
             MINISTERING TO THE SICK AND THE TERMINALLY ILL

                                   by
                             Lily de Silva


                          Bodhi Leaves No. 132

                      Copyright 1994 Lily de Silva


                      BUDDHIST PUBLICATION SOCIETY
                      KANDY              SRI LANKA

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                         DharmaNet Edition 1995


             Transcribed directly from BPS Pagemaker files
                        Formatting: John Bullitt

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             MINISTERING TO THE SICK AND THE TERMINALLY ILL
  
                                          
  "He who attends on the sick attends on me," declared the Buddha, 
  exhorting his disciples on the importance of ministering to the sick. 
  This famous statement was made by the Blessed One when he discovered a 
  monk lying in his soiled robes, desperately ill with an acute attack 
  of dysentery. With the help of Ananda, the Buddha washed and cleaned 
  the sick monk in warm water. On this occasion he reminded the monks 
  that they have neither parents nor relatives to look after them, so 
  they must look after one another. If the teacher is ill, it is the 
  bounden duty of the pupil to look after him, and if the pupil is ill 
  it is the teacher's duty to look after the sick pupil. If a teacher or 
  a pupil is not available it is the responsibility of the community to 
  look after the sick (Vin.i,301ff.).
  
    On another occasion the Buddha discovered a monk whose body was 
  covered with sores, his robe sticking to the body with pus oozing from 
  the sores. Unable to look after him, his fellow monks had abandoned 
  him. On discovering this monk, the Buddha boiled water and washed the 
  monk with his own hands, then cleaned and dried his robes. When the 
  monk felt comforted the Buddha preached to him and he became an 
  Arahant, soon after which he passed away (DhpA.i,319). Thus the Buddha 
  not only advocated the importance of looking after the sick, he also 
  set a noble example by himself ministering to those who were so ill 
  that they were even considered repulsive by others.
    
    The Buddha has enumerated the qualities that should be present in a 
  good nurse. He should be competent to administer the medicine, he 
  should know what is agreeable to the patient and what is not. He 
  should keep away what is disagreeable and give only what is agreeable 
  to the patient. He should be benevolent and kind-hearted, he should 
  perform his duties out of a sense of service and not just for the sake 
  of remuneration (//mettacitto gilanam upatthati no amisantaro//). He 
  should not feel repulsion towards saliva, phlegm, urine, stools, 
  sores, etc. He should be capable of exhorting and stimulating the 
  patient with noble ideas, with Dhamma talk (A.iii,144).
    
    Here it is noteworthy that the nurse is expected to be efficient 
  not only in taking care of the body by giving proper food and 
  medicine, but is also expected to nurture the patient's mental 
  condition. It is well known that the kindness of nurses and doctors is 
  almost as effective as medicine for a patient's morale and recovery. 
  When one is desperately ill and feels helpless, a kind word or a 
  gentle act becomes a source of comfort and hope. That is why 
  benevolence (//metta//) and compassion (//karuna//), which are also 
  sublime emotions (//brahmavihara//), are regarded as praiseworthy 
  qualities in a nurse. The sutta adds another dimension to the nursing 
  profession by including the spiritual element in a nurse's talk. 
  Sickness is a time when one is face to face with the realities of life 
  and it is a good opportunity to instill a sense of spiritual urgency 
  even in the most materialistic mind. Further, the fear of death is 
  naturally greater when a person is ill than when well. The best means 
  of calming this fear is by diverting attention to the Dhamma. A nurse 
  is expected to give this spiritual guidance to the patient in his or 
  her charge as a part and parcel of a nurse's duty.
    
    In the Anguttara Nikaya the Buddha describes three types of 
  patients (A.i,120). There are patients who do not recover whether or 
  not they get proper medical attention and nursing care; there are 
  others who recover irrespective of whether or not they get medical 
  attention and nursing care; there are others who recover only with 
  appropriate medical treatment and care. Because there is this third 
  type of patient, all those who are ill should be given the best 
  medical treatment available, agreeable food and proper nursing care. 
  So long as a patient is alive, everything possible should be done for 
  his recovery. 
    
    According to another sutta (A.iii,56,62), illness is one of the 
  inevitables in life. When faced with it, all resources available to 
  one, even magical incantations, should be utilized with the hope of 
  restoring health. Here the question of whether such performances are 
  effective or not is not discussed. The point seems to be that at the 
  time of a crisis there is no harm in trying out even methods 
  traditionally believed to be efficacious, but in which one does not 
  necessarily have faith or belief. Of course, such methods should not 
  clash with one's conscience. If, in spite of these efforts, death does 
  occur, then one has to accept it as a verdict of kamma with equanimity 
  and philosophical maturity.
    
    Here we are reminded of an episode (MA.i,203) where a mother who 
  was critically ill needed rabbit meat as a cure. The son, finding that 
  rabbit meat was not available in the open market, went in search of a 
  rabbit. He caught one but was loathe to kill even for the sake of his 
  mother. He let the rabbit go and wished his mother well. 
  Simultaneously with this wish, the power of the son's moral virtue 
  brought about the mother's recovery. The Buddhist tradition seems to 
  hold that under certain circumstances moral power has healing 
  properties that may work even in cases when orthodox medicine fails.
    
    The Medicines Chapter of the Vinaya Mahavagga (Vin.i,199ff.) shows 
  that the Buddha relaxed a number of minor disciplinary rules to 
  accommodate the needs of sick monks. Though a strict disciplinarian, 
  the Buddha has shown great sympathy and understanding to those who are 
  ill. The value of health has been fully realized and it is even 
  recognized as the greatest gain (//arogyaparama labha//, Dhp.204).
    
    The Buddha teaches that the patient too should cooperate with the 
  doctor and the nurse in order to get well. Such a good patient should 
  take and do only what is agreeable to him. Even in taking agreeable 
  food he should know the proper quantity. He should take the prescribed 
  medicine without fuss. He should honestly disclose his ailments to his 
  duty-conscious nurse. He should patiently bear physical pain even when 
  it is acute and excruciating (A.iii,144).
    
    The suttas show that the Buddha exercised great will power and 
  composure on occasions when he fell ill. He experienced excruciating 
  pain when a stone splinter pierced his foot after Devadatta hurled a 
  boulder at him. He endured such pain with mindfulness and 
  self-composure and was not overpowered by the pain (S.i,27, 210). 
  During his last illness, too, the Buddha mindfully bore up great 
  physical pain and with admirable courage he walked from Pava to 
  Kusinara with his devoted attendant Ananda, resting in a number of 
  places to soothe his tired body (D.ii,128,134). The Mahaparinibbana 
  Sutta also reports that the Buddha once willfully suppressed a grave 
  illness in Beluvagama and regained health (D.ii,99).
    
     It seems that those who are highly developed mentally are able to 
  suppress illness, at least on certain occasions. Once Nakulapita 
  visited the Buddha in old age, and the Master advised him to remain 
  mentally healthy even though the body is feeble (S.iii,1). There is 
  physical and mental pain (//dve vedana kayika ca cetasika ca//). If, 
  when one has physical pain, one becomes worried and adds mental pain 
  too, that is like being shot with two arrows (S.iv,208). One who is 
  spiritually evolved is capable of keeping the mind healthy 
  proportionate to his spiritual development. As an Arahant is fully 
  developed spiritually, he is capable of experiencing physical pain 
  only, without mental pain (//so ekam vedanam vediyati kayikam na 
  cetasikam//, S.iv,209).
    
    A number of suttas advocate the recitation of the enlightenment 
  factors (//bojjhanga//) for the purpose of healing physical ailments. 
  On two occasions, when the Elders Mahakassapa and Mahamoggallana were 
  ill, the Buddha recited the enlightenment factors and it is reported 
  that the monks regained normal health (S.v,79-80). It is perhaps 
  significant to note that all the monks concerned were Arahants, and 
  had therefore fully developed the enlightenment factors. The Bojjhanga 
  Samyutta also reports that once when the Buddha was ill, he requested 
  Cunda to recite the enlightenment factors (S.v,81). The Buddha was 
  pleased at the recitation and it is said that he regained health. On 
  another occasion, when the monk Girimananda was very ill (A.v,109), 
  the Buddha informed Ananda that if a discourse on ten perceptions 
  (//dasa sanna//) is delivered to him, he might get well. The ten 
  perceptions are the perception of impermanence, egolessness, impurity 
  of the body, evil consequences (of bodily existence), elimination (of 
  sense pleasures), detachment, cessation, disenchantment with the 
  entire world, impermanence of all component things, and mindfulness of 
  breathing. Ananda learnt the discourse from the Buddha and repeated it 
  for Girimananda and it is reported that he recovered.
    
    Once the Buddha heard that a newly ordained monk who was not very 
  well known among his fellow monks was very ill (S.iv,46). The Buddha 
  visited him. When he saw the Buddha approaching him he stirred in his 
  bed and tried to get up, but the Buddha cautioned him not to rise. 
  Having taken a seat, the Buddha inquired after his health, whether the 
  pains are decreasing and not increasing. The monk replied that he is 
  feeling very ill and weak, that his pains are increasing and not 
  decreasing. The Buddha then inquired whether he had any misgiving or 
  remorse. The monk replied that he had plenty of misgiving and remorse. 
  The Buddha then asked whether he reproached himself for breach of 
  virtue. He said no. Then the Buddha asked why he felt remorseful if he 
  was not guilty of any breach of virtue. The monk replied that the 
  Buddha does not preach the doctrine for purity of virtue, but for 
  detachment from lust (//ragaviragatthaya//). Greatly pleased, the 
  Buddha exclaimed //Sadhu Sadhu// in approbation. 
    
    The Buddha then went on to preach the doctrine to the monk. He 
  explained that the sense faculties are impermanent, unsatisfactory and 
  egoless, therefore they should not be considered as "I" and "mine." 
  Understanding their true nature the noble disciple becomes 
  disenchanted with the sense faculties. When this explanation of the 
  Dhamma was being given the vision of truth (//dhammacakkhu//) dawned 
  on the monk; he realized that whatever has the nature of arising 
  necessarily has the nature of cessation. In other words he became a 
  //sotapanna//, a stream-enterer.
    
    According to the //Sotapattisamyutta// Anathapindika was once very 
  ill, and at his request the Venerable Sariputta visited him (S.v,380). 
  On being told that the pains are excruciating and increasing Sariputta 
  delivered a discourse reminding Anathapindika of his own virtues. 
  Sariputta explained that the uninstructed worldling who has no faith 
  in the Buddha, Dhamma and Sangha and who has not cultivated virtuous 
  moral habits goes to a state of woe on the destruction of the body. 
  But Anathapindika has unshakable conviction in the Buddha, Dhamma and 
  Sangha, and has cultivated noble moral habits. Sariputta told him that 
  when these noble qualities are mindfully appreciated the pains would 
  subside. 
    
    Further, Sariputta pointed out that uninstructed worldlings reach a 
  state of woe on the disintegration of the body as they have not 
  cultivated the Noble Eightfold Path. But on the contrary Anathapindika 
  has cultivated the Noble Eightfold Path. When attention is paid to 
  them and the noble qualities are appreciated the pains would subside. 
  It is reported that the pains subsided and Anathapindika recovered 
  from that illness. So much so, that Anathapindika got out of bed and 
  served the Venerable Sariputta with the meal that was prepared for 
  himself.
    
    The //Sotapattisamyutta// records an account of another occasion 
  when Anathapindika was ill (S.v,385). The Venerable Ananda was 
  summoned to the bedside and he delivered a discourse. Ananda explained 
  that uninstructed ordinary people who have no faith in the Buddha, 
  Dhamma and Sangha and who are given to immoral habits are seized with 
  trepidation and fear at the approach of death. But the noble disciple 
  who has deep conviction in the Buddha, Dhamma and Sangha and who has 
  cultivated moral habits does not experience trepidation and fear of 
  death. Anathapindika then confessed unshakable conviction in the 
  Buddha, Dhamma and Sangha, and declared that he is endowed with the 
  spotless virtue of a householder. Ananda exclaimed that it is indeed a 
  great gain that Anathapindika has disclosed the attainment of the 
  fruit of stream-entry. It is, however, not reported whether 
  Anathapindika recovered straight away.
    
    The Buddha recommends that a monk should not relax his energy and 
  determination for spiritual progress even when he is ill (A.iv,335). 
  It is possible that the illness might deteriorate, and before that 
  happens care should be taken to advance spiritually as much as 
  possible. After recovering from an illness, too, one should not be 
  negligent, because, should there be a relapse, the chances of gaining 
  higher spiritual attainments diminish.
    
    The Buddhist method of ministering to the sick, as is evident from 
  the canonical texts cited above, attaches great importance not only to 
  proper medical and nursing care, but also to directing the mind of the 
  patient to wholesome thoughts. There seems to be a belief that 
  attention paid to doctrinal topics, especially the recitation of 
  virtues which one has already cultivated, is endowed with healing 
  properties. In the case of the Buddha and Arahants the recitation of 
  the //bojjhangas// has restored normal health. In the case of the monk 
  Girimananda, who was probably not an Arahant at the time of his 
  illness, it was a discourse on the ten perceptions that restored his 
  good health. Anathapindika was //a sotapanna// and a discussion on the 
  special qualities of a //sotapanna// was instrumental for his speedy 
  recovery. It may be that when one is reminded of the spiritual 
  qualities one has already acquired, great joy arises in the mind. Such 
  joy is perhaps capable even of altering one's bodily chemistry in a 
  positive and healthy manner.
    
    Here we are reminded of a relevant episode contained in the 
  //Papancasudani// (MA.i,78). A monk while listening to the Dhamma was 
  bitten by a snake. He ignored the snake bite and continued to listen. 
  The venom spread and the pain became acute. He then reflected on the 
  unblemished purity of his virtuous conduct (//sila//) from the time of 
  his higher ordination. Great joy and satisfaction arose within him 
  when he realized the spotless nature of his character. This healthy 
  psychological change acted as anti-venom and he was immediately cured. 
  These episodes seem to reveal that when attention is drawn to one's 
  own spiritual qualities at times of serious illness, and pious joy 
  wells up in the mind thereby, health-promoting factors become 
  activated in the body, perhaps by way of the secretion of 
  health-restoring hormones. That may be the mechanism by which 
  spiritually advanced individuals regain health when appropriate suttas 
  are recited.
    
    There is much material in the Pali Canon on counseling the 
  terminally ill. Speaking about death to a terminally ill patient is 
  not avoided as an unpleasant topic. On the contrary, the reality of 
  death and perhaps its imminence are accepted without any pretense and 
  the patient is made to face the prospect of death with confidence and 
  tranquillity.
    
    The advice given by Nakulamata to Nakulapita is extremely valuable 
  in this connection (A.iii,295-98). Once Nakulapita was seriously ill 
  and his wife Nakulamata noticed that he was anxious and worried. She 
  advised him thus: "Please, sir, do not face death with anxiety. 
  Painful is death for one who is anxious. The Buddha has looked down 
  upon death with anxiety. It may be you are anxious that I will not be 
  able to support the family after your death. Please do not think so. I 
  am capable of spinning and weaving, and I will be able to bring up the 
  children even if you are no more. Perhaps you are worried that I will 
  remarry after your death. Please do not think so. We both led pure 
  wholesome lives according to the noble conduct of householders. So do 
  not entertain any anxiety on that account. It may be you are worried 
  that I will neglect attending on the Buddha and the Sangha. Please do 
  not think so. I will be more devoted to the Buddha and the Sangha 
  after your death. Perhaps you are worried that I will neglect keeping 
  to the precepts. Please do not have any doubts on that account. I am 
  one of those who fully practice the moral habits declared for the 
  laity, and if you wish please ask the Buddha about this matter. 
  Perhaps you fear that I have not gained inner mental composure. Please 
  do not think so. I am one of those who have gained inner mental 
  composure as much as a householder could gain. If you have any doubts 
  about this, the Buddha is at Bhesakalavana, ask him. Perhaps it occurs 
  to you that I have not attained proficiency in the Buddha's 
  dispensation, that I have not gone beyond doubt and perplexity without 
  depending on another. If you wish to have these matters clarified ask 
  the Buddha. But please do not face death with anxiety, for it is 
  painful and censured by the Buddha." It is reported that after 
  Nakulapita was thus admonished by Nakulamata, he regained his health, 
  and gone was that illness never to recur. Later on this whole incident 
  was narrated to the Buddha, who commended Nakulamata for her sagacious 
  advice.
    
    The //Sotapattisamyutta// contains a valuable discourse on the 
  question of counseling the terminally ill (S.v,408). Once Mahanama the 
  Sakyan inquired from the Buddha how a wise layman should advise 
  another wise layman who is terminally ill. Here it should be noted 
  that both the counselor and the patient are wise lay Buddhists. The 
  Buddha delivered a whole discourse on how this should be done. First, 
  a 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 also have cultivated unblemished virtuous conduct 
  which is conducive to concentration." Having thus comforted the 
  patient with the four assurances, he should ask him whether he has any 
  longing for his parents. If he says yes, 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. Then, if he says 
  he gives up his longing for his parents, he should be asked whether he 
  has longing for his wife and children. With the same reasoning he 
  should be persuaded to give up that longing too. Then he should be 
  asked if he has any longing for the pleasures of the senses. If he 
  says yes, he should be convinced that divine pleasures are superior to 
  human pleasures, and should be encouraged to aspire for divine 
  pleasures. Then he should be gradually led up the scale of divine 
  pleasures and when he comes to the highest heaven of the sense sphere, 
  his attention should be diverted to the Brahma-world. If he says he 
  has resolved on the attainment of the Brahma-world, he should be 
  admonished that even the Brahma-world is characterized by impermanence 
  and the rebirth personality. Therefore it is better to aspire for the 
  cessation of the rebirth personality. If he can 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.
    
    This, no doubt, is the highest form of counseling that can be given 
  to a highly advanced person who is terminally ill by an equally 
  spiritually advanced person. It is very clear from the discourse that 
  the patient must be one who is as advanced as a stream-enterer, as the 
  four assurances or the consoling factors mentioned at the very 
  beginning of the discourse are identical with the qualities of a 
  stream-enterer.
    
    The //Cittasamyutta// contains an interesting episode of the death 
  of a spiritually advanced learned lay disciple  (S.iv,302). Citta the 
  householder was a non-returner (//anagamin//, A.iii,451). When he fell 
  critically ill, a group of sylvan deities invited Citta to set his 
  mind on becoming a universal monarch (//cakkavattiraja//) because the 
  aspirations of the virtuous come to pass. He refused, saying that that 
  too is impermanent. Though lying on his deathbed he admonished his 
  relatives, who had assembled round him, on the importance of 
  cultivating faith in the Buddha, Dhamma and Sangha, and on the 
  importance of charity, then he passed away.
    
    According to the //Sotapattisamyutta// the Buddha once visited the 
  bedside of Dighavu the lay disciple who was terminally ill (S.v,344). 
  The Master advised him to fix his attention on unwavering confidence 
  in the noble qualities of the Triple Gem and to will that he be 
  endowed with spotless virtuous conduct. Dighavu replied that these 
  qualities of a stream-enterer are already found in him. Then the 
  Buddha advised him to be established in those virtues and develop the 
  six qualities conducive to understanding, namely, the perception of 
  the impermanence of all component things, the unsatisfactoriness of 
  all that is impermanent, the egolessness of what is unsatisfactory, 
  the perception of elimination, detachment and cessation. Dighavu 
  replied that these qualities too are found in him, but he is concerned 
  that his father will be sad when he dies. Then Jotipala, his father, 
  advised him not to be worried on that account, but to pay heed to what 
  the Buddha says. The Buddha, having admonished him, left and Dighavu 
  died soon after. Later the Buddha declared that Dighavu passed away as 
  a non-returner.
    
    The brahmin Dhananjani was an unscrupulous tax collector who 
  exploited both the king and the public (M.ii,184-96). The Venerable 
  Sariputta met him once and exhorted him on the evil consequences of an 
  unrighteous life. Shortly thereafter Dhananjani was seriously ill and 
  Sariputta was summoned to his bedside. On being inquired about his 
  health, Dhananjani informed Sariputta that he has an unbearable 
  headache. Sariputta then engaged him in a conversation gradually 
  drawing his attention from lower to higher realms of existence as far 
  as the Brahma-world. Having thus diverted the attention of the 
  near-death patient to the Brahma-world, Sariputta went on to explain 
  the path leading to the attainment of the Brahma-world, namely, the 
  full development of the //brahmaviharas// -- loving kindness, 
  compassion, altruistic joy and equanimity -- to suffuse all quarters. 
  At the end of the discourse Dhananjani requested Sariputta to convey 
  his respects to the Buddha. Sariputta departed and shortly afterwards 
  Dhananjani died. It is reported that he was reborn in the 
  Brahma-world. Later when the matter was related to the Buddha, he 
  found fault with Sariputta for not having led Dhananjani further on 
  the spiritual path.
    
    This sutta shows that a man who had been unscrupulous in his 
  dealings could also be guided to a happier rebirth by counseling 
  during the crucial period just prior to death. It is highly doubtful 
  whether any and every evil doer could be thus guided towards rebirth 
  in a happy realm. Perhaps Dhananjani's good qualities outweighed his 
  evil deeds (Dhp.173) and that may be the reason why it was possible to 
  lead him to rebirth in a happy state by counsel offered by a noble 
  Arahant at the hour of death.
    
    That this may have been so can be inferred from the facts reported 
  in the sutta (M.ii,185). Sariputta made it a point to inquire about 
  Dhananjani's spiritual zeal, soon after inquiring about the Buddha's 
  health, from a monk coming from Rajagaha, when he himself was touring 
  in the far away Dakkhinapatha. It is very likely that Dhananjani was a 
  faithful patron of the Sangha when his first wife, a lady full of 
  faith, was alive. His second wife was a faithless woman. When 
  Sariputta heard that Dhananjani was negligent he was dismayed, and 
  made up his mind to talk to Dhananjani should the occasion arise to 
  meet him.
    
    Another important noteworthy feature in this discourse is that the 
  Venerable Sariputta starts the discourse from the lowest state of 
  existence, and works upwards as far as the Brahma-world. Perhaps he 
  started from the hells because Dhananjani had deteriorated to that 
  level. Sariputta may have helped to remind him of his former good 
  deeds, and also may have drawn his attention to a relevant Dhamma 
  discourse Sariputta had delivered to him, perhaps only a few days 
  prior to his illness. Thus by drawing on the spiritual potential that 
  was hidden in him, Sariputta may have been able to help Dhananjani 
  attain a happy rebirth by last minute counseling.
    
    Here we are reminded of the episode of young Mattakundali 
  (DhpA.i,26). When he was lying on his death-bed the Blessed One 
  appeared and Mattakundali, being greatly pleased, generated much faith 
  in the Buddha. Dying soon after, he was reborn in a celestial realm.
    
    A sutta in the //Sotapattisamyutta// (S.v,386) maintains that when 
  an uninstructed ordinary person at the threshold of death sees that he 
  has no faith in the noble qualities of the Buddha, Dhamma and Sangha, 
  and that he has led an immoral life, great fear of death and 
  trepidation arise in him. But a person who has deep unwavering faith 
  in the noble qualities of the Triple Gem, and who is spotlessly pure 
  in his conduct, experiences no such fear of death and trepidation. It 
  seems to be the guilty conscience that causes much anguish at the 
  moment of death. When there is fear and anxiety at this crucial moment 
  rebirth must take place in a sphere that is proportionate and 
  commensurate to that experience of anguish.
    
    It is appropriate to record here a relevant discussion Mahanama the 
  Sakyan had with the Buddha regarding the fate of one who meets with a 
  violent death (S.v,369). Mahanama tells the Buddha that when he comes 
  to the serene atmosphere of the monastery and associates with pious 
  monks of noble qualities, he feels quite calm and self-possessed. But 
  when he goes out into the streets of Kapilavatthu, busy with constant 
  traffic, he feels frightened over the future birth that would await 
  him should he meet with a violent death in a traffic accident. The 
  Buddha assures him that a person who has cultivated moral virtues and 
  led a righteous life need not entertain such fears. He explains the 
  situation with the help of a simile. If a pot of ghee is broken after 
  being submerged 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.
    
    It is the same idea that is emphasized in suttas such as 
  Sankharuppatti, (M.iii,99) Kukkuravatika (M.i,387) and Tevijja 
  (D.i,235). Rebirth usually depends on the thoughts that are most often 
  entertained during a life-time. If one entertains thoughts and 
  dispositions that are suitable for an animal, for a dog or a cow as 
  given in the Kukkuravatika Sutta, then it is likely one will be reborn 
  among these animals, i.e. among beings who have similar dispositions. 
  If, on the other hand, one has entertained thoughts and dispositions 
  comparable to those among the Brahmas, by the cultivation of sublime 
  emotions such as universal love and compassion, one has a good chance 
  of being reborn among the Brahmas. Therefore preparation for death 
  really has to be done while living. Even to be guided in thought to a 
  higher rebirth when death is imminent one needs the prior requisite of 
  faith in the ideal of human virtue and understanding -- for this is 
  what is meant by having faith in the Buddha, Dhamma and Sangha -- and 
  the cultivation of moral habits. If one lacks virtue, guidance of 
  thought patterns at the hour of death to a higher level will be 
  difficult to the extent that one is deficient in virtue. But however 
  difficult and effective the actual guidance may be, it is a Buddhist 
  custom to invite a monk to the bedside of a terminally ill patient 
  with the hope that the chanting of certain protective suttas 
  (//paritta//) will help the patient to develop faith and elevate his 
  thoughts to a higher plane of spirituality.
    
    We are reminded here that, according to the Vinaya (iii,8), some 
  previous Buddhas such as Vessabhu, whose dispensations did not last 
  long, used to instruct their disciples by looking into their minds 
  with telepathic powers and guiding their thought patterns thus: "Think 
  thus, do not think thus, pay attention thus, do not pay attention 
  thus, give this up, develop this," etc. Perhaps this may be the 
  technique used by Gotama Buddha and his eminent disciples to guide 
  thought patterns of amenable adherents at the hour of death. They seem 
  to have mainly used more general techniques with lengthy doctrinal 
  discourses at other normal times in preference to guided meditation 
  with insight into the thought patterns of individuals.
    
    The question may arise of how effective spiritual guidance will be 
  if the terminally ill patient is unconscious. Here what is actually 
  important is that we are really unaware of the patient's mental 
  condition at the hour of death. The doctors and onlookers might 
  conclude that the patient is unconscious because he does not respond 
  to his surroundings and to the questions put to him. His five 
  faculties may have become partly or completely defunct, but nobody can 
  be certain whether or not his mental faculty is active. We certainly 
  do not know what special potentialities the mind harbors on the 
  occasion of death. It is quite likely that the mental faculty is most 
  active at this crucial hour. Perhaps this is the time that one has the 
  most violent mental struggle, yearning for life with the firm habitual 
  resistance and protest against death. 
    
    It is our conjecture that yearning for life is greatest when the 
  fear of death is greatest. The fear of death is greatest when one's 
  sense of guilt is greatest, the fear that one has squandered the great 
  opportunity of human life, an opportunity which could have been well 
  utilized for spiritual growth. If, on the other hand, one has well 
  utilized the opportunity of human life for spiritual growth, one can 
  face the inevitability of death with relative calm, contentment and 
  happy satisfaction. One's rebirth seems to be commensurate with one's 
  spiritual potential, which in Buddhist terminology is called 
  //kamma//.
    
    It is appropriate to conclude this essay by giving thought to what 
  we should do when we visit a terminally ill patient. Our normal 
  attitude is one of sadness and pity, but Buddhism holds that it is 
  wrong to entertain negative thoughts at such a moment. It is my 
  opinion that it would be helpful to the terminally ill patient, and to 
  any patient for that matter, if we radiate thoughts of //metta//, 
  loving kindness to him. As the dying person's mind may be working at 
  this crucial hour, unencumbered by the limitations imposed by the 
  physical sense faculties, 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 the dying person may be adversely affected. But if gentle 
  thoughts of love and kindness are extended, such thoughts may function 
  as a subtle mental balm that allays the distress and anxiety brought 
  on by the approach of death and envelops the dying person's mind in a 
  warm protective cloak of consoling peace.
    
    
                                 * * *
    
    
                             ABBREVIATIONS
                                          
                                          
  All references in text are to the editions of the Pali Text Society, 
  Oxford.
  
  
    A.       Anguttara Nikaya
    D.       Digha Nikaya
    Dhp.     Dhammapada 
    DhpA.    Dhammapada Atthakatha
    M.       Majjhima Nikaya
    MA.      Majjhima Nikaya Atthakatha
    S.       Samyutta Nikaya
    Vin.     Vinaya Pitaka
    
    
                                 * * *
                                          
                                          
                                          
                            ABOUT THE AUTHOR
  
  
  Lily de Silva is Professor of Pali and Buddhist Studies at the 
  University of Peradeniya in Sri Lanka. A regular contributor to 
  Buddhist scholarly and popular journals, she is also the editor of the 
  Digha Nikaya Tika, published by the Pali Text Society. Her previous 
  BPS publications include //One Foot in the World// (Wheel No. 
  337/338), //The Self-Made Private// Prison (Bodhi Leaves No. 120), and 
  //Radical Therapy// (Bodhi Leaves No. 123).
  
    
                            * * * * * * * *



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                         DISTRIBUTION AGREEMENT
                         ~~~~~~~~~~~~~~~~~~~~~~
 TITLE OF WORK: Ministering to the Sick and Terminally Ill (Bodhi Leaves
                #132)
 FILENAME: BODHI132.ZIP
 AUTHOR: Lily de Silva
 AUTHOR'S ADDRESS: c/o Buddhist Publication Society
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 COPYRIGHT HOLDER: Lily de Silva (1994)
 DATE OF PUBLICATION: 1994
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