Should Pacemakers Be Implanted?
Question: A family member was medically advised to have a pacemaker implanted to regulate heartbeat, to prevent fainting due to low heartbeat, which might occur suddenly. However, knowing that it has to be removed before cremation, thus cutting the body, rejected it. What is best to do? (Note 1: In Singapore, pacemakers need to be removed before cremation to prevent explosion in the furnace. Removal of leadless pacemakers is not needed for burial.)
Answer: It is safer to implant the pacemaker, which only needs relatively simple and safe surgery. With this done, there will be no need to keep worrying about the heartbeat, thus having more peace of mind. It is urgent to prevent sudden death, for better practice of mindfulness of Buddha in everyday life. It is surely much more challenging to practise mindfulness of Buddha with needless distracting worries.
If death occurs at (home or) hospices, there can be ample offering of guidance (开示) and support-chanting (助念) done (e.g. up to eight hours or more), before (informing for certifying death, and) removal of the pacemaker. However, after death in (Singapore) hospitals (currently), there is an estimation of only two to five hours for support-chanting allowed, depending on the hospital’s busyness.
The truth is, even if departing at home, due to personal karmic conditions then, one might not have support-chanting available. Thus, what matters most is to learn and practise mindfulness of Buddha well in everyday life now, so as to prepare for swift connection to the Buddha for reaching Pure Land later. For example, a Purelander’s father had to have his pacemaker removed, but with practice done everyday before death, still manifested clear auspicious signs of blissful connection with the Buddha.
Avoiding physical contact with one’s body before and after death is to prevent causing magnified pain. However, whether touched or not, one should be as unattached to one’s body as possible. Merely not touching, moving or cutting the body for a number of hours after death does not guarantee birth in Pure Land. With pain or not, the key focus should be sincere mindfulness of Buddha then, for swift connection to the Buddha. If there is pain, there should be even more sincere mindfulness of Buddha, without any focus on the pain, which will aggravate suffering.
If there is still fear of experiencing being cut for pacemaker removal, choose burial then. (Note 2: In Singapore, due to land scarcity, graves have to be exhumed after 15 years of burial, for cremation.) If there is strong fear of burial (or cremation), this means the person is very attached to his or her body. Again, ‘what matters most is to learn and practise mindfulness of Buddha well in everyday life now, so as to prepare for swift connection to the Buddha for reaching Pure Land later’ – without any regard for the body or pain, when dying and after death.
Again, once we know we are dying, we should be mindful of the Buddha’s name (Āmítuófó: 阿弥陀佛) as sincerely we can, to connect to him quickly, with no need to bother about the future of the body, trusting the Buddha’s blessings fully. Be wholeheartedly mindful of the Buddha, not mindful of the body, not mindful of pain. (一心念佛，不念身体，不念疼痛。) Once connected to the Buddha, there will be bliss without pain. This is why those who depart with this smile.
The Three Great Essentials When Approaching Death
Please be mindful of your speech, Amituofo!