Preparing for Death & Helping the Dying - Urban Dharma

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Preparing for Death & Helping the Dying - Urban Dharma

Preparing for Deathand Helping the Dyingby Sangye KhadroeBUDDHANET'SBOOKLIBRARYE-mail: bdea@buddhanet.netWeb site: www.buddhanet.netBuddha Dharma Education Association Inc.


First published in 1999Revised edition published in May 2003for free distributionKong Meng San Phor Kark See MonasteryPublication, Art & Design Department88 Bright Hill RoadSingapore 574117Tel: (65) 6552 7426Email: publication@kmspks.orgwww.kmspks.org10,000 books, September 2003ISBN 981-04-8920-X© Sangye Khadro (Kathleen McDonald) 1999Although reprinting of our books for free distribution isencouraged as long as the publication is reprinted in itsentirety with no modifications, including this statement ofthe conditions, and credit is given to the author and thepublisher, we require permission to be obtained in writing,to ensure that the latest edition is used.Printed byAd Graphic Pte LtdTel: 6747 8320Email: ps@adgraphic.com.sgii


CONTENTSPreface To The Revised Edition ...... vIntroduction ...... viiBuddhist Perspective on DeathDeath is a natural, inevitable part of life ...... 1●●●It is very important to acceptand be aware of death ...... 4Death is not the end of everything,but a gateway into another life ...... 6It is possible to become free from deathand rebirth ...... 8How to Prepare for Death● The four tasks of living and dying ...... 10● Live ethically ...... 13● Study spiritual teachings ...... 15● Cultivate a spiritual practice ...... 15●Become familiar with the stagesof the death process ...... 19iii


Helping Others who are Dying● Working on our own emotions ...... 24● Giving hope and finding forgiveness ...... 26●●How to help someonewho is a Buddhist ...... 28How to help someonewho is not a Buddhist ...... 31● The time of death ...... 33● Helping after death ...... 36Conclusion ...... 38Appendix ...... 39Inspiring Quotes ...... 45Recommended Reading ...... 50iv


PREFACE TO THE REVISEDEDITIONThis booklet is based on material used during aseminar that I have taught a number of times inSingapore and elsewhere, entitled “Preparing forDeath and Helping the Dying.” This seminaranswers a genuine need in today’s world, asexpressed by one participant: “I am interested toknow more about death and how to help dyingpeople, but it’s very difficult to find anyone willingto talk about these things.”The material for the seminar is taken mainlyfrom two sources: traditional Buddhist teachings,and contemporary writings in the field of caringfor the dying. This booklet is meant as a briefintroduction to the subject rather than a detailedexplanation. My hope is that it will spark interestin the ideas presented. For those of you who wishto learn more, a list of recommended books isprovided at the end.The booklet was first published in October,1999 in Singapore. For this present edition, I havemade some changes to the original text, and addedv


more material, including two appendices. Anysuggestions for further changes and additions wouldbe most welcome.Sangye KhadroMarch, 2003vi


INTRODUCTIONDeath is a subject that most people do not like tohear about, talk about, or even think about. Whyis this? After all, whether we like it or not, each andevery one of us will have to die one day. And evenbefore we have to face our own death, we will mostprobably have to face the deaths of other people—our family members, friends, colleagues, and soforth. Death is a reality, a fact of life, so wouldn’tit be better to approach it with openness andacceptance, rather than fear and denial?Perhaps the discomfort we have towards deathis because we think it will be a terrible, painful anddepressing experience. However, it doesn’t have tobe so. Dying can be a time of learning and growth;a time of deepening our love, our awareness of whatis important in life, and our faith and commitmentto spiritual beliefs and practices. Death can even bean opportunity to gain insight into the true natureof ourselves and all things, an insight that willenable us to become free from all suffering.Let’s take the example of Inta McKimm, thedirector of a Buddhist centre in Brisbane, Australia.vii


training and preparation, a peaceful and positivedeath is possible for each and every one of us.It is important to examine the thoughts, feelingsand attitudes we have regarding death and dying, tosee whether or not they are realistic and healthy.How do you feel when you read or hear the newsof a disaster where many people were killedsuddenly and unexpectedly? How do you feel whenyou hear that one of your own family members orfriends has died or been diagnosed with cancer?How do you feel when you see a hearse, or drivepast a cemetery? What do you think it will be liketo die? And do you believe in anything beyond thislife, on the other side of death?There are two unhealthy attitudes peoplesometimes have towards death. One is to befrightened, thinking that it will be a horrible,painful experience, or that it means totalannihilation. This fear leads to denial and wantingto avoid thinking or talking about death. Is this agood idea, considering the fact that we will have togo through it one day? Wouldn’t it be better toix


accept the reality of death and then learn how toovercome our fears and be prepared for it when ithappens?The other unhealthy attitude is a careless,flippant one where one might say, “I don’t have anyfear of death. I know I’ll have to die one day but itwill be OK, I can handle it.” I had this attitudewhen I was younger, but one day I sat through anearthquake and for a few moments truly thought Iwas going to die, and then I discovered that I hadbeen wrong—in fact, I was terrified of death andtotally unprepared for it! In The Tibetan Book ofLiving and Dying (p.8), Sogyal Rinpoche quotes aTibetan master who said: “People often make themistake of being frivolous about death and think,‘Oh well, death happens to everyone. It’s not a bigdeal, it’s natural. I’ll be fine.’ That’s a nice theoryuntil one is dying.”If you notice that you have either of these twoattitudes, it might be a good idea to do moreresearch into what death is all about. Moreknowledge about death and dying will help decreasex


the fear of death (because we tend to be afraid ofwhat we don’t know about or understand), and willhelp those who have a flippant attitude to takedeath more seriously and realize the importance ofpreparing ourselves for it.This booklet is just a brief introduction to thesubject of death and dying, and the recommendedreading list at the end will let you know where youcan find more information.First of all, let’s look at how death is viewed in theBuddhist tradition.xi


BUDDHIST PERSPECTIVESON DEATHDEATH IS A NATURAL,INEVITABLE PART OF LIFEPeople sometimes think of death as a punishmentfor bad things they have done, or as a failure or mistake,but it is none of these. It is a natural part oflife. The sun rises and sets; the seasons come andgo; beautiful flowers become withered and brown;people and other beings are born, live for some time,then die.One of the principal things the Buddha discoveredand pointed out to us is the truth of impermanence:that things change and pass away. There aretwo aspects of impermanence: gross and subtle. Grossimpermanence refers to the fact that all producedthings—which includes humans and other living beings,all the phenomena in nature, and all humanmadethings—will not last forever, but will go outof existence at some point. As the Buddha himselfsaid:1


What is born will dieWhat has been gathered will be dispersed,What has been accumulated will be exhausted,What has been built up will collapse,And what has been high will be brought low.And:This existence of ours is as transient as autumnclouds.To watch the birth and death of beings is like lookingat the movements of a dance.A lifetime is like a flash of lightning in the sky,Rushing by, like a torrent down a steep mountain.Subtle impermanence refers to the changes that takeplace every moment in all animate and inanimatethings. The Buddha said that things do not remainthe same from one moment to the next, but are constantlychanging. This is confirmed by modernphysics, as Gary Zukav points out in The DancingWu Li Masters:Every subatomic interaction consists of the annihilationof the original particles and the creation of2


new subatomic particles. The subatomic world is acontinual dance of creation and annihilation, ofmass changing into energy and energy changing tomass. Transient forms sparkle in and out of existence,creating a never-ending, forever newly createdreality. 1The Buddha imparted the teaching on the inevitabilityof death in a very skilful way to one of his disciples,Kisa Gotami. Kisa Gotami was married andhad a child who was very dear to her heart. Whenthe child was about one year old, he became ill anddied. Overcome with grief and unable to accept thedeath of her child, Kisa Gotami took him in her armsand went in search of someone who could bring himback to life. Finally she met the Buddha, and beggedHim to help her. The Buddha agreed, and asked herto bring Him four or five mustard seeds, but theyhad to be obtained from a house where no one hadever died.Kisa Gotami went from house to house in thevillage, and although everyone was willing to giveher some mustard seeds, she was unable to find ahouse where death had not occurred. Gradually sherealized that death happened to everyone, so she re-3


turned to the Buddha, buried her child and becomeone of His followers. Under His guidance, she wasable to attain Nirvana, complete freedom from thecycle of birth and death.People may fear that accepting and thinkingabout death will make them morbid, or spoil theirenjoyment of life’s pleasures. But surprisingly, the oppositeis true. Denying death makes us tense; acceptingit brings peace. And it helps us become aware ofwhat is really important in life—for example, beingkind and loving to others, being honest and unselfish—sothat we will put our energy into those thingsand avoid doing what would cause us to feel fear andregret in the face of death.IT IS VERY IMPORTANT TO ACCEPTAND BE AWARE OF DEATHIn the Great Nirvana Sutra, the Buddha said:Of all ploughing, ploughing in the autumn is supreme.Of all footprints, the elephant’s is supreme.4


Of all perceptions, remembering death and impermanenceis supreme.Awareness and remembrance of death are extremelyimportant in Buddhism for two main reasons:1) By realising that our life is transitory, we will bemore likely to spend our time wisely, doing positive,beneficial, virtuous actions, and refrainingfrom negative, non-virtuous actions. The resultof this is that we will be able to die without regret,and will be born in fortunate circumstancesin our next life.2) Remembering death will induce a sense of thegreat need to prepare ourselves for death. Thereare various methods (e.g. prayer, meditation,working on our mind) that will enable us toovercome fear, attachment and other emotionsthat could arise at the time of death and causeour mind to be disturbed, unpeaceful, and evennegative. Preparing for death will enable us to diepeacefully, with a clear, positive state of mind.The benefits of being aware of death can be corroboratedby the results of the near-death experience. Thenear-death experience occurs when people seem to5


die, for example, on an operating table or in a caraccident, but later they come back to life and describethe experiences they had. As Sogyal Rinpochepoints out in The Tibetan Book of Living and Dying(p.29):Perhaps one of its most startling revelations is howit [the near-death experience] transforms the livesof those who have been through it. Researchers havenoted a startling range of aftereffects and changes:a reduced fear and deeper acceptance of death; anincreased concern for helping others; an enhancedvision of the importance of love; less interest inmaterialistic pursuits; a growing belief in a spiritualdimension and the spiritual meaning of life;and, of course, a greater openness to belief in theafterlife.DEATH IS NOT THE END OFEVERYTHING, BUT A GATEWAYINTO ANOTHER LIFEEach of us is made up of a body and a mind. Thebody consists of our physical parts—skin, bones, or-6


gans, etc.—and the mind consists of our thoughts,perceptions, emotions, etc. The mind is a continuous,ever-changing stream of experiences. It has nobeginning and no end. When we die, our mind separatesfrom our body and goes on to take a new life.Being able to accept and integrate this understandingis very helpful in overcoming fear of death andbeing less attached to the things of this life. In theTibetan tradition, we are advised to think of our existencein this life as similar to a traveler who staysa night or two in a hotel—he can enjoy his roomand the hotel, but does not become overly attachedbecause he doesn’t think that it’s his place, and knowsthat he will be moving on.The type of life we will be born into and theexperiences we will have are determined by the waywe live our life. Positive, beneficial, ethical actionswill lead to a good rebirth and happy experiences,whereas negative, harmful actions will lead to an unfortunaterebirth and miserable experiences.Another factor that is crucial in determining ournext rebirth is the state of our mind at the time ofdeath. We should aim to die with a positive, peacefulstate of mind, to ensure a good rebirth. Dyingwith anger, attachment or other negative attitudes7


may lead us to take birth in unfortunate circumstancesin our next life. This is another reason whyit is so important to prepare ourselves for death,because in order to have a positive state of mind atthat time, we need to start now to learn how to keepour minds free from negative attitudes, and to familiarizeourselves with positive attitudes, as muchas possible.IT IS POSSIBLE TO BECOME FREEFROM DEATH AND REBIRTHDying and taking rebirth are two of the symptomsof ordinary, cyclic existence (samsara), the state ofcontinuously-recurring problems, dissatisfaction, andnon-freedom which all of us are caught in. The reasonwe are in this situation is because of the presencein our mind of delusions—chiefly attachment,anger and ignorance—and the imprints of our actions(karma) performed under the influence ofdelusions.The Buddha was once like us, caught in samsara,but He found a way to become free, and achievedthe state of perfect, complete Enlightenment. He did8


this not just for His own sake, but for the sake of allother beings, because he realized that all beings havethe potential to become enlightened—this is calledour “Buddha nature,” and it is the true, pure natureof our minds.Buddha has the most perfect, pure compassionand love for all of us, all living beings, and taughtus how we too could become free from suffering andattain enlightenment. That’s what his teachings, theDharma, are all about. The Dharma shows us howwe can free our minds from delusions and karma—the causes of death, rebirth and all the other problemsof samsara—and thus to become free fromsamsara and attain the ultimate state of enlightenment.Remembering death is one of the most powerfulsources of the energy we need to practice theBuddha’s teachings and thus attain their blissfulresults.Now let’s take a look at some of the ways in whichwe can begin preparing ourselves for death.9


HOW TO PREPARE FORDEATHTHE FOUR TASKS OFLIVING AND DYINGChristine Longaker, an American woman with over20 years’ experience working with the dying, has formulatedfour tasks which will help us to prepare fordeath, as well as to live our lives fully and meaningfully.The four are:1) Understanding and transforming suffering. Basicallythis means coming to an acceptance of thevarious problems, difficulties and painful experienceswhich are an inevitable part of life, andlearning to cope with them. If we can learn tocope with the smaller sufferings that we encounteras we go through life, we will be better ableto cope with the bigger sufferings that we will facewhen we die.We can ask ourselves: how do I react when problems,physical or mental, happen to me? Is my wayof reacting healthy and satisfying, or could it be im-10


proved? What are some ways I can learn to copebetter with problems?Suggested practices from the Tibetan traditioninclude patience, thinking about karma, compassion,and tonglen (“taking and giving”—see Appendix1). An explanation of these practices canbe found in Transforming Problems into Happinessby Lama Zopa Rinpoche (Wisdom Publications,Boston, 1993).2) Making a connection, healing relationships andletting go. This task refers to our relationshipswith others, particularly family and friends. Themain points here are to learn to communicatehonestly, compassionately and unselfishly, and toresolve any unresolved problems we may havewith others.Think about your relationships with your family,friends, people you work with, etc. Are there anyunresolved problems? How can you start working towardsresolving these?Suggestions: Forgiveness meditation (see Appendix2), resolving problems.3) Preparing spiritually for death. Christine writes:11


“Every religious tradition emphasizes that to preparespiritually for death it is vital that we establishright now a daily spiritual practice, a practiceso deeply ingrained that it becomes part ofour flesh and bones, our reflexive response toevery situation in life, including our experiencesof suffering.” 2 A list of recommended spiritualpractices from the Buddhist tradition can befound below.Check: try to imagine yourself at the time ofdeath—what thoughts and feelings would come upin your mind at that time? Are there any spiritualideas or practices you have learned or experiencedthat would give you comfort and peace at that time?4) Finding meaning in life. Many of us go throughlife without a clear idea as to what is the purposeand meaning of our existence. This lack of claritycan become a problem as we become older andcloser to death because we become less capableand more dependent upon others. So it is importantto explore such questions as “What is the purposeof my life? Why am I here? What is importantand not important?”12


These four tasks are fully explained in Facing Deathand Finding Hope by Christine Longaker (NY:Doubleday, and London: Century, 1997) pps.37-157.LIVE ETHICALLYPainful or frightening experiences that occur at thetime of death and afterwards are the result of negativeactions, or karma. To prevent such experiences,we need to refrain from negative actions and do asmany positive actions as we can. For example, wecan do our best to avoid the ten non-virtuous actions(killing, stealing, sexual misconduct, harshspeech, lying, slander, gossip, covetousness, ill-willand wrong views) and to practice the ten virtues(consciously refraining from killing, etc. and doingactions opposite to the ten non-virtues). It’s also goodto take vows or precepts, and do purification practiceson a daily basis.Another aspect of Buddhist ethics is working onour minds to reduce the very causes of negative actions:delusions, or disturbing emotions, such as anger,greed, pride, and so forth. And awareness of13


death itself is one of the most effective antidotes fordelusions.To illustrate this point: I heard the story of awoman who had an argument with her son just beforethe son left home with his father to go on a fishingtrip. The son was killed on the trip. You can imaginethe pain the mother must have suffered—notonly did she lose her son, but the last words she spoketo him were angry ones.There is no way of knowing when death willhappen, to ourself or to another. Each time we partfrom someone, even for a short time, there’s no certaintythat we will meet them again. Realizing thiscan help us to avoid hanging on to negative feelings,and to resolve our conflicts with others as quickly aspossible. That will ensure that we do not die withthose burdens on our minds, or that we live withpainful regret if the person we had a problem withwere to die before we had a chance to apologize andclear up the problem.Also, as we approach death, it’s good to start givingaway our possessions, or at least make a will.Doing that will help reduce attachment and worry(“What will happen to all my things?” “Who will getwhat?”) at the time of death.14


STUDY SPIRITUAL TEACHINGSLearning spiritual teachings such as those given bythe Buddha will help us to overcome delusions andnegative behaviour, and will help us become morewise and compassionate. Also, the more we understandreality or truth—the nature of our life, the universe,karma, our capacity for spiritual developmentand how to bring it about—the less we will be afraidof death.CULTIVATE A SPIRITUAL PRACTICEAs we are dying, we may find ourselves experiencingphysical discomfort and pain. In addition to this,we may also experience disturbing thoughts andemotions, such as regrets about the past, fears aboutthe future, sadness about having to separate from ourloved ones and possessions, and anger about the misfortunesthat are happening to us. As mentionedabove, it is very important to keep our mind freefrom such negative thoughts, and instead to havepositive thoughts at the time of death. Examples ofpositive thoughts could include:15


• keeping in mind an object of our faith such asBuddha or God,• calm acceptance of our death and the problemsassociated with it,• non-attachment to our loved ones and possessions,• feeling positive about the way we have livedour life, remembering good things we havedone,• feeling loving-kindness and compassion forothers.In order to be able to invoke such thoughts or attitudesat the time of death, we need to be familiarwith them. Familiarity with positive states of minddepends upon putting time and effort into spiritualpractice while we are alive. And the best time to startis now, since we have no way of knowing when deathwill happen.Some recommended practices from the Buddhist traditioninclude:1) Taking refugeIn Buddhism, taking refuge is an attitude of feeling16


faith in and relying upon the Three Jewels: Buddha,Dharma and Sangha, accompanied by a sincere effortto learn and practice the Buddhist teachings inour life. It is said in the Buddhist teachings that takingrefuge at the time of death will ensure that wewill obtain a fortunate rebirth and avoid an unfortunateone in our next lifetime. 3 Faith in one’s personalspiritual teachers, or in a specific Buddha orBodhisattva such as Amitabha or Guan Yin, will alsohave the same result and will bring great comfort tothe mind at the time of death.2) Pure Land practiceA popular practice, particularly in the Mahayana tradition,is to pray for rebirth in a Pure Land, such asthe Pure Land of Bliss (Sukhavati) of Amitabha Buddha.Pure Lands are manifested by the Buddhas toaid those who wish to continue their spiritual practicein the next life, free of the distractions, hasslesand interferences of the ordinary world.Bokar Rinpoche mentions four essential conditionsthat need to be cultivated in order to take birthin Amitabha’s Pure Land: 1) making ourselves familiarwith the image of the Pure Land and meditatingupon it, 2) having a sincere wish to be born there,17


and making regular prayers for such a rebirth,3) purifying our negative actions and accumulatingpositive actions, and dedicating these to be born inthe Pure Land, and 4) having the motivation ofbodhicitta—the aspiration to attain enlightenment(Buddhahood) to be able to help all beings—as thereason for wishing to be born in the Pure Land. 43) MindfulnessMindfulness is a meditative practice that involves beingaware of whatever is happening in our body andmind accompanied by equanimity, free of attachmentto what is pleasant and aversion to what is unpleasant.Strong familiarity with this practice givesone the ability to cope with pain and discomfort,keep the mind free from disturbing emotions, andremain peaceful while dying. Several books on mindfulnessand meditation are mentioned in the readinglist.4) Loving-kindnessThis practice involves cultivating feelings of care,concern and kindness towards all other beings. Whenwe face difficulties or pain, our strong attachmentto ‘I’ augments our suffering, whereas being less18


concerned with ourselves and more concerned forothers diminishes our suffering. At the time of death,thinking of other beings and wishing them to behappy and free from suffering would bring greatpeace to our mind. Lama Zopa Rinpoche says thatthese are the best thoughts and feelings that we couldhave in our mind before and during death. Not onlydo they help us have a more peaceful death, but theyalso purify our negativities and accumulate positivepotential, or merit, which ensures a good rebirth inthe next life.More information on how to cultivate lovingkindnesscan be found in Sharon Salzburg’s book,LovingKindness—The Revolutionary Art of Happiness(see the recommended reading list).BECOME FAMILIAR WITHTHE STAGES OF THE DEATH PROCESSOne reason why people tend to be afraid of deathis because they do not know what will happen tothem. In the Tibetan tradition of Buddhism, thereis a clear and detailed explanation of the process ofdying, which involves eight stages. The eight stages19


correspond to the gradual dissolution of various factors,such as the four elements: earth, water, fire andair. As one passes through the eight stages, there arevarious internal and external signs.The four elements dissolve over the first fourstages. In the first stage, where the earth element dissolves,the external signs are that one’s body becomesthinner and weaker, and internally one has a visionof a mirage. The second stage involves the dissolutionof the water element; the external sign is thatone’s bodily fluids dry up, and internally one has avision of smoke. The fire element dissolves in thethird stage; the external sign is that the heat anddigestive power of the body decline, and internallyone has a vision of sparks. In the fourth stage, wherethe wind or air element dissolves, the external signis that breathing ceases, and internally one has avision of a flame about to go out. This is the pointat which one would normally be declared clinicallydead. The gross physical elements have all dissolved,the breath has stopped, and there is no longer anymovement in the brain or circulatory system. However,according to Buddhism death has not yet takenplace because the mind or consciousness is stillpresent in the body.20


There are various levels of the mind: gross, subtleand very subtle. The gross mind or consciousnessincludes our six consciousnesses (seeing, hearing,smell, taste, touch and mental consciousness)and eighty instinctive conceptions. The sixconsciousnesses dissolve over the first four stages ofthe death process, and the eighty conceptions dissolvein the fifth stage, following which one experiencesa white vision. In the sixth stage, the whitevision dissolves and a red vision appears. In the seventhstage, the red vision dissolves and a vision ofdarkness appears. The white, red and dark visionsconstitute the subtle level of consciousness.Finally, in the eighth stage, the dark vision dissolvesand the very subtle mind of clear light becomesmanifest. This is the most subtle and pure level ofour mind, or consciousness. Experienced meditatorsare able to use this clear light mind to meditate andgain a realization of absolute truth, and even attainenlightenment. That is why such meditators are notafraid of death, and even look forward to death asif they were going on a holiday!This is just a brief explanation of the eight stages.More detailed explanations can be found in anumber of books (see the recommended reading list),21


such as The Tibetan Book of the Dead, translated byRobert Thurman, p.23-50. Since we are naturallymore frightened of what is not known to us, becomingfamiliar with the stages of the death processwould help ease some of our fear of death. And ifwe are able to practice the meditations on simulatingthe death process and awakening the clear lightmind that are found in the Tibetan Vajrayana tradition,we might even be able to attain realizations aswe die.These are just a few recommended spiritual practicesthat we can learn and train ourselves in during thecourse of our life which will help us be more preparedfor death. However, there are many othermethods, which are suited to people of different temperaments.When it comes to choosing the methodthat is right for us, we can use our own intuitionand wisdom, or consult reliable spiritual teacherswith whom we have an affinity.Now let’s look at what we can do to help other peoplewho are dying.22


HELPING OTHERS WHOARE DYINGIt is said in the Buddhist teachings that helping anotherperson to die with a peaceful, positive state ofmind is one of the greatest acts of kindness we canoffer. The reason for this is that the moment of deathis so crucial for determining the rebirth to come,which in turn will affect subsequent rebirths.However, helping a dying person is no easy task.When people die, they experience numerous difficultiesand changes, and this would naturally giverise to confusion as well as painful emotions. Theyhave physical needs—relief from pain and discomfort,assistance in performing the most basic taskssuch as drinking, eating, relieving themselves, bathingand so forth. They have emotional needs—to betreated with respect, kindness and love; to talk andbe listened to; or, at certain times, to be left aloneand in silence. They have spiritual needs—to makesense of their life, their suffering, their death; to havehope for what lies beyond death; to feel that theywill be cared for and guided by someone or somethingwiser and more powerful than themselves.23


Thus one of the most important skills in helpinga dying person is to try to understand what theirneeds are, and do what we can to take care of these.We can best do this by putting aside our own needsand wishes whenever we visit them, and make upour mind to simply be there for them, ready to dowhatever has to be done, whatever will help themto be more comfortable, happy and at peace.There are many excellent books available on howto care for a dying person in terms of their physicaland emotional needs (see the recommended readinglist). Here we will focus on the spiritual needsand how to provide for these.WORKING ON OUR OWN EMOTIONSAs mentioned above, when people approach deaththey will at times experience disturbing emotionssuch as fear, regret, sadness, clinging to the peopleand things of this life, and even anger. They mayhave difficulty coping with these emotions, and mayfind themselves overwhelmed, as if drowning inthem. What is helpful to them during these difficulttimes is to sit with them, listen compassionately24


and offer comforting words to calm their minds.But to be able to do this effectively, we need toknow how to cope with our own emotions. Beingin the presence of death will most probably bringup the same disturbing emotions in our mind as inthe dying person’s mind—fear, sadness, attachment,a sense of helplessness, and so forth. Some of theseemotions we may never have experienced before, andwe may feel surprised and even confused to findthem in our mind. Thus we need to know how todeal with them in ourselves before we can really helpsomeone else to deal with them.One of the best methods for dealing with emotionsis mindfulness meditation (see above). Anotheris reminding ourselves of impermanence: the fact thatwe ourselves, other people, our bodies and minds,and just about everything in the world around us,is constantly changing, never the same from one momentto the next. Awareness and acceptance of impermanenceis one of the most powerful antidotesto clinging and attachment, as well as to fear, whichis often a sense of resistance to change. Also, cultivatingfirm faith in the Three Jewels of Refuge (Buddha,Dharma and Sangha) is extremely useful inproviding the strength and courage we need to face25


and deal with turbulent emotions.If the dying person is a family member or friend,we will have the additional challenge of having todeal with our attachments and expectations in relationto him or her. Although it is difficult, the bestthing we can do is learn to let go of the person.Clinging to them is unrealistic, and will only causemore suffering for both of us. Again, rememberingimpermanence is the most effective remedy to attachment.GIVING HOPE ANDFINDING FORGIVENESSSogyal Rinpoche, in The Tibetan Book of Living andDying (pps.212-213), says that two things that arevery important in helping a dying person are givinghope and finding forgiveness. When dying, manypeople experience guilt, regret, depression or a senseof hopelessness. You can help them by allowing themto express their feelings, and by listening compassionatelyand non-judgementally. But encouragethem to remember the good things they have donein their life, and to feel positive about the way they26


have lived. Focus on their successes and virtues, noton their failings and wrongdoings. If they are opento the idea, remind them that their nature is basicallypure and good (in Buddhism we call this “Buddhanature”) and that their faults and mistakes aretransitory and removable, like dirt on a window.Some people may be concerned that their wrongdoingsare so numerous and great that they couldnever be forgiven. If they believe in God or Buddha,assure them that the nature of God and Buddhais pure, unconditional love and compassion, sothey always forgive whatever mistakes we make. Ifthe person has no such belief, then what they needis to forgive themselves. You can help them to dothis by encouraging them to express their heartfeltregret for their mistakes and ask for forgiveness. Thatis all they need to do. Remind them that whateveractions were done in the past are over and cannotbe changed, so it’s best to let go of them. However,we can change from this moment on. If the persontruly regrets her mistakes and wishes to transformherself, there is no reason she cannot find forgiveness.If there are specific people the person hasharmed and who are still alive, encourage the personto express his regret and request forgiveness.27


Sogyal Rinpoche says (p.213):All religions stress the power of forgiveness, and thispower is never more necessary, nor more deeply felt,than when someone is dying. Through forgiving andbeing forgiven, we purify ourselves of the darknessof what we have done, and prepare ourselves morecompletely for the journey through death.HOW TO HELP SOMEONEWHO IS A BUDDHISTIf the dying person is a Buddhist, ask questions tofind out how much they know and understand, andtheir answers should give you a better idea aboutwhat to do to help them spiritually. For example, ifthe person has strong faith in Guan Yin (Tib:Chenrezig, Skt: Avalokitesvara), then you shouldencourage them to keep that faith in their mind andpray to Guan Yin as much as possible. Or if theperson were a practitioner of mindfulness meditation,encourage them to do that practice as often asthey can. In short, whatever teachings and practicesthey are familiar and comfortable with, remind them28


of these and do whatever you can to provide themwith confidence and inspiration to do these practices.If they have difficulty practicing on their own,due to pain or tiredness or a confused state of mind,do the practice with them.If possible, place images of Buddha, Guan Yin,Amitabha, and so forth within sight of the person.If he or she has any Spiritual Teachers, you can puttheir pictures as well. It’s also very beneficial to recitethe names of Buddhas to the person, becausethe Buddhas have promised to help living beingsavoid being reborn in states of suffering.Speak to the person, or read passages from books,about impermanence and other Buddhist teachings—butdo this only if they are receptive, do notforce it on them. Also, be cautious about teachingthem something that would cause their mind to beconfused or upset (for example, if the subject is toodifficult for them to understand, or if it is new andunfamiliar). Remember that the most importantthing is to help the person have a peaceful andpositive state of mind before and during their death.It may be that the dying person does not knowhow to meditate or pray. In that case you can meditateor do other prayers or practices in their pres-29


ence, dedicating the merit of these that they have apeaceful mind at the time of death and a good rebirth.You can also teach them how to pray, usingstandard Buddhist prayers, or by praying in their ownwords, in their own hearts. For example, they canpray to Buddha, Guan Yin or whichever Buddhafigurethey are familiar with, to be with them duringthis difficult time, to help them find the strengthand courage to deal with their suffering, to keep theirmind peaceful, and to guide them to a good rebirthin the next life.Here is a simple meditation you could teach thedying person to do: ask them to visualize in front ofthem whatever Buddha-figure they have faith in, seeingit as the embodiment of all positive, pure qualitiessuch as compassion, loving-kindness, forgivenessand wisdom. Light flows from this figure, filling theirbody and mind, purifying them of all the negativethings they have ever done or thought, and blessingthem to have only pure, positive thoughts in theirmind. The person’s mind becomes oneness with theBuddha’s mind, completely pure and good. If thedying person is not able to do this meditation (e.g.if they are too ill, or unconscious) then you can doit for them, imagining the Buddha-figure above the30


person’s head.Also, to help their minds be free of worry andanxiety, encourage them to not worry about theirloved ones and their possessions—assure them thateverything will be taken care of—and to not be afraidof what lies ahead but to have faith in the ThreeJewels. Do what you can to help them cultivatepositive thoughts, such as faith, loving-kindness andcompassion, and to avoid negative thoughts such asanger and attachment.HOW TO HELP SOMEONEWHO IS NOT A BUDDHISTIf the dying person belongs to another religion, makean effort to understand what they know and believe,and speak to them accordingly. For example, if theybelieve in God and heaven, encourage them to havefaith in and pray to God, and to feel confident thatthey will be with God in heaven after they leave thislife. And have a respectful attitude towards the personand their beliefs and practices. Remember, themost important thing is to help the person to havepositive thoughts in their mind, in accordance with31


their religious beliefs and practices. DO NOT attemptto impose your own beliefs or try to convertthem. To do that would be disrespectful and unethical,and could cause them to become confused anddisturbed.If the person has no religion, use non-religiousterminology to speak to them in ways that will helpthem to be free of negative thoughts such as angerand attachment, and develop positive thoughts anda peaceful state of mind. If they show interest inknowing what you believe in, you can tell them, butbe careful not to preach. It might be more effectiveto have a discussion in which you openly share ideaswith each other. For example, if the person asks youwhat happens after we die, instead of immediatelylaunching into an explanation of rebirth, you mightsay something like “I’m not really sure. What do youthink?” And take it from there.If they genuinely wish to know about Buddhistbeliefs and practices, it’s perfectly OK to explain theseto them. You can talk about the Buddha’s life andteachings, the Four Noble Truths, impermanence,loving-kindness and compassion, and so forth. Justbe sensitive to their response—be careful not to bepushy, otherwise the person could become negative.32


Remember, the bottom line is to help them remainfree from negative thoughts as much as possible, andto have a positive, peaceful state of mind.If the person is not a Buddhist and would notbe comfortable hearing or seeing you do any Buddhistprayers or practices, you can still do these practicessilently, without them knowing it. For example,you could sit beside them and meditate on loving-kindnessand send the energy of loving kindnessfrom your heart to fill them with peace. Or you couldvisualize Buddha or Guan Yin above the person’shead and silently recite prayers or mantras while visualizinga shower of light flowing from the Buddhainto the person, purifying them and helping theirmind to become more pure and peaceful. It is quitepossible that the person will feel the effects of thesepractices even though they have no idea that theyare being done on their behalf!THE TIME OF DEATHYou can continue to do meditation or recite prayers,mantras, the names of Buddhas and so forth as theperson is dying, and for as long as possible after they33


have stopped breathing. Remember that the cessationof the breath is not the sign of death accordingto Buddhism. That is only the fourth of the eightstages of the death process, and the actual point ofdeath, when the consciousness leaves the body, isafter the eighth stage.How long does it take for the person to get tothat stage after they have stopped breathing? That isnot certain—it depends on various factors such asthe cause of death (for example, if the person wasbadly injured in a car accident, the consciousnessmight leave sooner than in the case of a naturaldeath), and the state of the person’s mind (an experiencedmeditator would be able to stay in the eighthstage, the clear light state, longer than someone withlittle or no meditation experience.)So how can we know when the person has actuallydied? According to the Tibetan tradition, thereare several signs indicating that the consciousness hasleft the body: the heat of the heart ceases, a smellbegins to emanate from the body, and a smallamount of fluid will be emitted either from thenostrils or the sexual organ. So it is best to leave thebody undisturbed until these signs occur, whichcould be several hours or even several days after the34


eath has ceased. This is possible if the person hasdied at home, but would be difficult in a hospitalbecause hospitals have rules regarding how long abody can be kept in a room or ward. You can requestthe hospital staff to move the body to anotherroom where it could be left for several more hours,while prayers and mantras continue to be recited.It is best to not touch the body from the timethe breath has stopped until the consciousness hasdeparted. However, if it is necessary to touch thebody during this time, first pull the hair on the crownof the head (or just touch the crown if there is nohair). This will stimulate the person’s mind to leavefrom the crown, which is the exit-point for a fortunaterebirth—state such as in a Pure Land. After thatyou can touch other parts of the body.In the Buddhist tradition it is recommended thatwe not cry in the presence of someone who is dyingor has stopped breathing. It is also not good to talkabout the person’s possessions and how they shouldbe distributed. Hearing such sounds could disturbtheir mind. Family members and friends can go toanother room to cry, or to discuss practical matters.In the presence of the person who has died, it is bestto have only the sounds of prayers, mantras and35


spiritual instructions.Among the practices recommended by LamaZopa Rinpoche for a person who has passed awayare: Medicine Buddha, Amitabha, Chenrezig, GivingBreath to the Wretched, and the King of Prayers.Copies of these and other practices for the dyingand deceased can be obtained by writing tomaterials@fpmt.org. If there is a lama or ordainedperson in your area who knows how to do powa(transference of consciousness) practice, you caninvite them to do that. If there is no such personavailable, then just do whatever prayers and practicesyou know, with as much faith, sincerity andcompassion as you can generate in your heart.HELPING AFTER DEATHAfter the person has passed away, we can continueto benefit them by doing positive, virtuous actions—such as saying prayers (or asking monks and nunsto say prayers), making offerings, releasing animalswho are destined to be slaughtered, doing meditation,etc.—and dedicate the merits of these actionsfor the person to have a good rebirth, and to quickly36


ecome free from cyclic existence and attain enlightenment.It is perfectly all right to do these practiceswhether the person was a Buddhist or not.It is good to use some of the person’s own moneyto create merit, for example, making donations tocharity. Also, merit accumulated by family members(direct relatives of the deceased person) is especiallypowerful and helpful. Doing virtuous actions anddedicating the merits to the deceased can help theperson in the bardo (the intermediate state betweendeath and the next life, which could last up to 49days). However, once they have taken rebirth, themerit we dedicate may not help them in that life,but could help them in their subsequent rebirth, forexample, by shortening the length of an unfortunaterebirth.37


CONCLUSIONI hope that the ideas presented in this booklet willhelp you to be more accepting and less fearful ofdeath, your own and others’. There is a great wealthof material—from ancient religious and spiritualtraditions as well as from modern fields such as psychology,sociology and palliative care—that can guideus in living our lives in such a way as to be peaceful,calm and courageous in the face of death. And whensomeone we love is going through that experience,we can be a source of comfort, serenity and hopefor them. May this small work inspire you to learnmore on this subject. And may all beings becomefree from the sufferings of death, and attain thehighest peace and happiness beyond the cycle of birthand death.38


APPENDIX 1A Simple Tong-Len (Taking and Giving)Meditation Using One’s Own ProblemYou can use this method whenever you are experiencingany kind of problem—physical, emotional,in a relationship or at work. Sit down, calm themind, generate a positive motivation for doing thepractice. Then focus on your problem, allow it toarise in your mind, feel how painful it is, how yourmind wants to push it away.... Then think: “I amnot the only person experiencing a problem like this.There are many others....” Think of other peoplewho may be experiencing the same or a similarproblem, some to an even greater degree than yourself.(For example, if you have lost a loved one, thinkof people who have lost many loved ones, in a waror a famine.)Then generate compassion, thinking: “Howwonderful it would be if all those people could befree from their suffering.” Then decide that you willaccept or take on your own experience of this problem,in order that all those other people could befree from theirs. You can do this with the breath:visualize breathing in the suffering in the form of39


dark smoke. It comes into your heart, where the selfcherishingmind is located, in the form of a solid,dark spot or rock. The dark smoke of suffering absorbsinto the rock of self-cherishing and destroysit.....Then breathe out happiness and positive qualitiesand merit, in the form of bright light, giving toyourself and all those other people whatever qualitiesare needed to be able to deal with the problemand to progress along the path to enlightenment.Conclude the meditation by feeling joyful thatyou have done this practice, and dedicate the merit(positive energy) of the practice that all beings maybe happy and free from suffering.APPENDIX 2Meditation on ForgivenessAs we develop in our practice of meditation we naturallybecome more conscious of what is going on inour minds. We become clearer about what we feeland why. We start to uncover the discrepancies inour lives, and get in touch with the bruises and hurtsof old relationships. Slowly, we are able to tie loose40


ends and heal the wounds.The practice of a forgiveness meditation is awonderful way to heal the pain of the old hurts thatblock our heart and prevent us from trusting andloving ourselves and others. Forgiveness is the keyto opening our hearts, to learning from the painfullessons of the past in order to move into the futureunhindered.Begin by sitting quietly, relaxing your body andfocussing your mind with the breath. Allow memoriesand images and emotions to float freely in yourmind—things you have done, said and thought thatyou have not forgiven yourself for, no matter howpainful they are.From your heart say to yourself, “I forgive myselffor whatever I have done in the past, intentionallyor unintentionally, my actions, my words and mythoughts. I have suffered enough! I have learned andgrown and I am ready now to open my heart tomyself. May I be happy, may I be free from confusion,may I know the joy of truly understandingmyself, others and the world. May I come to knowmy own wholeness and fullness and help others todo the same.”Now, in the space in front of you, imagine a41


person you love whom you want to forgive or whoseforgiveness you need. From your heart to their heartdirectly communicate the following: “With all myheart I forgive you for whatever you may have done,intentionally or unintentionally, by your actions,your words or thoughts that have caused me pain.I forgive you, and I ask that you forgive me forwhatever I have done, intentionally or unintentionallyto you, by my actions, my words or mythoughts—I ask your forgiveness. May you be happy,free and joyful. May we both open our hearts andminds to meet in love and understanding as we growinto wholeness.” Imagine that this message has beenreceived and accepted, and affirm the healing thathas taken place within you and between the two ofyou. Then allow the image to melt into space.Next, think about the countless people towardwhom you have closed your heart. Remember howyou felt and what you did when people abused you,spoke harshly, took “your” parking place, crowdedin front of you in line, ad infinitum... Consider howmany people you have hurt in some way, by yourown conscious or unconscious actions, words andthoughts. How many times have you been the abuser,the one who crowded in, the one who spoke harshly?42


Imagine these countless beings standing before you.From your heart to theirs generate the essence of thefollowing: “I forgive you and ask you to forgive mefor whatever I have done, intentionally or unintentionally,that has hurt you. May you and I and allof us create the causes for happiness in our lives. Maywe all come to know the joy of truly understandingand experiencing our interrelationship. May we openour hearts and minds to each other and meet inharmony.”Repeat this reflective meditation as often as you like.At the conclusion, imagine and feel as vividly andwholeheartedly as you are able that you have actuallyreleased all guilt and blame towards yourself. Inthis present moment, allow yourself to feel forgivenessand a patient acceptance of your past actions.— From The Fine Arts of Relaxation, Concentrationand Meditation by Joel and Michelle Levey (WisdomPublications, Boston, 1991)43


NOTES1. Gary Zukav, The Dancing Wu Li Masters (NY:Bantam, 1980), p.197.2. Christine Longaker, Facing Death and FindingHope (London: Century, and NY: Doubleday,1997), p.113.3. Pabongka Rinpoche, Liberation in the Palm ofYour Hand (Boston: Wisdom, 1991), p.422.4. Bokar Rinpoche. Death and the Art of Dying inTibetan Buddhism. San Francisco: ClearPointPress, 1993; pps.52-53.44


INSPIRING QUOTES“My disciples, my end is approaching, our partingis near, but do not lament. Life is ever changing;none can escape the dissolution of the body. This Iam now to show by my own death, my body fallingapart like a dilapidated cart.Do not vainly lament, but realize that nothingis permanent and learn from it the emptiness ofhuman life. Do not cherish the unworthy desire thatthe changeable might become unchanging....” — lastwords to his disciples by Shakyamuni BuddhaDEATH IS CERTAIN‘No man, though he sees others dying around him,believes he himself will die.’ — Bhagavad-gitaWhen you are strong and healthy,You never think of sickness coming,But it descends with sudden force,Like a stroke of lightning.When involved in worldly things,45


You never think of death’s approach,Quick it comes like thunder,Crashing round your head.— MilarepaHOW TO DIE HAPPILYAND MEANINGFULLY‘If a person dies with the thought of benefitingothers, their mind is naturally happy and this makestheir death meaningful.’ — Lama Zopa Rinpoche‘A time will never come when you are free of allactivities, so everyday you have to find the opportunity....Death is definite but the time of death isindefinite—it can strike us at any time, therefore donot procrastinate.’ — HH Dalai LamaDIE TO LIVE‘The Buddha told his disciple Ananda to see impermanence,to see death with every breathe. We must46


know death; we must die in order to live.’ — AjahnChahWHY HELP THE DYING?‘The needs of a person who is experiencing death,who is at this crucial point in life, are unbelievable,and they need support.... For most people, whendeath is approaching they find it the hardest andmost difficult time in their life. So therefore, this isthe time that they really need some refuge or support.”— Lama Zopa RinpocheTo Friends of the DyingOh you,Who have come to this place,Sisters and brothers, friends,This person is dying.She (he) has not chosen to do so.She is suffering greatly.She has no home, no friends.Falling as from a cliff,She is entering a strange forest.47


Driven by the winds, swept by the ocean,She feels no solid ground.She is embarking on a great battle.Moved from state to state,She is alone and helpless.Embrace her with your love.— extracted from The Tibetan Book of the Dead forReading Aloud, adapted by Jean-Claude van Itallie.HOW TO HELP‘The main thing is to take care of the dying person’smind. Many others can take care of the body, butwe can take care of the mind.’ — Lama ZopaRinpoche‘The body has its own language of love, use it fearlessly,and you will find you bring to the dyingcomfort and consolation.’ — Sogyal Rinpoche‘When you do social service, and from the verybeginning what you have in your heart is to offerservice to others, because others are most important,48


then of course you enjoy the work because of thepure heart.’ — Lama Zopa Rinpoche“What is compassion? It is not simply a sense ofsympathy or caring for the person suffering, notsimply a warmth of heart toward the person beforeyou, or a sharp clarity or recognition of their needsand pain, it is also a sustained and practical determinationto do whatever is possible and necessaryto help alleviate their suffering.” — Glimpse AfterGlimpse by Sogyal RinpocheBENEFITS OF VOLUNTEERING‘Helping to look after people who are sick and dyingis itself the best preparation for our own death’— Lama Zopa Rinpoche‘To learn really to help those who are dying is tobegin to become fearless and responsible about ourown dying, and to find in ourselves the beginningsof an unbounded compassion that we may havenever suspected.’ — Sogyal Rinpoche49


RECOMMENDED READINGBUDDHIST TEACHINGS ONDEATH AND DYINGBokar Rinpoche. Death and the Art of Dying inTibetan Buddhsm. San Francisco: ClearPointPress, 1993.Kapleau, Philip, ed. The Wheel of Death. New York,Harper & Row, 1971.Lama Lodo. Bardo Teachings. Ithaca, NY: SnowLion, 1987.Lati Rinpochay and Jeffrey Hopkins. Death, IntermediateState and Rebirth. Ithaca, NY: SnowLion, 1985.Loden, Geshe Acharya Thubten. Path to Enlightenmentin Tibetan Buddhism, pps.225-253. Melbourne:Tushita Publications.Mullin, Glen H. Death and Dying: The Tibetan Tradition.London: Arkana, 1986.Pabongka Rinpoche. Liberation in the Palm of YourHand, pps.332-361. Boston: Wisdom, 1991.Sogyal Rinpoche. The Tibetan Book of Living andDying. San Francisco: HarperCollins, 1992.50


Thurman, Robert A.F., trans. The Tibetan Book ofthe Dead. New York: Bantam Books, 1994.Visuddhacara. Loving and Dying. Penang: MalaysianBuddhist Meditation Centre, 1993.BUDDHIST MEDITATIONGoldstein, Joseph. The Experience of Insight. Boston:Shambhala.Gunaratana, Venerable H. Mindfulness in PlainEnglish. Boston: Wisdom.McDonald, Kathleen. How to Meditate. Boston:Wisdom.Salzberg, Sharon. LovingKindness — theRevolutionay Art of Happiness. Boston:Shambhala, 1995.Thich Nhat Hahn. The Miracle of Mindfulness.Berkeley: Parallax Press.CARING FOR THE DYINGBuckman, Dr. Robert, I Don’t Know What to Say:How to Help and Support Someone who is51


Dying. London: Papermac, 1988.Callanan, Maggie and Patricia Kelley. Final Gifts:Understanding the Special Awareness, Needs andCommunications of the Dying. New York: Bantam,1992.Kubler-Ross, Elisabeth. On Death and Dying. NewYork: Collier, 1970._______. To Live Until We Say Goodbye. EnglewoodCliffs, NJ: Prentice Hall, 1978.Levine, Stephen. Who Dies? An Investigation of ConsciousLiving and Conscious Dying. Garden City,NY: Doubleday, 1982.Longaker, Christine. Facing Death and FindingHope. NY: Doubleday, and London: Century,1997.Stoddard, Sandol. The Hospice Movement: A BetterWay to Care for the Dying. New York: RandomHouse, 1991.WESTERN VIEWS ON DEATHNuland, Sherwin B. How We Die. London: Vintage,1997.52


Hospice Care Services in SingaporeORGANIZATIONSERVICESSingapore Hospice Council820 Thomson Road Singapore 574623 UmbrellaTel: 6356-6426 Fax: 6253-5312 bodyAssisi Home & Hospice820 Thomson Road Singapore 574623 In-patientTel: 6347-6446 Fax: 6253-5312Day careEmail: assisi@mtalvernia-hospital.org Home careDover Park HospiceThe Hospice Centre,10 Jalan Tan Tock Seng Singapore 308436Tel: 6355-8200 Fax: 6258-9007Email: dover_park_hospice@doverpark.org.sgIn-patientHospice Care Association12 Jalan Tan Tock Seng Singapore 308437 Home careTel: 6251-2561Day careFax: 6352-2030 (Home care)Fax: 6251 9318 (Day care)Email: info@hca.org.sgHomepage: http://www.hca.org.sg53


St Joseph’s Home & Hospice921 Jurong Road Singapore 649694 In-patientTel: 6268-0482 Fax: 6268-4787Email: stjoseph@stjh.org.sgSingapore Cancer Society15 Enggor Street #04-01 to Home care04 Realty Centre Singapore 079716Tel: 6221-9577 Fax: 6221-9575Email: enquiry@singaporecancersociety.org.sgMethodist Hospice Fellowship70 Barker Road #05-01 Singapore 309936 Home careTel: 6478-4712 Fax: 6478-4701Email: admin@mbf.mws.org.sgMetta Hospice Care296 Tampines Street 22 #01-526 Home careSingapore 520296Tel: 6787-2212 Fax: 6787-7542Email: hhospice@metta.org.sgBright Vision Hospital5 Lor Napiri Singapore 547530 In-patientTel: 6248-5755 Fax: 6881-0702Email: caremail@singnet.com.sg54

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