Compiled by:
 Ven Pende Hawter
 The Karuna Hospice Service
 P.O. Box 2020
 Windsor 4030
 Queensland, Australia
 Tel. (07) 3857 8555
 Fax: (07) 3857 8040
 In discussing the spiritual needs of the dying from the Buddhist
 perspective, we firstly need to look at several key points, namely:
 gaining an understanding of the shortness and preciousness of life.
 considering what can help ourselves and others at the same time of
 considering what goes on after death.
 the Buddhist concept of mind.
 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
 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:
 am I ready to die?      
 what unfinished business do I have?     
 what do I want to do or achieve in the time I have left?
 will my priorities change?
 what can help me at the time of death?
 or as somebody put it "Live each day as though it were your last and
 one day you'll be right!"
 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
         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
 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.1 This
 process of dissolution is associated with external and internal signs.
 This process continues even after the breathing ceases, for up to 3
 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
 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?
                 - if conscious, you can do the practices with them or
 get them to do them
                 - if unconscious, you have to do the practices for them 
         Does the person have specific religious beliefs or not?
                 - if religious, remind them of their religious
                 - if not religious, encourage them to have positive
 thoughts, or remind them of positive things they have done
 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
 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.2A 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,
 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,
 1         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. 
 2         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".