Paper 06

Abstract

Contemporary debates on euthanasia and end-of-life care often focus on patient autonomy and the relief of physical suffering. In contrast, Theravāda Buddhism evaluates a “good death” primarily in terms of the quality of consciousness and volition (cetanā) associated with the dying process.

This study aims to examine the concept of a good death from an Abhidhamma perspective and explores its ethical implications for contemporary debates on euthanasia and end-of-life care. Employing qualitative doctrinal and textual analysis of the Pāḷi Canon, Abhidhamma texts, commentarial literature, and relevant contemporary scholarship, the study focuses particularly on the near-death cognitive process (maraṇāsanna-vīthi), volition (cetanā), and death consciousness (cuti-citta). The findings indicate that an Abhidhamma conception of a good death is not determined primarily by external biological circumstances but by a wholesome and steady state of mind supported by ethical conduct, mindfulness, and mental cultivation. From this perspective, active euthanasia remains ethically problematic because it intentionally causes death, even when motivated by compassion. By contrast, withholding or withdrawing futile treatment may be ethically distinguishable from intentionally causing death when the intention is to allow the underlying illness to take its natural course. Palliative care is likewise compatible with Buddhist compassion when its primary purpose is the relief of suffering rather than the intentional termination of life. The findings of this research may also inform healthcare professionals about Buddhist values and beliefs to provide culturally relevant end-of-life care for Buddhist families.

Keywords: good death, Theravāda Buddhism, Abhidhamma, cuti-citta, euthanasia, Buddhist ethics

1. Introduction

Death is an inevitable part of human life, but the meaning of a “good death” varies across cultural, religious, and ethical traditions. In recent decades, population ageing, chronic and terminal illnesses, and advances in medical technology have made end-of-life care a major global concern. Consequently, dignity, quality of life, palliative care, and euthanasia have received growing attention in healthcare, bioethics, and religious studies. While modern medicine emphasizes relief of suffering and quality of life, religious traditions often emphasize moral conduct, spiritual cultivation, and inner peace. Recent research suggests that a good death involves not only physical comfort but also emotional and spiritual well-being, family support, personal values, and ethical decision-making. A systematic review of South Asian perspectives found that understandings of a good death are strongly shaped by cultural, religious, family, and ethical contexts (Wijeyaratne et al., 2025). Similarly, Zaman (2025) argues that no single definition of a good death exists because its meaning depends on cultural and religious contexts.

Earlier studies also support this holistic view. McCormick (2013) notes that Buddhist teachings emphasize acceptance of impermanence, mindfulness, and moral cultivation rather than fear or denial of death. Liu et al. (2021) highlight compassionate care, spiritual preparation, and family support, while Dorji and Lapierre (2022) emphasize conscious awareness, religious practice, and preparation for death among Buddhist practitioners. Islam (2022) further argues that physical comfort alone is insufficient without emotional and spiritual well-being. Together, these studies suggest that a good death encompasses interconnected physical, psychological, social, ethical, and spiritual dimensions. Theravāda Buddhism offers a distinctive perspective through its teachings on kamma, rebirth, and consciousness. Death is understood as the cessation of one psycho-physical continuum, followed by another according to kamma. From this perspective, the quality of consciousness near death has ethical significance because intentional action (cetanā) is central to the karmic process. A good death therefore involves not only physical comfort but also wholesome consciousness, moral conduct, wisdom, and freedom from attachment.

The Theravāda Abhidhamma analyzes the dying process through consciousness, describing death consciousness as the final consciousness of one life, followed by rebirth-linking consciousness (paṭisandhi-citta) according to kamma. It also examines volition and associated mental factors (cetasikas) in determining the ethical quality of mental processes. Complementing this framework, maraṇasati (mindfulness of death) cultivates awareness of mortality, reduces attachment, and supports ethical and mental preparation for death (Anālayo, 2016). These teachings provide a useful framework for examining contemporary issues of euthanasia and end-of-life care.

1.1 Research Gap

Existing literature often examines Buddhist ethics, maraṇasati, and palliative care separately. The integration of the Abhidhamma framework, particularly maraṇāsanna-vīthi and cetanā, remains underexplored in contemporary debates on euthanasia and end-of-life care. This study addresses this gap by offering an Abhidhamma-based ethical and psychological analysis of these issues.

1.2 Research Questions and Objectives

Research Questions

• How is a “good death” conceptualized within Theravāda Buddhism and Abhidhamma psychology?
• How does maraṇasati function as ethical and spiritual preparation for the dying process?
• How can Abhidhamma teachings on consciousness and volition inform contemporary debates on euthanasia and palliative care?

Research Objectives

• To examine the Abhidhamma understanding of a “good death” and its ethical implications.
• To examine the role of maraṇasati, sīla (ethical conduct), and bhāvanā (mental cultivation) in preparing the mind for death.
• To develop an Abhidhamma-based ethical perspective for contemporary discussions of euthanasia and palliative care.

2. Methodology

This study employs qualitative doctrinal and textual analysis of primary Pāḷi sources, including the Abhidhamma Piṭaka (Dhammasaṅgaṇī and Paṭṭhāna), Abhidhammattha Saṅgaha, and Buddhaghosa’s Visuddhimagga, supported by relevant secondary literature on Buddhist ethics and contemporary end-of-life care. The texts are analyzed through key Abhidhamma concepts, including maraṇāsanna-vīthi, cetanā, javana, cuti-citta, and paṭisandhi-citta. And then, these concepts are interpreted in relation to contemporary ethical debates on euthanasia, palliative care, and end-of-life decision-making from a Theravāda Abhidhamma perspective.

3. Findings and Discussion

3.1 A Good Death in Theravāda Buddhism

In Theravāda Buddhism, a good death is understood primarily in terms of the quality of mind at the end of life, rather than external circumstances. Physical comfort is important, but greater emphasis is placed on meeting death with a mind free from strong attachment, hatred, and delusion. This ethical and mental quality is cultivated through sīla (moral conduct), bhāvanā (mental development), and paññā (wisdom), with intentional action (cetanā) playing a central role in the karmic process.

Preparation for death includes appamāda (heedfulness) and maraṇasati (mindfulness of death), which foster awareness of impermanence (anicca) and reduce attachment. As Bodhi (2000) explains, a trained mind responds to painful experience differently from an untrained mind. Thus, a good death need not be defined by the absence of physical pain, but by the capacity to meet suffering with a wholesome, mindful, and steady mind. This provides a basis for examining the dying cognitive process from an Abhidhamma perspective.

3.2 The Abhidhamma Analysis of the Dying Cognitive Process

According to the Abhidhamma, death marks the cessation of consciousness in the present life but does not end the causal continuity of existence. The Dhammasaṅgaṇī, Paṭṭhāna, Abhidhammattha Saṅgaha, and Visuddhimagga describe the continuity of life through conditional relationships (paccaya). As death approaches, the life-continuum (bhavaṅga) is interrupted and a near-death cognitive process (maraṇāsanna-vīthi) occurs, in which an object associated with kamma may become prominent. This process culminates in death consciousness (cuti-citta), followed, according to kamma, by rebirth-linking consciousness (paṭisandhi-citta) in a subsequent existence (Buddhaghosa, 2011).

Within the cognitive process, javana moments are ethically significant because volition (cetanā) operates in relation to the mental process. Wholesome mental states are associated with non-greed (alobha), non-hatred (adosa), and non-delusion or wisdom (amoha), whereas unwholesome states are associated with greed (lobha), hatred (dosa), and delusion (moha). These qualities are not formed only at the moment of death but reflect patterns of conduct and mental cultivation developed throughout life.

Figure 3.1. Conceptual Representation of the Dying Cognitive Process

Bhavaṅga

Maraṇāsanna-vīthi

Javana (Cetanā)

Cuti-citta

Paṭisandhi-citta

Figure 3.1 presents a simplified conceptual representation of the dying cognitive process and highlights the ethical significance of javana and cetanā. Cuti-citta marks the cessation of the present life process, while paṭisandhi-citta marks the beginning of the subsequent life process. Death is therefore understood as a transition within the continuity of conditioned existence, rather than the end of a permanent self.

Figure 3.2. Abhidhamma Framework for a Good Death

Ethical and Mental Cultivation (Sīla, Bhāvanā, Paññā, Maraṇasati, Appamāda)

↓ Wholesome Mental Qualities (Alobha, Adosa, Amoha) ↓ Wholesome Mental State Near Death ↓ A Good Death

Figure 3.2 illustrates how ethical and mental cultivation throughout life may support wholesome mental qualities near death. Practices such as sīla, bhāvanā, paññā, maraṇasati, and appamāda contribute to mental preparation for death. From an Abhidhamma perspective, the quality of mind near death is connected with the ethical and mental development cultivated throughout life. This provides a basis for examining the ethical implications of intentionally bringing about death in contemporary euthanasia.

3.3 An Abhidhamma Perspective on Euthanasia and Palliative Care

The Abhidhamma provides a basis for examining euthanasia through intention (cetanā) and the nature of the action. Although contemporary arguments often emphasize relief of suffering and patient autonomy, Theravāda Buddhism holds that compassionate motivation alone does not determine the ethical character of an action; both intention and action must be considered.

Active euthanasia: Active euthanasia involves deliberately causing death. From a Buddhist ethical perspective, the central concern is the intentional taking of life (pāṇātipāta). Although motivated by compassion (karuṇā), intentionally causing death remains ethically problematic because the action directly involves the destruction of life.

Passive euthanasia: Withholding or withdrawing treatment that no longer provides meaningful benefit is ethically distinguishable from actively causing death. If treatment is withheld or withdrawn to avoid unnecessary burdens and allow natural dying, death is not directly intended. From an Abhidhamma perspective, this approach is not necessarily equivalent to intentionally taking life, while appropriate comfort care may continue.

Palliative care and palliative sedation: Palliative care primarily aims to relieve suffering rather than cause death and can therefore support compassionate end-of-life care. Palliative sedation requires greater consideration because reduced consciousness may affect mental awareness near death. However, when its primary purpose is symptom relief rather than intentional termination of life, it should not be equated with euthanasia. Where clinically possible, symptom control may be balanced with preservation of mental awareness and a peaceful dying environment.

Overall, the Abhidhamma evaluates end-of-life decisions through intention, action, and mental condition. Active euthanasia intentionally causes death, whereas withdrawing futile treatment and providing palliative care may allow natural dying without intending death.

3.4 Maraṇasati and Ethical–Spiritual Preparation for a Good Death

Maraṇasati, or mindfulness of death, prepares the mind to face mortality with greater awareness and less attachment. Rather than encouraging fear, regular reflection on death can help practitioners recognize impermanence (anicca) and develop a realistic attitude toward life and dying.

Maraṇasati is closely connected with appamāda (heedfulness), encouraging careful conduct and continued mental cultivation throughout life. As Anālayo (2016) explains, mindfulness of death can strengthen awareness of impermanence and readiness to face death. From an Abhidhamma perspective, such practice may support wholesome mental qualities and reduce fear, attachment, and agitation near the end of life. Thus, maraṇasati is not merely a reflection on the inevitability of death but a practical form of ethical and spiritual preparation. It connects lifelong mental cultivation with the Abhidhamma understanding of a wholesome state of mind at the end of life and therefore contributes to the Buddhist conception of a good death.

4. Conclusion

This study examined the concept of a good death in Theravāda Buddhism from an Abhidhamma perspective, focusing on consciousness, volition, maraṇasati, and euthanasia. The findings indicate that a good death is associated not simply with physical comfort or prolonged life but with a wholesome and steady state of mind supported by ethical conduct, mental cultivation, wisdom, and non-attachment. The Abhidhamma analysis highlights the ethical significance of the mental process near death and provides a basis for distinguishing intentional killing from end-of-life care aimed at relieving suffering. From this perspective, active euthanasia raises a distinct ethical concern because death is intentionally caused, whereas appropriate palliative care and withdrawal of futile treatment may allow the natural dying process to continue without intending death. Maraṇasati further provides a practical means of preparing for death through awareness, heedfulness, and reduced attachment. Overall, the Abhidhamma offers a Buddhist ethical framework that can contribute to contemporary discussions of euthanasia and support culturally sensitive end-of-life care for Buddhist patients and their families.

5. Future Research

Future research could extend this textual analysis through mixed-method empirical studies, including surveys and interviews with Buddhist scholars, healthcare professionals, caregivers, and patients, to explore the practical application of maraṇasati and Abhidhamma principles in end-of-life care.

References

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Buddhaghosa. (2011). The path of purification (Visuddhimagga) (B. Ñāṇamoli, Trans.). Buddhist Publication Society. (Original work published ca. 5th century CE)

Bodhi, B. (2000). The connected discourses of the Buddha: A new translation of the Saṃyutta Nikāya. Wisdom Publications.

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