Professional Documents
Culture Documents
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Religious Beliefs and
Healthcare Decisions
by Paul David Numrich
B
uddhism adheres to the basic Indian view, ·
0.
mals or disembodied beings. Liberation from liberation from life's unsatisfactoriness (i.e., nir
the cycle of samsara occurs through enlighten vana), and that there is an Eightfold Path lead
,_
ment, which is also known as nirvana or the ing to this liberation. The Buddha has been
Buddha nature inherent in all living beings. It likened to a great physician who diagnoses the
is, however, accessible only from the human underlying human dissatisfaction or "dis-ease"
realm of existence. with life-which includes physical illnesses as
Nirvana is impossible to explain in ordinary well as mental discon:Uorts-isolates the cause,
terms "because human language is too poor to then prescribes the cure. In ways not available
express the real nature of the Absolute Truth or to medicine, but compatible with medicine's
Ultimate Reality which is Nirvana."3 Buddhists concern for alleviating suffering, Buddhism
believe that upon death, an enlightened person offers the ultimate remedy for human affliction.6
does not experience rebirth within samsara. All existing things have three characteristics
What occurs in such cases cannot be fathomed or "marks:' The first is impermanence-change
by the unenlightened mind, other than to say is the only constant, nothing remains
that worldly existence comes to an end, along unchanged. Second, and deriving from the first,
with all its unsatisfactory aspects. The belief in nothing contains an unchanging essence or core.
nirvana results in a somewhat dualistic view of Therefore, human beings have no unchanging,
reality for Buddhists, who distinguish between essential identity or soul, and there is no God in
the conventional realm (the samsaric world) and the Western sense of an almighty and unchang
the ultimate realm (the nirvanic perspective). ing creator who made living souls in the divine
However, Mahayana philosophy pursued the image. The Buddha did recognize the existence
conclusion that, actually, "there is not the slight of "gods" or spiritual beings above the human
est bit of difference between the two," since the realm, but they too exhibit the three marks of
samsaric world can have only apparent reality in
the face of an ultimate nirvana.4
existence. Human beings consist of five aggre
gates, mental and physical strands, factors, or
l'
-y"iie Fourth Noble Truth taught by the Buddha duct, not to tell falsehoods, and not to take
I delineates the Eightfold Path to liberation. intoxicants that cause careless behavior.II Some
This path is often symbolized as a wheel with consider the principle of non-harm to living
eight spokes. By cultivating each spoke, a person beings, encapsulated in the first precept, to be
approaches the enlightened hub of the wheel, the heart of Buddhist ethics.12 The behavior of
that is, nirvana. Three spokes comprise the ethi Buddhist monks and nuns is governed by
cal aspect of the path: right speech, right action, numerous additional precepts and monastic dis
and right livelihood. Under right action we find ciplinary rules. The renunciant lifestyle of the
the five precepts, the basic moral commitments Buddha and his monastic community continues
incumbent upon all Buddhists: not to destroy to provide a powerful ethical ideal for many
life, not to steal, not to engage in sexual miscon Buddhist individuals, groups, and cultures.
the couple's gametes could only be counte unsafe pregnancies. Abortions are performed in
nanced in the simplest cases where the embryos Asian countries where Buddhism has been cul
were immediately implanted." Such practical turally influential. The Japanese have developed
restrictions would probably preclude IVF for a ritual for addressing the loss of fetal life as
Buddhists, according to Keown.20 well as the associated mental anguish of the par
ents. Most Buddhists would place responsibility
Abortion for the final decision about abortion with the
Traditionally, abortion has been considered a pregnant woman.22
violation of the first precept against destroying
life. Ancient monastic texts, for instance, Care of severely handicapped newborns
expressly forbid monks from causing an abor Handicapped human persons deserve the
tion, specifying some of the common methods of same ethical considerations as others. Buddhists
the day as "scorching, crushing, or the use of may consider handicap conditions to be the
medicine:•21 However, debate has arisen in result of karmic predispositions, but compas
recent years regarding such issues as when sionate care would be provided nonetheless.
GENETICS
generally understood as conception, and the being, including animals (see below under
moment of death, a period of up to 120 years.23 Medical Experimentation and Research).26
'This constitutes the temporal span of human per Barnhart suggests that Buddhism does not
sonhood, though Buddhists see it as bracketed condemn genetic engineering, gene therapy,
both before and after by other existences, not all cloning, and other new biotechnical procedures
of which are human. Michael G. Barnhart points per se. Buddhist moral judgment would evaluate
out that, in the Buddhist view, genes impinge on both motivations and consequences of particular
only one of the constituent aspects of the human actions. Egocentric motives would be disap
being-the body. Thus Buddhism does not sup proved and procedures that distract or deter a
port a "hard" genetic determinism: ''1he body person in their path toward enlightenment
and its associated genetic endowments do not ... would be rejected.21
determine the rest of our nature in any interest
ingly lawlike manner:•24
In discussing genetics and biotechnology gen
erally, the Dalai Lama counsels compassion and Sex sekction and se/,ective abortion
the non-harming of sentient beings. He also According to the Dalai Lama, gender and other
rejects profit, personal preferences, and mere preferences for offspring arise from parental preju
utility as legitimate motivations for genetic dices that should not be exploited for profit28
manipulation.2s Genetic experimentation involv Ethical considerations about selective abortion
ing the destruction of human embryos or other would follow the reasoning on abortion generally.
living organisms would fall under basic Buddhist
(\
/
included as one of the sense organs or faculties complementary rather than incompatible,
of the body-as other organs sense objects although they would argue that Buddhism deep
around us through sight, hearing, smell, taste, ens the insights of conventional psychology. Ryo
and touch, the mind senses mental objects such Imamura, a Japanese-American Buddhist priest
as thoughts, ideas, and imagination, and also therapist, sees Buddhist psychotherapy as "an
interprets and assimilates input from the physical expansion of Western psychotherapy. It appends
sense organs. Such input affects our thoughts. dimensions of compassion and nonduality to the
Buddhism places great emphasis on the mind's rational clarity and precision of Western psy
ability to control various states of health, both chotherapy:' Imamura gives the example of
physical and mental. Clarity of mind is essential; human suffering and happiness: both Western
meditation helps achieve it. 'This is underlined by and Buddhist psychotherapies seek to relieve
the prohibition against intoxication in the fifth suffering and enhance happiness, but only the
Ancient Buddhist beliefs and mythological suffering and offers the "complete transforma
views can be interpreted in modern psychologi tion" necessary to attain true happiness.45
,-iie key ethical consideration here concerns good of life and a breach of the first precept. H
I whether a particular experiment or research the goal is theoretical knowledge, it would
procedure violates Buddhism's first precept amount to the subordination of life to knowl
against destroying life and the principle of non edge, and as with any instrumentalisation [sic]
harm to living beings. H so, even the purported of a basic good would be impermissible." Keown
benefits of alleviation of suffering would he out notes that the Buddhist position makes no ethi
weighed by these fundamental Buddhist ethical cal distinction here between animated and
imperatives. unanimated embryos.46 Likewise, Buddhist ethi
cal prescriptions about human research apply
equally to animal research since animals are
sentient beings that suffer pain. "What about
Damien Keown's summary of the Buddhist issues like vivisection," asks the Dalai Lama,
position on human embryo experimentation can "where animals are routinely caused terrible suf
he generalized to similar kinds of research: "In fering before being killed as a means to further
Buddhist terms, destructive experimentation on ing scientific knowledge?" To a Buddhist, he
embryos represents a direct assault on the basic answers, sueh practi.ces are " shocking"47
.
A ccording to Buddhism, death for the vast grief so as to encourage an auspicious mindset
J-\majority of people falls within the cycle of for the transition. Some Buddhist patients may
samsara as a passage to rebirth into a new life attest to visions or intimations of the circum
form, another change amidst the impermanence stances of their next rebirth. Buddhist clergy
of existence that is governed by one's own often chant bedside blessings or protective ritu
karmic dispositions. Although penultimate in als, and dying patients may wish to meditate or
this sense, human life is nevertheless highly val to contemplate sermons on the dharma.48
ued as the only possible venue for the ultimate Buddhism recognizes that the person is not
goal of enlightenment, the final liberation for the body-the body being only one of five aggre
those who attain it. Dying Buddhist patients may gates comprising a human being-thus the body
ponder their progress-or lack of it-along the is not sacred in some sense at death. Neither is
path toward final liberation, and may experience the person essentially a soul, since Buddhism
anxiety about being reborn into less desirable does not recognize such an entity. At death a
human circumstances or even as a lower life person's aggregated organism disassembles, to
form. Discussion of impending death is not typi he reassembled in the next rebirth-or not, in
cally avoided, though positive thoughts and the case of the enlightened few.
encouragement are preferred over sadness or
Pain control and palliative care Suicide, assisted suicide, and eut"hanasia
Buddhism's emphasis on clarity of mind Despite examples of suicide and other types
recall the fifth precept eschewing intoxicants of voluntary death by religious notables in
may lead some Buddhists to forego pharmaco ancient texts, Buddhism generally condemns
logical palliation in order to maintain mindful deliberate attempts to end one's own life. This
ness in the midst of pain and the dying process. prohibition extends to any agent, such as a
On the other hand, Buddhists may approve of physician, who assists another's suicide-the
pharmacological palliation as an expression of texts label such an agent a "knife-bringer"-or
compassion for physical suffering. even encourages it out of compassion for tragic (J
Improvements in pain management that mini circumstances.57 Based on this Phillip Lecso
mize mental impairment have been welcomed.SI argues that Buddhism advocates hospice care
Buddhist patients may also attempt alleviation of over euthanasia.ss As to the latter, Peter Harvey
physical and mental pain through concentrated observes that "Euthanasia scenarios present a
mental efforts in meditation or through ceremo test for the implications of Buddhist compas
nial acts. sion, but the central Buddhist response is one of
Some Buddhist-influenced hospice and other aiding a person to continue to make the best of
programs for the dying have emerged in recent his or her 'precious human rebirth', even in very
years, including the Zen Hospice Project in San difficult circumstances:'s9
Francisco (http://www.zenhospice.ora;) and the
work of Buddhist teacher Joan Halifax in Santa Autopsy and post-mortem care
Fe, New Mexico (bttp:l!www.peacema1cercommuni Post-mortem care of the body should be kept
~- A small study of women in Thailand indi to the barest minimum, and, if possible, an
cated that "meditation can be a useful interven autopsy should be delayed for three days due to
tion to support women with HIVI AIDS and to the Buddhist belief in the slow release of con
provide a measure of control, to enhance their sciousness from the body (see above under
immunological response to stress, to reduce the Organ and Tissue Transplantation). Buddhist
side effects of treatment, and to diminish anxiety texts are often recited or chanted at death,
and fear."s2 The Dalai Lama counsels that wis though not necessarily in the presence of the
dom might dictate submitting to the karmic body. Buddhist clergy usually officiate at these
manifestations of physical suffering at the end of rituals. In fact, officiating at the occasion of
this life rather than face their prolongation into death became the special province of monks in ('
the next life.53 many parts of Asia.
SPECIAL CONCERNS
The multiple expressions of Buddhism in these dietary restrictions. Drugs that include
I America call for sensitivity to variations in intoxicants as ingredients are generally avoided
beliefs, practices, and cultural nuances among unless overriding medical benefits are indicated.
Buddhist patients and others involved in health
care. The major distinction between the so Religious rituals and obseroances
called "two Buddhisms" of America deserves Buddhism is primarily an individual and fam
special attention. Due to immigration and con ily oriented religion, although regular congrega
version patterns in American history, we find, on tional gatherings have become more common in
the one hand, Buddhists whose faith is an the United States as immigrants adopt the typi
expression of their cultural heritage as Asians cal American style of religion. The concept of
and, on the other hand, non-Asian Buddhists "worship" does not capture the religious experi
who converted to Buddhism as adults. ence of most Buddhists, who instead practice
Buddhism fulfills a different sociological func meditation or a ritual veneration of the histori
tion for each group-affirming ethnic identity in cal Gautama Buddha and various celestial
Asian-American Buddhists and transforming Buddhas and bodhisattvas. Candles, incense,
perspective and self-identity in non-Asian con flowers, gongs or bells, sacred statues and paint
verts.60 Within each of these "two Buddhisms," ings, beads, meditation cushions, and other ritu
of course, variations of expressions and under al accoutrements may be used. Chanting, dhar
standings also exist. ma sermons, and reading/reciting of scriptural
and liturgical texts are common practices. Each
Diet and drugs Asian culture celebrates its own set of religious
Although the first precept against destroying festivals, most tied to the lunar calendar. Special
life and the ethical imperative of non-harming importance is attached to the observation of the
imply an ideal of vegetarianism, most Buddhists historical Buddha's birth (Wesak, observed in
do not practice this ideal. Some Buddhist clergy the. Mahayana tradition, usually in March/April)
and laity may prefer vegetarian meals as a mat or combined birth/enlightenment/death
ter of piety, and a few Buddhist groups may (Visakha, observed in the Theravada tradition,
expect their members to follow the ideal. Most usually in May). An important cultural festival is
Buddhist monks and nuns are restricted by New Year's, held at various times depending on
monastic disciplinary rules to two meals per day, the Asian culture. These occasions draw large
to be completed before noon. After noon they numbers of Buddhists and others to temple
may consume liquids and soft foods that do not activities across the United States.
require chewing. Pious laity taking religious
i
\,
·()·'.
"I
·' vows at certain times of the year may also adopt
1. See, e.g., William Theodore de Bary, ed., The Buddhist 14. ~~~~ilva, "Ministering to the Sick and the Terminally (!'
Tradition in India, China, and Japan (New York:
Vintage Books, 1972); Thanissaro Bhikkhu, The
Buddhist Monastic Code (Valley Center, California: 15. Peter Harvey, "Vinaya Principles for Assigning Degrees
Metta Forest Monastery, 1994). For the sake of con of Culpability," Journal ofBuddhist Ethics, 6 (1999),
venience I have deleted diacritical marks in foreign 271-291.
terms and have not distinguished the languages from
which these terms come (usually Pali and Sanskrit). 16. Casey Frank, "Living Organs and Dying Bodies,"
Tricycle: The Buddhist Review, 7.1 (Fall 1997), 76-77.
2. Paul David Numrich, et al., "Buddhists in America:
Following a Different Religious Path," Buddhists, 17. Paul D. Numrich, Health, Marriage, and Family in
Hindus, and Sikhs in America. Religion in American Selected World Religions: Different Perspectives in a
Life series (New York: Oxford University Press, forth Pluralist America, Marriage, Health, and the
coming). Professions: The Implications ofNew Research into the
Health Bene.fits ofMarriage for Law, Medicine,
3. Walpola Rahula, What the Buddha Taught, 2d and Ministry, Therapy, and Business, Don Browning,
enlarged ed. (New York: Grove Press, 1974), 35. William Doherty, Steven Post, and John Wall, eds.
(Grand Rapids, Michicagan: Eerdmans, 2001). Also,
4. The quote is from the eminent second century see World Religions on Sexuality (Chicago: The Park
Mahayana philosopher Nagarjuna, cited in Peter Ridge Center for the Study of Health, Faith, and
Harvey, An Introduction to Buddhism: Teachings, Ethics, forthcoming).
History and Practices (New York: Cambridge
University Press, 1990), 103. 18. Peter Harvey, An Introduction to Buddhist Ethics:
Foundations, Values and Issues (Cambridge, :
5. The common translation for the term dukkha in the Cambridge University Press, 2000), 434.
First Noble Truth is "suffering," but that does not
carry the full weight of meaning. Dukkha refers to 19. Keown, Buddhism and Bioethics, 128-132.
life's fundamental unsatisfactoriness, which we readily
acknowledge in times of suffering but also experience 20. Keown, Buddhism and Bioethics, 126, 136.
in the best times of life, which do not last forever and
leave us wanting more. 21. Keown, Buddhism and Bioethics, 93-94.
6. Damien Keown, Buddhism and Bioethics (New York: 22. Phillip A. Lecso, "A Buddhist View of Abortion,"
St. Martin's Press, 1995), 1-2. Journal ofReligion and Health, 26.3 (Fall 1987), 214
218; Michael G. Barnhart, "Buddhism and the
7. Lily de Silva, "Ministering to the Sick and the Morality of Abortion," Journal ofBuddhist Ethics, 5
Terminally Ill," Bodhi Leaves series, BL 132 (Kandy, (1998), 276-297; Damien Keown, ed., Buddhism and
Sri Lanka: Buddhist Publication Society, 1994). Abortion (Honolulu: University of Hawaii Press, 1999};
William R. LaFleur, Liquid Life: Abortion and
8. Quoted in Tricycle: The Buddhist Review, 7.1 (Fall Buddhism in Japan (Princeton, NJ.: Princeton
1997), 37. University Press, 1992); Harvey, Introduction to
Buddhist Ethics, 328-341.
9. Keown, Buddhism and Bioethics, 3.
23. Keown, Buddhism and Bioethics, 93-94.
10. Harvey, Introduction to Buddhism, 180-182.
24. Michael G. Barnhart, "Nature, Nurture, and No-Self:
11. Paul D. Numrich, "Posting Five Precepts: A Buddhist Bioengineering and Buddhist Values," Journal of
Perspective on Ethics in Health Care," The Park Ridge Buddhist Ethics, 7 (2000), 131.
Center Bulletin (November/December 1999), 9-11.
25. His Holiness The Dalai Lama, Ethics for the New
12. Damien Keown, Buddhism: A Very Short Introduction
Millennium (New York: Riverhead, 1999), 155-157.
(New York: Oxford University Press, 1996), 10.
13. Keown, Buddhism: A M!ry Short Introduction, 109-112. Keown, Buddhism and Bioethics, 120.
27. Barnhart,"Nature, Nurture, and No-Self," 138. 45. Imamura, "Buddhist and Western Psychotherapies,"
231.
28. Dalai Lama, Ethics for the New Millennium, 156.
46. In the Buddhist view, an embryo is "animated" when
29. Barnhart, "Nature, Nurture, and No-Self," 141. human consciousness arises in it, usually understood
to occur at conception. An "unanimated" embryo has
30. Dalai Lama, Ethics for the New Millennium, 156-157. not been infused with human consciousness or has
lost it in some way. Keown, Buddhism and Bioethics,
31. Keown, Buddhism and Bioethics, 90. 120-122.
32. Keown, Buddhism and Bioethics, 158; Karma Lekshe 47. Dalai Lama, Ethics for the New Millennium, 157.
Tsomo, "Opportunity or Obstacle? Buddhist Views on
Organ Donation," Tricycle: The Buddhist Review, 2.4 48. de Silva, "Ministering to the Sick and the Terminally
(Summer 1993), 34-35. m:·
33. Tsomo, "Opportunity or Obstacle?" 49. James J. Hughes and Damien Keown, "Buddhism and
Medical Ethics: A Bibliographic Introduction,:'
34. See S. H. J. Sugunasiri, ''The Buddhist View Journal ofBuddhist Ethics, 2 (1995), 105-124.
Concerning the Dead Body," Transplantation
Proceedings, 22.3 (June 1990), 948. 50. Keown, Buddhism and Bioethics, 158.
35. Tsomo, "Opportunity or Obstacle?" 34. 51. Patricia Anderson, "Good Death: Mercy, Deliverance,
and the Nature of Suffering," Tricycle: The Buddhist
36. Frank, "Living Organs and Dying Bodies:' Review, 2.2 (Wmter 1992), 36-41.
37. Emma McCloy Layman, Buddhism in America 52. Barbara Dane, ''Thai Women: Meditation as a Way to
(Chicago: Nelson-Hall, 1976), chapter 10. Cope with AIDS," Journal ofReligion and Health,
40. Cited in Kate Prendergast, "Opening the Doors of 57. Keown, Buddhism and Bioethics, 58-60, 168-187;
Perception: Buddhism and the Mind: An Interview Damien Keown, "Attitudes to Euthanasia in the Vmaya
with Mark Epstein," Science and Spirit Magazine, 11.1 and Commentary," Journal ofBuddhist Ethics, 6
t (March/April 2000), 33.
(1999), 260-270.
t
41. Imamura, "Buddhist and Western Psychotherapies,"
234.
58. Phillip A. Lecso, "Euthanasia: A Buddhist
Patricia Anderson. "Good Death: Mercy, Deliverance, and Ryo Imamura. "Buddhist and Western Psychotherapies: An
the Nature of Suffering." Tricycle: The Buddhist Asian American Perspective." The Faces ofBuddhism
Review, 2.2 (Winter 1992), 39-42. in America. Charles S. Prebish and Kenneth K.
Tanaka. eds. (Berkeley: University of California Press,
Michael G. Barnhart. "Buddhism and the Morality of 1998), 228-237.
Abortion:' Journal ofBuddhist Ethics, 5 (1998), 276
297. Damien Keown. "Attitudes to Euthanasia in the Vinaya and
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--- "Nature, Nurture, and No-Self: Bioengineering and 260-270.
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William Theodore de Bary, ed. The Buddhist Tradition in
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Peter Harvey. An Introduction to Buddhism: Teachings, --- "Euthanasia: A Buddhist Perspective." Journal of
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Don Morreale, ed. The Complete Guide to Buddhist
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Different Religious Path:' Buddhists, Hindus, and
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291.
--- "Health, Marriage, and Family in Selected World
James J. Hughes and Damien Keown. "Buddhism and Religions: Different Perspectives in a Pluralist
Medical Ethics: A Bibliographic Introduction:' Journal America:' Marriage, Health, and the Professions: The
ofBuddhist Ethics, 2 (1995), 105-124. Implications ofNew Research into the Health Bene.fits
ofMarriage for Law, Medicine, Ministry, Therapy, and
A
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I
for their helpful comments on earlier drafts of this work.
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THE PARK RIDGE CENI'ER 15
Introduction to the series