安寧緩和醫療之死亡準備

Preparation of Death in Hospice Palliative Care

釋宗惇(Tsung-Tueng Bhikkhuni) ； 釋德嘉(Der-Chia Bhikkhuni) ； 陳慶餘(Ching-Yu Chen) ； 釋宏琳(Hung-Lin Bhikkhuni) ； 釋印本(Yinn-Been Bhikkhuni) ； 釋印適(Yin-Shi Bhikkhuni) ； 釋德俅(De-Chiou Bhikkhuni) ； 釋慧岳(Hwei-Yue Bhikkhuni) ； 釋惠敏(Huimin)

《安寧療護雜誌》 11卷2期 (2006/05) Pp. 117-136

https://doi.org/10.6537/TJHPC.2006.11(2).1

摘要

安寧療護運動推展三十年來，關於死亡準備議題的討論與臨床實際需求仍有一定的差距。本文從文獻回顧、個案範例、佛陀及高僧大德的死亡準備、臨床說法指引等角度探討死亡準備的內涵與實際。 死亡準備即是生命教育，也是生與死的教育。死亡準備或生命教育可以轉換成相對於死亡之各種不同的心理調適，以及生命意義的肯定。在沒有死亡準備的情況下，面對生命的結束往往造成恐懼，需要臨床法師之專業協助。一般面對死亡的調適，病人與法師的關係可分為：逃避期、謀合期、信任期。死亡準備包括三要素：認知死之將至而接受死亡、建立死亡是所有生命共相的態度並尋求因應之道、有內在力量提昇的信願行表現。臨終病人接受法師之後的開示說法很重要，關係著病人能否放下、死亡準備是否圓滿，及病人往生後家屬的悲傷輔導等問題。臨床說法包括：「生病即修行」的傳法、生命回顧、心願完成、生命意義的肯定、法門學習、死亡恐懼與四大分解時的說法、無所得的生死智慧等。病人的生活品質、死亡準備和善終是環環相扣的三件事，在良好生活品質的基礎上做死亡準備，加上家屬的生與死教育，能協助病人在臨終過程中學習成長，達到善終。 有生死智慧就不會有生死困頓。從佛教的立場來看，死亡準備如同高僧的修行，隨時要做且越早開始越好。廣義的宗教師角色就是在教導眾生做死亡準備，臨床佛教宗教師參與臨終照顧，將死亡準備作為核心的專業角色任務，結合修行與照顧，用生死智慧協助病人完成臨終前的修行。

關鍵字

死亡準備 ； 生死智慧 ； 生命教育 ； 臨床佛教宗教師

並列摘要

The hospice movement has proceeded for thirty years, but there are still certain discrepancies between the issues of death preparation and the clinical needs. This paper is to investigate the content and practice of death preparation through different dimensions: literature review, case studies, death preparation of the Buddha, great monks and nuns, and clinical Dharma talks.
Death preparation is life education, and it is also the education of living and dying. Death preparation or life education can be interpreted as a person's mental adjustments toward death and his or her recognition of life meaning. Without death preparation, confronting with the end of life often causes a person to feel terrified, and the person will need the special assistance of a clinical monk or nun. When a patient is facing death, his or her relationship with clinical monks or nuns will experience three stages: avoiding, understanding and trusting. Death preparation includes three factors: recognizing the coming of death and accepting it, developing the attitudes that death is universal among all living beings and looking for the ways to cope with death, and showing a person's believes, vows and actions which are brought by the upgrade of his or her inner power. It is crucial that a dying patient can accept a clinical monk's or nun's Dharma talks because this will affect the patient and the family members in several ways-if the patient will let go his or her present life, if he or she has prepared to die, and the family members' misery counseling after the patient's death. The clinical Dharma talks include ”Being ill is to practice Dharma,” life review, wish fulfillment, recognition of life meaning, learning Dharma methods, death terror and the dissolution of the four elements, and the life and death wisdom of no gains. Three things are closely related-the patient's living quality, death preparation and dignified dying. If the patient could prepare his or her death on the basis of good life quality and the family members who have received the life and death education could assist the patient learn in the process of dying, the goal of dignified dying could be achieved.
With life and death wisdom, a person would not have agony about life and death. From the Buddhist perspective, death preparation is just like the practice of great monks and nuns. A person should prepare it anytime and anywhere and as early as better. In a broad sense, the role of a religious teacher is to instruct sentient beings to prepare death. The clinical Buddhist monks and nuns participate hospice care, take death preparation as their primary mission, combine Dharma practice with hospice care, and assist patients to accomplish the practice of dying with life and death wisdom.

並列關鍵字

death preparation ； life and death wisdom ； life education ； clinical Buddhist chaplain