17 Buddhist Bioethics JAMES HUGHES

17 Buddhist Bioethics JAMES HUGHES Describing anything as ‘Buddhist’, including in this case law of the universe, and the acts that lead to bad karma, a distinctively Buddhist bioethics, is fundamentally prob- such as killing, stealing, lying, sexual misconduct and in- lematic from both a historic and Buddhist point of view. toxication, are clearly spelt out. Historically, the Buddhist tradition has evolved in dozens The problem with Buddhist ethics as natural law is that of countries for 2500 years, with no one tradition having the soteriological goal is one of liberating oneself from the clear doctrinal authority over the others. Internally, even if constraints of karmic causality to become an enlightened a common Buddhist ethics was implicit in the practices of being. The traditional anthropological explanation of this the dozens of Buddhist cultures or the exegetics of their tra- paradox has been to ascribe the natural law ethics of kammic ditions, the core philosophical insight of Buddhism is that reward and punishment to the laity and the nibbanic path all things are empty of essential, authentic being, including of escape from natural law to the monastics (King, 1964; the Buddhist tradition. So, starting from the understanding Spiro, 1972). More recent scholars (for instance, Keown, that there is no authentic Buddhist bioethics to explicate, 1992; Unno, 1999) have challenged this dichotomy and ar- and only a constellation of practices and ideas related to gued that monastic ethics have always revolved far more medicine and the body among Buddhists throughout his- around the exchange of accumulated merits for alms than tory, which may or may not be tied to core ideas of the the goal of enlightenment. Buddhist tradition, we can interrogate the tradition for the Nonetheless, the Buddhist ethical tradition does argue lessons it may hold for contemporary bioethics. for an escape from all mundane karmic constraints, and the illusions of material existence, to achieve a state of perfect wisdom and compassion. Damien Keown, (1995) the BUDDHIST ETHICS leading Western scholar explicating Buddhist bioethics, calls this a ‘teleological virtue ethics’. As in Aristotelian There is a vigorous debate among Buddhist scholars about virtue ethics, Buddhists are to strive for the perfection of a the correspondence of Buddhist ethics to the ethical tradi- set of moral virtues and personality attributes as their prin- tions of the West, and three traditions have the strongest cipal end, and all moral behaviour fl ows from the struggle resonances: natural law, virtue ethics and utilitarianism. to perfect them. But unlike the Aristotelian tradition, the The Western natural law tradition holds that morality is ethical goal for Buddhists is teleological because they gen- discernible in the nature of the world and the constitution erally believe that a fi nal state of moral perfection can be of human beings. In the Buddhist cosmogony all sentient achieved. As virtue ethics, Buddhist ethics focuses on the beings cycle through multiple rebirths, infl uenced by their intentionality of action, whether actions stem from hatred, past moral behaviour, karma. When the Buddhist properly greed and ignorance, or insight and empathy. understands the structure of mind, the effects of immoral In the Mahayana tradition the being who embodies these behaviour in creating suffering in this life and the next, and virtues is the bodhisattva, who strives to relieve the suffer- the importance of sila or moral discipline as the basis for ing of all beings by the most skilful means (upaya) neces- release from suffering, morality is the only rational choice. sary. As the bodhisattva is supposed to be insightful enough In this sense, Buddhist ethics are grounded in the natural to understand when ordinarily immoral acts are necessary Principles of Health Care Ethics, Second Edition Edited by R.E. Ashcroft, A. Dawson, H. Draper and J.R. McMillan © 2007 John Wiley & Sons, Ltd 128 PRINCIPLES OF HEALTH CARE ETHICS to alleviate suffering, and it is either willing to assume the asserting that beliefs and practices that are shown to be karmic consequences or is not subject to the karmic conse- unscientifi c and not empirically supported should be set quences of such acts, the consequentialist utilitarian tradi- aside (Gyatso, 2005). tion is also especially compatible with Buddhist ethics. The utilitarianism of J.S. Mill is most resonant with this interpre- tation of Buddhist ethics because Mill emphasized distinc- NO-PERSONHOOD ETHICS AND tions between coarse and fi ne states of mind, weighting the REINCARNATION contentment of the refi ned mind more heavily in the utility calculus than base pleasures. From a utilitarian approach, A basic, and nearly unique, aspect of Buddhist philosophy Buddhist moral precepts can be considered ‘rule utilitarian’ is its emphasis on the nonexistence of the self, anatta. Con- general guides to action, but not deontological absolutes. sequently, one of the most fundamental Buddhist contribu- Some writers have also explored the compatibility of Bud- tions to be made to contemporary medical ethics will be in dhism with the ‘ethics of care’ articulated by Carol Gilligan the debates over personal identity. (1982). Gilligan argues that women are more likely to draw The thrust of the no-self doctrine is complicated within on compassion in their moral reasoning, whereas men are the Buddhist tradition, however, by the doctrine of reincar- more inclined to employ ethical principles. Gilligan’s work nation. If there is no self, what reincarnates? The traditional is very resonant for those who see Buddhism as a ‘situation answer has been that the evolving constellation of mental ethics’ relying on direct intuition and empathic sensitivity substrates, the skandhas, causally encoded with karma, for appropriate behaviour, as teachers in the Zen tradition pass from one body to another but lack any anchor to an often do (Curtin & Curtin, 1994). unchanging soul, just as a causal chain connects a fl ame passed from one candle to another even though it cannot be said to be the same fl ame. (The fi ve skandhas are the body, BUDDHISM AND MEDICINE feelings, perceptions, will and consciousness.) Buddhist humanists and sceptics, most notably Stephen Batchelor From the outset the Buddhist tradition presents itself as (1997), have argued that the doctrine of reincarnation is not a clinical diagnosis of the cause of human suffering, and essential to Buddhist spiritual practice and that Buddhists a prescription for its alleviation (Duncan et al, 1981; Soni, have explicit doctrinal authorization to remain agnostic on 1976). The tradition does not set out divine commandments reincarnation and on all beliefs without empirical support. but simple statements about the dis-ease (dukkha) affl icting Buddhist agnostics note that, in the context of Buddhism’s human life, and the way the dis-ease can be treated. Although rejection of Hindu beliefs in an eternal soul, the teach- the emphasis is on a spiritual cure, Buddhism specifi cally re- ing on no-self is actually a negation of the importance of jects ascetic mortifi cation of the fl esh and accepts that medi- reincarnation. cine is necessary for monks and laity. Although the monas- Nonetheless, most Buddhists profess belief in reincarnation, tic code forbad monks and nuns from practising medicine, and belief in reincarnation shapes Buddhist practices and be- they were instructed to provide medicine to one another and liefs around abortion and dying. Interruption of the instan- to keep it at hand (Keown, 1995). The use of medicine for a tiation or transmigration of the reincarnating being, through longer, healthier life is in no way seen as incompatible with abortion or cadaveric organ transplantation, is therefore po- spiritual practice, but rather is seen as an aid for it. tentially as harmful, and has as weighty karmic implications, Buddhism has blended with the medical traditions of as murder. each country in which it has taken root. Zysk (1991) and Mitra (1985) discuss links between early Buddhism and the Indian medical tradition of ayurveda, and in China ABORTION and Tibet Buddhism mixed with traditional medicines and magic to create distinctive psycho-spiritual healing Certainly abortion has been generally disapproved of in practices and meditations. In the West, Buddhist-infl uenced Buddhist culture on the grounds that it is a form of mur- clinicians, such as Jon Kabat-Zinn and his Center for der. Traditional Buddhist beliefs about the exact timing of Mindfulness in Medicine, Healthcare and Society at the the instantiation of the reincarnating being in the embryo University of Massachusetts, are exploring the health or foetus are not doctrinal, however, but drawn from latter benefi ts of Buddhist meditation. The Dalai Lama, the exegetical texts. exiled monarch of the Tibetan kingdom and head of the Some contemporary, and especially Western, Buddhist Gelugpa sect of Tibetan Buddhism, has been distinctive writers on abortion have argued for a more tolerant posi- among religious leaders in embracing the application of tion, on a number of grounds. First, if the moral status of the scientifi c method to the spiritual experience and in the embryo and foetus are contingent on the instantiation of 17 BUDDHIST BIOETHICS 129 a sentient being, then current neurophysiological evidence support the heart-death standard instead, but Keown em- that suggests that sentience only emerges late in foetal devel- braces the whole-brain argument that brain stem death opment would validate abortion up to that point (Barnhart, will quickly cause all other bodily functions to cease.) The 1998; Hughes, 1999). Keown (1999) argues against this neocortical view, on the contrary, would apply to people in point of view, emphasizing the moral importance of the the ‘permanent vegetative state’ such as the Florida cause creation of just the fi rst of the fi ve skandhas, the embry- celebre Terri Schiavo. In Buddhism and Death: The Brain- onic body.

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