Join our Mailing List

"I believe that to meet the challenges of our times, human beings will have to develop a greater sense of universal responsibility. It is the foundation for world peace."

Insights into Living and Dying

June 3, 2008

Ennapadam S. Krishnamoorthy and Niranjana Bennett
The Hindu
June 1, 2008

Modern healthcare professionals can learn much from the Tibetan
Buddhist belief that it as important to die with dignity as it is to
live happily. Another look at a classic, a book by Sogyal Rinpoche,
that had its 10th anniversary reprint recently.

A life of contemplation: For that balanced perspective on dying.

Most books tell stories about life and living happily ever after "The
Tibetan Book of Living and Dying not only addresses life, but brings
the reader face to face with Death.

The book, authored by Sogyal Rinpoche, a renowned Buddhist teacher,
has been revised and updated to commemorate its 10th anniversary. The
book begins rather impressively with a foreword by the Dalai Lama,
who sets the tone: "No less significant than preparing for our own
death is helping others to die well." Sogyal Rinpoche places life and
death contextually together for our consideration, describing why we
must address death during our lives. The realm of gods in the
Buddhist teachings, who lived lives of fabulous luxury and pleasure
with little thought or time for spirituality until death appeared,
and who were unprepared for it, are alluded to here, as is active
laziness whereby unimportant tasks become responsibilities, part of a
rigid schedule, and begin to dictate one's existence.

"The fate of the gods reminds me of the way the elderly, the sick and
the dying are treated today. Our society is obsessed with youth, sex
and power and we shun old age and decay. Isn't it terrible that we
discard old people when their working life is finished and they are
no longer useful? Isn't it disturbing that we cast them into old
people's homes, where they die lonely and abandoned?"


He highlights instead, the importance of spirituality, contemplation
and the need to devote some time each day to examining the deeper
meaning of life.

Our task is to strike a balance, to find a middle way, to learn not
to overstretch ourselves with extraneous activities and
preoccupations, but to simplify our lives more and more. The key to
finding a happy balance in modern lives is simplicity.

He speaks of two groups of people whose attitudes to death clearly
affect the way they live life. One group lives in denial of death ­
repressing and refusing to acknowledge its potential impact. The
second group has a casual attitude towards death, not attributing to
it the seriousness of thought it deserves.

The author advocates that each individual attempts to understand the
nature of the mind, and then move on to train the mind through
different practices of meditation. Mindful meditation (having roots
in ancient Buddhist practice) is applicable to anyone suffering from
stress, anxiety or pain and Rinpoche describes its three essential
components. Rinpoche goes on to expound on several Buddhist beliefs:
rebirth, karma, reincarnation, bardos etc. and stresses on the
importance of the mind.

No one can die fearlessly and in complete security until they have
truly realised the nature of the mind.

In its second section the book deals with Dying. Most of us, even
medical professionals, are bewildered when confronted by the prospect
of death. Often we feel inadequate or embarrassed, not knowing what
we should say to the person who is dying, and to his near and dear
ones. Indeed, the most typical human response to death is denial of
the condition or the diminishing of its impact. However, the person
who is dying often has a much clearer knowledge and vision of this
inevitable outcome, achieved after weeks of intense suffering.
Helping the dying person achieve an early, more graceful acceptance
of death, without denying or diminishing his thoughts and feelings is
thought to be important. Rinpoche describes the case of a lady doctor
friend who, having dealt (in her perception) unsuccessfully with a
dying individual, asked Rinpoche what he would have done in that situation.

"I would have sat by his side, held his hand and let him talk. I have
been amazed again and again by how, if you just let people talk,
giving them your complete and compassionate attention, they will say
things of a surprising spiritual depth, even when they think they
don't have any spiritual beliefs. I have been very moved by how you
can help people help themselves by helping them discover their own
truth, a truth whose richness, sweetness, and profundity they may
have never suspected."


Two things most useful at the deathbed are, a sense of humour, a
useful tool to dissolve the gravity of the situation; and the ability
to not take things personally, since anger is a common response of
the dying person, and may be directed towards the person trying to
help. It is also important to show unconditional love, which can be
facilitated by thinking of yourself in the dying person's place
(empathy). Rinpoche also emphasises the importance of telling the
truth with love, a rare blend of virtues that directly addresses the
dying person's needs. Active compassion (expressed in action, not
mere words) is another ingredient that enables the experience of
dying. The Buddhist practice of Tonglen, the ability to take on the
suffering and pain of others and give them your happiness, well being
and peace of mind and the powerful Tibetan tradition of phowa
(pronounced po-wa), the transference of consciousness, are described
as being invaluable to the dying person. To be able to deal
effectively with the dying person's fears, it is important to
introspect and be aware of one's own fears about death.

"Caring for the dying makes you poignantly aware not only of their
mortality but also of your own."

While saying goodbye, two explicit verbal statements are
pre-requisites. The dying person must be given permission to die with
the assurance that his loved one(s) will be taken care of in the
aftermath. When the loved one is a child, Rinpoche suggests that it
is commendable to encourage the young one to pray, as it gives them a
sense of having contributed in some way. He also addresses the people
that the dying person leaves behind, saying that it is useful to be
open to grief rather than repress it, and try to learn from the grief.

"Bereavement can force you to look at your life directly, compelling
you to find a purpose in it where there may not have been one before."

In its third section, the book deals with Rebirth. Buddhist
philosophy endorses the concept of rebirth and Rinpoche expounds on
several related beliefs using the Bardo paradigm. In Tibetan Buddhist
teaching, our entire existence consists of four bardos: The natural
bardo of this life; the painful bardo of dying; the luminous bardo of
dharmata (after death) and the karmic bardo of becoming (rebirth).
The bardos are viewed as particularly powerful opportunities for
liberation. Leaving the body, achieving the transitory state of
dharmata and being reborn (or in turn liberated from the endless
cycle of birth and death) are all described in detail. Rinpoche
explains how we could, by adopting the correct mindset, be liberated
from the cycle of birth and death during the dharmata phase. He also
discusses the near death experience and its remarkable similarities
to the bardo of becoming, in that the mind is momentarily liberated
from the body and goes through a number of experiences akin to the
mental body in the bardo of becoming. Yet there is a distinct
difference ­ the person in the near death experience does not
actually die, whereas the bardos are viewed as transitory but
inevitably progressive states. Indeed, some Buddhist masters have
viewed near death as a "between bardos" state. While many of us may
not believe in life after death, and may view these concepts as being
unscientific, they have intrinsic value for the person who is on the
threshold of dying (for example due to a terminal illness) and for
their near and dear ones. In this Tibetan Buddhist framework of
thinking, death becomes an active process of willing engagement as
opposed to a passive process of mute spectatorship, both for the
person concerned and for his loved ones.


In the final part of the book, Rinpoche speaks about the significance
of understanding and accepting death because it is a universal
process. In his view, we live in a world that appears to be too
besotted with life to give much thought to death, an unhealthy
attitude that needs to change. It is not uncommon today, to have a
beloved elderly relative admitted in a hospital ICU, with multiple
tubes and support systems for his sustenance, often an unwilling
participant in the seemingly interminable fight for his life. Pray,
what price are we paying, to defy death under these circumstances?
What dignity is there in challenging death in this manner? Indeed,
what crime would we commit in allowing a person who has lead a full
life to meet his maker in a natural, dignified and well-prepared
manner? These philosophical thoughts assail one's mind, as one
contemplates life and death in the modern context. Rinpoche's
exhortation to the health professional is particularly moving.

"How can you be a truly effective doctor when you do not have at
least some understanding of the truth about death, or how to care
spiritually for your dying patient? How can you be a truly effective
nurse if you have not begun to face your own fear of dying and have
nothing to say to those who are dying when they ask you for guidance
and wisdom?"

For doctors, nurses and others confronted with the experience of
death he also has other valuable tips to share.

"I never go to the bedside of a dying person without practising
before hand, without steeping myself in the sacred atmosphere of the
nature of the mind. Then I do not have to struggle to find compassion
and authenticity for they will be there and radiate naturally."

Modern medicine has produced many miracles that have the potential to
save and prolong human lives, but has not succeeded in preventing the
process of death reach its natural conclusion, or in adding dignity
to the process. We would do well therefore to consider incorporating
the wisdom of Tibetan Buddhism into modern medical care. There is
however, a very real risk that this philosophy will be applied by
well meaning but misguided individuals, at inappropriate times, when
the possibility of saving a life still exists, causing much pain to
the concerned person and to relatives. It is therefore important to
understand that these principles are most applicable in the care of
terminally ill people. For example, those caring for terminally ill
people in hospices, hospitals or at home would benefit greatly, if
some of these thoughts and ideas were incorporated into their training.


Death and dying are an undeniable reality; a natural consequence of
all human existence. Dying well is a dream that most elders have (we
talk of Anayasa maranam in Hindu culture) and helping people die well
and peacefully is a duty, not just for the healthcare professional
but also for their near and dear ones. This book, therefore, has
obvious implications for every one of us, as we will all have to face
death at some point of time in our lives. Even individuals who do not
share Rinpoche's religious and spiritual inclinations have plenty to
learn from the book, as it offers practical insights into dealing with dying.

However, several of the principles expounded in the book are not
scientifically verifiable. Instances of the occurrence of a rainbow
body for example or beliefs about near death experiences and rebirth
have their testimony in anecdotal repetitions and not empirical
evidence. The book, therefore, is likely to appeal more to those with
spiritual inclination than those who subscribe strictly to modern
scientific tradition. Nevertheless, as the Tibetan saying goes, "If
you are too clever, you could miss the point entirely."

Sogyal Rinpoche's ability to clearly express himself, capturing the
reader's attention, with interesting anecdotes and quotations from
learned works is unquestionable. Even more commendable, however, is
his choice of subject" Most books speak of life and living happily
ever after. This one speaks of death as well.

Dr. E.S. Krishnamoorthy is Director, T.S . Srinivasan Chair and
Senior Consultant Neuropsychiatrist at The Institute of Neurological
Sciences-VHS, Chennai. E-mail:

Niranjana Bennet is a M.A. Psychology student at Christ College,
Bangalore. She researched for and co-wrote this article while
interning in TINS-VHS.

The Tibetan Book of Living and Dying, 10th Anniversary Edition,
Sogyal Rinpoche, Patrick D. Gaffney, Andrew Harvey

HarperCollins, 2002, price not stated.
CTC National Office 1425 René-Lévesque Blvd West, 3rd Floor, Montréal, Québec, Canada, H3G 1T7
T: (514) 487-0665
Developed by plank