Buddhism, euthanasia and the sanctity of life

·期刊原文

Buddhism, euthanasia and the sanctity of life

by Perrett, Roy W.

Journal of Medical Ethics

Vol. 22, No. 5 Oct.1996 , Pp.309-314

Copyright by Journal of Medical Ethics

Abstract

Damien and John Keown claim that there is important common ground between
Buddhism and Christianity on the issue of euthanasia and that both
traditions oppose it for similar reasons in order to espouse a "sanctity of
life" position. I argue that the appearance of consensus is partly created
by their failure to specify clearly enough certain key notions in the
argument: particularly Buddhism, euthanasia and the sanctity of life. Once
this is done, the Keowns' central claims can be seen to be either false or
only restrictedly true.

Introduction

Damien and John Keown claim that there is important common ground between
Buddhism and Christianity on the issue of euthanasia and that both
traditions oppose it for similar reasons in order to espouse a "sanctity of
life" position.~ More particularly, they claim that the following five
conclusions may be drawn about euthanasia in Buddhism and Christianity.
First, that despite their cultural and theological differences, there is a
striking similarity in the two religions' opposition to the intentional
killing of patients. Second, this opposition derives from their shared
rejection of consequentialist reasoning in favour of an ethical approach
grounded in a respect for life as a basic as opposed to an instrumental
good. Third, notwithstanding their absolute opposition to euthanasia, both
religions teach that life is not an absolute value to be preserved at all
costs and emphasise the transitoriness of earthly life. Fourth, this
consensus challenges prevalent assumptions about the impossibility of moral
consensus in the modem world. Fifth, this consensus lends support to the
conviction that a common set of core values may be found in the teachings
of the world religions?

The ecumenical spirit of these conclusions may be uplifting, but their
truth, I shall argue, is rather more dubious. Moreover, the appearance of
consensus between the two traditions is partly created by the Keowns'
failure to specify clearly enough certain key notions in the argument:
particularly Buddhism, euthanasia and the sanctity of life. Once this is
done, the claims above can be seen to be either false or only restrictedly
true.

Euthanasia

Euthanasia is "mercy killing". More formally, it is the killing of those
who are incurably ill and in great pain or distress, where the killing is
done for the sake of those killed, and in order to spare them further
suffering or distress. This motivation distinguishes euthanasia from most
other forms of taking life. Euthanasia can take three forms: voluntary,
involuntary and non-voluntary. Euthanasia is voluntary when it is carried
out at the request of the person killed. Sometimes this may be scarcely
distinguishable from assisted suicide; other times people wanting to die
may be physically incapable of killing themselves. Euthanasia is
involuntary when the person killed is capable of consenting to her own
death but does not do so. Euthanasia is nonvoluntary when the subject is
unable to consent: for instance, because she is a severely handicapped
infant, or because she is an irreversibly comatose adult who has omitted to
specify previously how she wished to be treated in such an eventuality.

All three kinds of euthanasia can be either active or passive. Active
euthanasia typically involves a deliberate act which results in the
patient's death (for example, administering a lethal injection). Passive
euthanasia involves a deliberate omission (for example, withdrawing or
withholding life-sustaining treatment).

What do the Keowns understand by "euthanasia"? They explain themselves
thus: "By 'euthanasia' we mean the intentional killing of a patient by act
or omission as part of his or her medical care. We are not concerned,
therefore, with either the administration of palliative drugs, or the
withdrawal of futile or excessively burdensome treatment, which may, as a
foreseen side-effect, hasten death".[3]

Given this gloss on "euthanasia" it seems the Keowns hold that both
Buddhism and Christianity reject euthanasia in its voluntary, involuntary
and non-voluntary forms. They also apparently include in this rejection
both active and passive euthanasia, since they concede that omissions as
well as acts can constitute euthanasia. However, they clearly feel too that
some version of the doctrine of double effect enables them to exclude as
cases of euthanasia certain acts and omissions, the foreseen but unintended
consequences of which, will be the patient's death. Thus, although Buddhism
and Christianity are both supposed to be opposed to euthanasia, neither is
thereby committed to life being an absolute value to be preserved at all
costs.

The sanctity of life

It is often rather unclear just what is meant by an appeal to "the sanctity
of life" in bioethical disputes. In the bioethical literature nowadays,
however, it is usually assumed that the doctrine of the sanctity of life is
roughly the claim that all human life is of equal intrinsic value.
Accordingly, except in cases of the legitimate defence of others' lives, it
is always intrinsically wrong to take human life (though it may sometimes
be permissible to let someone die).[4]

The Keowns express concern about the frequent misrepresentation of the
doctrine of the sanctity of life. But their own explanation of it is
unfortunately not as clear as it might be, for they offer several,
apparently logically distinct, formulations of it. These include the
following four theses: (1) That as life is a gift from God, it is to be
cherished. (2) All human beings are to be valued, irrespective of age, sex,
race, religion, social status or their potential for achievement. (3) The
deliberate taking of human life is prohibited except in self-defence or the
legitimate defence of others. (4) Human life is a basic good as opposed to
an instrumental good, a good in itself rather than as a means to an end.[5]

Obviously these four formulations are not logically equivalent, and the
supposed relations of implication between them are unspecified. But
presumably for the Keowns, affirming the sanctity of life doctrine at least
involves affirming one or more of (1)-(4). The Keowns quickly acknowledge
that (1) would be denied by Buddhism as a corollary of its denial of a
creator God. Instead, Buddhism's purported belief in the sanctity of life
"is grounded not in its divine origin but in its spiritual destiny, namely
the state of final perfection known as nirvana".[6]

Buddhism

Trying to make plausible general descriptive claims about Buddhism's
attitudes to euthanasia presents us with a number of difficulties. Firstly,
there is the relative paucity of explicit Buddhist discussions of this or
other bioethical issues.[7] Accordingly, most of the burgeoning secondary
literature in this area is reconstructive or speculative to varying
degrees. Secondly, there are many schools of Buddhism and no central
authority on matters of precept or practice.

The Keowns do not see a problem with this second issue. This is because
they claim that there is "a consensus on ethics among the main schools" and
that for the purposes of their article it is permissible to take the
Theravada tradition, "the oldest and most orthodox of the surviving
traditions", as representative of the Buddhist position.[8] This procedure,
however, just slides over a number of important questions in a quite
unacceptable way.

In the first place it is not at all clear that there is a consensus on
ethics among the main Buddhist schools, especially on this issue. Even if
we confine ourselves only to Indian Buddhism, there are significant
differences between the ethics of the Mahayana and the Hinayana, as Damien
Keown himself admits elsewhere? When we come to consider the Buddhist
traditions of Tibet, China and Japan we find still further differences.
Moreover, since the Keowns suggest that part of the interest of their
comparison lies in the fact that Buddhism is an influential religion with
roughly 500 million Asian adherents,[3] it is worth remarking that the vast
majority of these persons are Mahayanists. While the Theravada may indeed
be the oldest surviving Buddhist school, it is quite incorrect to suggest
that it is the "most orthodox" if by that is meant (as the dictionary
definition of "orthodox" would suggest) that it holds correct or
unheretical religious doctrines. Theravadin doctrines and texts have no
authority in Mahayana Buddhism.

In the second place we need to be clearer about what sort of evidence is
adduced in support of descriptive claims about Buddhism. The Keowns' claims
about Theravada Buddhism rely on certain canonical Pali texts. Observers
report, however, that sanctioned Buddhist practice in the Theravada lands
is often rather different.[10] Why valorize the textual, rather than the
contextual, tradition in making general claims about Buddhism? Certainly
truths about Buddhism which are based entirely on certain normative
monastic texts can have at best restricted scope.

Finally, the nature of the Theravada texts that are utilised by the Keowns
needs to be understood. They rely on the Vinayapitaka, the case books of
monastic discipline. However, rather than enunciating general principles
from which particular judgments can be derived, the Vinaya prefers
extensive listing of individual cases and the Buddha's reported judgment
thereon, often making it difficult to see what the ratio of the particular
judgment might be. Moreover it is important to realise that the cases
involve breaches of monastic discipline. Thus the Keowns correctly claim
that various cases of killing, and even inciting to suicide, are condemned
in the Vinaya as unsuitable activities for monks, meriting the stringent
penalty of parajika. But this penalty is not "lifelong excommunication", as
the Keowns gloss it.6 It is simply expulsion from the monastic order, not
from the Buddhist community. Moreover a monk can also suffer a similar fate
for three other offences: sexual intercourse, theft, and falsely claiming
superhuman powers. The special ethical demands on monks are obviously
rather more rigorous than those on Buddhist laypersons.

Five claims reconsidered

With these distinctions in mind, I want now to reconsider the Keown's five
claims about Buddhism and euthanasia.

(i) Buddhism and Christianity are united in their opposition to euthanasia.
I am only concerned with the Buddhist component of this assertion, which as
a general claim is surely false. Buddhists (like most bioethicists, secular
and religious) probably generally oppose involuntary euthanasia. But there
are Buddhist traditions sympathetic to both voluntary and non-voluntary
euthanasia, under certain conditions.

Since voluntary euthanasia often amounts to assisted suicide, it is
important to recognise that Buddhist attitudes to suicide have always been
much less harsh than Christian ones. Suicide from despair has been seen in
Buddhism as a prudential error since, given their unresolved karma,
suicides will just be reborn in situations similar to those they were
seeking to escape from. Even in the Pali canon, however, properly motivated
suicides of monks are permissible.[11] In the Mahayana Buddhism of East
Asia these tendencies become much more, [12] with this tradition coming to
some prominence in the 1960s because of the politically motivated
self-immolations of certain Vietnamese monks. Moreover, there developed in
Japan a well known cult of morally approved ritual suicide (seppuku or,
more vulgarly, harakiri), including the use of an attendant (kaishaku) who
assists the suicide by beheading him after he has stabbed himself, in order
to minimise his suffering. [13]

Traditional Japanese attitudes to the nonvoluntary euthanasia of infants
are also quite permissive. Midwives would not assume that a new-born baby
should live, but would ask if the infant was "to be left" or "to be
returned". Defective infants were regularly subject to "thinning"
(mabiki).[14] Just as a tolerance for, and ritualisation of, abortion
evolved in Japanese Buddhism,[15] so too did a tolerance for, and
ritualisation of, euthanasia under certain circumstances.

Tibetan Buddhism seems rather less tolerant of abortion.[16] However, the
Dalai Lama himself has indicated that euthanasia may sometimes be
permissible: "In the event a person is definitely going to die and he is
either in great pain or has virtually become a vegetable, and prolonging
his existence is only going to cause difficulties and suffering for others,
the termination of his life may be permitted according to Mahayana Buddhist
ethics".[17] And the late Kalu Rinpoche, a very senior Kagyu lama, said
clearly both that persons who are terminally ill and decide to take
themselves off life-support perform a "karmically neutral act", and that
assisting a dying person who asks us to remove life-support is also
karmically neutral, provided our basic motivation is to relieve the
patient's suffering.[18]

All of this is not, of course, to deny that some Buddhists may indeed
oppose euthanasia.[19] But there is no general Buddhist consensus on this
stand, particularly in the Mahayana traditions.

(ii) Buddhist and Christian opposition to euthanasia derives from a shared
rejection of consequentialist reasoning in favour of an approach that
respects human life as a basic, not an instrumental good. Again I dispute
the Buddhist part of this claim. Although Buddhist ethics emphasises the
importance of the agent's intentions or motives, it is also arguably
strongly consequentialist, especially in its Mahayana forms.[20]
Consequentialism as a theory of the right holds that actions are right
insofar as they promote the good.[21] For Buddhists this good is the
elimination of suffering (duhkha). Motives too are important in Buddhist
ethics, but consequentialists can admit the importance of motives, provided
the goodness of a motive depends on how good its overall consequences
are.[22] For Buddhists this means that the goodness of a motive depends on
whether it promotes the elimination of suffering. Thus we can find even
canonical Theravadin texts which affirm that whatever action, bodily,
verbal, or mental, leads to suffering for oneself, for others or for both,
that action is bad; while whatever action, bodily, verbal, or mental, does
not lead to suffering for oneself, for others or for both, that action is
good.[23]

Accordingly Buddhism does not value human life as an intrinsic good. It is
true that the extreme rarity and preciousness of a human birth is often
emphasised in Buddhism, especially in the Tibetan tradition. But the
preciousness of a human birth is because only as a human is it possible to
practise the dharma successfully and achieve the goal of the elimination of
suffering, ie nirvana.[24]

Nor does Buddhism affirm anything significantly like the Christian doctrine
of the sanctity of life. Consider again theses (1)-(4) above, which the
Keowns themselves offer as glosses of the doctrine. Buddhism actually
denies both (1) and (2). (3) is too narrow as a formulation of the
traditional sanctity of life doctrine, and anyway (as we have seen) there
are Buddhist exceptions to it. Since (2) does not indicate how much every
human is to be valued, it is so weak a formulation of the doctrine of the
sanctity of life as to be inoffensive not only to the Buddhist, but even
to the dreaded utilitarian bioethicist, who also, after all, opposes wanton
killing.

Consider instead the following thesis which seems to capture better an
important part of the traditional Christian understanding of the sanctity
of life doctrine and its resistance to quality of life tradeoffs:

(5) All human life is equally valuable and inviolable. Does Buddhism affirm
this (as, many claim, Christianity does)? Apparently not, for even the
authoritative Theravadin commentator Buddhaghosa writes: "In the case of
humans the killing is the more blameworthy the more virtuous they are".[25]

(iii) Both Buddhism and Christianity teach life is not an absolute value to
be preserved at all costs and emphasise the transistoriness of life.
Agreed, though Buddhism's reasons for this are significantly rather
different. Most importantly, however, Buddhism (unlike Christianity) does
not have to try to square this claim with the sanctity of life doctrine
since Buddhism does not affirm the latter doctrine in any form close to a
Christian understanding of it. Accordingly Buddhism does not have the same
pressure to espouse philosophically dubious notions such as the doctrine of
double effect, the distinction between "ordinary" and "extraordinary"
treatment, or the claimed intrinsic moral difference between acts and
omissions.

(iv-v) The consensus of Buddhism and Christianity about euthanasia both
challenges pessimism about the possibility of moral consensus and supports
the conviction that the world religions share a common core of values.
Since the supposed general consensus about euthanasia does not exist, the
optimism expressed in these claims remains to be justified.

Key words

Death and dying; religious ethics; Buddhism; euthanasia; sanctity of life.

References and notes

1 Keown D, Keown J. Killing, karma and caring: euthanasia in Buddhism and
Christianity. Journal of Medical Ethics 1995; 21: 265-.9.

2 See reference 1: 268.

3 See reference 1: 265.

4 On this understanding of the sanctity of life doctrine see, for instance,
Glover J. Causing death and saving lives. Harmondsworth: Penguin, 1977;
Kuhse H. The sanctity-of-life doctrine in medicine: a critique. Oxford:
Clarendon Press, 1987.

5 See reference 1: 267.

6 See reference 1: 266.

7 There is, however, a growing secondary literature on these issues. For a
useful (but by no means exhaustive) bibliographical review see Hughes J,
Keown D. Buddhism and medical ethics. Journal of Buddhist Ethics 1995; 2:
105-24.

8 See reference 1: 268, n. 3.

9 Keown D. The nature of Buddhist ethics. New York: St Martin's Press,
1992: ch. 6.

10 On Sri Lanka, for instance, see Gombrich R. Precept and practice.
Oxford: Clarendon Press, 1971; on Burma see King W. In the hope of nibbana.
LaSalle: Open Court, 1964, and Spiro M. Buddhism and society. New York:
Harper, 1970.

11 See Wiltshire M. The "suicide" problem in the Pali Canon. Journal of the
International Association of Buddhist Studies 1983; 6: 124-40; Lamotte E.
Religious suicide in early Buddhism. Buddhist Studies Review 1987; 4:
105-18. The Keowns admit this point (see reference 1:268 n. 13), but try to
play down its significance. See also Keown D. bioethics. New York: St
Martin's Press, 1995: 58-60.

12 See Jan Y. Buddhist self-immolation in medieval China. History of
Religions 1965; 4: 243-68; Rahula W. Zen and the taming of the bull.
London: Gordon Fraser, 1978:111-4.

13 Seward J. Hara-kiri: Japanese ritual suicide. Rutland: Charles E Tuttle,
1968; Kakubayashi F. A historical study of harakiri. Australian Journal of
Politics and History 1993; 39:217-24; Pinguet M. Voluntary death in Japan.
Cambridge: Polity Press, 1993. On the significance of these attitudes for
the issue of euthanasia see Becker C. Buddhist views of suicide and
euthanasia. Philosophy East and West 1990; 40: 543-56.

14 Singer P, Kuhse, H. Should the baby live.> Oxford: Oxford University
Press, 1985: 105-7.

15 On Japanese attitudes to abortion see LaFleur W. Liquid life: abortion
and Buddhism in Japan. Princeton: Princeton University Press, 1992.

16 Stott D. Buddhadharma and contemporary ethics. Religion 1992; 22:
171-81.

17 The Dalai Lama. [letter]. Asiaweek 1985 Nov 1: 73.

18 Sogyal Rinpoche. The Tibetan book of living and dying. London: Rider,
1992: 374.

19 Note, for instance, the reported "growing consensus among the Thai
public that euthanasia (passive or active) is morally unjustifiable" in
Ratanakul P. Thailand: refining cultural values. Hastings Center Report
1990; 20: 27. See also Florida R. Buddhist approaches to euthanasia.
Studies in Religion/Sciences Religieuses 1993; 22: 35-47, which is
primarily focused on Thailand.

20 Perrett R. Egoism, altruism and intentionalism in Buddhist ethics.
Journal of Indian Philosophy 1987; 15: 71-85.

21 See Pettit P. Consequentialism. In: Singer P, ed. A companion to ethics.
Oxford: Basil Blackwell, 1991: 230-40. Note that the Keowns' own definition
of "consequentialism" as the view that "the morality of an action turns
solely on its consequences" (see reference 1: 267) is probably too crudely
restrictive. For a sample of the varieties of consequentialism see Pettit
P, ed. Consequentialism. Aldershot: Dartmouth, 1993.

22 See Adams R. Motive utilitarianism. Journal of Philosophy 1976; 73:
467-81. For the even stronger suggestion that "broad consequentialism" (as
opposed to "narrow consequentialism", or utilitarianism) can allow for
certain modes of acting having intrinsic value which have to be included in
the calculations when seeking to maximise value see Sen A. Evaluator
relativity and consequential evaluation. Philosophy and Public Affairs
1983;

23 Majjhima-nikaya 61, 88. Elsewhere Damien Keown resists consequentialist
representations of Buddhist ethics in favour of a view of Buddhism as a
teleological virtue ethic (see reference 9: ch. 7). However, even there he
also readily concedes that consequentialist representations of Buddhist
ethics are popular with other Buddhist scholars and find support in both
Theravada and, most especially, Mahayana, texts. Personally I find quite
unpersuasive Keown's arguments for his own virtue-based representation of
Buddhist ethics, but this is a rather large issue which I cannot deal with
here.

24 See, for instance, Guenther H. The jewel ornament of liberation by
sGam.po.pa. Boulder: Prajna Press, 1971: 24.

25 Conze E. Buddhist scriptures. Harmondsworth: Penguin, 1959: 70.

By Roy W Perrett Massey University, Palmerston North, New Zealand

Roy W Perrett is Senior Lecturer in Philosophy in the Philosophy Department
of Massey University, Palmerston North, New Zealand.