Wednesday, October 21, 2009

Buddhist Bioethics On Euthanasia Practice

Buddhist Bioethics On Euthanasia Practice


The Centre of Buddhist Studies, The University of Hong Kong, Hong Kong

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Buddhist Bioethics On Euthanasia Practice


According to Buddhism, life is made possible because of the continuous interaction of all conditioning and conditioned factors. With no beginning and no end point, life is considered to be a continuous process of an endless cycle. Death is considered as an integral part of existence and is one phase of this endless cycle and cannot terminate the cycle.

Euthanasia, popularly known as “Mercy Killing”, is the act of causing painless death in order to end suffering. Though the concept of Euthanasia in India could be traced back from Buddhist era, but Buddhism is opposed to Euthanasia essentially because of its affirmative valuation of life. So, the doctor's aim would be to kill the pain and not the patient.

Key words: Mercy Killing, Painless Death, Valuation of Life

Buddhist Bioethics On Euthanasia Practice

Euthanasia is the act of causing painless death in order to end suffering. It is popularly known as “Mercy Killing”. 1 The concept of Euthanasia in India could be traced back from Buddhist era. It was noted that once Buddha had been preaching to the monks in the Mahavana in Vaisali regarding the defilement and filth of the body. Buddha retired into seclusion for a fortnight. Unfortunately, during this time, the monks, practicing philosophy and spirituality, developed disgust in sufferings of life and loathing for their physical existence.

This urge became so intense that many felt death would be preferable to such a repulsive existence. They found a willing assistant in form of Migalandika, an unfaithful monk, who agreed to assist by killing the monks in return for their robes and bowls. Migalandika started despatching his victims with a large sword, believing that by killing the monks he was saving them from the sufferings of samsara. After the first day’s killing spree, when he went to the river Vaggamuda to wash his sword, he was seized with remorse. An Evil Spirit appeared before him from the river and assured him that he was doing a noble service to the monks by helping them to commit suicide. This encouraged him and he ended up killing a large number of monks, up to sixty on a single day. When Buddha came out of His fortnight's seclusion, He noticed the drop in numbers among the monks and enquired as to the cause. When He learned what had taken place, He proclaimed this as the “third of the four most serious monastic offences.” This was the prohibition on taking human life, and was announced as follows: “Whatever monk should intentionally deprive a human being of life, or should look about to be his knife-bringer, he is also one who is defeated and is no more in communion.”1,2 This Precept prohibits murder even when the person being killed on request or provide assistance in dying. This would seem to make it immoral for the Buddhists to have any involvement in Euthanasia, either by requesting it or assisting in it. Both the person who administers Euthanasia and the one who requests it would be in breach of the Precepts.

Various cases could be cited in which monks played a direct or indirect part in causing death and had been reported during the Monastic Rule. Due to the amputation of hands and feet, an individual became disabled. A person in this condition would be unable to take care of himself and require constant attention and care, including assistance with feeding. The family expressed the opinion that it would be better if the man would die. This might be due to the reason that they judged his quality of life to be so poor that he would be 'better off dead. Perhaps their motive was simply to be free of the burden of providing the care and attention he required. It may even have been a combination of these reasons. A monk, who visited this person’s residence, took verbal consent from all his family members and assisted in bringing about the death of this invalid person by prescribing a drink, which proved fatal for him. The circumstances would suggest this was a case of active Euthanasia, although it is not clear whether it was voluntary or not. The monk who gave the advice was excommunicated.1,2

Another incident was concerned with an act of incitement to death, and related how a group of wicked monks became enamoured of the wife of a layman. In order to weaken his attachment to life the monks spoke to the husband of his virtues and the pleasures, which would be his reward in heaven and provoked him to eat and drink the wrong kind of food, who eventually succumbed to a fatal illness. When the matter was reported to Buddha, He excommunicated the monks and expanded the definition of the third serious monastic offence to include incitement to death: “Should any monk intentionally deprive a human being of life or look about so as to be his knife-bringer, or eulogise death, or incite [anyone] to death or who should deliberately and purposefully in various ways eulogise death or incite [anyone] to death; he is also one who is defeated, he is not in communion”. 1,2

During his visit to India in the seventh century A.D., Ven. Xuan Zang (i.e. Huen-tsang) reported that those who had become very old and felt that their goal of life had been achieved & time of death was approaching or those who were afflicted by an incurable disease, often consented to separate from this world and cast off humanity, contemptuous of mortal existence and desired to be away from the ways of the world. So their relatives and friends used to give them a farewell entertainment with food and music before boarding them on a boat and rowed them to the middle of the river Ganga where they drowned themselves, believing that they would be reborn in Heaven. One out of ten often found it difficult to carry out one’s contemptuous views. Rarely, one of them was seen not yet dead on the shores of the river. 1,3,4

Modern Concept of Euthanasia
According to Webster’s Dictionary‚ Euthanasia is the "act of causing death painlessly so to end suffering." Translated into Greek meaning "good death‚" Euthanasia it is also known as “Mercy Killing”. In the context of medical treatment we would define Euthanasia as: "the intentional killing of a patient or omission as part of his medical care."1

There are two forms of Euthanasia: passive and active. 'Active' Euthanasia is the deliberate killing of one person by an act, as for example, by lethal injection. ‘Passive’ Euthanasia is the intentional or deliberate causing of death by an omission, as for example, by not providing food or some other requisite for life. Each of these modes of Euthanasia can take three forms: (1) voluntary, (ii) non-voluntary and (iii) involuntary. 'Voluntary' Euthanasia involves the request by a legally competent person that their life should be terminated. 'Non-voluntary' Euthanasia is the killing of a non-competent patient. The removal of feeding tubes from comatose patients is an example of non-voluntary Euthanasia. 'Involuntary' Euthanasia is the intentional killing of a person against his will. 1
European countries like the Netherlands, Switzerland and Belgium allow physician-assisted death in various incarnations. In Holland alone, about 2,000 people die through assistance from their doctor each year. Dutch laws, like those in Switzerland and Belgium, require that the patient clearly and insistently request death. Oregon is the only state in US where physician-assisted suicide is legal. In countries where Euthanasia is legal‚ the patient is required to prove that they are of sound mind and have a legitimate reason to consider this form of death‚ such as a terminal illness. If a person chooses to undergo Euthanasia it is his own choice and others should not interfere.5
Some physicians believe that Euthanasia is immoral since the only reason people choose to end their life is because of the pain and effective pain management can be achieved with the help of modern medication. There has been a great improvement in hospice training and care‚ therefore Euthanasia is unnecessary. 6

There are also social considerations for Euthanasia other than suffering. People might not want their loved ones to have to deal with the financial constraints due to escalating medical bills that long time hospice can incur or see them drift further and further away from reality even though they are still alive. 5,6 To practice Euthanasia in modern clinical set up, usually the sedative sodium thiopental (anesthetic drug) is intravenously administered to induce a coma. Once it is certain that the patient is in a deep coma, typically after some minutes, a muscle relaxant is administered to stop the breathing and cause brain death. 5,6

Buddhist Attitude towards Life
The Buddhist perspective on life is explained in the theory of Dependent Origination. According to this, life is nothing but a collection of events, where each "event" or "happening" acts as the cause for the arising of the following event, which then provokes another event. The preceding cause transmits its potential force to the following effect. This concept is used to emphasize that life consists of interwoven activities of causes and effects, referred to as the kamma process, which is volitional activity whether mental, verbal or physical. The relationship between cause and effect is that both the earlier and later phases are an integral part of a single process with many psychophysical factors mutually conditioning one another. Life is made possible because of the continuous interaction of these conditioning and conditioned factors. With no beginning and no end point, life is thus considered to be a continuous process of an endless cycle. Death is considered as an integral part of existence and is one phase of this endless cycle and cannot terminate the cycle. This conditioned existence is called samsara and represented in Buddhist art by the Wheel of Life (bhavacakra). 1,2

Buddhist Bioethics on Euthanasia Practice
The concept of Euthanasia to cause death and end a precious human life is quite opposite to the concept of non-injury to life as mentioned in the Digha-Nikaya of Pali Canon. The Buddha’s profound appreciation for the universal existence of suffering had evoked a great compassionate response (karuna) and loving kindness (metta) for all living beings. The very first percept among the Five Precepts (paƱca sila), which form the minimum code of ethics for all the followers of Buddhism, involves abstention from injury to life. It is explained as casting aside of all forms of weapons and being conscientious about depriving a living being of life and promotes the cultivation of compassion and sympathy for all living beings. Buddhism also tirelessly advocates the virtues of non-greed, non-hatred and non-delusion in all human pursuits. Though the practice of Euthanasia is never encouraged according to the ethical aspect from the Buddhist perspective, but still it remains a debatable issue of whether to practice Euthanasia with restrictions and proper judgement on accounts of socio-economical considerations in real-life situations.1,2,3

Buddhist Hospice Care
According to Buddhism, life is a result of the continuous interaction of conditioning and conditioned factors and a continuous process of an endless cycle. On the other hand, Death is considered as an integral part of existence and is one phase of this endless cycle and cannot terminate the cycle. The Buddhist practice of compassion and wisdom, a willingness to serve, tolerance, a duty to do no harm, and the significance of death in the eternal process of rebirth, shares a commonality with hospice discourse.1,2,3

Some Buddhist organizations are providing hospice-at-home service, with expert nursing, counselling and palliative care. Apart from this, they are also providing the individual and family counselling, as well as bereavement counselling and mental support to cope with worries in times of crisis.6

Modern arguments in favour of Euthanasia emphasize the principle of autonomy, the right of an individual to choose life or death for him or herself. However, this issue is no longer one of individual rights because doctor is not simply an instrument of the patient's will. The doctor himself must also concur with the patient's reasons for seeking Euthanasia before the person administers it. Doctors must also use their own professional judgment about what is clinically and ethically right in a given case. Where patients in terminal illness are in great pain it may be necessary to administer drugs and other medication to relieve pain. The doctor's aim here, however, would be to kill the pain and not the patient.5,6 Buddhism is opposed to Euthanasia essentially because of its affirmative valuation of life. To value death above life is to deny that life is a basic good. From the perspective of Buddhist ethics, the ultimate aim of Buddhism is to overcome death. Any choice in favour of death is a rejection of this vision of human good. 1,2

1. Keown, D. 1995. Buddhism & Bio-Ethics. London: MacMillan:168-73.
2. Vinaya-Pitaka, iii, pp.68 ff.; Samantapasadika, ii, pp. 399 ff.
3. Si-Yu-Ki. 1969. Buddhist Records of the Western World. Delhi: Oriental Books Reprint Corporation Book Publishers:86-7.
4. Watters, T., Davids, T.W.R., Bushell, S.W., ed., 1961. On Yuan Chwan’s Travel in India (A.D. 629-645). Delhi: Munshi Ram Monohar Lal: 174-5.
5. Burdette, A.M., Hill, T.D., Benjamin, M.E. 2005. Religion and Attitudes toward Physician-Assisted Suicide and Terminal Palliative Care. Journal for the Scientific Study of Religion 44(1):79-93.
6. Werth, Jr., James, L., Blevins, D., Toussaint, K.L., Durham, M.R. 2002. The influence of cultural diversity on end-of-life care and decisions. The American Behavioural Scientist 46(2):204-219.

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