Buddhist perspectives on end of life care – a conversation with Phra Paisal Visalo

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What does Buddhism say about suffering in general and suffering at the end of life in particular?

In the Buddhist perspective, suffering is the reality that no one can escape from. We are all facing ageing, sickness, separation and loss, either sooner or later. The reason for this is that life is uncertainty. Everything in this world is only temporary. But change is certainty. That is: Impermanence. Our life is pressurised by internal and external factors which lead to constant changes. Everything ultimately is rotten and disintegrated, that is: suffering. There is no ‘self’ which is independent or permanent. We can only delay or escape suffering for a while but it is inevitable. What we can do is to alleviate suffering and lessen its effects when it occurs.

However, it is possible that those conditions of suffering can only affect us physically but not necessarily affect our mental conditions. Buddhism believes that every human can cultivate their mind to be free from suffering. Even though we all face ageing, sickness and death, our minds need not to be painful from these, if only we accept the reality with no refusal and no resistance. Acceptance is the most important factor for us to be free from suffering. 

Instead of being affected by physical suffering, we can use it to our benefit; open our eyes to the fact that nothing is certainty. Wisdom is also the key success to enlighten our minds to be free from suffering. There have been numerous monks and laypeople who received enlightenment while they were facing suffering due to sickness and the death. In other words, sickness and death can develop our wisdom to realize the ultimate truth and achieve enlightenment.

How relevant is learning from these ideas to the end of life care of non-Buddhists?

Buddhism believes the happiness is possible at the end of life. There should be no fear when the time has come. Every human has it in his own capacity to be happy, regardless of which religion he professes, or even if he has no religion at all. Peaceful death is possible for all human beings. 

What do you consider as a good death? 

Good death, from Buddhist perspective, is not determined by the way one dies, or the reason for death. It is rather characterized by the condition of mind at the time of death; dying in peace, without fear or mental suffering. This is possible when one accept one’s own death and lets go of everything – no attachment to anything or any person. Good death is also characterized by the blissful states of existence where one is reborn. Best of all is death with an enlightened mind, achieving the ultimate wisdom concerning the true essence of nature. This enables the mind to be free from suffering and realize nirvana, with no rebirth. 

What is good life?

Good life means life with well-being, free from sickness, poverty or exploitation. Good life also means living a life with morality; not taking advantage of others but also doing good deeds for others and society. It involves peaceful mind, having compassion and not being dominated by greed, anger and delusion. It is life not inflicted by suffering, resulting from understanding the reality of life and being capable of solving the problems that arise.

Do you think that good living always leads to a good or comfortable death?

Good life could lead to a peaceful death, but not always. When a person is dying, if his mind is in sorrow, or worried about his children, parents, the loved ones or could not let go of his properties, if he is guilty, or has unfinished business, he would refuse and fight with death at any cost. This will lead to torment, agitation and restlessness, with woeful existence after death. Besides, physical pain from sickness may cause patients to be angry and agitated and find no peace at the end of life.

On the other hand, do you think that a good death is possible without a good life?

Good death could happen to those who have unwholesome life, though it is very rare. This is because those who have unwholesome life are afraid that they will go to evil states after death. So they are fearful of death. Many suffer from guilt or are haunted by their bad conduct in the past. As for those who are dominated by greed, anger or delusion, they always find difficulty in letting go of their property or ill will. This will inevitably lead to death in torment. However, if they are lucky enough to have friends who can help them to recall good deeds and let go of everything, their mind will become wholesome and a good death will be possible for them. 

Death being certainty in life, how can one prepare for it?

Preparing for death is a necessity for all human beings, because we all will face it no matter how we are or who we are. We should prepare for death by exercising ‘the Contemplation of Death’. This means we should remind ourselves constantly that we will die sooner or later. We do not know when, where and how. Then we ask ourselves: If we were to die soon, are we ready for that? Have we done any good deeds to our loved ones and others? Is it enough? Are we sufficiently responsible for everything that we have? Are we ready to let things go yet? If the answer is: ‘not ready yet’, we must do good deeds from now on and try to complete those tasks and responsibilities. Finally, we have to learn how to let things go. Doing good deeds means we have nothing to be sorry for. Then letting things go will enable us to face the death and ready for it now and in the future.  

Fear of death is one of the major factors causing distress in the dying. Are there ways of addressing this, irrespective of one’s faith? 

The fear of death occurs when we tend to forget we all die sooner or later. We may have unfinished business and worry about beloved ones or belongings. One may be fearful of death because one is uncertain about what will happen after death. The fear of death can be relieved if we regularly practice the contemplation of death, try to do our best to our beloved ones and try to complete our important tasks and responsibilities. Meditation is a good way to cultivate our minds to accept death: seeing death as a part of life with no fear at all.

Can interventions like meditation assist in alleviating suffering towards the end of life? How? Even in a person who has not practised mediation till the final days of his or her life?

Meditation helps lessen suffering. At the end of life, when pain occurs, one can focus on one’s breath – in-breath and out-breath. Once mind and breath are in harmony, concentration and calmness will take place. Calmness of mind will produce some chemistry in one’s body that can gradually lessen the pain. Calmness meditation also diverts the mind from physical pain, and can enable one to be unaware of the pain or feel less pain.

Mindfulness meditation can also relieve suffering. Mindfulness meditation helps the mind to let go of the pain. Instead of ‘being pain’, mindfulness enables one to be aware of the pain. This will reduce mental pain. Only physical pain will exist. 

Experienced mediators can give advice to anyone to eliminate the degrees of suffering. An appropriate and peaceful environment can also help relieve pain. Reminding oneself of good deeds in the past, or concentrating on sacred things in which one has faith can support mindfulness meditation as well. 

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