clinging. If this involves resentment or a grudge toward the dying person, the chaplain may encourage a process of forgiveness. Close to the time of death it may be helpful for family and friends to indicate that as much as they love the person it is okay for the person to die and that they will be okay after the person has died. If appropriate, the chaplain should try to help the family and friends to grant the dying person permission to die.
The time shortly before death is extremely important and requires attending chaplains to use their best judgement and intuition as to what is needed. If the dying person can speak it is of course easiest to know their wishes. If he or she can’t speak but has given instructions before-hand for what to do, then it also might be relatively easy to know what to do. If the person is not speaking and has left no instruction then one must intuit what is needed. Whatever one does it is best to softly tell the person before doing so. Even if a person is unconscious or in a coma, it is best to assume that they can hear you and to tell them what you think they need to hear. Some people seem to prefer to die alone while others prefer to have someone present.
Whenever possible, a chaplain should try to find out in advance the answers to the following questions.
- Where does the person want to die?
- Who, if anyone, does the person want to be present at the time of death?
- Who does the person want notified as their death approaches?
- What does the person want while dying or when dead? E.g. specific practices, rituals, readings, chants, music, guided meditations, people in meditation in the room. This can include instruction concerning what to do with one’s body, and desires for what kind of memorial service.
Because Buddhism puts so much focus on dying peacefully it is important that the environment around the dying person be peaceful. Often this can best be accomplished at home and is one of the reasons to die at home. If a person is going to die in a hospital, then effort should be made to have the hospital room peaceful. Perhaps an altar can be set up, flowers displayed and pictures put on the wall. While dying is a process of letting go, Buddhism does not assume that all of a person’s attachments vanish as one dies. In order to assist in more thoroughly letting go, caregivers can quietly encourage a person to let go. A passage from the Tibetan Book of the Dead has been adapted by some Western Theravada teachers as a reading used during and after someone has died.
We cannot always know when the final moment of death has occurred.
Sometimes it is assumed that death occurs when the breath stops. However, there is a belief in Theravada Buddhism that death is final when the breath stops and the body has become cold. This means that the process of letting go may continue for a while after the breath stops. Sometimes people sense the consciousness or life force leaving the body and this is recognized as the moment of death. Sometimes there can be a sense that the person’s consciousness hovers for awhile in the room. Generally the final moment or moments of death are peaceful and the peacefulness of it can be quite palpable. During this peaceful period immediately after the last breath, it is best to assume that the person can still hear what is being said. If it seems appropriate one can softly speak to the person. One might continue giving the person instructions in letting go, read sacred texts, practice loving-kindness toward the person, chant the refuge chant, or meditate in the stillness. During this intermediate period after the breath has stopped it is recommended that the body not be touched in case such contact may disturb or confuse the letting go process of dying. While someone’s death may trigger great grief, it is recommended that the room where someone has died remain as quiet and peaceful as possible. If possible, loud expressions of grief should be reserved for later or be done elsewhere. The reason for this is so that the expressions of grief not confuse or effect the person who is dying/has died.
After a person has died the body should be treated with respect, honoring the memory of the person. In the case of a sudden unexpected death, the body will probably have to go to the coroner for an autopsy. There are no Theravada religious teachings that object to an autopsy. If a person dies in a hospital, the hospital may have limitations on how long the body can remain in a hospital room. If a person dies at home, a doctor or the coroner must be contacted so a death certificate can be issued. Once a person has died there is no need to immediately contact anyone. Even if someone dies in a hospital room, you can wait awhile before you inform the staff. In all circumstances, make contact with a nurse, doctor or coroner when you are ready. If a person dies at home and you are told to call 911 be prepared that emergency medics might come rushing to your house. Efforts should be made to head them off at the front door so that they don’t unnecessarily disturb the atmosphere in the house.
In the Theravada tradition once a person has died there is no particular practice or teaching about leaving the body undisturbed for any period of time. Sometimes burial or cremation happens as quickly as possible and sometimes the body is kept at home for several days. Sometimes there can be an actual or ritual washing of the body. Giving friends and family a chance to sit with the dead body can help their grieving process. People who don’t have this opportunity will sometimes have a harder time accepting that the person is really dead. Sometimes leaving the body at home for a day or more can help maintain a reverent, perhaps sacred atmosphere to mark a person’s death. If this is desired, there is the option of inviting in sangha members to sit and chant with the body. If a person dies in a hospital or some place away from home, it is sometimes possible to bring the body home, unless an autopsy is needed. However, if it adds to the distress of family and friends to keep the body for more than a short while, there is no problem in having a mortuary service come for the body.
In some of the Mahayana Buddhist traditions there is the practice of leaving the body alone for some time after death as a way of helping the departed through the intermediate state (bardo in Tibetan) before the next rebirth. While the intermediate state can last up to 49 days, a common custom is to leave the body undisturbed for three days. During this time people can come to meditate in the room with the body, perform Buddhist ceremonies such as the refuge ceremony, or continue to give instructions to the departed to help them negotiate the intermediate state.
While Theravada Buddhism does not share in this view of an extended intermediate period, there is sometimes a belief that the deceased person in his or her next rebirth can still benefit from things done for them. This means that while the beliefs are different, the practice of helping the departed is shared by both traditions. Theravada practices done for the departed are usually acts of merit. This can include doing a refuge ceremony, chanting Buddhist teachings, practicing acts of generosity in the name of the deceased, or dedicating merit to the departed. It is believed that these meritorious acts can benefit the departed if he or she is aware of the acts and rejoices in them. If a chaplain arrives after a person has died, he or she should discern what role is expected. Often the family and friends will look to the chaplain for guidance for what to do, especially in terms of spiritual and ritual matters. Generally it is good idea for the chaplain to immediately sit down next to the body of the departed and meditate with eyes open, taking in whatever presence of the person that might still remain in the room. Even if no presence can be “felt”, practicing mindfulness while being open or “receptive” to the possibility can be helpful. Alternatively, or in addition, the chaplain can focus mindfulness on whatever stillness or peace that can be sensed in the room. After a short time of doing this, the chaplain can do any of the things mentioned above for when a person is dying or just passed away.
Funerals, cremation rituals, and memorial services can be conducted in a great variety of ways that fulfill the wishes and needs of the departed and/or meet the needs and sensibility of those participating in the service. There is no fixed Theravada way of conducting these services. In Theravada countries and in South East Asian communities in the U.S. it is customary to have services officiated by monks. These services tend to be comprised of standardized rituals. Lay chaplains or Vipassana teachers in America who are asked to conduct memorial or funeral services are rarely expected to perform predominately ritual-centered services (expect perhaps for burials). Most Vipassana teachers will design a service around the desires of the departed, if known, and in consultation with close family members.
The two primary functions for these services are to help the departed and to help the living. In helping the departed, the rituals function as a rite of transition, helping the person move on to his or her next life. In general, funerals and cremations are likely to have a stronger “rite of transition” aspect than memorials.
In helping the living, these services are ways of helping people process the loss of a relative, friend, colleague, neighbor, etc. Some people appreciate the chance to express the range of feelings they might have, including anger. Other people find it most helpful if the service focuses on celebrating the departed’s life, perhaps recalling how the person enriched our lives.
What follows is a general outline with the most common elements I use when officiating a memorial service. They are listed in the order that they might occur during a service. In designing a ceremony, the different elements can be used and ordered as appropriate.
1. Opening statement: Welcomes everyone, states the purpose and perhaps the intention of the service. Attempts to set the appropriate mood, e.g. celebratory, subdued, reverent, irreverent, religious, secular, formal, informal.
- All things are impermanent,
- They arise and pass away.
- Having arisen, they come to an end,
- Their coming to peace is bliss.
These chants can be done in the name of the departed, as if done in proxy. If an altar is set up with a picture of the departed or with his or her ashes, the chaplain should face the altar as if the person is there.
3. Speaking to the departed: Here the chaplain speaks directly to the departed telling them what they need to hear or encouraging them in someway. Many of the things said to a person as they die or right after death can be said here. The chaplain can also use readings from Buddhist texts for this purpose. “The Flower Poem” is sometimes read here.
4. Eulogy: Given either by the chaplain or by someone else.
5. Statements from family and friends: This can be statements given by people decided on before the service or it can be impromptu, whoever wants to can stand up to speak. If the chaplain has addressed the departed earlier in the service, the family and friends can be invited to either address the departed directly or to speak to those assembled for the service.
7. Chanting: “Earth returns to earth, fire returns to fire, wind returns to wind, water returns to water, space returns to space, consciousness returns to consciousness. The path of liberation plunges into peace.”
8. Closing statement.