Damien Keown

End of life: the Buddhist view

In many Asian cultures, Buddhism is acknowledged asthe religion that has most to say about death and theafterlife. Buddhist teachings emphasise the ubiquity andinevitability of death, and for this reason, Buddhists tendto be psychologically prepared to accept impendingdeath with calmness and dignity. Buddhism imposes few special requirements onpatients or physicians, and there is no reason why theterminal care of Buddhist patients should pose anyspecific problems. The only exception would be that ifthe patient is a monk or nun, it would not be appropriatefor them to be on a mixed ward, and preferable for themto be treated by a physician of the same sex. Attitudes inthis respect vary with the age and cultural background ofpatients, but nowadays there is increasing acceptance oftreatment by physicians and nurses of the opposite sex,especially where medical resources are limited.Buddhism is a flexible and moderate religion that haslittle time for rigid formalities. Concepts of taboo andreligious purity have little, if any, part to play andreligious law imposes no special requirements orlimitations on medical treatment. There are no specialhygiene, purification, or dietary requirements (manyBuddhists are vegetarians but not all). Cremation is themost common way of disposing of the dead.In practice, local custom will have a greater bearing onthe physician-patient relationship than Buddhistdoctrine. It is difficult to generalise about local customs,but provided the conventions of normal medical etiquetteare respected, there is no reason why difficulties shouldarise. This is particularly so in the case of the manypeople from the developed world who have converted toBuddhism and who are unlikely to have any problemswith the conventions of modern medical practice. One point to note is that mindfulness and mental clarityare important values for Buddhists, hence the importanceplaced on meditation. Buddhism emphasises theimportance of death with an unclouded mind whereverpossible, because it is believed that this can lead to a betterrebirth. Some Buddhists may therefore be unwilling totake pain-relieving drugs or strong sedatives, and eventhose who are not in a terminal condition might prefer toremain as alert as possible, rather than take analgesicsthat would impair their mental or sensory capacities.

Buddhism and Abortion: Is There a ‘Middle Way’?

In this final chapter I would like to address directly a question which will have occurred to many readers while perusing this volume. The question is: Does Buddhism have the answer to the abortion question which has so far eluded the West? It will be clear from the preceding chapters that there are those who think that it might, or that it may at least provide new insights which will help to move the Western debate forward. Indeed, there seem to be a number of general reasons why Buddhism might be thought well placed to make a contribution to the Western debate.

Religious perspectives on embryo donation and research

The success of assisted reproductive technologies (ARTs) worldwide has led to an accumulation of frozen embryos that are surplus to the reproductive needs of those for whom they were created. In these situations, couples must decide whether to discard them or donate them for scientific research or for use by other infertile couples. While legislation and regulation may limit the decisions that couples make, their decisions are often shaped by their religious beliefs. Unfortunately, health professionals, scientists and policy-makers are often unaware of the way in which faith traditions view ART and decisions concerning the ‘fate’ of surplus embryos. In this paper scholars representing six major religious traditions provide a commentary on a hypothetical case concerning the donation or destruction of excess ART embryos. These commentaries provide a rich account of religious perspectives on the status of the human embryo and an insight into the relevance of faith to health and policy decisions, particularly in reproductive medicine, ART and embryo research.

At the Beginning of Life

Understanding the origin of human life, as well as being a fascinating scientific enquiry, is also a profoundly important exercise from the point of view of ethics. The view we hold as to when individual life begins will influence the moral judgements we make when dealing with the complex ethical issues surrounding life in its early stages. As we shall see in Chapter 3, it will also have a bearing on how we define the end of life. We begin this chapter with a review of the account of the beginning of life found in traditional sources after which we will pause to reflect on its implications and its compatibility with current scientific knowledge. This will lead in Section III to a discussion of some possible objections to the Buddhist account of when life begins. After addressing these questions we will turn in Sections IV, V and VI to the substantive issues of abortion, embryo research and fertility control.

New Occasions Teach New Duties? 14. Christian Ethics in the Light of Buddhist Ethics

was, perhaps, thinking of a process whose significance would become apparent over centuries rather than decades. Whether events will bear out his prediction remains to be seen, but it was an insightful one in its recognition that the problems facing the emerging global civilization of the twenty-first century will be not fundamentally of a political, economic or scientific nature but a spiritual and moral one. As the atheist

Religious Perspectives on the Use of Psychopharmaceuticals as an Enhancement Technology

The use of psychopharmaceuticals as an enhancement technology has been the focus of attention in the bioethics literature. However, there has been little examination of the challenges that this practice creates for religious traditions that place importance on questions of being, authenticity, and identity. We asked expert commentators from six major world religions to consider the issues raised by psychopharmaceuticals as an enhancement technology. These commentaries reveal that in assessing the appropriate place of medical therapies, religious traditions, like secular perspectives, rely upon ideas about health and disease and about normal human behavior. But unlike secular perspectives, faith traditions explicitly concern themselves with ways in which medicine should or should not be used to live a “good life”.

At the End of Life

The moral issues which arise at the end of life are no less complex than those surrounding its beginning. Nor is the task of analysing these issues made any easier by the tendency in contemporary discussions to run many of them together as, for example, by failing to distinguish clearly between euthanasia and suicide, or euthanasia and the withdrawal of futile medical treatment. We will endeavour as far as possible, therefore, to keep the discussion of the important ethical issues at the end of life as separate from one another as possible. Before turning to the moral issues, however, our first task is to arrive at a definition of death which Buddhism would endorse. We discuss first of all the general problem of defining death, and then move on to consider in Section II how death is defined in the early sources. The conclusions we reach regarding the Buddhist concept of death will equip us to address in Section III the moral issues raised by patients in a ‘persistent vegetative state’ (PVS). In Sections IV and V we consider euthanasia from the perspective of early and contemporary sources respectively.

Buddhism, Medicine and Ethics

Since the subject of this book is ethics in the context of medicine, it will be appropriate to begin with a few reflections on the links between Buddhism and medical practice. We will then turn in Section II to the role of ethics in Buddhism as an historical tradition. This will lead on in Section III to a consideration of how the subject of Buddhist ethics is to be approached in the present work. Section IV examines issues concerning moral subjects and Section V contains a discussion of the relation between ethics and human good in Buddhism. Section VI concludes the chapter by applying the theoretical conclusions reached to a case-history from the Monastic Rule.

Ethics in the Mahāyāna

The nature of Mahāyāna ethics is complex and there is evidence of development in a number of directions, at times contradictory ones. This means that it can appear very different depending on the perspective adopted, a feature which makes it difficult to categorise. Hindery makes the following comment in his 1978 sketch of Mahāyāna ethics: There are enough references to precepts, virtues, and moral models to suggest that MB [= Mahāyāna Buddhism] involves a moral perspective not merely as a worldview, but directly as a system. In either case ongoing research may uncover the phenomenon that MB morality contains no precepts and values which cannot be found in alternate or even stronger forms in other major ethical traditions. On the other hand, it may more profoundly realise that a new moral gestalt or ethos ensouls this ethics with a unique and still unappreciated dynamic, one symbolised by bodhisattvas, who go on living for others and surrender not to death, and by savior Buddhas with extended hands (1978: 248).

Ethics and Soteriology

The central claim of the transcendency thesis is that karma and nirvana are incompatible, antagonistic, and antithetical. The evidence adduced in support of this claim was reviewed in the last chapter and some fundamental problems were pointed out. The present chapter sets out to provide a more satisfactory account of the relationship between karma and nirvana which does no violence to the position of canonical Buddhism. We consider first of all (1) an alternative account of the Eightfold Path and its role as the medium between saṃsāra and nirvana. This is followed by (2) an attempt to define more precisely the meaning of the important ethical terms kamma, kusala, and punna and the relationship between them.