How can we best help a relative who is near death?
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Question- If a relative is near death, how can we best help that person in that moment?
Answer- Three levels of help – pre-death, death and post death- can be offered to the person.
Essentially death means that the soul is going to leave the body and go to another body. That generally happens when the body is breaking down. The body’s breaking down is inevitable. There is a physical closure of the body that happens when one approaches death. The key is if we want to help ease the transition out of the body, emotional closure also has to happen along with the physical closure. Emotional closure means that the soul who is leaving the body needs to emotionally accept that “now I have to leave the body”. If emotional closure has not happened, then the soul stays very strongly attached to the body and the soul’s transition becomes more difficult and painful. We can help such a person in emotional closure by having the six fold loving exchanges.
This answer is based on the Vedic scriptures directly and the book ‘Ultimate Journey: Death and Dying in the World’s Major Religions’, edited by Satyaraja Das (Steven Rosen) which talks about the experience of death as it is understood in various religious traditions. In addition, the Bhaktivedanta hospital also has palliative care unit where they offer dying care to terminally ill patients and their relatives and I am grateful for the inputs of Ramsharan Das for this answer.
In the pre-death care, we can have an improvised version of the six fold loving exchanges which can assist the patient in emotional closure. What are the six fold loving exchanges? First is that we can express to that person how much we love him or her. Second is that we can also express our appreciation for how that person loved us. We are talking especially about loved ones here, because emotional closure is especially difficult if there is some strain in love. In a traditional Indian setting, if it is clear that death is near, many times people would go to a holy place like Kashi or Vrindavan. Also, before they would leave for the holy place, especially if they are from a village, most of the villagers would come to meet the person and touch his or her feet and would have final interactions with the person.
Third is that we seek forgiveness for any way in which we may have hurt that person. Fourth is – we also offer our forgiveness for any way in which that person might have hurt us. If that person is elder it may sometimes seem a little presumptuous to offer forgiveness, but in every close relationship there is always a possibility of being hurt, and it can be phrased appropriately, keeping the relationship in mind. This means we have positive feelings about our relationship and there are no hard feelings.
Further, since the transition is going to happen, it is important to convey how much we are going to miss that person – that that person had a place in our life which was very important and it is a hole that is not going to be filled very easily. This is the fifth loving exchange. This also creates a solace for the person that his or her life was valuable.
The last and sixth loving exchange is important and that is, whatever obligations or anxieties may be remaining for that person, we assure him that they will be taken care of. For example, if a man in the late middle ages is dying and his daughter is unmarried, then some relatives may offer to take care of the marriage of the daughter. Or if the person is worried about the distribution of inheritance among the sons, then if possible we can have the bank manager take care of the same or perhaps have statement drawn up from that person. Basically depending on the situation make sure that whatever anxieties the person has, those anxieties are removed. Because the sense of obligation is quite deep rooted, and as long as that feeling remains, it ties the person.
By emotional closure, we mean that whatever is tying that person to this body must be cut off. In normal circumstances i.e. when the individual is healthy, this is done by cutting philosophical instruction. However, at this point in time, usually when the person is clear that I am going to die and the person has more or less accepted that I am going to die, we have to bring about the emotional closure in a loving and soothing way.
Once these six things are done, then we can ask that person if he or she has any final unfulfilled desires – any specific things that they would like to have done. If possible we can assure that they will be done or an attempt to do them will be made. We can also ask the person if there is anything special that can be done at the time of his or her death.
Sometimes if a person is about to die, relatives may conceal this news from the person so that the person may be peaceful. But if death is inevitable it may be better to help the person accept it by informing that person. The person may sometimes say that they like a particular pastime of Krishna very much and would like to hear about the pastime. Or that they like a particular kirtan or bhajan very much and request this bhajan to be sung. The person may like a particular picture of the Lord very much and would like to have darshan of that picture of the Lord. So whatever that person would like to have as a setting at the time of death, one can arrange for that. Generally, at the time of death we should see that that person is in one sense the master i.e. we allow that person to choose what best setting to depart in. This is with respect to pre-death.
At the time of death, it is good to have as much spiritual paraphernalia as possible around the person. As far as sound vibration is concerned, we can have the Hare Krishna mahamantra in soft kirtans. Kirtans should always be soft – they should not jar the person. Sometimes people at the time of death are sensitive to sound and loud kirtans might disturb them. Usually, we recite the second chapter of the Bhagavad-gītā because it is considered to be the summary of the Gītā. From there onwards chapters 7 to 12 are recited. Beyond this Ganga jal should be made available and periodically dropped into the mouth of the person. It should be dropped in such a way that that doesn’t make the person feel uncomfortable. If tulsi is given to the person it should be placed carefully and not in such a way that the windpipe gets choked. There can be as much devotional art as possible around the person in the room. That way there is sound, taste, and sight. We try to spiritualise the input that is coming from all the senses. For sound we have the mahamantra and the Bhagavad-gītā ślokas. For the sight we have the pictures of the Lord, devotional art. For the taste we have tulsi and Ganga jal. For the smell and for the touch we can have the maha garland of the Lord. If Ganga jal is not available, any sacred river that is nearby, that water can also be brought in small quantity, properly distilled and made available for the person. If the maha garland from the nearby temple is possible that’s good otherwise even from one’s own altar the garland can be used. Flowers should be used in such a way that their aroma does not create any problem (e.g. the person may be allergic to flowers or smell etc.).
There are books which talk about how to help the person in the final stages specifically in terms of understanding how far one is from death. Hospice care is a well-developed science now. Sangita Mataji, a devotee in ISKCON, has written a book (The Final Journey – Complete Hospice Care for Departing Vaishnavas) on ministering to the dying. Other devotees have also written books, but this is a more hands on book since she has worked in this field.
We can understand the time of death and accordingly help the person and be available in a spiritual setting for that person at that time. When the moment of death occurs, it is a sobering moment but for that soul if the emotional closure has happened then that soul can depart with relatively much lesser anxiety or agitation. With the spiritual sound vibration all around it can be a very auspicious departure as well.
In our tradition there are several other factors which often may or may not be followed by people in today’s time. For example, for several days before death people decrease their intake of food – the idea is if there is more energy in the body, stronger is the strength, and the prāṇa stays strongly attached to the body. With the decrease of the intake of food, the bondage of the prāṇa to the body is lessened. The soul actually leaves with the prāṇa when it moves to the next destination. From the medical point of view, we have to examine what is best for each particular individual. Srila Prabhupada himself, during his final days, ate very little and only took caraṇāmṛta or little more than that for several days, weeks, months. He was of course at a very exalted state of consciousness and others cannot imitate him. But according to time, place and circumstance this is a principal which is observed that the less the bodily distraction, the bodily energy, the less is the chance of further struggle and attachment for staying in the body. Of course if for medical reasons for having the transition smoothly the doctors recommend food, then that is also a factor which should be considered properly. But praya-vrata is a very respected traditional vow where the person chooses to fast to death. When a person is meditating on higher spiritual truth and his having a higher spiritual purpose then praya-vrata is considered to be an auspicious way of leaving the body.
Beyond this, if the person has any specific pending issues with a particular person, or something like that then it is best if that person is called and the issue is resolved. Usually forgiveness is exchanged and this can help in emotional closure. There are cases reported of people who did not have emotional closure and they stayed on much longer than the doctor expected. Then when that particular relative with whom they had some estrangement visited, they had a talk and with this emotional closure, soon after the person left the body.
After the person has departed the relatives will naturally be grief struck. At this time, it is not the time for preaching but rather of commiseration – for showing emotional solidarity with the relatives. Grief that is expressed at that time should not be supressed. If somebody is crying, the tears at this time are often cleansing. Supressing these tears will be undesirable. The relatives can offer mutual support to each other. Let the expression of grief bring about a sense of closure even for the relatives. Although the memories of that person will stay and there will be a natural sense of deep loss, the tears by venting grief help to bring about a sense of closure. At this time there may be anger – anger towards destiny or even anger towards God. This anger should not be taken as a devotional disqualification or a wrong attitude. It should be understood as a sentiment that comes about because of the force of the moment. We see even Arjuna when he heard about the death of Abhimanyu, was devastated and then infuriated. He lashed out at his brothers saying – “what were you doing? Were all your weapons bangles that you could not protect my son?” Then he even turned towards Krishna and asked “Krishna you must have known what was happening to Abhimanyu, why didn’t you tell me?”. The Mahabharat does not consider this to be a moral defect. Krishna does not philosophically try to justify anything, Krishna just consoles Arjuna by being next to him and offering solidarity to him.
Overall by having a spiritual atmosphere (and not so much as spiritual philosophy) that offer a soothing experience and by having an emotional sense of closure for the departing person and for those around, the experience of death can be made as less agitating and as spiritually uplifting as possible.