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Palliative care and buddhist death
Just like to get some views about how buddhists die (sorry to be morbid, professional interest). :banghead:
Reading the Tibetan book of living and dying, it explained that buddhists like to be as lucid as possible at the moment of death and so refuse opiate pain relief. On the other hand death from things like cancer and Aids can be excruciatingly painful which would cloud your mind.
Set me straight on this one please.
Reading the Tibetan book of living and dying, it explained that buddhists like to be as lucid as possible at the moment of death and so refuse opiate pain relief. On the other hand death from things like cancer and Aids can be excruciatingly painful which would cloud your mind.
Set me straight on this one please.
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Comments
It is certainly true that pain relief will usually be accompanied by some 'clouding' of the mind. This can be unpleasant and contemporary palliative care staff tend to understand that the balance of relief and 'clouding' must be a matter for the patient.
In terms of the practice of mindful death, as described by Sogyal Rinpoche and others, we are not all such noble practitioners that we can replace pain relief with meditation. We do the best we can.
There are many examples of people who have refused medication at the ends of their lives, preferring the pain to the sensation of "being at the bottom of the sea" (as Debussy called it). The first example that I came across was the poet Arthur Rimbaud. Some people would prefer to have the experience "neat" whilst others need help. There is no judgment to be made, only support for the wishes of the dying.
I'm naturally generalising here, because as Simon points out, each case is an individual one... everyone however, to my mind, no matter where, when or how, deserves to be treated with Compassion and care.
whether I agree with it or not:
Whether I think it to be right or not:
To my mind, if a patient expresses a specific wish, and they are in full control of their mental capacity, I believe they deserve to have their wishes respected.
This brings to light countless other related questions, and could open up a whole new can of worms (this subject has come up before, you see....) but I'm just answeing your specific question directly.
Simon, I'm not sure what the Flying Spagetti Monster's take on this would be.
With reference to the highlighted section above, KBuck, do you mean financially, practically or emotionally? There are relatives' support systems available for counselling and for the bereaved.....
The other instance where euthanasia is questionable is where (a) the patient has never mentioned or discussed it and (b) where the patient is unable to make a contributon or give an opinion /decision on what they feel would be best for them....
I would imagine the Flying Spaghetti Monster would be pasta caring.....
http://www.venganza.org/
I would think that the only circumstances that euthanasia would be totally acceptabe would be if the sick person, his family and other loved ones all agreed that that was
the best course of action. Otherwise, the overall "sum of suffering" could be greater than if the person were allowed to linger. In that situation, as in all situations, it would be important to consider the over-all amount of pain caused to everyone involved; by both the patient living or dying.
Again, just opinion. I'm certainly no expert on the subject. There are many factors to consider. What is the Karmic effect of the person administering the killing dose of whatever? Intent + Action = Karmic Accumulation. Even if the doctor assisting the suicide has the best of intentions, he is still killing another sentient being. At best, it would seem to cause some negative karma to be accumulated.
I'd say that's just one of many factors to be considered.
If an action is performed with nothing but compassionate intent but the result is harmful is the accumalation of karma negative or positive - is it an unskillful action? A case of your heart being in the right place...
How much more logical then for a SENTIENT Human being, with all the brain-power available, to be able to make the same decision for themselves?
Euthanasia is legal in Holland, but is governed by extremely stringent and hard-line procedures. If several criteria are satisfied to all the relevant (and unconnected) authorities involved, then a person is permitted to proceed, and the whole matter is carried out with kindness, compassion and dignity. Saw a programme once, on this very subject. It was poignant and touching, and extremely dignified......:)
According to Buddhist "doctrine", yes. However, the amount of negative karma generated from a harmful result with a completely compassionate intent is much less.
I myself am somewhat skeptical of "literal" karma accumulation. I fully belive that negative actions and intent will come back to bite you in the a@#, but as to life-time to life-time karma acumulation and expenditure I'm not very concerned. Whether or not the literal definition of karma is accurate, if you live your life by the teachings handed down by the buddha (or Jesus, for that matter) only good will come of it.
It is one of the Christian tenets (and mentioned by Jesus in his conv with Pilate) that he gave himself over, willingly, to death. What separates his action from that of, say, Judas or another suicide is intention.
Of course, if Jesus' death was suicide (and I used to startle my classes by calling it so), it does raise the whole question of what is "good" and what is "bad". A much more important question which goes to the very root of our dualisms.
You only have to look at the Picture/signature on *BeautifulSpringtimeFist*'s posts of the Monk, Thich Quang Duc, to illustrate your point, KBuck.....
http://www.answers.com/topic/thich-quang-duc
Do be sure to check out the references at the bottom. They all lead to other interesting sites and info, especially the 'more photos' link.... just as a point of interest....
Just a quick note-I believe that if you are willingly making a compassionate descision to alleviate pain in the dying person/patient (by assisting in their demise, at their own request), this would if anything assist in reducing your own karmic bank-balance.
I guarantee that someone will quote me and denigrate me again about this, but I feel that compassion and logic and "Testing it for yourself" far outweighs some person's "Token understanding" of something written thousands of years ago when pain-killing consisted of a hammer and maybe some alcohol.
Wouldnt it would be a noble act rather than an abhorrent deed-? I've contributed to a similar thread a while ago but I was gunned-down by "buddhists", (figuratively speaking) this seems to be an incredible touchy subject to some.
P.S. I am agreeing with you Federica, in case it seems a bit lost in the translation.
I think since this thread was begun, Elohim posted a good post on how our actions, instead of being measured according to 'Good' or 'bad' karma, (which is almost impossible, as there are so many different parameters to consider... so many people in the chain....) one should try to assess how "skillful" our actions are... we weigh them up according to our understanding and following of the Eightfold Path... and try our best (Try... yes, I know!) to suit our actions to the Word.....
Recently, a British woman Doctor suffering from Motor Neurone Disease asked her children to help her die, before she lost all capacity to function for herself.
She and her family had to go to Switzerland to carry out her wishes.
Last I heard was that if the Children came back to the UK, they risked being arrested....
I don't believe it would ever come to, or even stand up in court.
But if it ever DID come to it, it would be madness to put them through the ridiculous farce of a trial.....
basically, Buddhism says, Killing is wrong. OK. Fair enough....
But so is witholding Compassion.
You would have to assess and evaluate every single situation individually.....
And then decide, skillfully.
And do your best.
I mean, taking the life of another being- negative karma
Showing compassion- positive karma,
Therefore the karmic effect= zero?
I really don't think that taking the life of another being that wants to die would produce anything other than zero karma, wouldn't you think? There are so many millions of shades of grey these days.... :eek2:
"Just like to get some views about how buddhists die (sorry to be morbid, professional interest).
Reading the Tibetan book of living and dying, it explained that buddhists like to be as lucid as possible at the moment of death and so refuse opiate pain relief. On the other hand death from things like cancer and Aids can be excruciatingly painful which would cloud your mind.
Set me straight on this one please."
Some Buddhists may be so well practiced in meditation that they are able to control their own pain. Thích Quảng Đức is a good example. That level of concentration is astonishing and he left an indelible impression on me when I first learned about his self-immolation as a teenager. At that time, I was experiencing quite painful menstrual cramps and he gave me an idea; if he could set himself on fire and not move a muscle or cry out through sheer concentration, then I could surely rid myself of my pain by doing the same. I didn't know what he was concentrating on but I lay down in my dark, quiet room and hoped some idea would come to me. And it did! I decided to concentrate on the pain, the whole pain, and nothing but the pain. That's what I did. I blocked everything else out and focused only on the pain. And the most amazing thing happened. The pain was real one minute and then it began to lose its meaning. And then all of a sudden it stopped. After only about 5 or 6 minutes. It reminded me at the time of when you say a word, any word, over and over and over again and it suddenly loses its meaning and then it sounds ridiculous. That's exactly what it was like.
These days I'm very happy to have acquired that skill because there are times when no amount of pain meds work on the nerve pain I have and I have to fall back on it. It's nothing like Thích Quảng Đức's level of skill, obviously, and I certainly couldn't concentrate enough to do it if I were sitting on a busy street corner. I still need a dark and quiet room. But the seed of the skill is there and I owe it to him. He changed my whole life, actually, because he was the one who brought me to Buddhism. I just didn't know it when I was a teenager. But I know it now and I'll be grateful to him for as long as I exist.
Fede originally brought him up in this thread in relation to kbuck's comment that there is a fine line between suicide and self-martyrdom. But I think he also illustrates well the answer to twobitbob's first question.
Just wanted to know ....."is our life really owned by us anymore"? I mean here I am an organ donor. So I end up a "vegetable/paper weight" right, so I have informed my family that I want machines turned off and my organs "given away" to those who could really use them....hey its not like I'm attached or anything!!!!
Now my family, the doctor, the hospital, they can all override my decision.
Oh grat now I'm raving:banghead: Well another of my two cent ideas....maybe I need to pay more tax????
Regarding karma, i think most here agree that there is a difference between helping a 87 year old with terminal illness die is vastly different to helping a suicidal 16 year old die -the difference is not in the person's desire to die but in the skillful application of compassion and the intentions of any action. You try to convince the 16 yr old to live because there is so much potential for them, their suffering can be relieved without death.
The issue of a medicalised death is complex, i just want to make a few points:
1.) The medical profession have been playing god for a little while now and though most have come round to the idea of patient centred care - where the patient says what treatment they want - old habits die hard. People (not just doctors) will always think they know what is best for you, the trick is not to force this on other people.
2.) British society (can't speak for any other) shuns the issue of death, so when it comes people are not prepared for it. Esae has informed his family of his wishes which is exactly what needs to happen. But care is still needed, when you are a vegetable the medical team have only what the relatives say to go on and if a few of them just can't take losing you and want to keep you alive things become complicated. Living wills are starting to be introduced where you write down exactly what you want, which are legally binding. Obvoiusly emotions are raw and a consideration for many health professionals is the fact they would like to keep their job.
3.) There seems to be a belief emerging from Christian beliefs that life should be preserved for as long as possible. This confuses me since i thought Christian ethics was based on natural law concepts - intervening when someone is going to die anyway seems unnatural to me.
4.) Pro-life groups have argued that there is no need for euthanasia if palliative care can be improved so that no suffering is experienced at end-of-life. This is a noble stance but it simply is not pragmatic - governments, or private health insurance costumers, are not willing to put in the considerable financial resources this would require.
Then there is the issue, as pro-life groups point out, that some people may be pressurised into an early death because the family just want a quick end or to get their hands on some money (still can't believe this happens), and no matter what controls you put up family coersion can be very subtle.
The doctors deemed her basically brain dead. Her then husband was insistant that Terri would have wanted to die. Her family fought in court for YEARS! Eventually, they lost. Terri died a horrible death! Starvation!
I cannot understand why the husband did not release all legal rights...some say money...
I explained the situation to the nurses who were, without doubt, the most compassionate people I have met. They had known my mother lucid and they could see that she had, in most respects already died, it was only that her body insisted on breathing.
So they very quietly and efficiently started laying her on her back with no pillows so that her lungs would fill up and she would die of pneumonia. This only took a few days during which time my mother was unconscious. She kept a modicum of dignity, was not linked up to machines and I did not have to make the decision to switch off life support - I had, of course, already taken the decision to allow her to die as quickly as possible in accordance with her wishes. This was not a decision taken lightly but with a clear heart because I knew with complete certainty that this was what she wanted.
I accept any negative karma that might come my way because of this, but I would also willingly take any that should be due to the nurses, because their sole motivation was kindness. Their compassion both to me and to my mother was inspiring and humbling.
Her husband, by most fair accounts, was actually the only hero in the entire mess. She had been in this state for 14 years and the $1,000,000 insurance payment had largely been spent on her medical care and legal fees fighting her parents in court. He could have walked away at any time. In fact, at the time of her death, her husband already had a new family, 2 children with his fiancee. He could have divorced Terry years before, taken the money and started a new life with his new family. However, his conviction was so strong that Terry would not have wanted to be kept alive like this that he chose to stay and fight for her right to a death with dignity. He did this for Terry, not for himself and certainly not for money that was long gone by that time. Her parents were simply too emotionally clouded and unable to let their daughter go and their grasping attachment to her did what it does, caused suffering. The autopsy proved to the doctors that her husband had been right all along.
Sometimes those people lose their Irony chip.
P.S. I worked on these machines-they're good!
Sharpiegirl,
My pleasure and thank you for being so gracious! It's a relief to find out she didn't suffer like we were afraid she would, isn't it? The media coverage was massive leading up to her death but the autopsy results didn't get nearly as much attention. I for one heaved a huge sigh of relief. It's just so complex an issue and I've never known where to stand. Now that I'm practicing Buddhism with the whole karma question, it's even more difficult. In fact, this thread prompted me to talk to my parents about my wishes. All I could tell them was I wanted a "Do not resuscitate" order and no heroic measures but I couldn't ask them to euthanize me. I just don't know enough about the ramifications. Genryu was right about Buddhism not being a soft, comforting religion. It really is full of pointy corners.
Love,
Brigid
My expertise is in MRI primarily and NucMed secondarily and almost no X-ray (yea I know, but most people dont know what NucMed or Mri are, but if you say X-ray-then the penny drops)
Yea a NucMed scan uses a radioactive isotope that is attached chemically to a specific chemical that can attach to an organ or bones etc. for instance, if you want to "see" bones you use phosphorus or calcium-when bones grow/heal/ become cancerous there is an increase in the takeup of phosphorus etc. so obviously there is a greater concentration of radioactive activity around that area-so it shows op on the computer screen after processing, of course.
A brain scan would show a similar situation-where oxygen is consumed by the brain-thinking, in other words=activity, you can tell if brain-death has occurred or not.
It is interesting, but you get to see many real sad conditions-poor health. luckily I only work on the Imagers. I'm not the person that has to tell them that there is a huge tumour in their head.
Rather than looking at it as a decision to seek death, I prefer to look at it as a request to review prupose and meaning in the face of pain and a shortened future. Death might appear to be the solution to their situation but I think many want the opportunity to reconcile and explore how they feel about their life and future.