At 85 years of age, my Mother was still very independent, blessed with mobility to go wherever she wanted. When she was well, I always reminded her to Niànfó (念佛), explaining why reciting Āmítuófó (阿弥陀佛) is the most easy practice to do, including on the deathbed. I believe she practised what I suggested, with at least ten recitations in the morning and at night, before dedicating merits (回向功德) to all sentient beings. (Of course, more Niànfó would be even better.) Lately, I also encouraged her to do repentance (忏悔) practice in her own words. For example, by reciting, ‘I am sorry for all my wrongdoings in the past, that were done knowingly and unknowingly. For them, I now seek forgiveness.’ This was followed by Niànfó, with dedication of merits to karmic creditors (冤亲债主) too, (although they are also included in ‘all sentient beings’ above).
She was sent to A&E on the afternoon on 5th of August (Thursday) after she visited me in the morning. Thankfully, she had decided to go home to rest, at my brother’s house, instead of going shopping for her supplements. She had fainted just before the ambulance arrived. On the way to the hospital, her heart stopped. CPR was done but unable to revive her. At the hospital, the doctor managed to get her heart beating again, but with reliance on a machine. Initially, it was suspected to be a heart attack or stroke. When I arrived, I briefed the doctor on her history of headaches.
The brain department’s surgeon shared her CT scan, saying there was ‘messy’ internal bleeding in her head. Even if there was an operation, she would be in a coma indefinitely, as her heart had stopped earlier for at least 6 minutes, which deprived her brain of oxygen. (Although she did not clearly understand how the consciousness and dying process work, my Mother once mentioned, that in such a case, there should not be attempts to save her.) Thus, we decided not to operate. As the default practice, the doctor had already put her on a ventilator.
We only thought of following her ‘wish’ then, not wanting her to suffer further. We almost wanted to ‘let her go’ off life support when the hospital asked us to decide. As I was blinded by the thought of letting her depart ‘without’ suffering, I kind of agreed with my brother then. At the same time, I was trying to buy time for my other siblings to see her, while wanting to Niànfó for her. Due to new rules with the current pandemic, my Mother had to do a swab test before transferring to ICU. Thus, we thought of switching off the machine there in a few hours’ time, in the morning.
The ICU doctor shared that his mother had similar symptoms, encouraging me to be prepared as she might not survive beyond midnight. That got me worried as I still had to at least offer guidance (开示). At a loss, at about 8 pm, I sent a message to Laoshi (teacher) on the situation, to seek support-chanting (助念), although unsure of what exactly to ask for. (The COVID rules allowed two visitors at a time then, only for family members.) Laoshi’s reply (as summarised below) was a wake-up call for me. (Oh yes! I should not switch off my Mother!) Due to COVID precautions, with swab test results not yet out, I could only stand outside, by the ICU’s glass door, to offer guidance and Niànfó, following the steps Laoshi shared. (Patients have to 2 pass swab tests before visitors can visit up close, while visitors have to pass the swab test if they stay for more than 30 minutes.)
The nurse informed that her heart rate was stable, and since my siblings were on standby there, I rushed home to take a Rebirth Blanket (往生被) and Āmítuófó picture scroll (阿弥陀佛图像), before rushing back to the hospital. I started Niànfó again, still separated by the glass door, unable to go nearer. At midnight, her heart rate was still very stable while a second swab was needed, which means I had to wait for another 4 hours, for another negative result, before approaching her. I was a little panicky and prayed to Āmítuófó for the result to be negative, so as to be by her side, to offer guidance and Niànfó. (As I was tearing, I had to walk away a few times.)
At 4 am, when the negative swab result was clear, the nurse quickly let me in after some cleaning. I was grateful that she got me a chair. Before offering guidance, as I got emotional, I told my Mother, ‘Sorry for being a “useless” daughter, as my eyes are like a spoiled tap that is leaking. So, please don’t be bothered, and focus on sincere Niànfó’. I then recited the ‘Guidance Text For The Dying’ (临终者的开示), telling her that I will meet her in Pure Land when my time to depart comes. I then repeated the sequence of offering guidance, repentance, Niànfó and dedication of merits.
At about 8.45 am, the doctors were making their rounds. This is when there was family drama, disagreement with my siblings. I shared with them Laoshi’s messages on why we should NOT remove life support. Finally, I got them to agree to see how it goes for another day. I quickly ate a bowl of dessert for breakfast. At 10 am, it was my turn to go for another (daily) swab test, before returning to the ward at about 11 am.
Continuing with support-chanting, following Laoshi’s advice to express utmost sincerity, I got on my knees to seek Āmítuófó’s blessings for my Mother and myself, so that we can focus on Niànfó, for her to depart smoothly. I did so for about 2 rounds. I also managed to encourage my nephew to recite with me. As he stayed for more than 30 minutes, he had to take a swab test too. When we needed breaks for such matters, my siblings took over looking after my Mother.
According to the doctor, she might live on for another 3 to 4 hours, but she exceeded the duration. Every hour or hour and a half, I repeated the sequence of offering guidance, repentance (with kneeling), Niànfó and dedication of merits. At one point, feeling great sympathy for my Mother, I further sought Āmítuófó’s blessings for her smooth departure, making a small vow to uphold the Eight Precepts (八戒) on all Ten Precept Days (十斋日) for the next 3 months. Although her heart rate reduced from 100 to 78 in 24 hours, it was said to need more time to go down further. I decided to take a short nap as I did not sleep from Thursday to Friday night, asking the nurse to call me when it drops to 60, or if it is dropping quickly.
About one hour and 15 minutes later, the nurse informed that time was running out. I alerted my siblings on this before she passed on. I am unsure exactly when she flatlined, but there was no struggling or gasping for air. During this time, I offered guidance and Niànfó again, telling her not to be afraid as I am beside her, and that she must follow Āmítuófó only. ‘Āmítuófó (with Bodhisattvas of the great noble assembly) will come to welcome you. So, you must continue to Niànfó.’
After the doctor certified her death at 12.52 am, when I lightly touched her crown, it was warm. (The crown should be tapped if bald, or with its hair there tugged lightly, before further touching or moving the the rest of the body, so as to stimulate the consciousness to depart from there, if still within. If it is the last warm area of the body, the consciousness could have just departed, or is about to depart from there for Pure Land. This auspicious sign [瑞相] is called ‘with the head crown only warm’ [头顶独热].)
I continued to Niànfó for a short while. The nurse then needed to clean her body for the undertaker to collect it. (Usually, there can be bargaining for a few hours more, to allow more chanting first, before further touching and moving the body.) I again continued to Niànfó for her while waiting for the death certificate to be processed, which took about 4 hours. This allowed more time for Niànfó, while I asked my brother to handle the paperwork. Her mouth was open then, due to intubation earlier. I told her that it would be good if she can try to close her mouth, to look better, and in case a foreign object enters.
Before the undertaker collected her body at about 5 am, I told her that as her body had to temporarily go at the funeral service provider’s place for the wake venue to be ready, during this time, she should continue to Niànfó. About 11 am, her body was brought to the venue. When I saw her, without anyone else’s efforts, her mouth had already closed nicely, with a light smile. Her eyes were shut with a peaceful expression. There was no embalmment, make-up or any ‘adjustment’ done by the funeral service provider.
I told her, ‘Mother, you are amazing! You must have heard me, and you have done very well. You did it! Very good! Jiayou!’ (Strive on!) I felt very relieved, but continued to offer guidance and Niànfó, telling her she must not be slack, (in case she has yet to reach Pure Land), despite showing us auspicious signs. At the crematorium, following the ‘Guidance Before Cremation’ (火化前的开示), I told her, ‘Mother, you have already done very well (您已经做得很好). You have to let go, and continue to Niànfó, till you see the Buddha, to follow the Buddha, and only the Buddha (念佛，见佛，跟佛). When our time come, we will meet you there, in his Western Pure Land Of Ultimate Bliss (到时候，我们会去极乐世界和您见面).’
Here, I would like to sincerely thank Shi’an Laoshi, for his teachings, continuous sharing and ongoing support for Pureland Practice Fellowship, to have right practices and good cultivation. I am thankful for his swift reply to my messages. I am very grateful, with words difficult to describe my gratitude. Shi’an Laoshi, you have saved me from breaking the First Precept. Thank you so much! Āmítuófó! Āmítuófó! Āmítuófó!
14 Aug 2021
Summary Of Key Messages Shared:
Please do not remove life support. It is killing. Do not break the First Precept. Please do the following until there is natural departure:
BGRAM Steps To Follow At Deathbed
 Bowing thrice (or with join palms towards Buddha image) – if possible, or do on behalf of person
 Guidance Text (as below)
 Repentance Verse (as below)
 Āmítuófó’s Name: purelanders.com/mp3
 Merits’ Dedication (as below)
 Guidance Text For The Dying
‘Dearest __ [name of dying person], you have done much good already, having done __ [list some outstanding good deeds] for your family, friends and society. And we will continue to do more good in your name to create merits for you. For this, you should rejoice and have peace of mind. As you are about to depart, it is time to stop thinking about [your attachments such as] family, wealth, status, [or your aversions such as] pain, regrets, grudges and fears, as these thoughts cannot help you now, and can only disturb you. The best thing you can do for yourself and your loved ones is to Niànfó with us sincerely now, so that you can reach Āmítuófó’s Pure Land – where there is no more suffering, where there is only bliss. Do not worry that you are not pure enough, for Āmítuófó is compassionate and will receive you if you wish to be a better person from now on. Even those who had made great mistakes but repent can reach Pure Land by sincere Niànfó. Please follow our Niànfó and chant along softly, or in your mind. Focusing only on the name of Āmítuófó wholeheartedly, you will definitely see Āmítuófó come to guide you to his Pure Land. Please follow only Āmítuófó and no one else. Please do not worry about your loved ones, as they will be fine. They too will Niànfó to reach Pure Land when it is time to meet you there. Let us Niànfó sincerely now. Āmítuófó, Āmítuófó, Āmítuófó…’
「亲爱的 __ [临终者名]，您已经为了家人、朋友和社会，做了许多贡献，就好比 __ [列出一些杰出的善行]。我们将继续以您的名义，为您行善造功德。所以，您应该随喜功德而安心。既然您将要离开，现在就要放下【您的执着，如】家庭、财富、地位，【或所厌恶的，如】疼痛、遗憾、怨恨、恐惧，因为这些妄想都帮不了您，也只会干扰您。现在最能利益自己和您所爱的人的，就是真诚地跟我们一起念佛。这样就可以往生到阿弥陀佛的净土。那里没有痛苦，只有安乐。别担心您不够清净。只要您现在诚心悔过，阿弥陀佛一定会慈悲接引您。即使是犯过大错的人，一旦忏悔，而真诚念佛，也可以往生净土。请随着我们的念佛，轻声跟着念，或在心中默念。只要全心全意念佛，您一定会看到阿弥陀佛来接引您到他的净土。请只跟着阿弥陀佛去，而别跟随其他人。请别担心您的家人，因为他们都会安好。将来他们也会念佛往生净土，与您见面。让我们现在用最真诚的心念佛。阿弥陀佛、阿弥陀佛、阿弥陀佛…」
 Repentance Verse
Of all my past created evil karma,
all by beginningless greed, anger and delusion,
from my body, speech and mind as arisen,
for all I now express repentance.
 Merits’ Dedication Verse
May these meritorious virtues, adorn the Buddha’s Pure Land [so as to be born there], repay the four weighty sources of kindness [which are our parents, the Triple Gem (Buddhas, Dharma, Saṅgha), society (country) and all sentient beings] above, and relieve suffering of the three paths [of hell-beings, hungry ghosts and animals] below. If there are those who see or hear this, may all give rise to the Bodhi Mind [(Bodhicitta) which is the aspiration to attain Buddhahood while guiding all sentient beings to the same goal], and at the end of this one retribution body [that is karmically subject to suffering], be born in the Land Of Ultimate Bliss [which is Āmítuófó’s Pure Land] together.
Advice Before Departure
Never think it will take a long time for those on life support to depart naturally. Just follow the above steps sincerely. Tell her she must follow your Niànfó sincerely. Offering sincere guidance and Niànfó as above will expedite reach of Pure Land. To turn off the ventilator’s life support is to deprive of oxygen, which is to kill. Please do not kill. It is to force someone to enter the bardo (中阴) state unprepared and in an agitated state, to possibly be reborn elsewhere unfortunate quickly, as swept away by the winds of karma (业风).
It is a common misunderstanding that switching off will be peaceful, but it is like suicide or murder, and we know that the Buddha taught that both are unlikely to lead to good rebirths. Based on direct cause and effect, there is an astronomically low ‘chance’ that the moment life support is switched off is the moment the person has the best rebirth. Most who do not understand the power of Niànfó tend to think there is no choice but to switch off. But we know Āmítuófó will be able to help when we are sincere.
Those who want switching off wrongly think it will bring instant peace. This is how it will be instead… Imagine running out of air, ‘suffocating’. Similar to drowning, how can this be peaceful? The quality of the last thought before rebirth is the most important. Filial piety is expressed by ensuring there is the best rebirth possible. Cost should be the last concern, while negative karma and guilt created can haunt indefinitely. There is no time to waste. Do start BGRAM as above now. Explain to your Mother why switching off is dangerous, followed by the Guidance Text and the rest.
Practise Niànfó to eradicate negative karma (消业障), to relieve suffering and to facilitate swift rebirth. You can send her name for dedication of merits by Pureland Practice Fellowship’s Purelanders too. With sincere Niànfó, there will be smooth and natural departure. Please read the following too: https://purelanders.com/?s=life+support.
For family members who disagree, ask for 1 week’s time. And if still not departed by then, ask for another week… Be utmost sincere with your chanting. Kneel if needed. Āmítuófó will help too. Pace yourself. Stop work for now. Your full-time job now is to be a support-chanter. Rest normally when needed. The Rebirth Blanket should be put on her now, for protection against karmic creditors (冤亲债主) and to clear negative karma. Turn on the Buddha’s name around the clock as a reminder to Niànfó, even when resting.
As part of medical SOP, many will be put on life support by default during emergencies. While whether one should be put on it in the first place depends on several factors (such as whether it helps or hampers Niànfó), there should NOT be, once on life support, taking living people off it. While some forms of life support might cause some discomfort, they can also buy some crucial time for Niànfó, for swift and smooth departure. Of course, obviously ‘torturous’ life support should be avoided in the first place, (if avoidable at all), but ample guidance and support-chanting are still needed then, ideally beginning before departure.
Advice After Departure
Thank you for not switching off, and for your sincere Niànfó. Your Mother’s expression looks wonderful. Well done! With firm connection to Āmítuófó’s blessings, the expression can turn serene. It is an auspicious sign called the ‘facial expression as if alive’ (and well) (面相如生). This is often the most peaceful expression ever seen on the person. Very glad that you followed the advice to not simply switch off. Do jiayou with more Niànfó during this period, to create even more merits for her.
You must write a testimony to share on this, as many need to be persuaded to have faith in Niànfó, to not simply switch off loved ones. Your sharing will make it easier explain the benefits of Niànfó. Once again, thank you for being firm and brave in doing what is best for your Mother.
Beyond monastics’ scheduled daily chanting at the wake, this should be practised more at the wake: purelanders.com/wake, even if by oneself, at least once a day. During other slots of free time, you can skip the Amitābha Sūtra (阿弥陀经) in the link, focusing on more Niànfó. This additional effort is very important, to further ensure Pure Land is reached. Do pace yourself and get enough rest. Just practise as many rounds as you can.
Advice For Urn Storage
Offer another round of chanting following purelanders.com/wake. Change the Guidance Text to that at https://purelanders.com/2019/12/15/guidance-text-for-the-dying-deceased-visitors-n-karmic-creditors for urn storage. Even if she is now in Pure Land, merits dedicated can facilitate a higher grade of birth. Also, it is another chance for your family members to Niànfó together, to connect to Āmítuófó for their present and future benefits. Tell them this is to pay respects to your Mother too. Even if they are not keen, it is good to set a good example by doing so personally. Every seventh day, for seven weeks at least, practise this at her home too: purelanders.com/wake, with appropriate slight changing of the Guidance Text where needed.
It is crucial to personally learn well, on exactly what to do during emergencies, should someone be about to depart, or who had just departed. With possible unpredictable and limiting conditions such as the pandemic, we cannot take the availability of support-chanting by others for granted. (Even the number of people conducting wake support-chanting can be limited to one person chanting at a time.)
In relatively ‘peace times’, there should be careful and complete familiarisation of the principles at purelanders.com/now, before explaining them to family members, especially the more elderly, to seek their consent (with signatures on the first page of the book versions), on implementing its instructions by caregivers on their behalf. This expression of agreement can prevent family confusion and contention later on what to do and not do, should issues on life support and such suddenly arise. This is not just a matter of life or death, but of long-term rebirth too. Of course, one should personally set a good example by signing too. May all use these books fully, not just for reading, but for expressing clear consent too. (The book should be reused for further instruction of others, and not be destroyed upon departure.)
Is Support-Chanting Before, During And After Removing Life Support Alright?
Why Guidance Offered To The Dying Is The Way It Is
Life Support Issues
What To Chant At Wakes
What To Do Before, During And After Dying
Should A Medical Ventilator Be Accepted Or Rejected?