What No One Tells You About End-of-Life Planning: A Thai Buddhist Perspective on the 'State of Mind at the End'

It has been 15 years since the term "end-of-life planning" (shukatsu) became widespread. Bookstores are filled with hundreds of books on the subject. However, after reading several of them, I realized that their content is almost entirely focused on inheritance procedures and decluttering—in other words, "how to let go of material things."

On the other hand, statistics present a quiet reality. In Japan, approximately 1.6 million people pass away each year, and only 12% die of "old age," which is what many people envision. Sixty percent die from illness. Furthermore, it is said that before death, men spend an average of 8.5 years and women about 11.6 years in a state of needing nursing care or being bedridden.

In other words, many of us are likely to spend our final 8 to 10 years living with illness and eventually passing away from it. I am 47 years old now, and according to the statistics, I have only about 25 years left to remain in a healthy body.

In the Buddha's Pali Canon, there is the Upajjhatthana Sutta (the teaching to be reflected upon repeatedly every day).

So, what kind of state of mind should we have during those 10 years of being bedridden in our later years, or at the very moment of death? This "state of mind," which end-of-life planning books do not touch upon, is perhaps the unknown territory that many Japanese people encounter only when they are finally faced with illness.

Buddhists who train in mindfulness (sati) learn that "observing with awareness" is the correct way to place the mind, whether during illness or at the moment of death. However, the cultivation (bhavana) of the mind is difficult unless one is physically and mentally healthy, as it requires time and patience. It is too late to learn how to swim after you are already drowning in the ocean. If you know that old age, sickness, and death are waiting for you, you must start practicing mindfulness now.

Today's Step To ensure that your end-of-life planning does not end with just "tidying up things." Today, please try to direct your awareness to your breathing, even if just for a few minutes. That will be the most reliable preparation for your final day.

The full text also touches upon the dharma talks of Tanachai (Pui) on a good death, the final years of Ajahn Chah and his disciple Siripanyo, and the story of Khamkhien, who left a note five minutes before he passed away.