Death and Dying

I am now in a hotel in Singapore, having been invited by the Center for Biomedical Ethics of the National University Singapore to attend a conference on “Death and Dying.” Today is the first day of the conference and it’s a very full program. The presentations were very stimulating, and I learned a lot from listening to them.

Death and dying are among the most popular topics in bioethics. The topics concern the profession of medicine quite directly, since they have to deal with patients who are dying. But of course the focus is not exclusively a medical one, as the discussion centers around what doctors should do or should avoid doing in terms of death and dying.

The conference opened with a talk by Alastair Campbell on “What is Death?” This simple question does not find easy answers; in fact the question of what death really is has become much more complex due to advances in medical technology. Now it is possible to maintain the life (or live body) of someone who has completely lost the functioning of the brain. The reason why the body is still warm is a heart-lung machine that constantly pumps air to his lung, prompting the heart to beat even though the brain has stopped functioning.

Such a person is called ‘brain dead.’ This is an indication why definition of death has become problematic. We did not have any problem identifying a dead person. We know it instinctively once we come across one. However, the prospect of somebody lying in bed heaving loudly through a machine is a difficult one to judge. On the one hand, the body is warm and the heart is beating. On the other, he has completely lost all ability to respond to the outside world. He has completely lost consciousness. Due to the demands for bodily organs for transplantation, these bodies that are hooked to respirators were termed ‘brain dead’ — that is, death for a medical purpose. This has thrown all understandings about what death really is into confusion.

Other papers dealed with religious perspectives on death and dying. I myself gave a talk on the Buddhist perspective on the issue. This is a rather difficult task because the Buddha did not directly teach what one should do, say, when one faces the prospect of having one’s life prolonged almost indefinitely but with poor quality of life. But certainly we can extrapolate what the Buddha would have said.

So let’s look at the Buddhist perspective. One thing is that death is not the final end of life, as all sentient beings, wandering in samsara, have to take one life form after another with seemingly no end. A being may be a human being in this lifetime, but can be a non-human animal in another, and so on. This is in contrast with the usual belief in modern medicine where death represents the absolute end of life, after which there is absolutely nothing to talk about. This simple fact known to all Buddhists, and I would bet that everybody has in the back of their minds something along this line. The problem, nevertheless, is that the scientific attitude has it that this belief in the afterlife is unsupported and as Karl Popper said unfalsifiable; thus it does not merit serious attention. Well, I think it’s the problem of those who disregard the discussion of the life after death, not the Buddhists’

Another important point that people should learn from Buddhism is that the quality of the mind of the dying is crucial in determining what kind of life that person will have after he or she dies. The mind at the moment of death is like a door to the other world. If the person dies with a happy, peaceful attitude, then he or she will be reborn in a pleasant realm, such as heaven, but if the person dies when the mind is angry or depressed, then he or she will be reborn in a much lower realm. This is the reason why in Buddhism, and indeed in other religions, the dying person should be given every opportunity to get in touch with the sacred, so that their mind become acquainted with the sacred and the spiritual, which is uplift the mind, resulting in better rebirth.

Of course this cannot be proven by science, so when I gave this talk to the scientists in the audience there were a bit of chuckles. Nonetheless people were very interested in this point. There had been a discussion about the ‘good life’ and more directly the ‘good death.’ My contribution is that ‘good death’ is constituted by the quality of mind leading up to and at the moment of death as I mentioned in the last paragraph. The terminally ill patient should be given both physical care and a spiritual one. The latter is more important because the patient will soon embark on a journey he or she has not experienced before in this life (and in fact all of us have had experienced these cycles of birth, life, death and rebirth countless times before but we have just forgotten.) For example, monks can be invited to attend the bed of the dying and chant. This will lead the mind of the patient to very good places.

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