# The Contemporary Significance of Palliative Care and End-of-Life Care

*A teaching by Master Jiqun for the Life Care Project, July 2025*

- *The Contemporary Significance of Palliative Care and End-of-Life Care*

- *I. Palliative Care and End-of-Life Care*
  - 1. Palliative Care
  - 2. Differences Between Palliative Care and End-of-Life Care

- *II. Traditional Chinese Attitudes Toward Death*
  - 1. Accepting Death
  - 2. A Good Death as a Blessing
  - 3. Careful Funeral Rites and Remembrance of Ancestors

- *III. Why Modern People Need Life Care*
  - 1. Lack of Understanding About Death
  - 2. Overemphasis on Physical Cure

- *IV. Establishing a Correct View of Life, Death, and Treatment*
  - 1. Understanding the Relationship Between Life and Death
  - 2. Establishing a Correct Approach to Treatment

- *V. What Happens at Death and Rebirth*
  - 1. The Four Stages
  - 2. The Three Forces
  - 3. Faith, Vow, and Practice
  - 4. The Open Space of Mind

- *VI. End-of-Life Care*

- *VII. Conclusion*

Life care is an important charitable undertaking. We advocate mindful living — not only to make life more beautiful, more meaningful, and richer in quality, but also to cultivate the capacity to face aging, illness, and death. These are essential subjects that everyone must confront.

# I. Palliative Care and End-of-Life Care

This event focuses on two main areas: palliative care and end-of-life care. The latter belongs to Buddhism's traditional repertoire — many monasteries are already engaged in it, so it should not be unfamiliar. Palliative care, by contrast, is relatively new; our past charitable programs have touched on it but not in depth.

## 1. Palliative Care

Palliative care originated in Britain. Its founder was Dr. Cicely Saunders. She began as a nurse and, while caring for cancer patients, discovered many problems. She felt deeply that conventional medicine lacked care for those at the end of life. Driven by this insight, she did everything in her power to relieve patients' suffering, and in 1967 she founded the world's first hospice dedicated to palliative care.

In recent decades, as the population has aged, the number of cancer patients in China has steadily risen. According to relevant statistics, there are currently about 30 million existing cancer patients, and roughly 3 million people die of cancer each year — an enormous number. Once an illness is detected, hospitals and family members tend to make cure the sole objective. But for certain late-stage or incurable conditions, medicine is not all-powerful. An obsessive pursuit of cure often leads to overtreatment. Even when life hangs by a thread and treatment has ceased to have any value, people still frantically attempt to save the patient — tubes inserted everywhere — just to prolong survival by a few days or even hours. The result is that patients endure terrible suffering, approaching death in despair, helplessness, and confusion.

What palliative care advocates is comprehensive care for patients, enabling them to complete the final stretch of life with more dignity and less suffering. This is not giving up on treatment; it is giving up on treatments that are ineffective at curing or prolonging life. The focus shifts to relieving physical and mental pain and improving quality of life. This includes physical care, emotional comfort, spiritual guidance, and religious care. If, at the end of life, merely staying alive only adds suffering, and the patient does not wish to undergo futile emergency interventions, family members should accept and respect the patient's own decision.

Pain is the greatest difficulty faced by many who are dying. It is constituted by physical, psychological, social, and spiritual dimensions — what Dr. Saunders called "total pain." There is the physical pain caused by disease, the psychological pain of not accepting one's condition, the spiritual pain of facing the loss of all social connections, and the ultimate pain of knowing nothing about one's future destination. To address these issues, palliative care must construct multi-faceted care from different angles. This requires a multidisciplinary, multi-professional team, including physicians, nurses, psychotherapists, chaplains, and volunteers.

Palliative care fully embodies respect and care for human beings. Since its inception, it was quickly promoted by the United Nations worldwide. In 1988, Tianjin Medical College established China's first palliative care ward. In 2017, the National Health Commission officially issued the *Palliative Care Practice Guidelines (Trial)* and launched national pilot programs. Today, palliative care services cover 185 regions across China, but given the enormous population base, this is still a drop in the bucket. Faced with the needs of society at large, some charitable organizations and civil groups have also become actively involved. Here, I deeply rejoice in everyone's aspiration and altruistic spirit.

## 2. Differences Between Palliative Care and End-of-Life Care

All major Eastern and Western religions include elements of end-of-life care — for example, the reading of the Bible and hymns in Christianity, and the last sacraments in Catholicism. Buddhist scriptures also contain relevant records. In my lecture series "Selected Readings from the *Dharmaguptaka Vinaya*," there is the *Chapter on Caring for the Sick and Seeing Off the Dying*, which compiles the various matters prescribed in the monastic precepts for nursing the ill and accompanying the deceased — concrete and detailed. Clearly, these practices have a history of over two thousand years in Buddhism. Palliative care, by comparison, is still in its early stages. It shares common ground with end-of-life care, but each has a different emphasis.

In terms of time span, end-of-life care is mainly concentrated in the final period when life is nearing its end, whereas palliative care intervenes earlier and can occur at any stage of illness. When the World Health Organization redefined palliative care in 1990, it emphasized that it should "be applied early in the course of illness, in conjunction with other therapies that are intended to prolong life." In other words, palliative care can run throughout the patient's entire journey from falling ill to dying, lasting months or even years.

In terms of methods, end-of-life care leans toward the religious and spiritual dimension. Based on the dying person's faith and wishes, a suitable chaplain is found to provide psychological relief and guide the dying person to accept death and peacefully face the future. Palliative care, on the other hand, is comprehensive care. Beyond offering religious and psychological support, it also includes professional medical nursing — controlling symptoms, alleviating pain — and helping patients and their families confront the many pressures of fear, anxiety, financial burden, and caregiving.

# II. Traditional Chinese Attitudes Toward Death

The emergence of palliative care is deeply connected to modern medicine. Many new treatments can sustain life but also bring tremendous suffering to patients, to the point where living becomes worse than dying. How do we find the optimal balance between staying alive and living with quality? In ancient times, without all these life-extending measures, death was more natural. How did our ancestors view this question?

## 1. Accepting Death

In traditional Chinese culture, life and death are seen as natural attributes of existence, and there is a degree of acceptance toward death. When we were children, people of a certain age would prepare a coffin for themselves, called a *shoucai* — longevity wood. The local custom in Taining is even more interesting: when a person is born, the family adds a coffin for them, which is why the mountains around Taining hold many unopened coffins. The reception hall on Plum Blossom Island once stored seven or eight coffins, all of fine wood and craftsmanship. The island now has a guest room called "Impermanence Hall," which contains a coffin. Staying there — sleeping alongside a coffin — is a unique life experience.

There is a Chinese saying, "Life and death are decreed by fate; wealth and status depend on Heaven," which also reflects how Chinese people understand and approach death. Although Buddhism does not endorse pure fatalism, under the influence of this culture, people could peacefully accept death rather than resist it futilely. This is very important, because resistance not only fails to help — it adds unnecessary suffering.

## 2. A Good Death as a Blessing

As far back as three thousand years ago, the ancient Chinese regarded the Five Blessings as the standard of a complete happiness: longevity, wealth, health and peace, love of virtue, and a good death. A good death means passing away naturally, without illness — peacefully and serenely — drawing a perfect full stop to one's life. Conversely, "a bad death" became the most severe curse.

What constitutes a good death? It includes both physical and psychological dimensions. Physically, it means ending through natural aging, like a melon ripening and falling from the vine, or a leaf returning to its root — not through premature death, violent death, lingering in a sickbed, and certainly not through taking one's own life. Psychologically, it means having fulfilled one's family responsibilities, properly handled inheritance and social relationships, avoided causing disputes among relatives, and being buried alongside one's ancestors — then one can smile in the netherworld and die without regret. The iconic scene of a good death is being surrounded by children and grandchildren, giving final instructions. That is why, when parents or elders are dying, children will return from however far away to see them one last time — otherwise, the deceased would die with eyes open in grievance.

## 3. Careful Funeral Rites and Remembrance of Ancestors

The *Analects* says, "Attend carefully to the funeral rites of parents and remember the ancestors; then the people's virtue will return to richness." This reflects the Confucian emphasis on funeral and memorial rites, and the moral cultivation they represent. "Careful funeral rites" means handling the funeral of parents and elders according to propriety, without negligence. "Remembrance of ancestors" means conducting regular memorial ceremonies, recalling the ancestors, and never forgetting one's roots. Chinese culture is an ancestor-worshipping culture. Many families maintain ancestral halls housing the spirit tablets of generations of forebears. After a person dies, their place is added to the hall. So in the traditional view, after death one simply joins one's parents, grandparents — all the way back eighteen generations of ancestors. They all live in another world, and after death, one goes to that world to reunite with them. One is not alone.

In Chinese culture, a person becomes a ghost after death. The difference lies in this: those without merit become lonely, wandering spirits with no one to care for them; those with abundant merit receive offerings of incense, and may even become deities who receive worship. Traditional customs such as tomb-sweeping at Qingming and offering sacrifices to ancestors on the fifteenth day of the seventh lunar month represent both remembrance of the ancestors and a time when the ancestors return to visit their descendants. So on these days, people make sincere offerings, praying for their ancestors' blessings for future generations. From the Buddhist perspective, of course, the deceased have long since been reborn. The saying "in eighteen years I'll be a hero again" is influenced by the idea of rebirth. Confucianism, lacking the concept of rebirth, holds that ancestors all dwell in another realm and maintain a different form of connection with their descendants. Under the influence of this culture, death does not seem unacceptable.

Why can careful funeral rites and remembrance of ancestors make people's virtue return to richness? If one has a strong sense of family, on the one hand one feels that living in this world, you are not merely an isolated individual — you also represent a family system built on kinship and blood ties, where a slight move in one part affects the whole. Therefore, you must not act without virtue, still less commit wrongdoing. Otherwise, you not only bring censure upon yourself but also bring shame upon the entire family — an unbearable responsibility.

Beyond being accountable to the ancestors, one must also accumulate merit for future generations. The *Book of Changes* says, "A family that accumulates goodness will surely have abundant blessings; a family that accumulates evil will surely have abundant calamities." When the ancestors have virtue, the entire family enjoys lasting good fortune. In a sense, this also reflects the continuity of karma and has some connection to the Buddhist view of cause and effect. Within this cultural system, life is already integrated into the family system, a part of a continuous bloodline. Even if I die, the family remains, the descendants remain — so the individual's death is not so frightening.

At the same time, traditional Chinese medicine was relatively gentle, and physicians, taking the practice of medicine as a compassionate mission, would not overtreat for profit. Accordingly, patients and the elderly could depart without excessive intervention. And within traditional filial thinking, it was taken as a matter of course that the younger generation would care for their elders; failing to do so would bring double condemnation from society and one's own conscience. Thus, life care for patients could be handled within the family and would not become a social problem.

For Buddhist practitioners, spiritual practice is precisely learning how to face and transcend life and death. Pure Land practitioners can recite the Buddha's name and be reborn in the Western Pure Land. Chan practitioners can see their true nature and gain liberation from birth and death. So death is merely an exam — just the right moment to see how one's practice is doing, whether one can know the time of death in advance and depart freely.

In summary, whether Confucian thought or Buddhist faith, both contain, to varying degrees, elements of life care that help people prepare for death in advance.

# III. Why Modern People Need Life Care

Although we live within the cultural system of Confucianism, Buddhism, and Daoism, these ideas have not been well inherited or transmitted. As a result, most people today cannot accept death as calmly as the ancients did. In everyday life, we can see that those with severe illness often struggle in confusion, fear, and despair — body and mind tormented as if in a living hell. I once said in a teaching that the richer people are, the more agonizing their death may be. Because they cannot let go, they will fight to the end with treatments and emergency interventions. For the patient, this is actually being tortured until the very last moment, denied even the right to a natural death. If, once it is confirmed that treatment is ineffective, one can let things take their natural course, one may actually depart with greater ease.

A professor working in palliative care cited this passage of mine in a paper and supported it with data. A report on the quality of death surveyed 80 countries worldwide and found that the quality of death for Chinese people ranked 71st. From the perspective of ancient ideals, many people today cannot be said to have had a good death; instead, they depart in the midst of prolonged torment. Why does this phenomenon exist? I think the following factors are at work.

## 1. Lack of Understanding About Death

Our current education emphasizes knowledge and skills, mainly addressing survival-level needs, but lacks education on the level of life itself — life's meaning, where the heart finds its true home, and how to face death. In daily life, people tend to avoid the topic of death and are unwilling to face it; even mentioning the word "death" is considered unlucky. This leaves modern people neither understanding nor accepting death.

But not understanding and not accepting does not mean one can avoid it. In fact, death is the inevitable conclusion for every person — an indispensable and essential subject in life. Only by understanding it can one walk toward the end with clarity and composure. Only by accepting it can one prepare before the day arrives, rather than panicking, not knowing how to respond.

Through studying the Buddhadharma, we come to know that death is merely the period at the end of one phase of life; it is not a complete end. Life continues on and on, unceasing. And *how* we die is the critical factor that determines where we will be reborn in the next life. This requires, through study and practice, understanding the principles of rebirth, seeing clearly the truth of life and death, and gaining the ability to transcend them. Only then can we be at ease in life and without regret in death. For both life and death are processes in the flow of existence. By living each present day well, we can continuously elevate our life, life after life. This shifts us from passively awaiting death to actively taking hold of our destiny and transcending birth and death.

## 2. Overemphasis on Physical Cure

According to relevant surveys, one-third of the medical costs for many illnesses occur in the final month of life. At this point, the patient and the family are often filled with fear. Even if there is only a glimmer of hope, they will follow whatever the doctor says, staking everything on one throw. If the hospital places particular value on financial profit, it may overtreat for gain — even continuing aggressive interventions when it is already clear there is no hope. For the patient, this only adds physical and mental suffering; for the family, it imposes a crushing financial burden, driving many families into poverty because of illness.

To what extent should treatment go? As patients and family members, on the one hand, we must understand the illness itself, the medical resources available, the treatment's effectiveness, and the probability of cure. On the other hand, we must recognize that with birth, death is inevitable. Only by facing this squarely can we make an objective assessment and a reasonable decision for ourselves — neither giving up lightly nor indulging in wishful thinking.

As a person approaches death, they experience not only physical and psychological suffering, but also problems on the social and spiritual levels. We have lived several decades and built social connections over decades — all kinds of relationships, loves, and resentments. If, at the moment of departure, we cannot let go, we will also die badly. Moreover, many people's fear of death stems from fear of the unknown — not knowing where they go after death and what will happen. It can be said that people have not the slightest understanding of this and have made no preparation whatsoever. From this perspective, both palliative care and end-of-life care cannot be separated from religion, because these are ultimate questions that cannot be reached through the mundane level or through existing experience.

I once gave a lecture in New Zealand titled "The *Heart Sutra*'s View of Life and Death," where I discussed the Buddhist attitude toward and approach to death, and held a dialogue with a local expert working in palliative care. They were very interested in this content. How should we face death? Different religions handle it in different ways. It must be said that Buddhism's understanding of life and death is the most thorough, because the Buddha's original purpose in leaving home to practice was precisely to resolve the problem of life and death. Consequently, many of Buddhism's teachings and methods revolve around this question. It is regrettable that many people do not understand these ideas and even reject this wisdom culture out of misunderstanding.

Through life care, we can share the Buddhist view of life and death, helping people see new hope when the body can no longer be cured. For the mind is the true master of life. When the mind can be autonomous and free, it will not be bound by physical suffering, enabling us to face life and death directly and transcend them.

# IV. Establishing a Correct View of Life, Death, and Treatment

## 1. Understanding the Relationship Between Life and Death

In providing life care, we must first establish a correct view of life and death. The Three Dharma Seals in Buddhism — "all conditioned phenomena are impermanent, all phenomena are without self, nirvana is peace" — tell us that everything in the world is in constant change. The moon waxes and wanes, the four seasons cycle, never stopping. Life is the same: from the moment of birth, no matter how long one lives, every moment is moving toward death.

Death is inevitable and also uncertain — we never know when it will arrive. The key lies in *how* we die. This requires building positive life accumulations. Just as living well requires the right causes and conditions, if we want physical health, we must learn the way of nurturing life, balancing movement and stillness. If we want mental health, we must let go of negative emotions and cultivate positive qualities. If we want harmonious relationships, we must understand, accept, and treat others well. If we want abundant good fortune, we must do more good deeds and extend compassion to all beings.

Life is an endless accumulation, like a river flowing from the infinite past into the boundless future. Death is merely a transition within this flow, not an absolute disappearance. If our present moment is a positive accumulation, then life can continuously elevate as it continues, moving toward a beautiful future — like moving to a better place to live. Why cling? Why fear?

Next, we must also recognize death's significance for life. Socrates said that philosophy is the practice of death. He himself was a living embodiment of this idea: when sentenced to death, he not only refused to escape but calmly drank the hemlock, because he had seen through life and death thoroughly, and his inner cultivation had reached a level where he could face death directly. Western humanist thought holds that human beings are the essence of the universe and the spirit of all things. The life we have received is an extraordinarily precious opportunity. How can we make the best use of it? The existentialist philosopher Heidegger proposed "being-toward-death." Recognizing that we will eventually die, we come to know the finitude of life — we cannot pass through this life in numbness and confusion.

From the perspective of the Buddhadharma, we are guided to see the leisure, opportunity, great meaning, and rarity of human life. To obtain a human body — especially one with the capacity and time to study and practice the Dharma — is an opportunity that comes once in a thousand ages, of immense significance. In the six realms, the human realm is a transfer station, because humans possess reason and can determine their own actions of body, speech, and mind. When we use reason well, we can seek truth, perfect our moral character, benefit society, and even attain Buddhahood. That is why all Buddhas and World-Honored Ones appear in the human realm. But if we misuse reason, we not only create measureless afflictions for ourselves, sending our lives into decline, but also cause tremendous harm to others and to the world.

In short, death makes us see the brevity of this life, and thus cherish this rare and easily lost opportunity to realize the maximum value of human existence.

## 2. Establishing a Correct Approach to Treatment

Beyond the view of life and death, we must also, on the basis of understanding, respect, and care for patients, help them establish a correct approach to treatment. Many people's care for patients is mainly on the physical level. But in reality, when a person faces illness and death, not only the body needs care — the mind also needs care, including the soothing of emotions and guidance on the spiritual level. That is why palliative care teams must be composed of professionals from multiple disciplines.

In Western countries, working in palliative care requires specific training and qualifications. In the future, we must likewise have a cohort of people who receive professional training. On that foundation, by infusing the content of the Buddhadharma and integrating mindfulness practice, we can create a life care that reaches the heights of Eastern wisdom, offering a new perspective and a new exploration for palliative care.

# V. What Happens at Death and Rebirth

Whether engaged in palliative care or end-of-life care, understanding death and rebirth is essential. How can a person depart peacefully and be reborn in a good realm? This is a matter that carries real technical depth.

## 1. The Four Stages

The Buddhadharma tells us that the continuity of life consists of four stages: birth existence, life existence, death existence, and intermediate existence. Birth existence is the moment of birth. Life existence is one's present lifespan. Death existence is the instant of dying. Intermediate existence — the bardo state — is the period after death and before taking rebirth, like the interval after graduating from university or resigning from a job, when you have not yet found new work.

From birth to death is simply the beginning and end of one phase of life. In the long river of existence, one such phase follows another in unbroken continuity. Buddhism holds that a being in the intermediate state will usually take rebirth within seven days. If rebirth does not succeed, it continues for another seven-day period, generally not exceeding seven cycles of seven — forty-nine days. So, while Chinese people imagine ancestors waiting in the ancestral hall, the reality is that the ancestor may long since have become one of their own descendants, because ancestors often remain attached to the family and will repeatedly take rebirth within it. This is a key difference between Buddhist and traditional Chinese understandings of life and death.

In traditional Chinese culture, a person becomes a ghost after death and remains in the ghost realm. But Buddhism holds that life revolves unceasingly through the six realms — heavens, humans, asuras, animals, hungry ghosts, and hell beings. Through practice, one can transform from an ordinary being into a noble one — becoming a sage — including the four kinds: hearers, solitary realizers, bodhisattvas, and Buddhas. These six ordinary and four noble destinies together form the ten dharma realms. Thus, becoming a ghost after death is only a one-in-ten probability.

## 2. The Three Forces

Which of the six realms one enters after death is determined by three forces.

The first is going with karma — following one's karmic force. But a person accumulates much karma: heavy and light, fixed and unfixed, and so on. Among these, the heaviest karma ripens the fastest. As the saying goes, "When a person creates offenses, the strongest pulls them first." It is like being in debt and having to sell your house to repay — whoever you owe the most to gets paid first.

The second is going with habit — following one's habitual tendencies. The power of habit is immense. What we do or don't do, what we like or dislike — it seems we decide for ourselves, but in fact we are often unconsciously carried along by habit, helpless to resist. So if we want to know what our future life will be like, we can know by looking at the present. What you think about and do every day — the force accumulated thereby — will propel you toward a corresponding rebirth. The reason we practice meditation is precisely to help us awaken awareness, to break free from habitual tendencies, and not be driven by inertia. Otherwise, life sinks into ignorance — day after day, year after year. In the blink of an eye, ten years have passed; in another blink, twenty — and we are not even clear on what we have been doing.

The third is going with thought — following the thoughts that arise at the end of life. We usually think we are living in reality, but in truth, much of the time we are living in our own thoughts. Thoughts determine how you see the world and what you do or don't do. Every day we meet various people and face various situations. Whether these people and events make you happy or sad, fill you with love or hatred — all of this is bound up with your perceptions and your thoughts.

The Buddhist stories of cause and effect record many relevant cases. For instance, someone buried several gold bars under the bed and passed away without telling his children; he later turned into a dog that circled that spot every day without leaving. There was a grandmother who loved her grandson dearly; after she passed, she was so attached that she took rebirth and became his grandson's wife. Someone else generated intense anger at the moment of death and turned into a venomous snake. All of these outcomes were brought about by thoughts.

Furthermore, the six realms of cyclic existence are not only forms of life but also represent psychological states. In other words, different mind states manifest as corresponding life forms. A person moves from views to behavior, from repeated behavior to habit, from accumulated habit to character, and from the solidification of character to personality. One could say that personality is simply the specific shape taken by certain mental states that have been repeatedly reinforced.

From this perspective, even within the human realm there are the six realms. If one is full of ignorance, one manifests behavior comparable to animals. If one is full of greed and a sense of lack, one displays the characteristics of hungry ghosts. If one is full of anger and antagonism, one belongs to the life of an asura. If one is full of compassion and wisdom, one draws ever closer to the Buddhas and bodhisattvas. This is what the Dharma calls "mind being various, forms being various." The variety of minds manifests the variety of life forms.

Especially at the time of death, whatever kind of thought arises will call forth the corresponding kind of karma. Understanding the forces that determine rebirth, we then know how to choose. If we wish to be reborn in a good destination, we must cultivate good karma, be endowed with good conduct and good thoughts. At the end of life, these good karma, good conduct, and good thoughts will guide us to a good rebirth. Conversely, if we habitually create bad karma, bad conduct, and harbor unwholesome thoughts, when the great limit arrives, we will follow this bad karma, bad conduct, and unwholesome thoughts and fall into the lower realms.

## 3. Faith, Vow, and Practice

What can also affect karma is the power of vow. One could say this is a specific form of the power of thought. Most people, unable to see the truth of life clearly, can only drift along with karma. But through studying the Dharma, we know that life can be chosen with autonomy. On the one hand, we must begin from this moment to stop evil and cultivate good, accumulating merit and purifying obstacles. On the other hand, we must generate great vows, giving our life a new direction.

The Pure Land path advocates faith, vow, and practice as the three most important provisions for rebirth. First, we must generate faith in the Western Land of Ultimate Bliss and the Pure Land Dharma path, believing this to be the best destination for life. Only with faith will vow further arise. Then, this power of vow will propel us to practice diligently, fulfilling every condition for rebirth in the Western Land of Ultimate Bliss one by one — just as, upon learning the requirements for immigration, we make preparations according to the relevant criteria.

In fact, practicing any Dharma path — and even doing anything well in life — equally requires faith, vow, and practice. Take liberation, for example: only when we have faith in liberation will we vow to achieve it, and then put that vow into practice through cultivation.

## 4. The Open Space of Mind

Beyond karma, habitual tendencies, and the power of thought, there is a still more advanced force — right in the open space of mind.

Earlier, we discussed that the intermediate state is the form taken during the gap between life phases. For thoughts, too, there is such a gap — in the interval after the previous thought has passed and before the next thought has arisen. That is the true mind. In ordinary life, we live entirely within our thoughts, as though shrouded and obscured by clouds. But behind the layers of cloud, there is the cloudless clear sky — representing the power of inner awakening, the capacity of self-liberation.

The Chan records contain many accounts of Chan masters passing away in seated meditation without any illness. For example, Master Zhiduan foretold the date of his passing while showing no sign of illness, guiding his disciples as usual. On that day, after the meal, he ascended the teaching seat and bid farewell to the assembly. He asked, "On what day did the World-Honored One enter cessation?" Everyone replied, "At the hour of zi on the fifteenth day of the second month." The master said, "I shall go before the hour of zi today." Then he quietly passed away in seated meditation. Master Shenzan, facing the end of his life, shaved his head, bathed, gathered his disciples, and asked, "Do you recognize the samadhi of soundlessness?" The disciples said they did not. The master said, "Now listen carefully." As the disciples inclined their ears to listen intently, the master serenely passed away in seated meditation. There were also those who passed away in water at Huating, in seated meditation at Shishuang, lying down at Yuanzhao, and hanging upside-down at Yinfeng — all demonstrations of unimpeded mastery over life and death, coming and going in complete freedom.

How is this accomplished? First, through meditation practice, we must open a mind that is awake and clear, maintaining distance from our thoughts, no longer falling into them or being carried away by them. Through continuous training, we come to see that everything — from arising thoughts to speech and action, from birth, aging, illness, and death to mountains, rivers, and the great earth — is but an image in the sky of the mind, like a dream, an illusion, a bubble, a shadow.

The Buddha discovered the true mind behind our thoughts and told us that every person possesses the capacity for self-healing and self-liberation. As long as we find this mind, we can be autonomous amid thoughts and at ease amid life and death; we gain the power to choose the direction of our life. This power is profoundly important. Tibetan Buddhism speaks of bardo deliverance. But in truth, bardo deliverance is not only at the time of death — every moment, every instant of the present, as long as we do not fall into thought, we can experience the open space of mind, the power of awareness and liberation.

Therefore, do not wait until death arrives to consider liberation. By opening inner awareness in each present moment and becoming familiar with the clear mind, we can be liberated right in the present. Then, at the end of life, we may be at ease in life and death, passing away in seated meditation or standing. If we wait until death is imminent to start practicing, it is often too late. If our negative karma and habitual tendencies are too heavy, we may not have the good fortune to invoke others to guide us and chant supportively — we can only drift with karma.

True practice must be trained in ordinary times. Mindfulness practice is precisely what helps us open awareness, recognize our true mind, and, in the inner open space, experience the power that is luminously clear, distinctly knowing. This power not only resolves present afflictions but can also find for life an eternal well-being that extends into the endless future, because you have already opened the inexhaustible treasure of life itself. You can be at ease in life and death, benefiting both yourself and others. This is the ultimate life care that the Buddhadharma offers us.

# VI. End-of-Life Care

Having understood what death and rebirth involve, we must base our end-of-life care on this understanding.

First, create a good atmosphere. Just as we arrange the space before the Seven Steps of Mindful Tea, end-of-life care requires this even more. A dignified, pure, and proper atmosphere allows participants to gather their minds, and also makes clear to the family what matters most at this moment and what is most beneficial to the dying person — rather than wailing loudly or even arguing over inheritance, which would stir up the dying person's greed and anger, obstructing their peaceful departure. More importantly, a good atmosphere can reduce the dying person's fear of death, enabling them to rest in the present and maintain mindfulness.

If there are still things the dying person cannot let go of, we should offer psychological relief, guiding them to release all attachments and entanglements. If the dying person's own practice is not yet stable, we should, through supportive chanting and other means, help them bring forth right mindfulness. If the dying person has faith in the Pure Land path and wishes to be reborn in the West, we recite Amitabha Buddha's name so they may rest in the Buddha's name. If the dying person is more familiar with the Three Refuges, we chant the Three Refuges, helping them rest the mind in faith toward the Three Jewels. The ultimate approach is to open inner awareness and experience the clarity of mind — this is the best path of self-liberation. If the dying person has other religious faith, we should show respect and help make arrangements accordingly.

# VII. Conclusion

Life care, encompassing both palliative care and end-of-life care, is an important endeavor. On the one hand, everyone experiences birth, aging, illness, and death. Understanding these principles enables us to face them correctly ourselves. On the other hand, many people around us will have this need. Especially in international Dharma propagation, where overseas Chinese find themselves in a foreign culture, the need for this kind of care is all the greater in times of illness and at the end of life. I hope everyone will carry forward the project well and establish the six-step growth path. In the future, may we produce cohorts of practitioners, presenters, and teachers who go everywhere to share, guide, and serve the community.
