http://www.amtbweb.org/tchet306.htm
To my family and all those concerned with my care:
I,__________________________________, of
__________________________________being of sound mind, make this
statement as a directive to be followed if for any reason I become
unable to participate in decisions regarding my medical
care.
Upon my death and transition into the next life, I do not
wish to be reborn as a ghost path or an animal. I do not wish to
suffer. Instead, I wish to follow Amitabha Buddha and to arrive at
his Western Pure Land of Ultimate Bliss. To all my family and
friends, I wish to ask for your assistance so that I may not
suffer, but instead remain calm and peaceful to prepare for my
arrival to the Western Pure Land.
In the event that I should suffer from a terminal illness
to the extent that doctors foresee no possible recovery, I ask that
no medical treatment be undertaken. Should I already be in the
hospital at this point, I wish to be checked out and brought back
home. Please notify my assigned family member or friend
_____________________________________
at telephone number(s)________________________and
_________________________.
Once home, please position me in the most comfortable and
natural position in which I may rest. The assigned family member or
friend will lead others in chanting "Amituofo." Should I decline to
the point where I lose consciousness and I am no longer aware of my
surroundings, the assigned family member or friend shall have full
authority in making any decisions regarding my well-being. If this
person cannot be contacted, please find a Buddhist master or
Buddhist believer to aid in the chanting of "Amituofo" until the
assigned person can be reached.
Within twenty-four hours prior to and after my death, I
would like to ask my friends and family to comply with the
following:
1. Do not touch or move my body or even my
bed.
2. Do not change my clothing.
3. Do not place dry ice or other substances on my
body. Sandalwood incense may be burned if there is any
odor.
4. Do not let a breeze blow directly onto my
body.
5. Do not allow the scent of alcohol, onions,
scallions, garlic, or chives to enter the room.
6. Do not smoke, cry, or talk in the
room.
My purpose for asking this is to create an atmosphere in
which I may remain calm and at peace. The only sound I wish to hear
is “Amituofo,” so that he may escort me to the Pure Land.
If I am at home upon my death, my family should take turns
chanting "Amituofo" for eight to twenty-four hours. At this point,
I am ready to be moved, washed and dressed. This period of chanting
is the best time to assist me to be calm and peaceful. All funeral
arrangements can be set up afterwards. If I should pass away in the
hospital, please follow hospital policy and chant as much as is
allowed.
During my terminal illness and within forty-nine days
after my death, all family members should adopt a vegetarian diet.
I do not wish for any killing to be associated with my death. All
funeral offerings must be vegetarian. The use of alcohol is
strictly prohibited. Funeral arrangements should be kept simple,
and proper Buddhist etiquette should be followed. I do not wish for
any unnecessary excess.
Within forty-nine days following my death, I sincerely ask
my family members and friends to seek my rebirth into the Pure
Land, and to perform good deeds such as giving offerings to the
Three Jewels of the Buddha, Dharma, and Sangha, printing sutras,
helping the needy, and so on. These good deeds will help me to
attain additional good karma, and further assist me in arriving at
the Pure Land. Most important is for my family to sincerely chant
“Amituofo.”
In order for me to benefit the most and to peacefully
arrive at the Pure Land, the above points must be followed. This
will not only benefit me but all those involved as well. In this
manner, I wish for everyone to learn and to believe in Buddhism.
Thus, everyone can arrive at the Pure Land, as well.
Amituofo to all!
These directions express my legal right to request or
refuse treatment. Therefore, I expect my family, doctor, and all
those concerned with my care to regard themselves as legally and
morally bound to act in accord with my wishes.
Signed__________________________________________________Date_________________
Witness: I declare that the person
who signed this document, or asked another to sign this document on
his or her behalf, did so in my presence and that he or she appears
to be of sound mind and free of duress or undue
influence.
Witness__________________________________________________
Date_________________
Witness__________________________________________________
Date_________________