Caring for the Sick (Mv.8.26)

Venue: Hokkien Tiong Pavilion

During the Buddha’s time, there was a bhikkhu who suffered a severe case of dysentery. He was so weak that he was lying fouled in his own urine and excrement. When the Buddha saw this, he asked why no one cared for him. The bhikkhu replied that because he did not help others, they too do not care to help him. The Buddha himself and Ven Ananda then cleaned him up and put him on a bed.

The Buddha then had the monks assembled and questioned them about the matter. When they admitted to not caring for the sick monk though being aware of him being ill, the Buddha admonished them, saying that since all of them have no parents to look after them, they should look after one another. He further stressed that anyone who would care for the Tathagata (i.e., the Buddha himself) should care for the sick. [Note: The popular words “He who serves the sick, serves me.” do not come from this story. Its origin is unknown.]

He then sets out precise instruction as to who should take care of a sick monk. If one’s preceptor (upajjhaya) is present, he should care for one as long as life lasts or till one recovers. Otherwise, one’s teacher (acariya) should do it, or one’s student (saddhiviharika) or apprentice (antevasika), or fellow student or apprentice. If not, the monastic community (Sangha) should do it. Otherwise, there is a monastic offence for being negligent.

The Buddha then spoke on what makes a sick person difficult or easy to care for and also what makes a caregiver fit or unfit to care for the sick.

A sick person having 5 attributes is difficult to care for or treat. What are they?

1. 1. He does what is not beneficial. An example would be staying up late. Being awake around the hours of midnight affects the health of any person, not to mention one who is already sick.
   2. He knows not moderation in what is beneficial. For example, a person may take wild pepper to stimulate his digestive system. However, if he takes a big handful of it, thinking that the more he takes the better it is, he may end up being mildly poisoned.
   3. He does not consume the medicine. This is like the saying, “You can bring a horse to the river, but you cannot force it to drink.” That makes him a difficult patient. However, if he is not taking the medicine because he knows it is bad or not suitable for him, then that is of course a different matter.
   4. He does not make known his health problems as they really are to his caregiver or physician who is concerned for his welfare. Unless his healer is psychic and very patient, it would be rather difficult to help him.
   5. He is the kind who cannot bear painful bodily feelings. When one is sick, discomfort is to be expected. Furthermore, the healing process may involve even more discomfort. So, if he is unwilling to bear with that patiently, he makes things more difficult for himself and his caregiver.

A sick person can be difficult to care for, even if he has only one of such attributes, let alone if he has all five of them. It can be rather trying to the caregiver.

However, if he was to be the opposite of all these, he becomes easy to care for. That is to say he does what is beneficial, knows moderation in what is beneficial, takes his medicine, makes known his health problems as they really are, and endures the painful bodily feelings.

Now, as for a caregiver, the Buddha listed 5 attributes that make him unfit to care for the sick:

1. 1. He is incompetent at preparing and mixing the medicine. While a certain herbal medicine can cure a sick person, it may have a certain property that needs to be neutralised with something else to suit the patient, or it may have to be prepared in a certain way to optimise its effect on the patient.
   2. He does not know what is beneficial or not beneficial to the patient. He may even remove what is beneficial and bring what is not beneficial. This of course would make the patient even worse than before.
   3. He treats the sick with material gain in his mind and not with thoughts of goodwill. It seems that more and more doctors in private hospitals or medical centres are rather eager in recommending expensive treatments and medicines. Some even scare the patient into following their suggestions. This not only puts unnecessary financial burden on patients, it also puts them in a situation that is probably even more dangerous than their illness.
   4. He gets disgusted at taking away excrement, urine, saliva or vomit. When caring for a very sick person, such as in the case of the monk mentioned earlier, the caregiver must not be too disgusted to remove such bodily discharge. Otherwise, he is unfit to do the job.
   5. He is incompetent at instructing, urging, rousing, encouraging the sick person at timely occasions with a talk on the Dhamma. [From here, we can infer that the Buddha was probably speaking in the context of his ordained disciples—for both the patient and the caregiver. Nonetheless, it can apply to lay people too if the caregiver is competent enough in the Dhamma and the patient is also interested in it.]

So, a caregiver having these 5 attributes is said by the Buddha to be incompetent. If he has the first 3, he can even be a danger to the patient.

However, if he was to be the opposite of all these, he makes an excellent caregiver, particularly in the context of monastics. That is to say he is competent at preparing and mixing the medicine, knows enough to bring what is beneficial and remove what is not beneficial, treats the sick with thoughts of goodwill, is not disgusted at taking away bodily discharge which can be rather repulsive, and is competent at inspiring the sick person with the Dhamma.

I’d like to add something to the final point. When a person is very sick, he can be somewhat depressed, which of course would make him even sicker. For a faithful Buddhist, the talk on Dhamma can be a powerful way to uplift his spirits and bring about healing. There are quite a few examples in the suttas where people, including the Buddha himself, recover from their illness by listening to and being gladdened by the Dhamma. Even if one does not recover fully, the joy of Dhamma can certainly help in the healing.

So, I hope today’s Dhamma talk helps us to understand what makes a good caregiver and a good patient.