Compassionate Dying

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Modern life often seems to present us with moral dilemmas undreamed of by our great-grandparents, much less by the Indian sages who created yoga millennia ago. Thanks to the constant advances of modern medical technology, nowhere is this more obvious than in the decisions many of us need to make when we, or our loved ones, are dying.

As the end of life approaches, we may well confront choices about whether to use drugs that will ease our pain but interfere with the clarity of mind we seek as yoga practitioners. We may also have to decide whether we are willing to use these drugs to keep pain at bay even though the necessary dosage may hasten death. We may even grapple with whether we want to take the drugs precisely for that reason--so we can end life peacefully in the company of our loved ones and avoid days, weeks, or even months of intense suffering. And as difficult as these questions may be to sort out for ourselves, helping those we love to make such decisions can be even more poignant.

Such choices are almost always controversial. For example, in the six years since the voters of Oregon passed a ballot initiative allowing doctors to prescribe lethal doses of drugs for dying patients who requested them and met a strict set of criteria--a terminal diagnosis from two independent physicians, a positive psychological evaluation, the ability to self-administer the drugs--this law has come under concerted attack, including opposition by U.S. attorney general John Ashcroft. Yet the law has been just as passionately defended by advocates, who see it as the cutting edge of restoring choice, control, and a measure of dignity to the dying.

While modern medical technology may bring many more people face-to-face with dilemmas concerning death, the essential issues are timeless. There is nothing that's uniquely modern about the option of suicide to escape pain or the possibility of mercifully helping someone who, in the face of suffering, longs for death. And while there aren't many specific pronouncements on these issues in traditional yoga scriptures, the wisdom of yoga offers not only ethical principles that can guide us but also profoundly relevant teachings about death and its relationship to our lives.

The Paradox of Death

Death is, of course, inevitable, but one of the great paradoxes of human life is that we usually seem to believe and act as if life is certain and death is avoidable. In our more sober moments, however, we know that death is the only true certainty, and any attempt to avoid it can succeed only temporarily.

In yoga philosophy, the tendency toward abhinivesha, "clinging to life," is said to exist in all people, regardless of wisdom, age, wealth, or experience. We cling because we are afraid of the transition of death and of the pain, suffering, and decline that we may experience at the end of life. So we devise strategies to avoid thinking about death, such as acquiring material goods or experiences (including spiritual ones) or using drugs, or constantly creating "busyness" to fill up our time.

Yoga practice, especially asana practice, can certainly be used for focusing on momentary happiness and avoiding reality, such as the reality of death. At its deepest, however, the practice of yoga is not a strategy for avoiding pain--even the pain we feel when we think about the inevitability of death; it is a way of confronting the issue and the pain directly. In the yoga tradition, deeply acknowledging the reality of death is said to be a source of freedom. By accepting our mortality, we can free ourselves from the bondage of avidya (ignorance). When we acknowledge death as inevitable instead of being blinded by our fear of it, everything else just comes into clearer focus, including the preciousness of each and moment of life.

However, developing a clear awareness of reality, including our mortality, is not the only goal of yoga practice. In some ways, living with awareness is just the beginning of spiritual life. The great challenge of yoga is not simply to be more aware but to act in ways that reflect that awareness.

Let Compassion Be Your Guide

So what would it look like to act with full awareness in the face of death? Yoga teaches that when we reach true clarity, we see our oneness with all life; we are moved to act with compassion toward all beings and in such a way that we do not create harm. Compassion (karuna, in Sanskrit) and nonharming (ahimsa) are not just the fruits of yoga practice; from the moment we set forth on the yogic path, we are encouraged to adopt both concepts as ethical guidelines.

Making these principles concrete in a given situation requires all the clarity of mind we seek to cultivate through our yoga practice. How do we actually practice ahimsa as death approaches? Do we refuse painkillers because they may hasten death? Do we refuse drugs because they may dull our awareness? (According to some traditional teachings about reincarnation, the moment of death is critical in shaping the conditions of one's next birth, so clouding the mind with drugs may indeed be considered harmful.) Or is sparing ourselves or our loved ones great suffering a way of avoiding harm and practicing compassion?

In my mind, there are no easy, categorical answers to these questions. If a person has been practicing yoga with great dedication for many years, perhaps she has become so accustomed to maintaining clear awareness despite difficult physical and emotional challenges that she would prefer to be free of drugs even if she were experiencing great pain. For an individual with a different history, the same pain might be physically and emotionally devastating.

What constitutes nonharming and compassion can be very different in different circumstances. In fact, since yoga teaches that we should respond uniquely to each moment, we might be better off not deciding in advance what choices we will make when we are face-to-face with death. Any such decision would be academic, abstract, and not fully alive. Making rules ahead of time about how to act may even interfere with our ability to assess a life-and-death situation clearly when we come to it. On the other hand, thinking about death and practicing with awareness of its reality may be the best preparation we can make. You could say that we are rehearsing for death each time we practice being present and acting from that presence.

Is Suffering Your Karma?

Over and over, when we perform asanas, when we relate to people around us, whenever we act in the world, we are practicing yoga--and practicing for our death--if we seek to actualize our best understanding of karuna and ahimsa. No discussion of life-and-death matters and their relationship to yoga would be complete without some consideration of the term karma. It is sometimes said that any suffering we undergo is our karma--our just desserts--and that to use drugs to reduce our suffering or that of another at the time of death is to interfere with the unfolding of karma. However, that argument endlessly chases its own tail; there is no way to be sure that choosing to use drugs isn't someone's karma. Also, it can be far too easy to use karma as a rationalization for failing to act compassionately toward others. After all, their suffering is their karma, right? Actually, I think this belief expresses a deep misunderstanding of the nature of karma.

The word karma comes from the Sanskrit verb kri, which translates as "to do" or "to make." Historically, the term was used to connote the magically powerful actions of rituals, the effects of which were meant to ripple out into the future. Thus, the doctrine of karma means that whatever actions we choose will have consequences. Karma is not merely fate in a passive sense; rather, it is the sum of the effects we create with our choices.

Even with this understanding of karma, do I personally know what choices I will make when faced with my death or the deaths of my loved ones? My honest answer is that I don't. I do know that my practice of yoga is meant to help me be present in such moments so that I will have the ability to make clear-minded choices, based not on fear of death and clinging to life but on compassion for myself and others. As I practice yoga, I do so in the hope that the habit of awareness instilled by my practice of asana, Pranayama, and meditation carries me though the last moment of my life so that my final Savasana (Corpse Pose) is one in which I experience the gift of being fully present.

Judith Hanson Lasater, Ph.D. and physical therapist, has taught yoga since 1971. She teaches yoga classes and workshops around the world, and is the author of Relax and Renew (Rodmell, 1995) and Living Your Yoga (Rodmell, 2000). For more information about Lasater and her work, visit www.judithlasater.com.