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I hope that I can share some Buddhist ideas with you so that when you are taking care of a dying Buddhist, you will have some knowledge of their world view.

Beginningless time

There are certain basic Buddhist concepts that are important to understand. The first is that we believe that this life is one of an infinite series – a dying person is therefore not about to become nothing but is about to go on to another life.

We also believe that if we die well, with a peaceful mind, that will beneficially influence our next life. There are some transition periods at the time of death and the capacity to harness and focus the mind during these transition periods determines the kind of future life that will occur. It is thought that without the burden of sense consciousnesses the mind becomes extremely subtle and there is a chance to recognise its true nature at this point. If that occurs then the person reaches liberation – however, this is also understood to be extremely rare.

An indicator as to whether someone might have the capacity to recognise their true nature at the time of death is their ability to dream in a lucid way and to recognise that they are dreaming and even direct the events of the dream. For most of us this is clearly not possible.

However, it is also believed that the period of transition into the next life can take as long as 49 days. During this time the intermediate being – which is called by the Tibetans, a bardo body – can benefit from prayers and meritorious actions performed on their behalf.

Karma and Merit

Buddhists do not believe in a creator God. Buddhists believe that everything in the world is created by causes. We say that things don't happen by themselves, or through chaos, or for no reason, we say that things are caused by actions. Our life experience is largely determined by our own actions and in a sense, that gives us some responsibility for what we experience. We also do not believe in Absolute Good or Absolute Bad. Surprisingly, some people experience bad things but find strength and wisdom in the experience, such as Nelson Mandela who was in jail for many years and went on to become the Prime Minister of South Africa. Once South Africa was free, he led a process of reconciliation with the white population. A different kind of person might have wanted to take revenge for all the wrong doing of the past. Similarly, many rich and powerful people appear to have what is usually considered desirable or good, and could be assumed to be happy. But many suffer from a fear of losing their wealth and power, the pain of difficult children, and lack leisure and rest. So we see that there is no intrinsic happiness in any position in life, whether it is good or bad depends upon the way it is interpreted. An awful lot of our experience is perception. Therefore we create our experience of life according to our own wisdom and understanding.

When we talk about karma, we are talking about the results of the actions of body, speech and mind. Nobody has perfect karma because nobody has lived in a perfect way. However, everyone has done some good things, as well as some bad things. Karma is created not only by actions but by the way we think about actions. Therefore the attitude of rejoicing in good actions itself creates enormous karma. For a dying person, it is crucial for them to remember all the good actions that they have performed and to feel good about them. If a person has done some kind of bad action in their life, then it is important to remind them that there is no karma that cannot be purified. Karma is not destiny but energy. It's like the ripples of water in a pond after a stone has been thrown in. The ripple is just a movement of energy. The ripple does not exist forever. If a person feels strongly that they wish to purify a past karma then they need to confess the action, strongly regret it, recite a purification prayer if possible, and determine not to do it again. At the same time, karma is a very powerful thing and it would take a very powerful purification to completely purify some heinous past deeds. No one can purify another, nor can we really see the results of past actions except in the present.

However, a sincere attitude of regret and of determining not to do a wrong action in the future are considered genuine antidotes.

The most positive karma comes from love, compassion and wisdom. In order to create a positive state of mind at the time of death for Buddhists most of the interviewees for my booklet talked about creating a sacred atmosphere. They advised placing a Buddha statue in a place that the dying person can see it, playing tapes of chanting, inviting monks and nuns to come and say prayers, and generally to inspire a mind of faith. You, as secular palliative care workers, may not feel comfortable constructing shrines and playing chanting tapes, etc., I don't know, but perhaps if you are aware that the families and care givers of Buddhists may find benefit in these things you may be able to enable them in some way.

For some Buddhists there is a belief that through strong faith in the Buddha Amitabha, they will be reborn in his Pure Land, which is a little bit like a heaven. These are most likely to be Vietnamese or Chinese Buddhists.

Impermanence

One of my lamas once said that the good news about impermanence is that it means that if you don't own a Ferrari now, you may own one in the future. Because we believe in beginningless time and an uncountable series of lives we also believe that everything is constantly changing – nothing is fixed. I think it is interesting to look at old maps of the world. There is no single country that you can find on any old map that has a permanent shape and a fixed position for the past two thousand years. All kinds of countries and empires have come and gone, boundaries have shifted, languages and peoples have come into existence and passed away, nothing is fixed. For some people the changeability of life is a source of anxiety, but in Buddhism we believe that it is useful to become accustomed to it and that strength comes from being adaptable. If we see change as an opportunity, not a threat, then we can think about ways of making the best of a new situation. Again, what any situation is, is to a large extent determined by the way we think about it. But this depends upon developing great flexibility in thinking.

For a dying person, they are about to let go of – or lose – everything that they knew and had in this life. As a Buddhist, we would prefer to think about this as ‘letting go', rather than losing. The things of this life were never things that could be kept eternally. A dying person is letting go of their name, their nationality, their friends and possessions. You will notice that in the booklet the first method of preparation suggested by the Tibetan informant is that the dying person should organise their Will and give away all of their possessions to others. Others talk about the importance of organising laundry and shopping. The practical things need to be sorted out so that these are not of concern. Belief in karma means that if the person is able to give away their possessions to others who will use them in a good way, such as to good people or worthwhile charities, that the deceased will continue to benefit from the karma accrued from this action in their future life.

Impermanence means that although the person is losing their particular identity of this life, they will acquire another one in the next life, so in a sense there is some comfort and security in that idea. It is not the case that the person is about to cease to be, merely they are changing the clothes of their identity. As Buddhists we believe that we have been born in all parts of the world in all different races and ethnicities in the past. This idea completely contradicts the normal worldly point of view, where I am identified as a green eyed white woman of a certain age. Perhaps there is even the possibility of seeing this in an almost playful way. In the future, we could be anything, we have no way of knowing what, but the future is determined by what we do in the present.

Suffering

One of the key Buddhist ideas you will always find mentioned is the idea that conventional life is unsatisfactory, that families and possessions and wealth and titles and honour and power do not guarantee happiness, meaning or purpose. The answer here is that life is about not what we can get, but how we can grow and develop in an ongoing way, and most of all, how we can help others. From a Buddhist point of view, the path out of unsatisfactoriness depends upon living ethically, not harming others, and taming the mind. Helping others is very difficult and is easily done badly, but most of all depends upon a compassionate motivation and wisdom. Taming the mind refers to having some awareness when states of anger and fear arise and being able to step back and recognise that these are states of mind that are not intrinsically real.

One of the questions in the booklet asks whether it is advisable to have relatives present at the time of death. Western culture often makes an assumption that living in families is the happiest possible way to live, and that the birth of children is a joyful experience. The Buddhist point of view is a lot more pessimistic and sees families as a source of attachment that are not necessarily going to help you on your spiritual path at all. A potential source of conflict here is that a Buddhist may prefer to give authority for making decisions about difficult questions such as whether they should be kept alive or have further surgical intervention or undertake organ donation, to a Buddhist religious leader, such as a monk or a nun. In Australian law, the persons with that authority are the next of kin, and the ideas of the next of kin, particularly where the Buddhist is an Anglo- Australian who is not born to Buddhism, may be quite different.

At the Buddhist Council we had a discussion with representatives from the three main kinds of Buddhist practice, that is, Theravada, Mahayana and Vajrayana, i.e., a Sri Lankan, a Vietnamese and a Tibetan monk, on particular ethical issues. There is no disagreement amongst these three that euthanasia, or the intentional taking of life, is wrong according to Buddhism. Furthermore, in terms of minimising pain, the Vietnamese monk expressed great concern over the use of drugs that would produce a state of mind that could be cloudy or intoxicated.

Perhaps the principal aim is to create a calm state of mind and to overcome a person's fear. The way that pain is experienced is very often determined by what the pain is believed to mean. If pain is conjoined with fear, then I think the experience of the pain is increased enormously.

Another issue is around telling a person that they do not have long to live. A slightly controversial answer in the booklet is the Tibetan response where it is advised to tell the dying person that they look good and are getting better. This is because most people are not great yogis or Buddhist practitioners, and a fearful state of mind is not a helpful condition.

I was in Korea in June 2004 to talk about the booklet at the Sakyadhita International Buddhist Women's Conference. A Korean woman told me about the situation of her brother, who appears to have terminal cancer. At the same time, it seems he had a very sad life, first abandoned by his mother and then rejected by his wife. The time of death is very often a truly sad time where all the lost hopes and things that weren't achieved and pain are remembered. A Tibetan lama once said to me that people are much better at remembering pain than enjoyment. At any rate, a depressed state of mind is not a good state of mind for the next life, so I encouraged this woman to remind her brother of all the good things he had done in his life, the children he had raised, the business he had established, and that they at least had had a good relationship. Focus on the positive.

Death is sad and often untimely, but from the Buddhist point of view, there is a continuity and there is a future. If a person has suffered a lot then they can be reassured that all that karma has finished – it's been experienced, it's over.

Monks and Nuns

You will find at the back of the booklet the names and contact details of Buddhist temples and organisations around Victoria. If you are taking care of a dying Buddhist, do not hesitate to get in touch with one or more of these organisations. I have only listed bigger organisations – for example, I run a Buddhist group but it is too small to be included – and these bigger organisations have the resident monks and nuns that can be called upon. Many things in Buddhism are intangible – past and future lives are very intangible. One of the intangibles is the idea of ‘blessing'. A monk or a nun with good discipline is considered to be able to give a blessing and will offer pastoral support. A real blessing is something that will lift the spirits of the person substantially. One cultural issue is that very often monks and nuns will not volunteer advice – they have to be asked. So please ask as much as possible. ‘What would be good to do? Do you think it would be a good idea to do some chanting? Does he or she have any other needs? Is there something we have forgotten? Is there something that should be changed? What is your advice?' Asking open questions allows them to come up with a level of detail that we can't pre-empt. The person's family may find itself going off to a fish market and buying 100 live eels to release in the Yarra River. Buddhism is a vast science.

Conclusion

A dying Buddhist is preparing for the next life. The best possible transition is effected through having a peaceful mind and, if possible, a sacred atmosphere. Buddhists reflect on death a lot and see it as not as a terrible tragedy, but as something determined by karma. One of our stock phrases is that the young may die before the old and the healthy may die before the sick. We can't see what karma we have created, but the way we think about our experience determines what we understand our experience to be. There is no karma that cannot be purified and no state of suffering that will not change.