Euthanasia or “good death” is the concept of ending a life to relieve pain and suffering intentionally as long as there are approvals from the patient and their relatives. This concept can be classified into different categories: Voluntary, Non-voluntary or Involuntary and the procedural classifications: Active and Passive euthanasia which only the procedural will be discussed in this essay. Active euthanasia is the use of lethal substances or forces to end a patient’s life. Many cases involve directly injecting poison to the patient or an overdose of sleeping pills or pain killer. For passive euthanasia, it also have the intention of ending a patient’s life, but no real action being done. It usually defined as withdrawing medical treatment from the patient who requested euthanasia (Pregnantpause, 2001). The basic concept to distinguish between the two is whether there is an action involved in ending the patient’s life or not. When there is a topic about ending a life or killing, religion concepts are usually applied and talked about in society. Different religions have different perspectives for each topics and Buddhism will be the main focus. According to Florida (1993, 2), there is no Mahayama treatments of this topic, hence the majority of the discussion will be based on Theravada. This paper will underlie the bioethics of Buddhism, their perspective on active and passive euthanasia.
Religious path for Buddhist ethics have the ultimate goal of obtaining absolute wisdom and be released from cycle of rebirth (samsara). In the quest of enlightenment, a Buddhist need to go through threefold of training including ethics, meditation and wisdom. Just as the earth is the foundation of all things in the world, so does ethics are the root and basic of deeds (Fujii ,1991). When something is helpful to self and others, it is considered a skillful deed (kusula karma) and if it is harmful, it is an unskillful deed (akusula karma). Principles of ethics are good as long as ones followed the path assertively and are able to conduce along the path. Buddhist ethics have always been understood as the path of wisdom along with disciplinary aspects. For instance, one might meditate to gain wisdom and eventually enters the path of enlightenment and along the way, he has to restrain himself from sexual misconduct or taking alcoholic beverages (Florida, 1993, 3).
To understand euthanasia from Buddhist perspectives, the concept of karma should be understood. Karma refers to any actions that leave an imprint behind. It is the concept of actions from this life will have consequences within the same life or the next life. Negative actions will result in suffering and positive actions will result in happiness. Perspective of karma differs through religions (Fujii, 1991). For instance, Jainism views that all karma are negative as one always cause suffering for others, but Buddhism views this differently. Buddhists believe that there is no strict determination of karma. If one lives according to dharma, the law of righteousness and acts with good intentions then it’s considered a good karma and progress to enlightenment. If one acts with untamed mind-wills or poisonous motive of delusion, foolishness and aggression will shown then the act is unskillful and will result in harming oneself and others (Fujii, 1991). Another thing to consider is Buddhism is usually called a middle way, the way of non-extreme. This approach is very important because it is applied to the concept of morality as well. If one act too strict or too soft on the principle of karma, it is often seen as an extreme will. Principles are the guideline to manifest for wisdom, but not to be made an absolute.
In the matter of euthanasia, it is considered a very controversial topic in Buddhism, especially with the aspect of active euthanasia. The act of purposely ending life of a person is not an act of skillful deeds according to Buddhism. Buddhaghosa, the fifth-century sage, stated that taking life means to murder anything that lives or to put an end to life-force if they have one (Florida, 1993, 5). The size and the quality of the victim are also an important factor. Killing a large animal is worse than killing a small one and terminating a bad person’s life is better than a good person. Furthermore, Buddhaghosa believes that motivations (intentions) are the primary importance as it can determine karmic quality, but contemporary buddhists believed that active euthanasia is unskillful deeds. The reason is because if one motivation might be good, but if the action is to terminate someone’s life, it’s become an act of aversion (Florida, 1993, 6).
In addition, Buddhists believe that active euthanasia is a futile method to escape from karmic consequences as it is what bring illnesses and suffering in the first place. According to law of karma, one must suffer through their act from their previous life and if one tried to escape through this method, their next life will once again face suffering. One dilemma raise against this concept as if karma is the illness and suffering, does the act of medical treatment will be seen as a wicked act as it helps lessen pain and suffering. Furthermore, if illness really relates to karma, what is the point of medical treatment because it will only postpone the suffering one need to face (Lesco, 1986). These points are worth discussing, but according to Florida (1993, 7), the practice of medicine is always considered a skillful mean and should not be interfered. The arguments are considered extreme views and do not follow the teaching of Buddha. There is no direct approach to the active euthanasia because Buddhist view that all actions of terminating life are unskillful, but some can be exceptions. According to Wiltshire (1983, 128), Buddha also condone acts of suicide: “the protagonists suffering from a serious degenerative illness”. It is the matter of intentions because the body is mortal, thus the act of terminating illness to relieve pain and extreme suffering unselfishly can be committed.
Passive euthanasia is another problematic area needed to be discussed and many people uses different references and opinions to discuss this topic. According to Taniguchi (Florida, 1993, 7), using Theravada texts, passive euthanasia is also considered to be an unskillful act as he believes that choosing to die or refusal of medical treatments is an act of aggressive motivation towards suffering, or attached to being in the pleasant states, or falsely believe that death is the way to escape from suffering. This can also be considered an extreme view as Buddha himself also teach one to cure another one illness (Florida, 1993, 8). The matter of a person refuses to accept medication, in some situations, can be called a skillful act. If one can realized that their condition is far too worse and can no longer be cured or in the case of continuing with medical treatment will most likely cause suffering to others such as bankruptcy of the family for one more week of your life. If we take further consideration, prolonging a life could no longer be saved by receiving medical treatment might takes up space in the hospital for another person whose life could be saved. Now not only this causes suffering to the family, but also to other people who might face less severe cases, but cannot receive proper treatment due to lack of hospital space. Thus, not receive further treatment might be the skillful act rather than unskillful escape from suffering.
Another important factor is the process of dying in Buddhism. The religion consider life and death to be tied together through law of karma. Unfortunate existence can be caused by a akusala karma from a bad death and untamed mind. On the other hand, a good death will generate kusula karma and make one’s next life to be better (Florida, 1993, 11). Buddha can be used as the representative of dying properly. Buddha remained alive to continue his teaching when he was 80 years old with an ill health. According to Henry (1900), he and his followers were served food with one tainted-dish and Buddha insisted to take all the tainted food by himself and eventually lead him to death. This event support passive euthanasia as the Buddha chose to not extend his life and chose not to receive any treatment and allowed his body to passed away. Consideration of letting people go at the proper time and motive, passive euthanasia can be considered a skillful mean. All in all, passive euthanasia can be viewed as a skillful act or an unskillful act depending upon the motivation behind the action. If the action is to relieve pain or avoid suffering, it is unskillful. On the other hand, if the action is to avoid other suffering or acknowledgement of one self prolonging his life will not do any good, it is skillful act.
In conclusion, euthanasia or “good death” involved in Buddhist practice deeply. The act of terminating one’s life is considered an unskillful act, but exceptions from certain circumstances can be made. Unselfish death that leads to greater good for others would be one of the cases. The concept of euthanasia for medical uses can be very problematic in many situations because modern medical technology helps prolong a person’s life to a great extend which contradict with the law of karma. Medical treatments can be used to alleviate pain, but not to the extremes. If the usage of technology helps one to progress to the higher spiritual act, it can be considered a skillful mean. Acting with good intentions and follow dharma will lead one to the enlightened path.
List of references
- Florida, R. (1993). SAGE Journals: Your gateway to world-class journal research. p.5-11 [online] Available at: https://doi.org/10.1177%2F000842989302200103 [Accessed 16 Mar. 2019].
- Fujii, M. (1991). Buddhism and Bioethics. Bioethics Yearbook, pp.61-68
- Henry C. Warren, Buddhism in Translations (Cambridge, MA: Harvard University Press, 1900), p. 95-110; Edward J. Thomas, The Life of the Buddha (London: Routledge, 1927), p. 143-56; and Kapleau, Wheel of Life and Death, p. 70 and 84-86
- Lesco, P. (1986). Buddhism and Bioethics. [online] Available at: https://books.google.co.th/booksid=6Qy_DAAAQBAJ&pg=PA178&lpg=PA178&dq=is+medical+treatment+against+karma&source=bl&ots=u8L6GYhOAb&sig=ACfU3U1Ys9YbBxMJ8lmoChdHgdsSgFPDqQ&hl=en&sa=X&ved=2ahUKEwj-hPvGw4bhAhUZfX0KHSyq
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- Pregnantpause. (2001). Types of euthanasia. [online] Available at:http://www.pregnantpause.org/euth/types.htm [Accessed 16 Mar. 2019].
- Wiltshire, M.(1983), ‘The ’Suicide’ Problem in the Pâli Canon,’ The journal of the International Association of Buddhist Studies. p.128-129