比丘近永法師講於2022年11月18日加拿大溫哥華金佛寺網絡講座系列
A Dharma Talk by Bhikshu Jin Yong in the Online Lecture Series at Gold Buddha Monastery,Vancouver, BC, Canada on November 18, 2022 VBS644
今天要講「臨終關懷」。個人沒有太多的經驗，就據我所知道的跟大家分享。Today, we will discuss the crucial issue of end-of-life care. While I do not possess extensive personal-experience on the subject, I would like to share my knowledge with you.
「宗教師」的實習 Chaplain Internship Program
十多年前，有機會到臺大醫院的安寧病房去學習，參加「宗教師」的培訓班。「宗教師」成員大部分是佛教的出家人，比丘尼是臺柱。
I have vivid memories of the chance I had to study in the hospice ward of National Taiwan University (NTU) Hospital over a decade ago. It initially began as a training course for chaplains, with the majority of participants being Buddhist monastics, and the bhikshunis playing a pivotal role.
有鑑於重症末期病無法在醫院得到適切的「靈性照顧」，宗惇法師便萌生成立宗教師培訓的想法，德嘉法師也是她引進的。宗惇法師是個先驅者，也是非常有遠見的人。
In view of the fact that severe and terminal patients do not receive proper Spiritual Care in hospitals, Dharma Master Tsung Tun had the idea of setting up a chaplaintraining program, and she introduced Dharma Master Dejah to the program. Dharma Master Tsung Tun is a pioneer and a visionary.
《生死奧秘》一書是德嘉法師與宗惇法師的臨床經驗，經過近20年的教學，有16個生動的靈性對話。紀錄片《回眸》中，德嘉法師是主角，關懷很多臨終的病人，點出靈性照顧的重要。
The Mysteries of Life and Death is a spiritual dialogue of sixteen lively stories based on the clinical experiences of Venerable Dejah and Venerable Tsung Tun after nearly twenty years of research and teaching. The documentary “Looking Back” follows Venerable Dejah as she cares for dying patients and emphasizes the importance of spiritual care.
事實上，臺灣在臨終關懷這方面是獨步全球的。這種針對宗教師的培訓課程，在其他地方找不到的。日本、新加坡都來臺灣取經學習。
Taiwan is at the forefront of end-of-life care worldwide. This unique training program for chaplains is unparalleled and has attracted interest from Japan and Singapore, both of which have come to Taiwan to learn from it.
我在臺大醫院的安寧病房，當了三個月的實習「宗教師」，每週工作五天，從早到晚。我們每次會被分配4-5個病人。我就跟大家講講其中給我留下深刻印象的。
I spent three months as a chaplain intern in the hospice ward at NTU Hospital, dedicating five days a week, from morning to night. We were responsible for four to five patients at a time. Allow me to share the stories of the ones who left a lasting impression on me.
我碰到的第一位病人，他長得像美式足球球員那麽強壯，所以我很訝異看到他在安寧病房躺著。病人入住安寧病房的條件是：醫生評估你的壽命剩下不到六個月。所以這些都是病危的。我看到這個病人，很自然就說：「你這麽壯！」你猜他怎麽回答，他說：「沒有用啦！」當時我不曉得為什麽他說沒有用。一旦我不曉得他的問題，我就無法幫助他。
The first patient I met looked surprisingly strong, like a football player, considering he was in hospice care where patients are expected to have less than six months to live. When I told him he was strong, he responded with, “It’s no use!” I was puzzled by his statement, as it hindered my ability to understand and help him.
他現在連站都站不起來，長得這麽壯有什麽用？他以前可以做很粗重的工作，什麽東西都可以搬動；但現在，他連站都站不起來。所以他說長得這麽壯沒有用。他會說他「沒有用」，那你就可以從這裡開始幫助他。可以從「沒有用」轉變成「有用」。如果你能夠把它轉變成有用，他就會覺得生命還有希望。不然他就意志很消沉，這輩子就在等死。問題是怎麽幫助他呢？首先你必須讓他覺得有希望，對嗎？我們從佛教的觀點來看，是有希望的。有什麽希望，我們之後再談。這個是第一個問題。
He used to be able to do very heavy work, moving anything; but now, he can’t even stand up. That was why he said he was useless. If you can transform that sense of uselessness into something meaningful, then you can offer hope. Otherwise, he’ll remain deeply depressed, merely existing rather than truly living. The question is: how can we help him? The first step is to make him feel that there is hope, isn’t it? From the Buddhist perspective, there is indeed hope. What kind of hope? We will delve into that later. This is the first question.
瀕死的癥兆 The Symptoms of Dying
接下來我要介紹瀕死的癥狀。簡單來講，就是當疾病進展到末期，接近臨終的時候，身體會發生一些變化，出現一些癥狀。例如：常常出現幻覺與躁動，食欲不好與吞嚥問題；還有出現喉嚨呼嚕聲，這種聲音一旦出來，生命大概沒有剩下幾天的時間了。此外，呼吸模式也會改變，不像我們正常呼吸的樣子。血壓下降也是很自然的現象，排尿也有困難。
Next, I will introduce “The Signs and Symptoms of Approaching Death”. In a nutshell, when a person is about to die, the body will undergo some changes. Many signs and symptoms will appear. For example, patients may experience hallucination and restlessness. Also, patients may experience a decrease in appetite and difficulty in swallowing. Patients can create a rattling sound with their breathing. You can tell that the patient may only have a few days left if he or she starts to make this rattling sound. A patient’s breathing patterns change, which may cause discomfort or distress. It is different from the way we normally breathe. Decrease in blood pressure and difficulty in urination are also common and considered natural. These symptoms and signs naturally make the patient anxious and frightened, because most of us do not understand the process of dying and do not know where we will go after this life ends.
這些症狀都會使病人對死亡感到不安和恐懼，不知道死了以後會到哪裡去？所以很恐懼。這就是我們可以幫助病人的地方。但你怎麽去安慰他，讓他平靜下來，讓他不再恐懼呢？因此，親友的愛、關懷和陪伴是相當重要的。
It is only natural to have this uneasy and frightened feeling, and this is where we can step in to help in end-of-life care. How will we comfort the patients and calm them down and make them feel at ease? The love, care, and support from family and friends are very important.
如何幫助病人？該注意什麼？How can I Assist/Help Patients and What Should I Focus On?
再詳細一點說：臨終的時候，首先就是身體各器官的功能衰退，體力虛弱，沒有辦法走路，嗜睡等。睡得愈來愈多，可以說返老還童，跟新生兒很類似；新生兒也睡得很多，也是沒辦法走路——等於是回過頭去。然後會有幻覺，還有躁動症，例如：看到已過世的親人、會大聲喊叫、雙手揮動等等。
To elaborate further on the common signs of impending death, it is important to consider the decrease in a patient’s bodily functions. They may experience weakness and difficulty in walking, and may also find themselves sleeping more often, similar to the sleep patterns of a newborn. This regression in bodily functions towards a more infant-like state is a notable aspect of the end of life. Additionally, hallucinations and restlessness are frequently observed, with patients potentially encountering visions of deceased relatives and exhibiting behaviors like screaming, shouting, or gesturing into the air.
進食量下降，還有吞嚥問題。病人不吃東西，他並不覺得餓，此時照顧的人也不要強迫他進食，因為他沒有辦法消化；如果你強迫他吃東西，反而會讓他的身體造成負擔，所以就要順其自然。安寧病房與其他病房的不同之處在於，不進行插管或做任何侵入性的治療，主要是要讓病人很自然離去。因此，他們不會給病人多吃東西，家屬也不要請醫護人員給病人多吃東西，或給他打點滴。
Decreased appetite and difficult swallowing are common symptoms of approaching death. Even though they eat less, they do not feel hungry, so caregivers should/better not force them to eat. They cannot digest food, so eating would only burden their body. Caregivers should respect the natural process of dying and support them to feel comfortable. In end-of-life care units, the goal is different from other units: they do not intubate or perform any invasive interventions. The goal is to let patients pass naturally. In this unit, medical staff do not offer unnecessary food. Family members should not expect them to provide more food or IV fluids.
其次，我們來談談瀕死的呼嚕聲。為什麽會發生這種情況？因為吞嚥功能差了，大量分泌物會積聚在咽喉深處，所以呼吸的時候就會出現這個聲音。這聲音並不會造成病人的不適，抽痰也沒有辦法改善。由於家屬不了解，認為病人喉嚨裡有東西，一定很不舒服，於是會要求醫護人員為病人抽痰。事實上，抽痰是很辛苦的，就是把一根管子插入喉嚨深處，這會讓病人不舒服。所以如果你是家屬的話，聽到這個聲音，不要要求醫護人員給病人抽痰，因為這除了不見得能改善，而且還容易導致出血。
Next, the rattling sound: Why do patients make the rattling sound? Because their swallowing function deteriorates, saliva and mucus get stuck at the back of their throat. However, they feel no discomfort. Their family members do not understand this process and assume that they are uncomfortable with something blocking their throat. They usually ask the medical staff to perform phlegm suctioning. Phlegm suctioning is actually very strenuous. The medical staff has to insert a tube deep into their throat to perform the suction. It makes them very uncomfortable. If someone is dying and makes the rattling sound, their family members should not pressure the medical staff to perform suction because it does not help them and may even cause bleeding. If the tube scratches their throat, they may bleed.
還有呼吸的不規律。病人吸了一口氣之後，會停頓很長的時間，你還以為他不再呼吸了，然而他又吸了一口氣。如果出現這種現象，就表示已經末期了。因為我們的吸氣本身需要能量，橫膈膜需要向下收縮，肋骨要向上提起，這都是肌肉收縮，而收縮是需要能量的。當病人到了末期時，呼吸是很費力的。我們現在覺得呼吸很平常、不費力，但是當你到了臨終的時候，你沒有體力的時候，你會發現光是呼吸本身就是一件很困難的事情。所以到後來，在他吐出一口氣以後，停頓了好久才能夠吸一口氣，然後呼氣。呼氣不需要能量，因為肌肉是放鬆的，所以氣吐出去之後，要等一陣子才能夠吸氣，會有這個現象。這是呼吸中樞逐漸衰竭的一個徵兆。
Next, the irregular breathing pattern: “The breathing pattern of the dying is fast and shallow to start. When they are close to the end of life, they may exhale, then stop for a long period of time; they may seem to have stopped breathing, but then they inhale again. This sign indicates that they may not have much time left. Inhalation requires energy: the diaphragm contracts and pushes down towards the abdomen, and the rib muscles contract to expand the lung. The respiratory muscles need to contract, and muscle contraction requires energy. Therefore, at the end of life, when patientw are very weak, even breathing becomes a very difficult task. We think breathing is normal and effortless, but dying patients are weak, so they exhale and pause for a long while before they inhale. Exhalation does not require energy because the muscles relax themselves. It takes a while for the dying patient to gather enough energy to contract the respiratory muscles to inhale.”
病人還有一個徵狀，就是血壓逐漸下降，手腳冰冷，末梢呈青藍色，皮膚有濕冷的情形，脈搏微弱或摸不到。另外一個徵狀，是尿液減少或排尿困難。尿液的顏色會變深，有的一天只排尿一兩次，甚至無法排尿或失禁，這是正常的生理跡象，因為身體的功能正快速退化。還有排便問題，往往都需要使用軟便劑，甚至還要通便。大便很硬就像羊的便一顆一顆的，不容易排出來，護士甚至需要戴手套去把它挖出來。畢竟整個消化系統都退化了，一旦沒有辦法排便，自然就沒有胃口──大便要排出才能夠進食。這些都是很自然的現象。
The patient has one more symptom: drop in blood pressure. They may have cold and bluish extremities; their skin may be damp and chilly. Their pulse becomes faint. Their urine output also decreases. Sometimes, they urinate only once or twice a day. Some patients even cannot urinate or are incontinent. The color of the urine becomes dark. This is normal because their bodily functions are failing. Many patients have difficulty with their bowel movements and often require stool softener. Sometimes, they need the nurses to perform dislodgment with gloves because their stools are very hard, like solid balls, similar to goat’s feces. It is very hard to pass. Their digestive systems are failing. If they cannot pass stools, they will not have an appetite. Stools need to be passed to make room for food. This is natural.
照護原則 Principles of Palliative Care
意識改變：聽覺是最後消失的知覺，佛教對此講很多。昏睡中的臨終病人，我們可以播放佛號，也可以和病人說話，安慰他、陪伴他、關心他。雖然他沒有反應，但他還是能聽到、感受到。很多人看到病人沒有了反應，就不理會，這樣會令病人更加不安，認爲沒有未來。
Fading in consciousness: “Hearing is the last sensory to disappear.” Buddhism has a lot to say about this. For a terminally ill patient in a coma, we can play their favorite Buddha recitation, or we can talk to them, comfort them, keep them company, and care for them. Although they do not respond, they can still hear and feel us. Many people ignore the patient when they see that they are not responding, and this will make them even more anxious and feel hopeless.
四道人生 The Four Last Goodbyes
前邊講到臨終者對死亡會有不安和恐懼。所以安寧照護很強調「四道」，就是完成道謝、道歉、道愛、道別的人生課題。這其實是對病人與家屬雙方而言。Earlier, I mentioned that a dying person experiences anxiety and a fear of death. That’s why hospice emphasizes “Saying Four Things”: “Say Thanks,” “Say Sorry,” “Express Love,” and “Say Goodbye.” This is beneficial for both the patient and the family.
病人剛進到安寧病房時，還可以溝通，你去幫助他的時候，可以讓他想一想：哪一些人，他想要跟他們道謝，好比師長、長輩等；如果有對不起的，他要跟人家道歉，並請求原諒；對所摯愛的親人，他要道愛，表達關愛；對親友道別，他再次感謝，說再見。這是站在病人的立場，做這四件事情，最後得以釋懷。
When patients first arrive at the hospice, they often still have the ability to communicate. As caregivers, we can guide them in reflecting upon four important aspects. First, we can encourage them to express gratitude towards individuals who have positively influenced their lives, such as parents and teachers. Next, we can support them in seeking forgiveness for any regrets or mistakes they may have. Additionally, it is essential for them to convey their love, using the heartfelt word “love,” to their cherished ones, emphasizing the depth of their affection. Lastly, we can aid them in saying their final goodbyes to their family and friends, expressing gratitude once more and bidding farewell. These four components enable the patient to find solace in the end, bringing about peace and closure.
親友可在醫護人員的引導下，向病人表達道謝、道歉、道別、道愛，陪伴病人走完生命最後一程，達到善終及生死兩相安的境界。如果病人是我們的父母親，我們要道謝；如果我們做了什麽不好的事，我們要跟他道歉；對父母親，我們要道愛；最後就是要道別。
Under the guidance of the medical team, loved ones have the opportunity to convey gratitude, seek forgiveness, express farewells, and share love with the patient as they accompany the patient through the final stage of life, ensuring that they can peacefully conclude their journey. To our parents we must thank them, we also need to seek their forgiveness for past wrongs, express our love toward them, and finally bid a heartfelt farewell to them.
這對病人是很重要的，要不然他會有遺憾。譬如某些人對他有恩，所以他需要去道謝；如果在有生之年，沒有機會這樣子做，他會遺憾。如果他對某人有對不起的地方，他如果沒有去道歉，他就會為此感到難過。
This is actually crucial for the patient as it ensures they don’t feel a sense of indebtedness. It’s important for them to express gratitude to those they feel they owe something to. If they don’t have the opportunity to do so during their lifetime, they may have regrets. Similarly, if they feel remorse toward someone but haven’t apologized, they will carry a burden of guilt.
在安寧病房，我們會和病人閒談，經常做的一件事情就是為病人進行生命回顧。讓他們回想從小到大所發生的事情，回顧中可以想到很多事情，而且通常會想到快樂的事情。因為他在安寧病房，曉得自己日子不多了，所以他很沮喪。讓他們回顧一生中的亮點，可以激起心中的歡喜。如果他們回顧自己曾做不對的事情，他們可以懺悔。我們可以引導他懺悔。所以幫助病人做生命的回顧，我覺得這是一個蠻有用的。我們也可以回顧自己的人生。因為這是很重要的！
One of the things we do in the hospice is to talk to our patients and do a life review– to reflect on many events since their childhood. It often brings to mind numerous memories, and usually, they think about happy things. Despite facing the reality of their limited time, this exercise can evoke feelings of joy and satisfaction as they reminisce about the highlights of their lives. Moreover, it provides an opportunity for them to confess their regrets. As chaplains, we help patients navigate this introspective journey, which I believe is a valuable tool. Indeed, reflecting on our own lives is also very important and rewarding.
佛教怎麼看「幻覺」？What is Buddhism’s Perspective on “Hallucinations”?
幻覺與躁動：在《地藏經‧閻羅王眾讚歎品第八》說：「是閻浮提，行善之人，臨命終時，亦有百千惡道鬼神，或變作父母，乃至諸眷屬。引接亡人，令落惡道，何況本造惡者。」臨命終的人，會看到過去的親友，還會跟那些親友講話，甚至跟他招手。我們就以為他有幻覺──但這不一定是幻覺。佛教的經典裡頭都講得很清楚，確實是親友來的，只是我們看不到而已。所以當他看到這個衆生的時候，我們最好只是聆聽，不要去否認或贊同他所說的。
Hallucinations and restlessness: Chapter eight of the Earth Store Sutra, “Lord Yama’s Praises” says, “When those who do good in Jambudvipa are about to die, hundreds of thousands of ghosts and spirits from the lower destinies transform themselves and appear as their parents or other relatives in an attempt to lead such people to fall into the lower destinies. How much more is that the case for those who have done evil deeds?”
When a person is nearing death, they may experience visions of their past relatives and friends, conversing with them and even acknowledging their presence. While some may dismiss these experiences as hallucinations, there is another perspective to consider: “The Buddhist scriptures maintain that these apparitions are, in fact, relatives and friends, but we are unable to perceive them.” When confronted with this phenomenon, it is important to listen attentively without outright denial or affirmation of their encounters.
《地藏經》又說：「是諸眷屬，當須設大供養，轉讀尊經，念佛菩薩名號。如是善緣，能令亡者離諸惡道，諸魔鬼神悉皆退散。」這些惡道的鬼神，變成過去的父母眷屬來擾亂；病人誤以爲是過去的父親母親來接他走，他不曉得所謂的這個親人，其實是一些壞的衆生來接他落到惡道去。此時，如果我們能夠念佛菩薩名號的話，這些衆生會消失，病人能順利利往生，得到佛接引。
The Earth Store Sutra says, “Their relatives should make generous offerings, recite the sacred sutras, and recite the names of Buddhas and Bodhisattvas. Such virtuous deeds can lead the deceased away from lower destinies, and all the demons, ghosts, and spirits will retreat and scatter.” These ghosts and spirits of the lower path transform into the patient’s past parents or family members to disturb them; the patient thinks that these are their past father and mother coming to take them away, but they don’t know that this so-called family member is actually a malicious being that wants to drag them to the lower path. At this time, if we can recite the name of a Buddha or Bodhisattva, these beings will vanish, and the patient will be able to go to the next life smoothly and be guided by the Buddha.
病人：我會往生淨土嗎？Patient: Will I be Reborn in the Pure Land?
接下來我們來談談另一個病人。安寧病房裡頭都有冷氣，而且冷氣都開得很大，所以病房裡並不熱，但是這個病人要求在他的臉旁放一個小風扇來吹風。我進去以後，他問我：「師父！我會往生淨土嗎？」他是佛教徒。病人為什麽會問這個問題，因為他很擔心去不了極樂世界。他非常躁動和不安，所以對這樣的病人，我們需要安他的心。問題是，如何安他的心？
Let’s discuss another patient. The hospice ward is adequately air-conditioned, maintaining a pleasant temperature. However, this patient has requested a small fan to be placed next to his face to circulate the air. When I entered the room, he asked me, “Master! Will I be reborn in the Pure Land?” He was a devoted Buddhist. He inquired about this because he was deeply concerned about his ability to reach the Pure Land. His expression was filled with anxiety and distress, so for such a patient, we must find ways to calm his mind. The question is: How do we bring tranquility to his unsettled mind?
九品往生 Nine Grades of Rebirth (and Three Levels)
下面我很快地談一下《佛說觀無量壽佛經》，講的九品往生。九品：上品上生，上品中生，上品下生；中品上生，中品中生，中品下生；下品上生，下品中生，下品下生。這大家都很熟悉，因為時間的關係，我們從中品開始談。
Allow me to briefly discuss the concept of the nine grades of rebirthas depicted in The Sutra on Contemplating Buddha Infinite Life. To save time, let’s begin with the middle grade.
中品上生。這是指受持五戒、持八關齋戒、修行諸戒的人，不造五逆，無眾過患，只要用這個功德來迴向，願意求生西方極樂世界。這樣你就可以生到極樂世界。
Upper Level of the Middle Grade. Those who are born into the upper level of the middle grade are sentient beings who have upheld the Five Precepts, Eight Precepts, or other precepts, and never commit the five heinous acts. They commit few transgressions. By transferring their merit and virtue and making a vow to be reborn in the Western Land of Ultimate Bliss, they can truly attain such a precious birth.
中品中生。只要你一日一夜持八關齋戒，然後把這個功德迴向願生西方極樂世界，這樣也可以生到極樂世界去。
Middle Level of the Middle Grade. You can be born on the middle level of the middle grade if you diligently observe the Eight Precepts for at least a day and a night, without violating any of the rules of conduct, and dedicate the merit you accumulate to the Land of Ultimate Bliss, with the aspiration to be reborn there.
中品下生。這品人不用是佛教徒，但是他是個好人，孝養父母、行世仁慈。如果他臨命終時能夠遇到善知識，為他廣說極樂世界的樂事，並為他說48大願；他聽了以後，命終時，就會往生到極樂世界去。
Individuals born on the Lower Level of the Middle Grade are characterized as good and caring individuals who fulfill their duties towards their parents and engage in benevolent acts towards others. They don’t have to be Buddhists. When approaching death, such individuals may encounter a wise teacher who imparts a profound understanding of the immense joy found in the Land of Ultimate Bliss and the forty-eight great vows of Amitabha Buddha. Upon hearing and understanding these, they will be reborn into the Land of Ultimate Bliss at the end of their life.
下品上生。他不僅不是佛教徒，而且還是一個作眾惡業的人，雖然他沒有誹謗方等經典，卻造了很多的惡法，還無有慚愧。可是他臨命終的時候，遇到善知識，為他讚歎大乘十二部經名字；他因為聽聞經名的緣故，除卻千劫極重的惡業。善知識又教他稱念南無阿彌陀佛；因為稱佛名的緣故，就能除掉50億劫生死之罪。這樣就可以往生到極樂世界去。這時候，佛就會派化佛、化觀音菩薩、化大勢至菩薩，來接他，讚說：善哉！善男子！因為你稱佛名號，你的一切惡業都會消滅，我現在來接你。所以這個雖然是壞人，只要他能稱佛名號，就可以往生極樂世界。
Upper Level of the Lower Grade. Those who are born in the upper level of the lower grade are sentient beings who engage in various evil deeds without shame or remorse, but refrain from slandering the greater scope Mahayana sutras. When such foolish ones reached the end of their lives, they encountered a virtuous advisor. This wise teacher then bestowed upon him or her high praise for the twelve divisions of the Mahayana sutras, and as a result of merely hearing the names of these sutras, he or she was cleansed of the immensely heavy karmic burden of a thousand kalpas.
And the wise advisor advises him to join his palms and recite, “Homage to Amitābha Buddha.” Reciting the name of the Buddha eliminates the negative karma that would tie the dying individual to the cycle of birth and death for fifty koṭis of kalpas, and allows him to be reborn in the Land of Ultimate Bliss.
The Buddha then sends the “Transformation Buddha”, the “Transformation Guanyin Bodhisattva”, and the “Transformation Great Strength Bodhisattva” to come and receive him, praising, “How wonderful! Good man, your negative karma has been eradicated by reciting the Buddha’s name, and I have arrived to welcome you.”
下品中生。這些更是犯戒的人，犯五戒、八戒、具足戒，他造惡業，無有慚愧，以諸惡法而自莊嚴。像這樣的罪人，他造惡業的緣故，應該要墮地獄的。他命終的時候，地獄的眾火，一時俱至。他也運氣很好，碰到善知識為他讚說阿彌陀佛的十力威德，也廣讚阿彌陀佛的光明神力，也讚歎戒定慧、解脫、解脫知見。這個罪人，光聽了這些東西，他就除掉80億劫的生死之罪，然後就可以往生到極樂世界去。
Middle Level of the Lower Grade. The beings born on this level are those who have broken the five precepts, the eight precepts, or the complete precepts of monastics. They commit evil deeds without feeling any remorse. Consequently, they defile themselves with evil karma and are at risk of falling into hell.
In the final moments of his life, as the eternal flames draw near, he is fortunate enough to encounter a wise advisor who, with utmost compassion, reveals to him the ten extraordinary powers of Amitabha Buddha. This wise instructor elaborates on the magnificence of the Buddha’s radiant light and expounds upon his virtues of upholding the precepts, cultivating mindfulness through meditation, attaining profound wisdom, experiencing liberation, and attaining the ultimate state of enlightenment.
Upon hearing this, all the negative karma that would have kept him bound to the cycle of birth and death for eighty koṭis of kalpas, is completely eradicated. As a result, he is reborn in the land of Ultimate Bliss.
下品下生。這些人更是造了五逆十惡，他本來是應該要墮惡道，經歷多劫，受苦無窮。但是他碰到了善知識，用種種方法來安慰他，來教他念佛。這個罪人，因為他臨終的時候很痛苦，雖然有善知識為他說妙法，但他沒有辦法念佛。善知識就教他：你若是不能念佛，那你就要一心稱唸無量壽佛。「無量壽佛」，就是阿彌陀佛。經文「教令念佛」，是心裡念佛、憶念佛；但因為臨終太痛苦了，沒辦法憶念佛，所以善知識就教他，用嘴巴稱唸阿彌陀佛名號。
Lower Level of the Lower Grade. Those who are born on the lower level of the lower grade are sentient beings who engage in deplorable actions, such as committing the five heinous offenses, the ten evil acts, and various forms of immorality.
Due to the accumulation of negative karma, an ignorant individual like this will inevitably be plunged into the realms of suffering, enduring immeasurable torment for countless eons. However, as the time of his passing approaches, there is a glimmer of hope. Perhaps he will encounter a wise advisor, in numerous ways, seeks to comfort him, imparting the profound wisdom of the Dharma and encouraging him to be mindful of the Buddha. Regrettably, the excruciating pain he experiences overwhelms his ability to focus on the teachings. The wise advisor suggests an alternative: “If you cannot concentrate on the Buddha, then recite by mouth instead, ‘Amitabha Buddha.’”
念佛的力量 Power of Amitabha Recitation
如果你能在臨終時，至心唸南無阿彌陀佛，稱佛的聲音不絕。如果具足十念稱南無阿彌陀佛，稱佛名號的緣故，於念念中，就能除滅80億劫生死之罪。這個「念念」，上人解釋為「十念」，也就是十口氣的意思。有人把「十念」解釋為十稱，十口氣已經很簡單了，十稱未免太容易了！
If you can sincerely and continuously recite Namo Amitabha with all your heart at the end of your life, and if you have ten recitations of Namo Amitabha and call on the Buddha’s name, you will be able to eradicate offenses resulting in eighty koṭis kalpas of birth and death in your recitations. This “Ten recitations,” which is explained by Master Hua, means “Ten Breaths.”
所以十念法可以生到極樂世界去，這主要就是要講唸佛有這麽大的效果。下品上生、下品下生都是因爲唸佛而生到極樂世界去，即使犯了五逆十惡的人也都可以去。這就是唸佛的力量，藉阿彌陀佛慈悲願力，行惡眾生稱其名號，亦能帶業往生極樂世界！
The Ten Recitation method can lead to the Land of Ultimate Bliss, and the recitation of the Buddha’s name has a profound effect. It is possible for even those who have committed grave offenses, such as the five heinous offenses or the ten evil deeds, to be born in the Land of Ultimate Bliss in the lower grades. This showcases the incredible power of reciting the Buddha’s name. By the power of Amitabha’s compassion and great vows, even evil beings can be reborn in the Western Pure Land by reciting his name!
所以我們有機會去助念的時候，要記得開示。開示對病人很有幫助，即便昏迷了，但他們還聽得到，所以還是要跟他們開示。開示後，病人多能放下這個色身。
When we have the opportunity to recite the Buddha’s name for the patients, it’s crucial to provide them with instructions. Giving instructions can greatly benefit the patients, as even after they have become unconscious, they can still hear. Therefore, it remains essential to give them instructions. By assisting them with their prayers and providing instructions, we can help them depart swiftly.
《地藏經‧利益存亡品第七》也講到助念的重要性：「未來現在諸眾生等，臨命終日，得聞一佛名、一菩薩名、一辟支佛名，不問有罪無罪，悉得解脫…」Chapter Seven “Benefiting the Living and the Dead” in the Earth Store Sutra also states the importance of reciting the Buddha’s name: “If beings of the present and future, when on the verge of dying, hear the name of one Buddha, one Bodhisattva, or one Pratyekabuddha, they will attain liberation whether they have committed offenses or not…”
該經還說：「是命終人，未得受生，在七七日內，念念之間，望諸骨肉眷屬，與造福力救拔。過是日後，隨業受報，若是罪人，動經千百歲中，無解脫日。若是五無間罪，墮大地獄，千劫萬劫，永受眾苦。」所以親屬應該在這七七四十九日內為亡者多做功德。
The Earth Store Sutra continues, “Throughout forty-nine days, those whose lives have ended, and who have not yet been reborn, will be hoping every moment that their immediate relatives will create blessings powerful enough to rescue them. At the end of that time, the deceased will undergo retribution according to their karma…” Therefore, relatives should create more merit on behalf of the deceased during these forty-nine days.
一心不亂 With One Heart Unconfused
另外要提到的，就是在《阿彌陀經》說的：「若有善男子、善女人，聞說阿彌陀佛，執持名號；若一日，若二日，若三日，若四日，若五日，若六日，若七日，一心不亂。其人臨命終時，阿彌陀佛與諸聖眾，現在其前。是人終時，心不顛倒，即得往生阿彌陀佛極樂國土。」
Another thing to mention is what is said in the Amitabha Sutra: “If there is a good man or woman who hears spoken ‘Amitabha’ and holds the name, whether for one day, two days, three, four, five days, six days, as long as seven days, with one heart unconfused. When this person approaches the end of life, before him will appear Amitabha and the assembly of holy ones. When the end comes, his heart is without inversion. In Amitaha’s land of ultimate bliss he will attain rebirth.”
經中提到「是人終時，心不顛倒」，你能保證你在臨終的時候心不顛倒嗎？你心不顛倒，才能生到極樂世界去──那這個門檻很高啊，是不是？我們會覺得這是一個很苛的條件。
It is mentioned in the sutra that “When the end comes, one’s heart is without inversion.” Can you guarantee that your mind will not be confused at the end of your life? Only with an undisturbed mind can you be reborn in the land of Ultimate Bliss — a truly demanding requirement, isn’t it? It might seem like a very challenging condition to meet.
好消息是，玄奘大師所翻譯的《稱讚淨土佛攝受經》，這部經流通沒有這麽廣，講的也是極樂世界，和《阿彌陀經》很類似。經文說：「若有淨信諸善男子或善女人，得聞如是無量壽佛無量無邊不可思議功德名號、極樂世界功德莊嚴，聞已思惟，若一日夜，或二、或三、或四、或五、或六、或七，繫念不亂。」這部經和《阿彌陀經》講的一樣，就是念七日，一心不亂。接下來說：「是善男子或善女人臨命終時，無量壽佛與其無量聲聞弟子、菩薩眾俱前後圍繞，來住其前，慈悲加祐，令心不亂；既捨命已，隨佛眾會，生無量壽極樂世界清淨佛土。」這是一個很好的消息，對不對。我們看玄奘大師翻譯的這部經，就會覺得輕鬆很多。是阿彌陀佛令你心不亂，你就一定生到極樂世界去。所以這是一個好消息。
The good news is that Dharma Master Xuanzang’s translation of the Sutra on Praising the Pure Land and Gathering in by the Buddha, which is less well-known, also discusses the land of Ultimate bliss and shares many similarities with the Amitabha Sutra.
The sutra says, “Suppose there are good men and women of pure faith who hear the name of Buddha Infinite Life and the splendid merit and virtue of the Land of Ultimate Bliss, and having heard them, contemplate on them for one, two, three, four, five, six, or seven days and nights with a focused and unscattered mind. When they are about to die, Buddha Infinite Life, surrounded by countless shravaka disciples and Bodhisattvas will appear before them to compassionately bless them and calm their mind. When their life comes to an end, they will follow the Buddha and his assembly and be reborn in the land of Ultimate Bliss.” This is very good news, isn’t it? When we read this sutra translated by Master Xuanzang, we will feel much more relaxed. It is Amitabha Buddha who brings peace and concentration to our minds, ensuring that we will be reborn in the land of Ultimate bliss. This news is truly wonderful!
第三個病人 The Third Patient
最後我想講一個病人的例子。這位病人年紀很大，80多歲了。他的女兒是一位很虔誠的佛教徒，但我不確定病人本身是不是佛教徒，因為當時他已經沒有辦法言談，也沒有辦法念出佛號來。我在病人的床尾掛了一張阿彌陀佛像。
The last patient I would like to talk about was an elderly, over eighty years old. Although his daughter was a devout Buddhist, it was uncertain whether the patient himself followed the same faith. As he was unable to speak and chant the Buddha’s name, we decided to hang an image of Amitabha at the foot of his bed.
這位病人入住的時候，已經快過年了。過年期間我們不上班，所以那幾天我沒有去安寧病房。碰巧我的受訓也在過年前圓滿了，所以我就沒有過去。這尊佛像就一直掛在病房裡。
This patient was admitted shortly before the New Year. Since we don’t go to work during the New Year’s holiday, besides my internship training was completed right before the New Year, I didn’t see the patient again. The image of Amitabha remains on the wall in the ward.
過完年，有一天，我再次回到安寧病房裡去探視病人，意外接到他女兒打來的電話。她聽到我的聲音，興奮地說：「我一直在找您呀！都找不到你。」她還說，父親沒有牙齒，整個臉都是凹陷了；但是經過助念以後，臉就變飽滿了，就像這尊阿彌陀佛一樣圓滿。而且他的老人斑也都消失了！」。所以他的女兒非常高興，認為父親已經往生到極樂世界了。佛像本身就有這個好處！我們講觀像念佛，如果他沒有辦法念佛的話，他可以觀像念佛，觀想也可以。
One day after Chinese New Year, I visited the hospice ward and surprisingly received a call from his daughter. When she heard my voice, she said excitedly, “I have been looking for you for some time! I couldn’t find you.” She then shared the news of her father’s passing. “My father had no teeth, and his cheeks appeared hollow. However, after we chanted Amitabha’s name for him, his cheeks miraculously filled up, resembling the serene face depicted in the Buddha image you gave him. And his age spots all disappeared!” This brought immense joy to her, as she believed her father had been reborn in the Land of Ultimate Bliss. The power of the Buddha image is truly extraordinary! We often discuss the importance of visualizing the Buddha; even if one is unable to recite the Buddha’s name, they can simply gaze at the image or visualize it in their mind.
往生，生日 Rebirth, Birthday
這件事情讓我們看到一個事實。在佛教中，我們不講「死」，我們講「往生」。為什麽叫「往生」？這對病人來說是有意義的。我們是去投胎呀，我們是去出生啊。這並不是意味著這輩子完了就完了，我們還有下輩子。要緊的是，下輩子你會到哪裡？如果你能到極樂淨土去，一個好地方，那是不是值得慶祝、慶生？這位病人的女兒，她對父親的往生感到非常高興。你說她不孝順嗎？不是！她很孝順。她為父親高興，認為父親是生到極樂世界去。所以這就等於在替父親慶生。This incident illustrates a fact. In Buddhism, we do not refer to “death” as such, but rather as “rebirth.” And why do we choose to use the term “rebirth”? Because this concept holds deep significance. It means the continuation of our existence, as we move from one life to another. The beauty is that this current life is not the end, but there is another chapter in our journey. The crucial question, therefore, becomes: Where will we be reborn in the next life? Imagine, if we could be reborn in the Pure Land of Ultimate Bliss, a wonderful realm beyond comparison. Isn’t that a cause for celebration?
所以我們可以從生命沒有希望，引導到充滿希望。臨終並不一定是件傷心的事。如果你下輩子能夠到一個好的地方，那是值得慶祝的。我想這是一個重要的訊息，我們可以給病人的是「你有希望的」，就看你要不要去淨土。
This is a story about a daughter who finds solace in her father’s passing. While this may seem unusual, she is actually very filial, cherishing her father’s memory and believing he has transitioned to a better place. Her joy stems from celebrating his rebirth and the peace she believes he has attained in the Pure Land.
So, we can change a life from hopelessness to hope. Death does not have to be seen as a tragedy. If we go to a better place in our next life, then we should definitely celebrate! I think this is an essential message to convey to our patients: “There is hope for you,” it all depends on whether you aspire to go to the Pure Land or not.
念觀音菩薩聖號的好處 The Benefit of Reciting Guanyin Bodhisattva
另外我要提的是，我們經常要求病人家屬念阿彌陀佛。如果他不信佛，你叫他念阿彌陀佛，他會很反對，甚至把你趕走。因為一般人認為念阿彌陀佛，是快要死的人才念，或是已經死了才念。他會認為你來催他家人死啊，所以他要把你趕走。避免這種情形發生，我建議可以念觀音菩薩聖號，因為大家對於觀音菩薩不會有這樣的感覺，而且大家對觀音菩薩都很親切。上人曾講過，念西方三聖的聖號，都可以往生西方極樂世界。因此，念觀音聖號和阿彌陀佛聖號，是具有同樣的功用，如果你要生極樂世界，你就可以生極樂世界。對於不信佛的人而言，他們是可以接受觀音菩薩聖號，這對他們就會有幫助，就不會把你趕走，是不是？I also want to mention that we often ask the family members of our patients to pray to Amitabha Buddha. If they are not Buddhists, they might refuse to recite Amitabha’s name, and they might even reject your request and drive you away.
The reason is that many people believe that Amitabha’s name is only recited for those who are dying or have already passed away. Some may think that you are attempting to speed up the passing of their loved ones and could hold negative feelings toward you for it. In this scenario, I recommend reciting the holy name of Guanyin Bodhisattva. People do not typically hold such connotations with Guanyin Bodhisattva, and many people feel a profound connection to her.
The Master has said that by reciting the names of the three sages of the Western Pure Land, one can attain rebirth in the Land of Ultimate Bliss. Therefore, chanting the names of Guanyin and Amitabha has an equal effect. If your aspiration is to be reborn in the Pure Land, it is achievable. For those who are not Buddhists, they can still accept the name of Guanyin Bodhisattva, and that will benefit them, and they will not turn you away.
如何提升臨終關懷的能力？ How to Improve Your Skills in End-of-Life Care
怎麼幫助病人呢？首先，我們要了解臨終及死亡的過程，並為病人講解，讓病人的恐懼可以消除；還要了解病人及家屬的心靈需求，並且培養同理心，以及傾聽的技巧。當我們陪伴病人時，是需要多傾聽，光聽就夠了，不必說話。然後要了解死後的世界，給病人講解，減低病人的恐懼及不安，並及早為死後做準備。這是我們佛教徒能夠真正幫助病人的地方。
Lastly, we need to consider how to help the patient. First, we need to understand the process of dying and death and explain it to the patient to ease their fear. We also need to understand the spiritual needs of the patient and their family, and cultivate empathy and listening skills. When we are with a patient, we need to listen more than talk, and just be present with them. Then we need to understand the world after death and explain it to the patient, so that they can overcome their fear and prepare for the afterlife. This is something that we Buddhists can do to truly help the patient.
接下來是，要培養我們自己的智慧，以增強幫助病人及其家屬的能力。我想這要從修行著手，多修行，智慧就會增長，就能夠了解病人的需求並幫助病人。現在回頭看過去那三個月在安寧病房，我真的沒有幫助到病人；因為我自己沒有智慧，不懂得病人的需求，自然就幫助不到病人──所以那些病人就成了是我的白老鼠。最後想要問各位同學：第一位病人，長得這麼強壯，卻說他自己沒有用啦！那您要怎麼幫助這位病人？]
We can enhance our ability to assist patients and their families by cultivating our own wisdom. To achieve this, it is essential to engage in regular practice. Through consistent practice, our wisdom will expand, allowing us to better comprehend patients’ needs and provide them with more effective support.
Looking back at my time in the hospice ward, I realized that I wasn’t able to assist the patients much because I didn’t have the wisdom to understand their needs. Therefore, I couldn’t effectively help them – it felt as if they were my guinea pigs.
Finally, I would like to ask all the students: How can you help the first patient, who appears to have great strength but expresses a deep sense of worthlessness?]♦