Dealing with Dying and Death a common sense

Dealing with Dying and Death a common sense and a Buddhist’s approach Dr Wong Yin Onn, Clinical Associate Professor, Monash University Malaysia

• Most people are terrified of death, both those who are dying and those around them. People feel at a loss and helpless. • So the first things as doctors, students, nurses and friends is for us to minimise fear!

FEAR • The fear of death is often connected to 1. the fear of pain 2. the fear of separation from all that is loved and 3. the fear of the Unknown Beyond • FIRST dictum is TO RELIEF always, and doctors are trained to relief pain

1. Pain • Always reassure a dying person, such as someone who has cancer, that they won't be allowed to suffer, that they won't have to endure excruciating pain, that they will be given medicine for pain relief. • An important result of this is that they can relax and eventually die more peacefully.

Death need not be frightening • It is only frightening when one does not KNOW anything about it and is NOT prepared mentally/spiritually • There are 2 parties involved- the sick and the attendant, the patient and the Doctor • Both parties should ideally be ‘well trained’ before the event • Both parties need help • This talk addresses BOTH parties

Realise Realities • 1. Everyone must die. . . • 2. The remainder of our life span is decreasing continually. • 3. Death will come regardless of whether or not we have made time for it! • 4. Human life expectancy is uncertain. • 5. There are many causes of death.

Good Health is merely the slowest way to DIE • We are alive, therefore we will die. This is the simplest, most obvious truth of our existence, and yet very few of us have really come to terms with it. • As doctors, we deal with the Dying and the relatives of those terminally ill and Dead everyday • We need to be prepared to handle Dying and Death, and to help those in need

2. Separation from Loved Ones • The other worry is the separation from loved ones, from one's possessions. • Of course, if we've contemplated this before, it's a lot easier. We know that to come together implies separation. That's just the way it is. • If a dying person hasn't done this kind of contemplation, then you need to gently encourage and reassure him or her that the children and those left behind are capable of taking care of themselves or will be taken care of.

• Although intellectually we all know that one day we will die, we live our life as if we are going to be in this world forever. • • Material possessions, reputation, the pleasures of the senses – become of paramount importance, so we devote our time and energy to obtaining them and engage in many negative actions for their sake.

At a personal level • We are so preoccupied with the concerns of this life that there is little room for genuine spiritual practice. • When the time of death actually arrives we discover that by having ignored death all our lives, we are completely unprepared.

• Please realise that it is NOT a Monk or a Nun or a Layman or Laywoman who gets Enlightened! • It is the Mind that gets Enlightened!

What is death? (The Non Medical View!) • Death is the cessation of the connection between our mind and our body. • The mind is a formless ever changing continuum that is a separate entity from the body. When the body disintegrates at death, the mind does not cease. • The continuum of the mind has no beginning and no end. It is NOT a man or a woman who gets enlightened but the mind which, when thoroughly purified, transforms into the omniscient mind of an Enlightened Being.

Do NOT be unprepared

• When one is actually dying it is a bit late to begin thinking seriously about death. • We should familiarize ourselves with the thought long before we hope it will happen! • And besides, even for the young and strong, it can still come with unexpected suddenness. Mors certa — hora incerta, "Death is certain — the hour is uncertain. " To bear this in mind is for the Buddhist an important aspect of Right Understanding.

It makes NO DIFFERENCE what religion the patient subscribes to; whatever he/she holds to as Wholesome and Good, let that be his/her comfort and strength • As a doctor we treat all patients of whatever Belief and Creed equally with Loving-Kindness and Compassion

• 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.

• A quiet and peaceful atmosphere is most beneficial when one is sick or dying. This allows for the sick person to rest better, as well as to practice meditation and contemplation.

Every Religion teaches us to be Good, and Teachings of an afterlife is common to them • Be it reborn in Heaven • Or reborn in Hell

Or to be born again on Earth!

The doctor as friend and medicine man • Does the person have specific religious beliefs or not? • if religious, remind them of their religious practices • if not religious, encourage them to have positive thoughts, or remind them of positive things they have done

When you are the BIG Consultant. . • For a person with a spiritual faith, allow him to have spiritual objects around eg. an image, pictures of their spiritual teacher, or to play spiritual music, and so on - whatever reminds them of their spiritual practice. • Allow relatives to chant, recite prayers of their respective faiths

• A Doctor must be Neutral and treat all patients of all Faiths equally • While he has his own beliefs and practice, he must NEVER impose it on his patients

• It is important to avoid religious activities that are inappropriate or unwanted by the dying person. • Attempted deathbed conversions are inappropriate and may anger the dying person and loved ones. NEVER IMPOSE BELIEFS ON OTHERS • The basic aim is to avoid any objects or people that generate strong attachment or anger in the mind 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. • We have to do whatever we can to allow the person to die in a calm/happy/peaceful state of mind.

Help the Living make Decisions!

• Respect the wishes of Terminally Ill patients who request for ‘DNR’ – Do NOT Resuscitate Common sense and Wisdom must prevail, for to the Terminally Ill, death is NOT the problem but the gate to a new state irrespective of his/her religion

Is there anything for the attending doctor or student or relative to fear from the dead? • NOTHING beyond the fear of infectious diseases! • “Be Good to the Dhamma and the Dhamma will be good to you” • Only the Ignorant fears because of superstition

As doctors (and the Buddhist practitioners) • The goal of Buddhist practice is to develop the mind to its fullest potential which involves the perfection of compassion and wisdom. • Spiritual well-being involves developing a calm compassionate mind and working with the suffering of illness and death in an optimal way • Let us apply this Mind of Metta-Karuna to the dying patients • Metta is a quality which protects you against any malevolent beings

• So for the doctor, relieving pain and other distressing symptoms is of utmost importance • Reassure the family that everything possible is done to help make the dying comfortable, for a highly stressed family will transmit that stress to the patient • Allow the family Venerable, Pastor, Iman to be with the family and the patient, as he/she can help to resolve emotional issues, and give spiritual counsel

Allow the family space and time to GRIEVE • It is natural to grieve the loss of family members and others we knew, as we adjust to living without their presence and missing them. The death of a loved one, or even someone we were not close to, is terribly painful event • As time goes on and the people we know pass away along the journey of life, we are reminded of our own inevitable end and everything is a blip of transience and impermanence.

3. Fear of the Unknown Beyond • Is it really unknown? • Science has made remarkable progress in understanding the beyond!

Scientific Proof of Rebirth is found in Prof Dr. Ian Stevenson's Life Work • He was the head of the Department of Psychiatry at the University of Virginia, and Director of the Division of Personality Studies at the University of Virginia • He collected thousands of cases of children who spontaneously remember a past life using strict scientific protocols. • Dr. Stevenson devoted forty years to the scientific documentation of past life memories of children from all over the world. He has over 3000 cases in his files. Even skeptics agree that these cases offer the best evidence yet

The Lancet, 15 December 2001 • Near-death experience in survivors of cardiac arrest: a prospective study in the Netherlands • Dr Pirn van Lommel, Cardiologist risked his reputation with a full, systematic trial into the phenomenon. He interviewed 344 heart patients at his hospital who had all clinically died, before being successfully resuscitated. • Of these, 62 - or 18 per cent - reported some ongoing experience after the medical monitors had pronounced them to be dead. • Half were aware they were 'dead, ' and 15 had outof-body experiences where they were aware of the actions of the hospital staff around their body.

• Dr. Brian Weiss, M. D. , graduating Phi Beta Kappa, magna cum laude, from Columbia University and Yale Medical School, spent years in the disciplined study of the human psychology, training his mind to think as a scientist and a physician. • He was a Professor of Psychiatry at the University of Florida

• When he met his 27 -year old patient, Catherine, in 1980, who came to his office seeking help for her anxiety, panic attacks, and phobias, he was taken aback at what unfolded in therapy sessions that followed • Under hypnosis, Catherine recalled “past life” memories that proved to be the causative factors of her recurring nightmares and anxiety attack symptoms. • She remembers “living 86 times in physical state” in different places on this earth both as male and female. She recalled vividly the details of each birth – her name, her family, physical appearance, the landscape, and how she was killed by stabbing, by drowning, or illness.

• For 10 years, Prof Weiss kept this to himself fearing that revealing it would ruin his academic career and reputation • He finally decided to reveal all as he felt that this stunning finding could not be silent any longer

The technique of Past Life Regression Therapy is even available in Malaysia!

• So now I hope that you have less fear of the “Known Beyond” • Give your Body away to help another! Why let it rot or burn? • That is the Last Act of Charity/Dana we can do!

• Unfortunately there is NO book called “DYING for Dummies”

For the Buddhists • Here are some simple instructions for you when you die : • Do not get angry- pay attention to the moment, take care of your death. Do not get angry- at this critical moment, if you are angry, mad, you may be reborn in a lower realm. • Forgive and forget – do not think of your enemies or vengeance, because you will take vengeance at each other endlessly. • Do not become attached to material processions or wealth, etc. This attachment will keep you attached and lead you to lower realm (e. g. a ghost or an animal).

Try NOT to be so attached to all our ATTACHMENTS!

• The Buddha urged us to prepare for death, • to prepare for that journey by purifying the mind and not being so attached to things, • to be able to let go and release ourselves from needing to be, from needing to have. • Through this we will not suffer so much as we pass through the final stage of the present life, • we can let go, be grateful for what we had but not clutch to it

• From the Buddhist perspective, death is never seen as the end, birth is not the beginning either. • It's just one tiny part of a whole process, a whole cyclic process of birth, death, rebirth, dying again, rebirth, dying again. . . • If one has some appreciation or understanding of that, death begins to lose its sting, because it's not final, it's not really the end. It is only the end of a cycle.

In reality, there is no death - only transition. So, the real question is; "How can we live our life now to make our "transition" as smooth and easy as possible? " • Be the BEST person you can be! • Death is not to be feared by one who has lived wisely • There are two sides to the phenomenon known as death, this side where we live, and the other side where we shall continue to live. Eternity does not start with death. We are in eternity now!

Be a good doctor, husband, father, son, daughter, student, teacher, etc • As a well spent day brings happy sleep, so a life well used brings a happy death. • There is Nothing to fear but only words left unsaid and deeds left undone! • So let us say it now and Do it now