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Buddhism, Euthanasia and the Sanctity of Life

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Buddhism, Euthanasia and the Sanctity of Life J7ournal ofMedical Ethics 1996; 22: 309-313 J Med Ethics: first published as 10.1136/jme.22.5.309 on 1 October 1996. Downloaded from Buddhism, euthanasia and the sanctity of life Roy W Perrett Massey University, Palmerston North, New Zealand Abstract between the two traditions is partly created by the Damien and John Keown claim that there is important Keowns' failure to specify clearly enough certain key common ground between Buddhism and Christianity on notions in the argument: particularly Buddhism, the issue ofeuthanasia and that both traditions oppose it euthanasia and the sanctity of life. Once this is done, for similar reasons in order to espouse a "sanctity oflife" the claims above can be seen to be either false or only position. I argue that the appearance ofconsensus is restrictedly true. partly created by theirfailure to specify clearly enough certain key notions in the argument: particularly Buddhism, euthanasia and the sanctity of life. Euthanasia Once this is done, the Keowns' central claims can be Euthanasia is "mercy killing". More formally, it is seen to be eitherfalse or only restrictedly true. 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 furthercopyright. Introduction suffering or distress. This motivation distinguishes Damien and John Keown claim that there is euthanasia from most other forms of taking life. important common ground between Buddhism and Euthanasia can take three forms: voluntary, involun- Christianity on the issue of euthanasia and that both tary and non-voluntary. Euthanasia is voluntary traditions oppose it for similar reasons in order when it is carried out at the request of the person to espouse a "sanctity of life" position.' More killed. Sometimes this may be scarcely distinguish- particularly, they claim that the following five con- able from assisted suicide; other times people clusions may be drawn about euthanasia in wanting to die may be physically incapable of killing http://jme.bmj.com/ Buddhism and Christianity. First, that despite their themselves. Euthanasia is involuntary when the cultural and theological differences, there is a person killed is capable of consenting to her own striking similarity in the two religions' opposition to death but does not do so. Euthanasia is non- the intentional killing of patients. Second, this voluntary when the subject is unable to consent: for opposition derives from their shared rejection of instance, because she is a severely handicapped consequentialist reasoning in favour of an ethical infant, or because she is an irreversibly comatose in a respect for life as a basic as adult who has omitted to specify previously how she approach grounded on October 1, 2021 by guest. Protected opposed to an instrumental good. Third, notwith- wished to be treated in such an eventuality. standing their absolute opposition to euthanasia, All three kinds of euthanasia can be either active both religions teach that life is not an absolute value or passive. Active euthanasia typically involves a to be preserved at all costs and emphasise the transi- deliberate act which results in the patient's death toriness of earthly life. Fourth, this consensus chal- (for example, administering a lethal injection). lenges prevalent assumptions about the impossibility Passive euthanasia involves a deliberate omission (for of moral consensus in the modem world. Fifth, this example, withdrawing or withholding life-sustaining consensus lends support to the conviction that a treatment). common set of core values may be found in the What do the Keowns understand by "euthanasia"? teachings of the world religions.2 They explain themselves thus: "By 'euthanasia' we The ecumenical spirit ofthese conclusions may be mean the intentional killing of a patient by act or uplifting, but their truth, I shall argue, is rather more omission as part of his or her medical care. We are dubious. Moreover, the appearance of consensus not concerned, therefore, with either the administra- tion of palliative drugs, or the withdrawal of futile or excessively burdensome treatment, which may, as a Key words foreseen side-effect, hasten death".3 Death and dying; religious ethics; Buddhism; euthanasia; Given this gloss on "euthanasia" it seems the sanctity of life. Keowns hold that both Buddhism and Christianity 310 Buddhism, euthanasia and the sanctity oflife J Med Ethics: first published as 10.1136/jme.22.5.309 on 1 October 1996. Downloaded from reject euthanasia in its voluntary, involuntary and this or other bioethical issues.7 Accordingly, most of non-voluntary forms. They also apparently include the burgeoning secondary literature in this area is in this rejection both active and passive euthanasia, reconstructive or speculative to varying degrees. since they concede that omissions as well as acts can Secondly, there are many schools of Buddhism and constitute euthanasia. However, they clearly feel too no central authority on matters of precept or that some version of the doctrine of double effect practice. enables them to exclude as cases of euthanasia The Keowns do not see a problem with this certain acts and omissions, the foreseen but second issue. This is because they claim that there is unintended consequences of which, will be the "a consensus on ethics among the main schools" and patient's death. Thus, although Buddhism and that for the purposes of their article it is permissible Christianity are both supposed to be opposed to to take the Theravada tradition, "the oldest and euthanasia, neither is thereby committed to life most orthodox of the surviving traditions", as repre- being an absolute value to be preserved at all costs. sentative of the Buddhist position.8 This procedure, however, just slides over a number of important questions in a quite unacceptable way. The sanctity oflife In the first place it is not at all clear that there is a It is often rather unclear just what is meant by an consensus on ethics among the main Buddhist appeal to "the sanctity of life" in bioethical disputes. schools, especially on this issue. Even if we confine In the bioethical literature nowadays, however, it is ourselves only to Indian Buddhism, there are signifi- usually assumed that the doctrine of the sanctity of cant differences between the ethics of the Mahayana life is roughly the claim that all human life is of equal and the Hinayana, as Damien Keown himself admits intrinsic value. Accordingly, except in cases of the elsewhere.9 When we come to consider the Buddhist legitimate defence of others' lives, it is always intrin- traditions of Tibet, China and Japan we find still sically wrong to take human life (though it may further differences. Moreover, since the Keowns sometimes be permissible to let someone die).' suggest that part of the interest of their comparison The Keowns express concern about the frequent lies in the fact that Buddhism is an influential misrepresentation of the doctrine of the sanctity of religion with roughly 500 million Asian adherents,3 copyright. life. But their own explanation of it is unfortunately it is worth remarking that the vast majority of these not as clear as it might be, for they offer several, persons are Mahayanists. While the Theravada may apparently logically distinct, formulations of it. indeed be the oldest surviving Buddhist school, it is These include the following four theses: quite incorrect to suggest that it is the "most (1) That as life is a gift from God, it is to be orthodox" if by that is meant (as the dictionary cherished. definition of "orthodox" would suggest) that it (2) All human beings are to be valued, irrespective of holds correct or unheretical religious doctrines. age, sex, race, religion, social status or their potential Theravadin doctrines and texts have no authority in http://jme.bmj.com/ for achievement. Mahayana Buddhism. (3) The deliberate taking of human life is prohibited In the second place we need to be clearer about except in self-defence or the legitimate defence of what sort of evidence is adduced in support of others. descriptive claims about Buddhism. The Keowns' (4) Human life is a basic good as opposed to an claims about Theravada Buddhism rely on certain instrumental good, a good in itself rather than as a canonical Pali texts. Observers report, however, that means to an end.5 sanctioned Buddhist practice in the Theravada lands on October 1, 2021 by guest. Protected Obviously these four formulations are not is often rather different.'0 Why valorize the textual, logically equivalent, and the supposed relations of rather than the contextual, tradition in making implication between them are unspecified. But pre- general claims about Buddhism? Certainly truths sumably for the Keowns, affirming the sanctity oflife about Buddhism which are based entirely on certain doctrine at least involves affirming one or more of normative monastic texts can have at best restricted (1)-(4). The Keowns quickly acknowledge that (1) scope. would be denied by Buddhism as a corollary of its Finally, the nature of the Theravada texts that are denial of a creator God. Instead, Buddhism's pur- utilised by the Keowns needs to be understood. ported belief in the sanctity of life "is grounded not They rely on the Vinayapi(aka, the case books of in its divine origin but in its spiritual destiny, namely monastic discipline. However, rather than enunciat- the state of final perfection known as nirvana".6 ing general principles from which particular judg- ments can be derived, the Vinaya prefers extensive listing of individual cases and the Buddha's reported Buddhism judgment thereon, often making it difficult to see Trying to make plausible general descriptive claims what the ratio of the particular judgment might be. about Buddhism's attitudes to euthanasia presents Moreover it is important to realise that the cases us with a number of difficulties.
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