Modern-Day Art of Dying: Reviving Buddhist and Christian Perspectives on Death with Implications for Palliative Care
Angelin Mathew, Yale University School of Medicine, New Haven, CT and Benjamin Doolittle, MD, MDiv, FAAP, FACP, Yale University School of Medicine, New Haven, CT
Death is the only certainty in our existence, yet it feels more distant to us now than it did historically. Over 70% of Americans die in institutional settings with minimal existential and spiritual care. Religious and cultural communities around the world pioneered texts to guide their members in dying well. We investigate key lessons on preparing for death from two perspectives: The Tibetan Book of Living and Dying, rooted in the Vajrayana Buddhism of Bhutan, and Taksa for Anointing of the Sick from Syro-Malabar Catholicism in India. In this inter-religious project, we articulate a novel, modern-day “art of dying” from the ancient wisdom from two different Eastern cultural and spiritual traditions. Comparatively studying these traditions reveals three significant points of departure: (1) interpretations of the metaphysics of dying, (2) understandings of the afterlife, and (3) spiritually concordant preparations for death. These differences have implications for patient care since Buddhist and Christian patients view death as an important spiritual opportunity. In particular, these traditions offer a modern lesson for those palliative care providers who support patients to die with dignity.
1) The Metaphysics of the Dying Process
Vajrayana Buddhists understand the process of dying as the sequential dissolution of five elements that make up the body: earth, water, fire, air, and space. Each of these dissolution stages have distinct symptoms that are documented in detail to ensure that Buddhists can make sense of their physical changes and use their death for spiritual advancement. The disconnection between the physical body and conventional mind allows practitioners to recognize the pure unconditioned nature of mind. Importantly, Buddhists do not believe in a soul. Buddhists emphasize the importance of mind, consciousness, and continuity of accumulated karma.
Syro-Malabar Catholics’ understanding of the physical dying process is not as systematic. Syro-Malabar Catholics believe in a dualistic view of humans as being composed of body and soul. God calls the faithful at the correctly ordained time of death. At the moment of death, the soul departs from the body and begins a journey to God and becoming like God. Through prayer, deceased saints can accompany the soul in the journey. As physical symptoms like the body’s weakening and breathing difficulties are noted, an ordained Catholic priest is consulted to perform Anointing of the Sick, Viaticum, and Confession.
2) The Afterlife
Both Vajrayana Buddhists and Syro-Malabar Catholics believe death is a transition. However, what they imagine happens after death remarkably differs. Buddhists believe in the transmigration of consciousness to a new body for rebirth. Broadly, there are six realms which a being can be reborn into: humans, animals, hungry ghosts, hell, demi-gods, and gods. The cycle of rebirth is considered suffering so a Buddhist’s goal is to reach nirvana to break the cycle of suffering. One of the key features of nirvana is complete dissolution of division between self and others.
In contrast, Syro-Malabar Catholics do not believe in rebirth on earth but rather a resurrection of the dead. God transforms bodies (free of suffering and decay) and reunites them with souls. The primary hope and vision derives from Jesus Christ’s own resurrection. Syro-Malabar Catholics do also believe in purgatory, hell, and heaven. However, there is a strong emphasis on solemnity, hope, and community.
3) Spiritual Preparations for Dying
Religious rituals reaffirm metaphysical realities and offer comfort amidst significant life transitions. For Vajrayana Buddhists, the Phowa ritual provides instructions for transferring a dying person’s consciousness to nirvana or higher realms for rebirth. Experienced monks will help patients chant mantras and visualize the Buddha’s Pure Land. For Syro-Malabar Catholics, the last Eucharist provides "food for the journey” and symbolizes Jesus Christ accompanying the soul in the journey. It provides the dying person with assurance in eternal life and readiness to meet God. Thus, palliative care providers can help ease death anxiety and foster better relationships with patients by inquiring about important rituals and connecting with the patient’s trusted community religious figures to coordinate the rituals.
Ultimately, we seek to emphasize the diversity in religious belief about death and the afterlife. Patients with unmet spiritual and existential needs report higher depressive symptoms and less care satisfaction. Currently in the US, 94% of patients received no spiritual or existential care. This disparity is heightened for patients identifying as racial and religious minorities.
1) The Metaphysics of the Dying Process
Vajrayana Buddhists understand the process of dying as the sequential dissolution of five elements that make up the body: earth, water, fire, air, and space. Each of these dissolution stages have distinct symptoms that are documented in detail to ensure that Buddhists can make sense of their physical changes and use their death for spiritual advancement. The disconnection between the physical body and conventional mind allows practitioners to recognize the pure unconditioned nature of mind. Importantly, Buddhists do not believe in a soul. Buddhists emphasize the importance of mind, consciousness, and continuity of accumulated karma.
Syro-Malabar Catholics’ understanding of the physical dying process is not as systematic. Syro-Malabar Catholics believe in a dualistic view of humans as being composed of body and soul. God calls the faithful at the correctly ordained time of death. At the moment of death, the soul departs from the body and begins a journey to God and becoming like God. Through prayer, deceased saints can accompany the soul in the journey. As physical symptoms like the body’s weakening and breathing difficulties are noted, an ordained Catholic priest is consulted to perform Anointing of the Sick, Viaticum, and Confession.
2) The Afterlife
Both Vajrayana Buddhists and Syro-Malabar Catholics believe death is a transition. However, what they imagine happens after death remarkably differs. Buddhists believe in the transmigration of consciousness to a new body for rebirth. Broadly, there are six realms which a being can be reborn into: humans, animals, hungry ghosts, hell, demi-gods, and gods. The cycle of rebirth is considered suffering so a Buddhist’s goal is to reach nirvana to break the cycle of suffering. One of the key features of nirvana is complete dissolution of division between self and others.
In contrast, Syro-Malabar Catholics do not believe in rebirth on earth but rather a resurrection of the dead. God transforms bodies (free of suffering and decay) and reunites them with souls. The primary hope and vision derives from Jesus Christ’s own resurrection. Syro-Malabar Catholics do also believe in purgatory, hell, and heaven. However, there is a strong emphasis on solemnity, hope, and community.
3) Spiritual Preparations for Dying
Religious rituals reaffirm metaphysical realities and offer comfort amidst significant life transitions. For Vajrayana Buddhists, the Phowa ritual provides instructions for transferring a dying person’s consciousness to nirvana or higher realms for rebirth. Experienced monks will help patients chant mantras and visualize the Buddha’s Pure Land. For Syro-Malabar Catholics, the last Eucharist provides "food for the journey” and symbolizes Jesus Christ accompanying the soul in the journey. It provides the dying person with assurance in eternal life and readiness to meet God. Thus, palliative care providers can help ease death anxiety and foster better relationships with patients by inquiring about important rituals and connecting with the patient’s trusted community religious figures to coordinate the rituals.
Ultimately, we seek to emphasize the diversity in religious belief about death and the afterlife. Patients with unmet spiritual and existential needs report higher depressive symptoms and less care satisfaction. Currently in the US, 94% of patients received no spiritual or existential care. This disparity is heightened for patients identifying as racial and religious minorities.