During the Illness
The main thing is to take care of the dying person's mind. Many others can take care of the body, but we can take care of the mind. The most worthwhile thing to do is to inspire the person to think of others with loving kindness and compassion, to wish others to be happy and free from suffering. If a person dies with the thought of benefiting others, the mind is naturally happy and this makes the person’s death meaningful.
Teach the person taking-and-giving meditation (tong-len: taking upon oneself others' suffering and giving others one's happiness) or loving kindness meditation (metta), according to the capacity of the person’s mind. If the person has a stronger nature of compassion, a "brave mind," they will be able to do tong-len, to take others’ suffering and give happiness. If the person can do tong-len, it's the best way to die, as it means dying with bodhicitta. His Holiness the Dalai Lama calls this a "self-supporting death." For those who don't think others are more important than themselves, wishing others happiness and to be free of suffering is easier.
It's very important to know the person's mind. Teach according to the person’s capacity: check at the time, use your own wisdom, and judge how profound a method to present. It would be best if you could give the dying person some idea of the death process according to tantra: the evolution of the dissolution of the elements, the senses, the consciousness, all the way to the subtle consciousness.
For the person who has lost the capacity to understand because of coma, dementia, and so on, there is not much possibility for him or her to understand. We should aim to help the person at least have a precious human rebirth. This should be our aim, not necessarily that the person believes in karma, for example, but that the person dies with a positive, happy mind, loving kindness, and compassion; this is our precious gift. Our main aim is to take care of the physical body so that we can take care of the mind, to transform the mind to the positive, so that at least the person can die without anger, desire, etc.
Learn various methods to benefit the mind, calm down the mind, to be of benefit now and in the future. Get an idea of what level of method to offer. If one visualizes Buddha, in the mind or outside, for example, or watches the conventional nature of mind, its clarity, other thoughts such as anger and attachment do not arise. If one can do this at the time of death, according to the person's mind, you can talk about the "fully enlightened being" rather than the Sanskrit "Buddha." Talk about God if that's more skillful: compassionate God or loving God, or Omniscient One. Explain to the person that the nature of the mind, the heart, is completely pure, and that the fully enlightened one, God, is compassionate to everyone, including him or her. Get the person to think that his or her loving heart is oneness with God, that the kingdom of God is within. This frees people from guilt, anger and their negative thoughts.
Initiations and vows don't necessarily protect you from the lower realms; if you take them and don’t fulfill your commitments you just create more negative karma and more causes for a lower rebirth.
Mantras, for example, help the person eventually to attain a higher rebirth after the negative karma is used up. Even if the person doesn't want to hear mantras, they leave a positive imprint on the mind, so that sooner or later the person will meet the path and have the ability to practice teachings, to clear obscurations, and attain enlightenment. Even if the person gets angry hearing mantras and dies with an angry mind, it's still better than not hearing mantras and staying peaceful. In this way, step-by-step, a person's karma brings him or her to the Mahayana path and to enlightenment. Arhats get stuck, while the Mahayanist gets enlightened, even if the arhat starts off with the higher rebirth.
When the Person Is Dying
If you have studied the death process, you will be able to recognize the stages a person's consciousness is going through, what elements are absorbing, and so forth, when the person is actually dying. It is better if the family don't cry, as this creates clinging in the mind of the dying person. There are sounds to help the consciousness at the time of death, sounds that benefit, mantras and so forth.
Other than this, keep quiet and don't make any sound. Teach the family how to create this atmosphere.
It is OK to medicate pain in order to help the person to be able to think, but medicating for mental anguish is not OK. Sedation before death prevents working out bad karma. Anguish becomes fruitful if the person can experience it. It is hard to tell the difference. Often families want the patient medicated, but it is more for their own comfort than the patient's.
At death, invite the Sangha to chant mantras nicely, in an uplifting way, as the Chinese do. When they chant like this, the person feels that nothing is more important than Amitabha Buddha. They feel protected, supported, and guided.
Chanting the Thirty-Five Buddhas' names is extremely powerful. People can come and chant together. Also, chant the five very powerful deities' mantras, normally used in Jangwa to liberate those dying and the dead, and to purify living ones and liberate those in the lower realms. Giving Breath to the Wretched has powerful mantras, and is the text to use to help.
Place a stupa on the person's chest or let the person hold it. It purifies negative karma each time the stupa touches the person. Even if the consciousness has already left the body, it can still be beneficial to touch the body with the stupa. This is also good to do with babies or with people who don't understand. Even to a non-Buddhist you can say that the stupa is for peace, healing or purification. The person can visualize light rays coming from the stupa.
It is also good to have a few stupas on hand for healing or to dispel spirit harms. Also, a sheet of paper with the Ten Great Mantras written on it can be put on the dying person's body while reciting the Dedication Prayer at the end.
When the Breath Has Stopped
The very first thing you could do after the breath has stopped is Medicine Buddha practice as a group or individually (for animals as well). Chant the names and the mantra. Medicine Buddha made a promise that whoever chants his name and mantra will have all his or her prayers and wishes succeed. The power of the prayer has been achieved by Medicine Buddha, so it's very powerful for the prayers to succeed. Of the Ten Powers, one is prayer, so pray as if you are Medicine Buddha's agent, on behalf of the being who has died. Then do Amitabha po-wa (transference of consciousness to a pure land) and other practices.
Recite Sang Chö, The Prayer of Good Deeds [commonly known as the King of Prayers.] At funerals, it is also good for everyone attending to read it together.
Recite the Namgyalma [Ushnisha Vijaya] mantra 21 times, then blow on water, sesame seeds, or perfume or talcum powder, blessing it with the mantra, and then sprinkle that over the dead body. The Namgyalma mantra is very powerful for purifying; it is best to recite the long mantra if possible, but the short mantra can also be recited. If it is written on a cloth or paper and placed on a mountain top or roof, or where the wind can blow it, whoever is touched by the wind receives blessings and their karma is purified.
Circumambulating a stupa that contains the mantra purifies all the karma to be reborn in the hot hells.
In Tibet, when the breath stops, you would not touch the body until a lama in the village did po-wa; this is important. Look for signs that the consciousness has left the body (after po-wa), for example: the white drop, like pus or water from the nostril or, for a woman, blood and water from the lower part of the body. First pull the hair in the center of the crown toward the back, so that the consciousness comes out through there. Also, a sign is if hair falls out from the back of the head.
His Holiness the Dalai Lama says that is it difficult at the time of death to really meditate as you did in life. If, during your life, you couldn't meditate well, then you can't keep your concentration at death. The essence is to have accumulated merit and practiced purification in everyday life in your relationships with sentient beings, to have served others with a sincere heart, loving kindness, and compassion, to have done hard work to benefit them, and to have made offerings to the Guru Triple Gem.
Practicing the good heart during your life, that is, bodhicitta, purifies so much negative karma, even very heavy karma, and it stops the creation of more negative karma. It is this negative karma that makes the mind experience fear of death. Especially, bodhicitta stops the immeasurable suffering, the suffering rebirths, that arise later from these negative actions. You should live in morality, the precepts, taking the precepts from a spiritual master or in the front of holy objects.
It is very important to integrate into your life the Five Powers and to learn the Five Powers to be practiced at death. These are very special practices to achieve enlightenment quickly. They involve po-wa: transference of consciousness at the time of death into a pure land. In the pure land one receives teachings on the Vajrayana, which enables one to achieve enlightenment in one lifetime. How effective the po-wa is depends on how well one practices the Five Powers at death. And this depends on how well one performs the general practices in life.
The lam-rim explains the four ways to accumulate powerful, extensive merit. One should attempt this in everyday life, while performing all the normal activities – eating, sleeping, and walking, etc. – rather than the actions being done out of worldly desire and samsaric attachment.
Creating a Conducive Environment for the Dying: Advice for Tara Home Hospice
Make the place as beautiful as possible: a calm, peaceful, serene, holy environment is so important. There should be beautiful views, beautiful art, flowers, and images of Tara. Flowers give a very special spiritual feeling. The point is to create a positive imprint on the person's mind. By being there, the person is not afraid of dying, and the mind is elevated. When families come, they see it's a nice place and want to come. It makes them feel that there's no need to be afraid of death.
Because of His Holiness the Dalai Lama's wisdom and compassion, more and more people are feeling comfortable with Buddhism these days. We need to help people have an open mind to different methods. You can make it clear to people that Tara Home is Buddhist, then if they're OK with that, they can come.
The religious tradition of the residents depends on their prior practice in daily life. Advice you give them depends on what you have been doing yourself – lam-rim, thought transformation – how one has been practicing in daily life, not just sitting meditation. In general, the Mahayana has much to offer to the dying, or to anyone with problems. Highest Yoga Tantra is the only system that offers a real explanation of death. The precise instructions only exist in the Highest Tantra, not in other traditions. Only general instructions are given in other traditions, not explanations in terms of the subtle consciousness, winds, and chakras, etc.
The robed Sangha can live in Tara Home for several months at a time, to distinguish the level of practice that each patient can relate to, and to create a holding environment.
The new people just joining, who haven't done this service before, need to learn from the people who have been offering service for a long time. Those who are experienced in how peoples' minds are should study different books, different teachings from different sources, and from their experience come to know what states of mind people die with.
Meet together once or twice a month; everyone should read what has been compiled. People with more skill and wisdom can then edit this and it can become a book. There is no need to rush. This book will become a guide for the long run, for the organization, and to benefit other organizations.
You should practice po-wa. Each year, take po-wa teachings and do retreat on po-wa so that you can practice. It is very important to do po-wa retreat every year. If one becomes accomplished at po-wa and receives the signs of accomplishment, then this can be the best public service–liberating others and helping them at the time of death.
It is OK to ask other lamas to do po-wa–any Tibetan lama who is a good practitioner. Bring in high lamas to do po-wa and Jangwa purification. If it is difficult to invite the lama to the hospice, then the lama can do po-wa wherever they are, from a distance. You need to inform the lama which direction the head of the person is facing.
In general, it would be good to perform the elaborate Medicine Buddha practice once a week; this is very good for a successful death. Also, you can recite the Medicine Buddha Sutra once a month. The special text, with 100,000 Buddhas’ names, by Pabongka Rinpoche, can be recited at the time of death. Ribur Rinpoche got the text recently from Lhasa; it is at Tushita Meditation Centre in Delhi and Tibetan monks can read it. This text is rare.