by Thanissaro Bhikkhu

If you have any friends or family members who are sick or dying, I know of no one who would tell you to treat them in a hardhearted way. Everyone would agree that you should be as compassionate as you can. The problem is that there’s little agreement on how compassion translates into specific actions. For some people, compassion means extending life as long as possible; for others it means terminating life — through assisted suicide or euthanasia — when quality of life falls below a certain level. And neither of these two groups sees the other as compassionate at all. The first sees the second as criminal; the second sees the first as heartless and cruel.

For those of us trying to negotiate the murky territory between these two extremes, there’s not much reliable guidance. Ours is a culture that doesn’t like to think about illness and death, and as a result, when faced with someone who’s sick or dying, we’re at a loss as to what to do. Some people will advise you simply to do what feels right, but feelings have a way of turning slippery and devious. Some things feel right simply because they make you feel good, regardless of whether they’re genuinely right for the other person. A desire to extend life may mask a deeper fear of your own death; a desire to terminate a miserable illness may rationalize your distress at having to witness suffering. Even if you’re told to act from a place of mindful presence, you may find that what seem to be your spontaneous inspirations are actually conditioned by hidden, unexamined assumptions about what life and death are all about.

This is why the simple injunction to be compassionate or mindful in the presence of a sick or dying person isn’t enough. We need help in educating our compassion: specific advice on how to think through the implications of our actions in the face of life and death, and specific examples of how people who have contemplated these issues thoroughly have actually acted in the past.

With this thought in mind, I searched through the Pali canon — the oldest extant record of the Buddha’s teachings — to see what lessons could be drawn from the Buddha’s example. After all, the Buddha often referred to himself as a doctor, and to his Dharma as medicine for the sufferings of the world. From his point of view, we’re all sick and dying on a subtle level, so we all deserve continual compassion. But what sort of advice did this doctor give when face-to-face with the flesh and blood suffering of illness and death? How did he treat people who were physically sick or dying? Continue reading →