<< ‘He who tends to the sick tends to me’ – The Buddha

On many instances the Buddha tended to severely sick people and setting an example. Once when a monk was discovered with sores all over his body with pus oozing out from the sores, and abandoned by fellow monks, the Buddha boiled water and washed the monk with his own hands and cleaned and dried the robes. After listening to the Buddha’s sermon the monk attained Arhanthood and soon passed away.

The Buddha expounded the real qualities that should be present in a caregiver – competence to dispense the medicine, be thorough of what is agreeable and disagreeable to the patient and refraining from giving what is disagreeable. A caregiver should also be compassionate, kind and should not be repulsed by saliva, phlegm, urine, stools or sores. The caregiver should be able to stimulate the patients with good bedside manner.

Kindness

When one is severely sick apart from providing proper food and medicine, it is important to take care of the mental conditions as well. As such kindness of doctors and nurses is as important as effective medicine to a speedy recovery. Thus kind words and acts are helpful in bringing in hopes and comfort to a helpless patient. Metta and Karuna are sublime emotions (brahamavihara).

Sickness is a period where one faces the realities of life and the fear of death is naturally greater when a person is sick than when one is feeling well. Diverting one’s attention to Dhamma is the best remedy of calming the fear and caregivers are expected to help patients to turn to spiritualism.The Buddha describes three types of patients in Anguttara Nikaya – those who do not recover whether they do get or do not get the proper medical attention and care; those who recover irrespective of whether or not they get medical attention and care and those who recover only with suitable medical treatment and care. However, as long as a patient is alive, everything possible should be done with best medical treatment available and suitable food and care for his or her recovery.
In other Suttas too the Buddha has explained that illness is inevitable in life. In such instances people do whatever possible to restore good health. Though it is not incorrect to do so in such crisis those attempts should not disagree with the conscience of a person. Death might occur in spite of those attempts where one has to accept it with self-control and rational mind as a result of kamma.

Advance spirituality

The Buddha has showered the sick with great compassion and understanding. In the Dhammapada it is explained that health is the best benefit (Aarogya Parama Labha) and the Buddha has laid several minor disciplinary rules to adapt to the requirements of sick monks.The Buddha has used great will power and self-control when he fell ill. The Buddha when he fell ill last had courage to walk from Pava to Kusinara with Ananda Thera, while resting in a number of places. One spiritually developed should be capable of maintaining good mental health proportionate to his spiritual development.

Recitation of the enlightenment factors (Bojjhanga) is useful in healing physical ailments. When Mahakassapa and Mahamoggalllana were sick, the Buddha recited the enlightenment factors and they had regained good health. It is reported in Bojjhanga Samyutta that when the Buddha was ill, he requested Cunda to recite the enlightenment factors and Buddha regained good health.

When monk Girimananda was ill, the Buddha informed Ananda Thera that he might recover if a discourse on ten perceptions (Dasa sanna) is delivered to him. The ten perceptions are on the impermanence, egoless ness, impurity of the body, evil consequences (of bodily existence), elimination (of sensual pleasures), detachment, cessation, disenchantment with the entire world, and impermanence of all component things and mindfulness of breathing. Ananda Thera learnt the discourse from the Buddha and repeated it for Girimananda Thera and it was stated that he recovered as well.

The Buddha recommended that a monk should not loose his energy and determination for spiritual progress even when he is ill. When one is sick it might deteriorate, but before that happens, care should be taken to advance spirituality as much as possible. In the process of recovery too one should not be careless, because chances of relapse might reduce the chances of gaining higher spiritual attainments.

Joy and satisfaction

When one is reminded of the spiritual qualities that he has already acquired, it helps to create great joy in the mind. Such joy helps to the point it can even alter body chemistry in a positive and healthy manner. It is mentioned in Papancasudani that a monk had been bitten by a snake while he was listening to Dhamma. However, he ignored the snakebite and continued to listen and the venom spread and the pain had become acute. He had then reflected on the purity of his Sila from the time of his higher ordination. A great joy and satisfaction had arisen within him at that moment. The psychological change had acted as anti-venom and he was immediately cured.

It is mentioned in Papancasudani that a monk had been bitten by a snake while he was listening to Dhamma. However, he ignored the snakebite and continued to listen and the venom spread and the pain had become acute. He had then reflected on the purity of his Sila from the time of his higher ordination. A great joy and satisfaction had arisen within him at that moment. The psychological change had acted as anti-venom and he was immediately cured.

It is clear from this incident that health promoting factors become activated in the body through the secretion of health restoring hormones, when one dwells on his or her own spiritual qualities at times of serious illness. The Pali Canon describes elaborately on counseling the terminally ill. Talking about death to a terminally ill patient is not avoided as an obnoxious topic. Instead the reality of death is accepted to enable the patient to face the situation with confidence and tranquility.

Once Mahanama, the Sakyan inquired from the Buddha as to how a wise layman should advise another wise layman who is terminally ill. It is explained in Sotapattisamyutta that the Buddha delivered a whole discourse; firstly the wise layman should comfort a wise layman who is terminally ill with the four assurances; “be comforted friend, you have unshakable confidence in the Buddha, Dhamma and Sangha, that the Buddha is fully enlightened, the Dhamma is well proclaimed and the Sangha is well disciplined. You have also cultivated perfect virtuous conduct which is helpful to concentration.

Divine pleasures

As one comforts the patient with these four assurances, he should ask the sick whether he has any longing for his parents. If they do, it should be pointed out that death will certainly come whether he has longing for his parents or not – therefore, it is better to give up the longing. Likewise he should be asked whether he has longing for other relatives and then pleasures of the senses. He should be convinced that divine pleasures are superior to human pleasures. He should be diverted to the Brahma world. If one may establish his mind on the cessation of the rebirth personality, then the Buddha says there is no difference between him and the monk who is liberated.

An interesting episode of the death of a spiritually advanced learned lay disciple is explained in Cittasamyutta. Citta the householder was an Anagamin. When he fell critically ill, a group of sylvan deities invited Citta to set his mind on becoming a universal monarch or Cakkavattiraia. However, he refused this invitation saying that too is impermanent. While lying on his death-bed amidst his relatives who had assembled round him, he reiterated the importance of cultivating faith on the Buddha, Dhamma and Sangha and on the importance of charity. He then passed away.

An unscrupulous tax collector, Brahmin Dhananjani exploited both the king and the public. Once Arhant Sariputta met him and exhorted him on the evil consequences of an unrighteous life. When he was seriously ill, Arhant Sariputta was called upon to his bedside. Dhanjani said that he was having an unbearable headache. Arhant Sariputta engaged Dhananjani’s attention from lower to higher realms of existence as far as the Brahma world. Then the Arhant explained the path leading to the attainment of the Brahma world through the full development of the brahmaviharas – loving kindness, compassion, unselfish joy and equanimity to spread all over the quarters.

At the end of the discourse Dhananjani requested the Arhant Sariputta to convey his respect to the Buddha. Soon after Dhananjani passed away and was born in the Brahma world. This sutra explains that even a person who had been leading unscrupulous life could be guided to a better rebirth by counseling during the crucial period just prior to death. But it is doubtful whether every evil doer could be thus guided towards rebirth in a happy realm. Perhaps the good qualities of Dhananjani outweighed his evil deeds that helped to lead him to be reborn in a happy state through counsel offered by a noble Arhant at the hour of death.

Cultured mind

An important feature of the discourse of Arhant Sariputta was that he started from the lowest state of existence and proceeded upwards as far as Brahma world. He would have started from hell because Dhananjani had deteriorated to that state. Arhant Sariputta would have helped Dhananjani to reminisce his good deeds in the past to draw his attention to a relevant discourse a few days prior to his illness. Dhananjani would have been benefited through the last minute counseling by bringing back the spiritual potential hidden in him.

This is somewhat similar to the episode of young Mattakundali who was greatly pleased and generated much faith when Buddha appeared at his deathbed and was reborn in a celestial realm. In the Sotapattisamyutta it is explained how great fear of death and nervousness arise in a person who has had no faith in the noble qualities of the Buddha, Dhamma and Sangha and led an immoral life, at the threshold of his or her death. But a person who has deep steady faith in the noble qualities of the Triple Gem and has had led a pure life, such fear do not arise when face with death. It is the guilty conscience which causes much anguish at the moment of death. When one is in fear and anxiety at this crucial moment, rebirth must take place in a sphere that is proportionate and matching to that.

The Buddha has said that a person who has cultivated moral virtues and led a righteous life need not give thought to fears. The Exalted One said; “If a pot of ghee is broken after being flooded in water, the potsherds will sink to the riverbed, but the ghee will rise to the surface. Similarly, the body will disintegrate, but the cultured mind will rise up like the ghee.”

In Sankharuppatti, Kukkurayatika and Tevijja Suttas it is explained that rebirth usually depends on the thoughts that occur during a lifetime. If one contemplates on thoughts and qualities that are suitable for an animal, as given in the Kukkuraytika Sutta, then it is likely that one will be reborn among those animals that have similar characteristics. Those who have cultivated sublime emotions such as universal love and compassion have good chances of being reborn among the Brahmas.

Therefore, preparation for death really has to be done while living. Having faith in the Buddha, Dhamma and Sangha and cultivation of moral habits is indeed a prerequisite for attaining higher rebirth. Though becoming deficient in virtue is a hindrance at the hour of death to reach a higher level, the Buddhist custom is to invite a monk to the bedside of a terminally ill patient with the hope that the chanting of certain protective Suttas will help the patient to develop faith and elevate his thoughts to a higher plane of spirituality.

Spiritual guidance

A question may arise as to how spiritual guidance could be effective if the terminally ill patient is unconscious. The doctors and onlookers might conclude that the patient is unconscious because he does not respond to his surroundings. The five faculties may have become partly or completely defunct, but nobody can be certain whether or not his mental faculty is active. It is quite likely that the mental faculty is most active at this crucial hour. This is the time one has the most violent mental struggle yearning for life with the firm habitual resistance and protest against death. Our imaginations that yearn for life are greatest when the fear of death is greater. If one has strong spiritual growth, he may face the inevitability of death with relative calm, contentment and satisfaction. A person’s rebirth corresponds with his spiritual potential and this is called kamma.

When we visit a terminally ill patient, our normal attitude is to feel sad, but according to Buddhism it is wrong to have negative thoughts at such moments. If we radiate thoughts of metta, loving kindness to him, it would be helpful to the terminally ill patient as the dying person’s mind maybe working at this crucial hour. It is possible that the person’s mind will be sensitive and receptive to the spiritual thought waves of those around him. If negative thought waves are generated by grief and lamentation, then the dying person maybe adversely affected. But if gentle thoughts of love and kindness are extended, such thoughts may serve as a subtle mental balm that relieves distress and anxiety at the moment of death.