(Only relevant instructions are listed here, while pointless customs are omitted.)
 Appointment: When well, or when dying but conscious, one should appoint two persons to take charge of implementing all instructions in this book. Their contact information should be made available to immediate family members after filling in the first page of this book [which is only available in the hardcopy], which should be kept close by. Should the main person not be available when one is unconscious or unable to communicate, the second person should stand in.
It is best to prepare in advance, both a living will (for carrying out these instructions should one be alive but unable to communicate), and a last will (for carrying out instructions should one be deceased, which should include Dharma donations for merit-making too).
All these wishes, especially to follow the instructions in this book, should be clearly shared with all crucial family members to avoid conflicts when dying or after death.
 Life-Sustaining Treatment (Life Support): If the dying person is unconscious and already on any life-sustaining treatment (e.g. mechanical ventilator with intubation) that prolongs life, even when it cannot cure the terminal sickness, it should not be ended before natural death, as doing so might disturb the consciousness, abruptly forcing it to leave the body, to possibly be reborn in an unfortunate realm due to agitation, pain, fear, confusion and lack of readiness.
Even with no hope of revival or recovery, if the body is alive, the consciousness is within (although possibly sometimes not). For prolonged and possibly painful cases, there should be more sincere guidance and support-chanting to encourage the dying person to Niànfó (be wholeheartedly mindful of the name of Āmítuófó) to be reborn in Pure Land swiftly. Merits from Niànfó should also be shared for relief of suffering. (See page 90 for ‘Verse For Sharing Of Merits’.)
If one can help decide whether to have life-sustaining treatment or not, it can be refused if it only creates more pain and discomfort, which makes it more difficult to Niànfó well. However, there should be swift and ample sincere guidance and support-chanting before and after any decision.
In the Singapore context, one has to carefully decide whether to personally opt in AMD (Advanced Medical Directive) or not. Opting in means to refuse in advance any life-sustaining treatment to be used to prolong your life should you become terminally ill and unconscious, and where death is imminent. (For updates and details, please see moh.gov.sg)
The key consideration is whether such life-sustaining treatment will help or hamper ability to Niànfó well, such as by causing great pain or discomfort (e.g. from CPR by defibrillators or hand, cardiotonic injections). When uncertain, it is best to swiftly and sincerely pray to Āmítuófó for inspired advice, on what best to do.
Those who practise Niànfó well in everyday life are likelier to not have prolonged or painful dying processes, which will instead be swifter and less painful or painless. They are even able to depart before any need for life-sustaining treatment.
 Organ & Body Donations: Organ and body donations should perhaps be avoided if there is uncertainty that one’s consciousness can swiftly depart from the body before or upon being pronounced deceased.
Due to lifelong habitual attachment to the body, the average donor’s consciousness is likely to remain within the body for some time, during which there will be cutting of the body for removing of organs, thus naturally experiencing pain magnified by nine times, with possibly corresponding magnified fear and anger, which might obstruct the ability to Niànfó well, and even lead to an unfortunate rebirth.
Regret for an act of generosity destroys any positive karma created from it, while giving rise to the defilements above creates negative karma. Also, dissolution of the elements when dying might already be very disturbing. Thus, even those not easily irritated might become agitated when dying or just deceased.
Only those who have strong positive karma, strong negative karma or strong Niànfó Practice (or the equivalent) can have swift rebirths – in the higher realms, lower realms or Pure Land respectively.
Although organ and body donations are noble, the priority of ensuring one reaches Pure Land for the swiftest training to become an enlightened Bodhisattva to help immeasurably more beings much more effectively and extensively should be considered.
Should attachment to wanting to help with a few organs or one body lead to aversion that results in an unfortunate rebirth, with oneself becoming an unfortunate being who needs others’ help, many other unfortunate beings cannot be helped.
Only if very certain that one can swiftly depart for Pure Land should one go for organ or body donation. When well now, one can also donate with one’s wealth, goods, time, energy, knowledge, blood, bone marrow, kidney, liver (partially), hair and such with less or no risks.
In the Singapore context, HOTA (Human Organ Transplant Act) should perhaps be opted out, with MTERA (Medical Therapy, Educational and Research Act for body donation) not opted in if one is not yet a very confident Niànfó practitioner. Note that one who had opted out of HOTA will be given lower priority should one need a donated organ, although good Niànfó Practice can prevent and/or cure serious illnesses. (For updates and details on opting out, please see moh.gov.sg)
 Euthanasia: With or without permission, even if there is extreme physical pain and/or mental agony, there should be no so-called ‘mercy killing’ of oneself, another, or by another, as this is essentially suicide, murder or inciting of murder respectively, which is extremely unlikely to lead to any release from suffering or to a good rebirth.
Applying to putting animals to ‘sleep’ too, euthanasia is much more likely to lead to continuation of suffering in the next life instead, with the possibility of being reborn with similar illnesses due to abruptly interrupted ripening negative karma in the past life, and having died with a severely disturbed mind. This is thus somewhat ‘merciless killing’ in effect.
For prolonged and possibly painful cases, there should be more sincere guidance and support-chanting to encourage the dying person or animal to Niànfó to be reborn in Pure Land swiftly. Merits from Niànfó should also be shared for relief of suffering.
 Feeding: There should be no force-feeding for the dying person if it only creates more pain and discomfort, which makes it more difficult to Niànfó well.
 Painkillers: Painkillers can be used as long as they do not impair clarity of mind significantly. They should not be overused.
The dying person should be encouraged to be sincerely mindful only of Āmítuófó (Niànfó), and not be mindful of any pain, which can ‘worsen’ with frustrations. Mindfulness of Āmítuófó instead not only takes the mind off the pain (as the mind can only have one thought at a time), it also connects to Āmítuófó’s blessings, which will lessen the pain, and even gives rise to bliss – which is why those who Niànfó often depart with peaceful smiles.
Sincere Niànfó also swiftens birth in Pure Land instead of letting pain prolong. As the person might be too distracted and discouraged by pain, there should be more sincere guidance and support-chanting to encourage the dying person to Niànfó to be reborn in Pure Land swiftly. Merits from Niànfó should also be shared for relief of suffering.
 Home Return: When it is just a matter of awaiting for death, the dying person should be sent home swiftly, where there is a more comfortable and familiar environment, with greater ease and control of following these instructions.
 Hospice Transfer: If it is not convenient to return home, the dying person should switch to a hospice which allows greater ease and control of following these instructions.
 Last Wishes & Messages: If the dying person wishes to communicate, swiftly ask for last wishes and messages through speech or writing, for noting, promising and conveying accordingly, so as to take the mind off the unfulfilled, to offer peace of mind, and to swiftly encourage focus only on Niànfó. Having a detailed will in advance helps.
 Lasting Power Of Attorney: An LPA is a legal document that allows one to appoint a trustworthy person or more to decide and act on one’s behalf on matters of personal welfare, finance and property if one is alive but has lost mental capacity.
The instructions here should be entrusted too. Having an LPA can lessen difficulties and confusion potentially faced by caregivers in the future. (For details in the Singapore context, please see msf.gov.sg/opg)
© Shen Shi’an (Recirculation with permission via purelanders.com/contact)