This month, I review two books on Tibetan Buddhist beliefs about death, dying and the ‘after death’: The Tibetan Book of Living and Dying by Soygal Rinpoche and Life Death and After Death by Lama Yeshe.
The Tibetan Book of Living and Dying
For those people, myself included, who have tried and failed to make it through the Tibetan Book of the Dead, The Tibetan Book of Living and Dying comes as a relief. The first part gives an introduction to some basic Buddhist concepts, such as the impermanence of conditioned existence and the ‘true perfect nature of the mind’. Soygal Rinpoche explains that the ‘true nature of the mind’ can be experienced through meditation and a number of meditation practices are described.
The second part focuses on providing advice on how to help the dying, including information about communication, cultivating compassion, and providing spiritual and bereavement care.
Tibetan Buddhism encourages followers to mediate on death, indeed, to experience the process of death through meditation and to prepare throughout their lives for the moment of death. A person’s state of mind approaching and at the moment of death directly influences their next rebirth. A good death therefore means a good rebirth, and the consequences of a bad death are far-reaching. Helping others ‘die well’ is considered an important part of preparing for one’s own death and parallels are drawn between Tibetan Buddhist end-of-life practices and the approach to care taken by the modern hospice movement. The work of Elisabeth Kübler-Ross and Cicely Saunders, amongst others, is praised for challenging the medicalisation of death and for providing compassionate care for the dying.
The actual dying process (the painful ‘bardo’ of dying) is described from the viewpoint of Tibetan Buddhist teachings. The physical deterioration that often precedes death is described in terms of the four elements that make up the body (fire, water, earth and air) dissolving and disappearing one by one. According to Tibetan Buddhism, after a person has been declared medically dead, there are still a number of internal processes (the inner dissolution) that continue before the ‘mind’ actually leaves the body. It is therefore recommended not to move the body during this time.
Some of the advice given in the book resonates with palliative care principles. For example, telling the truth about diagnosis and prognosis is considered essential in order for the patient to prepare for death. People are encouraged to talk with their relatives and physicians about their end-of-life preferences and living wills are recommended. Futile medical interventions are also discouraged: when it is certain that death is near, medical staff are advised to avoid disturbing the patient, turn off monitors, stop taking tests and to move the patient to a private room if possible.
Ethical debates surrounding death and dying are also addressed (in the appendix). Prolonging life, when there is no hope of recovery, is said to be worthwhile only if a person is capable of having positive, virtuous thoughts. Euthanasia is also discussed: no explicit opposition to euthanasia is stated, however, both Cicley Sauder’s and Elizabeth Kübler-Ross’ arguments against euthanasia are outlined.
Although the more dogmatic sections may put some people off, The Tibetan Book of Living and Dying is, at its core, about genuine and compassionate care for the dying and, as such, has relevance for people from a wide range of backgrounds and beliefs.
Life, Death and the After Life
Life, Death and the After Life covers much of the same subject matter as The Tibetan Book of Living and Dying. The book consists of the transcripts of three talks given in the 80s by Lama Yeshe, a charismatic Tibetan Buddhist teacher.
The book does not situate Buddhist teachings in their historical or cultural context to the same extent as The Tibetan Book of Living and Dying, however, its shorter length, simple language and often humorous approach makes it a very accessible introduction to the core Tibetan Buddhist beliefs on death and dying.
The book also gives simple meditation techniques that it claims can help people achieve equanimity and cultivate compassion. Meditating on the process of death is recommended to dispel fears about death and lead to a better death when the time comes.
Reviewer: Natalie Evans
For the next bookclub, Natalie will review The Wounded Storyteller: Body, Illness and Ethics by Arthur W. Frank. If you would like to suggest a book for review, or review a book yourself, please get in contact with Natalie – n.evans@vumc.nl
Cultural Issues in End of Life Care 