Ven. Paisal Visalo has this list that he calls, "
Seven Factors of a Peaceful Death."
1. Extending love and sympathy
One should remember that patients in their final stages feel very vulnerable. They need someone they feel they can rely on, someone who is ready to be there for them during times of crisis. If they have someone who can give them unconditional love, they will have the strength of spirit to deal with all the various forms of suffering that are converging on them at this time.
2. Helping the dying person accept impending death
Not all patients can accept the truth after they are told. However, there could be several reasons for this besides the fear of death. They could have some unfinished business or other worries. Relatives ought to help them express their concerns. If they feel they have someone ready to listen to and to understand them, they will feel safe enough to confide their inner thoughts. Posing appropriate questions can also help them identify what it is that is preventing them from accepting death or help them realize that death may not be so fearsome. What relatives can do is listen to them with an open, nonjudgmental, and sympathetic heart. They should focus more on asking questions rather than lecturing or sermonizing. Helping patients lessen their worries about their children, grandchildren, spouse, or other loved ones may help them accept their death
3. Helping the dying person focus her mind on goodness
Thinking of goodness helps the mind become wholesome, peaceful, bright, less fearful, and better able to deal with pain. What the Buddha and his disciples often recommended to those on the verge of death was to recollect and have firm faith in the Three Refuges. These can be thought of as something virtuous or sacred that the patient can worship. The Buddha also had them re-establish themselves in the observance of morality (sila) as well as recollect the good deeds they had done in the past. There are many ways to help incline patients to recollect these things. For example, you can:
- Place in the patient’s room a Buddha statue, other sacred objects, or pictures of respected spiritual teachers to serve as aids to recollection
- Invite the patient to chant or pray together
- Read dharma books out loud to the patient
- Play recordings of dharma talks or chanting
- Invite monks, especially ones the patient has a connection with, to visit the patient and provide counseling.
In applying these ideas, keep in mind the patient’s cultural background and personal habits. For example, patients of Chinese background may respond best to pictures of the bodhisattva Kuan Yin. If the patient is Christian or Muslim, one may use the appropriate symbols of these religions instead.
4. Helping the dying person settle unfinished business
One major cause of suffering that prevents people from dying peacefully is unfinished business. Such anxieties or other negative feelings need to be released as soon as possible. Otherwise, they will cause the patient to suffer, feel heavy-hearted and push away death, thus becoming unable to die peacefully and resulting in an unfortunate rebirth. A patient’s family and friends should be very concerned about these matters and be quick to act on them. Sometimes patients may not bring the matter up directly. Those who are around the patients should thus be very sensitive to it and ask them about it with genuine concern and kindness, not annoyance. These are some general guidelines that can help in such situations:
- If they have remaining work, responsibilities, or a will that has not been settled\, find a way to help bring these matters to a conclusion.
- If they wish to see someone for the last time, especially a loved one or someone they wish to ask forgiveness from, hurry and contact that person.
- If they are nursing an angry grudge against someone or hurt feelings and grievances against a close intimate, advise them to forgive that person and let go of any anger.
- If they are feeling nagging guilt over some wrong they had done, now is not the time to judge or criticize them. Instead, one should help them release their feelings of guilt. One can help them open up and feel secure enough to ask forgiveness from someone, while at the same time guiding the other party to accept the apology and forgive the person.
5. Helping the dying person let go of everything
A refusal to accept death and the reality of its imminence can be a great cause of suffering for people who are close to dying. A reason for such refusal can be that they are still deeply attached to certain things and unable to be separated from them. These things could be children or grandchildren, lovers, parents, work, or the entire world with which they are familiar. A feeling of deep attachment can be experienced by people even if they do not have any lingering feelings of guilt in their hearts. Once attachment is felt, it leads to worry and fear of separation from that which they love. Family and friends as well as doctors and nurses should help dying persons let go of their attachments as much as possible, such as by:
- Reassuring them that their children and other descendants can take care of themselves
- Reassuring them that their parents will be taken care of well.
- Reminding them that all their material possessions are only theirs temporarily. When the time comes, they have to be given to others to take care of.
6. Creating a peaceful atmosphere
With regard to a patient’s spiritual well-being, the least that family, friends, doctors, and nurses can do is to help create a peaceful atmosphere for them. They should avoid talk that disturbs the patient. Family members should refrain from arguing amongst themselves or crying. These things would only increase the anxiety and unease of the patient. If family and friends can try to keep their minds in a healthy state - not sad or depressed - this will already be a great help to dying patients. The states of mind of the people surrounding the dying patient can affect the atmosphere in the room and the person’s mind. The human mind is sensitive; it can sense the feelings of other people even if they don’t say anything out loud. People do not only have this sensitivity when they are normal and conscious. It is possible even for patients in comas to sense the mental energy of those around them.
In addition, family and friends can create a peaceful environment by encouraging dying patients to practice meditation together with them. One form of meditation is anapanasati, or mindfulness of breathing. When breathing in, mentally recite “Bud”. When breathing out, mentally recite “Dho”. When put together, “Buddho” is the recitation of the Buddha’s name. Alternatively, with each out-breath, count, “1, 2, 3….10 ,” and then start again. If it is not easy for them to be mindful of the breath, they can focus their awareness on the rising and falling of the abdomen as they breathe in and out by placing both hands on top of the abdomen. On the in-breath, as the abdomen rises, mentally recite, “rising”. On the out-breath, as the abdomen falls, mentally recite, “falling”.
7. Saying goodbye
For those who would like to say what is in their hearts to the dying person, such as saying sorry or goodbye, it is not too late to do so. As a person’s pulse weakens progressively and they approach the moment of death, if family and friends wish to say goodbye, they should first establish mindfulness and restrain their grief. Then they can whisper their final words in the ear of the dying person. They should talk of the good feelings they have towards the person, give them praise and thanks for all the good they have done, and ask for forgiveness for any wrongs committed. Then they can guide the person’s mind to ever more wholesome states by advising them to let go of everything, drop all worries, and recollect the Three Refuges or whatever the person venerates. If the person has some grounding in Buddhist teachings, ask them to let go of the “self” and all conditioned things, to incline the mind towards emptiness, and to keep the mind focused on nirvana; then, say goodbye.
