Many people fear death partly because of the perception they might suffer increasing pain and other awful symptoms the nearer it gets. There’s often the belief palliative care may not alleviate such pain, leaving many people to die excruciating deaths.
But an excruciating death is extremely rare. The evidence about palliative care is that pain and other symptoms, such as fatigue, insomnia and breathing issues, actually improve as people move closer to death. More than 85% of palliative care patients have no severe symptoms by the time they die.
Evidence from the Australian Palliative Care Outcomes Collaboration (PCOC) shows that there has been a statistically significant improvement over the last decade in pain and other end-of-life symptoms. Several factors linked to more effective palliative care are responsible.
These include more thorough assessments of patient needs, better medications and improved multidisciplinary care (not just doctors and nurses but also allied health workers such as therapists, counsellors and spiritual support).
But not everyone receives the same standard of clinical care at the end of life. Each year in Australia, about 160,000 people die and we estimate 100,000 of these deaths are predictable. Yet, the PCOC estimates only about 40,000 people receive specialist palliative care per year. Symptoms at the end of life
For the greater majority of those who do receive palliative care, the evidence shows it is highly effective.
The most common symptom that causes people distress towards the end of life is fatigue. In 2016, 13.3% of patients reported feeling severe distress due to fatigue at the start of their palliative care. This was followed by pain (7.4%) and appetite (7.1%) problems.
Distress from fatigue and appetite is not surprising as a loss of energy and appetite is common as death approaches, while most pain can be effectively managed. Other problems such as breathing, insomnia, nausea and bowel issues are experienced less often and typically improve as death approaches.
Contrary to popular perceptions, people in their final days and hours experience less pain and other problems than earlier in their illness. In 2016, about a quarter of all palliative care patients (26%) reported having one or more severe symptoms when they started palliative care. This decreased to 13.9% as death approached.
The most common problem at the start was fatigue, which remained the most common problem at the end. Pain is much less common than fatigue. In total, 7.4% of patients reported severe pain at the beginning of their palliative care and only 2.5% reported severe pain in the last few days. Breathing difficulties cause more distress than pain in the final days of life.
These figures must be considered in relation to a person’s wishes. It’s true for a small number of patients that existing medications and other interventions do not adequately relieve pain and other symptoms.
But some patients who report problematic pain and symptoms elect to have little or no pain relief. This might be because of family, personal or religious reasons. For some patients, this includes a fear opioids (the active ingredient in drugs like codeine) and sedating medications will shorten their life. For others, being as alert as possible at the point of death is essential for spiritual reasons.
Sources: https://theconversation.com/amp/no-most-people-arent-in-severe-pain-when-they-die-86835
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yaksha parva in Mahabharata!
what is most wonderful or surprising!?
Day after day countless creatures leave for abode of yama ( god of death). yet who live behind think and act as if they are immortal. those that carry a dead man to the cremation ground think they would live for ever!
this is most surprising and wonderful!
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KS
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KS
SLJ- The rise of the tanmātras is the distraction- the tanmātras (śabda, sparśa, rūpa, rasa, and gandha). Don’t be attentive to these: any sound (śabda), any sparśa (touch), rūpa (form), rasa (taste), and gandha (smell)–these tanmātras–and the mind, the ego, and buddhi (intellect). So they are eight: śabda, sparśa, rūpa, rasa, gandha (the five tanmātras), the mind, the intellect, and the ego. And this is puryaṣṭaka, this is the body of the subtle body. This is the subtle body, this is the substance(Eight-fold) of the subtle body.
This is the only cycle which makes you travel in unlimited repeated births and deaths of this world. [But] if you hold these tanmātras [and the inner organs] in your own nature, if you fix them with focus, in your own God-consciousness, then there is no fear.
Tadbhāvāt, by this puryaṣṭaka, by the functioning of this eight[-fold] cycle of puryaṣṭaka, he goes in saṁsāra– he comes, goes, he dies, he gets birth. So this happens without any stoppage.
Next verse- how to stop the cycle of travelling in the cycle of repeated births and deaths.
KS
Mark D- The power of action is the supreme energy of consciousness, Spanda itself, which is so-called because it is by virtue of His inner dynamism that Siva, the one universal consciousness and innate nature of every perceiving and acting subject, creates all things and acts through them. At the same time, it is through this, His universal energy, that Maya - the world of duality is generated. Thus it has two aspects.
KS
Mark D- The main point this Stanza aims to make is that all perceptions, thoughts, and sensations, along with the entire range of our experience should be gathered together and united in the oneness of consciousness. The dichotomizing activity of thought cannot continue to break up the unity of consciousness when it is all brought together in one place. When this happens, the yogi attains liberation by becoming the master of the energies of consciousness that have been brought together into the unity of his dominion (final Stanza)
This 'one place' is, as Kallata says, consciousness. A state of awareness which is constantly alert recognizes this to be the one light of consciousness which uniformly illumines all things, even as they are perceived in their diversity.
Ksemaraja understands this Stanza as following on directly from the previous one which taught, as he says, how the yogi 'submerges embodied subjectivity in his own nature, which is the expansion of consciousness and attains the supreme subjectivity which is of that very form (i.e., expansion).'
Thus the previous Stanza taught how to develop consciousness expansion (unmesa) and this one how to consolidate it by merging all differentiation into this expansion, which he identifies with the universal pulsation of consciousness.
Thus, the yogi, who manages to remain alert in all the states of consciousness and in all the phases of perception, maintains the awakened state of enlightenment, lays hold of the pulsation of consciousness, which has expanded out, and does not allow it to contract back again. In this way all things are brought together into the yogi's true nature equally in both states of introverted and extroverted contemplation.
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KS
NON DISCUSRSIVE CONSCIOUSNESS
Definition of nondiscursive
: not of or relating to language or discourse : not discursive Making music, while it fulfills many emotional needs, is a nondiscursive enterprise; it doesn't take place within language.— Randall Butler.
Mark D- Abhinavagupta quotes this Stanza in his commentary on the Paratrisika about non-discursive consciousness and the manner in which the yogi can penetrate into it.
Bhairava's light illumines all things by its expansion (vikasa) from the highest undifferentiated level down to the grossest physical object, in such a way that every stage of this descent contains all the preceding ones as their culmination, while all the successive ones abide within it as a potential.
In this way consciousness contains in its entirety every part of this sequence in a state of perpetual expansion. In order to realize this intrinsically free and universal nature of consciousness, Abhinava prescribes a spiritual discipline which frees the aspirant of the particularized thought constructs and individualized cognitions which seemingly obscure this, his essential conscious nature. He must find a place where his vision can range freely without obstruction in order to experience a pure state of awareness which, uncluttered by individual objects and hence undivided, contains within the fullness of its expansion the infinite variety of things.
Once the yogi is well practiced in this way, he can achieve this same intuitive awareness whenever he perceives any single thing. In order to do this, the yogi must be able to elevate his consciousness from the grossest perception to its sublest source. In this way he rises progressively through the gross elements, sensations, the senses, mind, individuality, the principles which obscure consciousness, and up through the principles representing aspects of the inner state of non-objectivized consciousness, until he reaches the state of pure cognitive intent. This is the 'desire to see' to which this Stanza refers. At one with this pervasive, empowered state of consciousness he realizes his authentic conscious nature in its fullness and unconditioned expansion.
The first step in this process is to make the entire cosmic order a single object of knowledge. This is possible because it is in fact the yogi's own nature which illumines itself in this form. Then the yogi must realize his identity with it by perceiving the inherent unity of this, the macrocosm, with the microcosm which is the psycho-physical vehicle of his consciousness. In this way the consciousness which, through ignorance, once appeared to be limited and individualized is now realized to be universal and full of the entire sphere of bjectivity that it itself makes manifest.
At the end of this sensation the power of awareness (samvitti), which is the pure Sky of Consciousness, (becomes manifest). He who is established in this attains the supreme self-illuminating (state of consciousness).
KS VBT
At the end of this sensation the power of awareness (samvitti), which is the pure Sky of Consciousness, (becomes manifest). He who is established in this attains the supreme self-illuminating (state of consciousness).
Mark D- The practice taught here, that the attention be fixed in the center between one thought and the next. It is there that the pure consciousness of the perceiver resides. In the Center, the yogi can lay hold of the intuitive consciousness which contains all things within itself in their latent form as energy.
Perceptions arise out of this pure intuitive awareness, gradually assuming clearer and more specific forms to ultimately form a part of the variety of manifestation. Then this same intuitive consciousness grasps them all together in the undivided span of its vision - just as a person on a mountain views a town in the valley below him.
Abhinava identifies this intuitive consciousness with the goddess who embodies the energy of universal consciousness of which he writes:
This intuitive consciousness that manifests in each interval between the two perceptions, one that precedes it and the other that follows after it, encompasses all things. The one who is immersed in this and identifies himself with it, can find the supreme power.
The way the Center can be found is taught in the Vijnanabhairava. There, the yogi is taught that he must first be conscious of the flow of perceptions as they follow each other one after the other. Then, once he has clearly distinguished between prior and subsequent perceptions, he must try to rest between them in such a way that the interval between them increases until he can finally abandon both, and the reality of consciousness alone remains, shining in the center.
He may also practice checking his consciousness from moving on to a second perception. If he is successful, the contemplative absorption (bhavana) of higher levels of consciousness will expand spontaneously from the
Center he has managed to penetrate.
These two methods can analogously be applied to the volitional aspect of the activity of consciousness, just as it is to the cognitive, as Sivopadhyaya explains in his commentary on the following verse from the same Tantra:
Once observed the desire that has just arisen, (the yogi) should immediately pacify it. Thus it dissolves away there in that very place from whence it has arisen.