Modern healthcare professionals can learn much from the Tibetan Buddhist belief that it as important to die with dignity as it is to live happily. Another look at a classic, a book by Sogyal Rinpoche, that had its 10th anniversary reprint recently.
Most books tell stories about life and living happily ever after…The Tibetan Book of Living and Dying not only addresses life, but brings the reader face to face with Death.
The book, authored by Sogyal Rinpoche, a renowned Buddhist teacher, has been revised and updated to commemorate its 10th anniversary. The book begins rather impressively with a foreword by the Dalai Lama, who sets the tone: “No less significant than preparing for our own death is helping others to die well”. Sogyal Rinpoche places life and death contextually together for our consideration, describing why we must address death during our lives. The realm of gods in the Buddhist teachings, who lived lives of fabulous luxury and pleasure with little thought or time for spirituality until death appeared, and who were unprepared for it, are alluded to here, as is active laziness whereby unimportant tasks become responsibilities, part of a rigid schedule, and begin to dictate one’s existence.
Contemplating deeper meanings
He highlights instead, the importance of spirituality, contemplation and the need to devote some time each day to examining the deeper meaning of life.
He speaks of two groups of people whose attitudes to death clearly affect the way they live life. One group lives in denial of death — repressing and refusing to acknowledge its potential impact. The second group has a casual attitude towards death, not attributing to it the seriousness of thought it deserves.
The author advocates that each individual attempts to understand the nature of the mind, and then move on to train the mind through different practices of meditation. Mindful meditation (having roots in ancient Buddhist practice) is applicable to anyone suffering from stress, anxiety or pain and Rinpoche describes its three essential components. Rinpoche goes on to expound on several Buddhist beliefs: rebirth, karma, reincarnation, bardos etc. and stresses on the importance of the mind.
In its second section the book deals with Dying. Most of us, even medical professionals, are bewildered when confronted by the prospect of death. Often we feel inadequate or embarrassed, not knowing what we should say to the person who is dying, and to his near and dear ones. Indeed, the most typical human response to death is denial of the condition or the diminishing of its impact. However, the person who is dying often has a much clearer knowledge and vision of this inevitable outcome, achieved after weeks of intense suffering. Helping the dying person achieve an early, more graceful acceptance of death, without denying or diminishing his thoughts and feelings is thought to be important. Rinpoche describes the case of a lady doctor friend who, having dealt (in her perception) unsuccessfully with a dying individual, asked Rinpoche what he would have done in that situation.
Two things most useful at the deathbed are, a sense of humour, a useful tool to dissolve the gravity of the situation; and the ability to not take things personally, since anger is a common response of the dying person, and may be directed towards the person trying to help. It is also important to show unconditional love, which can be facilitated by thinking of yourself in the dying person’s place (empathy). Rinpoche also emphasises the importance of telling the truth with love, a rare blend of virtues that directly addresses the dying person’s needs. Active compassion (expressed in action, not mere words) is another ingredient that enables the experience of dying. The Buddhist practice of Tonglen, the ability to take on the suffering and pain of others and give them your happiness, well being and peace of mind and the powerful Tibetan tradition of phowa (pronounced po-wa), the transference of consciousness, are described as being invaluable to the dying person. To be able to deal effectively with the dying person’s fears, it is important to introspect and be aware of one’s own fears about death.
While saying goodbye, two explicit verbal statements are pre-requisites. The dying person must be given permission to die with the assurance that his loved one(s) will be taken care of in the aftermath. When the loved one is a child, Rinpoche suggests that it is commendable to encourage the young one to pray, as it gives them a sense of having contributed in some way. He also addresses the people that the dying person leaves behind, saying that it is useful to be open to grief rather than repress it, and try to learn from the grief.
In its third section, the book deals with Rebirth. Buddhist philosophy endorses the concept of rebirth and Rinpoche expounds on several related beliefs using the Bardo paradigm. In Tibetan Buddhist teaching, our entire existence consists of four bardos: The natural bardo of this life; the painful bardo of dying; the luminous bardo of dharmata (after death) and the karmic bardo of becoming (rebirth). The bardos are viewed as particularly powerful opportunities for liberation. Leaving the body, achieving the transitory state of dharmata and being reborn (or in turn liberated from the endless cycle of birth and death) are all described in detail. Rinpoche explains how we could, by adopting the correct mindset, be liberated from the cycle of birth and death during the dharmata phase. He also discusses the near death experience and its remarkable similarities to the bardo of becoming, in that the mind is momentarily liberated from the body and goes through a number of experiences akin to the mental body in the bardo of becoming. Yet there is a distinct difference — the person in the near death experience does not actually die, whereas the bardos are viewed as transitory but inevitably progressive states. Indeed, some Buddhist masters have viewed near death as a “between bardos” state. While many of us may not believe in life after death, and may view these concepts as being unscientific, they have intrinsic value for the person who is on the threshold of dying (for example due to a terminal illness) and for their near and dear ones. In this Tibetan Buddhist framework of thinking, death becomes an active process of willing engagement as opposed to a passive process of mute spectatorship, both for the person concerned and for his loved ones.
In the final part of the book, Rinpoche speaks about the significance of understanding and accepting death because it is a universal process. In his view, we live in a world that appears to be too besotted with life to give much thought to death, an unhealthy attitude that needs to change. It is not uncommon today, to have a beloved elderly relative admitted in a hospital ICU, with multiple tubes and support systems for his sustenance, often an unwilling participant in the seemingly interminable fight for his life. Pray, what price are we paying, to defy death under these circumstances? What dignity is there in challenging death in this manner? Indeed, what crime would we commit in allowing a person who has lead a full life to meet his maker in a natural, dignified and well-prepared manner? These philosophical thoughts assail one’s mind, as one contemplates life and death in the modern context. Rinpoche’s exhortation to the health professional is particularly moving.
For doctors, nurses and others confronted with the experience of death he also has other valuable tips to share.
Modern medicine has produced many miracles that have the potential to save and prolong human lives, but has not succeeded in preventing the process of death reach its natural conclusion, or in adding dignity to the process. We would do well therefore to consider incorporating the wisdom of Tibetan Buddhism into modern medical care. There is however, a very real risk that this philosophy will be applied by well meaning but misguided individuals, at inappropriate times, when the possibility of saving a life still exists, causing much pain to the concerned person and to relatives. It is therefore important to understand that these principles are most applicable in the care of terminally ill people. For example, those caring for terminally ill people in hospices, hospitals or at home would benefit greatly, if some of these thoughts and ideas were incorporated into their training.
Death and dying are an undeniable reality; a natural consequence of all human existence. Dying well is a dream that most elders have (we talk of Anayasa maranam in Hindu culture) and helping people die well and peacefully is a duty, not just for the healthcare professional but also for their near and dear ones. This book, therefore, has obvious implications for every one of us, as we will all have to face death at some point of time in our lives. Even individuals who do not share Rinpoche’s religious and spiritual inclinations have plenty to learn from the book, as it offers practical insights into dealing with dying.
However, several of the principles expounded in the book are not scientifically verifiable. Instances of the occurrence of a rainbow body for example or beliefs about near death experiences and rebirth have their testimony in anecdotal repetitions and not empirical evidence. The book, therefore, is likely to appeal more to those with spiritual inclination than those who subscribe strictly to modern scientific tradition. Nevertheless, as the Tibetan saying goes, “If you are too clever, you could miss the point entirely.”
Sogyal Rinpoche’s ability to clearly express himself, capturing the reader’s attention, with interesting anecdotes and quotations from learned works is unquestionable. Even more commendable, however, is his choice of subject… Most books speak of life and living happily ever after. This one speaks of death as well.
Dr. E.S. Krishnamoorthy is Director, T.S . Srinivasan Chair and Senior Consultant Neuropsychiatrist at The Institute of Neurological Sciences-VHS, Chennai. E-mail: >firstname.lastname@example.org Niranjana Bennet is a M.A. Psychology student at Christ College, Bangalore. She researched for and co-wrote this article while interning in TINS-VHS.
The Tibetan Book of Living and Dying, 10th Anniversary Edition, Sogyal Rinpoche, Patrick D. Gaffney, Andrew Harvey
HarperCollins, 2002, price not stated.