Gilana Sutta (Sick Person Discourse)

Venue: TIMS

Today’s talk is based on Gilana Sutta from the Anguttara Nikaya, Book of Threes, Sutta No. 22. Gilana means “sick person” or “patient”. So it is called the “Patient Sutta”.

In this sutta, the Buddha compared 3 types of patients in this world to 3 types of people who can benefit from his teachings. The 3 types of patients are:

1. 1. A patient who will never be able to recover from his sickness whether he can get suitable food, medicine or nursing
   2. One who will recover from his sickness irrespective of whether he gets good/suitable food, medicine or nursing.
   3. One who will only recover if he gets the appropriate food, medicine or nursing

I will now explain in more detail. The first type consists of those who don’t recover irregardless of whether they receive suitable food, medication or appropriate nursing. Nowadays, we can see many examples of such kinds of sick people such as heart cases or terminal cancer patients. However, when we talk about suitable food, medication and care we must look at it from a holistic point of view because both western and traditional therapies have their own ways of diagnosing diseases and treatment methods. For example, Chinese traditional medicine and Indian ayuverdic therapy don’t regard sicknesses as being caused by bacteria/viruses in contrast to western medicine, which pin-points them as the primary cause. Traditional therapy sees a sick person as having an imbalance in their bodily elements, obstructing the flow of vital energy (qi- Chinese, prana- ayuverdic) in the body. Their treatment consists of eating suitable food to reset this imbalance in addition to practicing qi gong / yoga. Before we put someone into this first category of patients, we must explore all possible treatment options (both western and traditional).

The second group comprises patients who recover regardless of whether they receive suitable food, medication or nursing care. A good example of this is the homeless people who don’t have basic amenities at their disposal such as proper homes, food or sanitation and yet, we hardly ever see them get sick. When they do, they usually get back on their feet with the minimum of fuss. This could be due to their excellent immune system as a result of being exposed to filth daily or could be due to their past karma. They have to live a long life in hardship—a sort of living hell here on earth.

The third group is the patient who can only recover if he receives suitable food, medication and nursing care. Otherwise he will not recover. The Buddha said it was on account if this third type of patient in the Sangha that he allowed special food, medicine and nursing for the sick monk. If a member of the Sangha is sick, he has to be taken care of by fellow members of the Sangha. If there are no volunteers, then the Sangha is obliged to appoint one bhikkhu or a samanera. On one occasion, the Buddha came across a very sick monk whom no other monks wanted to tend to. Together with Ven Ananda, he personally undertook the task of cleaning up and looking after the poor monk. Subsequently, he scolded the monks saying, “Monks, you have left home and have no parents, children or relatives to care for you. If you don’t take care of yourselves, then who else will bother about you? Monks, any one who would look after me should look after the sick.”

The Buddha also said that it was on account of this third group of patients that the other two groups should be taken care of. In the sutta, he did not elaborate further on this statement. However, the commentaries mention that a patient in the first group would feel resentment if no one bothered with him. If he died with this unhappy thought, there is a high possibility of him being reborn in a woeful state. On the other hand, if he was cared for even though he would not recover, he would feel gratitude and be more philosophical about his illness—coming to accept that it was a result of his past karma. When he dies, he will die a good death. The second type of patient needs to be cared for too so that he may be able to get well faster and continue his practise to gain realisation faster.

The Buddha then used the simile of the sick persons to illustrate 3 types of people who can benefit from his teaching:

1. 1. People who will never achieve Enlightenment regardless of whether they meet with the Buddha, or listen to his Dhamma.
   2. Those who will achieve Enlightenment even if they don’t meet the Buddha or listen to his Dhamma.
   3. Those who can only achieve Enlightenment if they meet with the Buddha or listen to his Dhamma.

In the sutta itself, the word Enlightenment is not used. The actual Pali words used were Okkamati niyamam, kusalesu dhammesu sammattam. Niyama means ‘the Path of Assurance’, okkamati means ‘to enter’, kusalesu dhammesu sammattam means ‘to achieve perfection in wholesome things. The interpretation given by the commentaries is that “the perfection of wholesome things” means Enlightenment while “to enter the Path of Assurance” refers to one becoming at the very least a sotapanna.

The Buddha continued to say that it was on account of this third group of people that he taught the Dhamma. Otherwise they would not be enlightened. On account of this third group too, the other two groups should also have the opportunity to listen to the Dhamma. The commentaries said that the first group consists of people who are padaparama—that is, their highest attainment is only to learn and understand the words of the Buddha intellectually. They cannot go any further and cannot get enlightened even if they practise diligently. What is the point then of teaching such people? This is to help them lay a good foundation in this present life so that they can have better conditions for enlightenment in a future life.

The second sort of person is one who can enter into this Path of Assurance, the perfection of wholesome states whether or not he meets the Buddha or listens to the Buddha-Dhamma. Now this is a very interesting part of the sutta. Who is this person who can still get enlightened whether or not he has the chance to meet the Buddha or listen to his Dhamma? The commentaries tell us this refers the Pacekka Buddha. You know what Pacekka Buddhas are? Our understanding of the Pacekka Buddha is based on the Commentaries. They tell us that he is one who is self-enlightened outside of the Buddha-Sasana and he is unable to preach the Dhamma to others. Pacceka Buddhas are loners and they do not need a teacher to get enlightened. But they can exist only outside the Buddha-Sasana. Outside the Buddha-Sasana means when the Buddha-Sasana has disappeared from the face of the earth.

However, the Buddha said that on account of the third sort of person the Dhamma should also be preached to the other two types of persons. Now this is interesting because the second sort of person is said to be a Pacceka Buddha who is not supposed to exist when the Buddha is around—so how can one preach to someone who’s not around? This may imply that outside the Buddha-Sasana does not necessarily mean when it has completely disappeared from the face of the earth.

There may be people who have not heard of the Buddha-Dhamma in this life and they may be practising by themselves somewhere. They may have some past paramis, e.g. they might have heard the Buddha-Dhamma in their past lives. If they are meditating somewhere in the caves, they can also become enlightened. They could also enter the Path of Assurance, the perfection of wholesome states.

This is food for thought and something we should bear in mind so that we can keep an open mind. A lot of conflicts arise in the world among religions and among Buddhists because they always claim theirs is the only way. Only they can get enlightened, nobody else can get enlightened. So they tend to look down on others who do not subscribe to their way of thinking.

This sutta is very interesting although it is very short because it shows us the possibility that there can be other enlightened beings outside the Buddha-Sasana.