Practical and Spiritual Actions on Visits to the Dying [1]
Introduction
Visiting a person who is very sick or dying can be very beneficial and a wonderful thing to do. But before the visit, it is not unusual to feel a little apprehensive or unsure of yourself. That’s why spending a few quiet minutes deliberately preparing yourself is so important. If that is not possible and the only time you have is driving there, then in the car try to say an appropriate prayer or recite a relevant mantra, such as the mantra of the Medicine Buddha (Tayata Om Bhekandze Bhekandze Maha Bhekandze Bhekandze Soha) or Shakyamuni Buddha (Tayata Om Mune Mune Maha Muniye Soha).
This article is in four sections: preparing for the visit, building trust, helpful practical and spiritual actions, and what to do close to the time of death.
1. Preparing for the Visit
| 1.1 | Call the person or their carer on the phone to arrange the first and subsequent visits, provide comfort, catch up on developments etc. |
| 1.2 | Try to be on time. Check that you have the appropriate materials & documents for that visit. Be prepared to be flexible. You may be dismissed shortly after arriving or you may be deeply involved for several hours. |
| 1.3 | Prepare yourself before the visit, e.g. if you are a Buddhist, take refuge and generate compassion. |
| 1.4 | Prepare yourself again immediately before entering the room. Think, “I will try to connect through my heart to the person’s deeper self.” Also, “I will do my best. I am here to listen and support, not to heal or preach.” |
2. Building Trust
| 2.1 | Bring a peaceful mental atmosphere with you, and if appropriate try to create a peaceful physical atmosphere in the room. |
| 2.2 | Listen to what the person has to say (use ‘active listening’, empathy, sincere interest, ‘effective communication’ etc). Try to ‘speak the same language’ from observing what their interests are. |
| 2.3 | Help the person to tell their story. Emphasize the positive aspects of their life. |
| 2.4 | Encourage them to remember the beneficial things they did in their life. |
| 2.5 | Try to clarify why the person or their carer has asked you to come. Have they got a particular request? What’s on their mind? |
| 2.6 | Develop the relationship by slowly building trust. |
| 2.7 | When their needs become clearer, decide on the extent of your ‘offer’ of help, e.g., in terms of when, how, why, what. |
| 2.8 | Don’t overstay your welcome; very sick people tire easily. Try to get independent feedback on your visit (this may or may not be possible; don’t worry). |
3. Helpful Actions When Visiting the Very Sick or Dying
3.1 Practical Actions
| 3.1.1 | Be aware of, and try to be open with, other family or friends who may be present, and who may or may not agree with your presence. Try to gain their confidence but respect their wishes. |
| 3.1.2 | Validate the sick person and their own particular journey. |
| 3.1.3 | If asked and if appropriate, guide the person in calming meditations e.g. body awareness, focussing on the breath, nine-round breathing. |
| 3.1.4 | Don’t be afraid to touch because at this time the simple holding of a hand or gentle stroking of hand can be very reassuring; but be mindful and only proceed if you see that the person is accepting. |
| 3.1.5 | Where appropriate offer timely and relevant information e.g. links to other services. |
| 3.1.6 | If asked and if appropriate, link the person to appropriate experts in drafting a Will, Power of Attorney, Advance Health Directive, Enduring Power of Guardianship, or Funeral. |
3.2 Spiritual Actions
| 3.2.1 | Check your motivation; are you really there for the other person? |
| 3.2.2 | If asked, say the person’s favourite prayers with them or read them aloud to them, whether Buddhist or not. |
| 3.2.3 | If asked, read to the person their favourite spiritual teachings, psalms etc., whether Buddhist or not. |
| 3.2.4 | Whether asked or not, say silent prayers for the person, including doing the practice of tonglen for the person. If the person is conscious and agrees, suggest they hold a stupa while you guide them through the tonglen practice. |
| 3.2.5 | If asked and if appropriate, set up an altar for the person with their favourite images etc, whether Buddhist or not. |
| 3.2.6 | If asked and if appropriate, suggest practices that the person might do to cope with pain, fear, regret, unease etc. |
| 3.2.7 | If appropriate, help the person to deal with ‘unfinished business’. Encourage them to forgive whomever they need to forgive and to apologize to whomever they need to apologize to. They first might need to forgive themselves. |
| 3.2.7 | If invited, discuss with the person the process of dying and death and the next life. |
| 3.2.9 | If asked, explain the basic principles of Buddhist philosophy and practice in a way that is relevant to the person. |
| 3.2.10 | If asked and if appropriate, leave prayers, mantras, CD’s, books, etc. |
4. Helpful Actions When the Person is Approaching the Actual Time of Death
4.1 Practical Actions
| 4.1.1 | Some Buddhists may not want medical interventions that artificially prolong life; this needs to be checked with each individual. If they are unable to communicate, refer to their ‘Advance Health Directive’ or their ‘Last Letter’. |
| 4.1.2 | Maintain a peaceful, relaxed atmosphere in the person’s room. No TV or radio. Do not argue, gossip or talk about medical procedures or such across the person’s bed, even if they appear unconscious. Leave the room if you are emotionally upset or crying. |
| 4.1.3 | Assume that the dying person can hear, even though they may appear unconscious. |
| 4.1.4 | Try to adjust the level of pain relief so that the person is relatively peaceful, yet remains as mentally alert as possible. |
| 4.1.5 | Unless instructed otherwise, arrange to have the person’s closest family and/or friends present. |
| 4.1.6 | Frequently the person who is about to die will wait to die until family members have left the room and they are either alone or with someone who is not family. Don’t feel that you ‘did something wrong’ or abandoned them if they die while you are not there. |
| 4.1.7 | Remember: you can’t prevent anyone from dying. |
| 4.1.8 | Trust them in their process and be supportive. |
4.2 Spiritual Actions
| 4.2.1 | Just being there with the compassionate spirit of love in your heart is enough; words are not necessary |
| 4.2.2 | Respect the spiritual beliefs of the dying person; silent or spoken prayers may be helpful. |
| 4.2.3 | Family or friends may be invited to help set up a small, simple altar in full view of the person, and according to their wishes. |
| 4.2.4 | Encourage the person to hold a stupa as often as possible. If unconscious, place a sheet of paper with sacred words such as the ‘Ten Great Mantras’ written on it, on their heart, with dedications. Or do whatever is appropriate from their spiritual tradition. |
| 4.2.5 | If the dying person asks for their Buddhist teachers, or Buddhist friends to phone and visit, even though they may not be family, try to arrange this through their family. The same applies whether the dying person is Christian, Muslim, Jewish, Hindu, etc. |
| 4.2.6 | Give the dying person permission to die, especially if you are very close to them. |
| 4.2.7 | Reassure the dying person that all will be well after they die; they will be guided and cared for by a power greater than them. |
[1] Compiled by Wheel of Life Palliative Care Support Group in 2013: Hayagriva Buddhist Centre, 64 Banksia Terrace, Kensington 6151. Edited by Len Warren in November 2018, for The Pure Land of the Indestructible Buddha.
