Chapter 26 APPENDIX II QUESTIONS RELATING TO DEATH

Advances in medical technology and medical technology have helped to save countless lives and relieve unspeakable pain.At the same time, however, they pose many complex and sometimes intractable ethical dilemmas for the dying, their families, and physicians.For example, should we put dying relatives and friends on life support?Or unplug it?Should those who themselves feel guilty and must die a long and painful death agree to or even help them commit suicide?I am often asked these questions about death and dying, and I would like to touch on a few here. About forty years ago, most people died at home, but now most people die in hospitals or hospices.Hence the fact that life is maintained by machines is a real and frightening fact.People then ask themselves what can be done to ensure a humane and dignified death rather than an unnecessary prolongation of life.This is a very complex issue.For example, after a serious accident, how do we decide whether to provide life support to the person involved?What if someone is unconscious, unable to speak, or presumed brain dead due to a degenerative disease?What about a baby with severe deformities and brain injuries?

Answering these kinds of questions is not easy, but there are a few principles that can guide us.According to the Buddha's teaching, all life is sacred; all beings have Buddha-nature, and as we have seen, life offers the possibility of enlightenment to all beings.Ahimsa is considered the first principle of human behavior.However, the Buddha was also very much against dogmatism, and I believe we should not cling to one point of view, or "official" position, or make rules about these issues.Only according to your own wisdom, according to each situation to act. Is it necessary to maintain life artificially? The Guru Lama pointed out an important consideration - the state of mind of the dying person: "From a Buddhist point of view, if the dying person has the opportunity to have positive, wholesome thoughts, it is important to allow them to live even for a few minutes longer. and with a purpose.” He specifically mentions the pressures on family members in such situations: “If there is no opportunity for the dying person to have positive thoughts, spending a lot of money just to keep someone alive seems There is no reason anymore. But each case has to be dealt with individually and it is difficult to make general rules.”

At the moment of death, the life support system or use of a resuscitator can be a cause of upset, annoyance and distraction.We know from Buddhist teachings and evidence from near-death experiences that even in a coma, the dying person is very aware of everything that is going on around them.What happens in the moments before and at death, when the body and the mind finally separate, is a very important time for anyone, especially for a spiritual practitioner who is seeking to practice or dwell in the nature of mind. Generally speaking, life support systems that prolong the dying process only cause unnecessary attachment, hatred and frustration in the dying person, especially when it is not of the dying person's own will.When faced with this difficult decision, loved ones of the dying should consider that if there really is no chance of recovery, the quality of their loved one's final days or hours may be more important than simply keeping him alive.In addition, since we cannot really know whether the consciousness is still in the body, we even self-defeatingly imprison them in the useless physical body.

Dilgo Khyentse Rinpoche said: There is no point in using a life support system when one has no chance of healing.It is good to let them die naturally in a peaceful atmosphere and to take positive action in their stead.When life support is put on and there is no hope, then stopping the machine is not a sin, because there is no way to keep the patient alive, you are just "keeping" them alive artificially. First aid for resuscitating the dying is sometimes redundant and an unnecessary distraction.A doctor wrote: The hospital suddenly became a rush, and dozens of people rushed to the bedside to give first aid to the last hope.In essence, the deceased patient was drugged, had dozens of needles inserted, and received electric shocks to the heart.The heart rate, blood gas value, and brain wave graph of our dying process are recorded in detail.Finally, when the doctors tried everything, this flustered first aid came to an end.

Maybe you don't want life support or resuscitation, maybe you want a period of uninterrupted time after death.You wish to be able to die in a peaceful environment as recommended by your master, but how can you be sure that your wishes will be respected? Even if you state your wish not to be treated in a hospital, your request will not necessarily be honored.If your loved ones disagree with your wishes, they may order the hospital to do some kind of treatment, even if you can still speak clearly.Unfortunately, doctors often follow the wishes of the family rather than the dying person.When you are dying, the best way to take control of your medical care is to die at home.

In some areas, you can use a document such as a "will" to indicate what kind of treatment you want to receive if you are unable to make decisions about your future.It's a sensible precaution that can help doctors make decisions in difficult situations.However, such documents are not legally binding and do not predict disease complexity.In the United States, you can sign a "enduring power of attorney for medical care" with an attorney, which is the most effective way to state your choices and try to ensure that your choices will be respected.On this document, you can appoint an attorney or legal advocate who understands your attitudes and wishes, who can respond to your particular condition and make important decisions on your behalf.

As I said in Chapter 11, I recommend that you find out if your doctor is willing to respect your wishes, especially if you wish to take life support off, or if your heart stops and you don't want resuscitation.You want to make sure your doctor tells the hospital staff and puts your wishes in the medical certificate.You will discuss your end of life issues with relatives.You ask family or friends to have the staff unplug any monitors and IV lines at the start of your dying process, and if possible move you from intensive care to a private room in an attempt to make the atmosphere around you Be still, serene, and try not to panic.

In 1986, the American Medical Association decided that it was ethical for doctors to remove life support from terminally ill patients who were dying and people who might be comatose.Four years later, a Gallup poll showed that 84 percent of Americans said they would rather not seek treatment if they were dependent on life support and had no hope of recovery. The decision to limit or eliminate life-sustaining treatments is often referred to as "passive euthanasia."In terminally ill conditions, it is acceptable to suspend medical intervention or life-saving measures that may only prolong life by a few hours or days, and let death occur naturally.This includes discontinuing aggressive treatments, life support machines, intravenous nutrition and cardiac resuscitators.It is also a passive form of euthanasia when families and doctors sometimes choose not to deal with derivative conditions that lead to death.For example, a patient with bone cancer at the end stage may develop pneumonia. If the pneumonia is not treated, the patient may die more peacefully and less painfully without delaying the death.

What about those who are terminally ill and decide to take off their life support themselves?Did they create bad karma by ending their own lives?Kalu Rinpoche answered this question quite clearly: when people think they have suffered enough and wish to be allowed to die, they are in a situation that cannot be called good or bad.We absolutely cannot blame anyone for making that decision.This is not a bad karma, it is just a wish to avoid suffering, which is the basic wish of all sentient beings.On the other hand, this is not a particularly good karma, ... it is not a wish to end life, but a wish to end suffering.Therefore, it is no record karma (neutral behavior).

What should we do if a dying person in our care asks us to take off life support?Kalu Rinpoche said: We may not be able to save the patient's life, we may not be able to relieve his pain, but we must do our best with the purest heart.Whatever we do, even if we do not succeed in the end, it cannot be regarded as bad karma. If the patient asks the healer to take off the life support system, it puts the healer in a difficult position, because intuition may tell them, "If this person is put on the life support system, he will die." Karma is determined by The healer's motivation, because the healer is depriving someone of the means to continue living, even if that's what the patient tells us to do.If the healer's basic motivation has been to help and benefit the person and relieve his suffering, then such a state of mind does not seem to produce any negative karma.

The 1990 Gallup poll cited above showed that 66 percent of Americans believed that a person in a situation of extreme distress with "no hope of improvement" would end himself. moral right to life.In the Netherlands, it is estimated that 10,000 people choose euthanasia every year.A doctor who assists them in dying must demonstrate that it was with the consent of the patient, that he had fully discussed the options with the patient, and that he had consulted another doctor for his opinion.In the United States, this topic is very popular. There is a book that clearly describes how people can commit suicide when they reach the terminal stage of the disease. legalization. What will happen if euthanasia is legalized?Many fear that those deemed terminally ill, especially those in extreme pain, may choose to die, even though their suffering may be managed and their lives may be prolonged.Others worry that older adults may feel responsible for dying because choosing to die can reduce stress and save family members money. Many people who work with the dying feel that a high standard of hospice care can answer requests for euthanasia.When she was asked about euthanasia in legislation, Dr. Ross replied, "I think it's a sad thing to have this kind of law. I think everyone should use their own judgment and get over their fear of death." Then we are able to respect the needs of patients and listen to them.” People's fear of death is unbearable, disorienting, and meaningless.Buddhism offers different attitudes to death and gives it purpose. The Guru Lama pointed out: Your suffering comes from your karma, and no matter what, you must bear the consequences of your karma in this life or another, unless you can find a way to purify your karma.Therefore, Buddhism believes that if you are lucky enough to be born in this life and have the ability to bear it in a better way, you should experience karma; this is better than suffering when you are reincarnated to a helpless person (such as an animal). Can be much bigger. According to Dharma, we must do everything possible to help dying people deal with the exhaustion, pain and fear they face, and provide loving support to make the end of life meaningful.Saunders, founder of St.Christophers Hospice in London (St.Christophers Hospice), said: "If someone among our patients asks for euthanasia, it means that we have not fulfilled our responsibility." She refuted the legalization of euthanasia : Our society is not too poor to provide time, love, and money to help people die peacefully To the point, we don't need to kill them...Legalizing voluntary (active) euthanasia would be an irresponsible act that would interfere with our true respect and responsibility for the old, the handicapped, and the dying. What happens to the spiritual development of people who die before birth or in infancy?What can parents do to help? Dilgo Khyentse Rinpoche explained that people who die before, during birth or in infancy, their consciousness goes through the various bardo stages again, and then they are reincarnated.The meritorious deeds done for ordinary dead can also be done for them, such as Vajrasattva's purification method and mantra recitation, lighting lamps, purification of ashes, etc. In the case of abortion, in addition to these practices, if the parents feel remorse, they can express their repentance, ask for forgiveness, and practice the purification methods of Vajrasattva sincerely, which will help them.Parents can also offer lamps, release animals, help others, sponsor charity or practice programs, and dedicate all merits to the peace and future enlightenment of the baby's spiritual consciousness. What will happen to the spiritual consciousness of the suicide? Dilgo Khyentse Rinpoche said: When a person chooses to commit suicide, the spiritual consciousness has no choice but to follow its bad karma, and there may be ghosts controlling and possessing its vitality.In the case of suicide, a powerful guru must perform special practices, such as fire pujas and other rituals, to liberate the dead person's mind. Can we donate organs when we die?What if the organ must be removed while the blood is still circulating, or before the death process is complete?Wouldn't this interfere with or harm the consciousness before death? All the teachers I have consulted on this matter agree that organ donation is a great act of kindness because it comes from a sincere desire to benefit others, so as long as it is indeed the wish of the dying person, it will never harm the dying person. The consciousness of the flesh.On the contrary, this final act of generosity can accumulate good karma.Another master said that the pain suffered during the donation of organs, and every moment of distraction, turns into good karma. Dilgo Khyentse Rinpoche explained: "If a person is indeed going to die soon, he also expresses the desire to donate his organs. His heart is full of compassion, and his organs can be removed even before the heart stops beating." What about freezing a person's body or head until medical advances can one day revive it? Dilgo Khyentse Rinpoche said it was pointless.After a person dies, his consciousness cannot return to his physical body.The idea of ​​preserving a dead body for future resurrection apparently lures one's mind into a tragic increase in attachment to the physical body, thus making it more painful and hindering reincarnation.One master likened this type of organ freezing to going straight to hell without even going through the bardo. What can we do about aging parents who are regressing or developing dementia? At this time, it may be useless to explain the Dharma, but practicing quietly in front of him, or reciting mantras, or chanting the names of the Buddhas can still help him.Kalu Rinpoche explains: You are sowing seeds.Your vows and your loving care for him are very important.In such a situation, you must have a genuine interest in their interests and well-being from the heart of your heart. ...The relationship between parents and children is very strong. Because of this relationship, if we treat our parents for the benefit of other sentient beings, then we can obtain many excellent benefits at a subtle level.