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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 into the ghost kingdom or the animal kingdom. 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, 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 am no longer aware of my surroundings, the assigned family member or friend shall have full authority in making any decisions regarding my well-
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 to if there is any odor.
4. Do not let a breeze to blow directly onto my body.
5. Do not allow the scent of alcohol, onion, scallion, 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-
During my terminal illness and within forty-
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.
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.
Note: This example of “Living Will” is translated by the Amitabha Buddhist Society of Philadelphia.
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