Assisted chanting and Buddhist end-of-life care in contemporary China

The intersection of medicine and Buddhist spiritual care in institutional end-of-life settings remains underexplored, particularly regarding post-death rituals. This qualitative study examines how Buddhist assisted chanting (zhunian, ) - a 24-hour continuous recitation of Amitabha Buddha's name - functions as a model of holistic end-of-life care that addresses the spiritual, emotional, psychological, and relational dimensions of dying.

Semi-structured, in-person interviews were conducted with 34 participants (18 volunteers, 8 patients, and 8 family caregivers) at the Lotus Assisted Chanting Association housed within Cihai Hospital in Shenzhen, China, between June 22 and July 5, 2025. Interviews were conducted in Mandarin, transcribed, and anonymized. Coding was performed in NVivo N15 using an iterative thematic framework developed by open-coding an initial subset of transcripts.

Three care frameworks emerged: (1) spiritual care, including adherence to end-of-life Buddhist practices, acceptance of death, belief in rebirth, and release of worldly attachments; (2) emotional and psychological care, encompassing companionship, peace and tranquility, and financial burden alleviation; and (3) reverse care, in which dying patients exercised personal agency and tended to those around them by resisting over-medicalization, expressing concern for caregivers, and transforming caregiving into an opportunity to practice filial piety and strengthen faith.

These findings characterize Buddhist assisted chanting as a reciprocal model of end-of-life care that extends care beyond the moment of death. Dying patients act as moral agents who tend to those around them, challenging the unidirectional caregiver-recipient model that underlies most palliative care research. These contributions show how culturally and spiritually informed palliative care prepares families for loss and shapes how patients find meaning at the end of life. More broadly, this study illustrates how Buddhist ritual frameworks can render dying as a humanistic and mindful process.