The Buddhist Tradition Religious Beliefs and Healthcare Decisions by Paul David Numrich uddhism originated as a movement of spiritual Brenunciants who followed Siddhartha Gautama, a prince of the Shakya people in northern India around 500 B.C.E. (before the common era, often designated B.C.). Legend recounts that after Siddhartha confront- ed the realities of old age, illness, and death, he Contents renounced his privileged social position to seek spiri- Beliefs Relating to Healthcare 2 tual salvation. Through years spent studying spiritual Overview of 3 practices and practicing disciplined meditation he dis- Religious Morality and Ethics covered a kind of transcendent clarity of perspective, The Individual and 4 which is referred to as enlightenment or nirvana. The the Patient-Caregiver Relationship prince Siddhartha thereafter became known as the Family, Sexuality, and Procreation 5 Buddha (Enlightened One) and Shakyamuni (Sage of the Shakyas). Genetics 6 Buddhism spread throughout Asia and divided into Organ and Tissue Transplantation 7 three major branches, each with distinctive beliefs, Mental Health 8 practices, and cultural nuances: Theravada Buddhism Medical Experimentation 9 in southern and Southeast Asia (the modern coun- and Research tries of Sri Lanka, Myanmar, Thailand, Laos, Death and Dying 9 Cambodia, and Vietnam), Mahayana Buddhism in Special Concerns 11 eastern Asia (China, Korea, and Japan), and Vajrayana Buddhism in central Asia (mainly Tibet). Each major branch includes various sub-branches and groups; for instance, Chan Buddhism in China (known as Zen Buddhism in Japan) and the Dalai Lama’s Gelugpa lineage in Tibetan Vajrayana Buddhism. A volumi- nous body of scriptures developed among these Part of the “Religious Traditions and Buddhist traditions, including texts of the Buddha’s Healthcare Decisions” handbook series teachings, known as dharma, as well as monastic dis- published by the Park Ridge Center ciplinary rules and commentaries by later religious for the Study of Health, Faith, and Ethics authorities.1 THE PARK RIDGE CENTER In recent times Buddhism has spread outside society, differing both racially and religiously of Asia through population migration and con- from the majority population. Over Buddhism’s versions, today constituting more than 350 mil- 150-year history in America, reception has been lion people worldwide. Perhaps as many as three a mixture of hostility, primarily linked to anti- million Americans now consider themselves Asian sentiment, and fascination, as seen in Buddhists, the majority being ethnic-Asian Buddhism’s attractiveness to some segments of immigrants and their descendants. Ethnic-Asian the larger population.2 Buddhists are a double minority in American BELIEFS RELATING TO HEALTH CARE uddhism adheres to the basic Indian view, The Buddha’s most fundamental insights con- Bone shared with Hinduism and Jainism, that cerned the predicament of human existence and human existence is part of an ongoing cycle of the way of salvation from it, insights he gained multiple lifetimes (samsara) the circumstances from personal experience. In his first sermon of which are governed by one’s deeds or actions following enlightenment, called “Setting in (karma). Death is an inevitable part of existence Motion the Wheel of the Dharma,” the Buddha and subsequent rebirth reflects the outcome of laid out the Four Noble Truths: that life is one’s karmic dispositions, which may occur at unsatisfactory, 5 that our own desires cause life’s the human or another level, such as that of ani- unsatisfactoriness, that there can be cessation or 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 discomforts—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 existence. Human beings consist of five aggre- the face of an ultimate nirvana.4 gates, mental and physical strands, factors, or 2 THE BUDDHIST TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS aspects that include the body and consciousness. ple] is not obsessed with the idea that ‘I am the The third mark of existence, unsatisfactoriness, body’ or ‘The body is mine.’ As he is not derives from the other two marks: as we attempt obsessed with these ideas, his body changes and to grasp onto that which changes continuously, alters, but he does not fall into sorrow, lamenta- ever seeking permanence in a sea of imperma- tion, pain, distress, or despair over its change nency, we create dissatisfaction in ourselves. As and alteration.”8 noted above, the Four Noble Truths explain how Buddhist tradition and iconography include to overcome this dilemma. celestial Buddhas, which are not to be confused Ancient Buddhist texts portray the Buddha with the historical Gautama Buddha, and bod- and other enlightened notables as exhibiting hisattvas, beings that postpone their own final great mental composure under circumstances of enlightenment in order to facilitate enlighten- physical pain, even suppressing bodily illnesses ment in others. These beings carry implications in some cases. Such notables offer an ideal even for health, healing, and general well-being. Faith though the vast majority of Buddhists in all in Bhaishajya-guru (Master of Healing) Buddha, periods would not consider themselves capable for instance, is considered efficacious in times of of reaching such a state of enlightenment in illness and in overcoming negative effects of their present lifetime. For any patient, regardless karma at death. The bodhisattva of the level of spiritual attainment, the textual Avalokiteshvara’s very name invokes notions of tradition encourages cultivation of a wholesome celestial care: the Lord Who Looks Down (with mindset through contemplation of the dharma Compassion), known in China in female form as and consideration of one’s own spiritual virtues. Kuan-yin, which translates to the One Who These activities are portrayed as having healing Regards Cries or the One Who Hears Prayers. efficacy. The texts also distinguish two types of Many Buddhists seek the services of Buddhist pain, physical and mental, explaining that when monks trained in ancient Indian medical prac- a person suffering from the former adds the lat- tices known as Ayurveda. According to some ter, it is as if that person were shot with two scholars, Buddhist monastic practitioners played arrows instead of just one.7 Thus the Buddha a key role in the historical development of taught his monastic followers to distinguish Ayurvedic medicine, although it is usually asso- between the two: “You should train yourself: ciated with Hinduism.9 Buddhist monks also Even though I may be sick in body, my mind receive training in the ritual use of special vers- will be free of sickness. [A Buddhist disci- es that carry protective and healing properties.10 OVERVIEW OF RELIGIOUS MORALITY AND ETHICS he Fourth Noble Truth taught by the Buddha duct, not to tell falsehoods, and not to take Tdelineates the Eightfold Path to liberation. intoxicants that cause careless behavior.11 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 PARK RIDGE CENTER 3 Other Buddhist virtues and ethical insights sublime states will root out the fundamental impinge upon healthcare issues. Following the causes of evil actions in human beings, namely, example of Gautama Buddha himself, Buddhists ignorance and delusion.