Compassion alone is never enough

Thanissaro offers bedside instructions from the Buddha for how to act with those who are ill and dying.

If you have any friends or family mem- inspirations are actually conditioned by hidden, bers who are sick or dying, I know of no unexamined assumptions about what life and one who would tell you to treat them in a death are all about. hardhearted way. Everyone would agree that you should be as compassionate as This is why the simple injunction to be com- you can. The problem is that there's little passionate or mindful in the presence of a sick agreement on how compassion translates or dying person isn't enough. We need help into specific actions. For some people, compas- in educating our compassion: specific advice sion means extending life as long as possible; on how to think through the implications of for others it means terminating life–through as- our actions in the face of life and death, and sisted suicide or euthanasia–when quality of life specific examples of how people who have falls below a certain level. And neither of these contemplated these issues thoroughly have two groups sees the other as compassionate at all. actually acted in the past. The first sees the second as criminal; the second sees the first as heartless and cruel. With this thought in mind, I searched through For those of us trying to negotiate the murky the canon–the oldest extant record of the territory between these two extremes, there's not Buddha's teachings–to see what lessons could much reliable guidance. Ours is a culture that be drawn from the Buddha's example. After all, doesn't like to think about illness and death, and the Buddha often referred to himself as a doctor, as a result, when faced with someone who's sick and to his as medicine for the sufferings or dying, we're at a loss as to what to do. Some of the world. From his point of view, we're all people will advise you simply to do what feels sick and dying on a subtle level, so we all deserve right, but feelings have a way of turning slippery continual compassion. But what sort of advice and devious. Some things feel right simply did this doctor give when facing the flesh and because they make you feel good, regardless of blood suffering of illness and death? How did he whether they're genuinely right for the other treat people who were physically sick or dying? person. A desire to extend life may mask a deeper fear of your own death; a desire to terminate a You probably know the story of how, together miserable illness may rationalize your distress at with Venerable Ananda, he once found an having to witness suffering. Even if you're told unattended sick monk lying in his own filth. to act from a place of mindful presence, you After washing the monk, he assembled the may find that what seem to be your spontaneous other monks, chided them for abandoning their 6 brother, and gave them strong incentive to follow expels the monks from the monkhood. Thus, his example: "Whoever would tend to me," he from the Buddha's perspective, encouraging a said, "should tend to the sick." He arranged that sick person to relax her grip on life or to give monks nursing their fellow monks should receive up the will to live would not count as an act of special allotments of food, to encourage them compassion. Instead of trying to ease the patient's in their work and help lighten their burden. But transition to death, the Buddha focused on easing he didn't subscribe to the notion that medical his or her insight into suffering and its end. treatment should try to extend life at all costs. The , his monastic discipline, imposes This is because he regarded every moment of life only a minor penalty on a monk who refuses as an opportunity to practice and benefit from to care for a fellow monk who is sick or dying, the dharma. It's a well-known principle in all or who totally abandons a sick monk before the traditions that a moment's insight latter recovers or dies. And there's no penalty for into the pain of the present is far more beneficial withholding or discontinuing a specific medical than viewing the present moment with disgust treatment. So the rules convey no and placing one's hopes on a better message that the failure to keep future. This principle applies as life going is an offense of any kind. much at the end of life as it does At the same time, though, a monk ...we're all anywhere in the middle. In fact, the who deliberately ends the life of a Buddha encouraged his monks to patient, even from compassionate sick and reflect constantly on the potential motives, is expelled from the dying on imminence of death at every monkhood and can never reordain moment, even when in ordinary in this life, so there's no room for a subtle health, so that they could bring a euthanasia or assisted suicide. sense of urgency to their practice level, so we and give the present moment their all deserve full attention. If you learn to treat This means that the middle all moments as potentially your last, ground is where true compassion continual then when your last moment does can be exercised. The Buddha sets come you will face it prepared. out some guidelines for this area compassion. in his definition of the ideal nurse. You're qualified to tend to the Most often, though, a sick or sick if (1) you know how to prepare medicines; dying person hasn't been living with this sort of (2) you know what's amenable to the patient's urgent alertness, so the first step in advising such cure, taking away whatever's unamenable and a person is to aim at clearing away any emotional providing things that are amenable; (3) you're obstacles to learning from the present. The Pali motivated by compassion and not by material texts note two such obstacles: worry over the gain; (4) you're not squeamish about cleaning responsibilities the person is leaving behind, up urine, excrement, saliva, or vomit; and (5) and fear of death. In one poignant discourse, a you're competent at encouraging the patient at man appears to be dying and his wife consoles the proper times with talk on dharma. him not to worry: She'll be able to provide for herself and their children in his absence; she Of these five qualifications, the one most won't go looking for another husband; and she'll discussed in the Pali canon is the fifth. So what continue in her practice of the dharma. With qualifies as a helpful and compassionate talk on each reassurance she repeats the refrain, "So dharma to a person who is sick or dying, and don't be worried as you die. Death is painful for what doesn't? one who is worried. The Blessed One has warned against being worried at the time of death." The Here again, the don'ts mark off the territory for man recovers unexpectedly and, while still frail, the do's. The vinaya cites cases where monks tell goes to visit the Buddha, telling him of his wife's a sick person to focus his thoughts on dying, in reassurances. The Buddha comments on how the belief that death would be better than the fortunate the man is for having such a wise and miserable state of his life. The sick person does as sympathetic wife. they advise, he dies as a result, and the Buddha 7 As for fear of death, the Buddha notes relinquishment, both for the body that one of the primary reasons for this and for feelings of any sort. With fear is the remembrance of hurtful or relinquishment would come a genuine cruel things you've done in the past. insight into the dharma which, being Thus the Vinaya shows that monks Deathless, would end all fear of death. would often console a fellow monk n another occasion, Venerable on his deathbed by asking him to call O Sariputta visited the famous supporter to mind something more positive–his of the Buddha, Anathapindika, who highest meditative attainment–and to was on his deathbed. After learning that focus his thoughts there. In a similar Anathapindika's disease was worsening, vein, a common practice in he advised him to train Asian Buddhist countries himself: "I won't cling to is to remind a dying person the eye; my consciousness . . .when of the acts of generosity won't be dependent on or virtue he or she has the eye. I won't cling to performed in this life. Even you the ear; my consciousness if the person is unable to won't be dependent on the muster the meditate ear," and so forth through and alertness needed to all the six senses, their gain further insight into the objects, and any mental you're present, any events dependent on them. that helps allay worries and Although Anathapindika gaining forestall fears is an act of was unable to develop this true compassion. independent consciousness practice in line with Sariputta's The Buddha comments, instructions, he asked that in how however, that there are three additional these instructions be given to other lay reasons for fearing death: attachment people as well, for there would be those to die . . . to the body, attachment to sensual who would understand and benefit pleasures, and a lack of direct insight from them. into the unconditioned dharma of bviously, these recommendations are the Deathless. His more advanced O all shaped by the Buddha's teachings on instructions for sick and dying people how the state of one's mind influences thus focus on cutting these reasons the process of death and , for fear at the root. He once visited a but that doesn't mean that they're sick ward and told the monks there appropriate only for those who would to approach the moment of death call themselves Buddhist. Regardless mindful and alert. Instead of focusing of your religious beliefs, when you're on whether they would recover, they faced with obvious pain you're bound should observe the movements of to see the value of any instructions that the feelings they were experiencing: show you how to reduce suffering by painful, pleasant, or neutral. Observing investigating the pain in and of itself. a sensation of pain, for instance, they If you have the strength to follow should notice how inconstant it is and through with the instructions and if then focus on the repeated dissolution you encounter the Deathless in the of all pains. They could then apply the course of your efforts, you're not going same focused alertness to pleasant and to quibble about whether to call it by a neutral feelings as well. The steadiness Buddhist or non-Buddhist name. of their focus would give rise to a sense of ease independent of sensory feelings, This point is illustrated by another and from this point of independence story involving Venerable Sariputta. they could develop dispassion and Visiting an aged brahman on his 8 Meditate as an act of compassion both for yourself and for others, even if death seems far away. deathbed, Sariputta reflected that From my own personal experience– tive in teaching the dharma to those on brahmans desire union with Brahma, both in watching my teachers their deathbed. You won't be disturbed so he taught the man to develop the implement these instructions and in by the physical horrors of death, you'll four attitudes of a Brahma — infinite trying to implement them myself– I've be able to communicate directly to the good will, compassion, appreciation, learned two major lessons. One is that needs of the dying person, and your and equanimity. After following these the patients best suited for making words will carry more weight, for they instructions, the brahman was reborn the most of the dharma when sick or come from direct experience. Your as a Brahma after death. The Buddha, dying are those who are not tormented compassion will be educated not by however, later chided Sariputta for not with memories of cruel or hurtful books or feelings, but by a clear insight teaching the brahman to focus instead things they did in the past, and who into what dies and what doesn't. on investigating pain, for if he had, have already developed a meditative the brahman would have experienced or contemplative practice prior to Ultimately, these two lessons boil and been freed from rebirth their illness. Even if that practice isn't down to one: Meditate, as an act of altogether. Buddhist, they intuitively respond compassion both for yourself and for to the Buddha's message on pain and others, even if death seems far away. are able to use it to alleviate their own When the time comes to die, you'll hat's striking about all these W sufferings. The lesson here is that as be less of a burden on those who are instructions is that, from the Buddha's long as you know you're going to die caring for you. In the meantime, if point of view, deathbed dharma is no someday, it's a good idea to avoid you're called on to comfort those who different from dharma taught to people cruel actions and to get started on a are sick or dying, your compassion will in ordinary health. The cause of suffering be more genuinely helpful, and you'll is in every case the same, and the path to meditative practice of your own, so have a more effective message to teach. the end of suffering is the same as well: that you'll be prepared for illness and comprehend suffering, abandon its death when they come. cause, realize its cessation, and develop the qualities of mind that lead to its As m y t e a c h e r , A j a h n F u a n g , o n c e s a i d : cessation. The only difference is that "when you meditate you're gaining the obvious proximity of death makes practice in how to die–how to be teaching the dharma both easier and mindful and alert, how to endure harder–easier in that the patient is freed pain, how to gain control over from extraneous responsibilities and wayward thoughts and maybe even can see clearly the need to understand reach the deathless–so that when and gain release from pain; harder in the time comes to die, you'll do it Thanissaro Bhikkhu (Geoffrey DeGraff) that the patient may be too weakened with skill." is an American monk of the . After graduating from college, he physically or emotionally, through fear The second lesson is that if you want studied meditation under or worry, to put the instructions into in , himself a student of the late Ajahn practice. But whatever the case, it's to help other people overcome their Lee, and was ordained in 1976. In 1991 he worth noting that up to the moment of fear of death, you have to learn how helped establish Metta Monastery in the hills death the Buddha would have you focus to overcome your own fear of death of San Diego County, California, where he is as well, by abandoning attachment currently the abbot. He is a prolific author less on the limitations of the situation and translator of the Pali scriptures. than on the potential opportunities. to the body, abandoning attachment Even one moment of insight in the to sensual pleasures, avoiding cruel midst of pain and suffering, he said, is actions, and gaining direct insight worth more than one hundred years of into the Deathless. With your fears good health. overcome, you'll be much more effec-

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