Educating Compassion

　　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‐toface with the flesh and blood suffering of illness and death

　　 How did he treat people who were physically sick or dying

　　You probably know the story of how, together with Ven. Ananda, he once found an unattended sick monk lying in his own filth. After washing the monk, he assembled the other monks, chided them for abandoning their brother, and gave them strong incentive to follow his example: “Whoever would tend to me,” he said, “should tend to the sick.” He arranged that monks nursing their fellow monks should receive special allotments of food, to encourage them in their work and help lighten their burden. But he didn”t subscribe to the notion that medical treatment should try to extend life at all costs. The Vinaya, his monastic discipline, imposes only a minor penalty on a monk who refuses to care for a fellow monk who is sick or dying, or who totally abandons a sick monk before the latter recovers or dies. And there”s no penalty for withholding or discontinuing a specific medical treatment. So the rules convey no message that the failure to keep life going is an offense of any kind. At the same time, though, a monk who deliberately ends the life of a patient, even from compassionate motives, is expelled from the monkhood and can never reordain in this life, so there”s no room for euthanasia or assisted suicide.

　　Thi…

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