But each time he is devoured, so each time he is reborn more sensitive than before.
(Saddharma-smrtyupasthana Sutra, cf. Siksa-Samuccaya. Santideva, fl. 8th century)
Recently I let loose a thoroughly cynical comment on facebook about how I could never be any type of guide or counsellor because I would somehow inadvertently or indirectly encourage people to kill themselves.
When I was a child, my friends used to call me Mother Nature, because I was gentle with all of life and would defend even the nastiest insect. So, those who know me laughed, but for others, my comments touched a nerve. And I was told, in no uncertain terms, that euthenasia is illegal in Canada.
Something I well know.
My sister is a doctor in Nova Scotia. Through her, I heard about Nancy Morrison, a physician charged with 1st degree murder for injecting a dying cancer patient with nitroglycerine and potassium chloride to stop his heart. The patient’s family had removed him from life support, but his dying was horrible and slow and painful. And the painkillers she’d administered, already at a lethal dose, weren’t working.
The courts acquitted Dr. Morrison on the grounds that any number of conditions at the time could have caused her patient’s death. She was also supported by many colleagues who respected her as physician and educator, and didn’t question that she acted with the highest and clearest sense of duty toward her patient.
However, she was suspended from the ICU at Victoria Hospital in Halifax for three months, and later reprimanded by the Nova Scotia College of Physicians and Surgeons. Also, Nova Scotia’s Tibetan Buddhist community came out against her, which surprises me, because the Dalai Lama has said that in exceptional circumstances euthenasia may be possible.
The ethics around euthenasia are obviously a universal concern. Any broad-based argument for it leads to horror and chaos. But according to an Alberta study, many people think that the dying should be allowed to consider assisted suicide – a form of euthenasia. As the author of the study says, the concern demands more than ” just some abstract answer that this isn’t right.”
So why would the Tibetan buddhist community in Nova Scotia take issue with a respected doctor who specializes in end-of-life care, and who made a compassionate decision to hasten a man’s departure rather than make him suffer tortured death throes?
All religions have their load-bearing articles of faith, without which they cannot stand. Buddhism, looser than many religions, more syncretic and adaptive, is still no exception. We cannot underestimate the importance of karma and samsara (cycle of rebirth) in the buddhist faith. Belief in karma and samsara undergirds the tradition, as does a belief in the wisdom of Buddha and his Four Noble Truths.
Teachings on Right View, one of the most important elements of the 8-Fold Path, assert, among other things, that “There is this world, there is a world beyond: this world is not unreal, and one goes on to another world after death.” (Harvey, 2000)
Together, karma and samsara make up the cosmic carrot in front of the donkey – they constrain to make buddhism moral – and belief in them makes buddhists sit up and wonder “Does it really matter what I do?”
Buddhism sets itself apart from other religions, first and foremost, through its chain of causation – a complex notion, more fully developed as dependent co-origination – and in its doctrines of impermanence and no-self. Also, enlightenment is possible for all sentient beings (that means bugs and animals), even if human existence is the best possible state to be in to reach nirvana.
Notably, buddhism focuses on the quality of mind and intentions behind human action and expression, rather than on the actions themselves.
Buddhist doctrine is also not divine revelation from one, or any, god. The Buddha is not a prophet and his words are not prophecy. Rather, he discovered his wisdom over the course of his life(s) through meditative experience. As a result, buddhism does not place the same expectations upon everyone. Buddhists tend to work out their own salvation, for themselves, through meditation, reflection upon scripture, life experience and participation in a religious community, be it monastic or lay. And the tradition offers many ways to achieve enlightenment.
Ethics, though, deal with our treatment of each other – and the quality of such things as cooperation, dependency, power, trust and conflict. Christians have long criticized buddhists for taking no interest in the lot of others, but of course, this is not true. Buddhists tune in to worldly concerns.
However, buddhism takes a ‘middle way‘ when dealing with the stuff of life. Hence the Dalai Lama’s comments in regards to euthenasia … ” the Buddhist way is to judge the right and wrong, or the pros and cons.”
It seems the question at hand is the standards by which buddhists evaluate the rights and wrongs, pros and cons of euthenasia.
According the the Four Noble truths, we are trapped in the human condition (dukkha – suffering) through our ignorance over its true cause.
That cause is usually translated as craving, or desire, but I will call it ‘clinging to that which is not real,’ because craving is a loaded term. I wish to escape the heavy handed morality that comes, especially in Theravada and Tibetan buddhism, as a result of too much focus on the ‘three poisons’ of craving: delusion, greed and hatred (not to mention the insane over-complexity that comes with their scholastic bent for categorization).
Tibetan buddhists (and other Mahayana buddhists) often refer to the Kalama Sutra, with its teaching on rebirth in a lower order as the karmic consequences of ‘unwholesome’ mental states: delusion, greed and hatred. It’s a simple interpretation of the Four Noble Truths, since, according to the chain of causation, consciousness itself arises from craving and craving from consciousness.
There is no linear relationship from delusion, greed or hatred to craving to rebirth. Rather, because everything depends upon everything else, to cut it all, one must cut at the root – ignorance about the true nature of things. How that’s best done, of course, varies between all the powerful schools of buddhism. Nevertheless, insight into the reality of things and a state of non-attachment approximates nirvana across all of buddhism.
Yes, we all know that nirvana is the buddhist end game – extinguishment of karma, freedom from suffering and the cycle of rebirth. Whether it takes on cosmic properties or not, is also subject to different ideas among the schools. I don’t find nirvana particularly exciting if it doesn’t take on cosmic properties. On the other hand, the situation gets insensible when it does. Hocus pocus. Something else buddhism is famous for.
Though the wise should hope, “By this virtue or this performance of duty, or this penance, or this righteousness will I make the karma that is not yet mature, mature.
Though the fool should hope, by the same means, to gradually get rid of karma that has matured. Neither of them can do it.
According to the Fourth Noble Truth, perfecting the 8-fold path will eventually lead to nirvana and the end of suffering; you will stop producing karma, find wisdom, and become ‘one’ with the truth. While right view is seen as the keystone to an arising in toto of the 8-fold path, morality – Right Speech, Right Action, Right Livelihood – usually comes as a first step. Buddhism is moral: good behaviour helps support good habits of mind.
The five precepts, taken by lay and monastic buddhists alike, describe, to a certain extent, the ‘right’ moral behaviour of the 8-fold path. The first precept is to abstain from ‘onslaught’ of a sentient being; in other words, do no harm. It is just one of those things that automatically produces karma. Blatantly, this means to abstain from killing.
As I mentioned earlier, buddhism stresses that intentions more powerfully generate karma than actions themselves. Buddhism’s main criteria in thinking about the wholesomeness of actions are:
- the motivation of the action – state of mind – with greed, hatred and delusion (lying in all forms) being unwholesome motivation, and the opposites non-greed, non-hatred and non-delusion being wholesome motivation.
- the intention of the action – its intended direct effects – implies reflection upon the consequences of actions in self and others, and abstaining if the actions can be seen to cause harm, either spiritual or material.
- the action’s contribution to spiritual development – its consequences – did they aid enlightenment and its attributes or did they lead to further torment.
Buddhists worry about state of mind at time of death, because they believe it helps determine the rebirth to follow. So a main objective in buddhist end-of-life care (see research on buddhist hospice movement) is to help a person have a ‘good’ death: one which is calm and free from all attachments. But, as Buddha pointed out, “we are all on fire.” Many people are far removed from mediation and a buddhist insight into our true nature, so really, outside of the faith, is dying like the Buddha the only possible ‘good’ death available to us?
I think so.
As with everything, buddhism takes the middle way. Theravada accepts that society changes, and sees the precepts as principles that help people work out codes to meet their circumstances, rather than as iron-clad social laws.
More so than Theravada, Mahayana applies the precepts with an eye to the circumstances at the time: under certain conditions they may be broken, if doing so is an unavoidable part of acting to help someone when motivated by compassion.
The well-instructed disciple of the noble ones discerns what ideas are fit for attention, and what ideas are unfit for attention. This being so, he does not attend to ideas unfit for attention, and attends to ideas fit for attention.
He attends appropriately, This is suffering… This is the origin of suffering… This is cessation of suffering… This is path leading to the end of suffering. As he attends appropriately in this way, three fetters are abandoned in him: identity-view, doubt, and grasping at precepts & practices.
It is not by caring for one’s own body or killing one’s own body that one acquires karmic fruitfulness or commits a misdeed. That is why it is said in the Vinaya that suicide is not a fault of onslaught on a living being, but it is sullied by delusion, by attachment, and by hate.
While suicide is not a breach the 1st precept, buddhists assert that no one in a state of equanimity would kill themselves; the state of mind that leads to suicide must be aversion to an unpleasant situation, or craving for some goal. And since craving and aversion lead to suffering and rebirth, the state of mind that leads to suicide is not the state of mind in which spiritual development can be achieved. So, suicide, including martyrdom, is strongly discouraged.
Conversely, according to the buddhist monastic code (Theravada), the Vinaya (III.82, and Buddhaghosa’s Commentary A.467), we have no moral obligation to 1) preserve life at all costs or 2) to eke out a life in which no more spiritual development can attain.
The code legitimates two instances of suicide when death is imminent. In both cases, death does not impede spiritual development. And, it is the unintended side-effect of compassionate acts. Neither case is an example of assisted suicide.
- But of whom there is a great illness, long-lasting, (and) the attending monks are wearied, are disgusted, and worry ‘what now if we were to set (him) free from sickness?’: if he, (thinking): ‘this body being nursed does not endure, and the monks are wearied’, stops eating, does not take medicine, it is acceptable.
- Who (thinking) ‘this illness is intense, the life-activities do not persist, and this special (meditative) attainment of mine is seen as if I can put my hand on it’ stops (eating): it is acceptable, surely.
Euthenasia or Mercy Killing
What happens, though, when similar actions are carried out by another: a doctor kills someone in intense pain whose death is at hand, or kills someone unable to agree or disagree to it – for example via a decision taken in consultation with relatives, or via permission of the courts, to remove someone from life support?
While one would think that buddhist emphasis on compassion, and its acceptance that death is the natural course of a life would permit euthenasia, the Vinaya rejects the idea that life could ever be sacrificed in the name of another value, such as friendship or compassion. The code is unequivocal: the intent of euthenasia is to deliberately kill a person, to cause a person to be killed or to approve of the killing. It condemns all such acts as a breach of the 1st precept.
The Vinaya elaborates upon its condemnation of euthenasia via the following points:
- Killing someone to end their suffering may not have its intended consequences, the suffering may continue, and in worse form than before.
- No act of euthenasia could be carried out without aversion to the patient’s pain and suffering. The pain disturbs the caregiver, so to advocate death on the grounds of compassion is rooted in delusion and the compassion involved is unwise.
- A person can use the process of dying as an opportunity for gaining insight into reality. An enforced death could cut short an opportunity, which, given the buddhist principle of no-self, could arise at any time, since a person is changeable moment by moment. In all cases a person who kills someone must bear responsibility for the action, even if that person has asked to be killed.
The first argument above is clearly informed by specific religious concerns; the notion of reincarnation is a matter of faith, it does not hold universally and can be dismissed. The consequences that follow from euthenasia in this life need to be considered, and the effects of the act on all concerned, rather than speculating about what may take place in the next.
The second argument, I think holds universally. All of life is suffering, it’s inescapable. However, for buddhists, suffering has no inherent value. Unlike christianity, buddhism rules out suffering for the sake of penance, or because it has been ordained by God. As humans, we are free to take action and change our circumstances, rather than to simply bear them. Moreover, specific types of suffering are not necessarily the result of one’s karma.
According to buddhism, life’s causes are so complex they can only be seen by the “pure mind of a Buddha.” At some point, people are limited by space and time and the circumstances they are in. Since most of us do not partake of the ‘mind of the Buddha,’ we have to make human decisions and errors, and accept responsibility for them.
I agree with some of the implications in third argument: it’s a sound metaphysical principle that our true nature consists of no-self, subject to conditioned arising. Its natural extension, picked up in Mahayana, is that enlightenment is possible for anyone at any time, given the right conditions. However, unless a person can accept suffering in a way that allows spiritual progress, it has no good, or practical use.
At what point a doctor would be assisting to hasten the death of someone who is dying in much pain, or obstructing the full extent of a meaningful life is a fine distinction, certainly. However, Buddha’s wisdom tells us that we suffer until we let go of all attachments – including any to karma or to suffering. So, the distinction is not one to made, at the point it must be, by theologians worrying about little more than the effects in the afterlife. It is a distinction to be made by a physician – someone who has vowed to preserve life and do no harm – experienced in managing end-of-life care, who has the quality of person and ethical foundations that enable her to best serve the needs of the person dying – with compassion above self-interest.
When Santideva, author of the Way of the Bodhisattva, argued that trying to cultivate indifference to the suffering of others was as absurd as trying to cultivate indifference to one’s own suffering, buddhism shifted from a focus on personal spiritual development to a focus on the development of compassion and working toward the welfare of all sentient beings.
An 8th century Madhyamika, Santideva demonstrated that ‘self ’ and ‘other’ are empty terms: they can only be understood relative to each other. Neither ‘the self’ nor ‘the other’ can be shown, in any way, to intrinsically be ‘the self’ or ‘the other.’ So, there is no self, there is no other, and there is no distinction between the two. There is, also, no point in attaching to these concepts.
Moreover, with tricky Madhyamaka – all processes of conditioned arising (the phenomenal world as a whole – everything we know), are empty of inherent, substantial existence – even karmic fruitfulness is empty – so, there is no real fault in any action done out of craving as long as it is allied with compassion ( i.e., its motive is to help people find enlightenment). Since suffering is nothing special to anyone, and since it’s unnecessary and it hurts, (or worse can do spiritual harm), we should work to get rid of it where ever we find it.
Santideva was a fan of the bodhisattva: great, enlightened figures with one foot in nirvana, the other in samsara: perfectly wise, compassionate and equanimous, utterly selfless, willing to take on karmic results on behalf of others in order to help with their salvation. A bodhisattva is prepared to go to hell, rather than allow another to be reborn there.
Skillful Means (Upaya kaushalya)
At the time for giving one can overlook the practice of morality and so forth. But for all that he must not be lax.
( Aksayamati Sutra cf. Santideva)
The bodhisattva’s use of skillful means is central to Mahayana doctrine. It is the bodhisattva’s capacity, in a state of perfected wisdom and compassion, to fit teachings or ethics to the audience and situation at hand. The bodhisattvas’ compassion undercuts any sense of self-other, while their wisdom ensures appropriate, effective action. So, according to their enlightened point of view, bodhisattvas can act with plenty of leeway, even to the point of ‘skilfully’ breaking the precepts.
Some Mahayana texts (e.g. Upaya kaushalya Sutra) justify a bodhisattva’s killing a human on the grounds of compassion in dire circumstances. For example, killing a person would have to be the the least evil of several evils and done out of a compassion developed by virtue of the 8-fold path (i.e., is perfected). The act of killing would be accompanied by horror. The bodhisattva would have to acknowledges that the killing is evil, not in anyway justified or meritorious, and that it can lead to many rebirths in hell. The bodhisattva would have to be willing to suffer accordingly.
Obviously, the ends justify the means approach in skillful means leaves the doctrine open to abuses on the basis of expedience. Buddhists understood this – it is an exclusive province of the capable, and fraught with very imminent peril (Tsongkha-pa) – which is why its teaching was reserved for practitioners with a level of spiritual maturity advanced enough for them to act appropriately.
The doctrine of skillful means suggests that it is selfish to put one’s own salvation ahead of another’s simply to observe a set of principles suited for conditions that do not persist in the immediate situation. Rather, first we have to see things for what they really are, as they are, in their full entirety, and only then make painfully careful decisions and take full responsibility for their consequences.
If we return to my original enquiry …
the question at hand is the standards by which buddhists evaluate the pros and cons of euthenasia ..
I think I’ve been able to provide an answer.
Clearly, rather than any normative, external law, such as ‘thou shalt not kill,’ the standard of concern for buddhists is the state of mind in both the subject of euthenasia and the person(s) who commit the act. On both sides of the equation euthenasia cannot be an expedient, it must be a pure manifestation, as it were, of right view.
I think the fundamental question buddhism asks that I have not answered is not whether we can, but “Should we?”
Therevada constrains us to say, “No, we should not,” because the situations that persist in life will always be conditioned – there is an arising between people that will never be clean of the potential, if not the reality, for false perception.
Theravada, of course, does allow for unlimited expression of a fully aware mind. As is typical, though, with Theravada, everything important is a lonely business. So, an individual, spiritually advanced and gifted with insight, can make for him/herself a clean death. It will take lifetimes in the making, but gentle self-mortification – suicide – while not preferred, can be an expression of enlightenment.
I have to rely upon a Soto Zen expression of skillful means “body and mind dropping off, dropping off body and mind,” to demonstrate my point here. And that is, that skillful means exists in both traditions, and it imparts some moral flexibility to the buddhist opinion on terminating a life before it’s due.
I will end here, where I think both Theravada and Mahayana merge – with the capacity for enlightenment given the worst conditions in this world.
Mahayana is not so pessimistic as Theravada about people. At its core, through Hua-yen, it recognizes that we get our fingers in each other’s clay. All of life is interpenetration. This insight, in its full flower, breeds boundless, wise compassion. Pain and love – all the beauty and all the ugliness – everything – even enlightenment – is in the mud we’re made of. For Mahayana, enlightenment can arise out of that mud under any conditions, plain and simple.
It doesn’t require 8000 lives and dedicated study in a temple to find a clear mind. Moment by moment, bit by bit, part by part, that’s the mud we’re made of. So, as we play the potter to see what shapes we can make of each other, if a lotus is in the making and wends it way up from the murky bottom of a pond to blossom on the clear waters at top, rare though it may be, it be a lotus.
Buddhism … enlightenment and death are tied so closely together. Certainly, enlightenment is what’s at stake for the Tibetan buddhist community in the Nancy Morrison case, and not some worry over a rabid angel of death running around tidily and clinically killing weak old people under the cover of darkness.
Was struggling in the last moments of a guy’s life, whose chest was caved in and whose throat was out of his mouth, to ease burning agony some pure act of enlightenment?
But if it were my dad, enlightenment would be the very last thing on my mind. And there would be no cause to put him through that, just so that I could sit back and observe that I am upset by his suffering and save myself from heading down the roads of hell with him.