Is ‘An Honest Death’ An Ideal Death?

‘An Honest Death: A Palliative Care Doctor’s Final Days’ is a documentary featured on NHK World Prime. Masahiro Tanaka was a palliative care doctor and a Japanese Buddhist priest, who had helped thousands to die peacefully. He requested the filming of his dying process when he was diagnosed with terminal stage 4 pancreatic cancer, hoping to document an ‘ideal death’. However, what ensued was called by the narrator as an ‘honest death’, that showed his various vulnerabilities.

As a doctor, Mr. Masahiro relieved physical pain of the dying. He specialised in palliative care when he realised the limitations of medication as a young doctor, and that patients are often afraid of death, unwilling to accept it. In addition, he became the chief priest of his family shrine after his father’s sudden death, and eased anxieties of patients with this other status. (Yes, there is a custom of married priest-fathers passing custody of temples to sons in Japan.) 

Surprisingly and sadly, there is little portrayal of Buddhist practices aiding his passing, with the only spiritual element being some chanting during his funeral. With his also Buddhist wife and personal doctor, they had an understanding not to take death too seriously – at first, though conditions became increasingly heartbreaking towards the end. It turned out to be much more challenging for both the husband, to transit towards death smoothly, and the wife, to aid him along. 

In better times, he even wrongly believed that he should continue enjoying that he does – drinking beer and wine (which is against the Fifth Precept) – even if bad for his illness, since there is no more hope for recovery. According to the American Cancer Society (ACS), ‘Some studies have shown a link between heavy alcohol use and pancreatic cancer… [H]eavy alcohol use can lead to conditions such as chronic pancreatitis and cirrhosis, which are known to increase pancreatic cancer risk.’ 

A scene shows his wife feeding him with (most likely dairy) ice-cream, his favourite food, and another asking if he wants cutlets. Dairy foods are long known to promote cancer growth. Again, according to ACS, ‘Some studies have linked pancreatic cancer to diets that are high in red and processed meats (such as sausage and bacon) and low in fruits and vegetables.’ Sadly, not many doctors are learned in nutrition, to embrace the optimum wholefood plant-based (Maha-vegan) diet.

As his last day neared, he showed irritation, confusion and frustration. His communication becomes incoherent. In pain and tears, uneasy and restless, he realised he was, in his words, ‘completely helpless’ and ‘cannot do anything’. As he became more delirious, he kept calling his wife’s name, as if ‘chanting’. It was clear that she was his refuge, perhaps more so than any Buddha. However, due to work to help other patients, she could not always be there for him like the Buddhas can. 

Near the end, he utters, ‘Please let me sleep’. He was perhaps referring to his directive to be put in continuous deep sedation to suppress consciousness, hoping that sleep can relieve unbearable pain, and to pass away in sleep. This is not a good idea as it disables mindfulness, and with it the possibility of spiritual practice. Instead of the simple but powerful practice of sincere mindfulness of Buddha for blessings to relieve pain, he listened to music, which might stir up troubling attachment.

His wife tells him that as everyone wants him to live even a day longer, he should not cry, and that there is a lot left for him to do. This is no consolation for one who is definitely dying, who is not guided spiritually and adequately to a good death. She even asked, ‘Why did you become so weak?’ Is it not a basic Buddhist teaching that all will face ageing, sickness and death? There should be skilful urging to connect to Amitabha Buddha (Amituofo) for blissful departure to Pure Land instead.
 
Some time after sedation was applied, she woke him, not wanting him to give up yet. But the one awakened was clearly suffering even more. She also went against his DNR (Do Not Resuscitate) wish, by giving him cardiac massage after his heart stopped, which can be extremely painful due to magnified sensitivity – if the consciousness is still habitually within the body. (Not touching and moving the dying and deceased is common knowledge in Chinese Pure Land Buddhism.)

Was his death ‘honest’? The truth is, all deaths are ‘honest’, since the manner of dying cannot be faked. It is however heartwrenching, at least in the context of the film, that the practice of Buddhist support-chanting was absent. The Pure Land teachings are especially precious as having sincere mindfulness of Amituofo with an unshakeable sense of refuge, all pain will be banished, replaced by bliss. All distress will be vanquished, with a clear direction of where one is going to.

The narrator commented that there might be no such thing as an ideal death, and that no one can plan for it. This is not true, as proficient Pure Land practitioners are able to depart peacefully, even with advanced calm and clear announcements of when Amituofo will arrive to guide them to his Pure Land. (Although the film crew did not record the actual last few moments, his final expression looked peaceful. May Mr. Masahiro Tanaka have a good rebirth!) Namo Amituofo.